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January 4, 2019

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Health Culture Assessment Tools

Practitioner’s guide – an evaluation of health culture assessment tools

David Day, Head of SHE at nuclear specialist Nuvia UK, offers his views on the strengths and limitations of each health culture assessment tool.

In a recent article, I offered readers information on what health culture assessments tools (HCATs) are out there.

As a next step, I thought it might be useful to share the findings of an evaluation of each HCAT that I conducted recently. What follows is my view of each (obviously, this is just my opinion; I will leave it up to the reader to make their own judgement!).

The Questionnaire for Self-assessment (QSA)

Strengths

checklistThe QSA offers a systematic and user-friendly method of assessing health culture. The questions are logical, succinct, and easy to understand. Designed as a benchmarking tool, the QSA provides a percentage success score and individual section score of the organisation’s workplace health percentage for each of the six criteria. Furthermore, an organisation can use the success scores to identify strengths and weaknesses in health culture.

The QSA has solid theoretical underpinning and credibility, as it is based on the ‘Excellence Model’ from the European Foundation for Quality Management which has been used all over the world to continually improve organisational performance. Finally, the output gives an organisation an understanding of their workplace health promotion culture maturity and aspects which require attention, thus informing any health culture improvement strategy.

Limitations

The intended users of the QSA are health and safety professionals, human resources specialists, and workplace health promotion working groups. It is not designed for frontline employees, which results in the overall success ratings being based on the views of the management only.

According to its developer, numerous assumptions have been made about organisations completing the tool. These include senior management’s commitment to health, compliance with health and safety legislation, and positive two-way communication. This suggests that the QSA is designed for organisations with a mature health culture, thus leaving it to be of limited use to less mature organisational health cultures.

The Organizational Health Audit (OHA)

Strengths

The tool is user-friendly and simple to complete. The category headings are in depth covering corporate culture, policies, procedures and work processes, programmes and services, and the physical environment. Moreover, both tangible and intangible aspects of health culture are investigated by the OHA. For example, an entire section assesses the work processes supporting a healthy workplace (tangible aspect) and an entire section assesses the organisation’s cultural support for health (intangible aspect).

Indeed, the corporate culture section is very detailed, covering a range of subjects from the organisation’s corporate mission, to management support for health and wellbeing initiatives. The tool is designed to be incorporated with other human resources and is health-related, which means an organisation could easily integrate the findings into a health strategy.

Limitations

The OHA is designed to be completed by a workplace health steering committee; it does not attempt to explore the perceptions of employees. Furthermore, given the wide-ranging scope of the tool, it may not be suitable for smaller organisations. For example, the section covering the physical environment assesses factors such as shower facilities, outdoor recreation, and cafeterias; smaller organisations may not have the resources available.

The producers of the OHA give the following warning, ‘Reliability and validity tests have not been conducted on this assessment. It is merely suggested as a guide to build interest and awareness’, which means that organisations should use it with a degree of caution.

The OHA is a simple checklist that supplies an organisation with a graded score, it does not offer an understanding of an organisation’s health culture maturity. To gain this insight the OHA needs to be integrated with other health-related and human resource data.

The Occupational Health Maturity Matrix (OHMM)

Strengths

Work by Tyers and Hicks (2012) reported the OHMM to be user-friendly. In this study, it was well received by the contractors, who stated that the tool had facilitated visible changes in their organisation’s management and the use the tool has left a legacy and will be used by construction companies in the future. Both tangible and intangible aspects are assessed by the tool, e.g. risk control measures (tangible) and senior management commitment (intangible).

Limitations

The OHMM scope is fairly limited and does not explore more tangible health culture aspects, such as incident investigation, workforce involvement, and communication of health issues. The OHMM is designed to be completed by Occupational Hygienists, not employees, which means that the final maturity level is based on the view of a single person, and therefore, not including employees.

The Health Risk Management Maturity Index (HeRMMIN)

Strengths

The HeRMMIN is designed to be completed every 12 months, which allows an organisation to plan improvements to progress. Respondents are offered a user-friendly, visual representation of their health culture maturity on a five-level cultural ladder. Furthermore, the HRMMI has been reliably tested and is reported to have good internal consistency. Currently, although the index is in its infancy, it is used by the Health and Safety Executive to collect benchmarking data of construction companies’ health culture maturity.

Limitations

The HeRMMIN is limited to senior management and leaves the perceptions of frontline employees unexplored. Consequently, the organisation is only informed of the senior management’s perception of health culture and not the whole organisation. Additionally, the tool takes quite a while to complete as it requires detailed information about health statistics and headcount.

Health Enhancement Research Organization Scorecard (The Scorecard)

Strengths

The Scorecard investigates a wide range of health culture aspects covering planning to implementation; it covers in excess of 64 health and wellbeing-related questions, for example, including personal health and the physical working environment. The tool collects employer-specific data on health management programmes, which is then used to identify best practices. Once completed, a benchmark report is received, which provides assessment against their peer groups. This makes it a useful resource for fairly mature organisational health cultures Furthermore, the number of users is increasing yearly; it has been used extensively in the USA by more than 500 organisations.

Limitations

The Scorecard may not be suited for organisations with nascent health cultures. The questions require a large amount of health-related data, suggesting that is more suited for organisations with a high level of management support. An extensive level of health data, which would only be available to the health professionals or the senior management but not the frontline employees. Organisations with lower levels of health culture maturity may not have the data required to complete the Scorecard. When completing the Scorecard, respondents might be willing to over-report the positive elements of their health culture, thus biasing their results. Finally, it is mainly used as a benchmarking tool and does not give an insight into an organisation’s level of health culture maturity.

So, what does this tell us?

On balance, my view is that due to its simplicity, breadth and potential for integration into business planning, the OHA offers a great way to assess an organisation’s health culture.

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John Kersey
John Kersey

interesting review – how about one for the safety equivalents?

Mike
Mike

It is good to see this sort of evaluation, but the HSE in the UK has for many years offered several alternatives to the approaches described. The most sophisticated in my view is sold via their Laboratory – “Safety Climate Tool – see; https://www.hsl.gov.uk/products/safety-climate-tool, but see also their work on safety opinion surveys. Loughborough University and IOSHH also offer tools. The critical point is that although safety culture/climate is a fundamental driver of safety performance no company should embark on this sort of assessment unless they are prepared to respond properly and honestly to the results.