| | 1) Open Rota System for Work Scheduling | Author(s): Joanna Pryce, Karen Albertsen, Karina Nielsen Level of Intervention: Primary | Is the intervention sector specific? | No | Is the intervention usable with different enterprise sizes? | Yes | Is the intervention equally applicable to both genders? | Yes | Is the intervention based on theory? | Yes | Can the intervention approach be adapted/ tailored? | Yes | Does the intervention promote CSR and how? | Yes, the intervention promotes responsible business practices. It requires impetus from management of companies to be successful. | Does the intervention promote social dialogue and how?aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa | Yes, the intervention draws upon a participatory approach, whereby participants were actively involved through out the entire intervention process: design, implementation and evaluation. | Overview (including risk assessment and law – legal requirements etc.):
The Working Environment Act of 23 December 1975 lays down the functions and responsibilities of the institutions, authorities and persons responsible for the working environment in most sectors. Its objective is to ensure that working conditions are such that workers will not be subject, in the short term, to accident or disease or, in the long term, to physical and psychological problems. The Act makes it compulsory for work to be conducted in such a way that employees’ health and safety are protected. The obligation to produce a result implies findings that means and establishing the sort of relationship between the employers and labour organisations (the social partners) which will ensure that health and safety problems at work are solved and working conditions are improved. As in the case of all other working environment problems, psychosocial issues, according to the policy of the Danish occupational safety and health authorities, best addressed by the management and employees of the enterprise, possibly with assistance from their respective organisations, the occupational health service or other external sources.
An approach which can involve multiple stakeholders working together for addressing psychosocial issues is the open-rota system for work scheduling. This approach/intervention was introduced into a Danish psychiatric hospital, with the overall objective of improving employee job satisfaction and work-life balance. Described below is an example of a work scheduling intervention developed to improve work scheduling for nurses; with the broader aim of increasing employee control and influence on their work schedule and, in turn, promote increase job satisfaction and overall experience of work-life balance. This intervention draws upon a participatory approach, whereby participants were actively involved through out the entire intervention process: design, implementation and evaluation | Implementation:
Each of the nursing teams, which voluntarily decided to participate in this project, began by forming a steering group, composed of safety, trade union and project representatives. The steering group was supported by a larger project group of 5-6 employees and two external consultants. The external consultants invited the steering groups to attend a one day workshop during which case studies of work scheduling interventions were presented and discussed.
Following the workshop, the steering groups in collaboration with the larger project groups discussed and, in turn, identified an appropriate work scheduling intervention to be implemented in the nursing teams. The intervention selected by the majority of the intervention groups was implementing an open-rota system. Within an open-rota system employees are asked to schedule their shift preferences into an open (and uncompleted) rota. When completing their preferred shifts into the open-rota, employees were asked to do so responsibly and fairly (i.e., considering the needs and preferences of the work colleagues and the relief required in other departments). Following which, one or two employees had the responsibility of fine-tuning and finalising the rota; this assigned responsibility was rotated between staff members each week. | Practical applications:
The intervention is easily transferable to other teams in other occupational sectors. However, the design and evaluation of the intervention requires external expertise.
| Innovative aspects: The intervention uses the knowledge and expertise of the management and employees of the organisation, with assistance from their respective organisations, the occupational health service and other external consultants to address the psychosocial issues, which is in accordance with the policy of the Danish occupational safety and health authorities. | Evaluation (including process issues, outcomes and sustainability):
The aim of the evaluation was to assess the impact of an open-rota scheduling system on the health, work-life balance and job satisfaction of nurses working in a psychiatric ward in Denmark. Eight nursing teams volunteered to participate in the study; four of which were randomly allocated to the intervention condition (where the teams implemented the intervention) and the remaining four to the control condition (where the teams did not implement the intervention). The random allocation was done so that the actual effects of the intervention could be compared between the teams implementing and not implementing the intervention. Participants, in both the intervention condition and in the control condition, were asked to complete a questionnaire survey prior to the intervention and 20 months following.
Additionally, an evaluation of the process involved in developing, implementing and maintaining the intervention was conducted. This was accomplished by recording ongoing discussions between the researcher and the teams, and a series of interviews conducted with members of the teams to identify the potential barriers and facilitators to the process. The outcome measures, used to assess the effectiveness of the intervention, were indices surrounding work scheduling, work-life balance, and health and wellbeing. | Benefits (including cost effectiveness): The results of the evaluation of the intervention indicate the following observed benefits to the open-rota scheduling system as intervention to enhance employee health, wellbeing, job satisfaction and work-life balance. Employees reported a greater level of satisfaction with their work hours, and, in turn, they were less likely to swap their shift. Additionally, employees working within the open-rota scheduling system reported a significant increase in their work-life balance. Additionally, compared to the non-intervention group (the control group) positive significant differences were observed in the intervention group were: work-life balance, job satisfaction, social support and an overall increase sense of community in the workplace.
The results of the process evaluation demonstrated that employees reported that the open-rota system not only saved time, but also provided them with an insight into how the department operated; thereby suggesting a greater influence and greater overall level of satisfaction. Additionally, it was reported that the open-rota system had resulted in a greater understanding by employees of the availability and utilisation of resources; for example, the cost of absenteeism. Furthermore, it was reported that the open-rota system had resulted in an increase in team awareness within the groups. Based on the overall evaluation of the process-based assessment the authors concluded that the new approach to work scheduling took into account the needs and constraints of the individual, the group and the organisation-at-large. | References:
Pryce, J., Albertsen, K., & Nielsen, K. (2006). Evaluation of an open-rota system in a Danish psychiatric hospital: a mechanism for improving job satisfaction and work-life balance. Journal of Nursing Management, 14, 282-288. | Comments: The findings of the evaluation of the open-rota system suggest this is an effective intervention to enhance job satisfaction, work-life balance, support and cooperation within nursing teams and is applicable to other teams in other occupational sectors. However, as the intervention requires external expertise, it is not ideally suited for smaller organisations;. |
| 2) A multidisciplinary stress programme to reduce sick leave | Author(s): Bo Netterstrøm & Per Bech Level of Intervention: Tertiary | Is the intervention sector specific? | No | Is the intervention usable with different enterprise sizes? | Yes | Is the intervention equally applicable to both genders? | Yes | Is the intervention based on theory? | Yes | Can the intervention approach be adapted/ tailored? | Yes | Does the intervention promote CSR and how? | The intervention was not explicitly linked to responsible business practices although it does promote employee well-being | Does the intervention promote social dialogue and how?aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa | Social dialogue was not a key component of this intervention | Overview (including risk assessment and law – legal requirements etc.):
A multidisciplinary stress management was administered to employees referred to the Stress Clinic, part of the Clinic of Occupational Medicine, Hillerød Hospital, Denmark. The key objective of this programme was to have a positive effect on the return to work rate of employees suffering from stress-related distress. These individuals came from a variety of jobs and professions, and were from a wide range of ages (25-61).
| Implementation: Employees were referred to participate in this programme by their General Practitioner. The multidisciplinary stress management programme consisted of several stages: · Identification of relevant stressors · Changing the coping strategies of the participants · Decreasing the workload and tasks · Relaxation techniques · Physical exercise · Psychiatric evaluation if there were a high score on the depression Each patient attended six one-hour sessions during four months approximately | Practical applications:
All sessions of the multidisciplinary stress programme were carried out by a specialist in occupational medicine.
| Innovative aspects: This stress management programme uses a multidisciplinary focus to address both the elements of work design and the working environment, and promoting positive coping strategies and the promotion of health-enhancing behaviours. | Evaluation (including process issues, outcomes and sustainability):
The effectiveness of this multidisciplinary stress programme was assessed by comparing a set of individuals who participated in the intervention, to a group of employees referred to the Clinic of Occupational Medicine by their General Practitioners served as a control group (non-intervention group). The individuals were assessed at a one-hour consultation prior to beginning the intervention and after four months. Additionally, individuals were asked to fill out a series of questionnaires, examining levels of depression and stress symptoms prior to beginning the intervention, following four months, one and two years after the completion of the intervention.
| Benefits (including cost effectiveness): The evaluation of the multidisciplinary stress programme demonstrated several positive benefits experienced by the participants. Namely, the level of sick leave in the stress management group dropped from 53 to 17 % during the first year of follow-up and continued to remain stable. In both groups, stress symptoms and depression scores decreased significantly during the four months and again during the next eight months. The decrease in depression symptoms was significantly higher in the stress management group as compared to the non intervention group. The multidisciplinary stress programme demonstrated showed a significant effect on the return. | References:
Netterstrøm, B., & Bech, P (2008). The effect of a multidisciplinary stress programme on sick leave. Poster presented at the Work, Stress and Health Conference: Health and Safe Work through Research, Practice and Partnerships, APA/NIOSH, Washington D.C.
| Comments: For the non-intervention group, the reduction in sick leave was significantly lower. Additionally, no significant difference between the intervention and non-intervention groups was observed after one and two years. |
| 3) MARS - Measures Against Work-Related Stress | Author(s): M.V. Willert, A.M. Thulstrup, and J.P. Bonde Level of Intervention: Tertiary | Is the intervention sector specific? | No | Is the intervention usable with different enterprise sizes? | Yes | Is the intervention equally applicable to both genders? | Yes | Is the intervention based on theory? | Yes | Can the intervention approach be adapted/ tailored? | Yes | Does the intervention promote CSR and how? | The intervention does not explicitly promote responsible business practices, although it does promote employee wellbeing. | Does the intervention promote social dialogue and how?aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa | Mars does not promote social dialogue, as it is oriented at the individual, and does not directly involve the workplace. | Overview (including risk assessment and law – legal requirements etc.):
The MARS research project investigates the effect of a group-based stress management intervention for participants with elevated symptoms of work-related stress (symptoms of sustained arousal and reactivity of symptoms to demands at work). The MARS intervention is underpinned by a bio-psychosocial framework1 and has been built on the foundations of cognitive behaviour therapy.
| Implementation:
A group therapy format is used to train individuals in stress management techniques. Integral to the intervention format is the encouragement of individuals to implementation the techniques, experiences and skills gained in the group sessions at the workplace. This is partially achieved by assigning homework following each group session (i.e. assignments on how to try out newly acquired skills at the workplace between group sessions). Treatment lasts approximately 3 months.
| Practical applications:
The MARS intervention is designed to allow for easy adaptation and implementation in a variety of organisational and cultural settings. The intervention is built on the foundations of cognitive behaviour therapy, which has been shown to be adaptable to different cultural settings, whilst still retaining its treatment potential. The successful implementation of this programme requires a trained health professional.
| Innovative aspects: The MARS intervention has adapted the proven effective methods and techniques from cognitive behavioural therapy used to treat anxiety and depression to address work-related stress and its consequences of individual’s wellbeing. | Evaluation (including process issues, outcomes and sustainability):
In 2007-2008, 12 groups participated in the MARS intervention. In order to assess the effectiveness of the intervention, those individuals participating in the MARS intervention were compared to participants on a waiting-listing for treatment (non-intervention group). Data was collected at several time points (prior to intervention, directly following, three months and one year following the treatment), using a variety of sources of data: 1) questionnaires on psycho-social wellbeing, health and work conditions, 2) a limited neuropsychological test battery, 3) bio-markers of stress (blood samples), 4) physiological data as well as 5) self-reported and register data on absenteeism.
| Benefits (including cost effectiveness):
Several benefits of the intervention have been observed: The preliminary analysis of the questionnaire data demonstrates a significant treatment effects on several major areas of individuals wellbeing. Three months after termination of treatment the gains achieved during treatment are observed to be maintained. Preliminary analysis of the self-reported data on absenteeism point at a possible reduction in long-term sick leave during the intervention. Feedback received from the participants, both in-session and as rated by questionnaires, reflects a high degree of satisfaction and perceived benefit of the intervention. Additionally the practitioners undertaking the intervention perceive the intervention format as both feasible and functional.
As the evaluation of the intervention is currently ongoing, the one year follow-up questionnaires will be sent out in 2008-2009, which will enable an assessment of the long-term effects and the sustainability of the intervention. In addition, to date the register data has yet to be retrieved and the collected bio-physiological data analysed.
A cost-benefit analysis is planned. This analysis will examine the average cost of the intervention per participant in relation to the benefits of reduced absenteeism costs and prevented loss in productivity. | References: Will be published in 2009 and onwards. | Comments: After the research project examining the effectiveness of the MARS intervention has ended, the intervention has been implemented as part of the regular available treatment options for work-related stress at the Department of Occupational Health, Aarhus University Hospital, Denmark.
1The bio-psychosocial model is an approach that postulates that biological, psychological (which entails thoughts, emotions, and behaviors), and social factors all play a significant role in human functioning in the context of disease or illness. |
| |