Total Worker Health TM

Total Worker Health TM Promising and Best Practices in the Integration of Occupational Safety and Health Protection with Health Promotion in the Workplace Veterans Health Administration Perspective Kathleen McPhaul, PhD, Chief Consultant, Occupational Health Ebi Awosika, MD, Director, Employee Health Promotion/Disease Impairment Prevention Tamara Schulte, PhD Jennifer Lipkowitz-Eaton, MD, David Mohr, PhD

Veterans Health Administration VA is one of the largest civilian employers in the federal government and one of the largest health care employers in the world. 304,000+Total VHA Employees 117,000+ Veteran Employees 23,000+ Physicians 87,000+ Nurses* *Includes registered nurses, licensed practical nurses and licensed vocational nurses. 2

Categories of Recognized Hazards Health Care Work Environment Infectious (e.g. Hepatitis B, Hepatitis C, HIV, TB) Chemical (e.g. cleaning chemicals; toxic drugs) Ergonomic/Mechanical (Patient lifting, trips/falls) Physical hazards (e.g. radiation, noise, assaults) Organization of Work (e.g. stress, burnout, verbal abuse, staffing, work hours, control over work; job demands) 3

U.S. Occupational Injury and Illness Rates 1989-2011 4

Incidence Rates of NFOII DAFW Cases for Healthcare Support Occupations (HCSOs) in US Private Industry, 2006-2010 - NIOSH Analysis 2006 128 279 2007 122 262 2008 113 244 2009 106 236 2010 108 242 0 50 100 150 200 250 300 All Occupations Healthcare Support Occupations

Questions for the Panel and VHA: What is success? What is the value of these programs? What specific measures or outcomes are being used to demonstrate success? What metrics could be more useful? What are the differences of opinion over the validity of various metrics and their use? 6

What is success? * (*According to me) Public Health Success Occupational Health Success Health Delivery/ Primary Care Success Employer Employee Veterans Health Administration 7

What is success? *(*According to me) Perceptions of success determine usefulness/value of metrics Public Health Success: Recognition that work, work history and current job are important determinants of health and are assessed as widely and consistently as other determinants of health such as family history, smoking status, body mass index, exercise behavior, chronic disease status, mental health. Occupational Health Success: Work, past work or current job does not adversely impact health but rather serves to enhance health Health Delivery/ Primary Care Success: Primary care providers possess and utilize occupational history taking skills, have access to OM/OH specialty care as needed, have information about work risks/hazards and health risk reduction programs at their patients work, and electronic health record contributes to employees understanding of personal health and access to information without compromising personal privacy rights. 8

What is success? Employer Success Productive and engaged employees whose passion, enjoyment of and commitment to their jobs improves the bottom line and puts them at the top of their industry in quality, productivity and job satisfaction metrics. Employee Success Work improves their mental and physical health by being enjoyable and meaningful, by contributing to personal, educational, social, community service and career goals. Work is organized in such a way that the job tasks and work environment are safe while facilitating access to choice in health care, exercise support, healthy food options, preventive health services, and social and cultural services such as eldercare/childcare and education. 9

What does VHA success look like? Integration at Central Office Headquarters 3 Total Worker Health Pilots in Medical Facilities Address the Psychosocial Work Environment Measure/Improve the Psychosocial Work Environment Acceptance by Labor Partners/VHA Leadership Impact on Employee Health Behaviors, Occupational Injury, Psychosocial Work Environment, Job Satisfaction, Patient Safety, Veteran Care Quality and Facility Leadership Support, 10

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Occupational Health 10P3D Integration at Headquarters Employee Health Promotion Disease and Impairment Prevention Occupational Health Employee Occupational Health (EOH) Occupational Metrics & Surveillance Workplace Violence Prevention Safe Patient Handling Workers Compensation 12

Many existing VHA Metrics can be used for TWH pilots Demographics: HR and Annual All Employee Survey Health Behaviors: via self report survey/hra Occupational Safety: Safety Incidents, Workers Comp Work Environment Characteristics: AWE/other Job Satisfaction and Turnover: AES and HR Job Stress/Workplace Violence/Bullying/Psychosocial: AES, Workplace Violence measures Program Update Measures 13

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> 60% VHA s Work Force is Graying 35.0% 30.0% 29.10% 27.60% 25.0% 20.0% 15.0% 16.5% 21.80% 10.0% 5.0% 0.0% 5.10% Less than 34 35-44 45-54 55-64 65+

VHA WCP Statistics Injuries in 2013 by Age Group 60's 4196 26% 70's 1017 6% 80's 498 3% 90's 114 1% 100's 2 0% 30's 1322 8% 20's 304 2% 40's 2852 17% 50's 6072 37% 16

3.00 VHA FY 2013 Lost Total Case Rate(LTCR) Performance Chart 2.50 2.00 2013 VHA Target 1.55 1.50 1.00 0.50 0.00 FY 2013 Performance: Green: at or below 1.55 (MEETING GOAL) Yellow: Above 1.55 but less than 1.95 Red: At or above 1.95 17

600 Injury Rates due to Lifting-Repositioning Patients Among Nursing Occupations for All Facilities (N=139) Incidence Rate per 10,000 FTE 500 400 300 200 100 Nursing Assistant Practical Nurse Nurse Nursing Occupations All Occupations 0 FY04 FY05 FY06 FY07 FY08 FY09 FY10 FY11 Fiscal Year

Selected Employee Health Indicators 2010 Voice of the VA (VoVA) Health Promotion Survey 50.0% 45.0% 40.0% 35.0% % of Employees 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% % Smokers % Obese % Physically Inactive HealthyPeople 2010 Smoking Goal HealthyPeople 2010 Obesity Goal

Smoking and Obesity by Occupation

Provider Health Behaviors and Chronic Conditions by Ethnicity, Gender, and Race MDs, Dentists, PAs and NPs (Professionally Licensed Providers) Current Smokers (%) Obese (%) Physically Inactive (%) Diabetic (%) Have HBP (%) Arthritic (%) Hispanic 7.9% 28.8% 29.6% 4.5% 24.6% 22.2% Non-Hispanic 3.9% 17.2% 16.7% 3.5% 19.3% 22.5% Male 4.7% 15.8% 15.3% 3.8% 22.4% 18.2% Female 3.7% 20.3% 19.2% 3.2% 18.6% 25.9% White 4.5% 19.2% 16.5% 2.9% 19.5% 23.9% Non-White 4.0% 15.1% 22.3% 7.3% 23.2% 17.7% Differences between demographic groups are statistically significant (p < 0.05).

Penetration of Employee Health Promotion (EHP) Services by VISN and Facility VISN No. Medical Centers No. with Cert Coach Percent with Coach No. participating in a pilot Percent participating in pilot 1 11 4 36% 1 9% 2 6 3 50% 1 17% 3 8 6 75% 2 25% 4 12 6 50% 0 0% 5 5 3 60% 0 0% 6 8 4 50% 0 0% 7 9 7 78% 1 11% 8 8 6 75% 2 25% 9 9 2 22% 2 22% 10 5 5 100% 2 40% 11 8 7 88% 1 13% 12 7 5 71% 1 14% 15 9 5 56% 5 56% 16 11 7 64% 2 18% 17 7 0 0% 1 14% 18 7 7 100% 0 0% 19 6 2 33% 0 0% 20 10 2 20% 2 20% 21 8 2 25% 1 13% 22 6 3 50% 1 17% 23 9 3 33% 4 44% OVERALL 169 89 49% 29 17%

Impact of FTE and Certified Coach Training on EHP Service Provision 100% 90% 80% 70% 89% 78% 73% 83% 70% 66% 67% 60% 50% 45% 56% 54% 44% 55% 51% 40% 30% 23% 32% 32% 23% 36% 30% 20% 10% 9% 0% Wellness Committee Wellness Plan Healthy Food Environment Employee Wgt Management Comp Tobacco Cessation Coach with FTE and training (n = 36) Coach with no FTE but Training (n = 37) Coach with no FTE and no Training (n = 22) No Coach (n = 45)

The link between the work environment and patient safety is not a new concept (IOM Report, 2004) The IOM report, Keeping Patients Safe: Transforming the Work Environment of Nurses, emphasizes the importance of the work environment in which nurses provide care. 24

In VA, as psychological safety perceptions increase, employees also report greater job satisfaction, intentions to stay with VA (i.e., retention), workforce engagement, workplace civility, and innovation 5/29/2014 25

VHA Turnover Rate FY03-12 All occupations

Summary Success depends on perspective Existing VHA Metrics Still need: Measures of program Integration and Baseline Facility Assessment Tool Site visit audit process/participatory process documentation Better measures of chronic disease Measures of patient care quality/patient safety integrated with TWH measures Facility specific dashboard for leadership and employees Improved conceptualization and communication of Psychosocial Work Environment and Job Stress 27

THANK YOU!

Educational Attainment 35% 33% % Employees 30% 27% 25% 20% 20% 15% 10% 5% 0% 1% 11% 5% <HS Grad HS Grad HS Grad+ BS/BA Prof Degree 2% BS/BA+ Grad/Adv Degree

Veteran Status 30.00% 25.00% 20.00% 15.00% 39% of VHA Employees are Veterans 24.20% 10.00% 9.10% 5.00% 5.20% 0.00% Vietnam Era Veteran 0.20% Pre-Vietnam Era Veteran Post-Vietnam Era Veteran Not Vietnam Era Veteran