*3.3. Employee*

In order from most to least frequently mentioned, leaders mentioned employees as a barrier to program effectiveness, employees who are treated like family, employees demonstrating leadership in the program, employees participating in workplace health and safety programs, and individual accountability. Leaders mentioned difficulty in getting employees engaged in the programs for several reasons, such as adding more work to their busy schedules and cultural differences.

"The reality is that everyone is juggling things like having a family, getting their work done ... having a hard time finding time to fit it exercise or gardening or all of the great stuff that we'd do if we only worked 30-h weeks".

"It matters from an employee perspective obviously because we have got a small workforce . . . We wear a lot of different hats".

"Our employee base is mostly Latino based and in most cases there is a difference of cultures between their originating country and here in the United States".

Business leaders also expressed an understanding that employees have other non-work responsibilities, like family. Some even promoted family inclusion to increase participation in health and wellness initiatives.

" . . . people can bring their families and their pets".

Some leaders mentioned that their employees demonstrate leadership. For example, leaders mentioned instances in which employees identify hazards and help to control them, help build safety and/or wellness programs, and senior employees who voluntarily coach newer employees until they become familiar with safe work processes.

"I think it's important to involve employees in that decision-making process and development of programs".

"So we take somebody who is extremely knowledgeable and skilled and they have to oversee someone actually executing on a procedure before they sign off that they are competent to do that".

Finally, as it pertains to health in general, some leaders mentioned that ultimately employees have to make the decision to be healthy.

"We just try to leave it up to the individual to make their own decisions about what they are comfortable with".

#### **4. Discussion**

We sought to understand TWH from the small business leader perspective. When we asked leaders about their leadership practices for health, safety, and well-being, leaders reflected upon their business 65% of the time, on themselves 28% of the time, and their employees 7% of the time. These findings demonstrate that small business leaders primarily communicate about TWH through the lens of their business policies and programs. Within each of these three overarching themes, leaders most commonly discussed elements of their TWH programs followed by the ways in which they lead by example within these programs and the employee barriers to TWH program effectiveness. Leaders rarely discussed the ways in which they integrate health, safety, and well-being.

Historically, leadership research focused on individual leader qualities and practices. The leaders in our study mentioned several times that they lead by example and considered the individual needs of their workforce, both of which were previously linked to health and safety outcomes [39]. However, other positive leadership characteristics such as empowering employees, coaching and teaching, motivating and inspiring, being authentic and ethical, and sharing or distributing leadership were rarely mentioned in the interviews [36,45,47,50,51]. Leaders mentioned business practices to encourage employee growth (i.e., training), solicit employee feedback, and communicate health messages. However, they did not specifically mention the ways in which they personally engaged in these practices.

Present day leadership research expands the concept of leadership from the individual leader to followers, the work environment, culture, etc. [52]. Our finding that small business leaders overwhelmingly discuss health, safety and well-being in the context of their business when asked about TWH leadership practices highlights the importance of considering leadership in a more comprehensive context. Similar to other qualitative studies on management perceptions of safety or health promotion programs [53,54], leaders mentioned a variety of policies and programs they have for their employees, as well as barriers to program effectiveness and outcomes of the program if successful. This perspective focuses on what Burke et al. [55] would call a transactional rather than transformational perspective. A transactional perspective focuses on management issues (e.g., TWH structures and systems), whereas a transformational perspective focuses on leadership, culture, and overall organizational mission and vision. Both are important aspects of a business's TWH strategy [7]. Our findings point to an opportunity to study leadership practices in the context of existing TWH systems, especially as it pertains to integration. It also demonstrates a need to help small business leaders connect their own practices to their business's TWH structures and systems in practice [52].

In our study, leaders rarely talked about their employees' perspective of health, safety, and well-being. When leaders did, they talked about employees in the context of barriers to program effectiveness. Small businesses leaders who wish to increase employee engagement must be able to understand and describe their employee's perceptions of the TWH program. Safety climate research demonstrates the importance of employee perception, showing that employees often report worse perceptions of organizational or management commitment to safety than managers [56,57]. Huang et al. [56] argues that this difference can result in management failing to act to improve safety conditions, and as a result that more weight should be placed on the employee than management perspective when making program decisions. Furthermore, TWH researchers argue for a participatory approach to program development and management [58]. Thus, if small business leaders are primarily focused on TWH in a business context, as found in the present study, there are likely substantial gaps between TWH programs and employee needs and interests.

In practice, these finding suggests that small business leaders may be more receptive to TWH leadership practices if it is communicated through the lens of their business. To obtain leadership support for TWH, academics and practitioners should build an argument for why and how consideration of their employees perspective as well as their own perspective on TWH contributes to business operations and overall business success.

It is worth noting that there may be some alternative explanations for the code frequencies we observed. As mentioned above, leaders rarely talked about specific leadership practices. However, this does not mean they do not display them in their daily work activities. It may mean that they do not naturally discuss them. We may have observed different results had we structured our questions differently. For example, we did not preface the interview with an explanation of what leadership is nor did we explain what TWH is. The latter may have helped leaders better understand of the aim of the interview and resulted in more description of their leadership practices. The former may have contributed to our finding that small business leaders primarily discussed health, safety, and well-being separately. Leaders may have interpreted the questions as asking for non-integrative responses.

#### *4.1. Future Research*

The present study adds to the literature on leadership support for TWH business practices [59] by being the first to begin to understand what leadership support means from small business leaders' own words. This follows previous calls by leadership researchers for more mixed methods leadership research to better understand leadership in context [52]. Building upon the present study, future qualitative research should consider focusing interview questions on TWH as an integrative concept to better understand the ways leadership practices are used to simultaneously influence health, safety, and well-being. Additionally, concrete questions should be used to hone in on specific leadership practices such as coaching or ethics. An important next step in this research will also be to study small business TWH leadership from the employee perspective to learn whether they observe their leaders engaging in leadership practices. As described above, employee and management perceptions often differ.

Next, a quantitative needs assessment that employs a larger sample of small business leaders is needed to quantify opportunities for TWH leadership development. This should investigate which leadership styles, or combination of styles, elicit the best health, safety, and well-being outcomes including organizational-level indicators of TWH [60] as well as employee-level health, safety, and well-being outcomes. It will be important to assess TWH leadership from multiple perspectives, such as management, health and safety manager, human resources manager, and employee. Finally, future research on this topic should consider how contextual factors including business size, industry, business structure, geographic location, ownership, and other factors are associated with leadership. Other factors, including leaders' age, gender, race, ethnicity, and identifying workforce information (e.g., diversity, industry sector, part-time, full-time) should be considered as well.

Another next step is to investigate TWH leadership development strategies. Leadership development research for health promotion and safety has historically been siloed. Thus, an important next step will be to investigate the ways in which leadership development can be a means of improving TWH. We are currently investigating a TWH leadership development program described in Schwatka et al. [7] by structuring the learning content based on the three themes learned in this qualitative study: their business's TWH policies and practices, their employee's perspective of these policies and practices, and their own perspective via key leadership practices curated from multiple leadership theories. Our aim is to help small business leaders place their business practices in the context of their employees TWH needs as well as their own leadership practices.
