NIOSH’s Holistic Strategy Reduces the Number of Workers’ Compensation Claims Dramatically

Written by Dell Dorn

By Steve Babitsky, Esq., President and Founder SEAK, Inc.

SEAK, Inc. recently conducted an interview with Ms Deborah Fell-Carlson, RN, MSPH, COHN-S. Here is the result of the interview:

Q. Ms. Fell-Carlson, what is the NIOSH Total Worker Health® approach?

A. In short, the Total Worker Health® Approach broadens injury prevention to include supporting worker well-being as an injury prevention strategy. The National Institute for Occupational Safety and Health (NIOSH), a sub-agency of the Centers for Disease Control and Prevention, coined the term in 2011. NIOSH defines Total Worker Health® 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.”

A side benefit to the Total Worker Health® approach is reduction of chronic disease risk factors without necessarily implementing a formal wellness program. Conventional safety programs tend to focus mostly on the work environment, culture, and management practices with regulatory compliance as the cornerstone. Conventional wellness programs tend to target individual behavior change, often focusing narrowly on cardiovascular fitness and using contests and financial incentives to promote participation. As separate programs, neither is as effective as it could be. Total Worker Health® helps to change that. Although not a prescriptive program, the culture shift it produces promotes synergy across people centered functions by blending the strengths of each functional area, including safety and wellness. Emphasizing organizational changes and social supports normalize safe behaviors and healthy lifestyles at work and at home, supporting workers as they become ready to make healthy lifestyle choices. Total Worker Health® is not punitive; it creates sustainable systems that bring well-being choices within reach.

Q. How does it prevent injuries and shorten injury recovery time?

A. Total Worker Health® provides a framework to help employers create a safe work environment that helps reduce workplace health risk factors that contribute to injuries, making it easier for workers to engage in and sustain a safe and healthy lifestyle.

Individuals who enjoy physical, emotional, financial and spiritual fitness and feel a sense of purpose in their work are typically more alert, engaged, productive, and physically and psychologically resilient. Because they are able to be fully present, they are less likely to make a mistake resulting in injury, property, or product loss. They are also less likely to suffer chronic inflammation which contributes to several chronic health conditions. Healthy employees typically recover more quickly if they suffer an injury because chronic health conditions often impede injury recovery.

Evidence shows that environment has a tremendous influence on individual choice. Individuals can maintain positive behavior change only so long without organizational change and social supports. There are many examples of how this can play out. For example, it doesn’t matter how committed employees might be to a healthy eating plan – that commitment can be crushed if, day after day, they are faced with tasty pastries at that morning meeting and are teased by co-workers if they choose an apple instead. An individual who knows safety glasses are required for a specific task but who is ridiculed when putting them on is less likely to wear them – at work or at home. Individuals in sedentary jobs who are unable to move their bodies during the workday are unlikely to exercise after work if it takes time from friends and family.

Research is showing that workplace risk factors may undermine health in ways we hadn’t thought of in the past. Conversely, poor health brings risk factors and challenges that may make it difficult for an individual to function effectively at work. Work impacts health, and health impacts work, so Total Worker Health® is a win-win.

Q. What are some of the biggest health hazards that can be avoided with a proactive approach?

A. The typical US worker does not get enough sleep. Fatigue is probably the most ubiquitous health risk factor in our society today. Fatigue is also a significant injury risk. We read about fatigue related motor vehicle crashes regularly. This problem is magnified in the workplace, especially in industries with 24/7 operations or with workers who are frequently on the road, such as trucking and sales.

The health effects of chronic stress on overall health are well-known. Stress also contributes to injuries. Information fatigue, workload, 24/7 operations, and struggles with work-life balance contribute to presenteeism, an inability to focus due to health challenges. Presenteeism contributes to increased errors, some of which result in serious injuries and fatalities.

Finally, evidence suggests that fatigue and chronic stress may lead to unhealthy eating patterns and challenges in getting sufficient exercise. Over time, they might also contribute to a depressed mood and/or a maladaptive coping spiral such as overeating or other substance abuse. These hazards are all connected to each other, and they all contribute separately to presenteeism, as well as synergistically when combined. Fatigue, chronic stress, unhealthy eating and inactivity are significant injury risks in the short term and health risks in the longer term, but are often left to the worker to manage. Total Worker Health® offers practical organizational strategies that support worker success as they strive to achieve an optimal state of well-being.

Q. How cost-effective is “total worker health”?

A. The short answer is that there is not yet a solid evidence-base for a financial return-on- investment (ROI) for Total Worker Health®, but the evidence is growing. We do know that Total Worker Health® returns value- on-investment (VOI). VOI can be more difficult to measure. The Institute for Organization Management defines VOI as “intangible assets that contribute heavily to an organization’s performance. These intangible assets include knowledge, processes, the organizational structure, and ability to collaborate.”

Even with tangible metrics and in the same industry, it is difficult to compare health improvement programs across companies. The environment differs, leadership differs, culture and social norms differ, and communication strategies may differ, even if the program elements are the same. More importantly, workers differ. Worker differences influence the effectiveness of a health improvement effort. Examples might include ethnicity, rural vs. urban location, factory or production workers vs. administrative or management, and lower socioeconomic vs. middle or upper class. In addition, studies reporting ROI on health improvement typically do not include injury prevention efforts, so these results are not applicable to Total Worker Health®.

Although the injury reduction impact often happens right away, it takes time to grow a Total Worker Health® culture of sufficient maturity – usually a minimum of three years – to impact the broader goals of improved retention, engagement, morale, productivity, and overall health.

NIOSH has funded six centers of excellence to do this work and papers are available on Center websites. The links to the centers can be found on the NIOSH Total Worker Health® website at

Deborah Fell-Carlson, RN, MSPH, COHN-S will be speaking at the SEAK 37th Annual National Workers’ Compensation and Occupational Medicine Conference to be held on July 18-20, 2017 on Cape Cod, MA. Ms. Fell-Carlson will be speaking on: Total Worker [email protected]: Best Practices.

Deborah Fell-Carlson, RN, MSPH, COHN-S is involved in strategic efforts to help Oregon employers gain efficiencies, improve productivity, prevent injuries, and shorten injury recovery times by applying National Institute for Occupational Safety and Health Total Worker Health® principles – an approach linking health improvement to injury prevention 24/7. Deb is a certified occupational health nurse specialist with a Masters’ Degree in Public Health from Oregon State University. She was selected to the 2013 American Association of Occupational Health Nurses Class of Fellows and was the 2013-2014 recipient of the American Society of Safety Engineers’ Columbia-Willamette Chapter Safety Professional of the Year Award.

SEAK 37th Annual National Workers’ Compensation and Occupational Medicine Conference Link:

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Dell Dorn

Dell Dorn is the founder of DORN Companies. He started DORN in 1998 to help employers save money on workers' compensation claims and reduce OSHA recordables. Today, DORN customers realize the immense cost of employee pain and the enormous impact our service has on employee morale and their bottom line.
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About the Author

Dell Dorn

Dell Dorn is the founder of DORN Companies. He started DORN in 1998 to help employers save money on workers' compensation claims and reduce OSHA recordables. Today, DORN customers realize the immense cost of employee pain and the enormous impact our service has on employee morale and their bottom line.
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