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Organizational Health

Organizational Health refers to an organizations ability to achieve its goals based on an environment that seeks to improve organizational performance and support employee well-being. While these two perspectives are very different, a nexus between them means issues in one affect the other. Improving organizational performance involves applying a systems thinking approach at organization, process, and role levels, and supporting employee well-being involves addressing both employee satisfaction and employee health (physical, mental, and social). Organizational health and employee well-being audits provide the means whereby an organization can continuously learn how to improve itself.

1. Organizational Health

1.1 Organizational Performance and Employee Well-being

Organizational Health refers to an organization's ability to achieve its goals based on an environment that seeks to improve Organizational Performance and support Employee Well-being[1].

Organizational Health, as a concept, reflects two perspectives:

• Organizational performance, based on the organization performing as an interacting system; and

• Employee well-being in terms of employee satisfaction and employee health.

A generic model of Organizational Health is shown in Figure 1 that incorporates both perspectives, providing examples of what can be considered when assessing and improving Organizational Health.

One way of recognising why attention should be given to addressing Organizational Health is to consider characteristics of unhealthy organizations. Unhealthy organizations can reflect, for example, lack of direction and accountability; misalignment of priorities; and poor coordination in and between systems and processes causing both costly inefficiencies and ineffectiveness. Unhealthy organizations can also demonstrate low employee commitment and disengagement as reflected in the costs of dissatisfaction, damaging conflicts, suppressed resentment, unnecessary absence, turnover, and presenteeism.

1.2. Organizational Performance Based on Human Activity Systems (HAS)

"any group of interacting, interrelated, or interdependent parts that form a complex and unified whole that has a specific purpose" [6]

To explain in practical terms how a systems approach to organizational performance can assess, develop, and improve Organizational Health, a Generic Human Activity System (HAS) with four key components is used. The four Key Components are:

Figure 2 examples this generic Human Activity System model with its four key components made up of "Meaning" that gives common understanding and direction to the system's "Means" and "Relations" components. These three components, in the way they interact and perform, affect the ability of a Human Activity System to achieve its Purpose [7].

In a Generic Human Activity System, the term "system" draws from two different sources:

• Systems Thinking. Organizational Health, and the Generic Human Activity System, uses a "systems thinking" approach to focus on improving interactions affecting organizational performance, productivity, and employee well-being.

• Management Systems. Within the "Means" component, the term system refers to management/ performance/ production/ architecture systems that focus on designing, managing, and controlling prescribed processes upon which the organization runs, where emphasis is on addressing "compliance" gaps between prescribed and actual outcomes. For example, in systems managing the application of legislation, regulation, and standards (e.g. HR Administration Policies, WH&S Management system, Financial Management systems) and the setting and achievement of targets & aims (e.g. Corporate and Employee Performance Management systems, and operating systems).

1.3 Human Activity Systems Operate at Multiple Levels

Human Activity Systems (HAS) are identifiable at Organizational; Process; Role (team and job) levels [8]. The organizational reporting structure in Figure 3 illustrates at organizational, process, and role level a number of Human Activity Systems drawn around identified problem situations. For example Human Activity Systems are drawn around:

• The Organizational Structure mapping the area affected by a lack of accountabililty;

• Function C mapping a Service Function area providing poor service;

• Functions A & B mapping an area with poor coordination across Functions that have interdependent processes (1, 2, 3, 4, 5 & 6) in providing delivery to external customers;

• Team 6 mapping an area with unsatisfactory team performance.

In these examples, addressing issues involves considering all the components of a Human Activity System, and not just the obvious part. For example, in an organizational structure the lack of accountability may have been identified as the problem situation, however in addressing this may also involve considering:

• Role redesign (Means);

• Change in "core" attitudes (Meaning) over their role accountability;
• Changes in the way managers are expected to work together (Relations); and
• Improved alignment between the organizational structure, roles; and work relations in achieving organizational objectives (Purpose).
  

Not all Human Activity Systems can be so graphically mapped against an organization's reporting structure, as shown in Figure 3. In Table 1, problem situations at different levels of an organization begin to be mapped into Human Activity Systems starting with a key component (e.g. Means) where problem situations are found.

Figure 4 shows an example of a Human Activity System applied to improving Health Care Services [9]. The Human Activity System shows the interrelationship between its key components, and the Human Activity System operating across multiple levels.

In considering approaching Human Activity Systems from organization, process, and role levels, the key components of a Human Activity System highlight factors relevant to that key component at that level, as exampled in Figure 5.

1.4 Improving Organizational Performance Through Alignment

The usual approach to improving performance and productivity is based on attention to variance in time; rate; quality; service, and cost around which management systems develop either incrementally, or transformationally as occurs in major system changes.

In contrast, Organizational Health seeks to improve performance and productivity through improved alignment. Human Activity Systems can be seen to operate at multiple levels of an organization, as described in Section 1.3. The purpose of these systems can be focused "horizontally" across an organization to improve the efficiency and effectiveness of organizational performance. The purposes of systems can also be "vertically" aligned to fit and link into strategic plans and organizational objectives in order to sustain an organization's ability to adapt to changing stakeholder and organizational needs [10].

Within a Human Activity System, the performance of individual key components can also be improved through alignment, for example:

• Competence: Improving competence of one or more of the key components, such as mindset, work design, and work relations, that better achieves a system's purpose. For example at role level, improving the technical competence in a role so the role is more effective.
• Interface: Improve the alignment between key components as a means of improving internal consistency and the system's performance. For example improving the interface between work processes within an operation, or the way work processes and employee work practices interact.
• Conflict: Reduce unhealthy conflict and improve collaborative work relations. For example, improving group dynamics in a team or management style to fit work situations.

2. Employee Well-Being

2.1 Employee Satisfaction

One perspective of employee well-being is considering employee attitudes over their job satisfaction "plus" [11]. That is to say employee attitudes toward their roles, and the consequences of those attitudes. The "plus" refers to physical and mental health issues such as work related stress.

Employee Satisfaction Surveys cover areas such as pay, benefits, interpersonal relations, participation in decision-making, role design, and work stress that are causing dissatisfaction and unhealthy stress. More recently, Organizational Climate Surveys identify the extent the work environment is personally beneficial or damaging/painful to a person's sense of well-being through factors such as leader support, management concern, job autonomy, work relations, work demands, and role clarity [12].

Reasons for paying attention to employee satisfaction includes the view that a positive organizational climate enhances motivation and increases the likelihood that an employee will allocate discretionary effort to their work, and that it assists in employee retention.

In seeking to improve organizational health, feedback from stakeholders, both internal and external, is of particular importance as the purpose of "systems" within an organization can be viewed as ultimately focusing on satisfying both the wants and needs of not only key external stakeholders but also key internal stakeholders such as employees [13]. Refer to Figure 6.

2.2 Employee Health

The World Health Organization (WHO) and International Labour Organization (ILO) define the aim of occupational health as [14]:

The promotion and maintenance of the highest degree of physical, mental and social well-being of workers in all occupations by prevention of departures from health, and controlling risks.

This highlights three aspects of employee well-being:

1. Employee Well-being is prescribed as Physical, Mental, and Social in nature;

2. Risks to Employee Well-being should be controlled;

3. Employee Well-being involves promotion, maintenance, and means of preventing departures.

Figure 7 resets these three aspects suggesting:

1. The work environment contains hazards that affect Employee Well-being;

2. The organization should develop Risk Management Systems to identify, assess, and manage uncontrolled environmental risks to Employee Well-being;

3. Employee Well-being should include personal development as a means of promoting employee physical, mental, and social well-being.

Figure 7 indicates that these three Well-being domains are not isolated, but interact with each other. For example, physical hazards such as excessive noise can cause mental distress, and antisocial behavior can result in mental distress. Additionally, there is a continuum between risk management and personal development as to means of addressing Employee Well-being.

Figure 7 illustrates physical, mental, and social well-being addressed through a risk management approach to work environment hazards, and, additionally, addressing personal health hazards through:

• Wellness programs to improve employees physical health;

• Emotional and cognitive development programs to improve employees mental resilience and comprehension to add value and contribution to theirs and others lives on a personal and vocational level; and

• A work culture that encourages pro social behavior to support employee and team collaboration.

The result of Workplace Health and Safety legislation can place pressure on an organization to prioritize both physical health, safety and mental health (e.g. stress) issues over social health issues, though all levels contribute not only to employee well-being but also to an organization's health (e.g. costs from physical and stress injury claims, presenteeism, employee disengagement, and turnover).

Social Well-being involves addressing the socially unfair treatment of employees. Such unfair treatment may be may be redressed through enforceable legislation, depending upon a Country's legislation. For example, there is labor law protecting employees from discrimination based on their sex, race, age, disability, religion, and from harassment.

Unfair treatment by an employer can affect more than one employee and result in Systemic Unfairness.

Systemic Unfairness is:

Ongoing actions, practices, and attitudes within an organization that knowingly or unknowingly allow employees to be (or feel) unfairly treated. [15]

In some cases, systemic unfairness may go unrecognized by an employer by being built into "neutral" and accepted practices that are nevertheless illegally discriminatory. For example, a belief that only men can, or should, do certain type or work.

Figure 8 illustrates the difference between illegal discrimination and systemic unfairness. Illegal discrimination refers to the interpretation of legislation set up to protect individuals from particular sections of the community in the way they are treated, and in the case of harassment the protection of all employees' health and safety.

Psychological contracts relate to employer and employee expectations of the other within the employment relationship, and influences the behavior of employees [16]. Such expectations may be informal and assumed, based on past actions and employer statements. Employee perceptions of the psychological contract can become negative with employees demonstrating negative behavior if the contract is viewed as having been breached. For example, where an employer exceeds an understanding of an employee such as when an employee is pressured into working excessive hours. Similarly, the trust in the contract relationship can be breached if there is a change in employment security.

A Social Contract, in comparison, is an unwritten and tacit agreement among members of a community or group that guides employee behavior in establishing rights and responsibilities [17]. This agreement therefore could result from associating with a social group outside of the organization. For example, dissatisfaction with the employer's employment conditions where a previous employer's employment conditions and employee treatment is perceived to have been better. Alternatively, dissatisfaction can arise from expectations that develop based on the employee's family or social group, such as a religious group.

Figure 9 illustrates how these variations can play out.

Pro-social behavior can be encouraged through the application of behavioral competencies. Behavioural competencies refer to:

Behaviors that employees demonstrate when effectively undertaking role-relevant tasks within a given organizational context [18].

Examples of Pro-social behavioral competencies are "Teamwork" and "Interpersonal relations" that can be sought of an employee in carrying out their role. That is, they are part of a Role's selection criteria, and employee's performance assessment. A Pro-social behavioral competency can also be a "core" competency sought of all employees by an organization as part of the values an organization wants to promote.

Unhealthy stress occurs whenever there is a departure from optimum conditions which an employee finds difficult, or unable, to cope with. It arises from the effect of exposure to stress risk factors in the work environment that an employee considers important where the extent of this exposure can vary from too little to too much [19], as exampled in Figure 10.

Where:

Eustress, results in a healthy response (e.g. collaborative problem solving that encourages personal growth and development)

Distress, results in an unhealthy response (e.g. anxiety and depression)

Hypostress and Hyperstress, results in an unhealthy extreme response extremes (e.g. too much or too little intrapersonal conflict).

Means of addressing unhealthy stress usually require one or more changes to the work environment and can include factors such as work demands; low levels of control; poor support from supervisors and/or co-workers; lack of role clarity; poorly managed relationships; low levels of recognition and reward; poorly managed change; and organizational justice [20].

The application of a Stress Risk Management Audit provides the basis for identifying and assessing underlying causes of stress, and determining what actions should be taken.

Personal development involves transformations and transitions. Personal transformation involves a person, as a conflict manager, adjusting their social interactions to better manage in their work environment. This can be associated with a shift, a transformation, in the way they perceive themselves. For example, an employee may need to adjust their perceptions of themselves and the way they manage their interactions with others because they are either being treated, or are treating others, in a manner that is causing distress [21].

An employee's work environment can also change involving an employee to respond by undergoing a personal transformation to successfully manage a role transition, such as occurs in a promotion to a different organizational level where the role requires the employee to act and think quite differently. For example, where a supervisor whose role is to ensure pre-specified quality and service outputs are achieved using prescribed standards and related competencies is promoted to a manager role managing a "mini organization" and is expected to create improvements in products, systems, and services [22].

Physical well-being is addressed from two perspectives:

Physical Well-being is dependent upon the level of risk an employee is exposed to resulting from hazards within the work environment. Thus, identifying, assessing, and managing risks resulting from environmental hazards are a matter to be addressed. In this respect:

A Hazard can be described as the capacity of a physical, chemical, or biological "agent" to cause an unhealthy effect;

A Risk can be described as the probability, in a certain amount of time, for an adverse unhealthy outcome to occur if exposed to a level of force, level of exposure, or level of toxicity (of a hazard).

Physical well-being can not only involve managing environmental hazards but also preventing health hazards through disease prevention and healthy lifestyle by, for example, increasing awareness through health promotions, screening for health hazards, and counseling employees [23]

The relationship of environmental and employee health hazards to risk management is illustrated in Figure 11 [24].

3. Improving Organizational Health

3.1 Collaborative Change Management Projects

The Collaborative Change Management (CCM) process is relevant where organizational conflict management is the key issue in an organizational change [25]. For example where interpersonal conflicts block, or are anticipated to block, a change sought by the organization.

The Collaborative Change Management process can also be linked to the stages of a standard project management process as a means of addressing latent and manifested stakeholder conflicts prior, during, and subsequent to a change.

The CCM Process has four Stages and places emphasis on collaboration and using conflict management methodologies. For example:

Stage 1. Analyze the situation.

Analyze the situation surrounding a proposed change. This can include steps such as a preliminary review to identify issues and stakeholders involved; explore understanding by collecting information; and assessing the overall situation.

Stage 2. Develop a Plan.

Develop an implementation plan, taking into account the issues identified in Stage 1. The development of this plan involves collaborative approach and incorporates the results of consultative feedback.

Stage 3. Work through the Plan

Implement the plan using a range of supporting conflict management techniques such as consultation, collaborative problem solving, and group facilitation techniques that help address stakeholders concerns and implementation. The emphasis is therefore on direct and personal communication where possible, and to address conflicts that can affect agreement and support of proposed changes.

Stage 4. Complete & Follow up

On implementing the change, either a review after a specified time and/or the ability of stakeholders to provide feedback is relevant to settle in a change and address loose ends.

3.2 Organizational Health and Employee Well-being Audits

Organizational Health Audits provide evaluative means to identify performance and well-being "gaps" within an organization's work environment. Organizational Health Audits assess a range of interactions (e.g. work practices and workplace relations) and their healthy or unhealthy consequences at organizational, process, and role levels. Equally, the social, mental, and physical wellness and well-being of employees can be assessed through a range of Employee Well-being Audits.

Audits have prescribed and different criteria to assess organizational performance or employee well-being, yet each, in different ways, represent differing and important aspects relating to Organizational Health. These audits can also involve the application of different models and legislative frameworks relevant to the audit process. Audits can also involve a range of methodologies such as surveys, workshops, and/or interviews as means of gathering information, depending upon the size of an audit. Audits may therefore be quick and simple lasting no more than a few hours, or draw out to a few days in search of recommendations to address "messy" and complicated problems.

Figure 12 illustrates the link between Organizational Health and assessment methodologies.

Organizational Heath Audits are multileveled, seeking underlying causes to issues. Figure 13 examples Organizational Health Audits as a continuous improvement process with feedback loops based on triple loop learning [26]. In this way, Organizational Health incorporates a dynamic systems thinking approach, and supports the concept of a continuous learning organization.

3.3 Organizational Health as an Improvement Program

To establish Organizational Health as an ongoing continuous improvement system applicable across an organization a three-staged Continuous Improvement Cycle of "Plan, Implement, and Review" (PIR) may be considered.

In Figure 14 a Continuous Improvement Cycle of Plan, Implement, and Review (PIR) is aligned to the Organizational Health model. It should be noted, however, that in implementing Organizational Health as a continuous improvement system there is an initial assessment stage (which uses assessment', review' or audit' tools) to set up the PIR cycle.

Conclusion

Organizational Health, as a concept, continues to evolve drawing from two distinct themes. One theme relates to the organization as a performance system and its ability to achieve organizational goals. The other theme relates to employee well-being and the impact of employee satisfaction and employee health upon both the organization and employees.

A Generic Human Activity System is used to provide a practical approach to Organizational Health, where improving an organization's performance takes a systems thinking approach at organizational, process, and role levels. This in turn suggests the need to improve the alignment within and between key components that make up such Human Activity Systems. Organizational health audits are a means of assessing and improving organizational performance at organizational, process, and role levels using feedback based on stakeholder satisfaction with services and deliveries from these systems. In this sense, organizational health audits cover both the improvement of organizational performance and employee satisfaction.

Employee well-being involves addressing employee health at a social, mental, and physical level. Problems relating to employee health incurs costs upon both the organization and employees. In addressing employee health both negative aspects causing risks and positive aspects that protect and develop employees, and support the achievement of organizational health are considered.

Organizational Health and Employee well-being audits provide the means of supporting a continuously improving, and learning, organization: A Healthy Organization.

Notes:

[2] A brief background on the historical perspectives covered under the term Organizational Health is available in Organisational health: A new perspective on performance improvement? published by the NHS Institute for Innovation and Improvement. A causal relationship between organizational health, organizational performance, and employee health and well-being is also briefly referred to.

[3] Both the NHS Institute for Innovation and Improvement in Organisational health: A new perspective on performance improvement? and the Mckinsey & company in The Missing Link' refer to Soft' factors that can improve organizational performance such as Direction; Leadership; Accountability; Coordination & control; external orientation; capability; environment & values; motivation; and Innovation. ComCare in Building a case to invest in OHS and organisational health also identify seven elements: Direction, Leadership; Capability; Governance; Relationship; and Culture. ComCare's elements similarly reflect these "soft" factors.

[4] Mckinsey & company in The Missing Link includes areas such as Accountability, Coordination & Control, while European Network for Workplace Health 2009 Promotion also refers to the "work organisation". Dive dedicates a book to explaining how to improve accountability as a means of improving organizational performance in The Healthy Organization.

[5] In Improving performance and quality of working life: A model for organizational health assessment in emerging enterprises, Shoaf, Genaidy, Karwowski, and Huang provide an historical background to the development of the concept of organizational health in the United States, and refer to Organizational Health as a system of interrelated components, analogous to biological health.

[6] The description of what a "system" is, is taken from Introduction to Systems Thinking by Kim (1999, p2).

[7]. In this article the variables used are loosely based upon those found in the concept of a Human Activity System (HAS). The Human Activity System, as used in the article, is a system with a Purpose and the activity of the system involves "hard" "means", and "soft" "relations" supported by a "World View" or sense of "meaning". The term Human Activity System (HAS) was coined by Peter Checkland to cover "a set of activities so connected as to make a purposeful whole" (Soft Systems Methodology in Action), and the Human Activity System variables as used in this article are drawn and adapted from a discussion on system concepts by David Patching in Practical Soft Systems Analysis. The application of a Human Activity System is applied to both actual and "notional" systems, and separated from Checkland's Soft System Methodology, where a Human Activity System is applied in a quite specific way and to reflect "notional" or "ideal types" of solutions to problem situations (refer to Systems Thinking, Systems Practice, Glossary of an HAS). In the way a Human Activity System could be analyzed in this article, a methodology consistent with a Human Performance System (HPS) could be applied, refer to a brief explanation of HPS by Alan Ramais in The Human Performance System. More specifically the application of the Nine Performance Variables matrix found in Rummler and Brache (1995). For example, in that Matrix, Goals could equate to Purpose; Design and Management to Means; with Relations and Meaning opening out the matrix to performance issues more associated with a Human Activity System.

[8] In Improving performance and quality of working life: A model for organizational health assessment in emerging enterprises, Shoaf, Genaidy, Karwowski, and Huang propose a model covering a four orientation approach to organizational health. These orientations being: the organization, process, job, and individual. Rummler & Brache (1995) in Improving Performance: How to manage the white space on the organization chart also view organizations as systems, identifying three levels of performance: Organization, process, and job/performer

[9] Figure 4 is adapted from Figure 1 in Organizational climate of staff working conditions and safety - an integrative model. A difference is that "Work Design" would also include "hard" process issues relating to organizational performance not normally sought in climate surveys.

[10] Improving integration is referred to in Armstrong (2004 p8, 9). "Horizontal" integration is treated differently in this article, though the concept of "bundling" (i.e linking "inputs" required to achieve an output) seems to fit with a systems thinking approach. With regard to "vertical" integration there is consistency, and they both appear to complement the definition of Organizational Capability described by Ulrich & Lake (1990 p40). That is, organizational capability is "a business's ability to establish internal structures and processes that influence its members to create organization-specific competencies and thus enable the business to adapt to changing customer and strategic needs".

[11] The term Well-being in terms of addressing employee satisfaction as discussed in Work and Well-being by Warr & Wall (1975).

[12] The Queensland Public Agency Staff Survey (QPASS) is an example of an organizational climate survey that seeks employee opinion. Climate surveys focus on aspects of an immediate workplace that effect employee satisfaction such as supervisory style, participation in decisions affecting an employee, role clarity, and workload. Survey responses can lead to changes in work practices to improve employee satisfaction.

[13] The wants and needs of stakeholders are reflected in Performance and Health: In search of sustainable excellence by McKinsey and company and in The Performance Prism: The scorecard for measuring and managing business success by Neely, Adams, and Kennerley.

[14] Williams (1994, p8) includes a definition of the aims of occupational health by the World Health Organization (WHO) and the International Labour Organization (ILO). In that definition of occupational health well-being covers physical, mental, and social health of workers.

[15] Systemic Unfairness is based on the concept of systemic discrimination which are practices, laws, or attitudes, viewed as neutral and sometimes acceptable, but which entrench inequity and disadvantage to certain groups of people (based on Responding to systemic discrimination).

[16] Material on the Psychological Contract is based on the model to be found in Employee Well-being and the Psychological Contract of which a simplified model can be found in Managing Change: The role of the psychological contract.

[17] This description of a social contract is based on that found in the Business Directory.

[18] The description of what a competency is can be found in A Practical guide to competencies (2006) by Whiddett & Hollyforde. Their publication provides an explanation of what is meant by behavioural competencies, the development of behavioural based Competency Frameworks, and their application to areas such as Selection and Employee Performance Management.

[19] In Introduction to Stress Theory, the Cox and Mackay Model is described as four major stress response types; Eustress, distress, boredom, and exhaustion. The latter two described here as Hypostress and Hyperstress respectively. Their model's dimension of "Demands" is changed to "Conflict Intensity" and the "Performance" dimension to "Stress Response".

[20] An identification and explanation of Occupational Stress Risk Factors can be found on the Occupational Health and Safety Queensland website. Stress Risk Management Audits use stress risk factors as audit criteria to identify, risk assess, and recommend action to improve the well-being of employees.

[21] The approach to personal transformation draws from The Promise of mediation: The transformative approach to conflict (2005). Personal Transformation involves addressing both intrapersonal (internal) conflict and developing appropriate conflict management techniques to manage situations. In this respect examples in Conflict Coaching: Conflict management strategies and skills for the individual (2008) are viewed as reflecting this form of personal transformation.

[22] In Understanding professional competence: Beyond the limits of Functional Analysis Holmes refers to transition in terms of a promotion where a manager has to let go of past skills and behaviour patterns, that were previously successful and now ineffective, and adopt new ways of understanding what is involved in being a manager in the new situation. Dive (2008) in The Accountable Leader: Developing effective leadership through managerial accountability refers to the need to identify different levels of accountability (referred to here as Transition Levels). Other writers use alternative terms such as "Work Levels" and "Impact Levels" as is intended here under the term "Transition".

[23] An explanation of well-being from a health and wellness perspective is provided in Sloan Work and Family Network Glossary on Health and Wellness, definition(s) of.

[24] The description of a Hazard and a Risk, and the Risk Management Model are adapted from Guidelines for assessing human health risks from environmental hazards. The concept of Employee Health hazards has been added to this model to incorporate wellness aspects that fall within an Organizational Health perspective.

[25] The Collaborative Change Management process is mentioned in Healthy Organizations from conflict management: How conflict management helps manage change, performance and well-being. In that Google Knol reference is made to Claremont & Davies (2005) who use the more general and embracing term of Collaborative Conflict Management to provide examples of this approach applied to whole groups and organizations.

[26] An explanation of Triple Loop Learning is found in the Kansas Prevention WIKI. Both Brian Dive (2004), and Britten in Organizational learning and organizational health, view a Healthy Organization as a learning organization.

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