HWPP Case Study: Safety Consultants Facilitate Burnout Solutions (pdf)
Population: Behavioral Health Workers
Problem: Assault-related Injuries, Turnover


The Healthy Workplace Participatory Program (HWPP) is a toolkit to help employers implement a participatory Total Worker Health® program. The HWPP facilitate meaningful involvement of front-line workers in identifying root causes and solutions to workplace health, safety, and wellbeing concerns. This case study describes how safety consultants at SAIF Corporation, a workers compensation firm, used the HWPP approach with a client organization to address an intractable problem of assault-related injuries.

Problem and Setting: Workplace Assaults and High Turnover

A residential youth behavioral healthcare organization was struggling with high turnover among the caregiving staff. Caregivers experienced client-on-worker assaults and burnout, which caused them to leave the job. Despite prior attempts to address these problems, turnover remained high. Organizational leaders recognized the need to try a new approach and they embraced their safety consultant’s suggestion to implement a participatory Total Worker Health approach, using the HWPP process. The consultant, trained by CPH-NEW to implement the HWPP, was qualified and ready.

"We could attract people, but we couldn’t keep them. Too many people were getting injured and burned out. We weren’t able to get in front of the problem and had to try something different.” - V.P. of Operations and Training and Safety Director

Forming a Design Team: A key tool for front-line engagement

To ensure front-line worker involvement in the problem-solving process, the consultant guided the organization to form a Steering Committee and Design Team. The Steering Committee role was assigned to an existing executive safety oversight leadership team. A new Design Team was formed with frontline workers from the most challenging treatment service unit. Two safety consultants served as facilitators. The Design Team meetings were held virtually due to COVID-19 distancing rules.

“The HWPP approach fit with our caregiving philosophy, the sanctuary model, which values democracy and engaging people. Using the HWPP tool allowed people to engage in those values and to be heard in a different way.” - Director of Environment of Care

Root Cause Analysis

Design Team members identified workplace assaults as their general health and safety concern. The root cause analysis process revealed several contributing factors for intervention. Staffing shortages and stressful work climate left staff feeling unsupported. The physical and emotional job demands were also a struggle. Thus, their objective was to improve staff’s sense of support and safety.

Building Solutions

The Design Team used the IDEAS Tool, a 7-step process to develop intervention activities. Proposed solutions included: increasing sense of safety and support, staffing levels, opportunities for professional development, staff benefits and compensation, staff recognition, and staff trauma support and training. The Design Team organized three intervention package options and presented these to the Steering Committee for consideration.

“I like how it structured a complex problem. When you consider the complexity of workplace health and safety concerns due to the population we serve, there's a lot of layers to unpack. The structure of the IDEAS process does a nice job in organizing that complexity in a way that we could deal with it. One step at a time, one thought at a time, one objective at a time, and explore each of those things instead just tossing out a ton of ideas without a lot of clear organization.” - Training and Safety Director

Basic Package

Intervention activities:

  • Increase staff on standby
  • Increase staff benefits
  • Schedule breaks
  • Review compensation scale
  • Employee recognition plan
  • Promote EAP use
  • Review training

Comprehensive Package

Intervention activities:

  • Basic package, plus:
  • Increase float staff
  • Mentorship program
  • Compassion fatigue management
  • Establish career ladder
  • Review performance evaluations
  • Improve onboarding

Hybrid Package

Intervention activities:

  • Basic package, plus:
  • Define minimum staffing per shift and unit
  • Compassion fatigue management
  • Career ladder
  • Improve follow through

Program Impact

Steering Committee members were pleased with the twocommittee structure and stepwise process. The program empowered Design Team members by including them in the decision-making process to build comprehensive solutions to promote worker well-being. Based on the Design Team input, the company decided to update the staff retention element of their strategic plan.

"The HWPP gave us a way to engage new people in the process and give them a voice and an avenue to be heard.” - Director of Environment of Care

Intervention activities approved to date:

  • Wage increases for staff below the director level
  • Strengthened staff benefits package
  • New recruitment manager position
  • Supervisor development program
  • Professional development for all staff

Recommendations for Consultants

  • Dedicate significant time in between-meeting activities for meeting preparation and follow up. In this case study, most of the consultants’ time was directed at activities between meetings. Preparation time should lessen as consultants develop HWPP expertise.
  • Assess the organizational readiness of the client before implementing the participatory Total Worker Health program. Use the CPH-NEW readiness survey to identify areas that need to be strengthened for successful program implementation.
  • Emphasize the role of leaders for assigning personnel time and supporting implementation of proposed solutions. Managers need to authorize time during the work schedule for workers to participate in Design Team activities.
  • Set clear ground rules for the communication between participants and teams. Advise management not to take workers’ comments and suggestions personally.
  • Hold a kick-off meeting with Design Team and Steering Committee members to present an overview of the program roles and the IDEAS process. Do this before implementation to set expectations. Provide “just in time” in-depth training for each IDEAS step as you move through the process.

Recommendations for Organizations

  • Allocate work time for Design Team meetings, which offer a safe space for workers to openly discuss problems and brainstorm solutions.
  • Plan time for joint meetings between the Design Team and the Steering Committee. Joint discussions keep participants informed on the program progress and promote a shared understanding of root causes to problems. Managers need to be careful to use language that encourages, not discourages, worker input.
  • Identify a person responsible for meeting scheduling. The scheduler should coordinate meetings based on Design Team members’ time availability.
  • If meetings are scheduled virtually, consider using an online whiteboard to document participants opinions. Web whiteboard is free and does not require registration. We recommend having more than one co-facilitator for virtual meetings.
  • Be prepared to dedicate at least 6 months implementing the IDEAS process through the development of interventions and their presentation to management. Time is needed to build facilitation skills and positive group dynamics conducive to teamwork. The team needs flexibility to research and consider alternative solutions.
  • Visit the Total Worker Health for Employers page to learn more CPH-NEW resources.

Acknowledgements: We would like to thank Liz Hill, MPH, CIH, CSP, Total Worker Health Advisor and Angie Wisher, Senior Safety Consultant, at SAIF Corporation.

Total Worker Health® is a registered trademark of the U.S. Department of Health and Human Services (HHS). Participation by the Center for the Promotion of Health in the New England Workplace (CPH-NEW) does not imply endorsement by HHS, the Centers for Disease Control and Prevention, or the National Institute for Occupational Safety and Health (NIOSH). CPH-NEW was supported by Grant Number 1 U19 OH012299 from the NIOSH.