In Ontario, the WSIB is responsible for administering wage-loss and medical benefits, and return-to-work support for workers affected by work-related injuries or illnesses. Financed through employer-paid premiums, the WSIB operates a no-fault, collective liability insurance system serving more than 5 million workers across over 300,000 workplaces (33). The WSIB developed and launched the HSE program, a new voluntary OHS program, meant to replace several existing OHS programs. One of the aims of the program is to avoid an overly prescriptive or check-list driven approach, which had been of concern in previous programs.

The HSE program comprises 41 OHS topics (e.g., control of hazards; management review) organized across three levels: foundation, intermediate, advanced (Table 1). The HSE program is designed to support firms to develop their OHS systems as they progress through topics and levels. While the broad structural components build on previous WSIB OHS programs, the HSE model introduces greater customizability by allowing firms to select which topics, and how many, they complete each year as well as flexibility in demonstrating how topic requirements were met.

To enroll in the HSE program, firms register with a WSIB-approved program provider (Table 2), private health and safety consultants, who guide firms by supporting action plan creation, topic implementation, and evidence submission. Providers offer tiered priced packages, with firms paying their provider directly for their services. Following enrollment, firms complete a self-assessment of their current OHS system intended to identify their appropriate level in the program and develop an action plan, selecting up to five program topics with their program provider. After action plan approval, firms have up to 12 months to complete and validate their selected topics. The HSE program rewards firms for implementing new or significantly improved OHS initiatives; firms cannot use pre-existing initiatives to validate program topics.

The validation process aims to ensure that firms’ topics are complete and ‘living and breathing’ in the workplace, meaning they have become a part of day-to-day business activities. Firms submit evidence stories and supporting evidence files through the HSE program online portal. The evidence story is a narrative-based account of how the firm developed and implemented their topic, recounting work performed under each step of the ‘Plan-Do-Check-Act’ model (or other implementation cycle). The WSIB accepts varied forms of supporting evidence files, including videos and photographs. Validators review evidence to ensure topic completion and, where needed, grant firms 60 days to address any outstanding gaps in an additional evidence submission. If the additional evidence still fails to meet the topic requirements, the topic is marked as ‘incomplete’. A workers’ compensation premium rebate is earned for each topic that a firm completes. Completing all topics in a program level is additionally rewarded with a digital badge of recognition.

This study was conducted as part of an independent evaluation funded through WSIB grants program and was supported by a Project Evaluation Working Group, comprising researchers and WSIB operational staff, and a Project Advisory Committee, which included broader provincial representation, including Ontario Ministry of Labor stakeholders. These groups provided operational and policy context for the evaluation, and were not involved in qualitative data coding, analysis, or theme development. The evaluation consists of three components. The first is qualitative interviews to capture the experiences of participating firms during program rollout and provide program administrators with early feedback. The second is a documentation analysis meant to contextualize program barriers and support qualitative findings. The third is a quantitative analysis of the effectiveness of the program in reducing lost-time workers’ compensation claims.

The analytic team used data on participating firms from the HSE program online portal to develop a purposive recruitment strategy. The goal was to create rich data set representing a diversity of experiences by firm size, sector and region that allowed researchers to discern both recurring thematic patterns and points of divergence (34, 35). Participants from registered firms identified as the most knowledgeable on their firm’s health and safety program were invited to participate in a confidential interview via email. To ensure adequate representation, targeted follow-up emails and phone calls were placed to make final requests for participation and answer any questions.

We conducted interviews with two waves of participants. The first wave was recruited from firms that had enrolled in the HSE program from November 2019 to March 2020; the second wave included firms enrolled from April 2020 to March 2021. For both waves, the target population consisted of firms who had completed at least one program topic. We also recruited a subset of firms who had not completed any topics in wave two in order to better understand the barriers these firms faced. Due to significant disruptions to the Canadian healthcare sector and the designation of healthcare centers as ‘essential services’ during the COVID-19 pandemic, healthcare firms were recruited in the second wave only. Participants from wave one were interviewed between November 2020 to March 2021 and in wave two between October 2021 to December 2021.

The final study sample consisted of 76 participants from 71 firms (30 in wave one; 41 in wave two). In five cases, two participants from the same firm requested to participate in a single interview. Of the 76 participants, 39 (51%) had less than 5 years of experience at their current job, while 11 (15%) had 10 or more years of experience (Table 3). In terms of job role, 25 (33%) participants had roles focused specifically on health and safety, while 51 (67%) had roles in administration, human resources, operations, and senior leadership with additional health and safety duties. Of the 25 participants with a primary health and safety role, 2 (8%) were coordinators, 18 (72%) were managers, and 5 (20%) were senior leadership.

Of the 71 firms, 35 (49%) were large firms with over 100 employees, 13 (18%) were medium firms with between 50 and 99 employees, and 23 (32%) were small firms with between 1 and 49 employees. Construction (21; 30%) was the most represented industry, followed by manufacturing (16; 23%) and services (13; 18.3%). Six (9%) of the 71 firms had enrolled in all foundational level topics, 33 (47%) had at least one intermediate topic enrollment, and 32 (45%) had at least one advanced topic enrollment.

A structured interview guide was developed in collaboration with the Project Evaluation Working Group and piloted with four firms prior to conducting wave one interviews (Supplementary file 1). Before conducting the second wave of interviews, the guide underwent minor revisions intended to improve clarity and further explore preliminary themes identified from the first wave. The interview guide included questions about firms’ motivation to enroll in the HSE program, OHS changes made, barriers and facilitators to engaging in the program and completing topics, intentions to continue participating in the program, and whether they would recommend the program to other firms. Interviews were conducted by a team member with experience in collecting qualitative data related to workplace health and safety via video conference and lasted 45 min on average. The interview audio was recorded, transcribed verbatim by a professional transcription service and imported into NVivo software, version 12 Pro (QSR International Pty Ltd).

We sought to understand challenges and successes participants experienced in their first year of the program, why they enrolled and their overall experience in the program. We began the analysis with structural coding using NVivo software, in which conceptual phrases representing research questions were applied to segments of data (36). This organizational coding facilitated the exploration of commonalities and differences across the research questions guiding the program evaluation and that were of interest to HSE program administrators. The categorization technique provided a preliminary framework for further analysis.

We conducted reflexive thematic analysis, emphasizing iterative and in-depth engagement with the data and researcher reflexivity throughout the analytic process (34, 37, 38). To support rigor, multiple coders familiarized themselves with five interviews from wave one and independently generated preliminary codes through open coding of the same transcripts, documenting reflections and analytic decisions through memos (39). Weekly analytical team meetings were held to generate reflective dialog, resolve interpretive differences and reach shared understanding (38, 40). A coding manual was developed, starting with the preliminary codes, including definitions and examples for each code. For the remaining interviews, team members reviewed each transcript before coding and documented any coding additions or revisions in memos. The coding manual was iteratively refined throughout the analysis as the team deepened their interpretive engagement with the data. The dataset was evaluated on the richness, depth and recurrence of patterns across participants in line with reflective thematic analysis (35, 40).

Following wave one coding, the team examined patterns across and within the dataset to develop an initial set of themes and sub-themes (38). This iterative process involved refining themes and sub-themes, with the team repeatedly reviewing coded segments, full transcripts, candidate themes and emerging thematic groupings. The revised coding manual was applied to the second wave of participants and additional refinements were made following team agreement. As with the first wave, coders again reviewed each transcript before coding and kept detailed reflexive memos. Cross-wave comparison supported the stability of themes as there were no significant differences in themes or codes, and as such, the findings from the two waves are reported collectively. Study implications were developed collaboratively by the full investigative team.

Throughout the evaluation, we engaged the Project Evaluation Working Group to review key components of the study design, such as the interview guide, and to validate the credibility and relevance of emerging findings. The research team also consulted the Project Advisory Committee, which included senior WSIB leadership, the Chief Prevention Officer and Assistant Deputy Minister for Ontario, and other governmental subject-matter experts in OHS program management and delivery. Additionally, we presented our initial findings at the mid-point of our qualitative study. These consultations helped ensure that the evaluation was grounded in operational realities and supported the use of findings to inform program improvements and changes to program design and delivery.

As part of the broader evaluation strategy, we also conducted an in-depth documentation analysis in the third year of the evaluation, the purpose of which was to provide methodological triangulation for our qualitative findings (39, 41) and investigate the effect of specific program changes. Using a systematic approach, this review examined program materials and resources, 300 evidence submission records, validator correspondence, and documentation of program changes (42). The focus of the analysis was to corroborate interview findings and provide an understanding of how participant-reported challenges and experiences were reflected in the evidence submission and validation processes. This documentation review also generated evidence of how interview feedback was shaping tangible program improvements during the early stages of rollout. Together, the subject-matter consultation and documentation triangulation strengthened the credibility and robustness of the findings presented here, and underscored their importance for supporting program improvement.

The HSE program appeared to work best for firms at the foundational and intermediate level, who benefited from the program structure and had the internal resources available to invest in the program. Smaller, less resourced firms, firms with well-developed OHS systems and firms with a national or international reach encountered more challenges in making the program fit their workplace contexts.

Despite challenges raised here, participants largely recognized the value in the HSE program, with most intending to continue in the program or agreeing that they would recommend it to other firms. Improvements to their firm’s OHS system and safety culture, either expected or realized, were the primary reason participants gave for remain in or recommending the program. One participant from a small manufacturing firm noted that they reported zero claims in the 10-month period after enrolling in the program, where they would typically have three to four claims. Becoming more proactive in OHS, ‘learning how to do things well’, earning external recognition, and leaning into the opportunity to champion safety in their industry were also given as positive motivating factors. Another participant described the impact of the program on support from senior management:

Similarly, financial incentives were a strong motivator for participants, with rebates perceived as valuable rewards for their efforts and as critical incentives to motivate senior leadership in supporting future OHS initiatives.

However, for some participants, continued participation or recommendations to other firms came with a caveat or they signaled their intention to exit the program altogether. For these participants, the workload and amount of resources required were prohibitive and they raised concerns about the cost effectiveness of their continued engagement. This was particularly evident among smaller, less resourced firms and larger, more advanced firms. In one case, a participant from a medium manufacturing company worried they would have to ‘hire a $70,000 per year health and safety manager’ just to ‘receive a $3,000 rebate at year’s end’. An additional concern among participants from larger firms was that the program not well suited for global or national firms or firms with nested organizational structures, such as subsidiaries, because it was difficult to adapt validation requirements to their circumstances. Participants from more advanced firms also discussed ‘aging out’ of the program and moving on to more advanced health and safety programs. Finally, there were some participants who saw value in the program but indicated they would scale back their engagement in future years:

The research team engaged program administrators throughout the project, delivering three rounds of findings to the HSE program leadership in 2021, 2022 and 2023. After the first wave of interviews, we provided preliminary findings through presentations and a report focused on actionable recommendations. Following the second wave, we produced a final qualitative report and presentations highlighting key successes and challenges during the program’s first 2 years. A third report and presentations, specifically linking the documentation analysis with the findings from the qualitative interviews, was provided the following year. These findings were used as real-time evidence to guide iterative improvements to the HSE program.

Informed by our research, the program underwent a significant expansion of supports for participating firms, with small firms recognized as requiring the greatest additional assistance. In response, firms with 1–99 full-time employees became eligible for doubled rebates and a one-time payment of $1,000 upon action plan approval, intended to assist with initial work to implement the HSE program. In addition, a ‘recommended pathway’ of pre-selected topics was developed to facilitate initial engagement for small firms and firms with limited experience in occupational health and safety. A similar stream has been developed for larger, more mature firms that already have Certificate of Recognition (COR®) and ISO 45001:2018. More recently, program administrators, in partnership with a large program provider, have developed a Leadership Stream as an introductory option to better support small firms. This new stream waives registration fees and offers additional supporting during topic selection, a more comprehensive health and safety review, and live webinars for each topic. It offers a simplified entry point and was developed in direct response to challenges and gaps identified through our qualitative findings and documentation analysis. Alternately, for larger, more mature firms the program manual now clearly delineates a pathway to enroll in SOSE as they ‘age out’ of the program.

Given participant concerns about program workload, program administrators divided two of the broader foundational topics into five separate topics to make the requirements more manageable. More detailed instructions on how to meet topic requirements, including illustrative examples, were incorporated into the program instructional manual. These changes were later supported by our documentation analysis, which showed that firms often struggled to demonstrate the full breadth of requirements for this topic in their submissions. To further reduce uncertainty and administrative burden of evidence submissions, the program manual was updated with evidence story templates and illustrative examples for seven topics. Additionally, validators began to conduct clarification calls with firms during the review process. Findings from the documentation analysis suggested that these calls were effective in supporting firms and clarifying requirements.

The submission process itself was streamlined through improvements to the program’s online portal, reducing the number of steps required to upload and submit evidence. In response to inconsistencies in validation outcomes, program administrators introduced a process that ensures a single validator reviews all evidence submissions for multiple business accounts under one employer. The WSIB has also introduced provider rantings to assess the quality and reliability of program providers and address the variability in provider performance identified in our findings.

The responsive use of our research findings during program delivery highlights the value of integrating evaluation into the early stages of OHS program development and implementation. These changes represent the first phase of program evaluation, with future assessments focusing on the impact of the 2022 and 2023 modifications, and, ultimately, the HSE program’s effectiveness in reducing workplace injury and accident rates.

A key strength of the study is its systematic approach to data gathering and analysis. Participants were sampled across a range of job roles, firm sizes, industries, and locations within Ontario, offering a diverse set of perspectives. The use of a structured interview guide allowed for comparison across respondents, especially in areas of interest to the program administrators for program improvement. Structured guides can inadvertently shape responses toward researcher-identified priorities, however we addressed this concern by including probes, follow-up questions, and encouraging participants to provide any additional comments at the end of each interview.

A few limitations should be considered when interpreting our findings. Firstly, the HSE program operates exclusively in the province of Ontario, a single jurisdiction with a provincially administered no-fault employer-funded workers’ compensation system. Our findings may be of particular interest in other jurisdictions with comprehensive disability insurance systems, for instance other Canadian provinces, Australia and Europe, while generalizability may be more limited in jurisdictions with less institutional support. Secondly, our sample largely included firms that had progressed in the program and firms that that did not complete topics were underrepresented; though we attempted to address this by recruiting a subset of such firms in the second wave. Thirdly, we focused on those responsible for program implementation, meaning perspectives from employees, labor representatives and program providers were not captured. Future research should include these stakeholders to better understand buy-in on such OHS programs. Despite these limitations, our qualitative study provides valuable insights into early-stage implementation of a new OHS program, and lays the foundation for ongoing evaluation and program improvement.