Systems Approach to Organizational Health

Nicholas A. Lofton

December 1, 2017

The University of Houston Downtown

Systems Approach to Organizational Health 2

ABSTRACT

Health cannot be defined as one single variable, making identifying healthy attributes in

individuals a ceaselessly ending effort. Organizational health can also be many variables;

however, health can be evident by a systems’ efficiency. Individuals are limited by the

effectiveness of their body – the human movement system. Principle investigator has found

organizational stress influences an individual’s stress level, which can transmit to

musculoskeletal dysfunctions of the human movement system. The Functional Movement Screen

(FMS) will be used to determine what compensatory patterns are present at baseline and a

goniometer will measure various joints’ degree of range of motion (ROM). Once data has been

complied for individual health, organizational health data will come from the organizations

themselves providing information on performance, attendance, absenteeism, turnover, healthcare

expenditures, productivity, and costs. After all data has been collected, a t-test will be used to

compare mean job performance and the presence of musculoskeletal dysfunctions. ANOVA test

will examine how the totality of an individuals’ health influences organization’s health as a

whole. Results will likely show an individuals’ health status correlates with the level of health

within an organization.

Keywords: Organizational health, Occupational stress, Work-life balance, Employee well-being,

Musculoskeletal dysfunctions, Systems Theory

Systems Approach to Organizational Health 3

TABLE OF CONTENTS

Abstract ..................................................................................................................................2
Introduction ............................................................................................................................4
Purpose of Study ........................................................................................................5
Literature Review...................................................................................................................6
Conclusion .................................................................................................................11
Methodology ..........................................................................................................................12
Sample........................................................................................................................12
Instruments .................................................................................................................12
Operational Definition of Independent Variable .......................................................12
Operational Definition of Dependent Variable ..........................................................13
Procedures ..................................................................................................................13
Research Design.........................................................................................................14
Null Hypothesis .........................................................................................................14
Ethical Considerations ...............................................................................................14
Results ....................................................................................................................................15
Discussion ..................................................................................................................17
Discussion of Anticipated Findings ...........................................................................17
Limitation of Findings ...............................................................................................17
Areas for Further Research ........................................................................................17
References ..............................................................................................................................18
Systems Approach to Organizational Health 4

INTRODUCTION

Movement – the human body is made for this. The human movement system relies on

two main sub-systems; the nervous system and the musculoskeletal system which subsequently

can be broken down into more sub-systems (Clark et al., 2014, p. 17). If any of the sub-systems

are not functioning properly, all other sub-systems will be hindered and ultimately the whole

human movement system will be affected. Based on the research by Janda (1988) theorizing

muscle imbalances, the principal investigator chose to measure what effect individuals’ health

have on organizations’ health as a whole based on Systems Theory (Ludwig von Bertalanffy)

(1951, 1967).

Systems are constantly exchanging energy, striving to keep an equilibrium and maintain

homeostasis (Sayin, 2016). Organizations and corporations are no exception, they too are bound

by the same innate laws. Ludwig von Bertalanffy (1951, 1967) conceptualized Systems Theory

which translates a biological theory into an organizational theory. Each part of a system is

interrelated and systems are organized as wholes (Wood, 2004, p. 162).

Pattern overload, with respect to the human body, is a constant repetitive motion (Clark et

al., 2014, p. 170) of the human movement system. This repetitive motion, such as baseball

pitching, moving boxes, or even sitting for long periods of time can place abnormal stress on the

human body. Davis’s law (1867) explains when dysfunctions arise, our body responds as it

would to an injury; trauma to tissue creates inflammation which triggers the body’s protective

mechanism causing an increase in muscle tension and muscle spasms. Inelastic collagen matrices

form along the lines of stress (adhesions) in soft tissue around the tense muscle fibers. This

causes overlapping length-tension relations (leading to altered reciprocal inhibition), reduced

force-couple relations (leading to synergistic dominance), and arthrokinetic dysfunction (leading

Systems Approach to Organizational Health 5

to altered joint motion) which, when our brain sends an electric pulse from the central nervous

system to the peripheral nervous system and into the dendrites of muscle fibers, adhesions inhibit

proper movement of the proteins myosin and actin when interacting in the muscle cell thus

causing musculoskeletal dysfunctions (Clark et al., 2014, p. 170-172).

The American Psychological Association (2012) developed the Stress in America survey

and administered it online in the United States by Harris Interactive. The study shows 41% of

employees feel stress and tense while at work (2012a). Another study reports 70% of adults sight

work as a significant source of stress (2012b).

Purpose of Study

RQ1 “Is there a relationship between an individuals’ health, evident by musculoskeletal

dysfunctions, and the health of the organization, evident by performance, attendance,

absenteeism, turnover, healthcare expenditures, productivity, and costs?”

Systems Approach to Organizational Health 6

LITERATURE REVIEW

Munir et al., (2015) studied the relationship between work engagement and occupational

sitting time of Northern Ireland Civil Service (NICS) office-based workers. Out of 26,000 survey

links sent, 5,235 employees (20% response rate) returned the questionnaire. Questionnaires

completed by manual workers and non-permanent staff (n = 641) and office-based workers with

missing data (n = 158) were excluded, resulting in 4,436 questionnaires (1,945 male and 2,491

female) used in analyses. Total mean occupational sitting time was 379.63 minutes per day (s.d.

98.3); this was lower for men (362.4 minutes/day; s.d. 112.5) compared to women (385.7

minutes/day; s.d. 98.9) (t = 7.32; df =4434; p < .0001). Chi-Square analyses revealed the amount

of men (35.9%) reporting low occupational sitting times was significantly greater than for

women (31.3%); and the proportion of women (31.0%) reporting high occupational sitting times

was less than for men (35.2%), (χ2 = 12.89, df = 2 p < 0.002). More women than men reported

high dedication (n = 1108, 44.5% versus n = 806, 41.4%; χ2 = 9.68, df = 2 p < 0.008); high

absorption (n = 1099, 44.1% versus n = 643, 33.1%; χ2 = 53.91, df = 1 p < 0.0001); and work

performance (n = 2054, 82.5% versus n = 1336, 68.7%; χ2 = 115.48, df = 1 p < 0.0001). Higher

work engagement and job performance shows a correlation with lower occupational sitting

times.

Zehetmeir et al., (2015) gathered data from a study, dating back to 2006, of teachers in

Australia who have completed the PFL program (German acronym for ‘Pädagogik und

Fachdidaktik für Lehrinnen und Lehrer’, meaning ‘Pedagogy and Subject Didactics for

Teachers’) (2006) which demonstrates how to put theoretical accounts (Systems theory,

Constructivism, Action research) into practice. A sample of 131 teachers from different types of

schools’ data could be tracked over time, overall a total of 262 teachers participated. Of those
Systems Approach to Organizational Health 7

131, 69% were female and 27% were male (4% did not specify their gender, average was 41

years (standard deviation [SD] = 9.4). While the lowest value at t1 is Mt1 = 3.15, SDt1 = 0.70,

over time there shows to be a significant increase of participants’ interests, particularly in the

PFL program focus areas. In addition, teachers’ assessment of their own possessed knowledge

showed an increase in all four areas as well.

Bonzini et al., (2014) studied musculoskeletal pain as a cause rather than a consequence

of perceived occupational stress. Researchers in Varese, Italy reached out to 518 nurses, of

which 409 responded (79.0%) to complete a questionnaire from the CUPID study (Cultural and

Psychosocial Influences on Disability) (Coggon et al.) (2012), and the Effort Reward Imbalance

(ERI) questionnaire (Siegrist) (2000). A second follow-up questionnaire was sent out after 12

months to 322 participants (78.7%), 305 participants’ data remained after exclusions.

Participants were 82% female (250), mean age at baseline of 39 years (SD = 9 years), and mean

BMI (body mass index) of 24 kg/m2 (SD = 4.5 kg/m2). From the 305 participants, 55 (18%) had

an ERI >1, 159 (52%) reported LBP (low back pain), and 177 (58%) reported NSP

(neck/shoulder pain), of which 122 (40%) complained of having both LBP and NSP. The risk of

perceived occupational stress (ERI >1) at follow-up then at baseline doubled overall risk of

occupational stress (RR 2.1, 95% CI 1.4–3.3), however, this only included nurses who were free

from occupational stress at baseline (RR 2.7, 95% CI 1.4–5.0) and did not extend to those who

started with ERI >1. This study found only a small increase in the risk of subsequent

musculoskeletal pain from perceived occupational stress, whereas report of pain at baseline

carried a substantial increase in the risk of newly developed stress at follow-up. This study shows

that workers who report musculoskeletal pain are more likely to develop subsequent

apprehension of stress.
Systems Approach to Organizational Health 8

Blazovich, Smith, and Smith (2014) studied the impact on financial performance and risk

levels of employee-friendly companies, especially those with work-life balance programs in

place. Researchers created two datasets: the ‘full dataset’ and the ‘match pair dataset.’ The ‘full

dataset’ is a combination of companies listed on ‘100 Best Companies to Work For’ published

by Fortune magazine, partnered with Great Place to Work Institute (GPWI) resulting in 271

firms (76 unique firms) added to additional data by the Compustat North America Fundamentals

Annual database. The smaller ‘match pair dataset’ consists of only the 271 firms (76 unique

firms). In comparison to other companies the performance of employee-friendly companies is

greater, employee-friendly companies have higher market value of equity (p < 0.05) and

improved returns on assets (p < 0.05).

Lindegård, et al., (2013) surveyed Swedish health care workers over a two-year period. A

total of 4,739 health care workers were asked to participate, receiving only 3,481 responses, a

73% response rate. One follow-up only consisted of 3,209 of the original participants, the

response rate was now 70% (n = 2,223). Participants answered questions about perceived stress

from a modified version of the QPS-Nordic Questionnaire (Elo et al.) (2003). Baseline data and

follow-up data were analyzed by the log binomial model and noted as risk ratios (RR) consisting

of 95% confidence intervals (CI). Chronic musculoskeletal pain and perceived stress correlates

to the highest risk for reporting decreased work performance (RR 1.7; CI 1.28–2.32) in addition

to reduced work ability (RR 1.7; CI 1.27–2.30).

Wirtz et al., (2013) clinically studied the role of occupational role stress in relation to

levels of the stress hormone cortisol responding to acute psychosocial stress. The sample

consisted of 43 males (mean age ± SEM: 44.5 ± 2.0 years; mean body mass index ± SEM 25.7±

.4), all nonsmokers and not on medication. Participants answered questionnaires prior to
Systems Approach to Organizational Health 9

completing the Trier Social Stress Test (TSST) (Kirschbaum) (1993). Tests were two-tailed with

a level of significance set at p ≤ .05 and level of borderline significance at p ≤ 10. Prior to

analysis data were tested for normality using the Kolmogorov-Smirnov test, missing data were

list-wise excluded. Significant ANCOVA results were then analyzed by application of post-hoc

tests to determine the observed total stress reactivity effect related to a change in immediate

stress reactivity. Data showed a high degree of role uncertainty was associated with more cortisol

stress reactivity (p = .016), even when the full set of potential confounders were controlled (p <

.001).

Boschman et al., (2012) selected at random 750 bricklayers and 750 supervisors in the

Netherlands. A questionnaire was designed with ad-hoc questions by three ergonomic experts,

assessments of musculoskeletal disorders for both occupations were collected at baseline then a

follow-up questionnaire one year later. The baseline response rate was 39% for the bricklayers

(292/750) and 34% for the construction supervisors (256/750). After excluding partially

completed questionnaires, response rate was 36% (n = 267) for the bricklayers and 31% (n =

232) for the supervisors. No female workers responded. Musculoskeletal disorders among 267

bricklayers was 67% and 232 supervisors were 57%, initially. At follow-up, the response rate

was 80%; 83% for the bricklayers (222/267) and 76% for the supervisors (177/232). Most of the

bricklayers and half of the supervisors contribute their musculoskeletal complaints to work.

Cagnie et al., (2012) clinically studied the change of oxygen saturation and blood flow

within the trapezius muscle of office workers. Participants were right-handed, performed at least

four hours of computer work daily as part of their job, had no history of traumatic injuries, and

underwent no surgical procedures of the neck or upper limbs; a total of ten participants, and ten

controls. Muscle oxygen and blood flow data were collected with the O2C device (white light
Systems Approach to Organizational Health 10

spectroscopy and the laser Doppler technique) seven times at six different spots. A significant

main effect for time (p < 0.001) and muscle part (p < 0.001) and an interaction effect for muscle

part × group (p = 0.049) yielded a variance during the multivariate analysis. Over time, post hoc

tests show a decrease from T1 and T3 (p < 0.022), although no differences between T3 and T5,

and again a decrease at T6 and T7 when compared to T1-T5 (p < 0.050). This study shows one

hour of consecutively typing influenced both the oxygen saturation and blood flow in all three

parts of the trapezius muscle.

Siško, Videmšek, and Karpljuk (2011) studied the degree of joint range of motion (ROM)

and the level of musculoskeletal ache, pain, or discomfort experienced of office workers. There

were 19 female employees, aged from 40 and 54 years old (mean age 46 ± 4.6 years; average

hours using computer at work 6.2 ± 1.2 hours; mean number of hours sitting during work day 8.2

± 2.4). They all answered The Cornell Musculoskeletal Discomfort Questionnaire (The Human

Factors and Ergonomics Laboratory at Cornell University) (1994). Researchers compared the

mean results of measurements before and after the first and the last session for cervical flexion,

cervical extension, lumbar flexion, and lumbar extension (level of significance p < 0.05). The

amount of discomfort and interference with ability to work were lower (p < 0.05). A reduction

was shown for the neck (p = 0.002) and the upper back (p = 0.017) from the second to third

phase; for the neck (p = 0.004), and the upper back (p = 0.027) from the first and third phase.

Before the first session and after the last session were the greatest for cervical lateral flexion

(average of left and right measurements), which was 11.4º (28.8%), 7.7º (12.7%) for cervical

extension, 5º (9.6%) for cervical flexion, 5.5º (8%) for lumbar flexion, and a negative change of

-5.2º (-20.2%) for lumbar extension.

Systems Approach to Organizational Health 11

Murata et al., (2003) clinically studied localized muscular fatigue of the upper trapezius

muscle. Five undergraduate students, males ages 19 to 23, participated in an experimental task.

Measuring the maximum voluntary contraction (MVC) and root mean square (RMS) value of an

EMG signal and force relation. The scores were tested with a Friedman nonparametric test, χ2(4,

N = 5) = 13.316, p < .01, and found a significant main effect of block, then using ANOVA test

on mean power frequency (MPF) researchers showed there to be significant main effect of block,

F(4, 20) = 8.384, p < .01, also a Student–Newman–Keuls post-hoc test showed differences in the

following pairs were significant: BT and T60 (p < .01), BT and T90 (p < .01), and BT and T120

(p < .01). Localized muscular fatigue did appear in the shoulder and accumulated during the two-

hour experimental task. However, accumulated localized muscular fatigue did not affect the

work efficiency of the participants.

Conclusion

The health status of the human body should not be neglected when discussing

organizational health. Future research should emphasize how organizations can benefit by

allocating focus on smaller systems to accomplish equilibrium in the system as a whole. The

human body’s natural reaction to stress can cause musculoskeletal dysfunction. More research

needs to be done on how stressors affect performance and what corrective measures must be

taken to reduce, or better adapt, to today’s work environments. Once more research is published

on the effects of organizational induced stress on individual health, more organizations will

invest in their own research to better equip employees with a proactive work-life balance

program.
Systems Approach to Organizational Health 12

METHODOLOGY

Sample

Principle investigator will study the health of office workers in the oil and gas industry of

Houston, Texas. Participants will be free of past injuries and surgical procedures, not prescribed

any medications, possess no chronic health conditions, and must be able to physically exercise

with no apparent risk to health. This study will use both male and female participants, ranging

from 25 to 60 years in age, and participants must sit at a desk a minimum of two hours per work

day.

Instruments

Modified versions of the Chek Nutrition and Lifestyle Questionnaire (Chek) (2004) and

The Cornell Musculoskeletal Discomfort Questionnaire (The Human Factors and Ergonomics

Laboratory at Cornell University) (1994) will be administered. Physical assessments will

incorporate the Functional Movement Screen (FMS) and a goniometer will measure the degrees

of ROM. Organizational health will formulated by organizations’ data of performance,

attendance, absenteeism, turnover, healthcare expenditures, productivity, and costs.

Operational Definition of Independent Variable

Employee health is “not the absence of ill-ness rather the presence of well-being.” This

definition of health “requires that individuals possess symptoms of both positive feelings and

positive functioning” (Page, 2009).

Systems Approach to Organizational Health 13

Operational Definition of Dependent Variable

Organizational health is data collected of an organizations’ performance, attendance,

absenteeism, turnover, healthcare expenditures, productivity, and costs.

Procedures

The principal investigator seeks approval from the University of Houston Downtown’s

Institutional Review Board (IRB) committee allowing the facilitation of physical assessments

and gathering measurements of joints ROM, as well as administer modified versions of the Chek

Nutrition and Lifestyle Questionnaire (Chek) (2004) and The Cornell Musculoskeletal

Discomfort Questionnaire (The Human Factors and Ergonomics Laboratory at Cornell

University) (1994). Physical assessments will incorporate the Functional Movement Screen

(FMS) and a goniometer will measure the degrees of ROM at the trapezius and levator scapula,

pectoralis major/minor and sternocleidomastoid; the pelvis and hip flexors, lumbar spine and

hamstring complex; and at the iliopsoas and rectus femoris. These measurements will give a

baseline for individual health. Organizational health will be measured by organizations’ data

conveying job performance, attendance, absenteeism, turnover, healthcare expenditures,

productivity, and costs. Data will be collected at baseline then once every three months for a

year. Participants will work with certified personnel to incorporate some type of mental

stimulation, physical stimulation, and spiritual stimulation into their daily routine. Follow-up

assessments will take place every three months up to a year, four assessments in total.

Research Design

To examine the relationship between potential musculoskeletal dysfunctions and

individual health, discrete and continuous variables will be converted into categorical variables.
Systems Approach to Organizational Health 14

Composite FMS scores will then be dichotomized and individual scores examined for asymmetry

or a score of 1 (yes versus no). Principle investigator will use χ2 statistics to examine the

association between musculoskeletal dysfunctions and FMS summed score and between

musculoskeletal dysfunctions and an asymmetry or score of 1 on an individual test. Present

musculoskeletal dysfunctions or no musculoskeletal dysfunctions will be the dependent variable

for each analysis. Then a t-test will be used to compare mean job performance and the presence

of musculoskeletal dysfunctions. ANOVA test will examine how the totality of an individual’s

health influences organization’s health as a whole.

Null Hypothesis

Individual health is not related organizational health as based on Systems Theory (von

Bertalanffy, 1951, 1967).

Ethical Considerations

The University of Houston Downtown’s Institutional Review Board (IRB) committee is

working with the principal investigator to ensure no laws, local or federal, will be violated.

Informed consent forms will be issued describing the purpose of the study, identifying the

principle investigator and organization, identifying the expected length of study, and explaining

participation is voluntary with non-monetary compensation.

Systems Approach to Organizational Health 15

RESULTS

With previous research showing that levels of organizational stress contribute to an

individual’s level of stress, subsequent results are anticipated to indicate a significant effect on

organizational health when compared to individual health. According to Blazovich et al., (2014)

organizational performance of employee-friendly firms is better than those of the control firms

which are not considered employee-friendly. Specifically, employee-friendly firms have a

superior market value of equity, in addition to a higher return on assets, and lastly a better return

on equity. Table 1 shows the comparison of employee-friendly list firms to control firms.
Systems Approach to Organizational Health 16

Table 1

Hypotheses testing – Comparing list firms to control firms

Systems Approach to Organizational Health 17

DISCUSSION

Discussion of Anticipated Findings

Findings from this study could be beneficial in bridging the gap between organization

health and individual health. By making individuals’ health a priority, organizations are liaising

opportunities for individuals to live a healthier lifestyle which has a significant effect on job

performance and attendance, absenteeism, turnover, healthcare expenditures, productivity and

costs. An individuals’ health level can be associated with their quality of life, at home and in

society, thus allowing organizational equilibrium to resonate in every facet of an individuals’

life. Once society can operate as a system with equilibrium untold achievements are plausible.

Limitation of Findings

Office workers in the oil and gas industry of Houston, Texas do not share the same life

style of other office workers in the oil and gas industry throughout the United States. Not all

office workers coexist in the same organizational setting.

Areas for Further Research

The compensatory patterns of organizations have not been identified. Further research

can contribute to the conceptualization of the basic compensatory patterns of organizations,

explain why such compensation patterns exist, and what corrective exercises are needed to

correct imbalances contributing to the identified compensatory patterns.

Systems Approach to Organizational Health 18

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