by: Lawrence Earl, MD
December 5, 2021

The concept of total worker health (TWH) represents a fundamental transformation in how occupational safety and health is recognized in the workplace. TWH brings together all aspects that affect employee performance, including physical, mental, emotional, social, technological, and environmental conditions. By focusing on addressing the totality of influences at every level in an organization’s structure – individual, management, work design, the physical environment, policies, leadership styles – total worker health aims to improve safety and health protection as well as productivity.

At NAOHP we are calling our initiative Total Person Health, which better recognizes that the organization is comprised of and provides healthcare services or benefits to the employees and their family members.

Occupational medicine is a medical specialty that deals with preventing or minimizing disability or death related to pre-existing or developing diseases and disorders related to the workplace.

However, total worker health does not necessarily follow occupational medicine practices. Occupational medicine practice currently focuses mostly on employee illnesses and injuries caused by recognized hazards in the workplace, but total worker health encompasses a variety of other environments where employees spend time outside of work to sustain optimal performance.

Expanded Role of Occupational Health

In total worker health, the occupational medicine practice perspective of “recognize and prevent” is expanded to include total worker health promotion efforts.

Occupational Medicine Practitioners can Effectively Lead Organizations to Total Worker Health by:

    • Evaluating total exposure of employees to various risks leading to total healthcare outcomes.
    • Practice prevention strategies by identifying the total exposure and risk factors that may have a negative impact on employee performance
    • Identifying priority areas for improvement based on staff feedback that may otherwise be overlooked
    • Advocating for increased funding from management to provide the best possible environment for staff
    • Providing support to staff concerning wider social issues such as organizational culture or living conditions outside of work that might affect total worker health
    • Educating management on how to address total worker health, leading to buy-in from them when implementing change
    • Incorporating total worker health promotion in their practice by focusing more on prevention and intervention efforts rather than treatment of already existing medical conditions.

The Total Organization

Since total worker health incorporates all aspects of life, to improve performance, total worker health must be managed by a total organization. The total organization approach recognizes that all departments in an organization work together – human resources, safety and health, information technology, facilities management, etc – to ensure the end goal; creating active and healthy employees who are highly productive.

Total organizations must also recognize that negative influences exist outside of an employee’s work life (i.e., physical environment, emotional environment) and that total worker health cannot be achieved without balance between work and non-work life.

All total organizations must recognize total worker health as a priority, but it is the occupational medicine practitioners who are able to lead organizations towards total worker health. They are uniquely positioned to understand both healthcare related issues within an organization as well as larger organization issues, leading to potential opportunities for total worker health.

Merged Occupational Health and Employee Health

Some organizations, perhaps in part due to the move towards total person health, have or have plans to merge employee health into the occupational health department.

Dr. Laura Radke, Medical Director of Occupational health for Froedtert Health and the Medical College of Wisconsin, describes several reasons why they are merging their OH and EH departments:

    1. Our OH providers have a higher skill level and are used to managing more complicated conditions than our EH nursing staff.
    2. EH nurses can spend more time concentrating on managing exposures, influenza campaigns and other projects, as opposed to doing physicals.
    3. Provides more locations and flexibiility for new hires to get their onboarding completed.
    4. Work injuries can be seen and managed in OH; EH did not provide this service.

Expanding this model to total person health allows the OH providers to take a strategic view on health risks in the employee group and design intervention strategies that can be carried out and monitored by EH nursing staff in addition to health coaches, nutritionists, therapists, MSWs and many other disciplines recruited into the TPH process.

Employer Clients

As occupational health providers we can not only take the lead for total person health within our own healthcare organizations, but also for our employer clients.

How often do we feel we are being asked by our administrative higher ups to justify our existence?  That our departments don’t produce as much value (revenue) as say, orthopedics or the ED?

What if through our unique relationships with hundreds (thousands?) of employers we were to bring thousands or tens of thousands of patients into the system for more “routine” non work related healthcare?

For existing patients that care begins to shift from acute exacerbations of chronic disease to more proactive health maintenance and prevention.

But doesn’t that mean less revenue for the health system?

Maybe at first.  But the goal is to have a healthier more productive workforce, and by incorporating TPH principles, a healthier overall community.

An overburdened health care staff in many health systems should become less reactive (caring for exacerbations of chronic illness), more proactive (calmly managing chronic illness), be more efficient and experience less stress, avoiding burnout and other staffing related resource expenditure.

Greater productivity and efficiency generally translates to higher profitability.

Same for the employer client, solidifying the relationship and future healthcare business.

How Do You Start?

The first step in a TPH program is to learn what you are dealing with.  What are the health care costs  and risks in the employee population?

This is done by an analytics process like the Corporate Health Profile, a predictive analytics tool that evaluates claims and pharmacy data, as well as HRA, biometric and other available health care data, and reports out the conditions which are currently and likely in the future to create the most expense and affect on employee health and productivity.

Once this is known, an appropriate intervention strategy can be formulated and implemented through existing internal health promotion and disease management functions, as well as with the assistance of outsourced partners. They can bring additional expertise in reaching and managing previously less engaged members of the group and start to move them from high risk, low engagement, to less risk, higher engagement.

Trestletree is such an outsourced partner and sponsors the NAOHP TPH initiative.  Their programs have proven successful over 20+ years in producing measurable and sustainable behavior change across the entire risk continuum for the TPH initiative, particularly with people that are less motivated and struggle to change tough health behaviors.

TrestleTree’s behavior change expertise focuses on MSK and pain issues, obesity, stress management, chronic condition management (especially with diabetes and cardiovascular conditions), and more through their comprehensive behavior change coaching. 

We use the data analytics we talked about above to create community partnerships and flexible solutions to close gaps in care.


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