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ISBN ISBN ISBN 978-952-261-040-9 978-952-261-040-9 978-952-261-040-9
Towards Better Better Work Work and and Well-being Well-being Towards Towards Better Work and Well-being
ORDERS ORDERS ORDERS
PROCEEDINGS PROCEEDINGS PROCEEDINGS ofof of the the the International International International Conference Conference Conference 10–12 10–12 10–12 February February February 2010, 2010, 2010, Helsinki, Helsinki, Helsinki, Finland Finland Finland
PROCEEDINGS of of the the International International Conference Conference PROCEEDINGS PROCEEDINGS of the International Conference
Workplace Workplace Workplace well-being well-being well-being
Health Health Health safety safety safety solutions solutions solutions
& & &
Productivity Productivity Productivity Workplace Workplace Workplace health health health &well-being &well-being &well-being services services services
Policy Policy Policy
Proceedings of the International Conference
Towards Better Work and Well-being 10–12 February 2010, Helsinki, Finland
ORGANIZERS: Finnish Institute of Occupational Health Ministry of Social Affairs and Health Ministry of Employment and Economy Finnish Association of Occupational Health Physicians Finnish Association of Occupational Health Nurses
EDITORS: Hannu Anttonen Päivi Husman Tomi Hussi Timo Leino Matti Ylikoski
Finnish Institute of Occupational Health Helsinki 2010
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Acknowledgements
The International Conference “Towards Better Work and Well-being” has been financially supported by the Finnish Work Environment Fund, the Federation of Finnish Learned Societies, and the Local Government Pensions Institution. The authors are alone responsible for the views expressed in the signed articles of this publication. The Finnish Institute of Occupational Health is not liable for any use that may be made of the information contained in this publication. The Finnish Institute of Occupational Health (FIOH) holds the copyright for the collective work of which the individual proceedings articles form a part.
English language editing: Alice Lehtinen Cover design and layout: Tuula Solasaari Technical editors: Paula Ollila and Taina Pääkkönen
Edita Helsinki 2010 ISBN 978-952-261-040-9
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Contents
Preface Hannu Anttonen and Harri Vainio, Finland
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SCIENTIFIC AND PRACTICAL EVIDENCE Scientific and practical evidence - supporting policies and strategies Hannu Jokiluoma, Finland WHO global framework and model on healthy workplaces Evelyn Kortum, World Health Organization Joan Burton, Canada Making the business case for workplace health promotion in times of economic crisis Wolf Kirsten, Germany Implementation and evaluation of health promoting leadership Andrea Eriksson, Susanna Bihari Axelsson and Runo Axelsson, Sweden The role of international organizations/NGOs in promoting occupational health: identifying priorities for psychosocial risk management Aditya Jain and Stavroula Leka, UK Quality of work in Europe: Measuring working conditions through a cross-national survey Maija Lyly-Yrjänäinen, Greet Vermeylen and Agnès Parent-Thirion, European Foundation for the Improvement of Living and Working Conditions
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MANAGEMENT AND GOOD PRACTICES – BETTER PRODUCTIVITY Management of psychosocial risks at the workplace: Best practice through the development of effective policies, assessment and interventions Stavroula Leka, UK Implicit strategies to improve work and well-being: The social dimensions of organizational excellence Gerard I.J.M. Zwetsloot, the Netherlands/UK Ariella R. van Scheppingen, the Netherlands
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Intellectual capital-based future personnel management Tomi Hussi and Guy Ahonen, Finland
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Psychosocial work environment and performance Kasper Edwards and Niels Møller, Denmark
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Enhancing well-being in the public organization Jarmo Vorne and Hannu Anttonen, Finland
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Stress management at the workplace – building practice guidelines for occupational health services Juha Liira, Maritta Kinnunen-Amoroso, Riitta Sauni and Jani Ruotsalainen, Finland
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WORKPLACE AS AN ARENA FOR HEALTH AND SAFETY PROMOTION Worker values, culture, and community – values communication that goes directly to workers and supports well-being Robin M. Nicholas, USA
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Sustainability in workplace health promotion (WHP) Klaus Pelster, Germany
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Exploring work: Employee stories as tools for promoting workplace well-being Laura Seppänen and Annarita Koli, Finland
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EXPERT SERVICES AND POLICIES Integration and networks of different health and well-being services at the workplace Karl Kuhn, Germany Knowledge work in distributed, mobile teams Virpi Ruohomäki, Finland Well-being and work: A perspective from eight European countries on common areas of understanding, national drivers for progress, and research needs David Fishwick, Jennifer Lunt, Andrew D. Curran and Mary Trainor, PEROSH
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Author index
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List of participants
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Preface Hannu Anttonen and Harri Vainio Finnish Institute of Occupational Health, Helsinki, Finland
The ‘Towards Better Work and Well-being’ conference, held in Helsinki, February 2010, was attended by 190 participants from 34 countries. During the Conference, 12 keynote presentations, 57 oral and 47 poster communications were given. A selection of proceedings articles on the Conference presentations is published in this proceedings publication. Some articles based on the Conference presentations will also be submitted to the Journal of Occupational Medicine (JOEM) to be published later in 2010. The ‘Towards Better Work and Well-being 2010’ conference was arranged by the Finnish Institute of Occupational Health in co-operation with the Finnish Ministry of Social Affairs and Health, the Finnish Ministry of Employment and the Economy, the Finnish Association of Occupational Health Physicians, and the Finnish Association of Occupational Health Nurses. The Conference was supported by the World Health Organization, the International Labour Office, the European Network for Workplace Health Promotion, the European Network for Education and Training in Occupational Health and Safety, and the European Technology Platform on Industrial Safety. It was sponsored by the Federation of Finnish Learned Societies, The Finnish Work Environment Fund, The Local Government Pensions Institution, and the Finnish Heart Association. The aim of the Conference was to provide an opportunity to discuss strategies and tools for the promotion of health and well-being at work, and its effect on productivity. The main topics were: ~ Scientific and practical evidence ~ Management and good practices – better productivity ~ The workplace as an arena for health and safety promotion ~ Expert services and policies.
Comprehensive challenges The challenges of well-being at work (W-BW) are connected to continuous changes at work, and co-operation between the different actors (occupational health specialists, labour inspectors, Local Health Agencies) is needed now more than previously. Well-being at work involves an approach concerning comprehensive actions for the promotion of the better health, safety, and well-being of the workforce, combined with the promotion of productivity, and the success of companies and enterprises. As the function of individual risk strategies and organizational strategies, well-being at work is a more demanding, more holistic and integrated concept and more useful for SMEs than the concepts of control, safety management, work ability and health promotion alone.
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The promotion of well-being at work has been developed through national policies, and joint initiatives and strategies of the EU. The main background contexts of the development of well-being at work policies may be identified as follows: ~ Occupational Health Services (OHS) and Workplace Health Promotion, particularly as described in the World Health Organization (WHO) policies and strategies. ~ Occupational Safety and Health (OSH) strategies and activities with the tradition of occupational safety and the prevention of accidents at work (ILO). ~ Enterprises and organizations themselves at the heart of the recent development of W-BW. New management and leadership principles have been mainly developed to assure the competitiveness and success of companies and enterprises.
Benefits of well-being at work Most European countries have accepted that the benefits of WB-W can be seen at the levels of (1) national economy, (2) company, and (3) the individual worker. The improvement can be seen in: ~ Productivity, extended work careers, later retirement, decrease of absence from work ~ Workplace image, profit, quality, competitiveness, mutual respect, initiative ~ Better career options, increased motivation, better work and leisure, less stress.
What is well-being at work? Different disciplines have different definitions of well-being. Well-being is increasingly being understood as more than merely the absence of negative circumstances, such as illness. It is now seen as also entailing positive features such as the quality of the workplace or even contentment with one’s life. The Conference was historical in defining well-being at work and studying the interaction of occupational and personal risk factors together with the concepts of productivity and the quality of work life. The two main definitions of well-being at work as presented in the Conference are: ~ Well-being at work describes the worker’s experience of the safety and healthiness of work, good leadership, competence, change management, the organization of work, support of the individual from the work community, and how meaningful and rewarding a person finds his/her work (definition published at “Well-being at work – New innovations and good practices”, EU/Progress VP/2007/005/371 -project report, FIOH 2008). ~ Well-being at work is something experienced by employees when they feel that their work is meaningful and flexible, and takes place in a work environment and community which is safe, promotes health, and supports work careers (definition used by FIOH).
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Results of the Conference The main results of the Conference were: ~ Traditional occupational health and safety is the basis of well-being at work; ~ Evidence-based thinking in OHS practice needs to be strengthened; ~ The well-being of workers and the productivity of companies are clearly linked; and ~ Leadership style and organizational justice are important for creating a good work environment and for promoting productivity. Many important discussions took place at the Conference. Improving the health of the whole working-age population and making evidence-based thinking a key feature of OHS practice were two prominent topics. Decisions on policies and strategies on well-being at work should be based on the best available evidence. Ill-being at work may also cause substantial losses for both companies and society. The annual costs would currently be over 10 times higher than annual investments. Many business cases meant as a rationale for investment are reported. The payback period was less than six months for 60% of cases. Relatively strong evidence of cross-sectional associations of psychosocial factors, such as job strain, effort-reward imbalance, and organizational justice, with CHD and depressive symptoms across different populations, were shown. The quality and competences of service providers were discussed. The globalization of the economy entails restructuring organizations and the fragmentation of jobs. Jobs have become more mental and social. As regards psychosocial work environment and performance, it was found that specific leadership styles were responsible for creating a good work environment, which in turn leads to good performance. These styles were process-oriented, supportive and consistent, but also demanding. The findings showed that both the perceived justice of the employer and the perceived fulfilment of organizations’ obligations were positively connected to employee dedication in particular – a dimension of work engagement, and negatively connected to cynicism – a dimension of burnout. It was also proved that healthy work relates to healthy business in Swedish small and medium enterprises (SMEs). The Conference concluded that well-being at work depends on traditional health and safety, and occupational health services, and builds on them. In addition, communication, talking and listening are essential actions for wellbeing. Efforts are needed in clarifying the concepts of measurement and surveillance, creating paradigms, and developing the benchmarks of wellbeing at work. It is essential for occupational safety and health to renew its approaches in view of the forthcoming demographic changes due to ageing workers in many parts of the world.
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Scientific and practical evidence – supporting policies and strategies Hannu Jokiluoma Ministry of Social Affairs and Health, Finland
Abstract The decisions concerning policies and strategies on well-being at work should be based on the best available evidence. Evidence lays the foundation for high-quality and systematic policies, strategies and actions. It enables us to predict decisions and actions. The use of evidence is the cornerstone of the fair and equal treatment of citizens. Evidence is used in the planning phase of policies and strategies, both during their implementation, and when the results of the chosen policies and actions are monitored and evaluated. Analytical evidence-based policies lead to a variety of actions. Firm evidence enables an optimal allocation of resources for legislation, enforcement, research and development, information dissemination, financial incentives, and other purposes.
Key observations Evidence, and its competent interpretation, is a necessity for widely approved and effective policies, strategies and actions aimed at improving wellbeing at work. Firm evidence enables the optimal allocation of resources e.g. to actions related to legislation, enforcement, research, development and information dissemination. Well-being at work contributes not only to the well-being of individual persons and work communities, but also to the national economy, balanced pension costs, length of work careers, public health, and to social cohesion.
Role of evidence Evidence is attained through scientific research and practical experience. Acquiring it demands financial resources, but neglecting the use of existing evidence is also a common risk. Evidence has to be procured from social, economic and environmental perspectives. It should cover all necessary aspects related to decisions concerned. If evidence is too narrow in scope, it may lead to unnecessary investments or to the neglect of some areas.
Introduction The discussion regarding evidence-based management and the use of evidence has emerged, and will remain an important issue on the political agenda. Strategies and policies have a long timeframe, which emphasizes the availability and use of high-quality information as an essential element in decision-making processes. Policy-makers continuously need information
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and knowledge which enables them to make the right decisions and explain the motives of their decisions to citizens. In the public sector, the visions and goals should be transparent, and the information behind the decisions should be available to everybody. Of course, security and privacy may lead to exceptions to this principle. The scope of any policy or strategy is defined and decided in the planning phase. A balanced and comprehensive set of measures to reach the goals is formulated in order to lead society towards desirable goals. During the implementation of strategies, data and information are collected and analysed in order to follow the impact of the measures taken. Finally, high-quality monitoring and evaluation provides evidence for strengthening the most effective measures and for adjusting strategies and policies. When economic resources are insufficient for acquiring new technology, employing additional staff, expanding or even maintaining existing programmes, the importance of using evidence-based management cannot be overemphasized. Failure to adopt documented or generally accepted best practices is ethically indefensible. (Hofmann 2010) Overregulation is one of the risks involved in using evidence, if it is done so negligently. This happens, for instance, if we try to avoid all alleged or potential risks that are based on uncertain evidence. The interpretation of evidence is subject to change even if the data are always valid. Risks which manifest their effects later on are particularly difficult to deal with. Neglecting the use of existing evidence is also a widespread major risk. The formulation of policies requires people who are competent in research and who understand, for example, the intricacies of the university and academic worlds.
Approaches of policy-makers and scientific communities Evidence, and its competent interpretation, creates the foundation for highquality and systematic policies, strategies and actions aimed at improving well-being at work. From the policy-maker’s viewpoint, the scientific community is a service provider and necessary partner. Evidence is created by means of scientific research and practical experience. Life, with all its circumstances, is too diverse and variable to be fully documented in scientifically valid documents. Practical evidence is a useful asset in decision-making. Evidence should be acquired from social, economic and environmental perspectives. It should cover all necessary aspects related to the decisions concerned. If the evidence is too narrow in scope, it may lead to fruitless use of money or to the neglect of some important areas. Both the scientific community and policy-makers recognize the importance of research-based knowledge for making strategies and policies. However, they approach the science-policy interface from different perspectives. According to Hukkinen (2009), the difference in perspectives can be summarized through two issues: conflicting agendas, and conflicting timeframes. Conflicting agendas arise from the different nature of science and policy. For a policy-maker, issues raised in research may not look as policy-relevant. On the other hand, the topics that the policy-maker regards as relevant may, to
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Evaluated external evidence
Practitioner experience and judgments
Decision
Stakeholders, preferences, or values
Context, organizational actors, circumstances
Figure 1. Four elements of evidence-based management are necessary for the decision-making process. Adapted from Briner, Denyer and Rousseau 2009.
the researcher, seem too trivial or overly influenced by politics. Conflicting time frames are often caused by the policy-maker needing to make immediate decisions. Researchers often want to carry out so-called ‘good’ research, while policy-makers want quick solutions to acute situations. Despite conflicting agendas and timeframes, the perspectives of policy-makers and researchers often do match, and in most countries, the linking of research and policy is already taking place. The quality of evidence can be upgraded if the users are involved in the formulation of questions, choices of methods, and interpretation of results. Administrators and policy-makers have to be aware that the research community and individual researchers may also have their own interests that may dilute the evidence base.
Co-operation for societal goals Societal visions and goals do not necessarily need evidence and we do not need to argue for our visions through research or practice-based evidence. Despite this, widely approved and realistic national goals, policies and programmes provide a solid basis for development. A common vision of desirable societal conditions will gradually be achieved via certain steps and intermediate goals. Success requires good co-operation, in which the role of all social partners is essential. Individuals and organizations have different visions and goals. When formulating the national vision of well-being at work, the different organizations involved, such as the state and social partners, as a compromise, create a vision that is acceptable and satisfactory for each partner. During the process, each actor keeps its own vision and objectives in mind and tries to search for and propose means which particularly their own objectives but also support 10
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common goals. Normally one opposes proposals that are against one’s own objectives and ideology, even if they promote the achievement of common goals. In this kind of contradictory situation, different actors actively search for evidence that supports their own visions and objectives, but at the same time cannot see other evidence. Extending work careers is one of the most important and widely accepted goals of Finland’s policy to meet today’s demographic challenges. The goal is to raise the real retirement age by at least three years by the year 2025, and make people start their work careers one year earlier. An essential fact is that well-being at work gives a person a real opportunity to choose whether to continue working or leave work life. The person should be sufficiently healthy, and both physically and mentally capable of working. Besides, one has to be motivated to work and stay in the labour market. If a person is not capable of working, it is hardly possible to influence his or her real retirement age through legislation. Accident frequency, and the emergence of new occupational diseases are measurable goals, as is the proportion of sickness absence of working hours. Well-being at work means safe, healthy and productive work in a well-led organization, performed by competent workers and work communities who find their jobs meaningful and rewarding, and see work as a factor that supports their life management. Well-being comprises physical, mental and social well-being at work. Improving and promoting well-being at work is a self-evident and standalone human goal. Well-being is also an essential element in improving the productivity and success of organizations. In fact, well-being, productivity, and customer satisfaction can be improved simultaneously. Well-being at work also affects individuals, families, and larger communities and organizations. It contributes to the national economy, employment rate, length of work career, public health, balanced pension costs, sustainable development, social relations, environment, utilization of natural resources, equality, and social cohesion, etc.
National programmes A series of national work life programmes have been a significant success factor in Finland. As regards the methods, the programmes represent the policies adopted in the past couple of decades (Hurmalainen, Savolainen and Yrjänheikki 2007). Alongside management by norms and management by resources, the role of management by information is emphasized, and this is what the different programmes particularly aim to do. All the programmes have been carried out in co-operation with stakeholders. The programmes are an effective way of activating national policies into practice. The innovations and analyses concerning new trends as part of these programmes have also contributed to detecting new and emerging areas which require action. The concrete objectives of the programmes have also been widely utilized in setting objectives for public authorities and other organizations, such as research institutes. The National Forum for Well-being at Work under the auspices of the Min11
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istry of Social Affairs and Health is one module in the government Policy programme on employment, entrepreneurship and work life, and in the Policy programme for health promotion. It also creates synergy with the Policy programme for the well-being of children, youth and families. The forum builds on the heritage of previous work life programmes. It provides a sound platform for broad participation and improves interaction between workplaces and experts. The forum principle is a flexible approach that enables flexible reactions to major changes on the world scene. It comprises a directing council, which includes all the major interest groups. Its viewpoint is compatible with the new WHO concept of worker’s health. The Forum operations are aided by research and other organizations. It also has space for contributions from individuals and professionals interested in improving the various aspects of well-being at work. (Suomaa, Yrjänheikki, Jokiluoma and Savolainen 2009) Examples of executed work life programmes and their goals: National ageing workers programme 1998–2001 ~ To raise the average retirement age; higher employment rates of over 55 year-olds. Well-being at work programme 2001–2003 ~ To disseminate techniques and changing attitudes at the workplace level; ~ To prevent exclusion and burn-out. National accident prevention programme 2001–2005 ~ To reduce the number and severity of accidents and occupational diseases. Work attraction programme 2004–2007 (Veto programme 2009) ~ To ensure citizens’ full participation in work life, to promote the extension of work life, to improve the reconciliation of work and other life areas, to improve equality, and to increase the attractiveness of work as an option in different situations. The Finnish Workplace Development Programme has been reorganized recently, and it is now part of TEKES, The Finnish Funding Agency for Technology and Innovation. Its goal is to promote modest operation of enterprises and other work organizations with an eye to simultaneous enhancement of productivity and the quality of work life. Development activities are based on co-operation between the management and staff of the workplaces.
Conclusions Firm evidence enables the optimal allocation of resources for legislation, enforcement, research and development, information dissemination, and economic incentives. There is a need for an up-to-date policy for allocating resources. Synergy between well-being and economic growth has to be recognized because the social safety net promotes dynamism. The legal basis for well-being at work should be fair for all. The use of evidence is also the cornerstone of the fair and equal treatment of citizens. However, all aspects related to well-being at work can, although they should
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not, be regulated, and there should be great flexibility for finding the best local, sector-specific, and other solutions to practical questions. The sustainable production base can be best maintained through the intelligent use of evidence. Complexity and emerging technologies require insight into the possible undesirable effects on safety and health. Planning for the future requires long-term goal-setting and a vision of circumstances. The evidence base is not fully used at present; this is why the structures of an effective interface between researchers, policy-makers and citizens should be improved. We can use both scientific and practical evidence successfully.
References Briner, R.B., Denyer, D., Rousseau, D.M. 2009. Evidence-Based management: Concept Cleanup Time? Academy of Management Perspectives. November 2009. p. 22. Hofmann, P.B. 2010. The Ethics of Evidence-Based Management. Healthcare Executive. 2010: Jan/Feb. Hukkinen, J. 2009. Science-policy brokerage: Enhancing connectivity between research and policy-making in sustainable development. University of Helsinki. A working report for the European Commission. Hurmalainen, M., Savolainen, H. & Yrjänheikki, E. 2007. Occupational health care in Finland. The Parliament Politics, Policy and People Magazine. 2007: 253. p. 13. Suomaa, L., Yrjänheikki, E., Jokiluoma, H. & Savolainen, H. 2009. Regional Europe’s Regions and Cities Review. The Parliament Magazine. 2009:15. p. 58. Veto Programme. 2009. Final report of the Veto Programme 2003–2007 (Veto-ohjelman loppuraportti). Reports of Ministry of Social Affairs and Health. 2008: 53. ISBN 978-952-00-2748-3; ISBN 978-952-00-2749-0 (PDF).
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WHO Global Framework and Model on Healthy Workplaces Evelyn Kortum1 and Joan Burton2 World Health Organization (WHO) 2 Strategy Advisor for the Industrial Accident Prevention Association, Canada
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Abstract In May 2007, the World Health Assembly endorsed the Global Plan of Action on Workers Health, 2008–2017, with the aim to move from strategy to action and to provide new impetus for action by Member States. Nations and enterprises look to WHO for guidance in wading through the overabundance of information and recommendations on the creation of healthy workplaces. A priority activity was the development of a globally coherent framework and model for healthy workplaces, to assist enterprises in the planning, delivery and evaluation of essential interventions for workplace health protection and promotion (World Health Organization 2010). The framework and model developed by WHO are based on the new WHO definition: A healthy workplace is one in which workers and managers collaborate to use a continual improvement process to protect and promote the health, safety and well-being of all workers and the sustainability of the workplace by considering the following, based on identified needs: ~ Health and safety concerns in the physical work environment; ~ Health, safety and well-being concerns in the psychosocial work environment including organization of work and workplace culture; ~ Personal health resources in the workplace; and ~ Ways of participating in the community to improve the health of workers, their families and other members of the community.
Key observations This definition reflects how understanding of occupational health has evolved from an almost exclusive focus on the physical work environment to inclusion of psychosocial and personal health practice factors. The workplace is increasingly being used as a setting for health promotion and preventive health activities – not only to prevent occupational injury, but to assess and improve people’s overall health.
Why a Global Framework? A look at the global situation reveals that many, possibly most, enterprises, organizations and governments have either not understood the advantages of healthy workplaces, or do not have the knowledge, skills or tools to improve their situations. There is widespread agreement among global agencies, including the World Health Organization and the International Labour Organization, that the health, safety and well-being of workers, who make up nearly half the global population, is of paramount importance. It is important not only to individual 14
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workers and their families, but also to the productivity, competitiveness and sustainability of enterprises, and thus to the national economy of countries and ultimately to the global economy (Ylikoski, Lamberg, Yrjänheikki, Ilmarinen, Partinen, Jokiluoma, Vainio 2006). The European Union stresses that the lack of effective health and safety at work has not only a considerable human dimension but also a major negative impact on the economy (European Union 2007). In recent years, globalization has played a major role in workplace conditions. While international expansion provides an opportunity for multinational corporations to export their good practices from the industrialized world into developing nations, all too often the reverse is true. Short-term financial gains often motivate multinationals to export the worst of their working conditions, putting countless numbers of children, women and men at risk in developing nations (Frey 1998). In 1995, the World Health Assembly of WHO endorsed the Global Strategy on Occupational Health for All (World Health Organization 1995). The strategy emphasized the importance of primary prevention and encouraged countries with guidance and support from WHO and the ILO to establish national policies and programmes with the required infrastructures and resources for occupational health. In May 2007, the World Health Assembly endorsed the Global Plan of Action on Workers’ Health for the period 2008–2017 with the aim to move from strategy to action and to provide new impetus for action by Member States (World Health Organization 2007). The Global Plan takes a public health perspective in addressing the different aspects of workers’ health, including the primary prevention of occupational risks, the protection and promotion of health at work, the work-related social determinants of health, and the improvement of the performance of health systems. In particular, it set out five objectives: Objective 1: To devise and implement policy instruments on workers’ health Objective 2: To protect and promote health at the workplace Objective 3: To promote the performance of and access to occupational health services Objective 4: To provide and communicate evidence for action and practice Objective 5: To incorporate workers’ health into other policies. The Global Plan also provides a political framework for the development of policies, infrastructure, technologies and partnerships for linking occupational health with public health to achieve a basic level of health for all workers (Ivanov, Kortum and Wilburn 2008). It calls on all countries to develop national plans and strategies for its implementation. The WHO comprehensive model and framework includes both content and process, and may be implemented by any workplace of any size, in any country. There is no ‘one-size-fits-all’ policy, and each enterprise must adapt the recommendations to their own workplace, their own culture and their own country. The WHO model and framework bring together the principles 15
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and common factors that appear to be universally supported in the literature and the perceptions of experts and practitioners in the fields of health, safety and organizational health. The definition of a healthy workplace is strongly based on the WHO definition of health: “A state of complete physical, mental and social well-being, and not merely the absence of disease” (World Health Organization, undated) as well as evidence from best practice in the research and practice literature. The WHO definition of a healthy workplace (World Health Organization 2010) encompasses four avenues of influence employers can use in collaboration with workers or employees: A healthy workplace is one in which workers and managers collaborate to use a continual improvement process to protect and promote the health, safety and well-being of all workers and the sustainability of the workplace by considering the following, based on identified needs: ~ Health and safety concerns in the physical work environment; ~ Health, safety and well-being concerns in the psychosocial work environment including organization of work and workplace culture; ~ Personal health resources in the workplace; and ~ Ways of participating in the community to improve the health of workers, their families and other members of the community. The WHO definition and model are graphically represented in Figure 1. The four avenues (large circles) refer to content and not process. Each of the four avenues is explained further below, including some examples of interventions to make the workplace healthier and safer.
Figure 1. WHO Healthy Workplace Model: Avenues of influence, process and core principles.
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The physical work environment is the part of the workplace facility that can be detected by human or electronic senses, including the structure, air, machines, furniture, products, chemicals, materials and processes that are present or that occur in the workplace, and which can affect the physical or mental safety, health and well-being of workers. If the worker performs his or her tasks outdoors or in a vehicle, then that location is the physical work environment. Examples of interventions include: ~ Eliminating a toxic chemical or substituting with a less hazardous one; ~ Installing machine guards or local exhaust ventilation; ~ Training workers on safe operating procedures; ~ Providing personal protective equipment such as respirators or hard hats. The psychosocial work environment includes the organization of work and the organizational culture; the attitudes, values, beliefs and practices that are demonstrated on a daily basis in the enterprise/organization, and which affect the mental and physical well-being of employees. These are sometimes generally referred to as workplace stressors, which may cause emotional or mental stress to workers. Examples of interventions include: ~ Reallocating work to reduce workload; ~ Enforcing zero tolerance for harassment, bullying or discrimination; ~ Allowing flexibility in how and when work is carried out to respect workfamily balance; ~ Recognizing and rewarding good performance appropriately; ~ Allowing meaningful worker input into decisions that affect them. Personal health resources in the workplace means the supportive environment, health services, information, resources, opportunities and flexibility an enterprise provides to workers to support or motivate their efforts to improve or maintain healthy personal lifestyle practices, as well as to monitor and support their ongoing physical and mental health. Examples include: ~ Providing fitness facilities, classes or equipment for workers; ~ Providing healthy food choices in the cafeteria and vending machines; ~ Putting no smoking policies in place, and providing smoking cessation assistance; ~ Providing information about alcohol and drugs, and employee assistance counselling; ~ Providing confidential medical services such as health assessments, medical examinations, medical surveillance and medical treatment if not accessible in the community (e.g., antiretroviral treatment for HIV). Enterprise community involvement comprises the activities, expertise, and other resources an enterprise engages in or provides to the social and physical community or communities in which it operates; and which affect the physical and mental health, safety and well-being of workers and their families. It includes activities, expertise and resources provided to the immediate local environment, but also to the broader global environment. Examples include: ~ Providing free or affordable primary health care to workers, and including access for family members, SME employees and informal workers; 17
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~ Providing free supplemental literacy education to workers and their families; ~ Providing leadership and expertise related to workplace health and safety to SMEs in the community; ~ Implementing voluntary controls over pollutants released into the air or water; ~ Allowing workers to volunteer for non-profit organizations during working hours; ~ Providing financial support to worthwhile community causes without expectation of concomitant enterprise advertising; ~ Going beyond legislated standards for minimizing greenhouse gas emissions. Clearly every enterprise may not have the need to address each of these four avenues all the time. The way an enterprise addresses the four avenues must be based on the needs and preferences identified through an assessment process that involves extensive consultation with workers and their representatives. Implementing a healthy workplace programme that is sustainable and effective in meeting the needs of both workers and the employer requires more than knowing what kinds of issues to consider. To successfully create such a healthy workplace, an enterprise must follow a process that involves continual improvement (a management systems approach). This is graphically represented by the continual improvement loop of Mobilize, Assemble, Assess, Prioritize, Plan, Do, Evaluate, Improve, which is illustrated in the centre of the four avenues in Figure 1. There are also some core principles that underlie this model. Two of the key principles are leadership engagement based on core values and ethics, and worker involvement. These are not merely steps in the process, but are ongoing circumstances that must be tapped into at every stage of the process. Basic occupational health services (BOHS) relate to the healthy workplace framework and model, since the two concepts are similar, yet different, and serve to complement each other. BOHS as defined by Rantanen (2007) includes all the activities described in this model. It focuses on the identification of occupational health risks and needs of workers and workplaces, including surveillance of the work environment, surveillance of workers’ health (health examinations), and risk assessment. On the basis of surveillance results, actions for information, advice and practical assistance in the prevention and control of occupational health and safety hazards, and treatment or referral of occupational diseases are carried out by the Basic Occupational Health Services. The key idea of BOHS is to provide grassroots-level occupational health services with a practical approach and low-cost solutions. Wide coverage of BOHS can only be achieved through support from primary health care (PHC). For this, the PHC personnel needs short training in occupational health. Many countries are in dire need of Access to BOHS.
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Conclusion The model presented here is intended to provide the basis for developing a healthy workplace when workers, their representatives, and the employer work together in a collaborative manner. It is also recognized that governments, national and regional laws and standards, civil society, market conditions, and primary health care systems all have a tremendous impact on the workplace, and on what can be achieved by the workplace parties on their own. Global and country or sector-specific guidance will be developed in the future, as will adapted training programmes.
References European Union. 2007. Community strategy 2007–2012 on health and safety at work [online]. Undated [cited 18.2.2010]. Available from:
Frey, R.S. 1998. The export of hazardous industries to the peripheral zones of the world-system. In Nandi, P.K., Shahidullah, S.M. (Eds.) Globalization and the evolving world society. Leiden: Brill. p. 66–81. Ivanov, I., Kortum, E., Wilburn, S. 2007. Protecting and promoting health at the workplace. Global Occupational Health Network (GOHNET) – WHO Newsletter. 08: 14: 2. Rantanen, J. 2007. Basic occupational health services: strategy, structures, activities, resources. Helsinki: Finnish Institute for Occupational Health (3rd ed.). World Health Organization. Mental health [online]. Undated [cited 18.2.2010]. Available from:
World Health Organization. 1995. Global Strategy on Occupational Health For All [online]. Published 1995 [cited 18 February 2010]. Available from:
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Making the business case for workplace health promotion in times of economic crisis Wolf Kirsten International Health Consulting, Germany
Abstract From a global perspective, the majority of organizations have not implemented workplace health promotion programmes, in spite of the documented benefits. Therefore, there is a need for a strong business case for workplace health promotion. The paper outlines ten key principal areas for arguing the case; focusing on the most pressing challenges (e.g., ageing): the logic of workplace health promotion, the economic impact of presenteeism, the evidence of health promotion effectiveness, corporate social responsibility (CSR), corporate image, recruitment and retention, industry benchmarks and standards, legislation (national or European), starting small with a pilot project, and sound business ethics. Although financial arguments are essential in times of economic crisis, other significant aspects, such as business ethics and corporate image, should also be highlighted.
Key observations ~ Only a minority of organizations globally implement health promotion programmes. ~ More country-specific evidence of the effectiveness of workplace health promotion is needed. ~ The business case must feature financial arguments and the economic impact of presenteeism. ~ The business case should not be restricted to financial terms, but should also include corporate social responsibility (CSR), corporate image, and legislation. The global economic crisis has aggravated the following prevailing challenges in the working world: ~ the increasingly fast-paced business environment ~ the growing demands for increased productivity ~ the ageing and seemingly unhealthy workforce ~ the shortage of resources and a cost-cutting trend. Increasing workload, pressure, and work-related stress have led to a growing number of mental diseases. This chronic disease trend has further heightened the challenge faced by enterprises to employ a healthy and productive workforce. Obesity, heart disease, hypertension, diabetes, and cancer are constant problems, and public health initiatives do not seem to have made much progress in breaking the trend. The British insurance provider Bupa paints a rather depressing image of the workforce in their recent report (BUPA 2009). The authors project that the workforce will:
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~ become older, with more long-term conditions or ‘lifestyle’ conditions ~ be caring for others, be obese with diabetes and/or heart problems ~ comprise the kind of jobs more likely to have an impact on psychological health, and ~ work in knowledge-intensive or service industries. One can imagine how this is making forward-thinking business leaders and human resource managers nervous. The employee – and especially his or her intellectual capacity – is becoming increasingly important, and a highly valued asset. Without good health it will not be possible to achieve the set business goals and increase revenue. A number of studies have pointed out the dire consequences of poor employee health, health risks and lack of engagement in the form of absenteeism, presenteeism, accidents, and health care costs (Mills, Kessler, Cooper and Sullivan 2007). While a widespread consensus on the need for more proactive approaches to employee health seems to exist, given the many publications in Europe and other developed regions in the world, the majority of employers have not acted accordingly and invested in workplace health promotion. According to the Global Survey on Health Promotion and Workplace Wellness (Buck Consultants 2009), only 42% of surveyed employers offer health promotion programmes in Europe (out of 1103). Given the fact that survey participants are probably more progressive with regard to health strategies, this number is quite low. This is likely to be due to a myriad of reasons, e.g. the short-term focus of the business world, lack of country-specific cost-benefit data, or not being a priority on the enterprise level. Therefore, a great need for building evidence and making more convincing arguments for company management exists. This paper will make a strong business case for workplace health promotion and provide health professionals with a base to make the arguments in a business setting.
Focusing on the most pressing challenges To begin with, workplace health promotion should be positioned as a strategy to address the most pressing health-related challenges. Ageing is a major concern in Europe and is increasingly being recognized by employers, as sick leaves rise with age. Projecting the impact of ageing on the company in coming years, and documenting this visually will attract attention. Most companies are facing an engagement challenge, i.e. most workers are not engaged in their work, but stressed, possibly mentally ill, and in the worst case may commit suicide. While different reasons exist, these employee problems are often interrelated and require integrated solutions. Obesity presents another challenge for employers although this is still regarded as a public health problem with limited relevance to the workplace. No doubt, this will change as more data become available with regard to productivity loss due to obesity and associated diseases. In the United States, the argument for health promotion should first and foremost target health care costs and ways in which to stop the cost growth trend.
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Organizational Climate and Health-Related Programmes
Modifiable Health Risks, Working Environment, Work/Life Balance
Physical/Emotional Ability to Work & Engagement
Absenteeism Presenteeism
Profit
Productivity
Human Performance
Figure 1. The Logic of WHP. Adapted from Pelletier, Boles and Lynch in JOEM 2004.
Logic of workplace health promotion It is essential to communicate the logic of health promotion concisely. Brevity of argumentation, i.e., ‘getting to the point’, is required in the business world. The figure above shows the logical flow of how the health of employees affects work performance and subsequently, overall company profits. Based on the above flowchart, one should focus on the opportunity of improving employee health, as well as the work environment, and thereby business performance. This will eventually raise the question of how one can prove these relationships and translate them into financial terms.
Economic impact of presenteeism When discussing the business impact of poor employee health and working conditions, one needs to make the employer aware of the phenomenon of presenteeism – the degree to which employees are present at work but limited in their job performance by physical or mental health problems. The measurement of presenteeism has gained significance in recent years. A number of research studies have been conducted with varying estimations of lost productivity and business impact. The consensus is that the productivity lost due to presenteeism is significantly greater than that lost due to absenteeeism. The Harvard Business Review estimates that lost productivity due to presenteeism is, on average, 7.5 times greater than that lost to absenteeism, and three times that spent on direct medical costs (Hemp 2004). The Sainsbury Centre for Mental Health in the United Kingdom lists a range of 50% to 500% greater productivity losses due to presenteeism than estimates of cost based on absenteeism alone (Sainsbury Centre for Mental Health 2007). While an inherent uncertainty still persists with regard to presenteeism measurements, one can point to validated and mature selfreport instruments, such as the Work Limitations Questionnaire (WLQ), the Stanford Presenteeism Scale (SPS) and the Health and Work Performance Questionnaire (HPQ), as well as to scientific research. In addition, industry
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Figure 2. The Assessment of Chronic Health Conditions on Work Performance, Absence, and Total Economic Impact for Employers (Collins, Baase, Sharda, Ozminkowski, Nicholson, Billotti et al. 2005).
leaders are incorporating presenteeism into their measurement tools. Dow Chemical examined the origins of their health-related costs and found that for all chronic conditions studied, the cost associated with presenteeism greatly exceeded the combined costs of absenteeism and medical treatment combined – at least three times as much in all cases except diabetes (see Figure 2). This has led Dow to measure presenteeism on a global scale and use it as a key indicator on their scorecard. Not surprisingly, improving productivity and presenteeism was specified as the top strategic objective for implementing health promotion programmes by employers in most regions in the Global Survey of Health Promotion and Workplace Wellness Strategies (Buck Consultants 2009). Reducing health care costs remains the top objective in the United States. Reducing employee absences and improving worker morale and engagement were also top-ranking objectives.
Evidence base for workplace health promotion Citing existing research and pointing out the evidence base of health promotion makes all the following arguments more credible. Two landmark review studies from the United States (Aldana 2001, Chapman 2005) found positive cost-benefit ratios as a summary of multiple studies. Aldana (2001) reviewed 40 studies capturing a positive financial impact with an average return-on-investment of $1:3.48 for health care costs and $1:5.82 for absenteeism. Chapman (2005) found strong evidence for average reductions in sick leave, health plan costs and workers’ compensation and disability costs of slightly more than 25%. Cost-benefit studies are harder to find in Europe, but a number of studies have recently been published in the United Kingdom (see Mills et al. above), Germany and Finland. The European Network for
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Figure 3. Top employer objectives driving Health Promotion Initiatives.
Workplace Health Promotion issued a report on making a case for workplace health promotion (ENWHP 2004), citing numerous case studies with positive financial outcomes as well as a series of arguments. However, it stopped short of actually reviewing scientific studies.
Linking to Corporate Social Responsibility (CSR) However, cost-saving should not be the only argument. Pointing out the value of health promotion programmes to the company image cannot be underestimated. Maintaining a good corporate image is of high value in today’s world of heightened media attention. For large multi-national employers, the issue of corporate social responsibility (CSR) has become a key business focus linked to shareholder value. Product safety, labour standards, human rights, equal opportunity, and access are key elements of CSR. Promoting the health of employees and their dependents beyond occupational safety and health is a logical extension for employers. This connection should be explicitly pointed out to the company leadership, especially if CSR is a declared business goal. Tying health promotion to specific business goals is very powerful. The inherent link between CSR and workplace health promotion is being pushed by a number of international organizations and will receive further visibility in the near future (WEF 2008). The Dow Jones Sustainability Indexes highlight leading sustainability-driven companies worldwide as investment opportunities, according to specific corporate sustainability assessment criteria (DJSI 2009).
Corporate image and industry benchmarks The corporate image also plays a significant role in attracting and retaining quality employees. A shortage of skilled workers is already evident in certain industries, and will further intensify given the demographic trends. Provid24
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ing a healthy and attractive work environment will not only be beneficial in attracting talented employees but also in increasing the satisfaction and engagement of workers, which is a major concern among employers. However, employers need to be advised that this involves a comprehensive approach, i.e., more than merely offering attractive benefits in the form of recreation facilities or team events. Studying company leaders and knowing their ambitions beyond the publicized corporate strategies is useful. Most often, highly ambitious individuals are in leading positions. Therefore, appealing to their competitive spirit is a tried strategy. This involves highlighting the practices of industry leaders as benchmarks, provided that these have a more advanced health promotion programme (which is likely for a leader), and pointing towards a way of catching up to or overtaking the industry standard.
Workplace health promotion and legislation Although historically regarded as the employer’s discretion and mostly a private issue, health promotion is featured in some country legislation and European directives. Germany is one of the few countries with a legal foundation for workplace health promotion incorporated in article 20a of the social security law (SGB V). Health insurance companies are required to offer health promotion programmes at the workplace, by identifying and improving the health risks and potential of employees. The European Union Framework Directive 89/391/EEC obliges employers “to ensure the safety and health of workers in every aspect related to the work, primarily on the basis of the specified general principles of prevention” (Europa 2007). This includes psychosocial health risks, which for many employers is an open field without specific guidelines to follow. EU framework agreements on work-related stress, harassment, and violence at work outline principles of good practice and guidelines but stop short of any enforceable regulations. Employers will usually pay attention to potential violations of any law, and several high profile stress-related legal cases in the United Kingdom have heightened this sensitivity (The UK National Work Stress Network 2010).
Starting Small – an effective strategy In times of limited resources and economic pressure, demanding a large investment in human capital, no matter how worthy and strategic this may be, is a risky endeavour. If resources are an issue, the health promotion programme should be portrayed as an extension to the existing programme. For example, the occupational health services provide a logical platform for health promotion activities. In addition, implementing a programme on a small scale, i.e., a pilot programme with a contained group, is a utilized approach which often leads to larger scale investments if the pilot is run successfully. Nevertheless, one should always aim for a comprehensive and company-wide programme in the future.
Health promotion – the “right thing to do” Last but not least, appealing to the lofty goal of sound business ethics is a strategy that resonates well in most countries and with most employers. The World Health Organization sees the creation of a healthy workplace 25
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as a “moral imperative” (WHO 2010) and the “right thing to do”. Treating employees with respect, doing them no harm, and developing their health potential are basic ethical principles that employers must not neglect.
Ten principal arguments for workplace health promotion In summary, the following are ten principal arguments to make when lobbying for workplace health promotion: 1.
Focusing on the most pressing challenges (e.g., ageing)
2.
Outlining the logic of workplace health promotion
3.
Pointing out the economic impact of presenteeism
4.
Citing the evidence of health promotion effectiveness
5.
Tying health promotion to corporate social responsibility (CSR)
6.
Emphasizing corporate image, recruitment and retention
7.
Identifying industry benchmarks and standards
8.
Referring to relevant legislation – national or European
9.
Starting small with a pilot project
10. Appealing to sound business ethics.
References Aldana, S. 2001. Financial impact of health promotion programs: a comprehensive review of the literature. American Journal of Health Promotion. 15. p. 296–320. Arbeitsgemeinschaft der Spitzenverbände der Krankenkassen. 2008. Gemeinsame und einheitliche Handlungsfelder und Kriterien der Spitzenverbände der Krankenkassen zur Umsetzung von §§ 20 und 20a SGB V vom 21. Juni 2000 in der Fassung vom 2. Juni 2008. [Common and consistent action areas and criteria of the leading sickness fund associations for implementation of §§ 20 and 20a SGB V ]. Bergisch Gladbach: IKK Bundesverband. Buck Consultants. 2009. Report of Working Well: A Global Survey of Health Promotion and Workplace Wellness Strategies. San Francisco: Buck Consultants. BUPA. 2009. Healthy Work – Challenges and Opportunities to 2030. London: Bupa. Chapman, L. 2005. Meta-evaluation of worksite health promotion economic return studies: 2005 update. Art Health Promotion. 19: 6. p. 1–11. Collins, J., Baase, C., Sharda, C., Ozminkowski, R.J., Nicholson, S., Billotti, G.M. et al. 2005. Assessment of Chronic Health Conditions on Work Performance, Absence and Total Economic Impact for Employers. Journal of Occupational Environmental Medicine. 2005: 47. p. 547–557. Dow Jones Sustainability Index (DJSI). 2009. [Online index; cited 5 March 2010]. Available from: http://www. sustainability-index.com/. Europa. 2007. Summaries of EU legislation [Online material, cited 4 March 2010,]. Available from: http:// europa.eu/legislation_summaries/employment_and_social_policy/health_hygiene_safety_at_work/c11113_en.htm. European Network for Workplace Health Promotion (ENWHP). 2004. Making the case for workplace health promotion. Brussels: Prevent. Hemp, P. 2004. Presenteeism: At Work – But Out of It. Harvard Business Review 2004: October. p. 1–10.
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Mills, P.R., Kessler, R.C., Cooper, J. and Sullivan, S. 2007. Impact of a health promotion program on employee health risks and work productivity. American Journal of Health Promotion. 22. p. 45–53. Pelletier, B., Boles, M. and Lynch, W. 2004. Change in Health Risks and Work Productivity Over Time. Journal of Occupational and Environmental Medicine. 46: 7. p. 746–54. Sainsbury Centre for Mental Health. 2007. Mental health at work: developing the business case. London: Sainsbury Centre for Mental Health. The UK National Work Stress Network. 2010. The Law & Work-Related Stress, [cited 1 March 2010]. Available from: http://www.workstress.net/law.htm. World Economic Forum (WEF). 2008. Corporate Global Citizenship [cited 2 March 2010]. Available from: http:// www.weforum.org/en/initiatives/corporatecitizenship/index.htm. World Health Organization (WHO). 2010. Healthy Workplace Framework [cited 5 March 2010]. Available from: http://www.who.int/occupational_health/healthy_workplace_framework.pdf.
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Implementation and evaluation of health-promoting leadership Andrea Eriksson, Susanna Bihari Axelsson and Runo Axelsson Nordic School of Public Health, Sweden
Abstract The evaluation of health-promoting workplaces is believed to form an integral part of the planning and implementation of interventions. Recent approaches to workplace health promotion include how to organize work, and the integration of health needs into management and leadership principles. The objective of this paper is to discuss the implementation and evaluation of interventions aimed at developing health-promoting leadership. The paper presents results from two case studies, the interventions of which focused on developing health-promoting leadership in Swedish municipalities. However, a wider participatory approach was lacking in both cases, and therefore relevant courses of action for the specific workplaces were only identified and addressed to a limited extent. In order to succeed with similar programmes it seems necessary to integrate health-promoting activities into the daily work of managers, and to provide them with opportunities to influence environmental conditions of importance. The results show that successful interventions need to be adapted and integrated into the ongoing activities and developments of the workplace. This paper will be presented a possible outline of the self-evaluation of health-promoting leadership. Keywords: Health-promoting workplaces, Leadership, Evaluation, Case studies
Background Recent research has shown that leadership, organizational factors, and work design need to be addressed in order to improve the health of employees (Shain & Kramer 2004). The concept of workplace health promotion has thus developed from individually orientated ‘wellness’ activities to a more integrative and holistic settings approach regarding how to promote the health of employees. The settings approach includes broader organizational and environmental determinants for health (Chu, Breucker, Harris, Stitzel, Gan, Gu & Dwyer 2000). Research has concluded that health-promoting programmes have a better effect on the health of employees when their approach is comprehensive, targeting both individual and environmental issues (Shain & Kramer 2004). Health has in this context been defined not merely as an absence of disease but as a resource for everyday life, including physical, mental, and social well-being (WHO 1986). Developing health-promoting workplaces requires analysis, adaptation of the implementation process to contextual factors in the specific workplace, and continuous monitoring and evaluation (Chu et al. 2000; Polanyi, Cole,
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Ferrier, Facey et al. 2005). Leadership and organizational development are critical for this type of implementation process (Paton, Sengupta & Hassan 2005). The support and participation of key actors such as top management and the target group, is critical in the implementation of workplace health promotion (Breucker 1997; Bourdages, Sauvageau & Lepage 2003). The variety and complexity of workplaces make them challenging settings for evaluation. However, it may be difficult to isolate the intervention effects from other variables. The organizational structure, size and level of development, economic structure, corporate culture, including leadership culture, may differ significantly between different organizations. Therefore, Dugdill and Springett (2001, 285–308) suggest a holistic and innovative evaluation approach, including action-orientated methods involving both participating managers and employees. Although critical aspects of leadership are often acknowledged in connection with health-promoting workplaces (Shain & Kramer 2004), the concept of health-promoting leadership has been sparsely addressed in the research literature. There is no consensus on how to define and evaluate it. The objective of this paper is therefore to discuss the implementation and evaluation of health-promoting leadership. First, we focus on its definition. Next the results of two case studies performed by the authors will be used to illustrate the implications of the implementation and evaluation of healthpromoting leadership. Finally, we will present a possible outline of the selfevaluation of health-promoting leadership.
Definition of health-promoting leadership The literature on workplace health promotion makes a distinction between management support and supportive management climate (Shain & Kramer 2004). Management support means that managers provide employees with opportunities for different health-promoting activities, for example physical exercise or stress management. A supportive management climate, on the other hand, means that work is managed in a health-promoting way by, for example, balancing the demands placed on employees, increasing their participation, providing social support or granting adequate recognition for performance. This distinction can be compared to the concepts of management and leadership, where management is concerned with organizing, directing and controlling different activities, while leadership is more concerned with creating a shared culture and values to inspire and motivate employees (Yukl 2002, 2–47). Both are necessary, but leadership is more important for promoting change and development in an organization (Daft 1999, 39). Health promotion has been defined as a process aimed at enabling people to take action to improve their own health (WHO 1986). This means that health promotion interventions at workplaces should be carried out in a participatory manner together with both employees and managers. Against this background, health-promoting leadership can be defined as leadership that is concerned with creating a culture for health-promoting workplaces and values to inspire and motivate employees to participate in
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such development (Eriksson, Axelsson & Bihari Axelsson 2010a). This means that a health-promoting leader regards employees as resources for the development of a healthy workplace. This type of leadership can be seen as a critical part of the organizational capacity for health promotion, which includes the knowledge and skills of the employees as well as the policies and structures of the organization, for supporting the development of a health-promoting workplace (Riley, Taylor & Elliot 2003; Heward, Hutchins & Keleher 2007).
Comparison and analysis of two case studies The case studies of two different interventions aiming at developing healthpromoting leadership in Swedish municipalities were performed by the authors (here called intervention 1 and intervention 2). Both interventions included managers and aimed at developing their leadership skills. Interviews with staff managers, project leaders and participating managers were carried out. The case studies also included observations of group meetings, and results from a leadership survey. The design and results of the two specific case studies have been described in more detail elsewhere (Eriksson, Axelsson & Bihari Axelsson 2010a, 2010b). The analysis showed similarities and differences in the content of the interventions, in the views on health-promoting leadership, and in long-term goals. They are summarized in Table 1. Table 1. Comparison of content, views and long-term goals in the two studied interventions.
Intervention 1
Intervention 2
Content
A training programme aimed at developing health-promoting leadership
General leadership development
Views on healthpromoting leadership
A manager developing a healthy work environment on an individual, group and organizational level
Good leadership in general is the same as health-promoting leadership
Long-term goals
Improved health of employees
Decreased sickness rate
Both interventions mainly targeted managers’ knowledge and skills; environmental conditions were dealt with to a lesser extent. Intervention 1 consisted of a specific training programme providing managers with knowledge and insights of workplace health promotion and the health of employees. Intervention 2 dealt with general leadership development, for example providing managers with knowledge regarding group psychology. Individual knowledge and skills were the main targets of the interventions. Participating managers pointed out the environmental and structural aspects preventing them from being health-promoting workplaces. This shows the importance of a comprehensive approach to similar leadership interventions. The two interventions revealed different views on health-promoting leadership. In intervention 1, the manager was seen as responsible for creating a healthy work environment, and the need for managers working on individual, 30
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group and organizational levels was emphasized. Intervention 2 was vaguer in its definition of health-promoting leadership. It was seen as equivalent to good leadership in general, but the dimensions of good leadership were not clarified. Health-related issues were only dealt with to a limited extent in intervention 2. Finally, when comparing the long-term goals of the interventions, the main goal of intervention 1 was increased work attendance and the improved health of employees, while in intervention 2, the long-term goal was a decreased sickness rate. Based on the results from the case studies, a need exists to define healthpromoting leadership and to relate the aspects of this type of leadership to long-term goals. Whether or not a decreased sickness rate and increased work attendance are relevant long-term goals can be questioned. Sickness rate is a good indicator of the health of employees (Marmot, Feeney, Shipley, North & Syme 1995), but in this context it would be more relevant to assess whether employees’ feeling of well-being has improved (WHO 1986). Sub-goals linking intermediate health outcomes with these long-term goals could then include the different dimensions of managers’ capacities for developing health-promoting workplaces (Nutbeam 1998). The critical success factors shown by the results were that the programmes were integrated into the ongoing activities and developments of the workplace. This is supported by research showing that health-promoting efforts permeating the different levels in an organizational structure are likely to be more sustainable (Johnson & Baum 2001). A wider participatory approach was lacking in both interventions, and therefore relevant courses of action for the specific workplaces were only identified and addressed to a limited extent. In order to succeed with similar programmes it is necessary to in-
Table 2. Suggestions of important aspects to evaluate when developing health-promoting leadership.
Evaluation aspects
Check-list
Goals of the intervention
~ Clear sub-goals and long-term goals ~ Systematic analysis of health needs on an individual, group and organizational level ~ Participatory approach
Activities initiated within the
• •
intervention
• Organizational conditions either hindering or facilitating the implementation of the intervention
• •
Outcomes of the intervention
• • •
Individual skills and knowledge Environmental conditions, policies and organizational structures Degree of integration with other activities and developments Competence, structures, policies and resources of the organization supporting health-promoting leadership Support for planned activities from different organizational levels Assessment and development of organizational tools to monitor outcome Intermediate outcomes Long-term outcomes
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tegrate health-promoting activities into the daily work of managers, and to give them opportunities to influence important environmental conditions.
Outline of self-evaluation The conclusions from the case studies were that successful interventions need to be adapted and integrated into the ordinary daily work of the organization. Methods of self-evaluation provide organizations with opportunities to learn from their own experiences and can therefore be useful when evaluating health-promoting leadership (Fitzpatrick, Sanders & Worthen 2004, 16-29). Table 2 contains a possible outline of the self-evaluation of health-promoting leadership. In conclusion, health-promoting leadership can be regarded as an important part of developing organizational capacity for a health-promoting workplace. Therefore, it is also important to evaluate the processes as well as the outcomes of health-promoting leadership.
References Bourdages, J., Sauvageau, L. & Lepage, C. 2003. Factors in creating sustainable intersectoral community mobilization for prevention of heart and lung disease. Health Promotion International. 18: 2. p. 135–144. Breucker, G. 1997. Review and Evaluation of Success Factors and Quality of Workplace Health Promotion. Germany: Federal Association of Company Health Insurance Funds (BKK). Chu, C., Breucker, G., Harris, N., Stitzel, A., Gan, X., Gu, X. & Dwyer, S. 2000. Health promoting workplaces – international settings development. Health Promotion International. 15: 2. p. 155–167. Daft, R. 1999. Leadership: Theory and Practice. New York: Harcourt Brace. 496 p. ISBN 0-03-022417-9. Dugdill, L. & Springett, J. 2001. Evaluating health promotion programmes in the workplace. In Rootman, I., Goodstadt, M., Hyndman, B., McQueen, D., Potvin, L., Springett, J. & Ziglio, E. (Eds.) Evaluation in health promotion. Principles and Perspectives. WHO: Regional Publications European series, no 92. 533 p. ISBN 92-890-1359-1. Eriksson, A., Axelsson, R. & Bihari Axelsson, S. 2010a. Development of health promoting leadership experiences of a training programme. Health Education. 110: 2. p. 109–124. Eriksson, A., Bihari Axelsson, S. & Axelsson, R. 2010b. Collaboration in workplace health promotion – A case study in a Swedish region. [Manuscript]. Fitzpatrick, J., Sanders, J. & Worthen, B. 2004. Program Evaluation. Alternative Approaches and Practical Guidelines. Boston: Pearson Education, Inc. 555 p. ISBN 0-321-07706-7. Heward, S., Hutchins, C. & Keleher, H. 2007. Organizational change–key to capacity building and effective health promotion. Health Promotion International. 22: 2. p. 170–178. Johnson, A. & Baum, F. 2001. Health promoting hospitals: a typology of different organizational approaches to health promotion. Health Promotion International. 16: 3. p. 281–287. Marmot, M., Feeney, A., Shipley, M., North, F. & Syme, L. 1995. Sickness absence as a measure of health status and functioning: from the UK Whitehall II study. Journal of epidemiology and community health. 49: 2. p. 124–130. Nutbeam, D. 1998. Evaluating health promotion – progress, problems and solutions. Health Promotion International. 13: 1, p. 27–44.
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Paton, K., Sengupta, S. & Hassan, L. 2005. Settings, systems and organization development: the Healthy Living and Working Model. Health Promotion International. 20: 1. p. 81–89. Polanyi, M., Cole, D., Ferrier, S., Facey, M. & The Worksite Upper Extremity Research Group. 2005. Paddling upstream: a contextual analysis of implementation of a workplace ergonomic policy at a large newspaper. Applied Ergonomics. 36: 2, 231–239. Riley, B., Taylor, M. & Elliot, S. 2003. Organisational capacity and implementation change: a comparative case study of heart health promotion in Ontario public health agencies. Health Education Research. 18: 6. p. 754–769. Shain, M. & Kramer, D. 2004. Health promotion in the workplace: framing the concept; reviewing the evidence. Occupational and Environmental Medicine. 61: 7, p. 643–648. WHO. 1986. The Ottawa Charter for Health Promotion. Copenhagen: WHO. Yukl, G. 2002. Leadership in Organizations. New Jersey: Pearson Education, Inc. 542 p. ISBN 0-13-814268-8.
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The role of international organizations/NGOs in promoting occupational health: Identifying priorities for psychosocial risk management Aditya Jain and Stavroula Leka Institute of Work, Health and Organisations, University of Nottingham, UK
Abstract Psychosocial risks, work-related stress, violence, harassment, bullying and mobbing are now widely recognized challenges to occupational health and safety. Though people in industrialized countries are becoming more familiar with such risks, this may not yet be the case in developing countries. Along with the existing difficulties in controlling other more well-known occupational risks, there is a lack of awareness of work-related stress and psychosocial risks, and shortage of resources to deal with it at the national level. Globally, researchers, practitioners, government bodies, social partners and organizations differ in their awareness and understanding of these new types of challenges in work life. Although in some states there appears to be widespread awareness of the nature and impact of these issues, as well as agreement among stakeholders on their prioritization for the promotion of health, productivity and the quality of work life, this situation is not equally reflected across the globe, and there is a significant divide between the developed and developing world. This paper presents the findings of sixteen interviews conducted with key organizational stakeholders in occupational health (International Organizations, NGOs, Trade Unions and Employer organizations, such as the ILO, WHO, ISSA, EU-OSHA, IALI, IEA, ETUC) to assess their role in promoting occupational health policy, especially policies relating to psychosocial risk management. Keywords: psychosocial risk management, work-related stress, policies, priorities, NGOs, international organizations, stakeholders
Introduction In recent decades, significant changes closely linked to the organization and management of work have taken place in the world of work (EU-OSHA 2007). Psychosocial risks, such as work-related stress and workplace violence, are widely recognized major challenges to occupational health and safety (NIOSH 2002, EU-OSHA 2007). In a wider perspective, psychosocial risks are also a major public health concern, and are associated with economic and social security challenges. Globally, researchers, practitioners, government bodies, social partners and companies differ in their awareness and understanding of psychosocial risks at work. Although in some member states there appears to be widespread awareness of the nature and impact of these issues as well as agreement
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among stakeholders on their prioritization for the promotion of health, productivity and the quality of work life, this situation is not reflected across the globe and there is a significant divide between the developed and developing world (Leka and Cox 2008).
Policies to address psychosocial risks In the last decade, a number of organizations have developed measures and programmes to assess and manage psychosocial risks at work. International organizations, as well as the EU and international bodies, have published reports on ways in which to deal with psychosocial risk factors. Both general guidelines and basic steps in a risk control cycle have been provided, as well as more detailed accounts of various measures. The 2002 European Week for Safety and Health at Work gathered examples of best practices in stress, violence, and bullying at work. Policy-level interventions in the area of psychosocial risk management and the promotion of workers’ health can take various forms. In Europe, a number of significant developments towards the management of psychosocial risks have been achieved at policy level since the introduction of the 1989 EC Council Framework Directive 89/391/EEC on the Safety and Health of Workers at Work, after which a new EU risk prevention culture has been established. Important documents in this context include: the European Commission’s Guidance on Work-Related Stress (2002); the European Commission’s Green Paper on Promoting a European Framework for Corporate Social Responsibility (2001); the European Framework Agreement on WorkRelated Stress (2004); the European Framework Agreement on Harassment, and Violence at Work (2007). At the international level, significant developments have been the declaration of the Global Plan of Action for Workers’ Health at the recent WHO World Health Assembly (WHO 2007), WHO guidance on psychosocial risks, work-related stress and psychological harassment (e.g. Leka et al. 2003; Houtman et al. 2007; Leka & Cox 2008), ILO initiatives to promote social dialogue on health and safety issues and various ILO conventions on workers’ health. Examples of these policy-level interventions can also be found at the national level: the Management Standards approach (HSE, 2007) to work-related stress in the UK, the Health Covenants in the Netherlands, the ‘Victimization at work’ ordinance in Sweden, and specific anti-bullying legislation recently introduced in some countries, for example in France, Finland, Belgium and the Netherlands, are just a few of the many key initiatives taken at the national level across many EU member states. However, it has been widely acknowledged that initiatives aimed at promoting workers’ health have not had the impact anticipated by both experts and policymakers. The main reason for this has been the gap that exists between policy and practice (Levi 2005). It is important that both an increase of national capabilities focusing on psychosocial risks and occupational mental health, and their translation into practical measures and actions are seriously considered if progress at national levels is to be achieved and the gap between policy and practice is to be addressed and minimized. The first step in the process is to ascertain the role of key stakeholders such as Inter-
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national Organizations, NGOs, Trade Unions and Employer organizations (for example the ILO, WHO, ISSA, EU-OSHA, IEA, ETUC) in promoting occupational health policy relating to psychosocial risk management.
Methodology Policy-level interventions aim to develop and support action in key policy areas by translating policy into practice. The classification of policies for psychosocial risk management as presented by Leka et al. (2008) was used to conduct semi-structured interviews with key stakeholders at the policy level. Participants Key representatives from the organizational stakeholders who had been involved in the development, implementation and/or evaluation of policies relating to psychosocial risk management at the national, European and international levels were interviewed in order to assess the role of their organization in the policy process and to further explore key priorities at the policy level in the area of psychosocial risk management. Sixteen interviews were conducted. Table 1. Interview participant organisations
Organization
No. of Interviews
World Health Organization (Departments of Occupational Health, Health Promotion and Mental Health)
3
International Labour Organization (Safework)
1
European Commission – DG Employment and DG SANCO
2
European Agency for Safety & Health at Work
1
International Trade Union Confederation
1
European Trade Union Confederation
1
CEEP
1
BUSINESSEUROPE
1
International Organisation of Employers
1
International Commission on Occupational Health
1
International Occupational Hygiene Association
1
European Foundation for the Improvement of Living and Working Conditions
1
International Social Security Association
1
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Results Thematic analysis was used to analyse the data. Four thematic areas emerged: a) Organization’s role in promoting occupational health The roles of the organizational stakeholders ranged from the development of policy and guidance, implementation and enforcement, through the provision of evidence for policy development, to evaluation and advocacy. The role played by each stakeholder in the area of psychosocial risk management was largely dependent on their overall mandate and need expressed by its constituents. Although most stakeholders were aware of the effects of psychosocial risks, a lack of resources were generally cited as the main reason for no action. The main barriers to the development of policy level interventions were reported to be lack of government support for macro initiatives and conflict between different governmental departments, as highlighted in the case of bullying. Low prioritization of psychosocial issues and the lack of availability of enforcing mechanisms were also reported. Further low awareness of psychosocial issues and differences of opinion on the kind of policies (hard vs. soft policies) to be ratified have also been significant barriers to the development of policy level interventions. b) Main drivers in the development and implementation of policylevel interventions Most participants reported an increased awareness of psychosocial issues in organizations and society at large. However, all highlighted the significant differences between developing and developed countries, also in terms of lack of legal provision in the area. The existence of regulations and collective agreements helps make the challenges of bullying and violence at work more visible. Regulations were reported as being encouraging and increasing discussion in organizations and workplaces, leading to increased awareness and recognition of problems. In Europe, undeniable evidence of the losses and harm caused by mismanagement or ignorance of psychosocial risks, the related change in priorities, and new policy developments (such as framework agreements) were reported as the main drivers of the development of macro level interventions. A clear need for action and demand from the general population were also highlighted as key drivers. Further, it was suggested that highlighting issues such as the economic cost of psychosocial risks was likely to draw media attention, and media very often drives policy development. Increased awareness of psychosocial issues and increased prioritization and agreement with social partners were reported as the main success factors in the development of policy interventions. c) Involvement of other stakeholders in relation to policy development in the area of psychosocial risk management The main stakeholders in the area of psychosocial risk management, as reported by interviewees, included international organizations, the European Commission and its agencies, and the social partners at international and European level. However, most respondents did not explicitly discuss the role played by the key NGOs and professional associations such as ICOH,
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IOHA and IEA. Stakeholders at the national level were reported as varying; this variation was also found across sectors and in the type of initiatives undertaken. Some initiatives at the national level were developed on the basis of tripartite plus dialogue, that is, discussions between representatives from the government, employer organizations, trade unions and researchers/experts, while in some cases national governments implemented initiatives without consultation with social partners (as in the case of some health and safety legislation). National as well as sectoral differences in culture relating to dialogue were reported as determining the involvement of stakeholders in policy development. d) Main priorities at policy level in relation to psychosocial risk management The respondents pointed out that there were many priorities and that everyone should take the initiative. One of the main priorities was generally agreed on as the need to raise awareness of psychosocial issues in developing countries, and the development of a minimum legislative framework to address these issues. Legislation and other statutory requirements were seen as essential in supporting the management of work-related violence and harassment. It was reported that, although in many countries occupational health and safety legislation, environmental legislation, or specific legislation against bullying and violence existed, it was essential to develop such legislation in countries were they did not exist, particularly in most developing countries. In addition, in Europe, many agreed that since such a legislative framework existed, and due to the ‘nature’ of work-related stress, soft laws might be better suited to address the challenges posed. However, they also emphasized that such measures were meant to set minimum standards and that the outcome of a softer approach remains to be seen. The interviewees also discussed the priorities related to existing legislation and policies in the European and global spheres. They agreed that global initiatives were essential and a priority at this stage of globalization, to ensure that standards around the world were the same.
Discussion and conclusions The findings highlighted a number of important issues in relation to psychosocial risk management at the policy level and in the role of the key stakeholders. Findings indicated that diversity at work and the changing nature of the work environment and demographics were some of several problems related to psychosocial risks at the macro level, especially in developing countries. In addition, the role of women in society, the ageing workforce, and the increase of migrant workers were highlighted as priorities. Development of related legislation at the national level can help address some of these problems and serve as the basis for further action. However, differences in the prioritization of psychosocial risks, in policies for managing such risks, and in the capacities and structures to support their management were reported across countries. These differences can be attributed to lack of awareness and expertise, supporting the infrastructure and cultural variations between developed and developing countries. It was further reported that a number of methods (such as increasing aware-
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ness of relevant legislation and standards, guidance from international organizations, participation in networks etc.) can be used by policymakers to increase awareness and recognition of key challenges at different levels, to have an impact on attitudes both at the organizational and individual level, to encourage, and sometimes also push organizations to take action. The significance of the dissemination of guidance and examples of best practice for psychosocial risk management was also raised. It was pointed out that no significant efforts are made by countries or the key stakeholders to collaborate with each other in order to aid policy learning and transfer knowledge and experiences in the area of occupational heath and safety and psychosocial risk management. Although networks between national occupational health and safety institutes exist, such as PEROSH, the WHO global network of collaborating centres, and the ILO CIS centres, they are largely focused on research or informational activities in traditional occupational risks. The potential role of such networks to improve collaboration between member states to promote policy learning and the transfer of knowledge, particularly in today’s unequal global context, was emphasized. The main drivers for macro initiatives were found to be the increased awareness of psychosocial issues in the past few years, which has resulted in agreements and prioritization between social partners. However, the practical implications of the increased awareness were mainly seen in Europe in the management of stress and reduction of harassment and violence at work. Involvement and long-term commitment from key stakeholders were found to be the main factors for successful implementation of policy-level interventions. This is also a crucial success factor for primary interventions at the enterprise level in the area of psychosocial risk management. The findings clearly indicated that the key stakeholders’ role influences the policy-making process. The main barriers to the development of policy for psychosocial risk management included a lack of government support for macro initiatives, especially in developing countries. Conflict/competition between different governmental/international organization departments was also found to be a barrier as it hindered communication and collaboration among key stakeholders. A clear communication structure with clearly defined mandates for different ministries was considered essential, especially between the ministries of Labour and Health. It is crucial that co-operation between international organizations, such as the ILO and WHO, currently thought to be lacking in the area of psychosocial risk management, should be addressed, as should the engagement of key professional groups such as ICOH with policymakers and other stakeholders to effectively promote the management of psychosocial risks globally.
References EC Council Framework Directive 89/391/EEC on Safety and Health of Workers at Work Council Directive 89/391/ EEC of 12 June 1989 on the introduction of measures to encourage improvements in the safety and health of workers at work. Official Journal of the European Communities 1989; L183129, 6, 1-8. European Agency for Health and Safety at Work. 2007. Expert forecast on emerging psychosocial risks related to occupational safety and health. Luxembourg: Office for Official Publications of the European Communities. ISBN 9789291911400.
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European Commission. 2001. Promoting a European framework for CSR, Green Paper. Luxembourg: Office for Official Publications of the European Communities. European Commission. 2002. Guidance on work-related stress – Spice of life or kiss of death? Luxembourg: Office for Official Publications of the European Communities. ISBN 9289441577. European Social Partners. 2004. Framework agreement on work-related stress. Brussels: European social partners – ETUC, UNICE (BUSINESSEUROPE), UEAPME and CEEP. European Social Partners. 2007. Implementation Reports of the European framework agreement on workrelated stress 2007. Brussels: European social partners – (ETUC, BUSINESSEUROPE, UEAPME and CEEP). Houtman, I., Jettinghoff, A.K., Cedillo, L. 2007. Raising awareness of stress at work in developing countries: a modern hazard in a traditional working environment: advice to employers and worker representatives. Protecting Workers’ Health Series, no. 6. Geneva: World Health Organization. ISBN 92 4 159165 X. HSE. 2007. Managing the causes of work-related stress: A step-by-step approach using the Management Standards. Sudbury: HSE Books. ISBN 9780717662739. Leka, S., Cox, T. 2008. Psychosocial PRIMA-EF: Guidance on the European framework for psychosocial risk management. Protecting workers’ health series, no. 9. Geneva: World Health Organization. ISBN 9789241597104. Leka, S., Griffiths, A., Cox, T. 2003. Work Organization and Stress. Protecting Workers’ Health Series, no. 3. Geneva: World Health Organization. ISBN 92 4 159047 5. Leka, S., Jain, A., Zwetsloot, G., Vartia, M. & Pahkin, K. 2008. ‘Psychosocial Risk Management: The Importance of Policy Level Interventions’. In Leka, S., Cox, T. (Eds.) The European Framework for Psychosocial Risk Management: PRIMA-EF. Nottingham: I-WHO publications. p. 115–135. ISBN 9780955436529. Levi, L. 2005. Working life and mental health - A challenge to psychiatry? World Psychiatry. 4: 1. p. 53–57. NIOSH. 2002. The changing organization of work and the safety and health of working people: Knowledge gaps and research directions. DHHS (NIOSH). 2002: 116. WHO. 2007. Workers’ health: global plan of action. 60th World Assembly, 23rd May 2007. Geneva: World Health Organization.
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Quality of work in Europe Measuring working conditions through a cross-national survey Maija Lyly-Yrjänäinen, Greet Vermeylen and Agnès Parent-Thirion European Foundation for the Improvement of Living and Working Conditions1
In 2010, the European Working Conditions Survey (EWCS) celebrates its 20th anniversary of providing information on the quality of work in Europe to support decision-making at both European and national levels. The survey gives a unique picture of working conditions across Europe, and still today represents the only source of quantitative national data on working conditions for a number of EU Member States.
Key observations: ~ The quality of work and employment remains on the European agenda in the post-Lisbon context where sustainability of work is a key issue. ~ EWCS is a unique tool for gathering cross-national and policy-relevant information on the quality of work and employment. ~ The EWCS becomes more valuable with time as it provides knowledge regarding long-term trends in working conditions across the Member States.
Introduction The quality of work has been on the European employment policy agenda throughout the 2000s. The issue is important for several reasons. To give one example, the ageing of the population poses a great challenge to Europe, and it is commonly agreed that guaranteeing long work lives is crucial. In order to achieve this, along with maintaining good health, people need to be motivated to continue working until they are older. In a wider perspective, the quality of work is one aspect of the quality of life, and against this background, promoting the good quality of jobs becomes a priority without any specific goals. Even if it is accepted that the goal is not only to support having jobs but also having good quality ones, for the purposes of decisionmaking, the quality of jobs has to be somehow measurable (e.g. Muñoz de Bustillo, Fernándes, Antón and Esteve 2009).
Conceptualizing quality of work and employment Measuring the quality of work begins by defining the concept. In the analysis of the quality of work and employment (which is a wider concept than purely the quality of work), the well-being of society, of the workplace, and of 1
) This paper reflects the personal opinion of the authors, and not necessarily the official position of the European Foundation for the Improvement of Living and Working Conditions.
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the individual may not always coincide. Furthermore, there are differences at each of these levels, where the needs vary according to the individual situation. From the viewpoint of an individual, several issues come into play, such as adequate salary; safe, healthy working conditions; being able to successfully combine work and private life; good social relations; structures for representation and consultation at the workplace; freedom from violence, harassment and discrimination; opportunities for professional development; and job security. The conceptualization of the quality of work and employment that underlies the European Working Conditions Survey (EWCS) takes the above-mentioned aspects into account across four pillars: health and well-being, reconciliation of work and non-work life, skills development, and career and employment security (Figure 1).
Career and employment security - employment status - income - social protection - worker´s rights Health and well-being - risk exposure - work organization - health problems
Job and employment quality
Skills development - qualifications - training - learning organization - career development
Reconciliation of work and non-work life - work/non-work time - social infrastructures
European Foundation for the Improvement of Living and Working Conditions
Figure 1. Four pillars of quality of work and employment.
The EWCS provides indicators for all the above-mentioned four dimensions of the quality of work and employment. The survey focuses on topics for which comparable questions across different European countries are possible, and for which workers are sufficiently informed to answer questions. To this end, culture-specific topics in which the respondents’ interpretations of the question vary according to the institutional setting of the country, e.g. retirement benefits (under social protection), or issues of which the worker might not be aware, e.g. workplace policies and practices on health and safety (under health and well-being), are not included. Over the past 20 years, since the first wave in 1990, the content of the EWCS questionnaire has been gradually developed to better meet the objectives set at each wave of the survey. The EWCS has been designed to provide comparable data on working conditions across countries at regular intervals, with the aim of providing relevant information in order to support decision-making at European and national levels. To ensure the relevance, quality and transparency of the data, the survey questionnaire development and design involves working conditions and survey experts from the different
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Member States, and final approval is given by Eurofound’s tripartite stakeholders. The survey contributes first and foremost to the EU policy agenda on ‘Employment and social rights’, and gives data (and further analysis) to support meeting strategic goals (e.g. the Lisbon Strategy and the following 2020 Strategy). Furthermore, researchers across Europe analyse the data with their own specific research questions in mind. In practical terms, the survey is used as a tool for observing trends in working conditions across Europe, for analysing relationships between the various aspects of work (and non-work) and for identifying groups of workers at risk. Fieldwork for the 5th EWCS is being carried out during the present year (2010), and the questionnaire contains a wide range of questions on working time, different types of risks, health, work organization, job satisfaction, non-working activities, the blurring of borders between work and non-work life, precarious jobs, and leadership. Over the years, the geographical coverage of the survey has expanded to take account of the new countries joining the EU. For the 5th survey, 42 000 workers are being interviewed face-to-face in the EU27 countries and in Turkey, Croatia, the former Yugoslav Republic of Macedonia, Norway, Montenegro, Kosovo and Albania. The sample represents those aged 15 and over, who are in employment – the same universe covered in the Labour Force Survey (Eurostat).
Monitoring trends and analysing working conditions in Europe Having such broad objectives for the survey poses challenges for data gathering and analysis, as the data is used in various ways. Sometimes the different uses result in contradictory demands for the survey. Firstly, the indicators should provide data that is relevant across Europe. Secondly, although for monitoring trends it is necessary to have a core set of questions that remain the same over the years, in order to be able to address emerging issues, the questionnaire needs to be updated, which may mean adding new questions and dropping some of the old ones. Thirdly, to be able to analyse relationships (e.g. between work organization, physical risk factors, working time and satisfaction with working conditions), the survey should include a wide range of topics, but there also needs to be coherent and relevant set of indicators for each topic. As regards methodological issues, the most vulnerable workers may be underrepresented in the survey, as they may not want to take part in the interviews or may not always be in the sampling frame (e.g. unregistered citizens/workers in the case registers used for sampling). One example of a trend in working conditions from 1990 to 2005 is increasing work intensity. Three indicators measure work intensity in the EWCS: two have been included in every wave since 1990 (‘working at very high speed’ and ‘working to tight deadlines’) and the third (‘having enough time to get the job done’) was added in 1995. Concerning the first indicator in particular, the number of people who never work at a very high speed has decreased considerably (from 36% in 1990 to 21% in 2005) (Figure 2). EU enlargement is reflected in the trends (1990 figures include 12 and 2005 figures include 25 Member States), but as work intensity is generally less in the most recently joined Member States, the change would be even sharper if
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Working at a very high speed 0%
10 %
20 %
30 %
40 %
50 %
60 %
70 %
80 %
90 %
100 %
EU12 1990
EU15 1995
EU15 2000
EU25 2005 Never
Almost never
Around 1/4
Around half of time
Around 3/4
Almost all the time
All the time
European Working Conditions Survey (EWCS)
Figure 2. Monitoring trends: Increase in work intensity.
only the EU12 or EU15 countries were observed (for example, in 2005 in the EU15 countries, 21% of workers said that their job never involves working at a very high speed, whereas in the NMS10 the percentage was 26%). A great deal of analysis has been performed on the relationships between the various working condition indicators. One of the most recent ones – on work organization in Europe – was conducted by Valeyre, Lorenz, Cartron, Csizmadia, Gollac, Illéssy and Makó (2008). A typology of work organization was defined using hierarchical cluster analysis based on factor scores from multiple correspondence analysis. Four forms of organization were identified: discretionary learning, lean production, taylorist, and traditional or simple structure. Discretionary learning organizations represent 38% of European employees and are characterized by overrepresentation of autonomy, learning dynamics, task complexity, self-assessment of work, and autonomous teamwork. Lean production organizations, representing 26% of employees, have overrepresentation of teamwork, task rotation, quality management variables and objective determinants of work pace. Both show characteristics of new forms of work organization such as high learning dynamics and problem-solving activity, but they differ from each other in the dimensions of hierarchy and autonomy. Taylorist organizations represent 20% of employees and are characterized by low autonomy, low learning dynamics, low complexity, and overrepresentation of the objective determinants of work pace, repetitiveness, monotony and quality norms. Lastly, 16% of European employees work in traditional or simple structure organizations. In this cluster, all the variables of work organization are underrepresented (Valeyre et al. 2008.) 44
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For each type of work organization, working conditions, such as health and safety risks, working time, work intensity, work/life balance, intrinsic motivation and human resource practices were examined. For example, higher levels of health and safety risks and work intensity are reported in lean production and taylorist organizations, while work/life balance is better in discretionary learning and traditional or simple organizations. In the area of physical risks, exposure to repetitive movements and tiring positions are less frequent in discretionary learning and traditional organizations. The study concludes that when the widest range of indicators on quality of work and employment is observed, the workers with the greatest well-being are those in discretionary learning organizations (ibid.) Looking at the objectives of the Lisbon Strategy and the EU 2020 agenda, there are two groups who should be encouraged to participate in the Labour Market, namely older people and women. For achieving the well-known target of having 70% of the population of working age in employment by the end of 2010, two secondary targets were set: a 50% employment rate for workers aged 55 and over, and 60% for women. The massive economic downturn since 2008 has made it very difficult (if not impossible) to achieve this goal by the end of 2010. Nevertheless, despite the setback, high employment rates remain one of the key objectives for Europe: in view of population ageing, keeping older workers in employment is a priority, as well as keeping the majority of women in paid labour, and easing young people’s entry into the labour market (Lisbon Strategy evaluation 2010, pp. 15−17.). Promoting good working conditions could be one solution for maintaining or improving the attractiveness and sustainability of work. EWCS data has been analysed both in relation to age and from a gender point of view. Generally, younger workers are more exposed to risks in comparison to older workers, and age analysis finds that the sustainability of work for those who are exposed to risks at a younger age might be an issue. Older workers have a higher degree of autonomy in the workplace and are subjected to less work intensity than younger workers, but on the other hand they have fewer opportunities to be involved in new forms of work organization, such as High Performance Work Organization (HPWO), and fewer learning opportunities and training compared to younger workers. Positive correlations are found between older workers’ employment rates, especially in relation to work autonomy, the presence of HPWOs, access to learning and training, and job satisfaction. A clearly negative correlation exists between employment participation and exposure to physical risks at work. (Villosio, Di Pierro, Giordanengo, Pasqua and Richiardi 2008.) Concerning women, most of the gender inequalities in working conditions are filtered by the segregation of occupations and sectors, and differences in working times, hierarchical status and the share of domestic work. Segregated employment is a major factor contributing to the gender/pay gap. Part-time work, on the other hand, is one solution to problems of work/ life balance; however, with women being responsible for the majority of the housework, they also more often bear the risks that part-time employment brings, such as underemployment and reduced opportunities for career advancement. (Burchell, Fagan, O’Brien & Smith 2007.) Difficulties in
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combining family life and career are reflected, in for example, the continually low proportion of women in managerial positions, which was 33% in 2005 (Lyly-Yrjänäinen & Fernándes Macías 2008). In terms of concrete application of the information, it is of course very difficult to establish the areas in which the survey results have been useful for the decision-making process. Generally the findings on specific topics are discussed with and among national and European actors (governments and social partners), and then the survey findings contribute to the setting of the agenda. In some cases, the discussions lead to agreements or even to legislation. One example of a process in which the EWCS gave important background information is the European social partners’ negotiations on bullying and harassment, which led to the signing of an agreement to prevent and manage problems of bullying, harassment, and physical violence at the workplace, with zero tolerance for such behaviour (see COM (2007)686final).
References Burchell, B., Fagan, C., O’Brien, C. & Smith, M. 2007. Working conditions in the European Union: The gender perspective. Luxembourg: Office for Official Publications of the European Communities. p. 74. ISBN 987-92-897-0814-2. European Commission. 2010. Commission staff working document. Lisbon strategy evaluation. SEC(2010) 114 final. European Commission. 2007. Transmitting the European framework agreement on harassment and violence at work. COM(2007) 686 final. Lyly-Yrjänäinen, M., Fernándes, M.E. 2008. Women managers and hierarchical structures in working life. European Foundation for the Improvement of Living and Working Conditions. (http://www.eurofound.europa. eu/pubdocs/2008/103/en/1/EF08103EN.pdf) Muñoz de Bustillo, R., Fernándes, M.E., Antón, J.I., Esteve, F. 2009. Indicators of job quality in the European Union. Brussels: European Parliament. Valeyre, A., Lorenz, E., Cartron, D., Csizmadia, P., Gollac, M., Illéssy, M., Makó, C. 2008. Working conditions in the European Union: Work organisation. Luxembourg: Office for Official Publications of the European Communities. p. 59. ISBN 987-92-897-0832-6. Villosio, C., Di Pierro, D., Giordanengo, A., Pasqua, P., Richiardi, M. 2008. Working conditions of an ageing workforce. Luxembourg: Office for Official Publications of the European Communities. p. 70. ISBN 987-92-897-0815-9.
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Management of psychosocial risks at the workplace: Best practice through the development of effective policies, assessment and interventions Stavroula Leka Institute of Work, Health & Organisations, University of Nottingham, UK
Abstract The Member States of the European Union are likely to have procedures and systems for dealing with psychosocial risks and work-related stress; issues that are now widely recognized as major challenges to occupational health and safety. However, the approaches that exist vary greatly, with the most obvious distinction being between those that focus on the individual and ways of promoting their health or treating those in poor health, and those that focus on the causes of work-related stress in the design and management of work and which attempt organizational-level solutions. This paper focuses on best practices for the management of psychosocial risks and the prevention of work-related stress. It will draw on work completed through the PRIMA-EF project that established a European framework for work-related psychosocial risk management. The PRIMA framework accommodates all the existing major psychosocial risk management approaches at the workplace, across the European Union. It is based on the philosophy and logic of risk management of psychosocial risks in Europe, the strategies, methods and measures used, and the key principles involved.
Key observations ~ Psychosocial risks, work-related stress, violence, harassment and bullying are now widely recognized major challenges to occupational health and safety. ~ Particular challenges in relation to psychosocial risks and their management exist at both enterprise and macro policy levels. ~ Psychosocial risk management should represent a higher priority in national and international agendas, and stakeholders must be made more aware of its importance. ~ Social dialogue plays a critical role in the development and implementation of initiatives for psychosocial risk management at the macro as well as the organizational level, and should hence be promoted. ~ Standards for addressing psychosocial risks at work need to be developed.
Introduction Psychosocial risks, work-related stress, violence, harassment and bullying are now widely recognized major challenges to occupational health and safety (EU-OSHA 2007). Nearly one in three of Europe’s workers, more than 40 million people, report that they are affected by stress at work (EU-OSHA 47
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2002). In the 15 Member States of the pre-2004 EU, the cost of stress at work and the related mental health problems was estimated to be on average between 3% and 4% of the gross national product, amounting to €265 billion annually (Levi 2002). On the national level, it is estimated that stressrelated diseases are responsible for the loss of 6.5 million working days each year in the United Kingdom, costing employers around €571 million, and society as a whole as much as €5.7 billion (Koukoulaki 2004). In a wider perspective, psychosocial risks are also a major public health concern and are associated with economic and social security challenges. Throughout Europe, researchers, practitioners, government bodies, social partners and organizations differ in their awareness and understanding of these new types of challenges in work life. Although in some Member States there appears to be widespread awareness of the nature and impact of these issues, as well as agreement among stakeholders on their prioritization for the promotion of health, productivity and quality of work life, this situation is not reflected across the enlarged European Union (EU). Some EU Member States’ systems and methods have been developed to deal with these challenges at different levels, but a unifying framework that recognizes their commonalities and principles of best practice that could be used across the EU has been lacking. Particular challenges in relation to psychosocial risks and their management exist at both enterprise and macro levels. On the enterprise level there is a need for systematic and effective policies to prevent and control the various psychosocial risks at work, clearly linked to companies’ management practices. On the national and the EU levels, the main challenge is to translate existing policies into effective practice through the provision of tools that will stimulate and support organizations to undertake this challenge, thereby preventing and controlling psychosocial risks in our workplaces and societies alike. At both levels, these challenges require a comprehensive framework to address psychosocial risks. This paper presents a framework for psychosocial risk management in the EU that relates to enterprise and macro levels. Within this framework, at each of the two levels differentiated above, the logic of psychosocial risk management will be discussed and presented in a conceptual model.
Psychosocial risks: Policy and practice at the enterprise and macro levels The term ‘psychosocial hazards’ relates to that of psychosocial factors that have been defined by the International Labour Organization (ILO 1986) in terms of the interactions among job content, work organization and management, and other environmental and organizational conditions on the one hand, and employees’ competencies and needs on the other. Psychosocial hazards are relevant to imbalances in the psychosocial arena and refer to those interactions that prove to have a hazardous influence on employees’ health through their perceptions and experience (ILO 1986). There is a reasonable consensus in the literature of the nature of psychosocial hazards (see Table 1). Factors such as poor feedback, inadequate appraisal, communication processes, job insecurity, excessive working hours and a bullying managerial style have been suggested as imminent concerns for many
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employees. A number of models exist in Europe and elsewhere for the assessment of risks associated with psychosocial hazards (termed psychosocial risks) and their impact on the health and safety of employees and the healthiness of organizations (in terms of, e.g. productivity, quality of products and services, and general organizational climate). Table 1. Psychosocial Hazards Adapted from Leka, Griffiths & Cox 2003.
PSYCHOSOCIAL HAZARDS Job content
Lack of variety or short work cycles, fragmented or meaningless work, underuse of skills, high uncertainty, continuous exposure to people through work
Workload & work pace
Work overload or underload, machine pacing, high levels of time pressure, continually subject to deadlines
Work schedule
Shift working, night shifts, inflexible work schedules, unpredictable hours, long or unsociable hours
Control
Low participation in decision-making, lack of control over workload, pacing, shift work, etc.
Environment & equipment
Inadequate equipment availability, suitability or maintenance; poor environmental conditions such as lack of space, poor lighting, excessive noise
Organizational culture & function
Poor communication, low levels of support for problem-solving and personal development, lack of definition of, or agreement on organizational objectives
Interpersonal relationships at work
Social or physical isolation, poor relationships with superiors, interpersonal conflict, lack of social support
Role in organization
Role ambiguity, role conflict, and responsibility for people
Career development
Career stagnation and uncertainty, under-promotion or overpromotion, poor pay, job insecurity, low social value to work
Home-work interface
Conflicting demands of work and home, low support at home, dual career problems The psychosocial risk management framework presented here is meant to accommodate all existing (major) psychosocial risk management approaches across the EU. This framework is built from a theoretical analysis of the risk management process, identifying its key elements in logic and philosophy, strategy and procedures, areas and types of measurement, and also from a subsequent analysis of typical risk management approaches as used within the EU.
Psychosocial risk management policies and practice at the enterprise level The use of risk management in health and safety has a substantive history, and there are many texts that present and discuss its general principles and 49
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variants (Cox & Tait 1998; Hurst 1998), and its scientific and socio-political contexts (Bate 1997). Although the risk management approach was initially developed to reduce the exposure to hazards of a physical nature, the model is also relevant for tackling psychosocial hazards. Risk management models are often based on the Deming Cycle, or variations of it, consisting of the Plan, Do, Check and Act steps. They incorporate five important elements: (i) a declared focus on a defined work population, workplace, set of operations or particular type of equipment, (ii) an assessment of risks to understand the nature of the problem and their underlying causes, (iii) the design and implementation of actions designed to remove or reduce these risks (solutions), (iv) the evaluation of these actions, and (v) the active and careful management of the process (Leka, Griffiths & Cox 2005). These principles are also relevant and applicable at macro policy level. Managing psychosocial hazards is not a one-off activity but part of the ongoing cycle of effective management of work and of health and safety. As such it demands long-term orientation and commitment on the part of management. Figure 1 below shows how psychosocial risk management is relevant to work processes, and a number of key outcomes both within and outside the workplace. It also clarifies the key steps in the iterative risk management process. Management and organization of work processes PRODUCTION Design, development and operation of work and production
Translation/ Action planning
Innovation
Productivity and Quality
RISK MANAGEMENT PROCESS
Risk assessment and audit
Outcomes
Risk reduction (interventions/ controls)
Quality of Work
Workers’ Health Organizational learning and development
Evaluation
Societal Outcomes
Figure 1. Framework model for the management of psychosocial risks – enterprise level.
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Psychosocial risk management policies at the macro level The important level of policy interventions for the management of psychosocial risks has been largely ignored in the mainstream academic literature. Policy level interventions in this area may include the development of policy and legislation, the specification of best practice standards at national or stakeholder levels, the signing of stakeholder agreements towards a common strategy, the signing of declarations at European or international levels, often through international organization action and the promotion of social dialogue and corporate social responsibility (CSR) relating to the issues of concern. Examples of these policy-level interventions can be found in EC law, the Management Standards approach to work-related stress in the UK, the signed work-related stress framework agreement and the framework agreement on harassment and violence at work between social partners at the European level, the signed Global Plan of Action for Workers’ Health at the recent WHO World Health Assembly, ILO initiatives to promote social dialogue on health and safety issues, and the development of an EC CSR strategy. It is widely acknowledged that initiatives aiming to promote workers’ health have not had the impact anticipated by both experts and policy-makers, and that the main reason for this has been the gap that exists between policy and practice (Levi 2005). There are a number of reasons for this gap. One is a lack of awareness across the enlarged EU that is often associated with a lack of expertise, research and appropriate infrastructure. At the same time, the responsibility for understanding and managing the interface between work, employment and mental health varies greatly across countries. There are fundamental differences between countries in which the responsibility is shared between Ministries of Health and of Labour, and those in which it clearly belongs to either the former or latter. Ministries of Health operate from a public health framework and culture, while Ministries of Labour with responsibilities for occupational health and safety, operate from an occupational health framework and culture. It has been highlighted that the priorities and actions of these two groups differ in relation to work, employment and mental health (Cox, Leka, Ivanov & Kortum 2004). In addition, two other issues of relevance are the situation in ‘transition countries’ in Eastern and South-eastern Europe and the challenge of globalization; in particular shifts in the international division of labour and the dominant neo-liberal policy in European Union Member States aimed at enhancing productivity and competitiveness, with consequences such as rising work pressure, job intensity, longer working hours, and growing precariousness. However, despite the diversity that exists across the EU and in different Member States in terms of socioeconomic conditions, and capabilities such as the existence of infrastructure, availability of expertise, knowledge and understanding, and prioritization of psychosocial risks and mental health at work, the systematic evaluation of policy-level interventions across the EU has not been conducted adequately. It is important that both an increase of national capabilities and a systematic evaluation of policies focusing on psychosocial risks are seriously considered if progress at both EU and national
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levels is to be achieved, and the gap between policy and practice in this area is to be addressed and minimized. As the underlying key principles and philosophy are the same for the risk policy process compared to the risk management process at company level, the policy process at the macro level comprises similar steps and elements as those discussed at company level. The macro level risk management policy process POLICIES AFFECTING THE CHANGING WORLD OF WORK (economic, public health, labour market, trade policies, etc.)
Translation/ Policy Plans
Innovation
Economic Performance
RISK MANAGEMENT POLICY
Risk and Health Monitoring
Outcomes
Intervention Programmes
Quality of Work
Public and Occupational health Societal Learning
Policy Evaluation
Labour market impacts
Figure 2. Framework model for policies regarding the management of psychosocial risks.
Way forward: Challenges to be addressed Many of the priorities for action that have been highlighted are inter-related. Using the philosophy underlying PRIMA-EF, these issues can be addressed as follows. Development of appropriate infrastructure and support – building capacities An appropriate infrastructure for the management of psychosocial risks cannot be found in all EU Member States and, hence is sometimes lacking at national and local levels. This also applies to occupational health service provision. Due to the prevalence and impact of psychosocial risks, psychosocial risk management should represent a higher priority on national and international agendas, and stakeholders must be made more aware of its importance. In addition, psychosocial risk management tools and guidelines and their use should be promoted across the EU. It is important that an increase of national capabilities is considered if progress at both EU and national levels is to be achieved, and the gap between policy and practice is to be addressed and minimized.
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Training and awareness raising – developing tools at the enterprise level One of the key priorities identified by the results of the project is to raise awareness of psychosocial risks across the enlarged EU and among stakeholders. It is important that specific training programmes on psychosocial risk management are developed and promoted, for stakeholders, for occupational health and safety professionals and for health and safety inspectors. Training courses on PRIMA-EF are currently being developed and will be made available to these parties across the EU. Addressing stakeholder perceptions and promoting social dialogue Social dialogue is a useful form of communication among social partners and needs to be fostered at national and European levels as a means of closing the gap in perception between the various stakeholders, and facilitating civil dialogue and facilitated co-ordination. Social dialogue is also critical during the process of implementation of EU Directives and stakeholder agreements, as it involves the incorporation of such standards through national political-administrative systems and is not merely a top-down process. Studies of implementation show that successful implementation also depends on how the upstream process of developing e.g. legislation has been handled (Dehousse 1992). Moreover, regarding implementation, national adaptation depends on the extent to which existing national structures are embedded (Knill 1998). Social dialogue plays a critical role in the development and implementation of initiatives for psychosocial risk management at the macro as well as the organizational level, and hence should be promoted, especially in the new Member States in which existing social dialogue structures are weak. Developing a European standard for psychosocial risk management A standard is ‘a universally agreed-upon set of guidelines for interoperability’. Primarily, the use of European standardization in the area of occupational health supports the competitiveness of firms, as a healthier workforce has a direct impact on this. Currently there are a few complementary European approaches to addressing psychosocial risks at work, some of these have been outlined in recent European documents such as the European Commission’s Guidance on Work-Related Stress (2002), the European Standard (EN ISO 10075- 1&2 1991 and 1996) on Ergonomic Principles Related to Mental Work Load (European Committee for Standardization 2000), and the European Commission’s Green Paper on Promoting a European Framework for Corporate Social Responsibility (2001). These approaches are based on different but related paradigms, which might lead to confusion and misinterpretation. Therefore, standards for addressing psychosocial risks at work need to be developed, based on a framework unifying these approaches. Promoting a CSR-inspired approach A CSR approach to psychosocial risk management (that sees legal requirements as a floor and not a ceiling) is based on the recognition that a company cannot be responsible externally without being responsible internally, towards its own workforce. It recognizes that a healthy workforce and healthy
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organizations are essential for the optimum use of human and social capital, and thus for a vital economy. It will help for increasing productivity, fostering innovation, improving economic performance, and improving the functioning of the labour market (including strengthening of associated social security arrangements and social inclusion impacts). However, the business case for promoting psychosocial risk management needs to be developed and presented to employers. Development and evaluation of tools and initiatives at the policy level The importance and impact of policy interventions for the management of psychosocial risks has been largely ignored in the mainstream academic literature. The evaluation of the policy process, especially the implementation of the policy plan, is an important step, but one that is often overlooked or avoided. Evaluation must consider a wide variety of different types of information and draw it from a number of different but relevant perspectives. The results of the evaluation should allow the strengths and weaknesses of both the policy plan and the implementation process to be assessed. They should provide the basis for societal learning. Better transference of best practices between ministries within countries, between countries, and between international organizations, will also lead to the development of effective tools which can be implemented and evaluated effectively.
Conclusion Current data and reports, experts, and policy-makers agree that psychosocial risks and issues such as work-related stress, workplace violence, harassment and bullying are major concerns to occupational health and safety, with an associated significant impact on the health of people, organizational performance, Member States, and EU economies. This has been identified by the EC with the recent introduction of the European Pact for Mental Health, part of which focuses on the workplace level. The protection of people’s mental health in an ever-challenging socioeconomic and work context is not only a priority, but an ethical responsibility. PRIMA-EF has met the challenge of developing a European framework for psychosocial risk management. A number of priorities have been identified on the basis of this framework for the future of psychosocial risk management and the promotion of mental health at work in the EU. It is now a pressing time for bold decisions and the promotion of this unifying European approach at the EU level, to promote the translation of knowledge and policy into effective practice at enterprise and macro levels.
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References Bate, R. 1997. What Risk? Oxford: Butterworth-Heinemann. Cox, S. & Tait, R. 1998. Safety, Reliability and Risk Management. Oxford: Butterworth-Heinemann. Cox, T., Leka, S., Ivanov, I. & Kortum, E. 2004. Work, employment and mental health in Europe. Work & Stress. 18: 2. p. 179–185. Dehousse, R. 1992. Integration vs. Regulation? On the dynamics of regulation in the European Community. Journal of Common Market Studies. 30: 4. p. 383–402. European Commission. 2001. Promoting a European framework for CSR, Green Paper. Luxembourg: Office for Official Publications of the European Communities. European Commission. 2002. Guidance on work-related stress – Spice of life or kiss of death? Luxembourg: Office for Official Publications of the European Communities. European Agency for Health and Safety at Work. 2002. European Week 2002: Preventing psychosocial risks at work. Available from: http://ew2002.osha.europa.eu/. European Agency for Health and Safety at Work. 2007. Expert forecast on emerging psychosocial risks related to occupational safety and health. Luxembourg: Office for Official Publications of the European Communities. Hurst, N.W. 1998. Risk Assessment: The human dimension. Cambridge: Royal Society of Chemistry. International Labour Office. 1986. Psychosocial factors at work: Recognition and control. Occupational Safety and Health Series no: 56, International Labour Office, Geneva. ISO (1991). EN ISO 10075-1: Ergonomic principles related to work-load – General terms and definitions. Geneva: International Organisation for Standardisation. ISO (1996). EN ISO 10075-2: Ergonomic principles related to work-load – Design principles. Geneva: International Organisation for Standardisation. Knill, C. 1998. European policies: the impact of national administrative traditions. Journal of Public Policy. 18. p. 1–18. Koukoulaki, T. 2004. Stress prevention in Europe: trade union activities. In Iavicoli S. (Ed.) Stress at Work in Enlarging Europe. Rome: National Institute for Occupational Safety and Prevention. Leka, S., Griffiths, A. & Cox, T. 2003. Work Organization and Stress, Protecting Workers’ Health Series, No. 3. Geneva: World Health Organization. Leka, S., Griffiths, A.J. & Cox, T. 2005. Work-related stress: the risk management paradigm. In Antoniou A-S.G. & C.L. Cooper (Eds.) A Research Companion to Organizational Health Psychology. Chichester: Wiley. Levi, L. 2002. Spice of life or kiss of death. In Working on Stress, Magazine of the European Agency of Safety and Health at Work No. 5. Luxembourg: Office for Official Publications of the European Communities. Available from: http://osha.europa.eu/publications/magazine/5. Levi, L. 2005. Working life and mental health – A challenge to psychiatry? World Psychiatry 4: 1. p. 53–57.
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Implicit strategies to improve work and well-being: The social dimensions of organizational excellence Gerard I.J.M. Zwetsloot1,2 and Ariella R. van Scheppingen1, 3 1 TNO Quality of Life – Work and Employment, the Netherlands 2 Nottingham University, Institute of Work Health and Organisations, UK 3 VU University Amsterdam, the Netherlands
Abstract Significant improvements in health and well-being can be created as implicit by-products of activities from agents other than health professionals, with each of these agents having their own prime (i.e. parallel) interests. For this reason, more relevant strategies and interventions for promoting health and well-being at work exist than are usually considered. The aim of this paper is to explore such implicit strategies and interventions, to which we apply the label the ‘social dimensions of organizational excellence’. Our focus is on interactions between interests related to ‘healthy organizations’ and those related to ‘healthy people’. We present two inspiring case studies involving companies in the Netherlands. These examples demonstrate considerable potential for fostering health and well-being at work through implicit strategies and activities. They show the potential for creating a strategic link with the organization’s mission and vision. They also highlight the relevance of a focus on developing leadership and an organizational culture in which people are valued and which stimulates learning and innovation. The paper concludes with a discussion of several important challenges for research and corporate practice.
Key observations ~ Significant improvements in health and well-being at work can be created through activities aiming to improve organizational excellence. ~ Only the limited range of explicit strategies and interventions to promote health and well-being at work is usually considered. ~ An organizational mission, a vision, a leadership style and a culture in which people are valued are all relevant to achieving well-being at work.
Introduction There are many examples in which significant improvements in health and well-being have been created by activities that were not originally intended to improve health. Examples include the purification of drinking water and improvements in traffic safety, education and housing. In current times, we also know that having a job is generally much healthier than being out of work (Black 2008). These examples illustrate that improvements in health and well-being can be generated as by-products of activities undertaken by agents other than health care institutions or health experts. 56
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The Netherlands Ministry of Health, Welfare and Sport has recently developed policies based on the idea that other (i.e. parallel) interests and implicit strategies are relevant to health and well-being (VWS 2007). A quote from the author of the prestigious UK report Working for a Healthier Tomorrow illustrates the relevance of implicit strategies: “For me the most important factor for health at work is that people are well managed.” (Black 2009) The notions of ‘implicit health impacts’ and ‘parallel interests’ imply that more relevant strategies and interventions to promote health and well-being at work exist than are usually considered. Employers and their interest in good business are obviously key factors. The aim of this paper is to explore the potential of what we will refer to as the ‘social dimensions of organizational excellence’. Several organizations have expressed the idea of synergy between the social dimensions of organizational excellence and work health and well-being. One prominent example is the slogan adopted by the European Network for Workplace Health Promotion (ENWHP): “Healthy Employees in Healthy Organisations”. The ENWHP uses the term ‘healthy organization’ to embed health within the manner in which the entire organization operates. The concept combines individual health practices and organizational conditions, and it includes organizational culture, leadership principles and values (Breucker 2004). This links health promotion to organizational performance, learning and innovation. The Canadian National Quality Institute has acknowledged the importance of healthy organizations for business excellence by developing their award for excellence in healthy workplaces (Corbett 2004). A conceptual model is presented in Figure 1. The model illustrates mutual interactions between the healthy organization and healthy employees, as well as the potential for synergy between the strategic business impact of the social dimensions of organizational excellence and the impact of health promotion on individual health, well-being and productivity. Social dimensions of business excellence
Healthy organizations
Health, well-being productivity
Healthy employees
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Figure 1. Interactions between social dimensions of organizational excellence and individual health, well-being and productivity.
Employers are primarily interested in a healthy organization, and a healthy workforce is of secondary importance to them. For experts promoting health, safety and well-being at work, the priorities are reversed. When these differing interests are not well-understood, the potential of the social dimensions of organizational excellence for well-being at work remains unclear. Another relevant model, the European model for psychosocial risk management at work (Leka, Cox and Zwetsloot 2009), is presented in Figure 2.
Management and organization of work processes PRODUCTION, Design, development and operation of work and production
Outcomes
Innovation
Productivity & Quality Risk Assessment & Audit
Translation/ Action Plans
Risk Reduction (Interventions)
Quality of Work
Workers’ Health
Organizational Learning
Evaluation
Societal Outcomes
Figure 2. European Framework for Psychosocial Risk Management (PRIMA-EF) (Leka & Cox, eds. 2009).
The PRIMA-EF model shows clearly that psychosocial risk management can contribute to such organizational goals as innovation and productivity. It also demonstrates that, in addition to business impacts (innovation, production, quality), production activities also have an impact on health and well-being (e.g. quality of work and worker health), as well as on society as a whole.
Two corporate examples from the Netherlands Two examples from companies in the Netherlands illustrate the possibility of managing positive interactions between the social dimensions of organizational excellence and health and well-being at work (cases based on Zwetsloot, van Scheppingen, Dijkman, Heinrich, den Besten in press). The case of Siemens Engineering NL Siemens Netherlands is an engineering service provider with around 3000 employees. Their vision is: Our corporation strives to realize a world of demonstrated talent that generates radical innovations, creates a unique com-
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petitive advantage for customers and equips societies to meet their most important challenges while creating sustainable value (Siemens Nederland 2008). Siemens has been working to achieve excellence in terms of both their business practices and their people through their worldwide ‘Fit4More’ programme. The four pillars of the programme are summarized in Table 1. Siemens NL sees organizational development as a major factor in its efforts to achieve better health for the organization and its people. The company strives to cultivate good business and a healthy and employable workforce by creating a positive organizational identity and image while improving the company’s status in society, its capacity for innovation, and the employability of the people, in addition to being an employer of choice. Siemens NL deploys an active policy of creating flexible jobs in order to moderate a good work-life balance. The company has an active job-rotation practice aimed at keeping employees flexible and fit in their jobs until the end of their careers, and it actively stimulates employees to develop themselves further. The organization strives to prevent undesirable turnover among its personnel and to retain talented people. The company regards mental health, resilience, and responsibility as increasingly relevant to the sustainable deployment of people. Siemens has an outstanding internal occupational health service, which co-operates closely with the human resources department. The main goal of this service is to stimulate productive, healthy, and safe work, while enhancing the motivation and identification of people with the organization. The concrete initiatives of Siemens NL, linked to Fit4More include: ~ Stimulating a culture in which health, vitality and well-being are selfevident ~ Developing leadership and competence ~ Creating work that is healthy and productive ~ An extensive job-rotation programme ~ Comprehensive health-promotion programmes. The case of the provincial organization of Overijssel The mission of the provincial organization of Overijssel is as follows: ‘Our goal is to offer everyone the opportunity for healthy and pleasant living, Table 1. Four pillars of Siemens’ Fit4More programme (Siemens 2007).
Performance and portfolio
Listen to the market, and work continuously to create the optimal supply of products and solutions for the market.
Operational excellence
Achieve permanent optimization of all business processes.
Corporate responsibility
Balance societal, economic, ethical and ecological requirements. The aim is to receive sustainable confidence from society at large.
People excellence
Ensure that employees are ‘fit for the job’, both now and in the future, by identifying and recognizing talents, and coaching and developing individual talents.
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working and recreation within the province, and to achieve an environment that maintains a balance between restfulness, space and dynamics’. Overijssel sees organizational development as crucial to organizational excellence, and as the key to achieving better health for the organization and its people. In its vision statement, known as ‘the vital coalition’ (2006), the provincial organization expresses its intention to become a ‘networking organization’, emphasizing the importance of internal social cohesion and the development of an integrated way of working with internal and external stakeholders. This vision has several implications for people and health management. On the individual level, it is essential that employees are involved, empowered to use autonomy, develop personal resilience, respect each other’s roles, and act responsibly in all situations. This implies a general profile for employees (i.e. flexible, sensitive, results-orientated and co-operative). Employees are recognized as the owners of their own development, thereby ensuring their sustainable employability. Team leaders fulfil a crucial role as the linking pin between policy and operations; leadership style is a key factor. In this way, the vital coalition encompasses the excellence and health status of the organization as a whole, its departments, and all its employees. The provincial organization of Overijssel uses an employee-satisfaction survey as a management tool for monitoring and managing the health and wellbeing of its employees. The survey data are aggregated on various levels, and they provide input for work and improvement plans on all levels. Actions can be directed towards problem-solving (risk control) or contribute towards goal achievement (development orientation). Health problems identified in the survey are seen not only as individual problems, but also as symptoms of organizational problems. Concrete initiatives that the provincial organization of Overijssel has taken to realize its vision include the following: ~ Leadership and culture initiatives (to promote a more business-like and open culture, in which mistakes are allowed, but learning from them is a must) ~ A programme to support employee development and resilience ~ A comprehensive health-promotion programme ~ An extensive monitoring programme.
Conclusions Implicit strategies and activities offer considerable potential for fostering health and well-being at work. The two corporate cases that we have presented clearly show the potential of a strategic link with the organization’s mission and vision. A company’s mission and vision form the basis for the strategic embedding of organizational policies to enhance health and wellbeing, with the creation of a healthy or vital workforce as a primary goal of the organization. The examples demonstrate the potential of strategies that focus on developing leadership and creating an organizational culture and practice in which people are valued, and in which learning and innovation are stimulated.
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Challenges for the future The findings presented in this paper imply several challenges and opportunities for research, as well as for corporate practice. The main challenges are as follows: ~ To conduct a more systematic exploration of implicit strategies to foster health and well-being ~ To become more systematic in triggering ‘parallel interests’ for creating or strengthening management and organizational commitment for health and well-being at work ~ To help companies develop an optimal mix of implicit and explicit strategies for health and well-being ~ To develop adequate research designs and evaluation criteria for implicit strategies and interventions (as experimental designs to promote health and well-being are likely to be inappropriate for implicit strategies).
References Black, C. 2008. Working for a healthier tomorrow – Dame Carol Black’s review of the health of Britain’s working age population. London: TSO. 125 p. ISBN 978-0-11-702513-4. Black, C. 2009. Keeping people healthy at work, UK Government strategy, presentation at the eight global meeting of WHO Collaborating Centres in Occupational Health, 19–23 October 2009, Geneva. Breucker, G. 2004. Towards healthy organisations in Europe – From Utopia to real practice, BKK & ENWHP, Essen [Online publication]. Available from: http://www.enwhp.org/fileadmin/downloads/Publications/Towards_ Healthy_Organisations_in_Europe.pdf. Corbett, D. 2004. Excellence in Canada: Healthy Organizations – Achieving results by Acting Responsibly. Journal of Business Ethics. 55, Special Issue on Social Dimensions of Organisational Excellence – EFQM-EOQ Convention 2003. p. 125–133. Leka, S., Cox, T., Zwetsloot, G.I.J.M. 2009. The European Framework for Psychosocial Risk Management (PRIMAEF). In Leka S. & T. Cox (Eds.) The European Framework for Psychosocial Risk Management. Nottingham. I-WHO Publications 184 p. Chapter 1, p. 1–16, ISBN 978-0-9554365-2-9. Siemens Nederland. 2008. Jaarverslag 2007 [Annual Report 2007]. p. 4. The Hague: Siemens Nederland. Available from: http://www.siemens.nl/onderneming/download/SIEMENS_JAARVERSLAG_2007.pdf. Siemens AG. 2007. From Fit4More to Fit4-2010, Programmes for sustainable development and value creation. In Jaarverslag 2007 [Annual Report 2007]. pp. 32–43. Available from: http://w1.siemens.com/annual/07/pool/ download/pdf/e07_00_gb2007.pdf. Dutch Ministry of Health, Welfare and Sport (VWS). 2007. Being Healthy and Staying Healthy; A vision of Health and Prevention – The Netherlands. The Hague: Ministry of Health, Welfare and Sport. Available from: http://www.rivm.nl/vtv/object_binary/o5512_fo_being_healthy.pdf. Zwetsloot, G.I.J.M., van Scheppingen, A.R., Dijkman, A., Heinrich J., den Besten H. (in press). The organisational benefits of investing in workplace health. International Journal of Workplace Health Management.
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Intellectual capital-based future personnel management Tomi Hussi and Guy Ahonen Finnish Institute of Occupational Health, Helsinki, Finland
Abstract Younger generations participating in work life have different expectations to those of the older generations. Issues such as quality of life, meaningfulness and well-being are increasingly important, along with development opportunities and a reasonable income level. Intellectual capital is the framework for outlining the value creation logic of a knowledge-intensive organization. Intellectual capital consists of three dimensions, namely human capital, structural capital, and relational capital. Besides providing interesting and even exciting business opportunities, companies also have to be able to communicate the extent of their commitment to meet the other abovementioned expectations. The strategy-based model of work-related well-being is a tool not only for communicating, but also for managing both the organization’s expectations and offerings. We argue that successful future personnel management is even more dependent on empowerment-emphasizing leadership practices. The essence of the intellectual capital framework is that an organization tries to make the best use of the knowledge resources available, both internally and externally. Work is based more on collaborative interaction between people to create new knowledge. Organizations need to be innovative in order to survive the competition. This also means fostering the employees in a sustainable manner in order to ensure innovativeness. The business rationale of the future ties well-being and productivity even more closely together.
Key observations It is argued that the Intellectual Capital framework provides valuable insights into how to identify the strengths of the different generations in work life and furthermore, on building the platform for inter-generational collaboration. Members of Generation Y are perceived to be ready to commit themselves to organizational goals, presuming the objectives and leadership are compatible with their life situation. Intellectual capital is the framework for outlining the value creation logic of a knowledge-intensive organization. The well-being aspect broadens the four different parts of the Danish framework of Intellectual Capital Statement together into a strategy-based workrelated well-being.
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Introduction The drivers of productivity are increasingly shifting from the tangible towards knowledge and other intangibles. At the same time, the labour force is getting older. The young generations entering work life today are very different from any of the preceding generations. These multi-dimensional changes profoundly challenge current personnel management policies. We need further information on the expectations and requirements of the different generations participating in work life. Furthermore, the value creation logic of the knowledge economy needs to be scrutinized. This paper discusses the implications of generation differences for Intellectual Capital, and highlights the means of communication for bridging the gap between the expectations of the organization and employees. These considerations provide grounds for analysing future personnel management in the concluding section of the paper.
Three generations of work life Society typically consists of five generations. It is generally considered that the labour input of three generations is needed to support the two depending generations; children and elderly citizens. The three active generations of work life can be labelled as juniors (under 35 years of age), the middle group (35–55) and seniors (55+) (Latta, Hussi and Ahonen 2010). There has been a great deal of discussion about the situation of seniors in work life (Ilmarinen 2006). It is widely recognized that the age structure of many Western countries leans towards older citizens due to decreasing fertility and growing life-expectancy (Ibid.). Longer participation in work life is seen as crucial for overcoming the challenges of this demographic change. Therefore different Age Management initiatives have been implemented to accommodate the changing resources of work life seniors in Finland and elsewhere. Middle groups have already gained work life experience and their abilities are generally of a high level. This group is sometimes even labelled ‘primeage’ and typically the stereotypes attached to it are only positive, whereas younger and older groups are also characterized by negative stereotypes (Vaahtio 2002). However, the middle group still faces various demands in its private life in addition to work life. Balancing work and private life places various pressures on an individual’s well-being. Unemployment periods and long-term sickness absences are serious threats to a solid work career. The current juniors of work life are often called Generation Y. This group has special characteristics in comparison to the other groups in work life, because of their lifestyle and their expectations, which are very different from those of preceding generations. As a group, Generation Y has unprecedented technological knowledge and experience. Issues such as quality of life, meaningfulness and well-being are increasingly important for this group, along with development opportunities. Members of Generation Y are ready to commit themselves to organizational goals, presuming the objectives and leadership are compatible with their life situation.
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It requires creativity and flexibility to orchestrate the sometimes conflicting interests of different work life generations. Different expectations of leadership practices can be especially difficult to handle, since seniors are used to a more authoritarian and hierarchical management style than the younger group. On the other hand, today’s ultimatum of creating new knowledge and innovations are in agreement with a combination of different perspectives and ideas. This apparent threat could be turned into a considerable opportunity and a new basis of competitive advantage if we could focus the different energies prevailing in the work community towards a shared goal. In an attempt to do this, we will now take a look at the Intellectual Capital framework, and its particular value creation logic.
Intellectual Capital Intellectual capital is the framework for outlining the value creation logic of a knowledge-intensive organization. Intellectual capital consists of three dimensions, namely human capital, structural capital and relational capital (Meritum 2002). Human Capital Human capital is usually assumed to include an individual’s knowledge, experiences, capabilities, skills, creativity and innovativeness (Edvinson & Malone 1997). People’s health, work ability and ability to perceive changes in the operational environment are also included in this category. Uncertainty about an employee’s commitment to the organization reduces the organization’s willingness to invest in people (Albert and Bradley 1997). Yet, competent personnel are essential in a company’s endeavour to realize and develop its business ideas (Hansson 2002; Sveiby 1990). Investments in personnel are as crucial for knowledge-intensive companies as industrial enterprises’ investments in tangible assets. Structural Capital Structural capital is the embodiment, empowerment, and supportive infrastructure of human capital. It provides the environment that encourages individuals to invest their human capital to create and leverage its knowledge. It encompasses organizational capacity, including the physical systems used to transmit and store intellectual material. Structural capital also includes corporate culture, management systems and leadership style, which is important from the generation management point of view. Relational Capital Relational capital consists of the knowledge and perceptions of the external stakeholders of the company. Customers, suppliers, authorities and competitors belong to the key stakeholders. Relational capital expands the company’s knowledge base and is essential for the creation of new knowledge. In particular, reputation among potential and actual customers determines the willingness to pay for the company’s services and products, and thereby its profits. A great deal of relational capital is the result of the way in which the two other forms of Intellectual Capital (IC) operate. In a successful case, the market appreciates the superior knowledge possessed by a company’s personnel and captured by its systems, and is therefore willing to pay prices which exceed the production costs of the company. 64
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Strengths and weaknesses of different generations in the light of Intellectual Capital Tacit knowledge accumulated through experience is a valuable asset for companies, as it ensures the fluency of work processes. Because of their long perspective, seniors are invaluable to organizations. They are often members of different networks of the organization and are therefore crucial creators of relational capital. Structural capital, however, can be seen as the weakest linkage for seniors, because both information and communication technology infrastructure, as well as corporate cultures have recently considerably changed to their disadvantage. The middle group can be seen as a group of all-rounders in an organization, but it is difficult to point out a specific dimension of Intellectual Capital that would be their speciality. Because of their gained experience, their human capital is already of a good level, yet it is not as outstanding as that of the seniors. They are also familiar with the networked work procedures related to structural capital and master relational capital, such as customer relationships, to a good degree. Generation Y’s strengths are especially related to structural capital. They are well-equipped for shared knowledge creation due to their highly networkorientated lifestyle. Their human and relational capital are, however, often inferior to that of their colleagues. We argue that the Intellectual Capital framework provides valuable insights into how to identify the strengths of the different generations in work life and furthermore, on building the bridge between members of the work community with different ages. As the study of this paper is only at a very preliminary phase, this discussion of the characteristics of different generations in terms of Intellectual Capital should be seen as initial hypotheses. We think, however, that it is important to start analysing the specific characteristics of the different generations in terms of intangible assets in order to more fully be able to take advantage of their relative strengths in the market place.
Managing Intellectual Capital and employee well-being Besides interesting and even exciting business opportunities, companies have to be able to communicate the extent of their commitment to meet expectations regarding sustainable well-being. The so-called strategy-based model of work-related well-being is not only a tool for communicating to current and future employees, as well as to other stakeholders such as investors, but also a tool for managing both the organization’s expectations and offerings. It is based on the so-called Danish framework of Intellectual Capital Statement. The original framework is supplemented with a specific section focusing on employee well-being. (Hussi & Ahonen 2007) The framework consists of four different parts; the knowledge narrative, management challenges, initiatives, and indicators. (DATI 2000, Mouritsen, Bukh, Flagstad, Thorbjørnsen, Johansen, Kotnis, Larsen, Nielsen, Kjærgaard, Krag, Jeppesen, Haisler and Stakemann 2003a, Mouritsen, Bukh, Johansen, Larsen, Nielsen, Haisler and Stakemann 2003b). The logic of the framework 65
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is that the knowledge narrative explains what kind of use value the organization is creating for its customer, with available knowledge resources and predetermined factors influencing the aim of creating use value. Management challenges determine the main areas that the company has to be able to handle in order to be successful in its activities. Initiatives are the concrete actions targeted to meet the management challenges. And finally, indicators are created to monitor the effectiveness of the initiatives – are we getting the expected results from our activities? To make this a strategy-based well-being approach, the elements of the above model are supplemented by a well-being aspect. The well-being narrative explains what kind of requirements the knowledge narrative outlines for well-being, available well-being resources, and predetermined factors related to well-being. The well-being narrative also explains the transition in the operational orientation. Organizations with a longer history have typically faced different operational environments and adapted their activities according to these contexts. However, this adaptation is far from complete, and many practices, but more importantly, the mindset of the employees, are at least partially still clinging to earlier operational orientation. These mismatches are a significant source of friction in organizations. From the employees’ perspective, this kind of information is highly relevant as the basis for the psychological agreement, which can be seen as a basic source in motivating oneself to a specific job. Based on the differences between the generations discussed above, the grounds for this psychological agreement may vary considerably among employee groups.
Conclusions Future employees will be ready for even strong involvement in the organization’s goals, but only if they find these objectives meaningful and reasonable in terms of their life as a whole. Future business rationale ties well-being and productivity even more closely together. We argue that successful future personnel management requires an approach that combines the specific characteristics of the different generations in the labour market with the structure and value creation logic of intangible assets. The essence of the intellectual capital framework is that an organization tries to make the best use of available knowledge resources, both internally and externally. Work is based on the collaborative interaction between people to create new knowledge. Organizations need to be innovative in order to survive the competition, and this may require totally new types of behaviour from both employers and employees.
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References Albert, S., Bradley, K. 1997. Managing knowledge: experts, agencies and organisations. Cambridge: Cambridge University press. Danish Agency for Trade and Industry (DATI). 2000. Guideline for Intellectual capital statements: A Key to Knowledge Management. Copenhagen: DATI. Edvinsson, L. Malone, M.S. 1997. Intellectual Capital. Realising your company’s true value by finding its hidden brainpower. New York: Harper Business. Hansson, B. 2002. Marketable Human Capital Investments: An Empirical Study of Employer-Sponsored Training. Stockholm: Stockholm University, School of Business Working Paper. Hussi, T., Ahonen, G. 2007. Business-oriented maintenance of work ability. Helsinki: Ministry of Social Affairs and Health. Ilmarinen, J. 2006. Towards a longer work life: ageing and the quality of work life in the European Union. Helsinki: Finnish Institute of Occupational Health & Ministry of Social Affairs and Health. Latta, M., Hussi, T., Ahonen, G. 2010. Työelämän sopeuttaminen elämänkulkuun – mahdoton haaste vai ainutkertainen mahdollisuus? [in Finnish; Adjusting worklife to life course – an impossible challenge or unique opportunity? Talous & yhteiskunta 2010: 1. p. 52–59. Meritum project. 2002. Guidelines for managing and reporting on intangibles (Intellectual Capital Report). Madrid: Airtel-Vodafone Foundation. Mouritsen, J., Bukh, P.N., Flagstad, K., Thorbjørnsen, S., Johansen, M.R., Kotnis, S., Larsen, H.T., Nielsen, C., Kjærgaard, I., Krag, L., Jeppesen, G., Haisler, J., Stakemann, B. 2003a. Intellectual Capital Statements – The New Guideline. Copenhagen: Danish Ministry of Science, Technology and Innovation. Mouritsen, J., Bukh, P.N., Johansen, M.R., Larsen, H.T., Nielsen, C., Haisler, J., Stakemann, B. 2003b. Analysing Intellectual Capital Statements. Copenhagen: Danish Ministry of Science, Technology and Innovation. Sveiby, K-E. 1990. Kunskapledning. 101 råd till ledare i kunskapintensiva organisationer [in Swedish; Knowledge Management. 101 hints for managers of knowledge-intensive organizations]. Stockholm: Affärsvärld förlag. Vaahtio, E-L. 2002. Rekrytointi, ikä ja ageismi. [in Finnish; Recruiting, age and ageism]. Helsinki: Työministeriö.
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Psychosocial work environment and performance Kasper Edwards and Niels Møller Technical University of Denmark, Denmark
Abstract A good psychosocial work environment has been assumed to lead to good work performance. However, little documentation exists to support this claim, as is also true for the opposite claim. This paper reports the first findings of a combined quantitative and qualitative study of the relationship between psychosocial work environment and performance in a large Danish firm.
Key observations The objects of the study were over 45 customer centres with 9–20 employees each. Using a combination of the Copenhagen psychosocial questionnaire and data from the firms’ balanced scorecard system, we show a positive significant correlation between performance and psychosocial work environment. A sample of 12 departments was selected for an in-depth qualitative study based on their relative change in performance and psychosocial work environment between 2005 and 2007. Through the qualitative study we are able to identify and describe the mechanism underlying the observed relationship. We observed that a specific leadership style is responsible for creating a good work environment, which in turn leads to good performance. The leadership style can be described as process orientated, supportive, consistent, but also demanding. Keywords: Psychosocial work environment, performance, leadership
Introduction Productivity is a highly important issue for companies, and maintaining high productivity may be the deciding difference between staying in business and going out of business. Psychosocial work environment is believed to have an impact on productivity, although significant documentation on the statistical or causal relationship remains to be seen. This paper reports findings from a study of a large Danish corporation, “The Corporation”, in which we have measured the relationship between psychosocial work environment and performance. It is the result of a research project that will answer the following research questions: 1) Is there a statistical correlation between psychosocial work environment and performance? 2) What is the nature of the correlation? The corporation is an ideal case, as it focuses on work environment and 68
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uses a validated COPSOQ (Kristensen, Hannerz, Hogh and Borg 2005) instrument for measuring the psychosocial work environment. Psychosocial work environment is a characteristic of the workplace which expresses how well people interact and work together. A good psychosocial work environment is, for instance, characterized by high levels of trust and justice, and low levels of sexual harassment and bullying. The psychosocial work environment is further thought to be significantly influenced by managers. The 1st line manager is particularly important as he/she sets the rules for day-to-day behaviour. The corporation has more than 40 branch offices, each with 7 to 25 employees. Work and tools are identical, apart from slight organizational differences, and of course different staff and management. The branch offices are essentially sales offices with accompanying administration. The similarity between the branch offices allows us to use them as the unit of analysis and compare them with each other. The financial corporation uses a performance management system based on the balanced score card system (Norton and Kaplan 1996) to measure and manage performance. The system aggregates from the individual worker to the branch office, and then to the corporate level. The performance management system records a wide variety of data, ranging from sales of individual products to number of sick days. Each employee has a sales target that must be met, and the branch office manager must take action if they fail to do so.
Methodology This project used a mixed methods approach, employing both statistics and two forms of interviews. At the core of the study is the corporation’s biennial measurement of the psychosocial work environment. The psychosocial work environment was measured using the COPSOQ instrument in 2005 and 2007. The COPSOQ instrument measures several dimensions. Leadership quality was chosen as the primary psychosocial indicator, as it has been shown to correlate strongly with social capital (Trust, justice and collaboration). Respondents were asked to rate their 1st line manager. The financial corporation provided full access to their performance management system which contains all kinds of financial and performance measures. Over 100 measures were available, which of course is far too much. A smaller number, or preferably a single measure for performance had to be chosen. Unlike psychosocial indicators, it proved difficult to select a single performance indicator because of their ambiguity. We developed three criteria as the primary selection criteria: 1) The branch office must be able to influence the KPI (key performance indicator), 2) Financial KPIs are excluded, and 3) Bonus related KPIs are included. The reasons for these criteria are straightforward – as the unit of analysis is the branch office, they must be able to influence the KPI. Financial KPIs reflect the stock market and not the psychosocial environment. A number of KPIs are included in the bonus system and good performance in these result in a bonus. Although the bonus is small, it directs attention to the specific KPIs and influences behaviour.
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The ambiguity of the KPIs proved to be a problem in the sense that some of them, such as ‘Total number of sales’ may not contribute to the overall economic performance of the branch office. This is because the cost of selling and managing the products is far greater than their related income. In the end, we chose a performance KPI called ‘Activity profit’, which is the profit the branch office receives for each sale of a specific kind of product. This KPI relates to the overall performance of the branch office and indicates if it is profitable. It had been increasingly under focus in recent years, and grown in weight in the bonus system from 1/7 to 3/7. We perceived this as an indication of the overall importance of this specific KPI. The relative change leadership quality and activity profit between 2005 and 2007 for each customer centre were plotted against each other (Ffigure 1). The 12 customer centres with the most extreme changes were selected for interview.
Figure 1. Customer centres which showed most extreme change in leadership quality and activity profit between 2005 and 2007 were selected for interview.
The manager of the customer centres and a group of approximately 30% of the employees were interviewed. Each manager was interviewed for 1.5 hrs with the purpose of uncovering their management practice, assumptions, and theory of leadership. Analytical interview methodology (Kreiner and Mouritsen 2005) was used. A history workshop was used to interview the employees. History workshops are a group interview methodology (Olesen, Thoft, Hasle and Kristensen 2008) which uncover the past history of an organization. Three questions were posed: 1) What are the most significant events in the past ten years? 2) Describe significant changes in management in the past ten years, and 3) Name significant persons in the past ten years. All questions are placed in the context of the customer centre and its work life. Each participant wrote the answer to the questions on different coloured paper. The questions were dealt with one by one, and the researcher placed the answers on a time line. The method provided a detailed description of the history of the customer centre in question. It made it possible to relate events to changes in performance, as the timeline could be co-related to performance data. 70
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Results and analysis The results from this project fall into two categories: 1) Statistic and 2) Qualitative. The statistical analysis shows a positive correlation between psychosocial factors and a number of KPIs (Figure 2). All correlations with the exception of ‘role conflict’ being negatively correlated with average illness supports the hypothesis of a good psychical work environment leading to improved performance.
Activity profit/ salary per manmonth per centre
Total sales per year per centre
Employee turnover per centre per year
Avg. illness per manmonth per centre
Predictability
0.24
0.32*
-0.20
-0.14
Recognition
0.38
0.31
-0.24
-0.06
Quality of leadership
0.24
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-0.28
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Social support from superior
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Social support from colleagues
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Social community
0.24
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Role clarity
0.28
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-0.32
-0.11
Role conflict
-0.19
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-0.21
Job satisfaction
0.10
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-0.06
-0.13
”Vertical” trust and credibility
0.34
0.23
-0.15
0.06
”Horizontal” trust and credibility
0.25
0.12
-0.22
0.03
Justice and respect
0.22
0.18
-0.18
0.02
Figure 2. Correlation matrix between psychosocial factors (left) and KPIs (top).
The qualitative results are rather interesting, as they provide insight into the day-to-day issues of leadership in a customer centre, and the relationship between customer centre and the corporate level. 71
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The 12 interviews with managers and the history workshops reveal two different management styles. One management style, which we call ‘outcomecentred’, focuses on acting as the management system dictates. This means that the manager primarily acts on the basis of the data provided by the performance management system. It also implies that the manager will act as prescribed when performance goals are not met. When a single employee does not meet his performance goals, the manager calls this employee to a meeting where he/she is asked to improve performance within the next three months. The corporate-centred management style focuses on outcome and reacts according to the historic data from the performance management system. Branch office managers are, in general, also subject to this same management style from their own next line managers, the regional managers. If one or more employees do not perform, it usually implies that the customer centre as a whole does not meet performance goals. This will result in follow-up action from the regional manager. The second type of management style identified may be called ‘effort-centred’, and takes a different approach. The main focus of these managers is on the effort of the employees and the processes of the branch office. The effort-centred managers constantly refine and improve the processes. When products or market conditions change, the manager steps in and analyses the processes. The processes are the links between effort and outcome – as one branch office manager explains “… the right process leads to the right results”. The two different management styles have significant implications for the well-being and performance of employees. The outcome-centred management style has the effect that employees become insecure and lose faith in their own abilities. They are essentially sales people with direct customer contact, and if they appear insecure the customer will, in the same vein, lose trust in the sales proposition and may abort the sales process. This induces a negative spiral in which the employee, who is already aware of his/her poor performance, is told to improve, but not how to improve. The ultimate consequence of this negative spiral is job termination. Interestingly, it is often the employee who quits before being terminated, probably because they know the direction in which they are heading. This, however, is merely speculation on the part of the authors. The effort-centred management style has the lowest employee turnover, highest average age, and best performance. This type of manager knows how much time each employee works for, and how many customers and how many sales meetings are in the pipeline. When an employee’s pipeline shows signs of decline, the manager steps in and asks how he/she may help. On one occasion, a manager noted that a particular type of product caused problems for an employee. The employee had been trying hard to sell this product and the amount of attention devoted to this product was affecting the performance of the other products and her self-confidence in general. The manager asked the employee to focus on the products she was most comfortable with and suspended the performance management system for a period of time. Shortly after, the manager asked the employee 72
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to include the difficult product and offered to support the sales process and sit in on meetings. Together, the manager and employee developed a sales process that worked, and sales began to pick up. As the manager noted: “Once she realized what she had to do, there was nothing to it…” Effort-centred managers are as interested in performance as the other managers. However, they approach performance demand differently. When employees understand the process that leads to results, it is possible to focus on outcome, but as soon as the product or other factors change, it is not clear what has to be done to get results. The effort-centred managers then switch back to analysing the process and making corrections, trying to get process right again. Essentially, the effort-centred managers continuously switch back and fourth between effort and outcome. Effects of performance management system As already noted, one of the two management styles appears to be more focused on the performance management system. The performance management system produces ranking lists, highlights who is not performing accordingly, but does not measure effort. Effort by itself is a product of the capability and capacity of the employee, and is responsible for the difficulty of the task. As such, resourceful employees only need to exercise a little effort in order to perform well. This sort of rich information is not transferred through the performance management system, and resides only in the head of the local branch office manager. It would appear that the performance management system promotes the outcome-centred management style. This is particularly interesting, as the top performing customer centres have an effort-centred management style. The unit of analysis in the performance management system is the individual employee, and they must all sell the same product to meet performance goals. Naturally, employees have different abilities, which make them better at selling one product rather than another. From a performance perspective, this would imply that the individual branch offices create teams or set individual sales goals. This is not possible under the current performance management system, and the organization is often locked-in to a particular constellation.
Conclusion We demonstrated a significant positive correlation between the psychosocial work environment and performance. Psychosocial work environment was measured using the COPSOQ instrument, and performance data were captured through the company’s performance management system. The psychosocial work environment is mediated through leadership of the 1st line managers. Two different management styles can be identified: 1) outcome-centred and 2) effort-centred. Effort-centred management showed the best performance: best economic performance, best psychosocial work environment, and lowest employee turnover. The effort-centred management develops social capital (trust, justice and collaboration) among employees, and defines the work processes.
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Contrary to intention, the performance management system induces outcome-centred behaviour, as only tangible results are measured e.g. number of sales. Focus on outcome is effective when employees can translate their outcome into activities. If products, the market, or other factors change it is not possible to make a direct translation, and the employee may become frustrated.
References Kreiner, K., Mouritsen, J. 2005. The analytical interview. Relevance beyond reflexivity. I The art of science. Stefan Tengblad, Solli, Rolf and Czarniawska, Barbara. Malmö, Liber, 153–176. Kristensen, T.S., Hannerz, H., Hogh, A., Borg, V. 2005. The Copenhagen Psychosocial Questionnaire – a tool for the assessment and improvement of the psychosocial work environment. Scandinavian Journal of Work Environment & Health. 31: 6. p. 438–449. Norton, D.P., Kaplan, R. 1996. The Balanced Scorecard: translating strategy into action. Harvard Business School Press Boston. Olesen, K.G., Thoft, E., Hasle, P., Kristensen, T.S. 2008. Virksomhedens sociale kapital - Hvidbog. Copenhagen: Arbejdsmiljørådet. English: “Social capital of the firm – a white book”, Copenhagen: Danish Working Environment Council. Web: http://www.amr.dk/.
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Enhancing well-being in the public organization Jarmo Vorne and Hannu Anttonen Finnish Institute of Occupational Health, Oulu, Finland
Abstract Today’s safety culture and employee attitude towards developing working conditions are becoming more positive in Finland. The health and well-being of workers is now widely recognized as enhancing productivity and competitiveness on the market (Aaltonen et al. 2006). Our development project for public administration created substance, indicators, goals and outlined the organization of the new model for well-being at work. The project was implemented in a large public organization in five different localities. Seventeen structured interviews were held, and 45 questionnaires responded and returned. The new model transforms the current reduced labour protection practice into a more global approach of well-being at the workplace. At the same time, the safety work initiative moves towards line organization (Simola 2005). The benefits of the new model are the combination of different committees, binding actions for management and the decision-making system (Räsänen & Anttonen 2008), the participation of personnel, and the active risk management work of the labour protection pairs in the field. According to the analysis, a rise from the basic to the top level of well-being requires development of workers’ health and well-being, ensuring operative actions, and improvements in the work environment section. The study claims that the effective documents supporting risk management are the strategy, the yearly plan of action, working instructions, and self-evaluation. The target levels should be defined in risk management and risk assessment. The collection of benchmarking data and near miss reporting data also enhances risk management. Risk assessment documents should be turned into summaries for management use. The safety management system, especially the included principle of continuous improvement, is essential for attaining maximum well-being at work. Through these operations, well-being at work can be notably improved.
Background Safety work has been part of the Finnish defence forces’ management for a long time. However until now, the risk assessment process has not been comprehensively assessed to support well-being from the management system’s point of view. The studied organization had several committees which discussed different sectors of well-being (Janatuinen 2004). The effectiveness of the risk management process can be enhanced by developing parts of the management system. Changes to the organizations’ safety development process are best 75
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made only after risk assessment work has been started. The starting point of the study was to find the best practices for the risk assessment process, how it effects management systems, and how it enhances well-being.
Aim of the study The aim of the study was to assess and develop the practices of risk assessment and management in the organizations, in order to form an effective and comprehensive well-being model as follows: 1. The risk assessment process was assessed by studying earlier risk assessments and the resulting developmental actions. How can the risk assessment’s results be utilized to enhance well-being? 2. Risk management’s role in the management system was studied by assessing the effectiveness of the risk assessment and the resulting actions in building a new, comprehensive organizational model.
Methods Two questionnaires were used: the ‘How to effectively perform risk assessment’ questionnaire was aimed at the organizations’ safety professionals (n=26) and ‘The management and safety management’ questionnaire was intended for the line organization’s key risk management personnel (n=19). The document analysis included analysis of the organizations’ risk management documents. Management system analysis was carried out using the Finnish Safety Ten method (Turvallisuuskymppi) (Liuhamo & Santonen 2001). This showed which organizational factors, processes and organizations should be enhanced in order to build a new, effective model.
Results The main development areas were risk reporting and occupational safety training. Risk reporting in the organization was insufficient (42%). A discus-
Results of risk assessment yes
no 100%
80
60
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20
0 Risk lower than expected
Risk higher than expected
Risks never found before
Figure 1. Results of risk analysis.
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Measures at workplace yes
no 100%
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0 Additional analysis
Ergonomics
Work environment Working methods
PPE
Priority change
Figure 2. Workplace measures.
sion between management and personnel should be organized after the risk assessment, for assessing the measures to reduce risks. The most challenging sector in risk assessment was mental stress. However, workplaces knew how to use external aid in assessment. Although the assessment of mental stress is challenging, it should be in balance with other sectors. According to the study, risk assessment made new hazards visible (Fig. 1) and encouraged personnel to develop occupational safety. As a result of the risk assessment, new measures were implemented to remove hazards and reduce risks. The results of the risk assessment were discussed in the safety committees and in other related committees. Risk management was seen to be carried out well and was versatile. Different measures (Fig. 2) such as new technical solutions, substituting products with safer ones, and changing working practices (35%) were taken to reduce risks. Exposure times were limited, and personal protective equipment was used (30%). The guidance to risk management was clear and detailed. However, it should be modified for smaller units, and should contain simple risk assessments and an action plan. According to the management system analysis, a rise from the basic to the top level of well-being requires the ensuring of operative action and development in the work environment sections. According to the document analysis, the effective documents supporting risk management were the strategy, the yearly action plan, and working instructions. The collection of benchmarking data enhanced risk management. The documents of risk assessment should be turned into summaries for management use.
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now 0
1
expected 2
3
4
5
Quality documents Strategy and vision Guidance to risk management Labour protection plan of action Introductory briefing programme Risk documents Accident documents Financial statement of personnel Labour protection co-operation Well-being programmes Budget, plan of action Plan of profits Self auditing Absence from work, illnesses Work atmosphere report Organization chart
Figure 3. Document analysis.
The developed model and organization for well-being, modified by Janatuinen 2004, economically integrated committee work, management, activities of labour protection pairs, and risk management. This enhanced the committee work’s effectiveness and reduced overlapping operations in the organization. The committee is able to make decisions without external support.
Conclusions 1. The risk assessment process improved from the basics to a comprehensive and effective model to enhance well-being. 2. The safety management system and the principle of continuous improvement hold the keys for achieving the top level in well-being at work. 3. The benefits of the new well-being model were the combination of different committees, binding actions for the management and the decision-making system, the participation of personnel, and the active risk management work of the labour protection pairs in the field.
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Workplace management Well-being committee
Personnel
- Safety - Occupational health care - Environmental health - Environmental protection - Medical service - Social affairs - Pastoral care - Physical exercise - Workplace canteen - Rehabilitation - Recreational service
Co-operative parties
The labour protection pair, activating and auditing
Operations supporting well-being External experts
Hard and expensive measures
RISKS
RISKS Easy and affordable measures
Data Security, maintenance, guarding, quality, fire and rescue, human resources/ work atmosphere/ recruiting, self evaluation, civil defence
Figure 4. Developed model and organization for well-being.
References Aaltonen, M., Anttonen, H., Grönqvist, R., Liuhamo, M., Saari, J., Vauhkonen, T., Vorne, J. 2006. Työturvallisuus liiketoimintana. Esiselvitys.[in Finnish; Safety business]. TEKES. Janatuinen, E. 2004. Työhyvinvointitoiminta ja sen kehittäminen puolustusvoimissa. [in Finnish; Well-being activity and development in the Finnish Military Forces]. Helsinki: Maanpuolustuskorkeakoulu, Johtamisen laitos. Julkaisusarja 1, Tutkimuksia n:o 29. p. 116. Liuhamo, M., Santonen, M. 2001. Turvallisuuskymppi. [in Finnish; Safety Ten]. Helsinki: Työturvallisuuskeskus. p. 40. Räsänen, T, Anttonen, H. 2008 (Eds.). Well-being at Work – New Innovations and Good Practices. Helsinki: Finnish Institute of Occupational Health. Simola, A. 2005. Turvallisuuden johtaminen esimiestyönä. [in Finnish; Safety management as work of task manager]. Dissertation. Oulu: Oulun yliopisto, Teknillinen tiedekunta, Tuotantotalouden osasto, Työtieteen yksikkö. p. 274.
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Stress management at the workplace – building practice guidelines for occupational health services Juha Liira, Maritta Kinnunen-Amoroso, Riitta Sauni and Jani Ruotsalainen Finnish Institute of Occupational Health, Helsinki, Finland
Abstract The formation of practice guidelines for occupational health services in Finland, on how to deal with work-related stress was initiated by a systematic research of the literature. The objective was to summarize research evidence on the effectiveness of work-related stress interventions, as well as the national and international regulations for the reduction of excess psychosocial load at workplaces. The resulting guidelines consist of definitions, evidence of health effects, evidence of effective interventions to reduce stress, and recommendations for the co-operation of occupational health and workplace representatives. The main causal factors of work stress appeared to be high and conflicting demands at work. Stress was also associated with increased sickness absence rates. Integrated stress reduction programmes appeared to reduce stress in workplace settings and cognitive-behavioural interventions were effective in reducing the stress symptoms of employees. The evidence, and its implications for occupational health practice, were assessed by an expert group covering a wide range of expertise from clinical medicine, through psychology, to legislation. The main take-home message of the guidelines is that workplaces and occupational health services should work in co-operation to assess risks, to reduce the observed stress at work, and to reduce the stress symptoms of employees. A pilot study on the implementation of practice guidelines will be carried out in occupational health service settings in Finland.
Key observations: ~ High and conflicting demands at work cause stress. ~ Stress may lead to absence from work. ~ Integrated stress management programmes appear to be effective in reducing stress. ~ Stress reduction requires an integrated effort of workplaces and occupational health services.
Introduction Stress has become one of the most prevalent complaints or exposures at modern workplaces. It inherently belongs to work process and thus may not be easily eradicated. It is suspected that stress-related diseases continue to grow, reducing productivity at workplaces. To prevent negative health outcomes there is a need for action – too much stress is intolerable. In a Finnish national survey on work and health issues, the prevalence of stress symptoms was 9% in all occupations. A slightly higher prevalence of 80
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12–13% was observed in technical, scientific and artistic work, and in white collar occupations in general (Kauppinen, Heikkilä, Kasvio, Lehtinen, Lindström, Toikkanen and Tossavainen 2006). Stress is the second most reported work-related health problem, affecting 22% of workers of the EU27 (in 2005). Furthermore, the number of people suffering from stress-related conditions either caused or worsened by work is likely to increase (OSHA 2005). There are no generally agreed upon measures for evaluating work-related stress. Practical methods to reduce and control stress at work are also badly needed. The Finnish labour market parties initiated this practice guidelines process. The Finnish Institute of Occupational Health carried out the process of evaluating the evidence, which culminated in the publication of the guidelines. The process began by systematically searching for evidence on aetiology, health effects and interventions for reducing stress. For the topics deemed most relevant, the evidence was summarized, and the strength of the evidence was evaluated. The practice guidelines also bring together national and international recommendations, and present practical tools for workplace managers and occupational health services, enhancing active co-operation between workplaces and occupational health services. An implementation study has been launched to evaluate the applicability of the guidelines.
Aetiology of stress Work-related stress has been shown to be caused by high demands at work or by poor working conditions combined with employees’ low objective or subjective capacity to control their work demands. Individual differences modify the experience of stress, but there are factors at work that load every employee (see Table 1). The risk of negative health consequences increases when excess stress lasts for a long period of time (Van der Doef 1999; de Lange, Taris, Kompier, Houtman and Bongers 2003; Karasek 1990). Low control over working time increases stress, and feelings of justice in managing work decrease stress (Kivimäki, Elovainio, Vahtera and Ferrie 2003).
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Table 1. Stress-inducing work demands include psychological, social and other factors (Lindström, Hopsu, Kandolin, Ketola, Lehtelä, Leppänen, Mukala, Rasa and Sallinen 2005).
I. Psychological factors
II. Psycho-social factors
III. Other factors
- unclear work objectives - too much work, strict deadlines - poor level of control - poor development opportunities - continuous interruptions - many responsibilities - insufficient feedback and respect - insecurity
- working alone - no co-operation - poor information - inconsistent management - unequal practices - unjust practices - poor social support - negative feelings in social and health care work
- insecurity about the future - threat of violence - long and unpleasant working hours
Health effects of stress The international classification of diseases (ICD-10) does not classify stress symptoms as a disease. Therefore, sick leave or other compensations are typically not prescribed due to stress symptoms. However, stress may cause absenteeism from work through its association with an increased prevalence of other diseases. Work-related stress appears to be an aetiological factor for many other diseases, such as psychological problems and musculoskeletal disorders. Stress is correlated with the incidence of burnout symptoms and depression, although the aetiology of these disorders also requires other factors (Ahola, Honkonen, Kivimäki, Virtanen, Isometsä, Aromaa and Lönnqvist 2006). Work-related musculoskeletal symptoms also increase with stress. Neck, shoulder and low back pains in particular are associated with work-related stress (Linton 2001; Bongers, Ijmker, van den Heuvel and Blatter 2006). Cardiovascular events may also increase due to long-term stress (Kivimäki, Virtanen, Elovainio, Kouvonen, Väänänen and Vahtera 2006; Belic, Landsbergis, Schnall and Baker 2004). Irrespective of aetiology, work-related stress increases sickness absence rates both among men and women (Virtanen, Vahtera, Pentti, Honkonen, Elovainio and Kivimäki 2007; Head, Kivimäki, Martikainen, Vahtera, Ferrie and Marmot 2006). Work-related stress also decreases productivity, and the mechanism appears to be that overt stress impairs cognitive capacity and psychological well-being at work (Honkonen, Lindström and Kivimäki 2003; Sallinen, Hublin, Lees, Nybo, Nygrén and Sainio 2006).
Effects of interventions to reduce stress Work stress interventions can be targeted at both the organizational and the individual level. Integrated interventions that include both organiza82
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tional and individual actions seem to be the most effective (Giga, Noblet and Cooper 2003; Lamontagne, Keegel, Louie, Ostry and Landsbergis 2008). Occupational health services may benefit from cognitive-behavioural interventions that are most effective in reducing stress symptoms and in increasing the feeling of psychological control among employees (Richardson and Rothstein 2008; Gardner, Rose, Mason, Tyler and Cushway 2005; Marine, Ruotsalainen, Serra and Verbeek 2006). Based on survey results, individual interventions that enforce coping skills, and teach relaxing techniques, and counselling may also reduce work-related stress (Michie and Williams 2003; Shapiro, Astin, Bishop and Cordova 2005; Rahe, Taylor, Tolles, Newhall, Veach and Bryson 2002).
Co-operation for stress reduction In October 2004, the EU-level central social partners signed a framework agreement on work-related stress (Eurofound 2004). This recommendation was also reinforced nationally in Member States. Practice guidelines for occupational health services are therefore a part of the process of the national implementation of this stress reduction recommendation in Finland. The EU recommendation states that not all stress is hazardous to health and that not all workplaces are stress-inducing. Neither do all employees experience work-related stress. When stress is recognized at workplaces, special attention could be targeted towards: ~ work organization (atypical working times, influence and control, workload) ~ working conditions (harassment, violence, working alone, noise, temperature, chemicals) ~ internal communication (unclear expectations, future of employment) ~ individual factors (psychological and social pressures, social support). A prerequisite for successful stress management in workplaces is that top management supports the initiative and associated action. Understanding the causes of stress, their deleterious health and productivity effects, and knowledge of effective ways in which to reduce stress help management launch actions. Economic losses due to poor quality of work and production caused by work-related stress are important grounds for active measures. Stress reduction may entail: ~ communication and leadership (vision and goals and role expectations clarified, management support for groups and individuals, responsibilities and control over work organization and process improvements, according to work demands ~ training supervisors and employees on work-related stress and its countermeasures ~ securing the conditions of supervisory work ~ the development of co-operation between management and personnel, influence of employees on working conditions and workplace health and safety. At the European Union level, good practice guidelines give examples of successful cases of stress reduction at the company level (OSHA 2002).
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Occupational health services evaluate all risks at the workplace. They observe work-related stress through e.g.: ~ risk evaluation reports made at workplaces ~ risk evaluation of psychosocial factors made by occupational health services ~ health examinations and health service reports (stress symptoms, burnout risk). At the individual level, work-related stress is evaluated by the presence of stress-related symptoms, such as anxiousness, nervousness, restlessness and sleep problems. Options for treating stress in an occupational health setting include: ~ supportive actions at the workplace, in co-operation with management ~ supportive discussion, anxiolytic or antidepressive medication, short therapy ~ prescribing short-term sick leave or part-time work. A nurse or a physician can take immediate action to reduce work-related stress. They can help the employee to figure out and restructure the factors that most contribute to experience of stress. Supportive factors such as management and team support at work should also be introduced. The reorganization of work tasks and the renegotiation of goals and processes may also help reduce work-related stress.
Implementation of stress reduction guidelines in Finland The authors of the guidelines are in the process of conducting an implementation and feasibility study in a sample of occupational health service pilot units. The guideline evidence, models and recommendations are tested in practice, first by introducing the guidelines to occupational health services. In the second phase, occupational health services are encouraged to plan how to implement collaborative actions with their client organization’s management and introduce the guideline principles to the organizations. If an agreement is reached, the occupational health services begin the planned action against work-related stress by risk evaluation, targeted interventions and follow-up. After the guidelines have been used in practice, both parties will be interviewed to collect their experiences. Best cases and good practices will be collected and published for others to use.
Discussion It is likely that in the near future work-related stress will become the most often reported adverse side effect of modern work. The degree or severity of stress varies both objectively and individually and with time. However, longterm severe work-related stress reduces productivity and well-being at work, regardless of work tasks, or the age, gender or status of the employee. Evidence of the effectiveness of stress management is starting to accumulate. Organizational and individual interventions are effective in stress prevention. Occupational health services cannot make the necessary changes without commitment and active co-operation with management and all relevant parties at the organizational level. Practice guidelines will be piloted in Finnish occupational health services. The results of their applicability will be published in the future. 84
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References Ahola, K., Honkonen, T., Kivimäki, M., Virtanen, M., Isometsä, E., Aromaa, A., Lönnqvist, J. 2006. Contribution of burnout to the association between job strain and depression: the Health 2000 study. Journal of Occupational and Environmental Medicine. 48: 10. p. 1023–30. Belic, K., Landsbergis, P., Schnall, P., Baker, D. 2004. Is job strain a major source of cardiovascular disease risk? Scandinavian Journal of Work Environment and Health. 30: 2. p. 85–128. Bongers, P., Ijmker, S., van den Heuvel, S., Blatter, B. 2006. Epidemiology of work related neck and upper limb problems: Psychosocial and personal risk factors (part I) and effective interventions from a bio-behavioural perspective (part II). Journal of Occupational Rehabilitation, 16. p. 279–302. Eurofound. 2004. Social partners stress agreement [online material; cited 01 04 2010]. Available from: (http:// www.eurofound.europa.eu/eiro/2004/10/feature/eu0410206f.htm). Gardner, B., Rose, J., Mason, O., Tyler, P., Cushway, E. 2005. Cognitive therapy and behavioural coping in the management of work-related stress: An intervention study. Work & Stress. 19: 2. p. 137–52. Giga, S., Noblet, A., Cooper, B. 2003. The UK perspective: a review of research on organisational stress management interventions. Australian Psychologist. 38: 2. p. 158–64. Head, J., Kivimäki, M., Martikainen, P., Vahtera, J., Ferrie, J., Marmot, M. 2006. Influence of change in psychosocial work characteristics on sickness absence: The Whitehall II study. Journal of Epidemiology and Community Health. 60. p. 55–61. Honkonen, T., Lindström, K., Kivimäki, M. 2003. Psykososiaalinen työkuormitus mielenterveyden häiriöiden etiologiassa [in Finnish; The role of work-related psychosocial stressors in the etiology of mental disorders]. Duodecim: lääketieteellinen aikakauskirja, 119: 14. p. 1327–33. Karasek, R. 1990. Healthy work: stress, productivity, and the reconstruction of working life. New York: Basic Books. Kauppinen, T., Heikkilä, P., Kasvio, A., Lehtinen, S., Lindström, K., Toikkanen, J., Tossavainen, A. (Eds.). 2006. Työ ja terveys Suomessa 2006 [in Finnish; Work and Health in Finland 2006]. Helsinki: Finnish Institute of Occupational Health. Kivimäki, M., Elovainio, M., Vahtera, J., Ferrie, J.E. 2003. Organisational justice and health of employees: prospective cohort study. Journal of Occupational and Environmental Medicine. 60: 1. p. 27–33. Kivimäki, M., Virtanen, M., Elovainio, M., Kouvonen, A., Väänänen, A., Vahtera, A. 2006. Work stress in the aetiology of coronary heart disease – a meta-analysis. Scandinavian Journal of Work Environment and Health. 32: 6. p. 431–42. Lamontagne, A.D., Keegel, T., Louie, A.M., Ostry, A., Landsbergis, P.A. 2008. A systematic review of the jobstress intervention evaluation literature, 1990–2005. International Journal of Occupational and Environmental Health. 14: 1. p. 268–80. de Lange, A.H., Taris, T.W., Kompier, M.A., Houtman, I.L., Bongers, P.M. 2003. “The very best of the millennium”: longitudinal research and the demand-control-(support) model. Journal of Occupational Health Psychology. 28: 4. p. 282–305. Lindström, K.E.A., Hopsu, L., Kandolin, I., Ketola, R., Lehtelä, J., Leppänen, A., Mukala, K., Rasa, P.L., Sallinen, M. 2005. Työkuormituksen arviointimenetelmä TIKKA. Työterveyslaitos [in Finnish; Method for work load estimation TIKKA]. Jyväskylä: Gummerus. Linton, S. 2001. Occupational psychological factors increase the risk for back pain: A systematic review. Journal of Occupational Rehabilitation. 11: 1. p. 53–66. Marine, A., Ruotsalainen, J., Serra, C., Verbeek, J. 2006. Preventing occupational stress in healthcare workers. Cochrane Database of Systematic Reviews. Issue 4. Art. No.: CD002892. DOI: 10.1002/14651858.CD002892. pub2.
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Michie, S., Williams, S. 2003. Reducing work related psychological ill health and sickness absence: a systematic literature review. Journal of Occupational Environmental Medicine. 60. p. 3–9. OSHA 2002. How to reduce work-related stress [online material; cited 01 04 2010]. Available from: (http:// osha.europa.eu/en/publications/factsheets/32). OSHA 2005. Work related stress [online material, cited 01 04 2010]. Available from: (http://osha.europa.eu/en/ topics/stress). Richardson, K., Rothstein, H. 2008. Effects of occupational stress management intervention programs: a metaanalysis. Journal of Occupational Health Psychology. 13: 1. p. 69–93. Sallinen, M., Hublin, C., Lees, R., Nybo, T., Nygrén, E., Sainio, M. 2006. Stressi ja muisti [in Finnish]. [Stress and cognition]. Suomen Lääkärilehti [Journal of Finnish Medical Association]. 61. p. 2967–72 Shapiro, S.L., Astin, J.A., Bishop S.R., Cordova M. 2005. Mindfulness-Based Stress Reduction for Health Care Professionals: Results from a Randomized Trial. International Journal of Stress Management. 2: 2. p. 164–176. Rahe, R.H., Taylor, C.B., Tolles, R.L., Newhall, L.M., Veach, T.L., Bryson, S. 2002. A novel stress and coping workplace program reduces illness and healthcare utilization. Psychosomatic Medicine. 64: 2. p. 278–86. Van der Doef, M.M.S. 1999. The Job Demand-Control(-Support) Model and psychological well-being: a review of 20 years of empirical research. Work and Stress. 13: 2. p. 87–114. Virtanen, M., Vahtera, J., Pentti, J., Honkonen, T., Elovainio, M., Kivimäki, M. 2007. Job strain and psychologic distress. Influence on sickness absence among Finnish employees. American Journal of Preventive Medicine. 33: 3. p. 182–87.
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Worker values, culture, and community − values communication that goes directly to workers and supports well-being Robin M. Nicholas Health and Safety Communications, USA
Abstract Effective communication celebrates workers by honouring their values and culture. Key technical information must still be communicated, but only within the greater context of workers’ core values of life, including family, community, dignity, and personal excellence. As humans, we reside in our knowledge − knowledge of who we are, what we know to be true, and our relationship with ourselves, our family, and our community. Effective communication engages this self-knowledge and these values in a human, cultural context that works best for each worker, giving workers the power they need to advance their own safety and well-being. In order to promote programmes that support well-being, a context must be established in which well-being can succeed. This is an environment that celebrates workers and their values, where each individual not only survives, but also thrives. In an environment such as this, the workplace can be re-defined as a community and a way of life, a place where workers take care of each other, discover themselves, and experience their own dignity, self-respect, and personal excellence. Key words: Work, values, communication, community
Introduction − Work and people Work is not who we are. But in its most ideal setting, work can be an opportunity to express who we are. Indeed, work is one way in which we bring ourselves into the world. Work is also an opportunity for people to discover, know, and understand themselves through their actions and relationships. In this way, work helps us build skills so that we can bring ourselves even further into the world. When we talk about work, we often speak in terms of productivity, especially product and service productivity. However, there is another potential productivity at work − person productivity − the growth and development of each person through their work. When we create an environment that empowers people, person productivity can flourish because workers have the opportunity to grow, come together, and create their best work. By its very nature, an environment such as this supports and honours workers’ values, culture, and communities. This creates a supportive environment familiar to workers who then have the opportunity to develop the skills and experiences that help them live fuller lives.
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So if the work environment that we create has the potential to empower people, the question is: “What are we giving each worker to take home?” After we meet the essential needs of health, food, shelter, and decent work, what can we provide for person productivity? Workers can take home salary and continued health, both of which are crucial. But in addition, we can give workers the experience of self-excellence and self-respect. We can give them an opportunity to express themselves through their work, and to have greater knowledge of themselves. As a result, we can contribute to each worker’s entire well-being. Ultimately, what is the point of work? Is it to be safe while being productive? Or, is it simply to be better at living life – which by default includes being safe and productive?
Safety as a core value One way to consider the workplace as a place of values, culture and community, is to look at safety and what it can tell us about our work. In safety, we usually begin by asking the question, “How can we be safe?” The answer is usually objective, expressed in terms of work practices, equipment, safety policies, and regulations. But another question should come first, “What are we being safe FOR?” Here, the answer is subjective; it is about family, relationships, and emotions – and it is about values. Though we have often viewed ourselves as thinking machines, we now realize through modern brain research, that as humans, we actually function as emotional machines that sometimes happen to think. (Grubin 2002) Both questions need to be answered, but in a specific order. First, we must answer, “What are we being safe FOR?” by honouring our core values and culture. Then we can apply our intellect to answer, “How can we be safe?” by developing safety programmes and practices. First we develop a human context of values for our work, and then we develop the technical content to implement our work.
Values, culture, and community Values themselves do not stand alone, but exist and arise out of our own cultures and communities. The United Nations Educational, Scientific and Cultural Organization (UNESCO) (2001, 1) defines culture as, “…the set of distinctive spiritual, material, intellectual, and emotional features of society or a social group, and…it encompasses, in addition to art and literature, lifestyles, ways of living together, value systems, traditions, and beliefs.” Nhlanhla Mkhize (2005, 1) at the University of Kwa-Zulu Natal, South Africa says it more simply, “As human beings, we cannot act without employing background knowledge − that knowledge that informs our decisions. Some call it Culture.” It is out of this knowledge and culture that our values arise, key beliefs that people consider the most important and valuable. Safety itself can be expressed as a core value: The individual’s life is to be celebrated and protected. This includes not only physical life, but also the qualities of life, such as family, relationship, self-respect, dignity, and personal excellence. The celebration of these qualities of life contributes to a person’s inner health, our inner world where we find our identity, selfawareness, relationships, and values. It is this inner health which then contributes to our outer physical health, our outer world in which we experience 88
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our physical bodies as we move through the physical environment. Without inner health, our outer health and well-being are incomplete.
Bringing values to the workplace We bring these values to the workplace by first celebrating the individual through the celebration of their culture, knowledge, and values. When we celebrate the individual, we help them build self-respect and dignity. With this strength, people can reach out to take care of their family, and reach out even further to take care of their community. In return, the community can provide the resources and compassion that further the individual’s selfrespect and dignity as each individual pursues their own personal excellence. The workplace can be that community. Once we have celebrated the individual, we can bring values to the workplace by further celebrating community. Community first begins as a location, a sense of place (Mulligan, Humphrey, James, Scanlon, Smith, and Welch 2006, 18–22). Then, as people encounter each other, the community becomes a place of relationships; and as these relationships combine and recombine, community becomes a way of life. The workplace can truly be community as a way of life. The key technique to discovering values is simply this…listening. Nhlanhla Mkhize (2005, 1) says, “It is necessary to listen, listen, and listen again, not just with our five senses, but with a sixth sense – listening with the heart.” Larry Littlebird, a storyteller in New Mexico, says that all we need to do is, “Sit down, be quiet, and listen” (Hosono 1993). Yaso Nadaraja (2010) at the Globalism Institute in Australia, tells us to go to that “in-between” place − resting in that place in-between cultures and individuals and listening to our common values. And why are we listening? We are listening for the answer to the question, “What are we being safe FOR?” Here, safety is no longer limited to information and company requirements. Safety now becomes a personal, emotional, psychological, and for some, spiritual process. When we listen, we create opportunities (Servan-Schreiber 2008, 54). We give the other person the opportunity to be themselves, to hear themselves think, and to resolve problems, including safety problems. We also give ourselves the opportunity to demonstrate respect and treat others with dignity. When we listen, we start answering the question, “What are we giving workers to take home?” Another key technique for bringing values to the workplace is values leadership (Reicher, Haslam, and Platow 2007, 24). Here, the leader identifies and understands the values of the individuals and communities in order to lead them. The leader becomes one with its working community. Managers and workers are equal partners, and workers have the opportunity to lead managers.
Finding balance − leadership and community For values leadership to succeed, it requires balance. Vertical, top-down management when left unto itself has the potential to be out-of-balance and to greatly increase stress simply due to the nature of hierarchy (Ferrie
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2004, 4-6). This leaves people at the bottom of the hierarchy, feeling a loss of control, a loss of being able to contribute, and a loss of predictability. This in turn creates greater chronic stress and the triggering of adrenaline and cortisol chain reactions. Ultimately, this results in the potential increase of accidents and ill health. However, the vertical dimension of top-down management can be balanced by the horizontal, integrated development of workers and the work community. Here, values leadership provides the physical and social resources that support workers’ values, culture, and community. Values leadership can support workers by building relationships between managers and workers and amongst workers, emphasizing one-on-one conversations and personal interactions. Values leadership can further support workers by listening and demonstrating caring and compassion, providing soft power for everyone − not power exerted over people, but power that is shared amongst people and even willingly given away from one person to another. When we celebrate the worker and the community, we are looking at the whole workplace for the whole person. This means moving from a workplace where we merely survive to one where we can thrive. Surviving is first and foremost, but eventually, it must lead to thriving — because the gift of being human is that we not only survive, but ultimately thrive as individuals and communities. Indeed, Martin Buber (1957, 261) described it well when he noted that as human beings, our greatest gift to each other is when we make life possible for each other. Ultimately, values communication that celebrates the individual and the community is about the messenger as much as it is about the message. Marshall McLuhan (1967, 7) said, “The medium is the message.” This means that it is not only about what we communicate; it is also about how we communicate. When we take care of each other, our actions become the communication. We ourselves become the message.
Some Examples – Speaking to worker values Within the essential dynamics of listening and values leadership, there are multiple day-to-day practices that can help communicate values and celebrate workers and community. Safety champions can advocate for workers’ well-being, and act as the link between company leaders and the local worker community. Simple, private one-on-one conversations can help build relationships, which in turn strengthens the work community. Encouraging workers to openly celebrate their values with pictures of family and friends can honour important qualities of life. Whenever possible, simple statements of values can be integrated into key safety messages and into training. Workers can be encouraged and rewarded for sharing stories about lessons learned and how safety incidents have affected their lives. Specific values such as family can be directly and openly integrated into the work community.
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Conclusion When we celebrate worker values, culture, and community, we have the opportunity to create work in its most ideal setting. Work can become an opportunity to express who we are, and to discover, know, and understand ourselves. Work can become a means in which we not only protect each other’s bodies, but we help nourish each other to thrive emotionally, psychologically, and spiritually. Through work we can contribute to each other’s well-being and help each other flourish. Indeed, well-being in the workplace is, in some ways, a symptom and by-product of a thriving, healthy, work community. In order to bring our values to this community, it is important to honour the human context in which our values reside. For they cannot be assigned to the intellect alone; they must be honoured in the personal and subjective realm of values, culture, and community –the human, creative realm in which we live, experience, and interpret our own personal lives.
References Buber, M. and Buber-Agassi, J. (Ed.). 1957 (1999). Martin Buber on Psychology and Psychotherapy: Essays, Letters, and Dialogue. Syracuse: Syracuse University Press. 297 p. ISBN 0-8156-0562-X. Ferrie, J. (Ed.). 2004. Work, Stress, and Health: The Whitehall II Study. Council of Civil Service Unions/Cabinet Office, UK. 26 p. Grubin, D. (Producer). 2002. The Secret Life of the Brain: Episode 4 The Adult Brain: To Think by Feeling. [DVD] PBS – Public Broadcasting System. Hosono, H. (Director). 1993. Travelling Our Splendid World: Be Still, Sit And Listen Well. [VHS] NHK – Japan Broadcasting Corporation. McLuhan, M. 1964 (1994). Understanding Media: The Extensions of Man. Cambridge: MIT Press. 389 p. ISBN: 0-262-63159-8. Mkhize, N. 2005. A Primer: Doing Research in Traditional Cultures. DOE Human Subjects Research Database Web Site [cited 11.2.2010]. [Online] 12. Available from: http://hsrd.orau.gov. Mulligan, M., Humphery, K., James, P., Scanlon, C., Smith, P. and Welch, N. 2006. Creating Community: Celebrations, Arts, and Wellbeing Within and Across Local Communities. Melbourne: RMIT Print Services. 176 p. ISBN: 978-0-646-47238-6. Nadarajah, Y. 2010 (Manuscript in press). Communities in Transition: Propagating a Yield of Violence. In Cervantes-Carson, A. and Cromer, G. (Ed.) De-Naturalising Violence: Trans-Disciplinary Explorations, Oxford: Inter-Disciplinary Press. Reicher, S., Platow, M. and Haslam, A. 2007. The New Psychology of Leadership, Scientific American Mind. 18: 4. p. 22–29. Servan-Schreiber, D. 2008. I’m Feeling Your Pain – Really. Ode. 6: 7. p. 54. United Nations Educational, Scientific and Cultural Organization (UNESCO). 2001. Universal Declaration on Cultural Diversity: The General Conference.
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Sustainability in workplace health promotion (WHP) Klaus Pelster Institut für Betriebliche Gesundheitsförderung BGF GmbH, Cologne, Germany
Abstract More and more companies in Germany have begun to realize the importance of investing in the health of their employees. However, the use of Workplace Health Promotion (WHP) could still be more widespread. Within the framework of a state-funded project by the Ministry of Labour and Social Affairs (BMAS) and the Federal Institute for Occupational Safety and Health (BAuA), a model, which was based on consultancy projects in the branches of confectionary production, public service and automobile delivery/sales, was developed and implemented to test the sustainability of WHP. The results demonstrated an outstanding number of possible links to the subject of health and wellness. In addition to firmly integrating WHP in the structure of the organization, various aspects of company culture play a significant role in its sustainability. The development of a single strategy towards the sustainability of WHP requires further understanding of the promotion of health within the industry. During the project, health and well-being was successfully established as an integral part of a company’s structure, thus achieving sustainability for WHP. As well as the internal operational motor, company culture also contributes to success. If participation is welcome, and a company is open for change, WHP can be implemented. Key observations: Sustainability, Workplace Health Promotion, HR development, organizational development, participation.
Sustainability in workplace health promotion Under the term of sustainability, there are a number of definitions and conceptions. In this paper, ‘Sustainability’ is understood as long-term or permanent. In this sense, company Workplace Health Promotion (WHP) can only be sustained when its transition succeeds from its project character into real processes. Only when Health Promotion is understood as an integral part of a company’s structures and processes with according prioritization, is it possible to achieve this goal. Workplace Health Promotion has experienced a significant ascent in the past few years. Programmes and projects on the promotion of employee health and management have been introduced by many employers. At the same time, demands are being made for broadening the content of WHP. Although companies initially thought that offering singular activities such as a Wellness Day or Postural Therapy was sufficient, they have since been
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developing diverse and sustainable programmes for health promotion (in a permanent sense): Workplace Health Management. Objection to the terminology is expected; a smaller company may become defensive where the term ‘management’ is concerned. Therefore, the name is not as important as the content of the programme and its longevity. Examples and approaches for anchoring the issue of WHP in daily company practices will be identified in the following section. Based on tried and tested strategies and methods, experience is being gathered through the NAGU Project funded by the German Federal Ministry of Labour and Social Affairs (BMAS); a project which is concerned with, ‘sustainable employment and health policies for companies and corporations’. In addition to the results of the project, it will present experiences gained from consultancy.
Success factors for sustainability – Results of the NAGU project The government funded, ‘Sustainable Work and Health Policy – Healthy People in Healthy Organizations’ (NAGU) project was launched in 2001. Within three different fields (the confectionery industry, the automotive industry, and public administration), the project developed and tested approaches and strategies for a three-year project which could lead to successful anchoring of sustainable WHP; taking into account factors that could greatly change or affect these approaches or strategies. A written survey conducted at the beginning of the project by corporate experts (including representatives of accident and health insurance companies, universities, and trade unions), identified the success factors for sustainability. These factors are shown in Figure 1. Areas of Activity for Sustainability Sustainability of Corporate Health Promotion
Allocation of Resources
Personal Determining Internal Motor the Budget
Integration into Structures and Processes (using the current systems)
Available Resources
Setting definite Goals
Integration of Concepts by Middle Management
Involving and Informing the Employees (Participation)
Figure 1. Expert-suggested success factors for sustainability – Results from the NAGU project.
Possible approaches which incorporate these success factors in practice are described below. The examples were mostly developed and tested in small and medium-sized companies with up to 300 employees. Thus it was shown that sustainable Workplace Health Management can also be successfully constructed beyond large-scale corporate structures.
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Setting clear goals Prior to establishing and implementing WHP, it is necessary to clearly define its objectives and approaches. These should be agreed upon with all stakeholders involved. Only with transparency of the objectives can all company interest groups understand what direction health management is taking, orientate themselves to it, and actively support it. Besides defining goals and expectations, it is essential to agree upon which values can act as criteria for measuring success. Possible indicators for Workplace Health Promotion could, for example, be: ~ =d\QTa^UbcPUU^]bXRZ[TPeT WTP[cWhbcPUU ~ 4\_[^hTTbPcXbUPRcX^] ~ APcT^U_PacXRX_PcX^]X]WTP[cW_a^\^cX^]PRcXeXcXTb ~ >eTacX\TWXbc^ah ~ BcPUUcda]^eTa ~ ?a^SdRcXeXch\TcaXRb ~ =d\QTa^U_a^_^bP[bX]4\_[^hTTBdVVTbcX^]BhbcT\cWPc_a^\^cT health and well-being. The formulation of goals in Workplace Health Management should follow the established criteria for formulating objectives. In our consultancy, a reviewing system referred to as the S-M-A-R-T model proved successful. Objectives are assessed against five criteria as to whether they are Specific (S), Measurable (M), can Actively be influenced (A), are Realistic (R) or are Time-phased (T). These values can be used to control the strategic direction of company health. In the same way, these figures can be used in determining personal objectives with executives. The following case study shows an example in application:
Case study 1:Integration of wellness issues in target-setting systems After a company had carried out a number of WHP activities over several years, it was noted that the lower and middle management level were still unsure about how to responsibly deal with the subject of ‘health and wellbeing’. Among the measures implemented were sessions on Postural Wellness, the implementation of ergonomic improvements in the workplace, training for managers to lead ‘Healthy Conversations’, and the inclusion of interviews between the employees and their supervisors as standard protocol after a leave of absence. Despite target group orientated implementation of WHP measures, it turned out that there was no uniform method of briefings after absences, although an improvement in standard consultation regarding these briefings had been sought by the supervisors. In many cases, executive management felt they lacked concrete tools to approach ‘health and well-being’ in a practical way. Consequently, the executive management decided to include health objectives in the target agreement. Three aspects were considered: 1. Reducing leaves of absence due to illness to 6.5%, 2. Supervisors must act as role models in health matters, and 3. Supervisors must provide complete documentation of briefings after leaves of absence. An information session was conducted in order to provide executives with practical aids and tools. In this event, an inventory of WHP was carried out, demonstrating the ways and means through which the executives could 94
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more strongly integrate the topic of health in everyday operations. Examples include: the integration of health issues and the announcement of health promotion measures in team meetings, or the selection and training of voluntary employees to enable them to instruct their colleagues in exercise breaks at work.
Integration in processes and structures using existing systems Often when WHP activities are set up as additional ‘isolated pillars’ in the company, they tend to become dormant. The NAGU project points towards ways in which an integration of health-related topics in entrepreneurial processes and structures is possible: ~ Personnel development (e.g. through the inclusion of health issues in the initial and advanced training of managers), ~ Organizational development (e.g. involving employees in the optimization of working conditions through workplace analysis), ~ Investment and planning (e.g., by considering ‘health-related’ criteria in the planning of new production facilities such as that of an on-site company physician), ~ Employee suggestions (e.g. through special initiatives such as the ‘Suggestions for the reduction of musculoskeletal-related health problems’), ~ Quality management (e.g. by processing employee-related issues of quality concerning Workplace Health Promotion), ~ Purchasing / procurement (e.g. considering health-related aspects in the reformulation of procurement guidelines), and ~ Sustainability management (e.g. through the use of Workplace Health Promotion as an element of internal Corporate Social Responsibility [CSR]). The following are further practice-based examples of the integration of health issues in company processes and structures: ~ At a company in the confectionery industry, new office furniture was exclusively acquired according to the principle: ‘always buy the cheapest’. The quality of the final procured products played a role equally minor to that of the consideration of their health-related aspects. Based on an assessment of the resulting situation, new procurement guidelines were outlined which also took health issues into account. ~ When formulating a staff development programme for managers at a company in the confectionery industry, confectionery-related topics were of foremost importance. Through Health Promotion, broader health-related issues were defined (i.e. dealing with conflicts, stress management, etc.). These were included as additional obligatory building blocks in the qualification programme.
Involving and informing employees (participation) Engaging those involved to really become involved – this is the principle of the Workplace Health Promotion approach. Only if we manage to make employees enthusiastic about WHP, involving them from the very beginning while taking advantage of their experience and knowledge, can it be successfully permanently rooted in the company and its administration. The
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Sustainability of Corporate Health Promotion through… Health Circles
Holding talks after sick absences (long/short)
Employee Suggestion System
Conversations / Dialogue
...Comprehensive Participation
Employee Reintegration in accordance with § 84 SGB IX
Analysing the work situation Examination of Work Hazards Having a say in construction planning Employee surveys
Figure 2. Participation Instruments in Workplace Health Promotion.
employees themselves often know best what potential improvements could be made. Health Promotion provides a wide range of instruments available to involved employees. A selection of these instruments is shown in Figure 2. An application example from the chemical industry, connecting the employees involved using existing structures together, is described in the following case study:
Case study 2: Integration of health issues in group work Group work was introduced in a chemical company. The tasks of the groups lay in the continuous improvement of work processes, their operation, and organization. An in-house trained mediator was present at regular group meetings or whenever special topics were to be discussed. The introduction of health groups was planned as a WHP instrument, but was stopped after a short testing phase because the excessive number of working group meetings was considered unacceptable by both the employees and their superiors. Nevertheless, the issue of ‘employee health’ in the on-going process of continuous improvement was integrated. For example, different groups were given a mandate to develop proposals for the reduction of musculoskeletalrelated health problems in their own work area. The topic of ‘demographical development’ is currently being addressed in group meetings. After showing a film to the personnel that had been made on location at the company in order to raise awareness regarding this topic, the groups developed specific approaches to deal with demographic change. The mediation of these group sessions was carried out by the in-house occupational physician and an employee from organizational development. Issues were addressed regarding possible company measures or programmes, and an employee mindset to become more responsible regarding one’s own health was encouraged. The individual suggestions of the groups were put together and presented to the WHP steering group. After the suggestions were put together and summarized, the suggestions were prioritized and implemented. In total, more than 40 group discussions took place, and about 500 proposals were 96
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developed: an important contribution to maintaining the integration of the topic of health in the working group process was made. Employee health thus became an integral part of the continual improvement process.
Sharing of resources (personnel, budgets, time) In order for WHP to become permanently anchored in a company, resources must be made available for its maintenance. In addition to funding, the necessary time and scope of WHP must be made available to those working on this issue. If WHP is treated as something apart from daily business by one or more employees (i.e. as virtually ‘extraneous’), there is a strong likelihood that it will fall through the cracks. Possible ways to avoid this are varied. In some companies, a ‘health manager’ is hired in order to manage the various WHP tasks, who then guarantees the sustainability of WHP. Should this not be an option, points of contact for the integration of the topic of ‘health’ within the organization must be searched for. The resulting synergies then help to reduce the financial use of resources, yet ensure that the issue is dealt with on a long-term basis. Regardless of where WHP is located in the organization, in order to make the topic of health a permanent operating fixture in a company, it is necessary to have an ‘internal engine’. This idea comes from experiences gathered from the NAGU project as well as from the daily experiences we have gathered from our consulting practices. Small and medium-sized companies are especially grateful for external support. Such an ‘Outboard Motor’ – as a complement to the internal engine – can bring in new ideas and suggestions, and thus create consideration of current issues and other fields of activity.
Conclusion With the increasing spread of WHP in companies, its responsibilities and standards have expanded. In addition to ‘classic topics’ such as stress, nutrition, relaxation, and exercise, WHP now increasingly focuses on issues of personnel development and the development of the organization itself. In addition to the expansion of its content, the main question that now stands in the forefront is how WHP can be made an enduring part of a company. Starting-point recommendations for this have been identified in the study. It is clear that the size of a company does not affect successful sustainability of WHP; the visible and tangible support of company management is more important. Only when companies understand that the issue of employee wellness is a key element for the permanent and long-term success of the company itself, will the money spent on this area be seen as an investment rather than an expense.
References Bundesanstalt für Arbeitschutz und Arbeitsmedizin (Ed.). 2007. NAGU >Nachhaltige Arbeits- und Gesundheitspolitik im Unternehmen< [NAGU >Sustainable Work and Health Policy - Healthy People in Healthy Organizations
