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Stage Theory of Organizational Change in Public Health

The Injury-Related Public Health Problem

The injury-related public health problem that will be discussed is the high incidence of injuries among teenager restaurant workers. Because restaurants become first formal place of employment for young workers, the rates of incidences there are also high. Approximately 30% of all workers employed by restaurants still have not reached their twenties (Ward et al., 2010). According to Ward et al. (2010), workers who are younger than 25, are injured during the working process “at a rate 1.2 to 2.0 times that of adult workers” (p. 58). In the Washington State, between the years 2000 and 2008, approximately 37% of occupational injuries happened in hospitality and food service (Ward et al., 2010, p. 58). The population at risk is teenagers and young adults who are from 12-13 to 20-24 years old.

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What Factors Might Influence Risk

The factors that might influence the risk of being injured at a workplace include specific risk factors in the restaurant industry: slippery floors, sharp objects, hot substances, objects, and equipment, awkward positions, and lifting of heavy objects (Ward et al., 2010). Psychological factors also should not be omitted and include increased pressure on teenage workers, pace pressure, prioritization of customer service over other responsibilities, and interaction with hostile customers (Ward et al., 2010). Moreover, work equipment that teenagers use is designed for adults and therefore can bring difficulties in the working process, resulting in illnesses and injuries as well.

Organizations, Injuries, and Violence

Teenagers are usually exposed to such type of violence as bullying; although bullying is more common for schools, it can also traverse to the working place, resulting in severe psychological and physical problems. Bullying at the working place is possible because underage employees are usually less aware of their rights and responsibilities; therefore, they can be manipulated or forced into performing a particular activity. What is more, “environmental and organisational factors can be sources of bullying” (Andersen, Labriola, Andersen, Lund, & Hansen, 2015, p. 4). If a bully and a bullied person work at the same restaurant, it is possible to expect that bullying will not cease during the working process as well. As Ward et al. (2010) state, injuries at restaurants and other food service facilities are often the cause of unsafe actions that employees other coworkers engage in.

Change Agents

Stage theory of organizational change is an idea that implies each organization has to pass through several steps and stages as they change (Butterfoss, Kegler, & Francisco, 2008). This theory explains how organizations should develop their goals, technologies, new ideas, and programs (Butterfoss et al., 2008). The stages that an organization has to pass are the following: awareness stage, adoption stage, implementation, and institutionalization (Butterfoss et al., 2008). The problem of bullying needs to be identified by the community; then, a policy that will address the problem will be formulated. After that, the innovation is to be implemented in one school or the whole community to see the reactions of participants. If the policy is confirmed to be successful, it can entrench in an organization (Butterfoss et al., 2008). Change agents play a specific role during these stages. Depending on the facility, change agents can be different and influence different stages of the theory. According to Butterfoss et al. (2008), senior administrators play a specifically important role during the problem awareness and definition stage, while mid-level administrators, such as principals or curriculum coordinators, can influence the adoption and early implementation stages (p. 359). Teachers can have an impact on the implementation stage, and senior administrators are highly influential during institutionalization (Butterfoss et al., 2008). Therefore, the role of change agents should not be diminished as a successful implementation of an intervention depends on them as well.

Additional Insights

Although it may not seem clear at first why public health should be focused on violence and bullying at school, it is important to remember that any violence in the community directly affects health of its residents, and, possibly, health services as well (Krug, Mercy, Dahlberg, & Zwi, 2002; Arkin, 2008). What is more, early intervention can prevent children’s evolvement into bullies, abusers, and other perpetrators of violence (Krug et al., 2002). Therefore, if an intervention focused on prevention of bullying is implemented in all grades, there is a better chance that bullying and other types of abuse will also reduce in this school.


Injuries among teenage workers and violence at school and in a community can be linked to each other, although not always. Better work culture, as well as a program that will prevent the development of violent behavior, need to be designed to address the problem. Another question that needs to be answered is the following: why bullying often transfers from school to work and vice versa?


Andersen, L. P., Labriola, M., Andersen, J. H., Lund, T., & Hansen, C. D. (2015). Bullied at school, bullied at work: A prospective study. BMC Psychology, 3(35), 1-15.

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Arkin, E. (2008). Making health communication programs work. Collingdale, PA: DIANE Publishing.

Butterfoss, F., Kegler, M., & Francisco, V. (2008). Mobilizing organizations for health promotion. In K. Glanz, B. Rimer, & K. Viswanath (Eds.), Health behavior and health education: Theory, research, and practice (pp. 335-361). San Francisco, CA: Jossey-Bass.

Krug, E. G., Mercy, J. A., Dahlber, L. L., & Zwi, A. B. (2002). Public health: The world report on violence and health. Lancet, 360(9339), 1083–1088.

Ward, J. A., De Castro, A. B., Tsai, J. H. C., Linker, D., Hildahl, L., & Miller, M. E. (2010). An injury prevention strategy for teen restaurant workers: Washington state’s ProSafety Project. AAOHN Journal, 58(2), 57–66.

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