Key points
The "Hierarchy of Controls Applied to NIOSH Total Worker Health®" (TWH) is a conceptual model. This model helps prioritize efforts to advance the well-being of all workers. Use this model as a guide for creating or expanding cultures of well-being within an organization.
About the hierarchy
The TWH approach promotes a hazard-free work environment for all workers. The hierarchy can aid employers in designing work that protects and promotes worker well-being starting at the organizational and environmental levels.
This model complements the traditional Hierarchy of Controls used in occupational safety and health. This version expands on the existing one to include strategies that advance worker well-being. Controls and strategies are presented in order of expected effectiveness, from top to bottom.
Intervention goals
Eliminating or reducing recognized hazards in the workplace is the most effective means of prevention. Workplace programs using a TWH approach should emphasize elimination or control of hazards as the primary goal.
Some hazards, like shift work, are difficult or impossible to eliminate from the work environment. These must be managed through engineering, administrative, or, as the very last resort, individual-level interventions. Programs aligned with the TWH approach should address environmental determinants of health rather than focusing on individual-level ones.
Elements
The hierarchy emphasizes organizational-level interventions to protect workers' safety, health, and well-being. Follow these steps to apply this model:
Eliminate
First, eliminate workplace conditions that cause or contribute to worker illness and injury, or otherwise negatively impact well-being. Examples include policies that remove root causes of stress and provide workers with increased flexibility and control over their schedules.
Substitute
Second, replace unsafe, unhealthy working conditions or practices with safer, health-enhancing policies, programs, and management practices. These should improve the culture of safety and health in the workplace. For example, encourage reports of unsafe work practices without fear of reprisal and replace workplace food options with healthier options.
Redesign
Third, redesign the work environment, as needed, for improved safety, health, and well-being. For example, enhance access to employer-sponsored benefits and improve shift work scheduling.
Educate
Fourth, provide safety and health education and resources to enhance individual knowledge for all workers. Examples include safe patient handling training and professional development training.
Encourage
Fifth, encourage personal behavior change to improve safety, health, and well-being. For example, support workers in making healthier choices with email and text message prompts and incentive programs.
Implementation tips
Examples of the hierarchy in action
A program to reduce musculoskeletal disorders could:
1. Eliminate workplace equipment that forces workers into damaging or unsafe positions to complete the task.
2. Reorganize or redesign work to minimize repetitive movement and awkward postures.
3. Provide ergonomic consultations to workers to improve job and workstation design. Offer ergonomic training and opportunities for workers to participate in design efforts.
4. Evaluate the age profile and health needs of the workforce. Provide education on self-management strategies, such as preventive exercise to avoid arthritis or other musculoskeletal conditions.
A program to reduce work-related stress might:
1. Implement organizational and management policies that eliminate root causes of stress. These include excess demands or workplace bullying. Instead, provide workers with increased flexibility and control over their work and schedules.
2. Provide training for supervisors on successful approaches and strategies to reduce stressful working conditions.
3. Provide training and interventions to build resiliency for stress management and reduction for all workers.
4. Provide access to Employee Assistance Programs.
Resources
No matter where you are in your journey, there are resources that can help:
- Find tools to support planning, assessment, and evaluation efforts
- Learn about the economic rationale for the TWH approach
- Assess worker well-being in your workplace
- Use this workbook to identify next steps and measure progress