Good. Better. Best. Applying good work design principles to maximise health and wellbeing

Construction Work Health Forum Podcast

Presented by: Dr Rebecca Loudoun and Jamie Gilbert

START OF TRANSCRIPT

MC:

Dr Rebecca Loudoun and Jamie Gilbert from Hutchinson Builders will discuss the development and trial of tools designed to improve worker health within urban construction sites as part of this research. Firstly, I'd like to introduce Dr Rebecca Loudoun. Dr Loudoun is a senior lecturer at Griffith University and a member of the Griffith Centre for Work Organisation and Wellbeing. She's the program director of the Griffith University Graduate Certificate and Masters of Personal Injury Management and she supervises PhD students and teaches undergraduate and postgraduate courses in work health and safety, negotiation and employment relations. Together with colleagues, she has successfully completed several large research consultancies for private, union and state based departments on work health and safety management in Australia, Italy and the UK.

Presenting with Dr Loudoun this morning is Jamie Gilbert, who is an experienced health and safety professional and has been involved with their build for life, an initiative of Hutchinson Builder construction projects. The build for life project started in 2014 in construction with Griffith Uni and Workplace Health and Safety Queensland's research project to raise awareness of the key lifestyle factors important to the business' direct and indirect workforce. The resources generated and learning outcomes achieved from the pilot have been recirculated internally to all teams nationally. Please join me in welcoming Dr Rebecca Loudoun and Jamie Gilbert to present.

Dr Rebecca Loudoun:

Good morning everybody. Can you hear me okay? Great. Thank you. So that was the second tier clap that we got just then. So I'm going to assume that you're really interested in this topic and you just didn't want to not get up from your seat and move.

As Di said, I'm Rebecca Loudoun. This is my co-presenter, Jamie Gilbert. [Long pause] our presentation today is on our research project that we completed in 2014/2015 that applied good work design principles to improve health promoting behaviour in project based construction. It was a partnership project between Griffith University, Hutchinson Builders and Workplace Health and Safety Queensland.

I've got three parts to the presentation. We're going to give you an overview of the broad study aims and how we came to focus on work environments. In this section, Jamie will also talk about why Hutchinson was interested in a project on health and focussing on design to improve the work environment around health and how it fits with Hutchinson broader agenda in this area. We will then go on to talk about the tools we developed for the study, the process used to develop those tools and how they operate in practice. That's where Jamie will come in again. We'll finish the presentation with a discussion of barriers and enablers that we found throughout the project for positive health change and future plans for the tool at Hutchinson and from a research perspective.

So an introduction to the research. The project was about, as I said, developing tools to assist with designing a healthier workplace. But it was part of a broader study agenda. So I wanted to first give you a little bit of background to establish how we came to a project on workplace design.

Chronic disease, as Di just said, such as diabetes and coronary heart disease, are amongst our most common causes of death in Australia. Construction is one of the most at risk industries. The prevalence of risk factors for coronary heart disease and other chronic diseases is high in construction compared with the general population and with most other industries. The industry sector is, as you would know, the third highest paid in Australia; yet the health benefits generally accrued with higher economic status are not present in this population group.

We put together a team from Griffith University of three researchers; my colleagues Professor Keith Townsend and Dr Katherine Markwell. The three of us have expertise in not just health, but also in industrial relations and particularly construction. We made the decision that, based on the timeline available for the study, which was about 14 months; focussing on health promoting behaviour around dietary intake was the most sensible SNAPO risk factor to focus on. We were very privileged to have Hutchinson agree to partner with us on this journey.

We also chose nutrition and dietary intake because research shows that improvements in this area are likely to have a positive, flow on effect to other risk factors and, conversely, poor nutrition has a complex relationship with other health and safety concerns in construction. For example, there are clear links between nutrition related diseases such as cardiovascular disease and diabetes and safety. Uncontrolled diabetes can cause blindness and numbness and reduced feelings in hand and feet, making it easier for things like blisters to appear, making it harder to detect them, easier for them to become infected and, once infected, harder to treat, just as one example. Also, diabetes is the leading cause of amputation in Australia. So that obviously has clear implications for work ability. Furthermore, about 8% of people with Type 2 diabetes are overweight or obese, so the link with nutrition is even clearer. Importantly, nutrition is also related to mental health. Suicide and poor mental health are increasing problems in construction, as I'm sure you know.

Looking at the study design for the project; we did the project at six sites doing substantial new build or refurbishment of mixed residential, office and retail space in the CBD or inner city Brisbane. We've got a picture there of one of the sites that we did the project at. That's at Milton. You might have seen that as you drive down Milton Road on the railway line. So that was one of the sites. Another site was Nundah. Another site was in the mall. Another site in Adelaide Street. Another site at Hamilton. And another site at Kelvin Grove. So they were all inner city Brisbane, if not in the CBD.

The largest study that we completed was an intervention study with pre and post test measures of health markers from 186 trades workers. The design involved a rolling control group and treatment groups organised around whole of site change versus individual change and messages targeted at participants readiness or openness for change. Throughout the project, we surveyed and interviewed approximately 23 managers and performed 18 focus groups with trades workers at three time points over 14 months, as I said.

As part of this intervention, we developed the multilevel food environment audit tool and site set up tool. That is the aspect of the study that we're focussing on today, as I said. I'm mentioning this larger study as a way of giving the context to this smaller aspect of the research, but also because the baseline measures of health and behaviours around food on site that we took and beliefs about food on site, in part, led us to the decision that a tool aimed at changing the work environment was needed in this context.

So just to give you a flavour for some of that health data that we collected. We looked at body mass index. We self-report data to calculate body mass index. Only 27% of respondents were within the healthy weight range. Fifty-five per cent identified as overweight and 14% as obese. That's almost 70% being categorised as overweight or obese. Although this is a frightening statistic, it isn't dissimilar to Australian values for men. But keep in mind that self-reported BMI tends to underestimate obesity, so we can expect these numbers to actually be higher. Looking at body mass index category by age; across all age groups – all age groups – respondents were more likely to be overweight than in the healthy weight range. Obesity incidents increased in those aged 35 to 44 years. It was highest in the 55 to 64 year age group. You will notice, if you can see that clearly, that there were many who did not report their age. It's likely that these people were in the older age groups where the higher incidence category were.

Looking at the risk of developing diabetes, we used the AUSDRISK tool to calculate risk. Forty-two per cent were at moderate risk of developing diabetes within the next five years. Almost 10% were at high risk. The AUSDRISK tool does include age as a risk factor with increased points given for increasing age, meaning you can expect a trend towards higher risk as age increases. However, in this population group, it appeared to peak between 35 to 55 years of age. So there's clearly something more going on in this industry.

The very first question, once we established baseline health markers that we were interested in, was what does food and behaviours around food look like in construction? What drives people to eat unhealthy food? What are the obstacles to eating good food? So our starting point was understanding the unique aspects of this industry that drive these problems. This was important because public health research to date hasn't taken into account or even identified in any systematic way the drivers and obstacles in construction for healthy food.

So what did we find? We found the guidelines around healthy behaviour did not guide food intake in construction. Many people were aware of the guidelines around nutrition, for example, the National Heart Foundation Guidelines. But they didn't think they applied to them. They were for other people. They were for desk workers. They're for people in offices. They're not for people who do the type of job that we do. Different rules apply to us.

Money does not drive food choices. Most people were spending, on average, $125 a week on food. That is a big slice of someone's pay packet, particularly an apprentice. That didn't worry anybody. We found that time was a big driver of food habits. People were too tired to eat. They had little time to eat, to source or prepare healthy food. We also found that many people were confused about food labelling and the media around food, but they didn't connect this with their behaviour. They connected that with other people's behaviour. Most people thought that they were doing a really good job in the eating department. They thought they were doing just fine. Fifty-five per cent said they were already eating healthily and they didn't need to change. They did not have a problem. Only 7% had thought about eating more healthily. Clearly, these views do not align with the health markers that we just discussed.

Looking at what people actually eat; we found trends for weekly saturated fat and fibre are in opposite directions. So most people ate a low fibre and medium to high intake of fat diet. We found an industry that was full of urban myths and hangovers from years gone by about pie vans and chuck trucks that just simply didn't exist in urban construction sites anymore. Having a Subway or Coles or a Woolworths on every other corner and new products to market – they've changed the things that people eat. Or for many people, the things that they replace food with. I'll talk more about that in a moment.

We found three clear eating patterns. Abstaining from food for long periods, usually breakfast, and then overeating later in the day. We found comfort or convenience eating from vending machines or some other source close by. Not even recognising what you were eating really. It was just throw it in and get going. We found people, as I said, replacing food with drinks or cigarettes. For most people, this meant replacing food with energy drinks. Or, more accurately, formulated caffeine beverages. We don't really say that, do we?

These drinks are deliberately marketed to this audience. They're deliberately marketed to men, particularly young, well paid men. And in an industry where people are time poor and they do physical work, the label 'energy drinks' is understandably extremely attractive. Every site, every age; they were found. The pattern might be different, but everybody drank them. Speaking in general patterns. We also found a significant statistical link between the length of work hours and how much caffeine people consume. There was almost no knowledge amongst tradesworkers about what is in energy drinks and how much is too much and why it's too much. So what it can do the body in general and, specifically, around things that are specific or relevant to sites like dehydration.

So just to summarise the data so far. We knew very early on that food habits on site are generally poor. We know that knowledge and awareness around healthy food choices are generally poor. We know that health indicators are worrying.

We started to feel, at this early stage, for some of the drivers of these habits. Certainly having time to prepare, source and consume healthy food was one driver, as I said. Most of these decisions were delayed until people got to work.

So then we started to think about – we were looking for opportunities or areas and agents for change. So we started to ask whose responsibility food was on site. So when people made these decisions, whose responsibility was it? Respondents' answers to these questions made it clear that the individualistic focus that we tend to have in Australian society towards food, whereby it's a personal responsibility, was widespread in this context. All managers and workers held the view, unanimously, that health was an individual's responsibility, particularly around food, and managers do not and should not have any influence over the eating habits of workers on their site. I've got some quotes up there to illustrate these very strong views that they held. Most managers, in addition to saying they didn't have any influence or scope for influence, thought it would be crossing a line to even try.

So you can see the quotes there. No, I think I have enough to do. It's hard enough getting them to do what they're supposed to do. They're grown men, for Pete's sake. They've made it this far in life. Another who said line managers have zero influence over what the blokes eat. I don't think I should have any responsibility over what blokes eat on the site. We tell them what to do all day; they can have that for themselves, surely.

Having said that though, it was very clear that managers were making decisions every day that influenced dietary habits. The influence was unintended, it was unrecognised and it was often hidden. But it was present nonetheless. The decisions were about things like the timing of breaks, the products stocked in vending machines, the behaviours encouraged and discouraged on site. Catering at site barbeques. The placement, size and fit out of lunchrooms beyond what was outlined in the site agreement. It was also clear that some managers were already making decisions about things with workers in mind; things that influenced food. However, the managers did not make the connection between these decisions and food behaviours on site. It was more about keeping the peace, reducing tension and sometimes even just being polite than it was about making better food choices.

For example, one manager in the site in the mall [long pause] didn't permit any tools to be used during breaks. I said why is that? He said I just think it's polite. It's so noisy on this site. I think it must drive the guys crazy. I certainly notice them looking happier when they come out. Another manager tried to organise the lunchroom around trades groups so the different groups could feel ownership of their area. He was hoping by doing this that they might care for the area; that they might leave basic food items and condiments and maybe a chessboard or something like that in the area. This was about trying to increase trust around food on site and about keeping people on the site. Because he was sick of losing people off the site to Subway or Coles or wherever.

Also, he said when people don't – people are concerned about their food being stolen on site, they put their food in eskies and then they carry the esky everywhere with them on the site and that just creates clutter and frustration for people trying to get around. So it wasn't so much about trying to improve food, but it certainly had an influence on those. Managers, as I might have just said, tended to base their ideas on their experience or their gut feeling. Maybe their experience when they were on their tools or from being a site manager, rather than using any informed or strategic approach.

This made us start to think about how we could change their decisions to make better outcomes for workers. We decided that if we could convince managers to make changes that didn't impinge on personal choice, because this was considered very, very important, then a positive impact on food consumption was likely to follow.

The last finding that prompted us to look at work environment design tools was the clear view that a whole of site approach was needed. Anything solely aimed at individuals – so, in this instance, trades workers and labourers – was not going to receive a warm welcome. Indeed, the broader intervention process that I mentioned confirmed this at the end of the 14 months where we found no change in the individual treatment group.

Employees are both the principal contractor and the subcontractors felt very strongly that it was important for the success of the project to see everyone playing their part, rather than the individual worker only participating in the behaviour change. There was a general consensus that no one person or group had the responsibility or capacity to change health promoting behaviours on site. I've given you some quotes here to illustrate that. Most people considered the elevated risk of ill health amongst construction workers to be an industry problem. They thought that it required a collective solutions. Trades workers were very sensitive to the idea that it was them alone that needed to change.

I'll hand you over to Jamie now.

Jamie Gilbert:

So Hutchinson Builders, prior to Rebecca and Griffith University approaching us, had already had a vested interest in the health of not only our direct workers, but for subcontractors that we have on site. We had applied for and been granted a separate portion of money through the state government to roll out initiatives on a second site that wasn't involved in Rebecca and Griffith's project. So we already had an existing awareness of the health of our workers and indirect subcontractors on our projects. Hutchies operate on a ratio of about 1:10. So for every one Hutchie guy or girl we have on site, there is ten subcontractors that are on our site. So by having Griffith on five different projects at the same time, the exposure to our subcontractors was greater than what we could initially roll out on one pilot site with our sister project that wasn't related, but just happened to run concurrently.

There wasn't a legislative requirement, but we knew that whatever findings that we got on our bigger sites, knowing work moving forward, it's going to be replicated on what is to come. So by having Rebecca and the team engaged, we could get a fair picture of not only the worker health, but what we needed to do internally to improve just organically whilst we moved forward with construction. Health isn't our main business. We're there to build a building. But if we can ensure worker comfort whilst on site, then that's a win-win for both ourselves and the workers that we have engaged.

Through our sister project, we created internal resources that we were able to put onto sites. We'll discuss that a little later how it's all worked together, concurrently, to use the tool that was created and push out further through our employees and subcontractors additional health information without being in their face, but just available on site.

Dr Rebecca Loudoun:

So to the tool that we developed. I've given an example of one page of the tool. Did we end up with the tool here? No. The tool is coming. It will be available on the website [long pause] very soon. But here's an example of one page of the tool.

So to the development of the tool. There is a lot of research available about manipulating people to alter food choices. You would all know this when you go to the supermarkets. They do it every single day. For example, when you go into the supermarket, a Woolworths or Coles, what's the first thing that you always see? You always see the fruit. Is that what someone said? Yes. You always see the fresh fruit. You always see the vegetables, the flowers. Then you move on and you see the freshly baked bread. You see the roasting chickens. It's the same in every supermarket. These sights and smells reinforce how fresh the produce is and it makes you feel hungry. The vibrant colours put you in a good mood. The happier you are, the more likely you are to spend.

Product placement to maximise sales of certain items is also another common strategy of supermarkets. Eye level is buy level. The number of facings – that's the term that's used. So the more visible a product, the more likely it is to be purchased. Putting complementary food together or next to each other is another strategy. You'll always find what's next to the drinks? What's on the other side of the drinks? Chips! Of course. If you're buying soft drink, crisps seems like oh, that's a good idea, isn't it? Convenience makes a purchase more likely.

We drew on this research to manipulate the food environment on sites to encourage people to adopt more positive behaviours around food. To choose healthier foods and drinks. We aimed to devise a tool to assist with setting up the site to best facilitate healthy eating whilst still allowing for the many and varied restrictions on urban sites; of which there are many brought about by build size, by type and by location. We were aware that all sites are not the same. So you'll see that on the tool, we tried to accommodate this.

We started by recognising, as I said, that the sites are different. So the tool needed to have a sliding scale. We couldn't expect every site to be the same. So that was the first thing that we started with. We also then looked at identifying relevant health promotion tools that assessed both nutrition relevant variables and other relevant areas and we assessed their suitability for the construction context.

Two main validated tools were considered; the commonly used and you might have heard of these already – Checklist of Health Promotion Environments at Work or the CHEW tool. Any nods? A few. And there's the State of Queensland Healthy Places Survey. Some of the items from these tools were retained. Others were retained, but modified. Some were not used because they didn't match the physical set up of construction sites.

So just to give you an example of what I mean. Looking at the CHEW tool, information around stairs and elevators were not included as they are dependent on the build and the item description centred on the physical signage and other stationery features in a building which are simply not present on construction sites. In the Healthy Workplace Survey, scoring of workplace cafeterias and fitness centres in workplaces, office job references – so stand up desks – were removed because, obviously, they're not relevant.

We also added some new or modified items, as I said. These were developed using project team expertise of the three of us, healthy eating principles developed by governments and other sources, such as healthy vending machine principles developed by the Western Australia Government, input from health and safety experts in construction, such as Jamie, registered dieticians and nutritionists and interviews and focus groups, as I said, with the workers, with the site management teams and with subcontractor managers. We've listed up there the main items in the tool. We've got sections around vending machines, nutritional information, site lunchroom set up, barbeques, catering, nutritional initiatives and a location review. So looking at what is around that particular location.

After deciding on suitable items, a series of iterative changes were made to the items; to their wording and response options following repeat rounds of scoring from site managers, on site health and safety officers, corporate health and safety managers and the research team. So we all took the tool and scored the site and then we got together and made sure that we all scored it the same way. If there'd been any confusion around certain items – and we just kept doing this until we had a consensus.

You'll notice that is designed, as I said, with a sliding scale. You might also notice that it has a scoring system. We did this in case comparisons wanted to be made between sites or between sites with some similarities or the same site over time or maybe a whole of workplace or at the firm level over time to see if any improvements are being made. [Long pause] you'll also notice, when you have a look at the tool, that it is broader than simply design changes in the lunchroom and it's aimed at changing the behaviour of all people on site, not just trades workers. I've already talked about why that is. But there's also good research reasons around holistic change and organisational change having better outcomes.

You might notice discussion in the tool about posters and information giving. Obviously, given what we've said already, awareness raising and education around food is clearly needed in this environment. When deciding on the topics to focus on in the tool and how best to attract attention; we tried in the first instance to choose topics that participants identified as of interest and around which they were particularly confused. We didn't choose the most important factors or the most alarming factors around chronic disease or what research has identified as the most risky factors because we were aware that we were touching on a sensitive area for some people. As I said, individual choice and control was considered to be very, very important. So we wanted them to feel like they were a part of the journey and a part of the decisions that they were made. We thought any obvious attempts to have an influence on control in particular would be met with resistance.

We gave different talks and focussed the talks differently for different audiences. So for managers, we talked more about how chronic health diseases can impact productivity and safety. Workers, however, wanted to know things like the best choice to make at Subway or the sushi shop. So we took groups on excursions to their local eateries at lunch break and we looked at what was on the menu. We talked about what was a better choice within the options that were available and why. They wanted to know where food manufacturers were hiding things in the food, where they were being tricked. They were really interested. They wanted to know things like the best sports drinks or other options beyond water to choose for hydration. How hydration affects their bodies and influences their mood and, importantly, their food cravings. Many people said they had really strong food cravings and they didn't know why. Quite often, that's to do with hydration. They wanted to know water doesn't feel like it's hydrating them. They said we drink water all day long but we get to a point where it just feels like it's not doing anything anymore. Why is that?

Our poster displays are not working very well [laughter], but I just wanted to give you some examples of what we did with the posters that we put on site. So these two fit together. [Laughter] we tried very hard to make posters that were really eye catching, that were relevant and they stood out on site. Because there's a lot of visual graffiti on site. There's already posters about all sorts of things. So we wanted these ones to stand out. We did things like – I don't know if you can read it, but we used quotes in the posters that people on site said. With their permission, obviously. So then people were talking about oh, who said that? Who said that? Really, anything that gets people to stop and talk, from our perspective, was a really good thing.

So there was some of the things we did. You'll see that we've got there the number of teaspoons of sugar [long pause] in these sugary drinks. Which is also something that was just a good reminder. We put them in walkways and we moved them around sites. The other one that I've got here on the slide was a canvas display that we did. It was a bit more like an art display. Again, we were just trying something different – to make them look like they were different to get people to stop and think. Stop and talk. Just pause for a moment. I think that's really important when you're doing a health promotion activity.

So Jamie will talk about how the tool is used at Hutchinson's on a daily – well, when it's used.

Jamie Gilbert:

So originally, because of the size of Hutchies and we do jobs from, say, $300,000 up to $365 million; the size and make up of our projects is vastly different. So initially, we focussed on our major projects here in southeast Queensland as well, because we have an existing HSC who can assist with completing the tool and talking to the site manager and safety committee about the use of it, what they're finding. It was more a collective approach as opposed to our smaller jobs that are run by a single site manager. It's just another thing that, at the moment, we're still working on integrating some questions into existing tools to raise awareness through our natural audit or inspection process, as opposed to that additional thing that they need to do.

So the site managers that were engaged, when you spoke to them about the use of it, it was good because it did highlight certain things. They didn't always stop and look at what was in the vending machine. I had a couple of site managers say I didn't even realise we didn't have water in these. I mean, we have water bubblers all through site, but there wasn't water available in the vending machine. Unless we gave them what a healthier option was, you couldn't say replace it with something healthy. We said these are alternatives that you can consider putting in your machine.

With the information, when we rolled it out, there was a broad spectrum of what was existing on site, the way that the info was set up or made available, depending on what the site manager – if they were intrinsically motivated to be healthy – the guys who go for a ride on a Monday morning with the team or the guys who participate in Tough Mudder or have an external sporting interest; they naturally had a few more things already happening on site. Not to say that the other site managers weren't healthy, but they just didn't have that [long pause] switch in them that made them assess what was available not just for the guys on site, but for them as well.

So we're rolling it out in a two phase process. We've put the information out there and we've got a lay of the land; what we currently have. From a corporate perspective, what more information do we need to make available to them? If there's nutritional information missing or any of the prompters on the SNAPO – smoking, nutrition, obesity – we don't find physical activity is a big one for us. Or [long pause] – there was one more. Alcohol consumption. We're just going to focus our information on the items that we've identified in the initial scope of what's happening on site.

Once we've got the information back, which we've done now, and this year we're moving forward some additional health initiatives. They'll all work in together so that we can tailor the information that the guys have identified is missing on site and make it available. So it's completely relevant to either what the safety committee has told us they have identified is an issue within that group, especially around nutritional information.

There has been good feedback about the tool but I think, at the moment, we're not pushing them to do anything. So we're getting an idea of what's available. We're not asking them to make changes, but it's highlighting areas where some of the site managers have rung their vending machine operators and said can you get out here and just shuffle around some of your products? Proactively doing things in small areas where they have control immediately. But things like information – that's something that is – I'm responsible for getting out to the sites a little bit quicker. We have an internal intranet which allows them immediate access to any of the materials that we make. But putting it on there and making it readily available – so we're going to do that once we're [long pause] – once we get feedback form our committees as well.

We found once your subcontractors buy into the process, it's a lot easier. Because they own whatever they've said that – our initiative aside, we did it in two different ways. Once we had subbies buy in and we were listening to what they wanted, we could tailor the information for what was relevant to them. Because Hutchies are predominantly managers. We manage our sites and our subcontractors build our buildings. So what our health issues are might be a bit different to our concreters, our steel fixers or our form workers. So we want to make sure it's relevant to everyone. Because we have that 10:1 ratio.

So as Rebecca said, there were two tools made. The one that you can see here is something that we'll incorporate and have started incorporating in our regular inspections or scheduled audits of the site. The other one was an initial set up tool which asked what vending machine will you have on site and what is the closest food vendor. It prompts to go and spark up the conversation that we're going to have. Three hundred construction workers working immediately down the road; are you open for morning coffees? What are your breakfast options? So you can suggest that that's a good spot for them to go. Just given the size of our projects, now is when that initial tool will start to be rolled out because they do that 18 month cycle.

Our managers have had a positive response to it to date. Moving forward, because it's going to keep the guys happier on site and [long pause] the items that they want available, they haven't had any internal objection to them using it and the feedback that you get from it. So it's been positive to date, the feedback.

Dr Rebecca Loudoun:

As Jamie said, it has been positive to date. But I don't want to suggest that it was smooth sailing the whole way. Over the 14 months was an I interesting 14 months. It was an interesting period. There were a lot of challenges. We had to work very, very hard as a research group; probably harder than I've ever worked before in research, I have to say. I do a lot of research in shift work, so I'm used to being up at all hours of the day and night. This was hard work, but it was really rewarding. It was very positive. We had some really positive changes.

Looking at what you can expect in an effective or a successful health intervention. On average, you can expect about 60% participation. We got that in some sites, but it was difficult to follow people and keep people involved for 14 months. So that was a challenge for us. Looking at how we – and initially getting people involved in the project, particularly managers when we were doing the whole of site treatment groups; it took some work.

There were some barriers. Some of the things that we found worked in this environment overcome these initial barriers – I'll just mention some of those now. We found that [long pause] making the links between nutrition and safety [long pause] clearer worked well in this environment. Participants rarely noted direct links between chronic health problems and safety, but many managers at all levels pointed to areas of interest in safety that a clear overlap with health. Most managers on site did not consider health promotion activities as part of their job, as I said. Or their job role. But they did when they thought it interacted with safety. Everyone was very, very focussed on safety. As you would expect in this context.

One particular area that managers connected with safety and expressed a strong interest in was hydration, as an example. Energy drinks were also of high importance to most managers because they perceive them to have impacts on safety. Yet excessive energy drink consumption was not seen as a health issue. One quote here that illustrates this. I've got some guys who I actually believe they're energy drink addicts. I do speak to them about it, but 98% of the time, laughter is the reply. Once again, that's a hydration thing for me. The energy drinks actually have the opposite effect. They do. I'm pretty sure it's proven. Dehydrate rather than rehydrate. I try to get them to cut down and drink more water. That's part of my role here, definitely; to keep them on their feet all day.

Another says I find a fair few people drinking energy drinks like it's water. You know that stuff's not good for you because we had a fair few incidents with them. They get hot and sweaty and they don't have enough water. They just collapsed. Jamie's seen a little bit of this over summer with some problems around energy drinks on site.

We found opportunities to promote the health intervention around conflict and tension on site. Although few people mentioned direct links between ill health and interpersonal relations on site, most spoke about food and drink choices making people irritable or difficult on site. So examples include this comment from a site manager. It's probably not so much that you see the impact of food every day, but it's part of the issues you face every day in construction. Confrontations and disagreements and guys on edge. It probably isn't the only contributing factor. But I know from a personal perspective what an influence it has on your mood, your frustration levels and tolerance.

And other. Harmony or industrial relations on site is so important. Everyone at every level is attuned to it. I think food or bad food and drinks on site have industrial implications, but people don't see them. Everyone knows people work hard on site and they get tired, but this comes about much sooner, I think, if people are eating pies, chips, chocolate and soft drink. They feel crap and tired and they're irritable. This has a ripple effect until the whole site is down and difficult. Everyone can feel it when a site has industrial problems, but I don't think they connect it with food and the way individuals feel physically and how this then affects how they talk to others on site. Whether they clean up or do the job slowly, which impacts on others and then it flows around the site.

So I think there's a real opportunity here to use these links as leverage points for health promotion. Research indicates that construction owners and contractors rank conflict amongst construction project participants as the highest factor affecting project costs. So I think there's some opportunities there.

Something else that we came across was morale and reputational benefits. In general, investing in health promotion was met with a lot of suspicion. And then surprise. Surprise that the principal contractor was interested in workers' health, particularly subcontractors. Particularly when they realised this concern was not attached to any legislative requirement. Once this suspicion was overcome, interviewees expressed very positive views about the parent company. It had a big positive impact on morale and company image for very little investment. This was apparent throughout interviews with managers and workers at all levels and subcontractors. It's not unusual for organisations to use positive elements of their HR practice to promote themselves as employers of choice within particular industries, but it is a strategy rarely used in construction.

Looking at productivity, trades workers were interested in disability and diabetes information, particularly if they thought this impacted on their ability to do work in the industry long term; but managers not so much. Indicators such as disability and longevity of workforce participation had little impact. When these topics were raised, limited interest was evidenced by ways of questions or comments. Mention was made of the usually short time span workers had on the project. However, managers were interested in possible influences of chronic health problems on project or task completion. This from one manager. When they're there, they are more productive, say, by being more hydrated or monitoring their diabetes then they can potentially finish a ten hour day in eight hours, just because they're more productive. Then you'll definitely get managers' buy in – definitely get managers to listen. They may not do it themselves as managers, but they may not become barriers to change.

So whether we're trying to achieve buy in from managers or stopping them from being barriers, the key way for us to do this, for them, was to focus on time. Most were happy to be involved, as Jamie said, to set up the workplace any way we suggested, as long as it didn't slow site progress down. Using the environment tool as a guide for setting up the site to minimise the many, many decisions that happen when a site is being set up or changed was seen as a very welcome edition. They were thrilled to have these decisions taken away from them.

Jamie Gilbert:

Our biggest challenge was working out how to use the tool time efficiently and get benefit from it from the information that we get from the guys and girls. So initially with our team that we've asked to get feedback from, we've worked out which questions we would like to retain and add into existing audit tools. That's the time challenge that we've overcome. The other one that we have identified is a challenge is actually enacting that change. So we've updated some safety committee templates to prompt for the discussion around health; just that inclusive – have the site buy into the process. Once your site management team and your committee are working together with your delegate on these big projects, it's a lot easier. They're the two main challenges we had.

The use, the concept, the time spent answering the questions was not a big deal for us. But it's just how to include it in our daily processes. We did not want another item for the guys and girls. Because of the size and variety of our projects, by adding questions into existing documents, we found, is going to be the easiest way to get the feedback and to make small change progressively, across projects.

[Long pause] I've pretty much just said all of this [laughter]. I did that succinctly.

Dr Rebecca Loudoun:

I'll just add to what Jamie said by talking about the tool. We need to [long pause] look at whether this tool works in other environments; in organisations that are set up with a different structure. Hutchies has a very unique structure. So we need to know whether it works on other sites, on sites in different areas, sites of different size. We need to look at, longitudinally – more longitudinal research to determine if the tool generates change in behaviour in the longer term. We know that it does in the short term in this environment, but does that – is there any longevity to that change?

We might leave it there. I'll talk more about what research is needed this afternoon in the panel discussion. So you can hear more there if you're interested.

Jamie Gilbert:

Before we finish, if there is anyone who is rolling out health initiatives on your construction projects or with your teams; we found, from our other project, a whole heap of barriers that, the first time we rolled it out, we didn't see them there. The second time we did it, we were over to come a whole heap of time wasting by doing certain things up front. So if anyone is doing it and you are interested in what we found with our subcontractor work groups or internally with our management on projects, I'm more than happy to give you my card to discuss. Because we wasted a lot of time at the front end by not doing certain things. If we had thought about the process or spoken to another contractor who had already done it, we probably would have got a bit more at the back end of our sister project. So I have cards at the front that you're more than welcome to take if that's something that you intend on rolling out internally. Thank you.

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