Author(s):  Birgit Aust & Antje Ducki                                  Level of Intervention: Primary

Is the intervention sector specific?

Is the intervention usable with different enterprise sizes?

Is the intervention equally applicable to both genders?

Is the intervention based on theory?

Can the intervention approach be adapted/ tailored?

Does the intervention promote CSR and how?

Does the intervention promote social dialogue and how?aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa

Overview (including risk assessment and law – legal requirements etc.):

Health circles were designed in Germany to facilitate health promotion in the workplace with an emphasis on organisational and psychosocial factors. Health circles are structured discussion groups were employees identify the major health-related problems in the workplace and develop and implement appropriate solutions to address these issues. The areas that are assessed include: lifestyle changes, and changes to the work environment and organisation. The overall aim of the health circles is to improve the working conditions, and thereby improve and promote the health and wellbeing of employees. The Health Circle approach is a flexible approach that can be tailored for various different companies and situations. Assessed outcomes vary according to the requirements of the organisation, in a tailored approach. Typical outcomes include reducing absenteeism, increasing job satisfaction, reducing turnover rates, reducing early retirement, and higher motivation.

This approach was developed as a result of changes in OSH legalisation in Germany during the 1980’s, which placed greater emphasis on prevention activities. This approach was designed using a participative problem solving approach; which is underpinned by the assumption that the employee/ worker are the experts on their work and the management of that work environment. Health circles use this ‘employee expertise’ to develop suggestions to improve the situation at the workplace, and, in turn, promote their health and wellbeing.

Implementation:

Health circles are generally implemented in departments which have specific problems related to absenteeism or dissatisfaction. Health circles are based on structured group discussions of employees, where employees evaluate psychosocial risk factors and define solutions to address the identified solutions. These meetings are conducted under the guidance of a specially trained facilitator, whose primary role is to act as a moderator. Meetings are generally conducted during paid working hours lasting a total of 90 minutes. In most cases, the process includes between 6 to 10 meetings.

The process has 6 steps:

·         Commitment & Infrastructure: A contract is signed between management and employees; thus, ensuring commitment of all parties throughout the intervention process and with the project goals.

·         Needs Assessment: A health surveillance report is produced from company or insurance data; identifying absenteeism rates, length and causes of sick leave, ‘high risk’ departments of absenteeism and the identification of possible psychosocial hazards. Following the health report, an employee survey assessing hazards (both physical and psychosocial), employee health and wellbeing is conducted.

·         Health Circles: A steering group is formed by those responsible for health and safety in the company; with the overall intention of overseeing the process. Approximately, 10-15 participants are invited to each health circle (these include representatives from the employees, company and the union, and the facilitators). Results of the needs assessment provides structure to the discussion; where participants discuss the identified problems, as perceived by a larger number of employees, and develop proposed solutions to the identified issues. These meetings are formally recorded and disseminated to all employees in the affected department. 

·         Feedback to the management team: The management team is informed of the progress and suggestions developed by the health circle. The management team makes the decision on which suggestions will be implemented, and in which order.

·         Implementation of solutions: Proposed solutions are implemented throughout the process. These provide the basis for health improvements.

·         Review and transfer: In the last health circle meeting, all participants are asked to evaluate what has been achieved. Additionally, it is commonplace to conduct a follow up meeting with the participants to complete the evaluation of the process. In some cases, the employee survey is repeated in the department were changes were implemented; thus allowing an assessment of the change in outcomes. 

Practical applications:

Health circles have been applied in hundreds of companies since its inception. Overall, participants report a high degree of satisfaction with health circles. The approach has been demonstrated to be an effective tool for improving the psychosocial and physical work environment and in reducing sickness absence.

Innovative aspects:

Health circles follow a systematic and structured participatory process that uses the expertise of the employee and is actively supported by additional key stakeholders. Health circles utilise both a bottom up and top down approach, and integrating these two methods through the use of social dialogue.

Evaluation (including process issues, outcomes and sustainability):
 

In the last stage (meeting) of the appraoch, the evaluation stage, all participants are asked to evaluate what has been achieved. The objectives of the evaluation stage are to determine: whether the proposed solutions were implemented effectively, and whether the solutions had any impact on the problems identified. Additionally, it is commonplace to conduct a follow up meeting with the participants to complete the evaluation of the process. In some cases, the employee survey is repeated in the department were changes were implemented; thus allowing an assessment of the changes in the outcomes.

Benefits (including cost effectiveness):

Health circles have been found to be an effective tool for the improvement of physical and psychosocial working conditions in many organisations and industrial sectors. Health circles have also been demonstrated to have a positive effect on outcomes; including, enhanced employee health and wellbeing and reduced sickness absence.

References:

Aust, B. & Ducki, A. (2004). Comprehensive health promotion interventions at the workplace: experiences with health circles in Germany. Journal of Occupational Health Psychology. 9(3), 258-270.

Schröer, A., & Sochert, M. (2000). Health promotion circles at the workplace. Essen, Germany: Federal Association of Company Health Insurance Funds

Beermann, B., Kuhn, K., Kompier, M. (1999). Germany: Reduction of stress by health circles. In M. Kompier & C. Cooper (Eds.), Preventing stress, improving productivity: European case studies in the workplace (pp. 222-241). London: Routledge.

Comments:

The Health Circle approach is a flexible approach that can be tailored for various different companies and situations. However, as the intervention requires a specially trained facilitator to moderate group meetings, smaller organisations may not always find this approach viable to implement.

Author(s):   B. Aust, R. Peter, & J. Siegrist                          Level of Intervention: Secondary

Is the intervention sector specific?

Is the intervention usable with different enterprise sizes?

Is the intervention equally applicable to both genders?

Is the intervention based on theory?

Can the intervention approach be adapted/ tailored?

Does the intervention promote CSR and how?

Does the intervention promote social dialogue and how?aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa

Overview (including risk assessment and law – legal requirements etc.):

An intervention based on a well established theory of stress (the effort-reward imbalance model; Siegrist, 1996 ) was developed to educate and train bus drivers in stress management; with the overall objective of decreasing the stress-related illness found in bus drivers.

Implementation:

The theory-guided intervention programme was tailored to meet the specific needs of the target group: urban bus drivers. The intervention consists of 12 group sessions (one session per week). Each group was guided by (an) expert(s) with extensive group experience: either a clinical psychologist and/or sociologist. There were two aspects to the stress management intervention:

• the first part was directed at the individual level and it combined different elements (e.g., progressive muscular relaxation, self-observation, and perception of arousal, coping with anger and self assertiveness with reduction of overcommitted work-related attitudes and behaviours, high need for control);

• (b) the second part of the programme addressed adverse job characteristics in terms of workload and occupational rewards, and stimulated the development of suggestions for structural changes by employees; which were subsequently dicussed with upper level management.¹.

Following the intervention, the occupational health and safety department were primarily responsible for their implementation.

Practical applications:

This intervention is an adaptable approach which has been implemented successfully within both the public sector and the healthcare sector. This approach has been used predominantly within medium to large sized organisations, and has not been implemented in smaller sized enterprises. The implementation of the stress management programme requires a trained professional to faciliate its implementation.

Innovative aspects:

The intervention and its main components were underpinned by theory; specifically based on a well established and tested theory of stress (effort-reward imbalance theory).

Evaluation (including process issues, outcomes and sustainability):

This stress management intervention was evaluated comparing the participating intervention group with a comparison group; a group of employees who chose not to participate in the intervention. Measurements were taken pre-intervention, post-intervention and three months following. Two types of standardized measures were applied, first those related to an evaluation of the programme (for example, employee participation, satisfaction with programme, and perceived benefits) and secondly, those related to defined outcome criteria: coping behaviour and overall mood and symptoms.

Benefits (including cost effectiveness):

The evaluation of the effectiveness of the intervention demonstrated beneficial effects on psychological outcomes; most notably, on critical coping behaviour (need for control).This significant reduction was found to remain stable for 3 months following the completion of the intervention. An observed positive trend toward improvements in mood and symptoms was observed. Subjective measurements of the evaluation of the programme by participants were all positive.

References:

Aust, B., Peter, R., & Siegrist, J. (1997). Stress management in bus drivers: A pilot study based on the model of effort-reward imbalance. International Journal of Stress Management, 4 (4), 297-305.

Siegrist, J. (1996). Adverse health effects of high effort—low reward conditions at work. Journal of Occupational Health Psychology, 1, 27-43.

Siegrist, J., (1998). Adverse health effects of effort-reward imbalance at work: theory, empirical support and implications for prevention. In C.L. Cooper. (Ed.), Theories of Organizational Stress. Oxford University Press, Oxford, pp. 190- 204.

Siegrst, J., Starke, D., Chandola, T., Godin, I., Marmot, M., Niedhammer, I, & Peter, R. (2004). The measurement of effort–reward imbalance at work: European comparisons. Social Science & Medicine, 58, 1483-1499.

Comments:

In view of the relatively low costs of the programme this approach may appeal to companies with a high proportion of highly stressed employees, as is the case with inner-city professional drivers; as noted by one of the intervention authors.

This internveiton can be classifed as both a secondary and primary level intervention; as it contains elements directly at both the individual (namely stresss managment), and job re-design work organisation. However, only the stress management component was systemically evaluated; therefore it is detailed and outlined herein.

Author(s):    Stefan Koch and A. Hillert                                Level of Intervention:  Tertiary

Is the intervention sector specific?

Is the intervention usable with different enterprise sizes?

Is the intervention equally applicable to both genders?

Is the intervention based on theory?

Can the intervention approach be adapted/ tailored?

Does the intervention promote CSR and how?

Does the intervention promote social dialogue and how?aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa

Overview (including risk assessment and law – legal requirements etc.):

Stefan Koch and colleagues at the Roseneck Centre of Behavioural Medicine,  Germany, have developed a job-related group-therapy intervention for the treatment of psychosomatic patients with high levels of occupational stress. The overall aim of this intervention is psychosomatic rehabilitation within the context of inpatient treatment. A core objective of the in-patient group therapy is to try and help people with chronic work problems and high levels of occupational stress, illness and disability to return to work; in short, to facilitate a more active participation and reintegration of patients into working life, and to teach sick-listed employees to manage and cope with stress more productively and effectively.

Implementation:

This in-patient group therapy has 8 sessions lasting 90 -100 minutes.  The group is made up of 8-10 individuals comprising of: men and women, individuals from a variety of professions, and with various health problems. Sessions are delivered over a course of 4 weeks: 2 sessions per week. The intervention programme consists of four modules:

• The first module discusses motivation and goal-setting changes in stress-relevant coping behaviour. One of the key components of this module is outlining the link between psychosocial issues and occupational stress, and psychosomatic symptoms: in both their development and maintenance over time.

• The second module examines job-specific social skills and coping with social conflicts at work. Subsequent session(s) is (are) spent utilizing role play exercises; thereby, allowing patients an opportunity to practise and develop the skills acquired during this module.

• The third module discusses coping with acute and chronic stress; specifically outlining both short-term and long-term coping strategies.

The fourth and final, module is entitled ‘job perspective’. This module seeks to discuss strategies and methods to transfer the knowledge and skills acquired through the previous three modules within the context of an inpatient programme into the ‘real world’ and fully integrated into working life.

Practical applications:

This a modular group therapy approach has an establish protocol and manual (recently published in German) making it easily applicable at practical level. Koch and colleagues indicate that this intervention’s protocol demonstrates a high level of adaptability to various kinds of clinical and counselling settings.  Additionally, the authors suggest that in order to implement this group therapy intervention effectively, the intervention leader/trainer requires a basic therapeutic background and established knowledge.

Innovative aspects:

The job-related group therapy intervention is the first clinical inpatient-treatment focussing on occupational stress management.

Evaluation (including process issues, outcomes and sustainability):

Patients in the intervention group were compared to patients in a standard symptomatic therapy only group. Measurements were taken at three time points: at admission, discharge, and at 12 months post-treatment follow up. A variety of measurements were taken: assessing the objective work environment (work status, sick days, applications for early retirement) and subjective estimates of intensity of work stressors, individual coping skills, and satisfaction with treatment.

Benefits (including cost effectiveness):

The results of the evaluation of the intervention, as compared to the standard symptomatic therapy, at 12 months post treatment assessment, demonstrate that participants were more likely to:

·         maintain work and a reduction in the demonstrated intention to apply for early retirement; 

·         a reduction in a type of coping related to ‘burn-out’;

·         and demonstrate increased satisfaction with work–related aspects to treatment (namely, occupational stress, and conflicts with colleagues).

Both treatment groups (intervention and standard group therapy) resulted in increased job satisfaction, experienced increased control at work; and an observed significant reduction in social stressors at work and occupational worries.

References:

Koch, S. & Hillert, A. Occupational stress management in tertiary prevention: Controlled evaluation of an inpatient program. In S. McIntyre & J. Houdmont Occupational Health Psychology: Key Paper of the European Academy of Occupational Health Psychology 7^th edition (pg.138-139). Edicoes ISMAI: Castelo da Maia, Portugal.

Comments:

The protocol for this intervention has recently been published as a book; however, currently it is only available in German.