Edith Natalia Gutiérrez-Bolaño1; Mónica Bermúdez-Lugo1; Jaime Moreno-Chaparro1,2; Olga Beatriz Guzmán-Suárez1
BACKGROUND: Healthy organizations are based on dynamic relationships between productivity, health and well-being. Understanding and transforming these labor-permeating relationships through health promotion actions is necessary in the present time.
OBJECTIVE: To implement an intervention involving strategies likely to enable the transformation of companies into healthy organizations, based on a collective approach and seeking to boost performance and well-being at work. Methods: Participants were organizations affiliated with an occupational risk management company, selected according to their size, degree of development of workplace health and safety systems and economic activity. We designed and implemented an intervention to evaluate workplace safety and health, to finally suggest strategies to enhance occupational well-being.
RESULTS: We detected advances in the implementation of workplace safety and health systems, and also in several other aspects, as e.g. continuous improvement and self-care programs. Additional results include the participating organizations' engagement in several problems common to all, which led to the creation of a collective network. Intervention focused on training, follow-up, consultancy and collective development of healthy organizations.
CONCLUSION: Our reflections are grounded on a collective process of creation and seek to elucidate the potential and difficulties inherent to the implemented intervention, outcome expectations, resulting social cooperation networks and the process to formulate strategies to link work to health, well-being and productivity.
Keywords: healthy lifestyle; occupational health; health promotion; occupational therapy; health organizations.
INTRODUCCIÓN: Las organizaciones saludables se fundamentan en relaciones dinámicas entre productividad, salud y bienestar. La actualidad requiere entender y transformar estas relaciones inmersas en el trabajo y la ocupación a través de la promoción de la salud.
OBJETIVO: Implementar una intervención a través de estrategias que permitan la transformación empresarial bajo los fundamentos de organizaciones saludables con enfoque colectivo, en el desempeño ocupacional y el bienestar laboral.
METODOLOGÍA: Se realizó una convocatoria entre organizaciones afiliadas a una administradora de riesgos laborales teniendo en cuenta tamaño empresarial, desarrollo de sistemas de salud y seguridad laboral, y sector económico. Se diseñó e implementó una intervención que evalúa la seguridad y salud en el trabajo, ejecuta acciones y actividades, para finalmente proponer estrategias enmarcadas en el bienestar laboral.
RESULTADOS: Se identificaron avances en la implementación del sistema de seguridad y salud en el trabajo; se evidenciaron avances en el desarrollo de ítems como la mejora continua y los programas de autocuidado. Por otro lado, se relacionaron resultados adicionales como la participación de las organizaciones saludables en diferentes problemáticas comunes que permitieron el desarrollo de una red colectiva. Las intervenciones realizadas se enfocaron en la capacitación, acompañamiento, asesoría y construcción colectiva de organizaciones saludables.
CONCLUSIONES: La reflexión parte de los procesos de construcción grupal entendiendo las potencialidades y dificultades de las intervenciones planteadas, la expectativa en los resultados, las redes de cooperación social resultantes y el proceso de proponer estrategias que permitan vincular la ocupación participativa laboralmente con la salud, el bienestar y la productividad.
Palabra clave: estilo de vida saludable; salud laboral; promoción de la salud; terapia ocupacional; organizaciones en salud.
Healthy organizations are companies, institutions, groups or communities which aim is to perform systematic, planned and proactive actions not only to ensure their economic sustainability, but also to improve the health and well-being of employees through changes in their performance, environment and life context1,2. The World Health Organization (WHO) has joined in these efforts and characterizes healthy workplaces as those which took the following aspects into account: optimal (physical, mental and social) health, safety conditions appropriate to guarantee the performance of tasks, and understanding of the determinants of work, health and the community through effective promotion3.
Within this context, several institutions, forums and actions implemented in Colombia aim at transforming organizations exclusively focused on economic and production goals into healthy organizations as per the WHO criteria, the occupational accident/disease prevention perspective, the fundamental principles and rights of labor, and improved production and competitiveness, among others4-6. Several organizations have striven to achieve an understanding of and transform the characteristics of work, organizational culture and policies to make health become an integrated part of labor, no matter whether companies are family businesses, medium-sized or multinational corporations7.
Making work healthy and productive is one of the goals of occupational therapy. Occupational therapists, at least in Colombia, have suggested changes in the work routine through the consideration of notions such as human performance, autonomy, productivity and personal accomplishment. Such proposals helped transform and improve national policies, particularly vis-à-vis small and medium-sized enterprises8.
The aim of the present study was to implement an intervention at micro- and small-sized enterprises to promote their transformation into healthy organizations based on a collective approach and seeking to boost the performance and quality of life of workers, given that:
micro- and small-sized enterprises represent 95% of organizations in Colombia;
biomechanical, psychosocial and environmental hazards account for more than 60% of occupational health and safety reports;
that this category of organizations exhibits the lowest rate of preventive actions against occupational accidents and diseases or to promote workplace safety and health9.
We invited to participate in the present study organizations affiliated with a Colombian occupational risk management company, which met the following criteria:
micro-, small- or medium-sized companies;
currently developing a workplace safety and health management system (WSHMS);
belonging to one of the following economic activities:
i. agriculture, livestock production, hunting and silviculture;
ii. manufacturing industries;
iii. community, social, health and personal services; and
iv. transport, storage and communications;
located in Bogotá D.C.
Having a 1x1 design, the study evolved in two phases:
Phase 1: evaluation of the implementation of and advances in WSHMS according to the legislation in force (Resolution no. 1111, 2017)10;
Phase 2: collective intervention which consisted in:
i. roundtables with legal representatives and/or WSHMS coordinators, and included debates, and group work, among other activities;
ii. group discussions coordinated by occupational therapists to reinforce the notion of healthy organizations among the employees of the participating organizations. In addition, we individually approached each participating organization to enhance the consolidation and appropriation of the information thus learned and consequently empower organizational actors.
Upon designing the intervention we took into account:
the 2013-2021 national plan for workplace safety and health formulated by the Colombian Ministry of Health and the Ibero American Social Security Organization11;
the criteria for healthy organizations established by the Colombian Ministry of Health12;
occupational therapy principles13.
The present study was conducted within the context of a partnership between Universidad Nacional de Colombia and Seguros de Vida Alfa ARL, signed on 6 June 2013, and included ethical review and support by Seguros de Vida Alfa ARL and the participating organizations. The study complied with the ethical principles stated in Declaration of Helsinki14. Participation was voluntary, and the participants signed an informed consent form. We ensured confidentiality and the anonymity of personal and organizational data, in compliance with the Resolution no. 8430/1993, on human research involving minimal risk15.
Twelve (50%) out of 24 organizations which met the inclusion criteria and were invited to take part in the present study agreed to participate. It should be noticed that we succeeded in complying with inclusion criteria #3, since the organizations represented all the preset economic activities:
agriculture, livestock production, hunting and silviculture (n=1);
manufacturing industries (n=6);
community, social, health and personal services (n=4);
transport, storage and communications (n=1).
The intervention began by identifying advances in the WSHMS of each participating organization, visits to their premises and checking compliance with requirements together with managers. In this step we found different rates of advancement in all the analyzed aspects, the overall rate ranging from 7% to 93% as per the criteria described in Resolution no. 1111, 201710. The improvement rates were largely heterogeneous for the analyzed aspects, as shown in Figure 1: strengths corresponded to WSHMS policies, rights and duties, and hygiene and safety, while continual improvement, sociodemographic characterization, and self-care and workplace well-being programs exhibited poorer improvement.
The results obtained in the evaluation phase guided the 1x1 intervention actions, which consisted in roundtables, described in Chart 1. The aim for each roundtable was to collectively formulate and develop concepts and tools to be implemented by the participating companies to become healthy organizations.
The roundtables proved to be an effective means of intervention, since the rate of participation was 95%. Their scope was not restricted to the aspects with the poorest rates of improvement (Figure 1), but also included the entire workplace health and safety system. Among the most relevant outcomes:
Increase of 50% in the rate of advance of item "Continuous improvement," once insight was gained on the need for reinforcement by the interventionists and collective evaluation and feedback relative to actions within organizations;
Increase of 70% in the rate of advance of item "Self-care programs/guides," once insight was gained on the fact that self-care and workplace well-being are the basis of healthy organizations. Additional outcomes included collective formulation of proposals and ideas for cultural, sport and culinary activities, among others. Participation of both employees and organizational leaders was highly significant for this purpose;
Advances in all the other items, with emphasis on the system as a whole and workers.
One of the outcomes that stood out as a strategic result of the present study was the creation of a collective network linking the participating organizations. On their own initiative, leaders or managers established mutual contact to multiply the impact of actions targeting employees, production and reinforcement of aspects of healthy and productive organizations committed to social transformation.
We further visited and provided individual consultancy to each participating organization to identify problems and design possible solutions, 95% of which were conveyed to the inter-organizational network for further debate and collective elaboration, with favorable outcomes. The key aspect in this step was to identify the precise moment when term "company" was replaced by "healthy organization" as an indicator of intervention consolidation, network creation and autonomous advancement of organizations.
At the end of intervention, we posed the following questions to the leaders/managers of the now healthy organizations:
how a healthy organization is created?;
what are the benefits of healthy organizations?;
what difficulties should be overcome along the process of becoming a healthy organization?
We obtained answers from 100% of the participating organizations. The answers to the first question were analyzed in terms of frequency. As Figure 2 shows, the vast majority of responses corresponded to aspects:
need for and divulgation of information and sensitization of organizations in regard to the actual workplace health conditions;
relevance of focusing on the contextual and production reality;
understanding of the notions of healthy organizations, health and safety.
In turn, the least mentioned aspects were:
numerical and statistical data on occupational accidents/diseases;
approaches to self-care, workplace well-being and healthy life and work habits; and 3) labor costs.
The frequencies of the responses to the second question, i.e. on benefits afforded by health organizations, are represented in Figure 3. The vast majority of the reported benefits corresponded to the development and maintenance of workers' motivation vis-à-vis productivity demands (an aspect also known as job satisfaction) and promotion of the organization's external image. Less frequent aspects were: improvement of interpersonal relationships and the work environment, and reduction of the absenteeism and work accident rates.
Finally, all the respondents agreed on that becoming a healthy organization is not simple, but has substantial financial costs, requires time and above all, the will to change.
Healthy organizations can be created according to variable perspectives, but always based on actions, which in the case of Colombia correspond to WSHMS and the legislation in force, and international notions formulated to enhance workplace well-being, working and health conditions, while acknowledging the relevance of community-based and collective approaches to performance, environment, productivity and quality of life3,4,6,9. These aspects have been previously addressed within attempts to establish links with reflections on fair labor, workers' resources and skills, and the responsibility of healthy organizations16. In this regard, and as a point of tension, we found that approaches from the perspective of occupational therapy and wellness, instead of that of organizational psychology, focus on the comprehension of such links, represented by cultural change, integration and dynamic organization-employee relationships. Occupational therapists, for instance, perform workplace inspections and interventions, provide healthy recommendations and suggest means to improve productivity and performance, all these actions being centered on individuals and their health, independently from environmental factors.
The current conditions and characteristics of micro- and small-sized enterprises in Colombia deserve special consideration, primarily because they represent a major economic power. Then, and in direct correlation with the results of the present study, the actions with the lowest rate of advance, less frequently implemented, but most important in the process of developing healthy organizations are those related with workplace well-being, self-care, health promotion, continuous improvement and identification of the workers' profile9.
Several studies were conducted globally on different ways to develop workplace strategies and services, including the aspects of health and well-being17,18. Such studies addressed relations within organizations and their policies, and performed interventions involving employee participation and decision-making on their own health, while avoiding judgements grounded on external regulations18,19. Nevertheless, many such actions are eventually implemented just to comply with regulations, instead of intentionally seeking to improve the quality of life and well-being of workers.
Some of the benefits of healthy organizations described in the literature include: better interpersonal relationships, workplace entertainment and strengthening of the advantages of the production-satisfaction interaction18. These, and also other, benefits were identified in the present study not only as was expected as a function of the assumptions underlying intervention, but also as favorable aspects in terms of collaborative working and sustainable development. Benefits of this kind extend into other human aspects, since some studies showed that job satisfaction is directly related to happy productive workers17.
The overall aim of intervention was to promote changes in perceptions, attitudes, behaviors and the work environment through a broad range of actions — such as e.g. workshops and training sessions — to enhance job satisfaction and workplace well-being20-22. While changes in attitudes and behaviors represent points of tension, their impact on the transformation of the work environment help refine the models designed for healthy organizations21. The techniques implemented in the present study were based on several approaches discussed in the literature1,7,17,18,20,21. One among such techniques focused on leadership, which helped evidence favorable adaptive responses to change and contributes to a safe organizational climate, conflict resolution and mediation between organizational demands and employees, among other benefits20.
Further outcomes of intervention were, among others: labor improvement, high-quality practices and a continuous improvement agenda. As in previous reviews of the development of healthy organizations20, these results are the product of collective work and of the creation of collaborative organizational networks.
We identified the following strategies as points of departure, tension and development along the process of transformation of the participating companies into healthy organizations.
Companies replace their former goals, exclusively centered on production and financial gains, by a focus on sustainable productivity, employee well-being and promotion of healthy policies in all the organizational levels. This shift has positive impact on production chains, frequency of occupational accidents/diseases and absenteeism and disability rates, among other aspects.
Healthy organizations do not only develop out of management awareness and an understanding of national and international policies, regulations and guidelines as the framework for preventive, instead of, punitive actions, but also based on the comprehension of notions such as: healthy, self-care, well-being and transformation. The latter aspect should represent the cornerstone for both managers and employees in the adoption of a proactive attitude that impregnates the entire organization.
Experiential and ludic-pedagogic workshops, training sessions, guided visits and consultancy, among others, are fundamental intervention tools. These actions should be deployed within three contexts — follow-up, construction and autonomy — to help healthy organizations become independent and autonomous in the future.
More through studies are needed for long-term evaluation of healthy organizations, their processes, dynamics and improvement. In addition, future studies should analyze the impact of this type of initiatives on the quality of life and performance of workers through measurement techniques such as the ones employed in the present study, instead of rigorous measurements of standards.
To the occupational therapists in training at Socio-occupational practice at the Universidad Nacional de Colombia, 2017–2018, the participating organizations and Seguros de Vida Alfa S.A.
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5 de Fevereiro de 2019.
Aceito em 9 de Julho de 2019.