Supportive Leaders Drive Organizational Improvements and Employee Health and Well-Being

Job stress has significant impacts on the short and long-term health and well-being of the U.S. workforce. Interpersonal conflict, lack of supervisor support, low job control, task overload, and work-family imbalance are examples of job stressors that can have detrimental health effects and interfere with the ability of employees to function optimally both in and outside of work. Here, we introduce three web-based Total Worker Health® training programs that promote supportive leadership behaviors to reduce employee exposure to workplace stressors and corresponding job stress to improve employees’ physical and mental health, including cardiovascular disease risk factors such as hypertension.

Job Stress is an Individual, Organizational, and Economic Burden

The association between job stress and the onset and progression of cardiovascular disease has been well-documented in the medical and psychological research literature.^1–3  Persistent job stress significantly increases workers’ risk of experiencing stress cardiomyopathy,³ incident coronary heart disease, and stroke.^4,5Many workers present with additional comorbid conditions like obesity, diabetes, smoking and drinking behaviors, and physical inactivity resulting from chronic stress.^2,6–7 For those at risk, acute triggers of major cardiac events include stress, anger, and depressed mood.³

The health consequences of job stress create a significant burden on the economy. The global cost of job stress is estimated to range from $221 million to $187 billion per year, with 70-90% of the costs due to productivity loss.⁹ Cardiovascular disease and stroke, leading causes of death in the U.S., cause $138 billion in lost job productivity.¹⁰ The treatment of type 2 diabetes, and associated production losses due to morbidity and premature mortality, is estimated to cost the US $1.31 trillion annually.¹¹ For patients presenting with both type 2 diabetes and cardiovascular disease, cardiovascular complications increase the total direct cost of treating type 2 diabetes by nearly 50%.¹²

Decreasing exposure to adverse working conditions linked to job stress is a key focus of NIOSH and its partners in academia, labor, and industry.  Relevant NIOSH partnership efforts include the National Occupational Research Agenda Healthy Work Design and Well-Being Cross-Sector Council and the Cardiovascular Disease prevention subgroup of the Cancer, Reproductive, Cardiovascular, and Other Chronic Disease Prevention Cross-sector Council.

Supportive Leadership Behaviors Protect Against Job Stress Impacts

Research shows that supportive leadership can be an important factor in reducing the negative effects of job stress. Leadership support for workers can take many forms, including support for: work-life balance, safety, military veterans in civilian workplaces, and sleep health. Employees who view their supervisors, organization, or both as being supportive of family priorities report experiencing significantly less work-family conflict, greater job satisfaction and increased organizational commitment.^13,14 Moreover, organizations that prioritize productivity over support for work-life balance are often, perhaps ironically, met with a less productive, less engaged workforce that has a higher likelihood of turnover and absenteeism.^15-17

Work-life stress has been identified as one of the top stressors impacting the U.S. workforce in several workplace surveys.^18-20 A common and significant barrier to achieving work-life balance is work-family conflict, where the demands of the job affect employees’ abilities to meet health, financial, and/or safety needs at home and, conversely, when the demands of home life make it difficult to meet work responsibilities. Work-family conflict can be a significant source of job stress that has been associated with multiple negative health outcomes including cardiovascular disease, depression and burnout, work-related injury, obesity, and addictive behaviors (i.e., smoking and alcohol use).¹⁵ Family-supportive supervision, in particular, has been shown to be beneficial for reducing work-family conflict.²¹ In contrast, when supervisors are viewed as unsupportive, organizations that boast policies and benefits designed to alleviate work-life conflict (e.g., flex plans, family and medical leave) see limited use of these benefit programs.^13,21,22

Web-based Leadership Trainings Improve Employee Health and Well-being

Researchers at the Oregon Healthy Workforce Center at the Oregon Institute for Occupational Health Sciences, Oregon Health & Science University, have spent the past 15 years developing and evaluating training interventions to promote healthy leadership within organizations across various industries (e.g., retail, forestry, information technology, healthcare, military). This work, funded by the National Institute for Occupational Safety and Health (NIOSH), the National Institutes of Health, and Department of Defense, has led to the production of several 1-hour evidence-based training programs designed to improve supervisor and managerial support for workers to facilitate improvements in employee health, safety, and well-being.^22-25

Each of these trainings is based in the Family-Supportive Supervisor Behavior (FSSB) framework,^14,19,26 and targets organization-level change leading to improved worker health, safety, and well-being. Additional resource guides and behavior tracking activities are included as part of the trainings to reinforce integration of the recommended leadership behaviors into everyday practice. Most of these training programs and resources are available free-of-charge and are now accessible online and on demand.  Summaries of the training programs follow.

• Safety Support (also known as the Safety & Health Improvement Program, or SHIP) teaches supervisors to provide emotional and instrumental support for safety communication and work-life balance challenges and integrate creative management strategies to provide greater flexibility and reduce job demands for workers. The Safety Support training includes a printable handbook, team effectiveness strategy guide (with meeting templates), and quick-reference resource sheets. Research evaluating the effectiveness of Safety Support has shown significant employee improvements in the following areas:^27-29
  • Cardiovascular health (i.e., blood pressure)
  • Job stress and work-life conflict
  • Team communication and effectiveness
  • Work processes and safety behaviors
• Sleep Support teaches organizational leaders to support workers’ sleep health and well-being through Sleep Leadership strategies (emotional, instrumental, and sleep hygiene supportive behaviors). This training was originally developed and evaluated through the Military Employee Sleep & Health (MESH) Study with the Oregon National Guard. A civilian version of the training has since been developed and is broadly available for use across industries. Research shows that Sleep Support, along with personal sleep tracking, produced significant employee improvements across a variety of outcomes, including:^30-31
  • Sleep quantity (objectively measured through actigraphy)
  • Sleep quality and insomnia symptoms
  • Psychosocial functioning
  • Job satisfaction and engagement
• Veteran Support is a leadership training designed to improve workplace support for reintegrated veterans in the general workforce across industries. It teaches supervisors and managers to appreciate and foster the unique skills, leadership experience, and dedication that veterans bring to the workplace, and improve veterans’ work-life balance, health, and well-being. This program was originally developed and evaluated through the Study for Employment Retention of Veterans (SERVe). Veteran Support produced significant employee improvements in the following areas:^32-37
  • Stress (among those whose supervisors’ attitudes toward veterans improved)
  • Physical health and sleep quality
  • Marital relationship quality and parenting behaviors
  • Job performance and turnover intentions

Web-based training that improves supportive leadership behaviors is a scalable and cost-effective method to drive widespread organizational changes in employee health, safety, and well-being. Training supervisors and managers requires a modest investment of staff time – compared to all-staff trainings – and supportive leadership strategies have been shown to provide significant cross-over impacts on employees’ mental and physical functioning, family health and well-being, and beneficial workplace outcomes. More information on these and other trainings can be found on the Center for Supportive Leadership website.

Share your knowledge!

We are interested in learning about other evidence-based interventions linked to improved employee health and wellbeing. Let us know if you have knowledge and resources about other organizational interventions not highlighted in this blog.

Leslie B. Hammer, Ph.D., is a Professor in the Oregon Institute of Occupational Health Sciences and Co-Director of the Oregon Healthy Workforce Center, Oregon Health & Science University; she is also a member of the NORA Healthy Work Design and Well-Being Cross-sector Council.

Lindsey Alley, M.S., served as Senior Research Associate for the Oregon Institute for Occupational Health Sciences at Oregon Health & Science University.

Jasmine Nelson, B.S., is a Public Health Program Specialist working with the NIOSH Division of Field Studies and Engineering, Reproductive Epidemiology team.

CAPT Leslie MacDonald, M.S., Sc.D., is a Senior Scientist Officer assigned to the NIOSH Division of Field Studies and Engineering and is a member of the NORA Cancer, Reproductive, Cardiovascular, and Other Chronic Disease Prevention Cross-sector Council.

This blog is a product of the NORA Cross -sector Councils: Cancer, Reproductive, Cardiovascular, and Other Chronic Disease Prevention and the Healthy Work Design and Well-Being.

References

1. Dimsdale, J. E. (2008). Psychological stress and cardiovascular disease. Journal of the American College of Cardiology, 51(13), 1237-1246. doi:10.1016/j.jacc.2007.12.024
2. Nyberg, S. T., Fransson, E. I., Heikkilä, K., Alfredsson, L., Casini, A., Clays, E., & IPD-Work Consortium. (2013). Job strain and cardiovascular disease risk factors: meta-analysis of individual-participant data from 47,000 men and women. PloS one, 8(6), e67323. doi:10.1371/journal.pone.0067323
3. Steptoe, A., & Kivimäki, M. (2013). Stress and cardiovascular disease: an update on current knowledge. Annual review of public health, 34, 337-354. doi:10.1146/annurev-publhealth-031912-114452
4. Li, J., Pega, F., Ujita, Y., Brisson, C., Clays, E., Descatha, A., & Siegrist, J. (2020). The effect of exposure to long working hours on ischaemic heart disease: A systematic review and meta-analysis from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury. Environment international, 142, 105739. doi:1016/j.envint.2020.105739
5. Descatha, A., Sembajwe, G., Pega, F., Ujita, Y., Baer, M., Boccuni, F., & Iavicoli, S. (2020). The effect of exposure to long working hours on stroke: A systematic review and meta-analysis from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury. Environment international, 142, 105746. doi:1016/j.envint.2020.105746
6. Gheisari, Z., Beiranvand, R., Karimi, A., Ghalavandi, S., Soleymani, A., Madmoli, M., & Bavarsad, A. H. (2018). Relationship between Occupational Stress and Cardiovascular Risk Factors Determination: A Case-control Study. Journal of Research in Medical and Dental Science, 6(3), 287-293. doi: 10.24896/jrmds.20186344
7. Heikkilä, K., Nyberg, S. T., Fransson, E. I., Alfredsson, L., De Bacquer, D., Bjorner, J. B., & IPD-Work Consortium. (2012). Job strain and tobacco smoking: an individual-participant data meta-analysis of 166 130 adults in 15 European studies. PloS one, 7(7), e35463. doi:10.1371/journal.pone.0035463
8. Nyberg, S. T., Fransson, E. I., Heikkilä, K., Ahola, K., Alfredsson, L., Bjorner, J. B., & Kivimäki, M. (2014). Job strain as a risk factor for type 2 diabetes: a pooled analysis of 124,808 men and women. Diabetes care, 37(8), 2268-2275. doi:10.2337/dc13-2936
9. Hassard, J., Teoh, K. R., Visockaite, G., Dewe, P., & Cox, T. (2018). The cost of work-related stress to society: A systematic review. Journal of occupational health psychology, 23(1), 1. doi:10.1037/ocp0000069
10. Benjamin, E. J., Virani, S. S., Callaway, C. W., Chamberlain, A. M., Chang, A. R., Cheng, S., & Muntner, P. (2018). Heart disease and stroke statistics—2018 update: a report from the American Heart Association. Circulation, 137(12), e67-e492. doi:10.1161/CIR.0000000000000558
11. Bommer, C., Heesemann, E., Sagalova, V., Manne-Goehler, J., Atun, R., Bärnighausen, T., & Vollmer, S. (2017). The global economic burden of diabetes in adults aged 20–79 years: a cost-of-illness study. The lancet Diabetes & endocrinology, 5(6), 423-430. doi:10.1016/S2213-8587(17)30097-9
12. Einarson, T. R., Acs, A., Ludwig, C., & Panton, U. H. (2018). Economic burden of cardiovascular disease in type 2 diabetes: a systematic review. Value in Health, 21(7), 881-890. doi:10.1016/j.jval.2017.12.019
13. Allen, T. D. (2001). Family-supportive work environments: The role of organizational perceptions. Journal of vocational behavior, 58(3), 414-435.
14. Hammer, L. B., Kossek, E. E., Yragui, N. L., Bodner, T. E., & Hanson, G. C. (2009). Development and validation of a multidimensional measure of family supportive supervisor behaviors (FSSB). Journal of management, 35(4), 837-856. doi:10.1177/0149206308328510
15. Kossek, E. E., Hammer, L. B., Kelly, E. L., & Moen, P. (2014). Designing work, family & health organizational change initiatives. Organizational dynamics, 43(1), 53. doi:10.1016/j.orgdyn.2013.10.007
16. Hammer, L. B., Kossek, E. E., Anger, W. K., Bodner, T., & Zimmerman, K. (2011). Clarifying work-family intervention processes: The roles of work-family conflict and family supportive supervisor behaviors. Journal of Applied Psychology, 96, 134-150.
17. Hammer, L. B., Bauer, T. N., & Grandey, A. A. (2003). Work-family conflict and work-related withdrawal behaviors. Journal of Business and Psychology, 17(3), 419-436. doi:10.1023/A:1022820609967
18. American Psychological Association. (2021, February). “Stress in America™ Press Room.” Retrieved August 20, 2021, from https://www.apa.org/news/press/releases/stress.
19. Hammer, L.B., Demsky, C.A., Kossek, E.E., Bray, J.W. Work-Family Intervention Research. In: Allen, T.D., Eby, L.T., eds. The Oxford Handbook of Work and Family. Oxford University Press; 2016:349-361.
20. Berkman, L. B., Liu, S. Y., Hammer, L. B., Moen, P., Klein, L. C., Kelly, E., Fay, M., Davis, K., Durham, M., Karuntzos, G., Buxton, O. M. (2015). Work/family demands, cardiometabolic risk and sleep duration in extended care employees. Journal of Occupational Health Psychology, 20, 420-433. doi: 10.1037/a0039143.
21. Landsbergis, P. A. (2009).Interventions to reduce job stress and improve work organization and worker health. In: Schnall, P., Rosskam, E., Dobson, M., Gordon, D., Landsbergis, P., Baker, D., eds. Unhealthy Work: Causes, Consequences and Cures. Amityville, NY:Baywood Publishing, 193-209.
22. Kossek, E. E., Pichler, S., Bodner, T., & Hammer, L. B. (2011). Workplace social support and work–family conflict: A meta‐analysis clarifying the influence of general and work–family‐specific supervisor and organizational support. Personnel psychology, 64(2), 289-313. doi:10.1111/j.1744-6570.201.1.01211.x
23. Crain, T. L., Hammer, L. B., Bodner, T., Kossek, E. E., Moen, P., Lilienthal, R., & Buxton, O. M. (2014). Work–family conflict, family-supportive supervisor behaviors (FSSB), and sleep outcomes. Journal of occupational health psychology, 19(2), 155. doi:10.1037/a0036010
24. Olson, R., Crain, T. L., Bodner, T. E., King, R., Hammer, L. B., Klein, L. C., … & Buxton, O. M. (2015). A workplace intervention improves sleep: results from the randomized controlled Work, Family, and Health Study. Sleep Health, 1(1), 55-65. doi:10.1016/j.sleh.2014.11.003
25. Rineer, J. R., Truxillo, D. M., Bodner, T. E., Hammer, L. B., & Kraner, M. A. (2017). The moderating effect of perceived organizational support on the relationships between organizational justice and objective measures of cardiovascular health. European Journal of Work and Organizational Psychology, 26(3), 399-410. doi:10.1080/1359432X.2016.1277207
26. Hammer, L. B., Kossek, E. E., Zimmerman, K., & Daniels, R. (2007). Clarifying the construct of family-supportive supervisory behaviors (FSSB): A multilevel perspective. In Exploring the work and non-work interface. Emerald Group Publishing Limited. doi:10.1016/S1479-3555(06)06005-7

27. Hammer, L. B., Truxillo, D. M., Bodner, T. Pytlovany, A. C., & Richman, A. (2019). Exploration of the impact of organizational context on a workplace safety and health intervention. Work and Stress, 33(2), 192-210. doi:10.1080/02678373.2018.1496159
28. Hammer, L. B., Truxillo, D. M., Bodner, T., Rineer, J., Pytlovany, A. C., & Richman, A. (2015). Effects of a workplace intervention targeting psychosocial risk factors on safety and health outcomes. BioMed Research International, 2015. doi:10.1155/2015/836967
29. Johnson, R. C., Eatough, E. M., Chang, C.-H., Hammer, L. B., & Truxillo, D. M. (2019). Home is where the mind is: Family interference with work and safety performance in two high risk industries. Journal of Vocational Behavior, 110, 117-130. doi:10.1016/j.jvb.2018.10.012 

30. Crain, T. L., Hammer, L. B., Brossoit, R. M., Brockwood, K. J., Mohr, C. D., Bodner, T. E., Allen, S. A., Dretsch, M., & Shea, S. A. (2021, April). Optimizing sleep: The military employee sleep and health randomized control trial. Presented virtually at the Annual Conference of the Society for Industrial and Organizational Psychology (SIOP) New Orleans, LA. 

31. Hammer, L. B., Brady, J. M., Brossoit, R. M., Mohr, C. D., Bodner, T. E., Crain, T. L., & Brockwood, K. J. (in press). Effects of a Total Worker Health® Leadership Intervention on Employee Well-Being and Functional Impairment. Journal of Occupational Health Psychology. 

32. Brady, J.M., Hammer, L.B., Mohr, C.D., & Bodner, T. (2021). Supportive Supervisor Training Improves Marital Relationship Quality among Employee and Spouse Dyads. Journal of Occupational Health Psychology, 26, 31-48. doi:10.1037/ocp0000264 

33. Crain, T. L., Hammer, L. B., Bodner, T., Olson, R., Kossek, E. E., Moen, P., & Buxton, O. M. (2019). Sustaining sleep: Results from the randomized controlled Work, Family, and Health Study. Journal of Occupational Health Psychology, 24, 180-197. doi/10.1037/ocp0000122 

34. Hammer, L.B., Brady J., Perry, M.L. (2020). Training supervisors to support veterans at work: Effects on supervisor attitudes and employee sleep and stress. Journal of Occupational and Organizational Psychology, 93, 273-301. doi:10.1111/joop.12299 

35. Hammer, L. B., Wan, W. H., Brockwood, K., Bodner, T., & Mohr, C. D. (2019). Supervisor support training effects on veterans in the workplace:Effects on health and work outcomes. Journal of Applied Psychology, 104, 52-69. doi:10.1037/apl0000354 

36. Mohr, C.D., Hammer, L.B., Brady, J., Perry, M. & Bodner, T. (2021). Can Supervisor Support Improve Daily Employee Well-being? Evidence of Supervisor Training Effectiveness in a Study of Veteran Employee Moods. Journal of Occupational and Organizational Psychology, 94, 400-426. doi:10.1111/joop.12342 

37. O’Neill, A. S., Mohr, C. D., Bodner, T. E., & Hammer, L. B. (2020). Perceived Partner Responsiveness, Pain, and Sleep: A Dyadic Study of Military-Connected Couples. Health Psychology, 39, 1089–1099. doi:10.1037/hea000103