The Path to a Healthy Workplace

A Critical Review Linking Healthy Workplace

Practices, Employee Well-being, and
Organizational Improvements
Matthew J. Grawitch, Melanie Gottschalk, St. Louis University
and David C. Munz

This review synthesizes much of the previous health of the employees (Jaffe, 1995). The
research since 1990 linking healthy workplace dual focus associated with the definition of
practices in organizations to employee well-be- a healthy workplace represents a shift in
ing and organizational improvements. Based on the conceptualization of what constitutes
the review, both a direct and an indirect link
health within an organization.
between healthy workplace practices and orga-
nizational improvements are proposed. Five
The notion of a healthy workplace has
general categories of healthy workplace prac- evolved throughout the past 60 years.
tices were identified in the literature: work-life Robin (2003) noted that originally the
balance, employee growth and development, health of an organization was evaluated in
health and safety, recognition, and employee terms of the bottom line. The goal of many
involvement. Previous research also suggests organizations was to avoid being unhealthy
that the link between these practices and em- as opposed to optimizing health. Beginning
ployee and organizational outcomes is contin- in the 1940s, organizations began hosting
gent on the effectiveness of communication outings and picnics for their employees. In
within the organization and the alignment of the 1970s and 1980s, companies provided
workplace practices with the organizational
fitness programs for workers. Now, em-
context. Finally, a discussion of some limita-
tions of previous research and recommenda-
ployees in companies worldwide are inun-
tions for future work in the area of healthy dated with a multitude of organizational
workplace practices are provided. programs designed to maximize employee
health and the health of organizations. Ap-
Keywords: healthy workplace, organizational proximately 90% of organizations with 50
performance, employee involvement or more employees provide some type of
program designed to promote health (Al-
Pets, yoga, music, awards, and stress dana, 2001). The rising interest and invest-
management at first glance may appear to ment in workplace health promotion paral-
be unrelated topics. However, today many lels the significant role of work in the ma-
organizations are integrating such seem- jority of individuals’ lives. Average adults
ingly unrelated and novel practices and pol- spend at least a quarter to a third of their
icies in an attempt to cultivate organiza-
tional health. A healthy workplace, as de-
Matthew J. Grawitch, Melanie Gottschalk,
fined by Sauter, Lim, and Murphy (1996),
and David C. Munz, Department of Psychology,
is any organization that “maximizes the St. Louis University.
integration of worker goals for well-being Correspondence concerning this article
and company objectives for profitability should be addressed to Matthew J. Grawitch,
and productivity” (p. 250). The two critical Department of Psychology, St. Louis Univer-
components embedded in this definition are sity, 3511 Laclede Avenue, St. Louis, MO
the performance of the organization and the 63103-2010. E-mail: grawitch@slu.edu

Copyright 2006 by the American Psychological Association and the Society of Consulting Psychology, 1065-9293/06/$12.00
DOI: 10.1037/1065-9293.58.3.129
129
Consulting Psychology Journal: Practice and Research, Vol. 58, No. 3, 129 –147
waking life at work (Harter, Schmidt, & teria and to recommend additional criteria,
Keyes, 2003). In addition, job satisfaction if necessary, in order to develop a compre-
is estimated to account for a fifth to a hensive framework within which to evalu-
quarter of life satisfaction in adults (Harter ate healthy workplace practices by organi-
et al., 2003). In light of these percentages, it zations. To that end, previous theory and
is understandable that so many organiza- research from the past 15 years was used to
tions spend a significant amount of time validate the need for understanding how
and energy developing, implementing, and workplace practices can affect employees
monitoring health promotion programs. and organizations. Specific categories of
Beyond the extensive amount of time workplace practices were identified and
that individuals spend at work, there are linked to employee well-being and organi-
several other mitigating factors behind the zational improvement outcomes. By estab-
application of innovative organizational lishing an empirical link between work-
practices. Past research and site investiga- place practices, employee well-being, and
tions have uncovered enormous financial organizational improvements psychology
and human costs associated with unhealthy can demonstrate its relevance to the devel-
organizations (Cooper, 1994). Human re- opment of healthy organizations.
source professionals have begun to position
healthy workplace programs and activities Literature Review Method
as a source of competitive advantage to Over the past 15 years, theory and re-
curtail increasing health care costs; assist in search focusing on psychological health in
the attraction, acquisition, and retention of the workplace has offered new and innova-
employees; better manage the employer- tive ways of both conceptualizing and mea-
employee relationship; meet the needs of suring the influence of healthy workplace
an increasingly diverse workforce, and initiatives. Therefore, this article focuses
boost employee morale (Fulmer, Gerhar, & on literature dating back primarily to 1990,
Scott, 2003; Jaffe, 1995; Pfeffer, 1994). since it offers the most developed body of
Given the multiple forces that drive or- information within which to understand the
ganizations to focus on organizational concept of psychological health in the
health, it is vital to identify the types of workplace. A variety of disciplines, such as
practices that are employed by healthy psychology, sociology, medicine, public
workplaces and how these various pro- health, management, and economics, have
grams and policies contribute to better em- contributed to the understanding of healthy
ployee and organizational health. The pur- workplace practices. In order to reflect this
pose of this article is to detail the various extensive coverage, specialized databases
forms of health initiatives undertaken by for health and medicine, psychology, busi-
organizations and their influence on em- ness, and multidisciplinary collections
ployee well-being and organizational im- were examined. The resulting journal arti-
provements. This article builds on recent cles and books obtained through this search
work conducted by the American Psycho- reflected the diverse background of spe-
logical Association (APA) Practice Direc- cialty areas that have investigated the topic
torate on its Psychologically Healthy of healthy workplaces. The literature was
Workplace Award. The award recognizes divided into the following four categories:
organizations that make a commitment to (1) the definition of key healthy workplace
programs and policies that enhance the practices; (2) the establishment of the rela-
health and well-being of their employees. tionship between employee well-being and
The purpose of this initiative was to vali- organizational improvements; (3) the rela-
date previously established APA award cri- tionship between healthy workplace prac-

130 Consulting Psychology Journal: Practice and Research

Summer 2006
tices and organizational improvements; and Adkins, Quick, and Moe (2000) ex-
(4) the connection among healthy work- panded the definition of a healthy work-
place practices, employee well-being, and place by describing the four guiding prin-
organizational improvements. A review of ciples of organizational health. The first
the primary articles was also conducted to principle proposes that health exists on a
identify additional sources of information continuum from mortality to vibrant well-
on organizational health initiatives. These being. The purpose of organizational health
four bodies of literature were used in the is not merely to avoid ultimate destruction,
development of the Practices for the Achieve- but rather it is a quest to move toward
ment of Total Health (PATH) model. abundant life. Organizations should focus
on promoting positive health outcomes in-
Organizational Health: An Overview stead of acting only to prevent the negative
outcomes of poor health. The second prin-
Revisiting the definition of a healthy
ciple states that organizational health is a
workplace serves as a useful starting point
continuous process, not an obtainable state.
to integrate the principles and themes iden-
Vigilance on the part of the organization is
tified in the literature. The definition of a
required to constantly maintain good
healthy workplace provided by Sauter et al.
health, even if and when optimal health is
(1996) is any organization that “maximizes
the integration of worker goals for well- achieved. Constant attention, evaluation,
being and company objectives for profit- and action are needed to maintain a healthy
ability and productivity” (p. 250). This def- workplace. The third principle addresses
inition suggests that when an organization the systemic nature of health, arguing that
embarks on its mission to become a healthy organizational health is the result of inter-
workplace, the organization and the indi- connections between multiple factors. An
viduals within it must be considered. The organization can only be healthy if all of its
need for dual consideration of the individ- parts are free from disease. The organiza-
ual as well as the organization is epito- tion must engage in risk assessment, based
mized by Browne’s (2000) argument that on its perceived threats and vulnerabilities.
human resource practices “are only pro- Moreover, damaging factors within the or-
gressive if the concern for organizational- ganization must be minimized in order to
level outcomes is matched by a concern for reach optimal systemic health. The final
the well-being of employees who are di- guiding principle of organizational health is
rectly affected by these practices” (p. 55). its reliance on fulfilling relationships. Ac-
There are two assumptions underlying tion within an organization is achieved
the definition of a healthy workplace through constant communication, collabo-
(Schmidt, Welch, & Wilson, 2000). First, it ration, and relationship building.
assumes that it is possible to identify the In addition to the guiding principles of
key characteristics of a healthy workplace organizational health, the multidiscipli-
based on a set of job and organizational nary literature reflects numerous common
factors. The second assumption is that the themes with respect to a healthy workplace.
establishment of a healthy workplace leads DeJoy and Wilson (2003), Jaffe (1995),
to a healthier and more productive work- Schmidt et al. (2000), and Williams (1994)
force, which translates into increased pro- all suggest that organizational health can
ductivity and a competitive advantage for the only be obtained by focusing on the orga-
organization. These two assumptions have nization as a system. Additionally, they all
guided researchers and practitioners alike to suggest that any successful attempt to pro-
apply and evaluate the practices advocated mote health within the organization must
under the healthy workplace paradigm. be accomplished at the organizational level,

Consulting Psychology Journal: Practice and Research 131

Summer 2006
rather than the department or group level. awareness, change behavior, and create en-
Finally, they all propose that healthy work- vironments that support good health prac-
place programs and policies must be tailored tices” (p. 297). According to the PATH
to meet the individual needs of employees. model, there are five categories of organi-
The issues and recommendations made zational practices, under which the vast ar-
by previous theory and research suggest ray of health programs and policies that
that an understanding of health in the work- organizations use to achieve maximal em-
place requires recognizing that it is an on- ployee well-being and organizational effec-
going process. The results of this process tiveness can be classified. The categories
arise from the continuous transactions that were developed using the criteria of family
occur between individuals and the work support, employee growth and develop-
environment. For example, to meet the ment, health and safety, and employee in-
health needs of employees, the employer volvement that are used by APA as part of
must (1) provide a way for employees to the Psychologically Healthy Workplace
make their needs known to the employer, Award program and are viewed as indica-
and (2) address those needs in a manner tors of healthy workplace practices. We
consistent with the organizational context. then reviewed much of the previous litera-
Therefore, developing a comprehensive ture to refine and expand on those catego-
framework for understanding the role of ries. Based on this process we identified
employee health and well-being in the five specific categories: (1) work-life bal-
workplace requires understanding the ways ance, (2) employee growth and develop-
in which health is affected through organi- ment, (3) health and safety, (4) recognition,
zational practices and the ways in which and (5) employee involvement.
employee health contributes to organiza- Work-life balance programs help indi-
tional success. viduals to balance the multiple demands of
their lives (Jamison & O’Mara, 1991).
The PATH Model: Practices for the Such practices and policies recognize that
Achievement of Total Health workers must have responsibilities and
lives outside of work. Although often con-
Figure 1 provides a framework for ex-
sidered primarily in the context of family
ploring healthy workplace practices in re-
support with an emphasis specifically on
lation to employee well-being and organi-
elder or child care, a narrow focus on the
zational improvements. The PATH model
family excludes those employees that do
reflects a synthesis of the previous research
on workplace health, integrating a variety not have demands related to elder or child
of different research disciplines and do- care. Instead, employees may have other
mains. Furthermore, the PATH model is responsibilities in their personal lives that
consistent with other conceptualizations of require flexibility. Therefore, redefining the
workplace practices (e.g., DeJoy & South- exclusive category of family support pro-
ern, 1993; Pfeffer, 1994), but the PATH grams into a more inclusive category of
model offers a more comprehensive ap- work-life balance programs provides all
proach to understanding the link between employees with the flexibility required to
organizational practices, employee well- meet the demands of their work and personal
being, and organizational improvements. lives. Examples of work-life balance pro-
grams include flexible scheduling, childcare,
Healthy Workplace Practices eldercare, and provision of job security.
Employee growth and development pro-
Aldana (2001) defined health promotion grams provide employees with the oppor-
programs as all “efforts that enhance tunity to expand their knowledge, skills,

132 Consulting Psychology Journal: Practice and Research

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 Employee Well-Being
Physical Health
Mental Health
Stress
Motivation
Commitment
Job Satisfaction
Morale
Climate

Healthy Workplace Practices

Work-Life Balance
Employee Growth &
Development
Health & Safety
Recognition
Employee Involvement

Organizational Improvements
Competitive Advantage
Performance/Productivity
Absenteeism
Turnover
Accident/Injury Rates
Cost Savings
Hiring Selectivity
Product/Service Quality
Customer Service/Satisfaction

Figure 1. The PATH model.

and abilities, and to apply the competencies Health and safety programs seek to
they have gained to new situations (e.g., maximize the physical and mental health of
Jamison & O’Mara, 1991; Pfeffer, 1998). employees through the prevention, assess-
Employee growth and development pro- ment, and treatment of potential health
grams allow an organization to capitalize risks and problems (Aldana, 2001). Em-
on the potential of all employees by helping ployee assistance programs for alcohol and
to develop leadership, problem-solving, drug addiction, wellness screenings, stress
and other skills that may make them more management training, counseling, and
committed to the organization and may in- safety training are all examples of potential
crease their likelihood of internal career ad- programs that organizations may imple-
vancement. Examples of employee growth ment to increase the health and safety of
and development programs include addi- their employees.
tional on-the-job training, leadership devel- Recognition programs allow employees
opment, continuing education classes, and to be rewarded for their contributions to the
provision of internal career opportunities. organization, as well as for their achieve-

Consulting Psychology Journal: Practice and Research 133

Summer 2006
ment of professional and personal mile- various constructs to determine their rel-
stones (e.g., Browne, 2000; Pfeffer, ative importance.
1998). Although usually conceptualized
as monetary rewards, such as bonuses or Organizational Improvements
raises, recognition programs can also in-
clude other types of rewards, including By integrating healthy workplace prac-
honorary ceremonies, plaques, and per- tices, employee well-being, and organiza-
sonal acknowledgment in official organi- tional improvements into a unified model,
zational communications, such as weekly the PATH model proposes specific organi-
newsletters. zational improvement outcomes that result
Finally, employee involvement pro- from healthy organizations. There are sev-
grams get employees involved in decision- eral ways that organizational practices and
making (e.g., Jaffe, 1995; Karasek & Theo- employee well-being can improve the or-
rell, 1990; Lawler, 1991). Perhaps the most ganization, including increases in competi-
popular of all healthy workplace practices, tive advantage, performance, productivity,
the goal of employee involvement is to hiring selectivity, and customer satisfac-
allow employees to bring a diverse set of tion, and decreases in absenteeism, turn-
ideas and perspectives to bear on solving over, injury/accident rates, and health care
organizational problems and finding ways costs (e.g., Anderson, Serxner, & Gold,
to increase organizational effectiveness. 2001; Browne, 2000; DeJoy & Wilson,
Greater employee participation in decision- 2003; Huselid, 1995).
making, empowerment, self-managed work
teams, and job autonomy represent organi-
Relationship Between Employee
zational practices designed to maximize Well-being and Organizational
employee involvement. Improvements
Previous research examining the rela-
Employee Well-being tionship between employee well-being and
organizational improvements is rich and
Employee well-being represents the extensive. Research implications drawn
physical, mental, and emotional facets of from the examination of this link have
employee health, synergistically acting to taken on new directions since the advent of
affect individuals in a complex manner the hypothesized relationship among em-
(DeJoy & Wilson, 2003). There is no gen- ployee well-being, organizational improve-
eral agreement on the best indicators of ments, and healthy workplace practices. As
employee well-being, and many types of such, it is essential to understand the rela-
employee well-being have consequences tionship between employee and organiza-
for the organization. Specifically, theory tional outcomes before applying these con-
and research has focused on constructs cepts to the study of healthy workplace
such as general physical health, general practices. Although numerous research
mental health, job satisfaction, employee studies have been conducted examining
morale, stress, motivation, organizational one or specific aspects of well-being and
commitment, and climate (e.g., Goetzel, one or more specific aspects of organiza-
2003; Jones, Flynn, & Kelloway, 1995; tional improvements, the following discus-
Yeung & Berman, 1997). In general, re- sion will highlight a few of the more mean-
search has suggested that the various con- ingful relationships. For the sake of brevity,
ceptualizations may all be important in all possible combinations of employee
understanding the well-being of employ- well-being and organizational outcome re-
ees, but no research has compared the lationships are not specifically examined.

134 Consulting Psychology Journal: Practice and Research

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 Much of the previous research on em- factors, such as the mental, physical, and
ployee well-being and organizational im- emotional health of individuals, when eval-
provements has focused on job satisfaction. uating organizational outcomes, such as
Recent studies, such as the meta-analysis health care costs and absenteeism.
conducted by Judge, Bono, Thoreson, and Research findings, such as the ones pre-
Patton (2001), report a moderate positive sented above, clearly demonstrate that it is
relationship between job satisfaction and advantageous for organizations to consider
individual job performance. However, employee well-being in addition to organi-
within the happy worker-productive worker zational improvements, given the relation-
line of research, there are a number of ship that exists between them. These stud-
discrepancies apparent in the findings. One ies lay the groundwork for examination of
review by Spector (1997) indicated that healthy workplace practices in relation to
employee satisfaction determined a variety both individual and organizational out-
of performance indicators, such as punctu- comes. The reinforcing link between em-
ality and lower absenteeism. Moving be- ployee well-being and organizational im-
yond the link between job satisfaction and provements serves to strengthen the posi-
performance, past research has also dem- tive impact of innovative organizational
onstrated that job satisfaction is related to practices.
organizational commitment (e.g., Vanden-
berg & Lance, 1992). In turn, organiza-
Three-factor Pathway
tional commitment has been associated
with lower turnover and higher perfor- The PATH model suggests two paths
mance (e.g., Mathieu & Zajac, 1990). that lead to organizational improvements.
Although job satisfaction has been the The first is a direct pathway from work-
dominant indicator of employee well-be- place practices to organizational improve-
ing, other combinations of employee well- ments. In addition to this direct pathway,
being and organizational improvement there exists an indirect path from work-
measures have been considered. A meta- place practices to organizational improve-
analysis conducted by Griffeth, Hom, and ments, through employee well-being. The
Gaertner (2000) provided evidence that job model reflects the concept of a healthy
satisfaction, organizational commitment, workplace, building on the premise that
and role stress are significantly predictive organizations that foster employee health
of turnover. Additionally, a recent literature and well-being are also profitable and com-
review by Aldana (2001) provided an ex- petitive in the marketplace. The indirect
tensive summary of previous research sup- path to organizational improvements recog-
porting the relationship between employee nizes that organizational practices can have
stress, employee health, and organizational a significant effect on employee commit-
health care. He cited a variety of individual ment, satisfaction and health, which in turn,
factors, such as heart disease, smoking, and affect productivity and the effectiveness of
obesity as correlates of high health care the organization (Schmidt, Welch, & Wil-
costs that are absorbed by organizations. son, 2000; Williams, 1994). Williams
The relationship between individual health (1994) suggested that the creation of a
factors and organizational health was also healthy workplace is an active process,
supported by Cooper (1994), who sug- which results in health for the individual
gested that approximately half of all ab- employee and the overall organization. Em-
sences are related to unhealthy work envi- ployee well-being is not a by-product of
ronments or stress. This finding highlights health initiatives but rather it is a critical
the need to consider a variety of employee link to achieving organizational improve-

Consulting Psychology Journal: Practice and Research 135

Summer 2006
ments. This point is put into perspective by Work-Life Balance Initiatives
DeJoy and Wilson (2003) who argued that:
Higgins, Duxbury, and Irving (1992)
People perceive and react to the reality they found that conflict between work and fam-
experience as members of an organization. ily roles diminish employees’ perceptions
The subjective or perceived qualities of the of quality of both work and family life
organization are at least as important as the which, in turn, influences organizational
objective or actual qualities. This process of outcomes such as productivity, absentee-
psychological adjustment is important to un-
ism, and turnover. They suggested that or-
derstanding the effects of various job and
ganizations could possibly reduce work-
organizational factors on employee health
and productivity. The levels of perceived
family conflicts by offering alternative
stress, job satisfaction, commitment, and so work arrangements. Their research indi-
forth that reflect this adjustment process can cated that the “structure of work has a
be used to assess how people are responding strong influence on family life and suggests
to their work environment and are predictive that there should be recognition on the part
of longer-term consequences on well-being of employers that the family consequences
and productivity. (p. 338) of work environment decisions are real and
that they need to be considered” (p. 71).
The following sections discuss the influ- Subsequent research by Scandura and
ence of specific healthy workplace prac- Lankau (1997) demonstrated that the exis-
tices on employee well-being and organi- tence of work-life programs, such as the
zational improvements (see also Table 1). offering of flextime, was positively related
Each of the five types of healthy workplace to organizational commitment and job sat-
practices is considered in relation to em- isfaction. Interestingly, their results showed
ployee well-being and organizational im- no difference between employees who had
provements. However, this discussion is participated in the program and those who
not meant to be an exhaustive listing of all had not participated, suggesting that the
possible relationships, but rather it seeks to mere act of instituting such work-life bal-
generate ample support for the three-factor ance policies demonstrates the organiza-
pathway posited by the PATH model. tion’s concern for employee well-being:

Table 1
Examples of the Relationship Between Healthy Workplace Practices, Employee Well-Being, and
Organizational Improvements
Organizational Improvement
Healthy Workplace Practice Employee Well-being Outcome Outcome
Work-life balance Organizational commitment (⫹) Productivity (⫹)
Job satisfaction (⫹) Absenteeism (⫺)
Employee morale (⫹) Turnover (⫺)
Employee growth & development Job satisfaction (⫹) Organizational effectiveness (⫹)
Job stress (⫺) Competitive advantage (⫹)
Motivation (⫹) Quality (⫹)
Health & safety Job stress (⫺) Health care costs (⫺)
Physical health risks (⫺) Absenteeism (⫺)
Organizational commitment (⫹) Accident/Injury rates (⫺)
Recognition Job satisfaction (⫹) Hiring selectivity (⫹)
Motivation (⫹) Productivity (⫹)
Job stress (⫺) Turnover (⫺)
Employee involvement Job satisfaction (⫹) Productivity (⫹)
Organizational commitment (⫹) Turnover (⫺)
Employee morale (⫹) Absenteeism (⫺)

136 Consulting Psychology Journal: Practice and Research

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“Crooker and Grover (1993) noted that pro- ity, defined in terms of health care costs and
viding family benefits to employees posi- illness-related absenteeism. He concluded
tively influences their attachment to work that increased health care expenditures and
through the symbolic action of the em- illness-related absenteeism were related to
ployer providing policies that are respon- high levels of stress, excessive body weight,
sive to employees’ needs. In response to the and the existence of multiple risk factors. In
offering of flexible work hours, employees addition, lack of physical activity or fitness
may reciprocate with greater loyalty to the was related to increased health care expendi-
employer and better morale” (as cited in tures but not illness-related absenteeism.
Scandura & Lankau, 1997, p. 380). The review conducted by Aldana (2001)
also evaluated the impact of health promo-
Employee Growth and Development tion programs on organizational productiv-
ity. Across studies, health promotion pro-
Initiatives
grams were related to lower absenteeism
The opportunity to gain additional skills, and health care expenditures. The average
knowledge, and experiences can act as a cost-benefit ratio for health promotion pro-
motivator for employees, which can trans- gram savings associated with reduced
late into positive gains for an organization health care costs was 3.48, a cost savings of
(Pfeffer, 1994). In an analysis of five hu- $3.48 for every dollar spent. The average
man resource practices, Browne (2000) cost-benefit ratio reported was 5.82 for
found training and internal career opportu- health promotion program savings associ-
nities to be significant predictors of organi- ated with absenteeism related expenditures.
zational effectiveness and job satisfaction. In total, Aldana’s review supports the idea
In addition, training was predictive of job that higher health risks are associated with
stress. Overall, out of the five practices firm performance. Furthermore, the review
studied, training was the best single overall suggests that health promotion programs do
predictor of all three outcomes, specifically positively affect the effectiveness of the
organizational effectiveness, job satisfac- organization when defined in terms of
tion, and job stress. The positive benefits health care expenditures and absenteeism.
associated with employee growth and de- A review conducted by Golaszewski
velopment programs can only be realized (2001) provided additional support for the
by organizations if they provide employees conclusions drawn by Aldana (2001). Go-
a chance to apply the knowledge and skills laszewski (2001) examined 12 studies and
acquired during development (Pfeffer, supported the findings that reduction in
1994). Moreover, when employees are health care expenditures and absenteeism
given a chance to apply what they have are possible through the implementation of
gained, employee growth and development health program initiatives. The impact of
programs become a source of competitive health and safety practices extends to other
advantage that differentiates one organiza- employee and organizational outcomes, aside
tion from another (Pfeffer, 1994; Rosen & from health risk factors, health care expendi-
Berger, 1991). tures, and absenteeism. For example, research
by Jones, Flynn, and Kelloway (1995) dem-
Health and Safety Initiatives onstrated that there is a strong negative cor-
relation between employees’ perceptions of
Aldana (2001) conducted a comprehen- organizational support and stress.
sive literature review of 72 studies to in- Implementation of healthy workplace
vestigate the relationship between health initiatives, such as those designed to pro-
risk factors and organizational productiv- mote health and safety, are a form of orga-

Consulting Psychology Journal: Practice and Research 137

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nizational support. Provision of such sup- the organization, allowing for greater selec-
port is beneficial for employees, who expe- tivity when hiring new employees (Pfeffer,
rience less stress as a result. Employee 1998). In addition, higher compensation
stress may be directly targeted through may aid in the retention of current employ-
worksite stress management programs. Re- ees. Besides monetary compensation, there
search indicates that stress management are other recognition practices that can mo-
training encourages employees to engage in tivate employees, such as award ceremo-
extra role behaviors and improves em- nies, recognition plaques, and celebrations
ployee emotional well-being, defined as af- for personal and professional milestones.
fect, depression, and perceived stress. In By acknowledging effort and good work,
addition, the organization stands to benefit organizations can increase employee satis-
from stress management programs, which faction, morale, and self-esteem (Rosen &
have been shown to increase productivity Berger, 1991), which, as we have already
and decrease absenteeism (e.g., Munz, discussed, will have a positive influence on
Kohler, & Greenberg, 2001; Munz & organizational effectiveness.
Kohler, 1997). The establishment of Em-
ployee Assistance Programs, such as alco- Employee Involvement Initiatives
hol or drug abuse counseling, is another
opportunity for organizations to demon- Employee involvement has been related
strate their commitment and concern for to employee well-being variables, such as
their employees. Organizations that are job satisfaction and employee morale, as
willing to demonstrate commitment to their well as organizational improvement vari-
employees may benefit from reciprocal ables, such as decreases in turnover and
commitment by their employees (Browne, absenteeism and increases in quality (e.g.,
2000). Moreover, reduction of destructive Lawler, 1991; Vandenberg, Richardson, &
behaviors such as alcohol or drug abuse Eastman, 1999). According to Freeman and
yields positive organizational results, in- Rogers (1999), previous research suggests
cluding a reduction in employee absences that employee involvement programs yield
and accidents (McFarlin & Fals-Stewart, a 2% to 5% increase in productivity. In
2002). addition, research by Freeman and Rogers
(1999) demonstrated a significant differ-
Recognition Initiatives ence between employee involvement pro-
gram participants and nonparticipants. Pro-
Browne (2000) demonstrated that recog- gram participants reported higher levels of
nition is a significant predictor of organiza- loyalty and commitment to their organiza-
tional effectiveness, job satisfaction, and tion, increased job satisfaction, and a more
stress. A particular type of recognition, positive view of management and labor re-
namely compensation, is a critical healthy lations than did nonparticipants. Therefore,
workplace factor. It is estimated that 70% employee involvement programs, if initi-
of an organization’s total costs are labor- ated effectively, produce positive conse-
related (Pfeffer, 1998). When implement- quences for both employee well-being and
ing policies regarding compensation, orga- organizational effectiveness.
nizations must be cognizant of the level and
nature of compensation being offered. Par- The SHAPE Framework: Placing
ticulars such as the schedule of payment Healthy Workplace Practices in
and the type of performance compensation Context
must be decided by each organization. If an
organization offers an attractive benefits Drawing from the work previously con-
package, more candidates may be lured to ducted by Pfeffer (1994, 1998) and others

138 Consulting Psychology Journal: Practice and Research

Summer 2006
in the field, the SHAPE framework was posits that the effectiveness of any one or-
created to more specifically delineate the ganizational practice is dependent on the
categories of healthy workplace practices consistency between that practice and other
(see Figure 2). The SHAPE framework organizational components, such as organi-
stands for “Stimulating Health And Prac- zational structure, technology, and strategy.
tice Effectiveness” and depicts the relation- Finally, the configurational approach ar-
ship between the primary types of healthy gues that it is the total system of organiza-
workplace practices and the organizational tional practices that together determine the
context in which those practices are imple- health and effectiveness gained by the or-
mented. Healthy workplace practices do ganization. This perspective differs from
not exist in a vacuum. Although research the universalistic or contingency approach
has not fully investigated the role of the because it stresses the need for a compre-
organizational context, it is necessary to hensive evaluation of the complete package
understand how each practice is situated in of practices. In addition, this approach ar-
relation to other workplace practices and gues that ideal types of practices can take
the overall organizational context. on varying forms. As such, the same ben-
When considering the interrelationships efits gained through the implementation of
between the basic types of healthy work- one set of practices may be achieved
place practices, Delery and Doty (1996) through the adoption of a different set of
proposed that one of three approaches is practices (i.e., equifinality). Lastly, this ap-
often adopted. The best practice, or univer- proach suggests that the practices adopted
salistic, approach suggests that there are a by an organization must be consistent with
number of practices that are universally one another as well as with the character-
effective. Certain practices are viewed as istics of the organization.
more effective than others under this ap- Research supports each approach as a
proach, regardless of the setting in which way to understand the relationship between
they are applied. The contingency approach healthy workplace practices and the orga-

Figure 2. The SHAPE framework.

Consulting Psychology Journal: Practice and Research 139

Summer 2006
nization. For example, Delery and Doty ditionally, promotion from within acts as a
(1996) found a universal effect of three form of recognition program that rewards
specific practices, namely profit-sharing, successful employee performance. Lastly,
results-oriented appraisals, and employ- promotion from within demands increased
ment security, on firm performance. In ad- employee involvement by enhancing the
dition, within the same study there was trust across organizational levels. The es-
evidence to suggest that the contingency tablishment of new healthy workplace
approach was also valid. Moderate support practices or changes to existing programs
for the contingency approach was found for should prompt organizations to reconsider
employee involvement, results-oriented ap- the total package because of the interrela-
praisals, and internal career opportunities, tionships among organizational practices.
as healthy workplace practices that are con- An understanding of the interrelation-
tingent on performance. Lastly, Delery and ships between healthy workplace practices
Doty (1996) also reported moderate sup- is typically interpreted through the lens of
port for the configurational approach. Re- organizational strategy. However, Pfeffer
sults indicated that higher performance was (1994) makes the critical distinction be-
associated with those practice systems es- tween practice existence and implementa-
tablished by firms that closely resembled an tion grounded in strategy. He argued:
idealized group of practices. In other
One would want to think systematically
words, the more closely an organization about the particular skills and behaviors one
can implement healthy workplace practices needs to execute the particular strategy in a
in a manner consistent with the organiza- specific market environment and obviously
tion’s structure, strategy, and values, the adjust the implementation of these practices
more likely those practices are to be to fit those requirements. However, there is
effective. an important distinction between the contin-
Beyond the study conducted by Delery gent nature of the implementation of these
and Doty (1996), which specifically tested practices, which everyone would agree is
each of the proposed approaches, many necessary, and the idea that the practices
themselves do not provide benefit in many, if
other investigators of healthy workplace
not most situations. (p. 65)
practices acknowledge the need to adopt a
particular approach. Williams (1994) ar- Pfeffer also indicated that strategy is not
gued that “organizations need to take a the only factor on which practices are con-
holistic approach to managing the health of tingent. Other organizational factors such
their employees and be aware of the inter- as structure, location, and nature of the job
action between the various elements” (p. represent further considerations that must
9). The application and impact of various be taken into account when implementing
healthy workplace practices may be under- healthy workplace practices.
stood best in relation to other workplace In a broader sense, healthy workplace
practices. For example, the employee initiatives and their effect must be consid-
growth and development practice of pro- ered within the context in which the busi-
moting from within is related to recognition ness operates (Brache, 2001). Research by
practices and employee involvement prac- Fitz-enz (1993) provided evidence for the
tices (Pfeffer, 1994). Promotion from underlying structure of healthy workplace
within encourages organizations to offer practices. Fitz-enz investigated over 600
additional training and development be- companies to identify best practices used to
cause employee participants are more promote organizational effectiveness and
likely to use their newly acquired knowl- productivity. Based on objective perfor-
edge and skills inside the organization. Ad- mance data, the top 25% of companies

140 Consulting Psychology Journal: Practice and Research

Summer 2006
were selected. Follow-up interviews were desired outcomes for the employee and the
conducted to ensure that the organizations organization. Specifically, communication
were actively involved in practice planning serves three functions in this process. First,
and execution, and that the implemented through bottom-up communication pro-
practices yielded objective successful re- cesses directed from employees to manage-
sults. Upon reviewing the data, Fitz-enz ment, organizations can tailor specific pro-
discovered that in many cases organiza- grams to meet the needs of the employees
tions with opposing practices yielded ex- for which they are designed (Fitz-enz,
cellent results. The interpretation of this 2000). In other words, an initiative focused
finding was that there had to be a deeper on work-life balance will not be effective at
philosophical basis beyond the best prac- creating a healthier workplace if employees
tices employed that could account for the do not value nor desire a work-life balance
excellent performance results shared across initiative.
the organizations. Second, in some instance, communica-
Indeed, Fitz-enz (1993) found evidence tion processes can actually be the vehicle
of a driving set of values that supported the within which the initiative occurs (Fitz-enz,
decisions made by the organizations. Fitz- 2000). For example, the effectiveness of
enz identified eight factors over a two-year employee involvement initiatives relies
period as the foundation for best practices specifically on the effectiveness of commu-
across organizations: (1) continuous com-
nication. If employees are going to actively
munication; (2) continuous improvement
participate in decision-making, then infor-
processes; (3) awareness of the organiza-
mation must freely flow from management
tion’s culture; (4) a focus on building rela-
to the employees and from the employees
tionships inside and outside the organiza-
to management, a bidirectional flow of
tion; (5) cross-functional cooperation and
communication and feedback.
communication; (6) risk taking; (7) long-
Finally, communication can serve to in-
term commitment to a strategic direction;
crease the utilization of specific organiza-
and (8) a constant linking of the organiza-
tion’s values to specific activities. These tional programs designed to promote men-
eight factors represent the foundation on tal and physical health in the workplace
which strong and effective practices are through a top-down approach (Fitz-enz,
erected. Consistency between organiza- 2000; Parchman & Miller, 2003). Although
tional actions and values increases the like- organizations may develop and implement
lihood of practice effectiveness. It is insuf- any number of programs designed to im-
ficient for an organization to implement prove the well-being of its workforce, em-
various healthy workplace practices only to ployees will not engage those programs or
undercut their intended purpose by not ac- services if (1) they are not aware of them,
tively supporting their workforce. and (2) they do not feel that management
Although Fitz-enz (1993) categorized supports and values the use of those pro-
communication as a contextual factor, fur- grams or services. Therefore, for any
ther evidence suggests that its importance healthy workplace initiative to be used by
is not solely contextually based. Instead, employees, the organization’s leadership
communication plays a more significant and management must communicate that
and central role in promoting the effective- the program exists, how that program is
ness of healthy workplace initiatives (Pfef- supposed to be used, and that the program
fer, 1998). Communication is the founda- is supported by the organizational leader-
tion upon which all five organizational ship. To be effective, communication about
practices must be developed to achieve the programs and services that promote well-

Consulting Psychology Journal: Practice and Research 141

Summer 2006
being must be coherent, consistent, and vision of personal coaches is an option that
timely (Parchman & Miller, 2003). organizations can use to tailor a plan for
In addition to communication, Parch- each employee based on the array of avail-
man and Miller discussed a variety of other able services.
factors that contribute to employee utiliza-
tion of healthy workplace programs. First, Limitations of the Research
employees must have ready access to the
Although organizational health research
programs. Onsite facilities and information,
has provided insights into understanding
telephone access, and online access repre-
how workplace practices can influence
sent options to increase the accessibility of
employee well-being and organizational
services to all employees. If it is inconve-
effectiveness, in general the research suf-
nient for the employee to utilize the ser-
fers from several methodological flaws.
vices provided by their employer, it is less
Ozminkowski and Goetzel (2001) identi-
likely that they will participate. Second, the
fied six common weaknesses associated
extent to which wellness services are inte-
with research on the financial impact of
grated into a set of activities can influence
healthy workplace program initiatives.
utilization. Participation in one program
First, typically in organizational settings,
may be enabled by participation in another.
randomization is not possible. Therefore,
For example, if an employee sees a physi- selection bias occurs, which is defined as
cian at the worksite, extra time may be the likelihood that voluntary program par-
gained from not having to drive to a doc- ticipants differ from nonparticipants. Dif-
tor’s office. This spare time could be ap- ferentiation between these two groups
plied to another activity, such as a yoga based on some preexisting differences,
class or tutorial on stress management of- such as initial health condition, represents a
fered by the organization. Third, utilization significant threat to the validity of a study.
can be influenced by the promotion of pos- Second, many financial impact studies are
itive and successful outcomes. For exam- inherently flawed because they fail to con-
ple, participation in a weight management trol for inflation, which may lead to exag-
program sponsored by an organization may gerated figures. Third, financial impact
increase if the employees who had reached studies often fail to use discounting, which
their target weight were pictured on a bul- adjusts for the change in the value of
letin board. Fourth, increasing awareness of money, which produces exaggerated fig-
programs and services can increase utiliza- ures. Fourth, small sample sizes are often
tion. Companies can host events, such as employed in evaluation studies, which may
health fairs, to raise employee awareness of lead to an inability to make generalizations
the wellness program options, which cre- to other organizations and may in some
ates a sense of anticipation and excitement instances have a profound negative effect
among employees. Reluctant employees on the validity of the results. Fifth, a nor-
and previously unaware employees may be mal data distribution may be violated when
brought into the fold if they are confronted considering various organizational out-
with the program options that are available. comes, such as health care expenditures
Excitement and anticipation may also be and days absent. Typically, there will be a
induced if group programs are imple- disproportionate number of employees who
mented. Such programs instill a sense of have zero values on such measures and a
camaraderie among employees, thereby few employees with extremely high values.
motivating participation. Lastly, making Such extreme values are considered outli-
wellness programs personal represents an- ers and result in skewed data, which must
other avenue to enhancing usage. The pro- be approached using alternative statistical

142 Consulting Psychology Journal: Practice and Research

Summer 2006
techniques. Finally, there is not a pre- comprehensive framework used to evaluate
defined set of common terminology applied psychologically healthy workplace prac-
across studies of the financial impact of tices. In other words, the goal of this liter-
health initiatives. ature review was to develop a framework
In addition to these special concerns as- that could be used to develop evaluation
sociated with research on the financial im- processes and instruments that are both sci-
pact of health programs, there are a few entifically valid and useful for advancing
general limitations of healthy workplace the role of psychology in the business
research. First, research on healthy work- world. To that end, we developed the
place initiatives typically is limited in its PATH model and the SHAPE framework,
scope. For example, a few components of using previous research from a variety of
workplace health programs, such as em- disciplines as a starting point for their en-
ployee participation and health education, deavors. In so doing, we made several rec-
may be investigated in relation to one or ommendations for validating the models
two outcomes, such as health care costs. we developed.
However, previous research has neglected First, evaluation processes and criteria
to examine total packages of healthy work- must be developed to evaluate the imple-
place practices. Second, although the defi- mentation of the five key healthy work-
nition of a healthy workplace includes both place practices (i.e., work-life balance, em-
employee well-being and organizational per- ployee growth and development, health and
formance, few have considered the interre- safety, employee involvement, and recog-
lationships between organizational prac- nition) as presented in the models. Second,
tices, employee well-being, and organiza- communication mechanisms must be eval-
tional improvements. Lastly, even though uated to determine how well the organiza-
context is often theorized to be the founda- tion is (1) communicating the awareness of
tion on which successful organizational programs to employees, and (2) listening to
health initiatives are built, it is rarely stud- and acting on the needs and recommenda-
ied or controlled in research designs. In- tions of employees. Third, mechanisms
stead of simply theorizing about the role of must be designed to determine whether the
context in implementation effectiveness, it healthy workplace practices implemented
should be a central variable.
by organizations are aligned with the orga-
nizational context, including the organiza-
Recommendations
tion’s values, strategy, and structure. This
The majority of this article was pre- will permit a more explicit recognition that
sented to APA’s Business of Practice Net- psychological health in the workplace oc-
work at the Practice Directorate’s annual curs through a configurational approach as
State Leadership Conference in March, Delery and Doty (1996) suggested. Fourth,
2004. The purpose was to synthesize and a consistent standard for the evaluation of
review the previous research regarding psy- healthy workplace initiatives must be de-
chological health in the workplace. Thirty- veloped. Throughout the literature, there is
seven state, provincial, and territorial psy- very little agreement as to how to evaluate
chological associations have conducted or the effectiveness of implementation. In
are currently developing a Psychologically fact, no comprehensive research studies
Healthy Workplace Award program. As have examined the combined effect of all
part of its effort to ensure that the award five healthy workplace practices. Further-
program is built on a solid empirical foun- more, there has been no attempt to empir-
dation, the APA Practice Directorate was ically compare and contrast the large set of
interested in evaluating and refining their employee well-being variables or organiza-

Consulting Psychology Journal: Practice and Research 143

Summer 2006
tional improvement variables to determine degree of employee involvement. As Fitz-
whether some set of these best represent the enz (2000) argued, organizations should
psychological health and organizational ef- consider the specific needs of employees
fectiveness outcomes of interest. Therefore, when designing any workplace initiative.
any attempt to pursue an increase in our This is accomplished through upward com-
understanding of the healthy workplace re- munication mechanisms, which suggests
quires a complex validation process. Only that the effective design and implementa-
by moving to more comprehensive research tion of any healthy workplace practice has
studies can we develop a more complete some degree of employee involvement as-
understanding of how the five key prac- sociated with it. However, employee in-
tices, communication, and context, com- volvement should not be seen as the only
bine to influence employee well-being and type of healthy workplace practice. The
organizational effectiveness. other four categories (i.e., work-life bal-
Additionally, for consulting psycholo- ance, employee growth and development,
gists, there are at least four primary impli- health and safety, and recognition) all offer
cations based on the synthesis presented potential benefits for employee well-being
here. First, many organizations do not rec- and organizational improvement outcomes.
ognize the relationship between employee Therefore, consulting psychologists should
well-being and organizational improve- explore ways to help organizations develop
ments. Instead, they view employee well- healthy workplace initiatives that integrate
being outcomes as nothing more than specific practices from multiple categories.
“soft” indicators, and instead choose to fo- For example, organizations interested in
cus on organizational improvement out- health and safety initiatives might consider
comes. As consulting psychologists, a only offering training programs designed to
stronger effort must be made to demon- improve the health and safety of employ-
strate the dual benefit of healthy workplace ees. On the other hand, by using the PATH
practices. In other words, consulting psy- model as a guide, consulting psychologists
chologists can help organizations under- could help the organization to integrate
stand that it is not a choice between focus- health and safety initiatives with recog-
ing on employee well-being or focusing on nition initiatives (e.g., by recognizing
organizational improvements. Instead, when employees, groups, or departments that
helping organizations to design and imple- demonstrate the greatest health and safety
ment healthy workplace practices, consult- improvements following the training pro-
ing psychologists should emphasize the as- gram). By combining and integrating spe-
sessment of both types of outcomes as a cific practices from the various catego-
way to demonstrate the benefit for both the ries, consulting psychologists may be
employees and the organization. able to optimize the overall benefit for the
Second, the PATH model provides con- organization.
sulting psychologists with a set of broad Third, consulting psychologists should
categories that can guide the development help the organization to think through the
of healthy workplace practices. Employee role of downward and upward communica-
involvement initiatives are sometimes seen tion mechanisms in the effective imple-
as the default category of healthy work- mentation of healthy workplace practices.
place practices, with emphases on Total Without effective downward and upward
Quality Management (TQM), gainsharing, communication mechanisms, the success-
and self-managed work teams, among oth- ful implementation of healthy workplace
ers. Additionally, numerous practices from practices may be severely diminished.
other categories may, in fact, involve some Given their expertise/training, consulting

144 Consulting Psychology Journal: Practice and Research

Summer 2006
psychologists are in the position to help staff is through the implementation of
organizations design or improve those planned program of health initiatives (Wil-
communication mechanisms. liams, 1994, p. 7).
Finally, and perhaps most importantly, This call to action clearly demonstrates
consulting psychologists should pay careful the need to engage in the process of creat-
attention to the role of context in the devel- ing a healthy workplace. Organizations are
opment and implementation of any healthy composed of employees, and without those
workplace initiative. Organizations often employees, there would be no organization.
implement initiatives without considering Employees within healthy workplaces are
the role of context in the success of that viewed as both assets and vehicles to
initiative. This review specified a variety of achieve success. Therefore, every organiza-
contextual factors that should be consid- tion should develop programs designed to
ered in the design and implementation of maximize the physical, mental, and emo-
healthy workplace practices, including an tional health of all employees, in addition
organization’s culture, strategy, and values. to the health of the organization. Healthy
Consulting psychologists can play a large workplaces recognize the need to look past
role in helping organizations to consider the bottom line to the most vital business
how well their initiatives are aligned with component, the people. Successful healthy
these contextual factors. In some cases, it workplace program initiatives will be re-
may mean that certain change efforts may flected not only in the financial returns but
need to occur before a healthy workplace also in the lives of each and every
practice can be implemented. For example, employee.
employee problem-solving teams (an em-
ployee involvement initiative) cannot be
successfully implemented in an organiza-
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