The intervention was implemented at five sites with support from district managers and senior leadership, focusing on the implementation of three modules that targeted identified priority working conditions. We analyzed our process tracking data to assess the extent to which the intervention was implemented as planned and the dose of intervention delivered based on number of contact points (i.e., in-person visits or meetings, phone calls).
Site level intervention: A member of the research team conducted an assessment related to each module as the basis for recommendations and an action planning process. The assessments were conducted and reports presented to site managers of the five intervention sites for each of the three modules, with the exception of one site, which did not receive a report for the Job Enrichment module due to turnover of the site manager.
The intervention plan specified that the research team would work with site managers to develop an action plan based on the report for each working condition. The action planning tool, adapted from a tool already in use by the company, was intended to offer a structure for outlining tasks to address the identified problem, a timeline for task completion, and a strategy for assigning task completion to specific employees. Based on feedback from site managers after the first module, the research team revised the action planning tool for simplicity and ease of use. Nonetheless, no site manager completed the action planning tool for any of the modules, citing lack of time and job demands as barriers. Instead, the research team member reviewed the action planning process and tool with each site manager and used site-specific examples to illustrate opportunities for improvement for each module. Thus, while the action planning tool itself was not utilized, the concepts outlined provided an approach to address priorities identified through the assessments and develop plans for making changes during the in-person and phone consultations with the research team.
The targeted number of visits and calls varied based on the content of each module. As shown in Table 2, the contact points were lowest for the Job Enrichment module, which also occurred during a busy holiday time period that presented significant competing priorities. In addition, three group sessions were conducted for all site managers with the goal of coordinating implementation and communications across intervention sites. Overall, the research team implemented approximately two-thirds of the intended contacts with site managers.
Table 2
Worksite-level Intervention: Mean number of contact points with Site Managers across the five intervention sites, by module and type of contact
Module
|
In-person Visits
|
Phone Calls
|
Group training/ discussion
|
Total contact points/planned
|
Project introduction and cross-site coordination
|
1/1
|
NA
|
1/1
|
2/2 (100%)
|
Safety & Ergonomics
|
2/3
|
1.8/3
|
NA
|
3.8/6 (63%)
|
Work Intensity
|
1/2
|
1.8/2
|
1/1
|
3.8/5 (76%)
|
Job Enrichment
|
.2/2
|
2/3
|
.8/1
|
3/6 (50%)
|
Total contact points
|
4.2/8
(53%)
|
5.6/8
(70%)
|
2.8/3
(93%)
|
12.6/19
(66%)
|
The research team offered to attend the huddles with frontline workers to address issues raised for each of the working conditions with the intention to encourage discussion and action planning that would involve both the site manager and the employees. Research team members attended huddles for four of the five sites for the Safety and Ergonomics module, but were not invited to attend huddles for the other two modules due to the sites’ time constraints and competing demands on site managers and frontline workers.
Leadership intervention: The research team met with senior leadership and district manages throughout the intervention, as summarized in Table 3. Rather than targeting a predetermined number of contacts, the number and type of contacts with leadership representatives was determined based on needed input for each module.
Table 3
Leadership-level Intervention: Contact Points with Leadership Representatives
Module(s)
|
Contact Points
|
Participants
|
Objectives
|
Project Introduction and Module Coordination
|
Two in-person meetings
|
Senior VPs representing Health and Safety, Human Resources and Operations
|
Introduce study; co-develop a shared vision for the intervention; identify potential internal resources
|
Safety and Ergonomics, Work Intensity, Job Enrichment
|
Four telephone meetings
|
District Managers
|
Quarterly meetings for reviewing module assessment reports, identifying internal resources for addressing site level priorities, supporting Site Manager participation
|
Safety and Ergonomics (S&E)
|
Two in-person meetings
Two telephone meetings
|
Health and Safety leadership
|
Provide input on the development of the S&E walkthrough assessment; align priorities with ongoing internal safety audits; review aggregate walkthrough findings; identify existing company resources and opportunities for addressing areas identified for improvement
|
Work Intensity (WI)
|
Four telephone meetings
|
Human Resources and Operations leadership
|
Review and discuss policies, practices and resources; explore challenges and opportunities to address WI across sites
|
Job Enrichment (JE)
|
Five telephone meetings
One in-person meeting
|
Human Resources and Operations leadership
|
Review available tools and resources and consider adaptations for use with frontline workers; identify opportunities to highlight performance goals and career advancement
|
Context and process: Results from qualitative data
To understand factors influencing intervention implementation, we analyzed qualitative data to explicate the extent to which the organizational context hindered or facilitated the process. Barriers within the work setting reflected the nature of food service in general, the complexities of the relationships between the parent employer and the client/host company, and competing priorities within the specific parent employer. We adapted the intervention in response to the identified challenges.
This setting illustrates the challenges of a complex system with various interacting elements, including the parent employer, the host organizations and the frontline workers. The environment was generally characterized by low profitability, low wages, high turnover, conflicting demands, and limited potential to modify the workspace because of the contracting relationship. Our interviews underscored that scheduling was complicated; frontline workers often worked multiple jobs to make ends meet and some needed to balance work with childcare arrangements. Frontline workers’ low wages contributed to high turnover. This food service company was competing for skilled staff; other employers, like hotels and restaurants, could afford to pay more. During the intervention, turnover presented a significant barrier across multiple levels, including among district managers, site managers, and frontline workers, with implications for continuity and engagement at the site:
“One that we systemically deal with is turnover …, from the district level down to the frontline supervisors. So continuity – I mean, if you’re gonna implement changes, you have to have some continuity. Someone supports the change and manages it and implements it and briefs the employees – that’s part of it.” (District Manager)
“The other piece of it – 14 months in our industry is an eternity. So when I looked at the accounts that were in the pilot, there was a lot of turnover in those positions. So looking at this list [of participating sites and site managers], he’s gone – he’s gone. He found another opportunity. That’s part of the lifecycle of our organization, and in this industry there’s turnover. So that’s been a bit of a challenge.” (Operations Manager)
The challenges in the work environment were further complicated by relationships with host organizations. As illustrated in the quotes below, responding to client requests was a top priority; and because relationships with clients were a top priority, site managers were often unavailable to participate fully in the intervention:
“The relationship [is] with the client, so if it’s volatile or shaky... we don’t want to do anything except please them and stick to our core business which is executing food. Right? So anything perceived as taking away time from that is not helpful.” (National Project Champion)
“Work intensity in particular was interesting…. it’s our mission to satisfy the customer, the client, [so we] take last-minute requests and catering orders. And that naturally adds to the work intensity. So, I think it was just very eye opening, that that was a struggle, and I don’t think we came up with a solution though, necessarily. Because the easiest solution would be, well, just stop taking these last-minute requests or re-educate the customer, but, easier said than done.” (District Manager)
The corporate client was the gatekeeper for some of the resources needed for making recommended changes. For example, the client designed and provided the physical space for the food services, and accordingly, could set limits on potential improvements. The following quote from a site manager in response to recommended changes illustrates the implications for the Safety and Ergonomics module:
“There are some that the client won’t allow to change. Specifically, adding a chair and a mat for the cashier. For aesthetics, the client won’t allow this. The account has no choice. Salad bar is old and needs updating or to be replaced. Client is responsible for maintenance … It’s their equipment. Most of the items on the list require client involvement and expenditures since the account doesn’t own the equipment – the client does.” (Site Manager)
The potential to lose a client contract was an ongoing source of anxiety about job security for site managers. Low profit margins in the food service industry in general dictated the need for efficiencies and productivity. For this parent company, financial constraints led to increasing cost-cutting measures and mounting budgetary pressures, illustrated in this quote:
“There used to be more floating managers and floating chefs so that if a chef or a manager had to call out sick or they wanted to take a week off, they were able to because there were resources to step in and cover for them. And that dwindled and then it disappeared because of financial constraints. Similarly, when they got new registers, it used to be that they had IT technology support to come in and program those registers. Now that’s something that’s being asked of the [site] manager.” (Research Team Member)
Frontline workers discussed how these pressures and the need for efficiency and productivity influenced their day-to-day demands:
“The food business is very demanding. It’s very unique. And I think a lot of people – from the outside looking in, you might not realize how intense of a business it is. I mean, that’s something I don’t think – if someone says, oh, you’re a chef. They think, oh, you make food all day long. And it’s like, you don’t know how many deadlines I hit all day long. It’s like you have a deadline to open the restaurant at this time, you have a deadline for every catering [job], you have a deadline with every vendor, and all – lots of things are coming at you at the same time, especially in a place like this that does a lot of catering.” (Frontline Worker)
Restructuring and downsizing across the organization also played a role, with changes in leadership engaged in the project and new priorities superseding the intervention. Site and district managers also reported new and ongoing competing demands on their time, including the implementation of a new register system, new reporting requirements, changes in catering demands, contract restructuring, and ongoing financial demands.
The organizational changes targeted by the intervention represented a culture change that may have required greater organizational investment than was available across all levels of the organization. As illustrated by the following quote, this need for a culture change was prioritized at the national level:
“I look at priorities as things that change all the time… It’s taken from a priority to more of a culture shift….It’s trying to get that culture shift in the organization. And we’re starting to see that shift turning into the direction which is good, which will ultimately benefit that frontline employee where they’re doing the work and putting their health and well-being at risk on a daily basis with the jobs that they do.” (National Project Champion)
Organizational change, however, requires significant commitment across various levels of leadership within the organization. Although senior leadership initially communicated support for the program, site managers reported that support was not communicated or sustained:
“So there wasn’t a lot of assistance above me for doing this. It was brought to me, I took that direction and then at one – the only time we had a general meeting of everyone at [research team location] we discussed some issues, and it never really went much further than that. So to say that there was a lot of assistance from those above us, there was a bit right after the meeting, but then that’s kind of where it ended.” (Site Manager)
Indeed, some leadership representatives reported that they saw their role in supporting the intervention as simply staying informed, rather than communicating about or encouraging engagement in the intervention, as illustrated here: “I was informed…So my role wasn’t to communicate [about the pilot] to anyone else.” (Safety Leadership)
District managers, who directly supervised site managers, placed a high priority on financial outcomes and deliverables. As a result, site managers reported that they generally did not feel comfortable sharing needs and ideas with district managers. When asked about communication with the district manager, one site manager reported it was:
“Terrible. Terrible. There isn’t any [communication]…. We won’t hear from the district manager unless there’s something wrong…. They work a lot with the clients to make sure the clients are happy, looking at the financials. So that’s kind of it… I mean the accounts really sort of felt like they were on their own and that the upper levels had no clue about what it took for them to manage the accounts. So the communication, I would say, is terrible.” (Site Manager)
As a consequence, the research team often served as the primary conduit for communications related to the intervention across levels of the organization, as noted by one district manager: “All of our interaction has been with you folks.”
The content of the intervention was informed by our formative research [43] and focused on the three working conditions targeted by the intervention modules. Leadership reported that these targeted working conditions were a good fit in that they aligned with existing company priorities:
“Job enrichment, I think just the fact of, again, bringing awareness to it. That’s something we’re trying to do with our employees, whether it’s through cross-training and getting more aware of different job responsibilities, or in some cases – I don’t think we got into it necessarily, but with education opportunities for us, for our staff and ability for them to grow. But I think, again, it’s just two really good concepts that we don’t spend enough time on, that the study brought awareness to.” (District Manager)
“Well, if you talk about environment, safety, employee engagement, I mean I think it’s safe to say it’s pretty well aligned with our strategic priorities as an organization, right? I would say it hits really the key pillars of what we are trying to accomplish with our associates in the workplace.” (Operations Manager)
Nonetheless, despite the strong fit of the content of the intervention with the stated corporate priorities, site managers pointed out challenges that reduced fit, including the significant competing priorities and time demands that limited site managers’ time and ability to participate in the intervention. Workload pressures were a significant concern for site managers, who as salaried employees, often needed to complete work tasks outside their standard work hours. Site managers reported difficulty taking vacation and many covered for chefs and other staff members who were taking time off:
“It’s so busy for the most part that it’s just finding the time to implement those things, and it’s always been a challenge for us. And it doesn’t make your study any different than our normal checks and balances. It’s just the fact of it is that being able to sit down and make time with everybody and – it’s never been easy.” (Site Manager)
The research team made adaptations throughout the intervention to improve fit. For example, although the intervention was initially planned for greater participation of frontline workers in the implementation process, based on input from site managers the research team adapted the approach to focus on site managers as the primary gatekeepers within the worksites:
“We are the ones that set the tone and pass through all the information. We know how to do that better than anybody because we work directly with all the different personalities that are here… it was handled correctly, in my eyes.” (Site Manager)
Plans for engaging frontline workers included huddles, which were an existing regular communication vehicle for site managers to engage workers, as well as through one-on-one conversations and existing committees, such as health and safety committees. Research team members observed that frontline workers attended huddles but rarely spoke. However, research team representatives were offered few opportunities to participate in huddles or committee meetings.
“We planned to have a short huddle after our meeting. When the [Site Manager] went back to the kitchen, he then came back out and told me that they were behind and couldn’t take time away from prep work to participate in a huddle.” (Research Team Member)