Nicole Kashine worked with HERO as a Research Intern from May – August 2019. She is an emerging Research Scientist at AbleTo in the virtual behavioral health care space and is currently an MPH candidate with a concentration on Social and Behavioral Health Sciences at New York Medical College. In her Masters program, she has been involved with projects that focus on analyzing social determinants and behavioral risk factors associated with prevalent public health issues. She also holds a Bachelors degree in Public Health and Psychology from the University of Massachusetts. Nicole looks forward to leveraging her background in workplace wellness and behavioral health to advance important public health initiatives in the future.

In recent years, there has been more of a focus on the complexity of the workplace environment and a need to conduct wellness initiatives at multiple levels, including organizational culture and environment.1 While workplace health promotion is growing, programs offered by employers vary considerably and it is difficult to ascertain which practices are becoming more common over time.

This commentary evaluates how workplace organizational and cultural support is changing over time and highlights emerging practices. Longitudinal data were used from the HERO Health and Well-being Best Practices Scorecard in Collaboration with Mercer© (HERO Scorecard). As of December 2018, 811 unique organizations completed the HERO Scorecard. Of these organizations, 142 completed it a second time approximately 1 to 4 years after their initial participation. The average time between assessments was 1.8 years. Data from the 142 repeat submissions were used in this analysis to assess whether and how organizations are improving their organizational and cultural support over time. The analysis focused on the Organizational & Cultural Support (OCS) section of the HERO Scorecard, which includes a maximum of 50 (25%) of the 200 possible Scorecard points if organizations indicate they are implementing all the recommended practices in that section.

Organizations were categorized into lower and higher scoring groups at time point 1 and 2, based on the OCS median score of 29. All completers with a score ≥ 29 were considered high scoring organizations, while a score lower than 29 was deemed a low scoring organization. Next, organizations were categorized by movement across scoring groups between time 1 and time 2, i.e. low to low (n=61), low to high (n=26), high to low (n=10), and high to high (n=45) score). Since this analysis assessed how organizations are improving their OCS practices over time, it focused on organizations moving from the low to high (n=26) scoring category and which practices were most commonly added to improve their score. The most common practices in this group (>90%) at timepoint 2 are built environment initiatives (i.e., healthy eating choices, physical activity accessibility, and safety) and the implementation of wellness champion networks.

Organizational and Cultural Support

Company efforts to create and maintain a culture of health are increasing in HERO surveyed organizations over time. At time-point 1, 87 organizations had a low OCS score and 55 organizations had a high score. At time point 2, 71 organizations had a low OCS score and 71 organizations had a high score.  Further, 26 (18%) organizations were able to build stronger and more robust wellness initiatives focusing on culture of health over time.

Culture of Health and Workplace Practices

More workplace practices are being implemented over time to increase employee HWB. At timepoint 2, 88% of organizations in the low to high score group reported that senior leaders consistently articulate the value and importance of health, which increased from 38% at timepoint 1 to 88% at timepoint 2. This finding suggests that leadership’s support of HWB is growing in the workplace. Of the organizations that increased from a low to high score at timepoint 2, the most common added leadership practices were authority by senior leaders to achieve organization’s goals for employee HWB and active participation from leaders (73% and 85%, respectively).

To supplement communication mechanisms and overall involvement from employees and leaders, policies have been enforced throughout organizations. Of the organizations that increased from a low to high score, there was an approximately 15 percent increase from timepoint 1 (61%) to timepoint 2 (70%) in organizations encouraging the use of community resources for HWB (for example, community gardens, recreational facilities, health education resources). The most common policy within this low to high group was a tobacco-free workplace or campus at both timepoints 1 and 2 (73% and 74%, respectively).

Moreover, there is a noticeable trend toward improving the responding organizations’ built environment. The analysis suggests organizations that provide an environment conducive to a healthy lifestyle can help employees adopt healthy behaviors. Almost all (96%) of these organizations provided healthy food options that were easily available to their employees and made physical activity easily accessible. The data showed that support of stress management and mental recovery breaks are becoming increasingly popular as well, with this practice nearly doubling in usage from timepoint 1 (46%) to timepoint 2 (88%). Meanwhile, 100% of organizations in the low to high group ensured safety was a priority within their work environment (for example, ergonomic design, lighting, safety rails, etc.) at timepoint 2.

Manager and organizational support of a culture of health

To supplement the descriptive analyses, improvement in score over time was also assessed by subtracting the overall OCS score at timepoint 2 from that at timepoint 1 to obtain a continuous change score. Organizations were then grouped into the following categories based on their amount change: decreased (n=49), stayed the same (n=18), increased 1 to 5 points (n=29), increased 6 to 10 points (n=17), and increased greater than 10 points (n=29). Overall, 75 (53%) organizations improved their scores between timepoint 1 and timepoint 2. An additional analysis was conducted on these 75 organizations to identify the practices most commonly increased over time.

At time point 1, 54% of organizations that increased their score reported managers were given a lot or some support to improve the HWB of employees, and this percentage increased by approximately 39% at timepoint 2. Similarly, organizations increasing their score had a 46 percent increase (54% at timepoint 1, 79% at timepoint 2) in responding that their organizational support strategies were effective. Moreover, there was a 62% increase in organizations with leaders prioritizing health and work / life balance and a 51% increase in organizations with leaders consistently articulating the value and importance of health.


This analysis offers insight into several emerging workplace wellness practices conducive to improved employee health and well-being. Employers are increasing practices related to leadership and manager support, environmental and programmatic support, and strategic and organizational support. Organizations that increased their score were also more likely to report their managers are supported in their efforts to improve employee HWB and to report more effective organizational support strategies. These observations are consistent with past research highlighting the need for organizational and leadership support in improving the HWB of employees.1-3

Surprisingly, practices related to allowing physical activity during work hours, measuring and reporting positive impact on employee health risk, and holding leaders accountable for supporting employee HWB were not common practices employers implemented over time. Future research should focus on such practices to understand employers’ challenges and rationale for not implementing these practices, since they have been shown to be successful in improving HWB of employees.4



  1. Payne, J., Cluff, L., Lang, J., Matson-Koffman, D., & Morgan-Lopez, A. (2018). Elements of a Workplace Culture of Health, Perceived Organizational Support for Health, and Lifestyle Risk, American Journal of Health Promotion, 32(7), 1555-1567.
  2. Flynn, J. P., Gascon, G., Doyle, S., Matson Koffman, D. M., Saringer, C., Grossmeier, J., et al. (2018). Supporting a culture of health in the workplace: a review of evidence-based elements. American Journal of Health Promotion32(8), 1755-1788.
  3. National Institute for Occupational Safety and Health. Essential elements of effective workplace programs and policies for improving worker health and wellbeing. Retrieved from
  4. HERO Health and Well-being Best Practices Scorecard in Collaboration with Mercer 2018 Progress Report. 2018: 36-39. Retrieved from


This commentary was based on organizations that repeated the US HERO Scorecard V4 between June 2014 and December 2018.




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