Retaining rewarding and motivating staff is always a challenge. Find out ways to maximize employee and organizational health thru best practices and case studies.
1. Promoting a Healthy
Work Environment
1:30 – 2:15 May 22, 2013 Occupational
Federated Press Conference Calgary
Chris Hylton, MA
CG Hylton Inc. 1
2. Agenda
• Overcoming barriers to a
healthy work environment,
absenteeism, toxic workplace
• Toxic workplace and lateral
violence
CG Hylton Inc. 2
3. Agenda
Best Practices
–The National Standard of Canada for
Psychological Health and Safety in the
Workplace
–Overview of the successful Screening, Brief
Intervention, and Referral to Treatment (SBIRT)
substance abuse model
–Wellness programs that work, at work
–The Aging workforce
CG Hylton Inc. 3
4. This is Your Show
• What would like to know from today’s
session?
• What are your big workplace health
issues we can deal with please?
CG Hylton Inc. 4
5. Overcoming Barriers to Healthy
Work Environment
Productivity loss from
presenteeism, absenteeism,
and the toxic workplace
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6. Which City is the healthiest
in terms of absence (days lost)
• Vancouver
• Edmonton
• Calgary
• Toronto
• Montreal
CG Hylton Inc. 6
7. Days lost per worker - 2011
CG Hylton Inc. 7
0 2 4 6 8 10 12
ON
MB
SK
AB
BC
Montréal
Toronto
Calgary
Edmonton
Vancouver
Personal or family resp
Illness / disability
Total
Source: Statistics Canada,
Labour Force Survey
8. Absenteeism
• 8.1% of full-time employees are absent for
all or part of the week for personal reasons:
5.9% due to their own illness or disability
and 2.2% due to personal or family
responsibilities.
• On average, in 2011, full-time employees
lost 3.7% of their work time each week due
to absenteeism
Source Stats Can 2011 Labour Force Data
CG Hylton Inc. 8
9. Presenteeism
• Absenteeism’s lesser known cousin, is lesser
known and stats are more difficult to find.
• US data shows presenteeism is 7 - 9 times the rate
of absenteeism (7 x 8.1% = 57%, 9 x 8.1% = 73%)
• Presenteeism occurs when employees who are
physically present are, due to a physical or
emotional issues, distracted to the point of
reduced productivity. Using a sports analogy they
are the walking wounded or playing hurt
CG Hylton Inc. 9
Source: Addressing the Presenteeism Issue, Esther Huberman, Benefits
Canada Oct 15, 2012
10. Why bother deal with absenteeism?
Direct Costs
• Replacement of absent worker
• Loss of productivity
• Sick leave with pay and benefits
Indirect Costs
• Reduced service to clients
• Damage to morale of other employees
• Time spent managing employee and/or claim
11. Presenteeism
• Performance objectives
• Performance appraisal
• Job description with Performance Objectives
built in, signed off, amended annually by ee and
er
CG Hylton Inc. 11
12. Solution:
• Absenteeism or Attendance Management Plan
• Does anyone have one of these?
• Care to share any comments?
CG Hylton Inc. 12
13. Case Study:
CLS’ Absenteeism Management
Program (AMP)
• Implemented May 2005
• Revisions July 2008
• Four Step Program
• Experiencing hi rates of absenteeism
• Target 3.5% absenteeism (9 days/year)
14. CLS Issues
• People working when sick
• Concern about singling people out
• Concern about Supervisor abuse – “I’ll be
watching you”
• Time required to manage program
• Education of staff is key
15.
16. CLS AMP Steps
• Step 1: Informal Notification, Initial Concern
– Notification package provided to employee
– Contains absence history, AMP process, internal and
external support
– Goal is to inform employee and offer education
17. Step 2
• Formal Discussion, Continued Concern
– Supervisor and employee meet
– Union representation is offered
– Purpose is to determine of there are underlying
health issues
– A referral to Occupational Health and Wellness may
be made
18. Step 3
• Formal Discussion, Advance Concern
– Supervisor and employee meet
– Union Representation offered
– Attempt to get at underlying issues
– Mandatory referral to Occupational Health and
Wellness
19. Step 4
• Employment Discussion
– Supervisor and Employee meet
– Union Representation required
– Focus on continued employment relationship in
serious jeopardy
– Employee is placed on a 90 day trial period.
20. Does anyone have any Attendance
Programs at their workplace they
wish to share?
Any ideas?
CG Hylton Inc. 20
22. Toxic Workplace
• Is anyone here from healthcare?
• Is there a link between a
workplace and its toxicity and
workplace violence and
absenteeism?
CG Hylton Inc. 22
25. Causes of Lateral Violence
• Aboriginal Communities
• Healthcare
• What do they have in common?
CG Hylton Inc. 25
26. What do Healthcare and Aboriginal
Communities have in Common?
• Tribal setting
• Close close bonds between workers,
families
• Long history with co workers
• Crab in a bucket syndrome
• Feeling of stress, hopelessness, fear
CG Hylton Inc. 26
27. Causes of Lateral Violence
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• Research finds a clear link between
abuse for patients/residents and the
workplace environment. There are
higher rates of violence in work areas
with short staffing, under-staffing, lack
of support from management, and
poor teamwork among health care
disciplines. Source: Adapted from Central Health
presentation: Defining bullying, harassment
and disrespectful behaviour, Healthcare
Workplace Safety Conference, April 13, 2011
28. What employees want
Surveys of Best Practices tell us what
employees want in the workplace:
1. Respect
2. Healthy and Safe work environment
3. Trustworthy Leadership
4. Work / Life Balance
5. Sense of Pride and Accomplishment
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29. If you are an employer where LV is
occurring, what do you do, any ideas?
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30. Policies and Training
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• Policies should have strong opening
statements regarding the company’s
attitude to harassment in the workplace
• Awareness training among staff is a key
strategy in addressing harassment
• Zero tolerance approach
31. Shunning Cuts Both ways
• Recent Research from University of
Rochester
• Giving someone the cold shoulder is as
painful to you as it is to them
• Shunning someone is just as painful for the
perpetrator as for the victim
• Excluding someone makes a person feel
guilty and shameful
CG Hylton Inc. 31
Source: Hurting You Hurts Me Too: The Psychological Costs
of Complying With Ostracism Psychological
Science 0956797612457951,first published on February 27, 2013
32. What is the National Standard for
Psychological Health & Safety in the
Workplace?
• Mental Health Commission
• Supports mental health best practices in
the Canadian workplace
• The new standard was developed with the
support of health care leaders,
government, labour and corporations,
including a $250,000 contribution from
the Bell Let’s Talk mental health initiative
CG Hylton Inc. 32
33. Why a Standard?
• According to an Ipsos Reid survey released
fall of 2012,
• seven in 10 (71 per cent) of Canadian
employees surveyed report some degree of
concern with psychological health and
safety in their workplace,
• including 14 per cent who disagreed that
their workplace is psychologically healthy
and safe
CG Hylton Inc. 33
Source: GWL press Release Oct 30, 2012 Ipsos Reid survey results
available at www.workplacestrategiesformentalhealth.com
34. Why a Standard?
• The survey indicated that more people feel
physically safe (20 per cent concerned)
• than psychologically safe (33 per cent
concerned) in their workplace. This may be
because psychological health and safety
has not historically received the attention,
profile or resources that physical health
CG Hylton Inc. 34
Source: Homewood Human Solutions Jan 16, 2013 Press
Release.
35. The National Standard is a
Voluntary Program
• Not enshrined in Law
• Not a regulation
• Provides guidelines and information
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36. How the Standard Lines up
• Aligns with the Plan-Do-Check-Act
management model found in CAN/CSA
Z1000, Occupational Health and Safety
Management
• Aligns with other key standards and guidelines,
including BNQ 9700-800 on Healthy
Enterprises, CSA Z1002 on OHS Hazard
Identification and Elimination and Risk
Assessment and Control, BSA PAS 1010
Guidance on the Management of Psychosocial
Risks in the Workplace, and Guarding Minds @
Work.
CG Hylton Inc. 36
37. Topics Included in the Standard
• Establishing commitment, leadership and
participation
• Understanding diverse ee needs
• Maintaining confidentiality
• Policy and planning process to implement the
system
• Identifying psych hazards, assessing risks, and
implementing preventive and protective
measures
• Infrastructure and resources required
• Providing education and awareness, and
ensuring key people are trained and competent
• Collecting data, monitoring and measuring
success CG Hylton Inc. 37
38. Training by the CSA
• CSA Group Learning Institute has
scheduled web-based training sessions
• Visit CSA.CA training for details
CG Hylton Inc. 38
39. Bell Let’s Talk
• Bell Let’s Talk is a 5-year, $50-million program to
promote Canadian mental health based on 4 action
pillars: anti-stigma, care and access, research, and
workplace best practices.
• With Bell Let’s Talk Day as its anti-stigma
centrepiece, Bell’s initiative is providing significant
funding for leading mental health hospitals and
grassroots organizations, driving new workplace
initiatives across corporate Canada, and supporting
new research.
CG Hylton Inc. 39
40. Let’s Talk Day - Feb 12
• For every text message, long distance call made
by Bell / Bell Aliant customers, and every tweet
using #BellLetsTalk, and every Facebook share of
our Bell Let's Talk message on February 12
• Bell donated 5 cents more to mental health
programs. In 2012, 78 million text messages,
long distance calls and retweets by 8 million
Canadians on Bell Let's Talk Day resulted in
• $3,926,014 in additional funding for
mental health.
CG Hylton Inc. 40
Source: Bell Press Release Jan 16, 2013. Jacqueline Michelis,
Bell Media Relations
41. Benefits Canada Poll
Has your organization taken steps to improve
psychological health?
• 60% No. We don’t see the need
• 14% Yes. We wanted to address existing
issues
• 26% We are working on this now
CG Hylton Inc. 41
Source: Benefits Canada Polls
http://www.benefitscanada.com/polls#topPoll
42. Benefits Canada Poll
Does your organization offer mental health
services and support for employees?
• 41% Yes, we have a robust program that
includes many services
• 26% Yes, but our program is still in progress
or only offers minimal services
• 15% No, but we plan to offer such services in
the future
• 19% No, we don't offer mental health services
CG Hylton Inc. 42
43. Benefits Canada Poll
Do you think the new workplace national
standard for psychological health and
safety will improve workplaces?
• 46% Yes
• 54% No
CG Hylton Inc. 43
44. Overview of the successful
Screening, Brief Intervention, and
Referral to Treatment (SBIRT)
substance abuse model
CG Hylton Inc. 44
45. Overview from “35,000
Feet”
Alcohol Screening, Brief Intervention and referral to Treatment
(SBIRT) is the leading way to help employees and businesses to
reduce the impact of unhealthy alcohol use.
Screenings
Brief Intervention
Referral to Treatment and Follow-Up
SBIRTScreening
Use a valid, brief (5 minutes or less)
standardized questionnaire about quantity,
frequency and consequences of alcohol use.
Referral to Treatment and Follow-up
Linking your client to specialized
addiction treatment and staying with the
client to support sustained success.
Brief Intervention
A behavior change strategy focused
on helping your client reduce or
stop unhealthy drinking.
46. Four Patterns of Alcohol Use
5%
20%
35%
40%
High Risk
Low Risk
Moderate Risk
No Risk
No Risk:
Those who never drink alcohol.
Moderate Risk:
Those who regularly exceed one of the recommended
daily, weekly or occasion limits for alcohol consumption.
Low Risk:
Drinkers who never exceed the
recommended daily, weekly and
occasion limits for alcohol consumption.
High Risk:
Those who regularly exceed 2 or more of the recommended
daily, weekly or occasion limits for alcohol consumption.
High Risk
5%
20%
Moderate Risk
35%
Low Risk
40%
No Risk
*Backgrounder | 2008 | The Case for
Low-Risk Drinking Guidelines for BC |
www.heretohelp.bc.ca
47. Recommended Low-Risk Drinking
Guidelines
• Men: 2,14,5 (< age 65) (US) No more than 2
drinks per day, 14 drinks per week, 5 drinks per
occasion
• 20 or less drinks per week (CA) to avoid health
damage*
• Women (and men 65+): 1,7,4 (US) No more
than 1 drink per day, 7 drinks per week, 4 drinks
per occasion
• 10 or less drinks per week (CA) to avoid health
damage*
CG Hylton Inc. 47
48. Workplace Intervention
• The workplace is a great place to establish
education, prevention and brief intervention
programs to impact one of the top three
avoidable killers today – unhealthy and
dependent alcohol use
• Few businesses use the simple, fast, inexpensive
and effective workplace programs described in
this training.
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49. Stats
• Nearly 80% of adults who have diagnosable
alcohol use disorders are employed.
• 40% of the B.C. population drinks too much at
least occasionally (e.g., hazardous use, binge
drinking)
CG Hylton Inc. 49
50. Costs to U.S. Employers
• Unhealthy drinkers are responsible for 60% of
alcohol-related missed work, poor work quality
and other work limitations.
• Unhealthy drinkers & dependent drinkers may
cause up to 40% of industrial fatalities and 47%
of industrial injuries.
• 20% of employees report being injured, forced
to cover for a co-worker or required to work
harder because of a colleague’s drinking.
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51. SBI IN WELLNESS PROGRAMS
• Alcohol screening can be included in
wellness programs.
• Employees can receive a stand-alone
screening or screening can be part of a
more comprehensive health risk
assessment that investigates a range of
health concerns including depression,
smoking, diabetes, hypertension and
obesity.
• When screening indicates that participants
may have alcohol problems, they can be
encouraged to contact an EAP or counselor.
CG Hylton Inc. 51
52. SBIRT Materials
• All free, All online
• All can be adapted for your use
• http://bigsbirteducation.webs.com/sbi
rttraining.htm
• www.rockymountainresearch.us
CG Hylton Inc. 52
54. 54
What is an
“Employer of Choice”?
• Any employer of any size in the public, private or
not-for-profit sector that attracts, optimizes and
retains top talent… because the employees choose
to be there
• Employees choose to work for your organization…
even when presented with other employment
opportunities
55. 55
Becoming an Employer of Choice
But does it really matter? Yes!
Nearly half of all American workers (49
percent) indicate that their companies'
brand, or image, played a key role in
their decision to apply for a job at their
respective workplace
56. 56
• Expectations
• Resources
• Do what I do
best
• Recognition
• Care
• Development
• Opinions count
• Mission
• Co-workers
• Best Friend
• Feedback
• Growth
First Break All the Rules
12 Good Questions Gallup
Buckingham & Coffman
58. 58
IPSOS Top 5 reasons for
staying in a job
1. like the work
2. like the co-workers
3. like the company
4. learning a lot
5. salary satisfaction
(Yes, this is in order of
preference)
59. 59
Conduct Discovery Interviews
What?
• Informal meetings, separate from
performance reviews.
Why?
• To emphasize each employee’s value.
• To understand his/her top motivators, job
satisfaction and any termination risk—so
that you can proactively address any
issues and focus on what really matters.
60. 60
Discovery Interview Questions
Job Satisfaction
What makes you want to come to work each day?
Job Content
Which particular projects/clients/assignments are
appealing to you?
Recognition
How can I make your day?
Manager Relationship
How can I be a more effective manager for you?
Retention
What is the number one reason you choose to continue
working for us?
61. 61
Benefit Plans that Work
• When paying employees it is wise to think
of how to maximize their compensation
• If you give them dollars, it is all taxable
• If you give them a benefit plan it is tax free
• If you are an owner or executive of a
company, you should run all your medical
and dental expenses thru a benefit plan or
health spending account
62. 62
Benefit Trends - Flex
• Traditional flex plans are
a pain
• Health Spending
Account gaining favour
• Tax effective
65. How will this change with the impact of an aging population, increase in
biologic drugs costs and the increase of chronic health conditions?
The Cost of Doing Nothing…..
$3,400
$3,800
$4,200
$4,600
$5,000
2009 2010 2011 2012 2013 2014
$3,701
$3,891
$4,119
$4,345
$4,584
$4,836
ActualCosts$
Total Benefit Costs Per Employee - Projected
65
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66. 66
Why Wellness
• Costs follow health risks
• Absenteeism, presenteeism &
productivity tied to health risks
• It pays to keep healthy people healthy
• Even small increases in physical activity
can produce results
• Gains in employee engagement can be
tied to wellness programs
• Programs do not have to be expensive
67. 67
Costs follow health risks
Annual medical
charges for
different ages
and health risk
groups
35-44
45-54
55-64
65-74
75+
Low Risk
Non-Participant
Medium Risk
High Risk
Low Risk
Non-Participant
Medium Risk
High Risk
Source: D. Edington.
Emerging Research: A View
From One Research Centre
68. 68
Absenteeism
University of Michigan study
• Workplace health promotion shown to decrease
absenteeism:
–10.5% in first year of implemented program
–14% in second year
• Translates into $1.22 - $1.63 savings per dollar
invested
69. Rx Drug stats a potential Wellness Tool?
69
CG Hylton 69
71. Compare Your Ees Rx Profile
71
• to typical usage profile
• Develop programs to educate
ees around major Rx uses
72. Question: are diseases preventable?
Are employers
able to
educate
employees
about
Tobacco Use Diet / Obesity Physical
Inactivity
Alcohol and
Drug Use
72
73. Employer Involvement
• Provide workshops in the four areas
• Link to the Rx profile to provide related
workshops and lunch and learns
• Provide wellness counselling for employees on a
voluntary basis
• Would this be expensive?
• Would it create change in employee health?
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74. Health Risks
High
Blood
Pressure
Type 2
Diabetes
High
Cholesterol
COPD
Lung
Cancer
Respiratory
Disease Cancer of
Pancreas,
Bladder, Kidney
Colon
Cancer Breast
Cancer
Prostate
Cancer
Cancer of mouth,
pharynx, larynx,
esophagus, liver
Heart
Disease
Mental
Disorders
Overweight
/ Obesity
Tobacco
Smoking
Unhealthy
Diet
Physical
Inactivity
Alcohol
Consumption
Musculoskeletal
Renal
Disease
Source: Ontario Ministry of Health and Long-term Care
CG Hylton 74
Source: Adapted from Sun Life Presentation, Healthy Outcomes
Conference, April 2008
75. 75
Case Study: Xerox Canada: Bwell
1. Assess ee health risks
2. Develop initiatives
throughout the year to
reduce and contain
health risk in supportive
environment
3. Measure success
Make participation
easy, non-threatening
…and fun!
76. 76
Step 1: Health Risk Assessment
BWell Cardiovascular Risk Assessment pilot program
– RN screens participants in a 15-minute appointment
– Measures blood pressure, total cholesterol, random
glucose, BMI and body fat
– Take away: personal scores and educational info on risk
factors
– Participants can be re-assessed each year
LifeWorks / Checkpoint HRA:
– Lifestyle – comprehensive risk assessment
– Can use the numbers received in the BWell assessment
– Access online
– Incentive / contest to get it going
77. 77
Step 1: Health Risk Assessment
• Risk factors identified year one (three pilot clinics):
– Smoking (19%)
– Systolic blood pressure (29%)
– Diastolic blood pressure (17%)
– Cholesterol (17%)
– Glucose (9%)
Source: Adapted from Sun Life Presentation, Healthy
Outcomes Conference, April 2008
78. Surprising Stats
• 72% fell into moderate to high risk
category for body composition and/or BMI
• Body composition is % of lean mass to fat
mass
• BMI is a weight for height ratio to estimate
body fat
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Source: Adapted from Sun Life Presentation, Healthy
Outcomes Conference, April 2008
79. Other Assessment Tools
Other risks EAP & OHS Reports
•#1 reason for STD: Psychological
•#1 EAP presenting issue: Stress and
work-life balance
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Source: Adapted from Sun Life Presentation, Healthy
Outcomes Conference, April 2008
80. 80
Activity Outcomes
BWell assessment Cardiovascular risk established
Bwell quarterly newsletter Information for staff and families at their fingertips
Spring fitness challenge Motivation: Create new habits in 30 days
Fall nutrition & wellness chall
Motivation: Nutrition
Create new habits in 30 days
Weight mgmt nutrition clinics Interactive onsite info session
Stress management
lunch & learn
Manage psychological stress,
build resilience
Ergonomics in the office Better posture, less strains & pains
Flu shots Flu prevention, reduced absenteeism
Step 2: Develop programs
81. 81
3a Measure success
Participation rates by ees
– Challenges engaged over 40%
– Cardio Vasc assessment: 25%
– Online assessment: 30%
– Lunch & Learn:s 15%
– Website: 60% (2288 unique users)
Source: Adapted from Sun Life Presentation, Healthy
Outcomes Conference, April 2008
82. 3b Measure success
Employee engagement
• 2007 Best 50 Employers Survey (Hewitt):
38th from 49th previously
• Xerox 2007 EES internal survey:
– 83% would recommend Xerox as a good
employer
– 86% are proud to work for Xerox
CG Hylton Inc. 82
Source: Adapted from Sun Life Presentation, Healthy
Outcomes Conference, April 2008
83. 83
3c Measure success
• 450 repeat participants
– 152 (38%) improved on four or more risk factors
• Weight loss
– 209 people (53%) improved
– 34 moved into a healthy zone
• 21 stopped smoking
ROI 2:1 after only one year into the program!
Source: Adapted from Sun Life Presentation, Healthy
Outcomes Conference, April 2008
87. Retirement has changed
• Organizations will feel impact of baby boom
retirement wave, just not hit yet
• This Wave is both a benefit and a problem
• Employers need talent, skills, knowledge,
experience
• Boomers need engagement, income, flexibility
and being valued
CG Hylton Inc. 87
88. Not your fathers retirement
• 60 or 65 and out
• Full pension or early pension
• With a life expectancy of 2 – 5 years
• WHY
• Another 10, 20, 30 or 40 years of life
• Switch from DB to DC pensions means less
income
• Just another stage of life
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89. Boomer Fears
• Unpredictability of their finances
• Downturn was a wake up call
• Fear outliving their money
• Fear more losses
• RSPs have replaced Defined Benefit plans
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90. 90
Older Workers Need to Work:
Insufficient Savings
0
10
20
30
40
50
1992-93 1996-97 2000 2007
Defined Contribution Defined Benefit
PercentageofWorkers
Source: U.S. Bureau of Labor Statistics CG Hylton
91. What boomers want
• To be valued, engaged, part of something
• To work for an employer that permits them to
create a flex schedule
• Renewed rejuvenated
• Active growing and learning
• Free time, flex time
• Extended time off
• Consulting work
CG Hylton Inc. 91
92. Phyllis
Diller
Whatever you may look like, marry a man
your own age - as your beauty fades, so
will his eyesight
I’m at an age when my back goes out more
than I do
CG Hylton Inc. 92
93. What boomers offer
• As productive or more productive
• Cost the same
• Superior communication skills
• Less likely to leave the job after short time
• Lower training costs
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94. Case Studies
• Career Lattice Program
• Ees can dial up, down, across career path
• Flexibility in ways to work
• Custom when, where, how
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95. CG Hylton Inc. 95Source: Deloitte
MassCareerCustomization_051310.pdf
96. • Best Companies for Multicultural
Women, Working Mother, 2012
• 100 Best Companies to Work For, Fortune, 2010
• Best Places to Work for LGBT Equality, Human
Rights Campaign, 2010
• Best Companies to Work for in Texas
(Large), Best Companies Group, 2010
• Employees’ Choice -50 Best Places to
Work, Glassdoor, 2009
CG Hylton Inc. 96
97. Adapting the workplace
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• Falls are the leading cause of hospitalization due
to injury for Canadians 65+
• one in three expected to experience this life
altering moment this year alone
• offices with flexi-floors, when those falls do
occur, special new “bouncy floors” could reduce
the risk of serious injury
Source: http://www.50plus.com/employment/new-
technology-could-help-older-workers/161615/ accessed Aug
11, 2012
98. Smart Canes
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• Another invention called Smart Canes, will
allow real-time feedback on proper gait and
alert a worker’s colleagues by text if a fall
occurs.
• “It’s a floor that’s compliant enough to prevent
injury in case of a fall, but hard enough that you
can do normal activities on it,” noted Feldman.
• Initial tests show that it could reduce hip
fractures up to 80 per cent.
99. 99
The Work Environment
• The spaces where we work
affect how we age
• We have control over how
workplaces are designed
• Work environment issues
are aging issues
– Physical demands of work
– Lighting and vision
– Cognitive demands of work
• We can design age friendly
workplaces
CG Hylton
100. Air bags
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• Workers will also have the option of of
wearing a belt with built-in
air bags that will deploy when the sensor
detects a fall
• Those with balance problems could
wear them as part of their regular
office wear
Source: http://www.50plus.com/employment/new-
technology-could-help-older-workers/161615/ accessed
Aug 11, 2012
102. Chris Hylton, MA
• Chris - benefit and HR consultant
• EAP network with counsellors across Canada
• Volunteer with many organizations including
Employee Assistance Society of North America and
the Aboriginal Friendship Centre of Calgary
• Patient Engagement Researcher in training thru U of
C School of Medicine and Alberta Health
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