Implementation of An Organizational Intervention To Improve Low-Wage Workers' Safety, Health And Wellbeing: Findings From The Workplace Organizational Health Study

Abstract

Background: Many organizational interventions aim to improve working conditions to promote and protect worker safety, health, and well-being. The Workplace Organizational Health Study used process evaluation to examine factors influencing implementation of an organizational intervention. This paper examines the extent to which the intervention was implemented as planned, the dose of intervention implemented, and ways the organizational context hindered or facilitated the implementation of the intervention.Methods: This proof-of-concept trial was conducted with a large, multinational company that provides food service through contractual arrangements with corporate clients. The 13-month intervention was launched in five intervention sites in October 2018. We report findings on intervention implementation based on process tracking and qualitative data. Qualitative data from 25 post-intervention interviews and 89 process tracking documents were coded and thematically analyzed.Results: Over the 13-month intervention, research team representatives met with site managers monthly to provide consultation and technical assistance on safety and ergonomics, work intensity, and job enrichment. Approximately two-thirds of the planned in-person or phone contacts occurred. We tailored the intervention to each site as we learned more about context, work demands, and relationships. The research team additionally met regularly with senior leadership and district managers, who provided corporate resources and guidance. By assessing the context of the food service setting in which the intervention was situated, we explored factors hindering and facilitating the implementation of the intervention. The financial pressures, competing priorities and the fast-paced work environment placed constraints on site managers’ availability and limited the full implementation of the intervention.Conclusions: Despite strong support from corporate senior leadership, we encountered barriers in the implementation of the planned intervention at the worksite and district levels. These included financial demands that drove work intensity; turnover of site and district managers disrupting continuity in the implementation of the intervention; and staffing constraints that further increased the work load and pace. Findings underscore the need for ongoing buy-in and support from both the parent employer and the host client.Trial registration: This study was retrospectively registered with the Clinical Trials.Gov Protocol and Results System on June 2, 2021 with assigned registration number NCT04913168.

Using Total Worker Health® Implementation Guidelines to Design an Organizational Intervention for Low-Wage Food Service Workers: The Workplace Organizational Health Study

“…Second, the Implementation Guidelines-organized into four stages of an integrated approach-provided a process to plan the intervention using strategies to change working conditions. The planning process culminated in a 13-month intervention implemented at both leadership and site levels to change our three working conditions (safety and ergonomics, work intensity, and job enrichment), as described in detail elsewhere [26].…”

“…We designed the intervention for sites to assess working conditions, develop action plans, and implement changes for three working conditions over the course of 13 months. However, another recent study reported that it may take worksites approximately nine months to form an integrated team and craft a TWH action plan with on-going technical assistance [63], suggesting we may have been too ambitious in our intervention timeline [26]. We also realize the intervention development process, design, and choice of key characteristics may look different for organizations that are creating an intervention for one site verses tailoring the intervention for multiple sites.…”

“…(2) participation; (3) policies, programs, and practices focused on positive working conditions; (4) comprehensive and collaborative strategies; (5) adherence; and (6) data-driven change [1,9]. We recently applied the Implementation Guidelines to develop and test an integrated, organizational intervention to improve worker safety, health, and well-being in a high-risk sector (low-wage food service) [21], a particularly challenging undertaking due to the hierarchical organizational structure and economic and social vulnerability of frontline staff in this setting [22][23][24][25][26].…”

“…We also anticipated making data-driven modifications to the overall intervention as needed. To achieve this, we created a tracking system of the intervention process and to what degree the intervention was actually implemented [26] to help us develop a deeper understanding of intervention implementation at both the site and leadership levels. This system included observations and reflections from the research staff members who served as the primary contacts for the intervention at the five sites.…”

“…Figure 2. Organizational intervention for improving safety, health, and well-being of low-wage food service workers[26].…”