Small + Safe + Well: lessons learned from a Total Worker Health® randomized intervention to promote organizational change in small business

Abstract

Background Leadership commitment to worker safety and health is one of the most important factors when organizations develop and implement a Total Worker Health® approach. We aimed to assess the effectiveness of a Total Worker Health (“TWH”) leadership development program that targeted owners and other senior-level leadership positions on changing organizational and worker outcomes from baseline to one-year later. Methods The Small + Safe + Well study included small businesses from a variety of industries in the state of Colorado, USA that were participating in Health Links™. We designed a randomized waitlisted control comparison design (RCT) to evaluate the added benefit of a TWH leadership development program. An employer assessment tool was used to assess TWH policies and programs, and an employee health and safety survey was used to assess safety leadership and health leadership practices, safety climate and health climate, safety behaviors and health behaviors, and well-being. We used a linear mixed model framework with random effects for business and employee to assess the impact of intervention on the outcomes of interest. Results Thirty-six businesses (37% retention) and 250 employees (9% retention) met the RCT study inclusion criteria and were included in the analysis. Businesses improved their TWH policies and programs score from baseline to one-year later, regardless of leadership intervention group assignment. Neither intervention group demonstrated improvements in employee-reported outcomes. Conclusions This study sought to address a gap in the literature regarding small business senior leadership development for TWH. Our study demonstrates many of the challenges of conducting studies focused on organizational change in workplaces, specifically in small businesses. When designing TWH intervention studies, researchers should consider how to best engage small business leaders in interventions and implementations early on, as well as methods that are well matched to measuring primary and secondary outcomes longitudinally. Future research is needed to test the feasibility and sustainability of TWH interventions in small business. Trial registration The trial was retrospectively registered with ClinicalTrials.gov (ID U19OH011227).

Feasibility of Implementing a Total Worker Health ® Intervention During the COVID-19 Pandemic in Small and Medium Businesses

“…We found that not only was there a clear need for occupational safety and health technical assistance during the COVID-19 pandemic, but the use of the TWH approach to provide technical assistance was also in demand, acceptable, and practical for participating businesses. Therefore, our study suggests that the TWH approach is feasible in small and medium businesses and that further research on TWH program implementation in this business category is warranted, especially considering reported challenges that small and medium businesses face 10–12 …”

“…Therefore, our study suggests that the TWH approach is feasible in small and medium businesses and that further research on TWH program implementation in this business category is warranted, especially considering reported challenges that small and medium businesses face. [10][11][12] We consistently heard feedback supporting the demand, practicality, and acceptability of the PROSPER team's technical assistance services and TWH protocol. Based on their experience with PROS-PER and knowledge of TWH, most participants reported that they would recommend a TWH approach to other small and medium organizations, because it is both a comprehensive approach to worker safety, health, and well-being supporting the whole worker, and appropriate for meeting employee expectations.…”

“…The study team’s TWH approach to providing occupational safety and health technical assistance was critically important for participating businesses during the height of this immensely debilitating public health crisis. In addition, there has been limited research on testing the feasibility of TWH interventions specifically in small businesses 10–12 . Therefore, we tested the feasibility (via Bowen et al’s demand, acceptability, and practicality domains) of using a TWH approach to deliver technical assistance to four small and medium businesses, including a minority-owned business, during the COVID-19 pandemic 8 .…”

“…in small businesses. [10][11][12] Therefore, we tested the feasibility (via Bowen et al's demand, acceptability, and practicality domains) of using a TWH approach to deliver technical assistance to four small and medium businesses, including a minority-owned business, during the COVID-19 pandemic. 8 We found that not only was there a clear need for occupational safety and health technical assistance during the COVID-19 pandemic, but the use of the TWH approach to provide technical assistance was also in demand, acceptable, and practical for participating businesses.…”

Improving Well-Being and Fostering Health-Oriented Leadership among Leaders in Small and Medium-Sized Enterprises (SMEs): A Systematic Review

“…Some core characteristics are listed below; for an aggregated overview on a quantitative level, see Table 2. If specified in the studies, the size of the SMEs ranged from less than 20 employees [39] to less than 500 employees [40]. Also, the occupational sectors were found to be heterogeneous across and within the studies, varying from a sake brewery [41] to the social assistance sector [40] to small craft businesses (e.g., hairdresser or painter [42]), as well as mixed samples in Saraf et al [43] (service sector, manufacturing and retailing), Martin et al [44]( transport, finance and retail) and Schwatka et al [45].…”