Total Worker Health®: A Comprehensive Approach to Employee Wellness

At Upstream Rehabilitation, we focus heavily on physical and occupational therapy as an intervention to manage a work-related injury. In fact, many of our prior blog posts have focused on FCEs, PT best practice guidelines, exercise performance, and dry needling as ways to rehabilitate injured worker and prepare them for return to work. While these topics certainly fall within our scope of practice, we’ve also spent a fair amount of time discussing non-traditional therapy considerations.

Topics like Post-Offer Employment Testing and ergonomics have certainly expanded on other opportunities for therapists to get involved in worker health and preventative care. Finally, we’ve dove into more abstract topics like pain science, a biopsychosocial approach to patient care, stress and anxiety as factors complicating rehabilitation, and how certain factors (like weight and sleep) can contribute to workplace injuries.

Hopefully, as you’ve read these posts, you’ve come to appreciate that there are a variety of considerations and approaches to facilitating worker health. You’ve also likely determined that in order to reduce costs, improve productivity, and minimize worker risk, no singular approach should be viewed as all-encompassing. Rather, it’s a combined approach that yields the best
outcomes. This leads us into today’s topic: Total Worker Health ® ¹.

Total Worker Health® is defined as policies, programs, and practices that integrate protection from work-related safety and health hazards with promotion of injury and illness-prevention efforts to advance worker well-being.

This definition focuses on a more holistic approach to employee health. There is an understanding that health goes beyond the workplace, and that employers who only focus on “at work” preventative measures fail to minimize risk to themselves and their employees.

Take for example our most recent blog, which discussed how sleep and BMI factor into workplace injuries. While employers cannot force employees to sleep 8 hours/night, and certainly cannot force them to exercise or eat healthy foods, employers do have the opportunity to intervene by redesigning the work environment and educating/encouraging staff. In the paragraphs ahead, we’ll discuss pragmatic options to enhance health across a spectrum. This spectrum is defined as the Hierarchy of Control.

The National Institute for Occupational Safety & Health (NIOSH) has developed a refreshed Hierarchy of Control, with the updated model referencing Total Worker Health ®. This model, which starts at the top with Eliminate, focuses globally on eliminating working conditions that threaten safety. Then, for each subsequent level, the approach becomes more and more specific to the individual. We’ll explore real world approaches that employers can take to address each level, and in doing so, improve the health and wellness of their employees.

Figure 1.

Let’s begin with Eliminate. As defined in Figure 1, this level focuses on eliminating aspects of a job that could jeopardize employee health. This can take many forms, ranging from automation of certain dangerous jobs to implementation of personal protective equipment as a company policy. Garnering feedback from employees and supervisors, along with assessing OSHA 300 logs to evaluate recordability and prevalence of injury, can all be effective steps at identifying roles within an organization with elevated injury rates. Steps can then be taken to identify causative factors and subsequently eliminate them. This initial level of identifying and removing dangerous variables is crucial before other levels to benefit the individual associate can be pursued.

Next, employers can Substitute. This level focuses on substituting in health-enhancing policies. This may take the form of a stretch/flex program as part of a pre-shift team meeting or a non-recordable care program to minimize onsite aches and pains. This step serves employees by providing resources to manage their health, while also promoting a culture of safety and health.

Employers can next Redesign the workplace. This level may involve ergonomic consultation and subsequent adjustments to work routines to minimize physical stress to employees. Additionally, redesigning current health policies or processes to better meet the needs of associates could include access to onsite counseling and/or stress management training or a redesigned hiring practice to include post-offer employment testing. Furthermore, break rooms can be redesigned with healthy snacks and educational material regarding health/wellness.

Education is another consideration for employers. This level could focus on healthy lifestyles (eating, sleeping, exercise). Additionally, knowledge experts could be brought in for quarterly discussions to enhance employee understanding of a variety of topics. Wellness programs can also be considered with the goal of offering cholesterol, blood pressure, and BMI measurements. This information can be used to educate employees with elevated risks in the hopes of prompting employee action to manage their risks.

Finally, Encouragement. Employers need to build a culture of health. In addition to education, employers need to encourage employees to take advantage of the programs in place. This includes providing time to access resources and even incentivizing (through reduced insurance premiums or gift cards) those taking an active role in their own health. By encouraging employees, employers make it clear that health/wellness is a priority for the organization.

For employers with questions around this Hierarchy of Control, and how implementation of various initiatives can benefit employee health (while improving productivity, retention, and injury rates) please reach out to industrialservices@bmrp.com

*Total Worker Health® is a registered trademark of the U.S. Department of Health and Human Services (HHS).

1. “Total Worker Health.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 28 July 2020, https://www.cdc.gov/niosh/twh/default.html.
2. “Hierarchy of Controls Applied to NIOSH Total Worker Health®.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 28 Dec. 2020, https://www.cdc.gov/niosh/twh/guidelines.html.
3. “United States Department of Labor.” Recordkeeping – Recordkeeping Forms | Occupational Safety and Health Administration, https://www.osha.gov/recordkeeping/forms.
4. “Hierarchy of Controls Applied to NIOSH Total Worker Health ®.” Centers for Disease Control and Prevention, CDC, 28 Dec. 2020, https://www.cdc.gov/niosh/twh/guidelines.html. Accessed 2 Nov. 2022.