Skip to main content

Evaluation of a Total Worker Health® Leadership Development Program for Small Business

Abstract

Leaders play a critical role in the development and execution of Total Worker Health® (TWH). Small businesses, in particular, can benefit from strong leadership support for TWH as the burden of work-related injury, illness and fatality, as well as poor health and well-being is high in this population. In the present study, we conducted a program evaluation of a TWH leadership development program for small business leaders using the RE-AIM framework. The goal of the program was to help change leaders’ behaviors around health, safety and well-being practices following the theory of transformational leadership. Two leaders from each business participated in pre-training activities on their own, a 6-h in-person training, and three months of access to virtual training transfer activities, including coaching and goal tracking. Our results suggest that the TWH leadership development program is effective at improving leaders’ self-reported TWH leadership practices and that the in-person training was implemented successfully. However, leaders did not report improvements in their personal health and in fact reported increased levels of work stress after the program. We also observed some challenges when implementing our training transfer strategies. Our study suggests that leaders may benefit from attending TWH leadership trainings alongside other colleagues in their organization to facilitate a shared vision and goals for TWH in their organization. As a next step, it will be important to determine the program’s effectiveness in changing business TWH policies and practices, employee perceptions of TWH and leadership, and employee health and safety outcomes.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

References

  • Al-Eisa, A. S., Furayyan, M. A., & Alhemoud, A. M. (2009). An empirical examination of the effects of self-efficacy, supervisor support and motivation to learn on transfer intention. Management Decision, 47(8), 1221–1244. https://doi.org/10.1108/00251740910984514.

    Article  Google Scholar 

  • Anger, W., Rameshbabu, A., Olson, R., Bodner, R., Hurtado, D., Parker, K., … Rohlman, D. (2019). Effectiveness of Total worker health interventions. In H. Hudson, J. Nigam, S. Sauter, L. Chosewood, A. Schill, & H. Howard (Eds.), Total worker health (pp. 61–89). American Psychological Association.

  • Bamberger, P. A., & Bacharach, S. B. (2006). Abusive supervision and subordinate problem drinking: Taking resistance, stress, and subordinate personality into account. Human Relations, 59(6), 723–752.

    Article  Google Scholar 

  • Barling, J., & Cloutier, A. (2017). Leaders' mental health at work: Empirical, methodological, and policy directions. Journal of Occupational Health Psychology, 22(3), 394–406. https://doi.org/10.1037/ocp0000055.

    Article  PubMed  Google Scholar 

  • Barnes, C. M., Guarana, C. L., Nauman, S., & Kong, D. T. (2016). Too tired to inspire or be inspired: Sleep deprivation and charismatic leadership. Journal of Applied Psychology, 101(8), 1191–1199. https://doi.org/10.1037/apl0000123.

    Article  Google Scholar 

  • Bass, B. (1985). Leadership and performance beyond expectations. Free Press.

  • Bronkhorst, B., Tummers, L., & Steijn, B. (2018). Improving safety climate and behavior through a multifaceted intervention: Results from a field experiment. Safety Science, 103, 293–304. https://doi.org/10.1016/j.ssci.2017.12.009.

    Article  Google Scholar 

  • Casey, T. W., Krauss, A. D., & Turner, N. (2018). The one that got away: Lessons learned from the evaluation of a safety training intervention in the Australian prawn fishing industry. Safety Science, 108, 218–224. https://doi.org/10.1016/j.ssci.2017.08.002.

    Article  Google Scholar 

  • Christian, M. S., Bradley, J. C., Wallace, J. C., & Burke, M. J. (2009). Workplace safety: A meta-analysis of the roles of person and situation factors. Journal of Applied Psychology, 94(5), 1103–1127. https://doi.org/10.1037/a0016172.

    Article  Google Scholar 

  • Clarke, S. (2013). Safety leadership: A meta-analytic review of transformational and transactional leadership styles as antecedents of safety behaviours. Journal of Occupational and Organizational Psychology, 86(1), 22–49. https://doi.org/10.1111/j.2044-8325.2012.02064.x.

    Article  Google Scholar 

  • Clarke, S., & Taylor, I. (2018). Reducing workplace accidents through the use of leadership interventions: A quasi-experimental field study. Accident Analysis & Prevention, 121, 314–320.

    Article  Google Scholar 

  • Conchie, S. M. (2013). Transformational leadership, intrinsic motivation, and trust: A moderated-mediated model of workplace safety. Journal of Occupational Health Psychology, 18(2), 198–210. https://doi.org/10.1037/a0031805.

    Article  PubMed  Google Scholar 

  • Cunningham, C., Woodward, C., Shannon, H., Lendrum, B., Rosenbloom, D., & Brown, J. (2002). Readiness for organizational change: A longitudinal study of workplace, psychological and behavioural correlates. Journal of Occupational & Organizational Psychology, 75(4), 377–392.

    Article  Google Scholar 

  • Cutts, T. F., Gunderson, G. R., Proeschold-Bell, R. J., & Swift, R. (2012). The life of leaders: An intensive health program for clergy. Journal of Religion and Health, 51(4), 1317–1324. https://doi.org/10.1007/s10943-010-9436-6.

    Article  PubMed  Google Scholar 

  • D’Innovenzo, L., Mathieu, J., & Kurkenberger, M. (2016). A meta-analysis of different forms of shared leadership–Team performance relations. Journal of Management, 42(7), 1964–1991.

    Article  Google Scholar 

  • Eisenberger, R., Huntinton, R., Hutchinson, S. R., & Sowa, D. (1986). Percieved organizational support. Journal of Applied Psychology, 71, 500–507.

    Article  Google Scholar 

  • Erikson, W. (2005). Work factors as predictors of smoking relapse in nurses’ aides. International Archives of Occupational and Environmental Health, 79(3), 244–250.

    Article  Google Scholar 

  • Eriksson, A., Axelsson, R., & Axelsson, S. (2010). Development of health promoting leadership – Experiences of a training programme. Health Education, 110(2), 109–124.

    Article  Google Scholar 

  • Fisher, G, G., Matthews, R, A., & Gibbons, A, M. (2015). Developing and investigating the use of single-item measures in organizational research. Journal of Occupational Health Psychology, 1–22. doi:https://doi.org/10.1037/a0039139.

  • Ford, J. K., Baldwin, T. T., & Prasad, J. (2018). Transfer of training: The known and the unknown. Annu Rev Organ Psychol Organ Behav, 5(1), 201–225.

    Article  Google Scholar 

  • Gaglio, B., Shoup, J. A., & Glasgow, R. E. (2013). The RE-AIM framework: A systematic review of use over time. American Journal of Public Health, 103(6), e38–e46. https://doi.org/10.2105/ajph.2013.301299.

    Article  PubMed  PubMed Central  Google Scholar 

  • Glasgow, R., Vogt, T., & Boles, S. (1999). Evaluating the public health impact of health promotion interventions: The RE-AIM framework. American Journal of Public Health, 89(9), 1322-1327. Retrieved from /PMC/articles/PMC1508772/?Report=abstract.

  • Griffin, M., & Neal, A. (2000). Perceptions of safety at work: a framework for linking safety climate to safety performance, knowledge, and motivation. Journal of Occupational Health Psychology, 1, 347–358. Retrieved from http://0-search.ebscohost.com.catalog.library.colostate.edu/login.aspx?direct=true&AuthType=cookie,ip,url,cpid&custid=s4640792&db=psyhref&AN=JOHP.A.CDG.GRIFFIN.PSWFLS&site=ehost-live.

  • Grover, S., & Furnham, A. (2016). Coaching as a developmental intervention in Organisations: A systematic review of its effectiveness and the mechanisms underlying it. PLoS One, 11(7), e0159137. https://doi.org/10.1371/journal.pone.0159137.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hammer, L. B., Truxillo, D. M., Bodner, T., Rineer, J., Pytlovany, A. C., & Richman, A. (2015). Effects of a workplace intervention targeting psychosocial risk factors on safety and health outcomes. BioMed Research International, 2015, 836967. https://doi.org/10.1155/2015/836967.

    Article  PubMed  PubMed Central  Google Scholar 

  • Jeschke, K. C., Kines, P., Rasmussen, L., Andersen, L. P. S., Dyreborg, J., Ajslev, J., et al. (2017). Process evaluation of a toolbox-training program for construction foremen in Denmark. Safety Science, 94, 152–160. https://doi.org/10.1016/j.ssci.2017.01.010.

    Article  Google Scholar 

  • Johnson, S. K., Garrison, L. L., Hernez-Broome, G., Fleenor, J. W., & Steed, J. L. (2012). Go for the goal(s): Relationship between goal setting and transfer of training following leadership development. Academy of management learning and education, 11(4), 555–569. https://doi.org/10.5465/amls.2010.0149.

    Article  Google Scholar 

  • Karlin, W., Brondolo, E., & Schwartz, J. (2003). Workplace social support and ambulatory cardiovascular activity in New York City traffic agents. Psychosomatic Medicine, 65, 67–176.

    Article  Google Scholar 

  • Kelloway, E. K., & Barling, J. (2010). Leadership development as an intervention in occupational health psychology. Work and Stress, 24(3), 260–279. https://doi.org/10.1080/02678373.2010.518441.

    Article  Google Scholar 

  • Kouzes, J. M., & Posner, B. Z. (2012). The leadership challenge: How to make extraordinary things happen in organizations (5th ed.). Wiley.

  • Kuoppala, J., Lamminp, A., Liira, J., & Vainio, H. (2008). Leadership, job well-being, and health effects - a systematic review and a meta-analysis. Journal of Occupational and Environmental Medicine, 50(8), 904–915. https://doi.org/10.1097/JOM.0b013e31817e918d.

    Article  PubMed  Google Scholar 

  • Larsson, R., Stier, J., Akerlind, I., & Sandmark, H. (2015). Implementing health-promoting leadership in municipal organizations: Managers’ experiences with a leadership program. Nordic Journal of Working Life Studies, 5(1), 93–114. Retrieved from http://rossy.ruc.dk/ojs/index.php/njwls/article/view/4767/2452

  • Lee, J., Huang, Y.-H., Robertson, M. M., Murphy, L. A., Garabet, A., & Chang, W.-R. (2014). External validity of a generic safety climate scale for lone workers across different industries and companies. Accident Analysis & Prevention, 63, 138–145. https://doi.org/10.1016/j.aap.2013.10.013.

    Article  Google Scholar 

  • Linnan, L., Bowling, M., Childress, J., Lindsay, G., Blakey, C., Pronk, S., et al. (2008). Results of the 2004 National Worksite Health Promotion Survey. American Journal of Public Health, 98(8), 1503–1509. https://doi.org/10.2105/AJPH.2006.100313.

    Article  PubMed  PubMed Central  Google Scholar 

  • Linnan, L., Vaughn, A., Smith, F., Westgate, P., Hales, D., Arandia, G., et al. (2020). Results of caring and reaching for health (CARE): A cluster-randomized controlled trial assessing a worksite wellness intervention for child care staff. International Journal of Behavioral Nutrition and Physical Activity, 17(1), 64. https://doi.org/10.1186/s12966-020-00968-x.

    Article  Google Scholar 

  • Machin, M. A., & Fogarty, G. J. (2004). Assessing the antecedents of transfer intentions in a training context. International Journal of Training and Development, 8(3), 222–236. https://doi.org/10.1111/j.1360-3736.2004.00210.x.

    Article  Google Scholar 

  • McColl, K. (2009). Betting on health. Bmj, 338, b1456. https://doi.org/10.1136/bmj.b1456.

    Article  PubMed  Google Scholar 

  • McCoy, K., Stinson, K., Scott, K., Tenney, L., & Newman, L. S. (2014). Health promotion in small business: A systematic review of factors influencing adoption and effectiveness of worksite wellness programs. Journal of Occupational and Environmental Medicine, 56(6), 579–587. https://doi.org/10.1097/JOM.0000000000000171.

    Article  PubMed  PubMed Central  Google Scholar 

  • Morgeson, F. P., & Humphrey, S. E. (2006). The work design questionnaire (WDQ): Developing and validating a comprehensive measure for assessing job design and the nature of work. Journal of Applied Psychology, 91(6), 1321–1339. https://doi.org/10.1037/0021-9010.91.6.1321.

    Article  Google Scholar 

  • Mullen, J., & Kelloway, E. (2009). Safety leadership: A longitudinal study of the effects of transformational leadership on safety outcomes. Journal of Occupational and Organizational Psychology, 82(2), 253–272. https://doi.org/10.1348/096317908x325313.

    Article  Google Scholar 

  • Mullen, J., Kelloway, K., & Teed, M. (2011). Inconsistent style of leadership as a predictor of safety behavior. Work and Stress, 25(1), 41–54.

    Article  Google Scholar 

  • Munir, F., & Nielsen, K. (2009). Does self-efficacy mediate the relationship between transformational leadership behaviours and healthcare workers’ sleep quality? A longitudinal study. Journal of Advanced Nursing, 65(9), 1833–1843. https://doi.org/10.1111/j.1365-2648.2009.05039.x.

    Article  PubMed  Google Scholar 

  • Munir, F., Nielsen, K., & Carneiro, I. G. (2010). Transformational leadership and depressive symptoms: A prospective study. Journal of Affective Disorders, 120(1–3), 235–239. https://doi.org/10.1016/j.jad.2009.03.020.

    Article  PubMed  Google Scholar 

  • Nahrgang, J. D., Morgeson, F. P., & Hofmann, D. A. (2011). Safety at work: A meta-analytic investigation of the link between job demands, job resources, burnout, engagement, and safety outcomes. Journal of Applied Psychology, 96(1), 71–94. https://doi.org/10.1037/a0021484.

    Article  Google Scholar 

  • Nielsen, K., Randall, R., Yarker, J., & Brenner, S.-O. (2008). The effects of transformational leadership on followers’ perceived work characteristics and psychological well-being: A longitudinal study. Work and Stress, 22(1), 16–32. https://doi.org/10.1080/02678370801979430.

    Article  Google Scholar 

  • NIOSH. (2020). What is Total Worker Health? Retrieved from https://www.cdc.gov/niosh/twh/default.html

  • Nyberg, A., Alfredsson, L., Theorell, T., Westerlund, H., Vahtera, J., & Kivimaki, M. (2009). Managerial leadership and ischaemic heart disease among employees: The Swedish WOLF study. Occupational and Environmental Medicine, 66(1), 51–55. https://doi.org/10.1136/oem.2008.039362.

    Article  PubMed  Google Scholar 

  • Punnett, L., Warren, N., Henning, R., Nobrega, S., Cherniack, M., & Research Team, C. P. H.-N. E. W. (2013). Participatory ergonomics as a model for integrated programs to prevent chronic disease. Journal of Occupational and Environmental Medicine, 55(12 Suppl), S19–S24. https://doi.org/10.1097/JOM.0000000000000040.

    Article  PubMed  Google Scholar 

  • Ryan, M., Erck, L., McGovern, L., McCabe, K., Myers, K., Nobrega, S., et al. (2019). "working on wellness:" protocol for a worksite health promotion capacity-building program for employers. BMC Public Health, 19(1), 111. https://doi.org/10.1186/s12889-019-6405-1.

    Article  PubMed  PubMed Central  Google Scholar 

  • Schwatka, N., Atherly, A., Dally, M. J., Fang, H., Brockbank, C. v., Tenney, L., et al. (2017). Health risk factors as predictors of workers' compensation claim occurrence and cost. Occupational and Environmental Medicine, 74(1), 14–23. https://doi.org/10.1136/oemed-2015-103334.

    Article  PubMed  Google Scholar 

  • Schwatka, N., Tenney, L., Dally, M., Scott, J., Brown, C., Weitzenkamp, D., et al. (2018). Small business Total worker health: A conceptual and methodological approach to facilitating organizational change. Occupational Health Science, 2(1), 25–41.

    Article  Google Scholar 

  • Schwatka, N., Goldenhar, L., Johnson, S., Beldon, M., Tessler, J., Dennerlein, J., et al. (2019). A training intervention to improve frontline construction leaders’ safety leadership practices and overall jobsite safety climate. Journal of Safety Research, 70, 253–262.

    Article  Google Scholar 

  • Shore, E., Schwatka, N., Dally, M., Brown, C., Tenney, L., & Newman, L. (2020). Small business employees perceptions of leadership are associated with safety and health climates and their own behaviors. Journal of Environmental and Occupational Medicine, 62(2), 156–162.

    Article  Google Scholar 

  • Sosik, J., & Godshalk, V. (2000). Leadership styles, mentoring functions received, and job- related stress: A conceptual model and preliminary study. Journal of Organizational Behavior, 21, 365–390.

    Article  Google Scholar 

  • Staehr, J. (1998). The use of well-being measures in primary health care-the DepCare project. World Health Organization, regional Office for Europe: Well-being measures in primary health care-the DepCare project. World Health Organization.

  • Tenney, L., Fan, W., Dally, M., Scott, J., Haan, M., Rivera, K., et al. (2019). Health LinksTM assessment of Total worker health practices as indicators of organizational behavior in small business. Journal of Occupational & Environmental Medicine, 61(8), 623–634.

    Article  Google Scholar 

  • Thompson, J., Schwatka, N., Tenney, L., & Newman, L. (2018). Total worker health: A small business leader perspective. International Journal of Environmental Research and Public Health, 15(11). https://doi.org/10.3390/ijerph15112416.

  • United States Census Bureau. (2020). 2016 SUSB annual data tables by establishment industry. Retrieved from https://www.census.gov/data/tables/2016/econ/susb/2016-susb-annual.html

  • von Thiele Schwarz, U., Hasson, H., & Tafvelin, S. (2016). Leadership training as an occupational health intervention: Improved safety and sustained productivity. Safety Science, 81, 35–45. https://doi.org/10.1016/j.ssci.2015.07.020.

    Article  Google Scholar 

  • Wu, Q., Cormican, K., & Chen, G. (2018). A meta-analysis of shared leadership: Antecedents, consequences, and moderators. Journal of Leadership & Organizational Studies, 52, 1–16.

    Google Scholar 

  • Zohar, D., & Polachek, T. (2014). Discourse-based intervention for modifying supervisory communication as leverage for safety climate and performance improvement: A randomized field study. Journal of Applied Psychology, 99(1), 113–124. https://doi.org/10.1037/a0034096.

    Article  Google Scholar 

  • Zweber, Z. M., Henning, R. A., & Magley, V. J. (2016). A practical scale for multi-faceted organizational health climate assessment. Journal of Occupational Health Psychology, 21(2), 250–259. https://doi.org/10.1037/a0039895.

    Article  PubMed  Google Scholar 

Download references

Funding

This publication was supported by the following grants K01OH011726 and U19OH011227 funded by the Centers for Disease Control and Prevention/National Institute for Occupational Safety and Health. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Natalie V. Schwatka.

Ethics declarations

Conflict of Interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

ESM 1

(DOCX 51 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Schwatka, N.V., Brown, C.E., Tenney, L. et al. Evaluation of a Total Worker Health® Leadership Development Program for Small Business. Occup Health Sci 5, 163–188 (2021). https://doi.org/10.1007/s41542-021-00086-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s41542-021-00086-5

Keywords

  • Leadership training
  • Program evaluation
  • Occupational health and safety
  • Training transfer
  • Health promotion
  • Health protection