Mary Imboden is the Director of Research at the Health Enhancement Research Organization (HERO), where she oversees the research agenda, research committees, and the HERO Health and Well-being Best Practices Scorecard in Collaboration with Mercer©. Mary is also the Chair and an assistant professor of the Kinesiology Department at George Fox University, where she leads the Find your Fit program, an employee health and well-being initiative. Mary obtained her doctorate in Human Bioenergetics with an emphasis in Clinical Exercise Physiology from Ball State University’s Human Performance Lab and her Master’s degree in Health and Exercise Science from Wake Forest University.
Although workplace safety and health and well-being (HWB) programs are often siloed within organizations they are often thought of as complementary approaches in the workplace. Workplace safety programs are designed to prevent work-related injury and health hazards, whereas workplace wellness programs are designed to improve an employees’ health and well-being. The integration of these initiatives has been shown to have a synergistic effect on employee safety, health, and well-being, as well as on improving business outcomes. Intentional integration of these complementary programs is a hallmark of the Total Worker Health program (TWH), established by the U.S. National Institute for Occupational Safety and Health (NIOSH)1.
Data from the HERO Health and Well-being Best Practices Scorecard in Collaboration with Mercer© (HERO Scorecard) has shown substantial differences between small, mid (500 to <5000 employees), and large (5000+ employees) size organization with respect to their approaches to health and well-being practices. Chia-Chia Chang Coordinator for Partnership and New Opportunity Development at NIOSH’s TWH program, notes that organizations of different sizes face unique challenges and opportunities when establishing integrated safety and health programs.2 This commentary aims to assess the differences between organizations of varying sizes relative to how they integrate their health and well-being initiatives with their worksite safety programs.
The HERO Scorecard is a free online assessment that was designed as an educational and benchmarking tool to help employers identify and assess their use of practices that support more effective health and well-being initiatives. Version 5.0 of the HERO Scorecard addresses the worksite safety and health and well-being program integration by asking: 1) Does your physical work environment support safety features; and 2) Is your organization’s health and well-being initiative integrated with your worksite safety program in any of the following ways:
- Safety and injury prevention are elements of health and well-being goals and objectives
- Health and well-being elements are included in the worksite safety program
- Safety data are combined with health and well-being data for identification, reporting, and analytics
- Transparency is encouraged in reporting of accidents, injuries, or safety risks
To assess the value of safety and well-being program integration, we examined data from 210 unique organizations that completed Version 5.0 of the HERO Scorecard in full between December 1, 2020 and September 30, 2022 and provided data on total number of employees. Organizations were then grouped into small (n=69; <500 employees), midsize (n=83; 500 to <5,000 employees), and large (n=54; 5,000+ employees) categories.
Overall, 69% of respondents reported that their physical work environment supports safety with 55% of small, 77% of midsize, and 76% of large organizations reporting they support safety features in their physical work environment. Table 1 provides the national rates of worksite safety and health and well-being integration practices, as well as a comparison by organization size. Overall, nearly 60% of organizations responded that transparency is encouraged in reporting of accidents, injuries, or safety risks. Forty percent of organizations reported that safety and injury prevention are elements of their health and well-being goals and objectives, and 34% indicated that health and well-being elements are included in the worksite safety program. Only 14% of respondent organizations reported that safety data are combined with health and well-being data for identification, reporting, and analytics. Finally, 16% of organizations responded that they do not integrate their programs in any of the ways identified in the Scorecard, and 11% noted they do not have a worksite safety program.
When comparing worksite health and well-being and safety program integration practices by organization size, large organizations were more likely to implement integration practices than small and midsize organizations for all practices. The exception to this was that organizations of all sizes reported similar low rates of combining safety and health and well-being data being for identification, reporting, and analytics.
Table 1. Integration of worksite safety program and health and well-being initiatives by organization size
| National (n=210) | Small (n=69) | Mid (n=83) | Large (n=54) | |
| Safety and injury prevention are elements of health and well-being goals and objectives | 40% | 36% | 45% | 46% |
| Health and well-being elements are included in the worksite safety program | 34% | 25% | 37% | 41% |
| Safety data are combined with health and well-being data for identification, reporting, and analytics | 14% | 14% | 16% | 13% |
| Transparency is encouraged in reporting of accidents, injuries, or safety risks | 59% | 57% | 55% | 65% |
| None of the above | 16% | 12% | 19% | 17% |
| Do not have a worksite safety program | 11% | 19% | 10% | 6% |
Discussion
There are known advantages to companies that integrate their health and well-being and safety programs. A past HERO Scorecard commentary found that organizations that integrate their health and well-being and safety programs and have leaders that believe health and well-being is tied to business outcomes reported 50% improvements in health risk3. This HERO Scorecard commentary provides a look into the current state of integration and highlights the underutilization of integration practices.
Small organizations showed the lowest rates of adoption for most integration practices, which may be a result of the challenges these organizations face, including fewer resources, time, and personnel. That being said, organizations of all sizes have opportunities for improvement. The Fundamentals of Total Worker Health® Approaches: Essential Elements for Advancing Worker Safety, Health, and Well-Being4 workbook provides useful information and recommended practices to help organizations improve the safety, health, and well-being of their workforce.
- https://www.cdc.gov/NIOSH/twh/
- Board on Health Sciences Policy; Institute of Medicine. Promising and Best Practices in Total Worker Health: Workshop Summary. Washington (DC): National Academies Press (US); 2014 Dec 19. 5, Total Worker Health for Small- and Medium-Sized Businesses. Available from: https://www.ncbi.nlm.nih.gov/books/NBK268670/
- Saringer C. Assessing the Influence of Leadership Commitment and Program Integration: https://hero-health.org/blog/assessing-the-influence-of-leadership-commitment-and-program-integration/
- Department of Health and Human Services, Centers of Disease Control, National Institute for Occupational Safety and Health. (2016). Fundamentals of Total Worker Health®Approaches: Essential Elements for Advancing Worker Safety, Health, and Well-Being Author Last Name, First initial. (2016). https://www.cdc.gov/niosh/docs/2017-112/pdfs/2017_112.pdf?id=10.26616/NIOSHPUB2017112
