• Promoting a Healthier Workforce

    Health and Productivity Management

  • Health and Productivity Management Center

    Application in the business community

    In addition to identifying the instruments capable of measuring the impact of general health, as well as migraines, on work loss and productivity, the Expert Panel discussed those issues within the business environment that would positively or negatively affect the success of using any instruments. These concerns were termed Contextual Issues, and addressing them is crucial to the success of implementing a productivity measurement survey in the workplace.

    The Expert Panel identified two categories of contextual concerns. First is the understanding that an assessment of productivity as part of an overall approach to describing health and human performance has definite financial implications for business. Occupational health and safety programs directly impact a company’s Workers’ Compensation experience. An organization must understand the number of recordable injuries/illnesses and number of lost time cases, severity of the cases, Workers’ Compensation costs and temporary disability days to effectively establish programs that impact these areas. Productivity evaluations can assist a company in determining the total economic burden /opportunity of health related factors on the organization. Overall, the results are very useful in the strategic and tactical level of planning and management for programs and services targeting the overall health of the workforce. When integrated with the general array of metrics used by occupational health professionals, productivity data adds a new dimension which is essential to managing overall investments and outcomes in workforce health.

    While the Expert Panel briefly discussed the overall economic impact, there are numerous business metrics that need further exploration in order to determine a productivity instrument’s ability to translate health assessments into business metrics. Some efforts were made to determine if the output of the instrument could be converted into dollars. However, a full review of the capability of the instruments to assess or predict economic impact was beyond the scope of this current study.

    The second category of contextual issues is that set of elements which represent critical success factors in the “how” a productivity assessment is conducted within a given workplace. The elements within this category of contextual issues include communications, ethics issues (confidentiality, privacy and informed consent), design of study, selection bias, stakeholders, external confounders and sponsorship and approval. (Table 1)

    Communications encompasses the interchange with various audiences, particularly the intended participants. It is important to craft the messages clearly and to articulate “what’s in it for me?” for the audience. If “Me” is the employee, his or her family, and/or their collective organized representative organization(s), the answer has its origin in the following concept: “The interests of the employee and his or her family are always best served when he/she is healthy, able and productive at work and at home.”

    To maximize success, aligning the effort of productivity assessment with organizational priorities, which are already established, is imperative. Employer’s interests are best served in the context of a maximally productive workforce, which derives, in a large part, from employee’s individual and collective work and personal health, their feeling of worth, and their quality of life. 

    The Expert Panel concluded that the point within the organization from which the survey is initiated would have an impact on employee acceptance and participation. Anticipating areas or individuals that may be threatened by the survey and addressing the threats in the design and communication activities will further aid in acceptance of the survey. Prior to implementing a survey, determining whom in the organization may provide the most effective and credible source of support and gaining that support is essential. Lastly, asking participants’ permission to use their data/input for the study as well as advising individuals of how to opt out of the study may further enhance the study’s response rate. 

    There are numerous ethical obligations and responsibilities associated with the collection of personal information required for productivity assessments. It is important to address privacy, confidentiality, informed consent and risk /benefit parameters for the participants. One of the better options would be to use a written protocol for the project, which defines the methods, and how the protections of personal information and ethics factors will be addressed. Productivity assessments can be part of overt “research” and would clearly benefit by an established protocol. In some cases, the use of an Institutional Review Board (IRB), if available, could play a valuable role in review and evaluation of ethical issues. In addition to ethical reviews, it is also advisable to have a legal review. With the advancement of privacy protections and other regulations, it is prudent to assure compliance with all relevant legal provisions including the Americans with Disabilities Act and the HIPAA regulations. 

    Productivity assessments are in an evolutionary stage, and the research design of the various instruments is continuously being refined. The various instruments assessed for this project are under revisions based on use in the field. It is important to be aware of the best practices being established in this arena. Prior to implementing any instrument, consideration must be given to the need for controls or other models of staggered implementation designs to enable the optimal analysis of results. The list of design factors is lengthy, and consultation with an expert in research design may be appropriate in some cases.

    Recognition of the limitations imposed by the specific workplace is important and selection bias must be factored into the results. Criteria applicable to selection bias include:

    • The survey may create expectations or commitments.
    • Labor contracts may limit or restrict certain categories of occupations from participation.
    • The survey is an intervention that may influence results.
    • The manner of administration – paper or electronic – may impact employees’ decision to participate.
    • Use of a control group or another work site as a control group would strengthen the reliability of the results.

    In any assessment of worker productivity there is a broad list of stakeholders including senior management, middle management, other functional departments, unions, employees, etc. The perspectives and needs of each group must be anticipated. All stakeholders will need to be engaged in the planning, process, and possibly the evaluation and eventual action plans. To assure success, there must be broad-based support for and recognition of the relevance of the study for all affected managers. Taking the time to determine the stakeholders and their interests, if and how they will be involved, and how communications will be structured will assist in the acceptance of the study. 

    When planning the productivity assessment review, possible confounders and factors in the environment that may impact outcomes or success must be identified. The timing of the assessment compared to other major corporate activities, especially labor negotiations, downsizing announcements, other major corporate changes, etc., must be considered as confounding factors when analyzing the survey results. 

    As noted under the communications above, it is important to ascertain the best organizational alignment and champion for a productivity assessment. There may not be a choice, but in any case, there must be clarity on the sponsorship and approval of the survey effort. Given the novelty of such a process, it may be more palatable and easier to start with a pilot or demonstration project when introducing productivity assessments rather than to approach a company-wide effort. Typically, approval is easier for a smaller scale demonstration project as well. 

    The above components and characteristics of context are important in the implementation of any survey. These are the issues that must be addressed by the employer prior to ever doing a survey if the survey is to be successful and useful to the company. By addressing these issues, there should be up-front corporate buy-in to the study. 

    Table 1: Context for Implementation of Productivity
    Measurements in the Workplace

    • Communication
    • Ethical Issues ( confidentiality, privacy, & informed consent)
    • Design issues (research design)
    • Selection bias
    • Stakeholders
    • External confounders
    • Sponsorship & approva