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Safeguard OSH Solutions - Thomson Reuters

Safeguard OSH Solutions - Thomson Reuters

Health like safety

LAWRENCE WATERMAN convinced the London Olympic Development Authority to invest significantly in occupational health and wellbeing. The ROI? £7 for every pound invested. Here are some of his reflections.

The challenge in occupational health is the tendency to discuss it in terms of employing doctors and nurses. That is important but secondary. The starting point with health should be the same as it is with safety – to focus on the risk.

One of the benefits of talking about health is that you can get away from safety’s focus on preventing negatives and instead talk about the positive outcomes from an investment in worker health.

The latency of many health exposures can make it hard for senior management to understand and to develop a sense of responsibility. For example, in the construction sector it is increasingly common to be required to weld stainless steel. Unfortunately this gives rise to airborne chrome, which causes lung cancer. To eliminate that health risk you have to go back to the design team, well before the construction phase commences, and ask them to get all the required stainless steel welding done in a factory before delivery to the site. That makes the process much easier to control from a health perspective, and it is cheaper and better organised. So you get better productivity, better quality, and the cost is less.

So to eliminate or minimise health risks you need to get designers involved at an early stage. Just as you would for safety risks.

When designers worked out a way to eliminate a risk at the design stage we got them to highlight in special boxes what they had done and why, so that later on, at the value engineering stage, someone wouldn’t be able to remove a piece of design that had been created to protect people’s health and safety.

It was an example of attention to detail, and it gave us opportunities to celebrate the designers who were doing a good job and to share it with other designers – it really worked.

The traditional approach to occupational health, at least in the UK, has been nurse-led and doctor-managed, with people isolated in a medical centre. The outcome is a reactive, worker-focused service instead of one which focuses on exposure risks.

The starting point for health has got to be, first, how can we eliminate exposure to risk? Second, how can we manage remaining residual risks to a lower level? And third, how can we use medical staff to best look after workers on the job? In other words, eliminate health risks rather than employ an army of people afterwards to tell you how much damage you’ve done.

It’s a move away from the medical model, so that we manage the risks first, then the symptoms.


The London ODA wanted workers to be fit, healthy, on-site and productive. The workers had the identical desire, because in construction you are only paid if you turn up. So it was in everyone’s interest to put significant effort into raising people’s knowledge about their own state of health and their ability to manage it.

On-site, the occupational health programme was run by a team of occupational hygienists and occupational health nurses. They ran a drop-in clinic every day where workers could have a lifestyle health check – cholesterol, blood pressure, advice on obesity management, and so on. Hundreds of people made use of the clinic each month. No bookings were taken – they just turned up, and we made sure the waiting time was never more than 15 minutes.

We ran pre-employment health screening using questionnaires, and for roles which were safety-critical (about a third of the workforce) applicants also had to undergo medicals. You don’t want your crane operators to have a stroke, so just as you’d expect pilots to undergo regular health checks, why shouldn’t that be true of safety-critical workers on a construction site?

The team also ran the drug and alcohol testing programme, not because we thought we could catch everyone who might be abusing drugs or over-indulging in alcohol and coming to work under the influence, but to create an atmosphere that drug and alcohol abuse isn’t tolerated on site. It was more about encouraging the workforce to manage their own behaviours than to catch people out.

But the meat in the sandwich was managing the health exposure risks workers were being asked to face. Our occupational hygienists worked with project teams to design out the risks, and if they couldn’t be designed out, how could they be managed so that fewer people are exposed, and how could we monitor exposures to ensure required controls are being maintained?

So we did those two things: we looked after individual workers and we looked after the workplace to make sure it didn’t damage them. That was our ticket to the game, if you like – it gave us the right to talk to workers about maintaining their personal fitness and health to be able to do a decent job on site. That was the wellbeing work.

Right through the project less than five percent of our health and safety programme spend was on wellbeing, but surveys revealed it made a phenomenal contribution to workforce engagement. The nurses and hygienists were talking all the time about looking after people, not about production. Workers really did feel they were being looked after – that was the phrase they used.

I asked one chap in the canteen what his engagement with the health team had meant for him. He said he used to have chips with all his canteen meals but now he had them only on Fridays as a special treat. He felt privileged that he was being given the opportunity to manage his own health more effectively, and he gave credit to his bosses because he recognised they were investing in him.

This engagement on health had a sunshine effect on workforce relationships, and on recruitment and retention – because word soon got out that the Olympics build was a good place to work because people felt well looked after.

One of the things you do with an occupational health programme is you keep on shouting at the workers in the politest way possible “WE CARE ABOUT YOU”. We don’t just say workers are our greatest asset, we demonstrate that we believe it; that we spend as much time and effort on trying to maintain your bodies as we do on maintaining the equipment on site.


On a large construction project the amount of time each member of the health team spent with each worker was necessarily small. So if a worker had a really good conversation with one of the team one day a month, but the other 30 days of the month his supervisor treats him poorly, that is what the felt leadership will look like to him.

So we co-opted the site’s supervisors as leaders of the health programme. We ran leadership training for them – with 12,000 workers on site at peak, there were 1000 supervisors. They wore black hard hats on site, had special badges, and their names and photos appeared on regular wall of fame posters all over the sites. They were our local leaders, and we spent a lot of time briefing them on the health programme, such as the next month’s lifestyle wellbeing focus. They felt special and were better able to engage with workers about health. The supervisors became our recruiting sergeants, our frontline marketers, to get people into the medical centres for a lung function check, for example.


As part of our efforts to identify, eliminate or manage health risks we celebrated whenever someone worked out a new way to control risk. I’ve gone through the records and worked out that we spent 19 times as much effort in celebrating things that were being done well than on circulating information about non-compliances.

So for example, when a group of carpenters came up with a new way of eliminating dust, we gave them an award and shared their method with everyone else on the project. And lo and behold, dust suppression became much more common elsewhere. And when they were invited to the overall awards dinner, even if they didn’t win they had an opportunity to explain what they had done, and everyone applauded.

We did the same for people’s efforts to eliminate noise, or slips and trips, or falls from height. We didn’t distinguish between accident prevention and health. We just made sure the health risks were treated with as much attention to detail as the safety risks in any job analysis.


We created job or task risk registers for health risks in the same way as for safety risks. We tried to make it as simple as possible, not because construction workers are thick but because they are busy people and they work hard.

Chief executives also appreciate this approach. So we used a lot of photos to illustrate the way people should prepare for a job in terms of PPE and use of equipment, rather than lots of text. One picture with a big cross on it – how long do you have to spend explaining that?

So we didn’t just address health, we tried to make it as simple and easy as possible to do the healthy thing. For example, we used green, amber and red zones of site contamination to make it easy for supervisors to understand the level of protection a worker required. If the supervisor wanted to put a worker in a red zone they would phone a hygienist to discuss the work to be done and the protection required. In a green zone workers simply used the standard PPE and work arrangements. In an amber zone workers adopted a standardised additional level of protection.

So you didn’t have to work it out. On a large site, think about the amount of management time you save when the only areas requiring extra time and planning are the red zones. We tried to make hygiene advice available to people in a way which made their work more efficient. We did the same with noise zones.

We also did a lot of lead indicators because every time someone is exposed to a health risk it has a negative impact on their health. In accidents, if someone is exposed to a risk but an accident doesn’t occur you go whew, lucky! But when you are exposed to dust you breathe it in, so it does impact on your health, it’s just that the impact is incremental and you need lots of it before you express the harm. So we looked at the way each contractor was managing health issues, and we asked the same kinds of questions and used the same kinds of maturity indices. Health like safety.


One cold January the nurses contacted me and said they had had some people fainting in the morning. The safety team contacted me and said they were getting a peak of minor accidents in the late morning – people stabbing themselves with screwdrivers and other minor incidents with plant.

We did a survey of people leaving the site at the end of the day. We asked them to stop and speak briefly to a nurse. You’d be surprised at their willingness to do that. We asked what did you eat for breakfast this morning? When did you have lunch? And what are you doing this evening for your meal?

It turned out nearly 80 percent of workers got a takeaway on the way home, because they were living in digs with no food storage or preparation facilities. The next morning they got on public transport, got to site, and immediately began working. In the late morning they’d have a late breakfast/early lunch. So they had 18 hours without any food. Their blood sugar level was somewhere through the floor. Hence the fainting.

But our doctors said it was worse than that. If you repeat a feast and famine mode of eating, where your blood sugar spikes and then drops very low, you become predisposed to metabolic imbalance. It ruins your body’s ability to manage your food intake and predisposes you to develop type 2 diabetes and other long-term health damage. So we had this lifestyle factor around eating causing accidents in the short term and health damage in the long term: safety, health, wellbeing.

So we ran a hugely successful porridge campaign, using Ronnie Barker on a poster. We used the OHS budget to arrange with all the site canteens to subsidise a bowl of porridge so it could be offered cheaply. The canteens never came to me for the subsidy because the offer increased foot traffic, and even the guys who didn’t like porridge went with their mates to have a cup of tea and some toast. We went from nearly 80 percent of people not having breakfast to the reverse. The late morning accident peak disappeared. There were no more faintings. And we knew we were improving the likelihood of people remaining healthy over a long period.

This wasn’t done secretly. The porridge campaign explained why it was a good idea to have slow release carbohydrate early in a working day which would see you through the morning before you stopped to have your midday meal, and would help you work more productively. Because if you have low blood sugar you feel knackered. It was like win-win-win. Who paid for the porridge? The guys paid. A pound a pop, which covered its cost. They’re healthier, they know a little bit more about looking after themselves, have fewer accidents, and are more productive on site.


The HSE and the ODA commissioned a study on the return on investment of our health programme. It was the first research project that we commissioned. I knew there wasn’t an adequately explicated business case for the kind of investment we were making. I had stretched credibility a little by claiming there was lots evidence and I was determined that at the end there would be some hard evidence.

The report shows the health programme had such an impact on the workers’ sense of being looked after: it enhanced business reputation, credibility, engagement, it was really positive. The managers felt supported in talking about health risks rather than feeling dumped on and not understanding it.

I don’t think there are many business investments that generate an ROI of seven. Some of the things we did resulted in such a reduction in delay in the work, because we had an on-site team that could respond rapidly to things like reports of asbestos. We could help people to keep working. There is now an evidence-based argument that not addressing health is poor management, and that health is an investment opportunity.

You need to devise a business case for your own organisation and then refresh it every year or so as you tune up the service to provide the maximum benefit for the minimum cost. In health and safety we need to be effective but we also need to be efficient. This is not an argument for a blank cheque.

It’s about weaving health management into the business in the same way that we’ve been weaving safety management. You need to make sure you align your health programme with the way in which your business sees itself. For example, if your business is particularly customer-focused, make sure your health programme will contribute to that.

Health programmes really do pay for themselves because looking after the people who work for you is always the right thing to do.

This is a selected edited summary of the author’s presentation to the Business Leaders’ Health and Safety Forum’s seminar on health, held in Auckland in October.


  • • 
    The starting point with health is to focus on the risk.
  • • 
    Investing in worker health has a tremendous effect on engagement.
  • • 
    Get designers involved early to eliminate or minimise health risks.
  • • 
    Safety-critical roles warrant a pre-employment medical.
  • • 
    Co-opt supervisors as day-to-day drivers of your health programme.
  • • 
    Encourage and celebrate worker suggestions to reduce health risks.
  • • 
    Make your health programme an operational enabler.
  • • 
    A good health and wellbeing programme can have significant ROI.

Lawrence Waterman is a senior partner with Park Health and Safety Partnership in the UK.

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