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22016©HERO.Allrightsreserved.

Health Enhancement Research Organization

Culture of Health Study Committee

DEFINING A CULTURE OF HEALTH KEY ELEMENTS THAT INFLUENCE EMPLOYEE HEALTH AND WELL-BEING

…………………………………………………………………………….……………………………………………

SEPTEMBER 2016

2016©HERO.Allrightsreserved. 33

TheHealthEnhancementResearchOrganization(HERO)isanationalnon-profitdedicatedtoidentifyingandsharingbestpracticesinthefieldofworkplacehealthandwell-being(HWB)toimprovetheHWBofworkers,theirspouses,dependents,andretirees.HERO’svisionisthatallworkplaceswillpositivelyinfluencetheHWBofemployees,families,andcommunities.TheCultureofHealth(CoH)StudyCommitteewascreatedtostudyandestablishadefinitionfora“cultureofhealth,”aswellaskeyelementsthatinfluenceandshapeacultureofhealth(CoH).Thecommitteeiscomprisedofacross-functionalgroupof21practitionersandresearchers.Becauseofthebreadthandcomplexityofthework,threeworkgroupswereformedtoaddress(1)Definitions;(2)Research;and(3)Value.ThisreportrepresentsphaseoneoftheongoingeffortsoftheCoHstudycommittee,whichfocusedonestablishingadefinitionfor“cultureofhealth”andidentifyingthekeyelementsinvolvedwithcreatingaCoHwithinanorganization.DevelopmentofThisReportThisreportisaproductoftheDefinitionsWorkgroupoftheHEROCoHStudyCommittee,whichincludes42subjectmatterexperts,practitioners,andresearchersworkingwithinthisarea.DevelopmentofthisreportwasledbyHEROstaffandmembersoftheDefinitionsWorkgroup,withcontributionsbymembersofthelargerCoHstudycommittee.Developersofthisreportinclude:

• JuddAllen,PhD,HumanResourcesInstitute• RalphColao,HEROStudyCommitteeCo-Chair• JenniferFlynn,MS,Mayo• SueGrauer,RN,BSN,Aetna• JessicaGrossmeier,PhD,MPH,HERO• DanKrick,HexagonandCoHDefinitionsWorkgroupLeader• TinaLankford,CDC• DyannMatsonKoffman,CDC• KarenMoseley,HERO• MarkPoindexter,ShellOilCo.• KimSilbaugh,LockheedMartinCorporation• PaulTerry,HERO• JoniTroester,MBA,CEBS,UniversityofIowaFormoreinformation,contactHEROat:HealthEnhancementResearchOrganization7400MetroBoulevard,Suite270Edina,MN55439952-835-4257|[email protected]|hero-health.org


INTRODUCTIONANDMETHODS

Practitionersandresearchersagreethatacultureexistsineveryorganizationwhetheror

notitwascreatedintentionally.Designingculturewithintentiskeyincreatingand

sustainingahealthyworkplaceculture.However,aclearvisionanddefinitionofcultureis

essentialtothatintention.

HEROlaunchedtheCultureofHealth(CoH)studycommitteein2013toestablishawidely

accepteddefinitionofCoH,includingalistofelementsandassociatedindicators,which

accuratelydescribesaculturethatsupportsthehealthandwell-beingofanemployer

population.Tobeginworktowardsthischarter,aWorkgroupwasformedtofocusonthe

developmentofaconsensusdefinitionandelements.

TheWorkgroupmetregularlyviateleconferenceforaperiodof10monthstodevelopa

definitionandthenidentifytheelementsofculture.Thefinalproposeddefinition,which

wasacceptedbythebroaderCoHstudycommittee,was:“Ahealthyworkplacecultureisone

intentionallydesignedwithelementsthatsupporthealthandwell-being.”

Oncethedefinitionwasagreedupon,workbeganontheseconddeliverableofidentifying

thekeyelementsinvolvedwithcreatingaCoHwithinanorganization.Theprocessof

identifyingelementscommencedwiththesubcommitteechairaskingeveryoneonthe

committeetosharewiththeWorkgrouptheelementstheybelievedarekeyinfluencersfor

creatingandsustainingaCoH.Theinitiallistwaswellover50elements.Avotingprocess

wasusedtohelpprioritizethediscussionofeachelementanditwasdeterminedthatfor

eachelement,theWorkgroupwouldcreatethefollowing:

1. Theelementdefinedinabroadsense(anorganizationaldevelopmentdescriptionor

strategiclevel)

2. Theelementdefinedinanoperationaldefinition,i.e.,thiselementspecificallyapplied

forthepurposeofcreatingahealthyworkplaceculture

3. Examplesthatrepresentvisiblebehaviorsorindicatorswithinahealthyculture


TheWorkgroupleaderfacilitatedaconsensusdecision-makingprocess.Theprocess

allowedforhealthydebateandchallenge,butultimatelywesoughtconsensusevenifthat

meantanindividualhadto“give”onaparticularpointwhenthebroadergroupsupporteda

differentvieworperspective.Workgroupmembersreferencedhealthycultureassessments,

casestudies,approaches,andpracticalexperiencetoidentifyhealthycultureelements.A

finallistof24elementswereidentifiedanddefined.Thesewerereviewed,modified,and

thenapprovedbytheentireCoHstudycommittee.

Asafinalstep,allHEROThinkTankmemberswereaskedtoparticipateinasurveyrelated

totheidentifiedelements.Foreachelement,memberswereaskedhowfrequentlythey

applytheelementincreatingahealthycultureandtheimpactoftheelementincreatinga

healthyculture.ThesurveywasconductedtoassisttheResearchWorkgroupinprioritizing

theirworkaswellasgathersomeinitialdataontheperceivedstrengthofeachelementas

aninfluenceronanorganization’sCoH.Thesurveyrevealedthatcertainelementswere

perceivedtohaveamuchhigherimpactthanothers.

ELEMENTSOFCULTURE

Thefulllistofthe24KeyElementsofaCoHaswellasapplicabledefinitionsandexamples

areprovidedintheTableattheendofthisreport.Notethattheyarenotpresentedinorder

ofpriorityorimportancebasedonthesurveybecausetheWorkgroupfelttheyshouldnot

berankorderedwithoutsupportingevidencefromtheResearchWorkgroup.

CONCLUSION

WeclosewithaninterestingperspectivesharedbytheDefinitionsWorkgroupthatwas

revealedinthecourseoftheirwork.Althoughthese24KeyElementswerediscussedand

detailedwithspecificexamplesforcreatingaculturethatsupportshealthandwell-being,it

shouldbenotedthatthesesameelements,withintentionaldesigncanproduceother

importantcompanyoutcomes–suchasaqualityculture,oraworldclasssafetyculture.It

alldependsonwhatthecompanyisfocusedonobtaining.Insimplisticthinking–flour,

sugar,andeggs–keyingredients(elements)canproducealotofdifferent,positive


outcomes–cookies,muffins,cake,pancakes,etc.It’swhatyouaddtothemthatcreatesthe

difference.

Finally,giventhelackofaconsensusdefinitionforacultureofhealthwithinthehealthand

well-beingindustry,developmentofaconsensussetofdefinitionsunderscoresthe

milestonerepresentedbythisWorkgroupreport.Theidentificationof24agreedupon

elementsbelievedtodriveacultureofhealthisalsonoteworthy.However,morework

remainstobedone.ThenextphaseofeffortfortheCoHstudycommitteeistoconducta

literaturereviewtodeterminethestrengthandrigorofevidencesupportingeachofthese

elementsasademonstrateddriverofaCoH.TheworkoftheDefinitionsWorkgroupthus

becomesthefoundationuponwhichtheResearchWorkgroup’seffortsarebuilt.

Definitionsof24KeyElementsofCulture

CoreCultureElement

ConceptualDefinitionofElement

OperationalDefinitioninaHealthyCulture

ObservableExamplesinHealthyCulture

Norms Informalandsometimesformalguidelinesaboutwhatisconsiderednormal(whatiscorrectorincorrect)socialbehaviorinaparticulargrouporsocialunit.Normsformthebasisofcollectiveexpectationsthatmembersofaculturehavefromeachother,andplayakeypartinsocialcontrolandsocialorderbyexertingapressureontheindividualtoconform.Inshort,"Thewaywedothingsaroundhere."

Normsarerecognizedandintentionallyinfluencedbythemembersoftheculturetosupportopennessforhealthybehaviorssuchasphysicalactivity,closesocialrelationships,andhealthyeating.

Acompanyidentifiesitspriorityhealthnorm,e.g.,stretchingbeforework,acceptanceofworkingoutoverlunch,supportiveandsafeenvironmentfordiscussionsregardingwell-being.

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CoreCultureElement




SharedValues Explicitorimplicitfundamentalbeliefs,concepts,andprinciplesthatunderliethecultureofanorganization,andwhichguidedecisionsandbehaviorofitsemployees,management,andmembers.Sometimesreferredtoaspriorities.

Thehealthandwell-beingofpeopleisamongthetopprioritiesofanorganization.Theorganizationrecognizesemployeesasinternalcustomersandprioritizestheirneeds;thisisoftenreferredtoasapeople-centricapproach.Peoplebelievethattheycanachievehealthylifestyleswithindividualinitiative,knowledge,andasupportiveenvironment.

Acompany’sstatedvaluesincludehealthandwell-beingandarerecognizedatthesamelevelasotherkeyvalues,e.g.,quality,customersatisfaction,profitability.Healthisvaluedinrelationshiptoperformance/productivityandiscommunicatedtoemployees.

ExecutiveLeadership Executiveleadershipwhosebehaviorsreflectthatofcommittingtothevaluesofthecompanyandpracticesthatarepeople-centricandbuildstrongculturesoftrustwithintheorganization.Leadershipthatshapes,lives,andspreadspeople-centricvaluesthatdrivetheorganizationtoachieveexceptionalresults.Instillsinpeopleasenseofpurposeorbelongingandcommitmentthatisnotaresultofsomeexternalincentiveorbenefittobegained.

Leaderspersonallyembracewell-beingthroughtheevidenceofitintheirlifestyleandalsoinsupportingwell-beingintheorganizationthroughtheirdecisionmakinginfluence,resourceallocation,andpersonalengagement.

Seniorleadershipdesignatesabudgetforhealthandwell-beingactivities,participatesinwellnessactivities,etc.

OrganizationalLeadership

Leadershipisaprocessofsocialinfluenceinwhichonepersoncanenlisttheaidandsupportofothersintheaccomplishmentofacommontask.

Executives,middle-mangers,peerleaders,andchampions(1)sharethevisionforhealthandwell-being,(2)serveasrolemodels,(3)alignformalandinformalpoliciesandprocedures,and(4)trackandcelebratehealthandwell-being.

Managersandleadersatalllevelsunderstandwhyandhowtosupporttheiremployeesintheirpersonalwell-beingefforts.Theyalsoactivelyparticipateinhealth/wellnessactivities.


CoreCultureElement




Communication Measurement,feedback,andaccesstoknowledgeprovidedbythegroup.Avarietyofcommunicationvehiclesandchannelsareusedthroughouttheorganizationonaregularbasistoensurethateveryoneisfullyawareofthestatusoftheorganization,currentandfutureactionsplanned,andeveryone’srole,etc.Formalandinformalprocessesforinputandfeedbackfromallconstituentgroupsandstakeholdersareactivelyobtainedanddisseminated.

Peoplegetregularfeedbackabouthowtheyandthegrouparedoinginachievinghealthylifestyles.Theyarealsokeptabreastofsuccessstoriesandresourcesavailableforpursinghealthandwell-being.Thepopulationisengagedinanongoingconversationabouthealth,itsvaluetoboththeindividualandtheorganization,andchangeinhealthstatusovertimeaswellasimpactontheorganizationovertime.

Newsletters,smallgroups,businessupdates,townhallmeetings,digitalsignage,intranet,socialmediathatopenlycommunicatehealthandwell-being.

Recruitment&Selection

Selectionandrecruitmentarestrategicallyalignedtotheorganization’svaluesandisintentionallydesignedtoachievespecificoutcomes.

Theorganizationhasareputationforbeingagreatplaceforhealth-orientedindividuals,andonethatpromotesmeaningfulwork,work-lifebalance,moralcongruenceofwork,empowerment,andself-worth.Theopportunitytopursueahealthylifeisoneoftheprimarybenefitsofemployment.Well-beingisfactoredintorecruitment,selection,promotions,andinternalplacements.

Personalwell-beinginterestandpropensitytoembracewell-beingisincludedinselectionquestionsandevaluationprocess–similartootherperformanceattributes.

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CoreCultureElement ConceptualDefinitionofElement



Metrics&Measurement Theorganizationhasestablishedmetricsandmeasurementsystemsthatprovidevisibleandtimelyfeedbackonperformance.Leadersandmanagersareheldaccountabletomeettheperformancemeasuresandthesemeasuresdriveresourceallocationanddecisionmaking.

Specificwell-beingmeasurementsareestablishedandsharedwithallemployees.Theresponsibilityforperformanceincludesthehealth&well-beingoftheworkforce.Employeesarerecognizedascontributingsignificantlytotheoverallvalueoftheenterprise.

Acompanymayhavemetricsandcommunicationonreducingthepopulationofmetabolicsyndrome,overallhealthcarecosts,tobaccousage,orincreasingvolunteerism.

Policies&Procedures Theorganizationhas“formal”policiesandproceduresthatareclearlyalignedwiththevaluesoftheorganizationandaredesignedwithintenttosupportthosevalues.

Specificwell-beingpoliciesandproceduresareestablishedandactiveintheorganizationtosupportacultureofwell-being.

Tobaccofreecampus,stretchingprograms,leavepolicies,etc.

SupportiveBuiltEnvironment

Thebuiltenvironmentissupportiveofactivitiesthatarealignedwiththevaluesoftheorganization.

Dedicatedfinancialandhumanresourcesareavailableforsupportofwell-beingsystemsandprograms(i.e.,adequatefinancialresources,budget,andhumanresources).

Staffingincludeswellnessresources,e.g.,wellnessmanager,externalproviders,programs.

OrganizationalResourceAllocation&Commitment

Organizationalresourcessuchasfinancialandhumanresourcesarededicatedtotheprioritiesofthebusinessasdictatedbythevaluesofthecompany.Time,resources,spaceareadequatetomeetobjectives.

Dedicatedfinancialandhumanresourcesareavailableforsupportofwell-beingsystemsandprograms(i.e.,adequatefinancialresources,budgetandhumanresources).

Staffingincludeswellnessresources,e.g.,wellnessmanager,externalproviders,programs.

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EmployeeInvolvement&Empowerment

Employeesareactivelyengagedindecisionmakinginallaspectsofthebusiness.Inaddition,theyareempoweredandprovidedampleautonomyandworkercontroltoaffordhealthyworkengagementlevels.

Employeesareactivelyengagedinwell-beinginitiatives.Theyserveasbothformalandinformalleadersinsupportofwell-being.Throughouttheorganization,employeeleadersareinvolvedandempoweredtopromote,encourage,model,andinstillhealthandwell-beingvaluesoftheorganization.

Wellnesscommittee,employeesengagedasleadersofwell-beingactivitiesincludingvolunteerism,basketball,runningclubs,etc.

Rewards&Recognition Rewardsandrecognitionarewaysaculturereinforcesdesiredbehaviorthroughtangiblerewards(suchasmoneyorprizes),throughrecognition(suchaspraise,acknowledgementandexpressionsofgratitude),andthroughpromotion(suchascareeradvancement).Rewardsandrecognitionarebothextrinsicandintrinsicinnature.

Peoplearerewardedandrecognizedforhealthybehavior,andindividualandgroupachievement.

Healthclubreimbursement,prizesforhighesthealthclubutilization,andunhealthypracticesarediscouragedornotrewarded,e.g.,tobacco-freediscountsonhealthpremiums.

PeerSupport Peersupportoccurswhenfriends,family,neighbors,andcoworkersprovideknowledge,experience,andemotional,social,orpracticalhelptoeachother.

Employeesadopthealthylifestyles,sharehowtheyachievedhealthypractices,participateinhealthinitiatives,andhelpotherswiththeirjourney.

Formalwell-beingaccountabilitypartnerssuchasapartnerinawellnesschallenge(steps,healthyeating,etc.),andinformalaccountabilitywhereasupportive,caringatmospherehasbeencreatedandencouragedforthissupport.

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PushBack Push-backiswhenmembersofacultureexpressdispleasurewithabehavior.Push-backissynonymouswithconfrontation.

Unhealthybehaviorisconfrontedandhealthybehaviorisrarelyconfronted.

Anonsmokerwouldfeelcomfortableandcompelledtoconfrontanindividualwhoisviolatingatobacco-freecampuspolicy.Theoppositewouldbewhereanindividualknowsthatheorshewouldnotbenegativelyconfrontedforaformalwalkingormeditatingbreak.

SenseofCommunity Asenseofcommunityexistswhenpeoplefeelthattheybelong,gettoknowoneanotherbeyondtheirjobs,mattertooneanother,trustoneanother,helponeanother,andseeafuturetogether.Healthyrelationshipscharacterizedbysocialandprofessionalinteractionsthatfosterasenseofbelongingandcoherenceexist.

Asenseofcommunityissupportedthroughhealthyrelationshipsthatarethesocialandprofessionalinteractionsthatfosterasenseofbelonging,coherenceandwell-being.Healthyrelationshipsarecharacterizedbyopencommunication,mutualrespect,mutualsupport,collaboration,andtrust.

Theworkenvironmentismorethan“work.”Peopletakeaninterestinthelifeoutsideofworkanddothingstogetheroutsideofworkbecauseofthecommunitybuiltwithintheworkenvironment,e.g.,campingtrips,golfleagues.

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SharedVision&Mission Asharedvisionexistswhenpeopleare(1)inspiredbythedirectionandpurposesofthegroup,(2)feelthatothergroupmembersareworkingtoachievethesamegoals,(3)seehowtheirowneffortssupportthegroup,and(4)feelthatthewaythingsaredoneisconsistentwiththeirpersonalvalues.Sharedvisionisanagreeduponsetofexplicitorimplicitfundamentalbeliefs,concepts,andprincipleswhichguidedecisionsandbehaviorofemployees,management,andmembers.Thevisionandmissiontranslatethosevaluesintoguidingstatementsaboutwhotheorganizationstrivestobeandhowitwillgetthere.

Thecompanyhelpspeoplefeelinspiredthattheirwell-beingeffortsareimportantandalignwithandbenefitthebroaderorganization.

Highlightinghowhealthylifestylesdrivedownhealthcarecoststhatcanbereinvestedintheorganizationorlowerpremiumsforeveryone.Sharingacommunityorvolunteerismreportcardwhichillustratesthepositiveimpactofvolunteerisminthecommunity.

PositiveOutlook Apositiveoutlookexistswhenpeople(1)recognizeeachother’sstrengths,(2)approachworkandchallengeswithenthusiasm,and(3)havefuntogether.

Thereisrecognitionthatourstrengthshelpusmoveforward.Individualsandworkteamsseetheopportunitiesineverydaychallenges.

Cultureand/oropinionsurveysillustrateastrongthemeofoptimismandpositivitytowardco-workersandthecompanyingeneral.

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Modeling Individualsvisiblydemonstratethedesiredbehaviorwithintheculture.

Individualsthroughouttheorganizationadopthealthylifestyles,sharehowtheyachievedhealthypractices,andparticipateinhealthinitiatives,thusdemonstratingthathealthylifestylechoicesareachievableandhighlybeneficial.Inaddition,leaderswhoarerespectedwithintheorganizationmodelhealthybehaviors.

Leadershipworksoutincompanygymvs.healthclubtomodeltherightbehavior.Groupmeetingsoverlunchorderhealthymenuvs.pizzaorunhealthyoptions.

Orientation&FirstImpressions

Theformalandinformalexperienceofnewmembersoftheculture.

Newpeoplearemadeawareofalltheresourcesandsupportavailableforlivingahealthylifestyle.

Newemployeeorientationincludesoverviewofwellnessprogramsandinitiatives.

Training&Learning Theskillsandexperiencethataretaughttomembersofagroup.

Lessonssharedbypeersandformaltrainingteachskillsforlivingahealthylifestyle.

Trainingandlearningcurriculumincludeswell-beingtopics,e.g.,financialmanagement,parentingclasses,dietingandnutrition,sleepseminars.

RelationshipDevelopment

Theformalandinformalwaysbywhichindividualsestablish,maintain,andfosterfriendships,formteams,andcollaboratetogether.

Socialrelationshipsareformedaroundhealthybehaviors.Healthyactivitiesareprimarywayspeoplemeetnewpeople,maintainfriendships,formteams,andstrengthenworkrelationships.

Sportsteams,basketballleague,fitnessclasses,etc.

Traditions&Symbols Atraditionisarecurringbehaviororactivitypasseddownwithinagroupthathascometohavespecialsignificance.Asymbolissomethingthatthegrouphasassignedspecialmeaning.

Traditionssuchasholidayshavebeenrevisedsothattheyincorporatehealthybehavior.Newwellnesstraditionsarecreatedsuchasoutingsthatincludephysicalactivityandannualconteststhatfeaturehealthybehavior.

“YellowJersey”(likeTourdeFrance)forpeoplethathaveaccomplishedsignificantwellnessachievements.WellnessChampionsrecognizedonawalloffame.





InternalCustomerOrientation

Viewingemployeesasinternalcustomers,includingassessingneeds,developingandimplementingagreed-uponprocesses,developinganddeliveringproductsandservicesthatsatisfyneeds,periodicallyassessingresultsandmakingnecessaryadjustments.

Aninternalcustomerorientationisusedtofocusonthehealthandwell-beingneedsoftheemployeesresultingincontributiontotheobjectivesoftheorganization.

Needsassessmentsthatareperformedinanorganizationtakeintoaccountwell-beingneedsofthepopulation.

ExternalCommunityConnections&Altruism

Intentionallysupportingtheexternalcommunityasanextensionofyourworkplaceenvironment,recognizingtheimportanceofsupportingthegreatercommunity.Theeffortsarealtruisticinnatureandinvolvedoingthingssimplyoutofadesiretohelp,notbecauseyoufeelobligatedtooutofduty,loyalty,orreligiousreasons.

Managementandemployeesregularlyvolunteerinthecommunitytosupportneedycausesandcharitableorganizations;sponsorhealth-relatedcommunityactivitiesandeventsandwillprovideanenvironmentatworkthatopenlysupportsthelessthisthinking.

VolunteeringtoteachJuniorAchievement,servingmealsatahomelessshelter,adoptahighway,BigBrothers/BigSisters,etc.

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