Author(s):    Carla Dahl-Jørgensen, Per Oystein Saksvik             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.):

Studies focusing on interactive service work that involves face-to-face interactions between employees and customers/clients have shown that employees tend to show symptoms of job dissatisfaction, stress, and emotional exhaustion because they are expected to display or suppress certain emotions in the performance of their jobs. To meet the health challenges and reduce sickness absenteeism among employees in this sector, two organisational interventions were implemented in two different parts of the service sector: municipal government and the retail sector. The interventions varied slightly in their design applied to the different sections of the sample; most notably in the different steps used in the process leading from the preparation phase to the discussion phase.

The overall objective of the intervention was to bring about changes in the factors perceived by employees as causes of stress at work and to bring about organisational changes at the unit level. The method utilised to identity the cause of stress, as perceived by the employees, was a three-step strategy culminating in a meeting where employees and their respective supervisors engaged in group discussion or ‘search conferences’. Additionally, these organisational level interventions were underpinned by three theoretical traditions: (1) a focus on participation, dialogue and workplace democracy; (2)  a primary emphasis on job redesign/ environmental causes of illness, rather than behavioural change aimed at the individual or on expressed symptoms of ill-health; and finally (3) using organisational theory as a method of initiate a learning process within the organisation, whereby improvements can be made in the performance of the organisational tasks and the value system of the organisation.

Implementation:

Prior to the start of the project, initial meetings were held between top-level management and researchers to discuss and outline the aims of the intervention. Subsequently, a letter was distributed to all participants about the nature and objectives of the project. The researchers visited each unit and informed them about the research project. The decision on whether to implement the project was decided at the administrative level of the organisation. All employees and managers accepted to actively participate in the project, throughout the process. Employees were not consulted in regards to the types or content of the intervention, nor whether the intervention should be implemented.

The Municipal Units: The initial phase of the intervention consisted of interviews with employees who had recently or in the past experienced one or more periods of sick leave. With the principle aim being the identification of: the perceived causes of the employees’ absenteeism, and what strategies, measure or precautions were taken at their workplaces on their return. In the second phase of the intervention, an assessment of risk factors and risk persons/groups in the workplace was conducted.  The results culminated in the first two phases of the intervention were applied as inputs into the final step in the intervention process; which consisted of a ‘search conference’ (or dialogue). The objective of the search conference was to identify and define the stress and health problems present in the workplace, and generate local solutions to problems associated with workplace.

The Retail Units: The initial phase of the intervention began with each employee describing a ‘typical working day’ to the researcher. The aim of this preliminary step was to identify stress-provoking incidents over the past three-week period. During the second phase of the intervention, the researcher analysed the collected information and diagnosed the problem. The identified problems were listed, in no particular order of importance, and distributed among the employees. The employees were then asked to discuss the identified problems in pairs or in groups of three at each work unit, and to prioritise possible solutions to the identified problems. A ranking list of the factors that needed to be reformed or changed was compiled, and this list became the basis of the discussion for the third phase. During third stage, managers and union representatives from each establishment were asked to identify one factor they wanted to change, before determining a strategy for how this change could be accomplished. The researchers ensured, through follow up visits, that the work units drew up a strategy for change in accordance with their targeted organisational factor.

Practical applications:

Although the interventions have been used in the retail sector, they is based on principles which are applicable in other organisational sectors and therefore the interventions can be tailored for most organisations.

Innovative aspects:

Prior to the intervention, the cause of stress as perceived by the employees was identified. Additionally, the subsequent organisational level interventions were underpinned on sound theoretical traditions.

Evaluation (including process issues, outcomes and sustainability):

The intervention was implemented into two different types of work units both in the service sector: municipal units and in retail units at a shopping mall. A total of 12 municipal work units participated in the study; eight units were randomly assigned to the experimental group (i.e., the intervention group), the remaining four units were allocated to a control condition (where the intervention was not implemented). While of the 30 retail work units that participated in the study; 17 were randomly allocated to the intervention condition and the remaining 13 to the control condition.  The design of the study consisted of the following steps: pre-survey, interventions, interviews and observation, and post –survey. The variables under investigation, and further explored by the survey, were: job stress, subjective health complaints, burnout, and sickness absenteeism. During the qualitative element of the evaluation, observations in the workplace and unstructured interviews with participants were conducted during the implementation of the interventions. These were subsequently studied, analysed, and discussed among the researchers throughout the data-collection period. Researchers examined participants’ reactions (either positive or negative) to the interventions.

Benefits (including cost effectiveness):

The survey results demonstrated positive changes on two factors for the retail sector employees; namely, depersonalisation and subjective health complaints. However, no significant differences in any of the outcome measures were observed in employees in the municipal units. The qualitative data demonstrated that constraints related to interactional and organisational practices acted as an significant barrier in the full participation of employees in the study during the implementation of the interventions.

References:

Dahl-Jørgensen, C. and Saksvik, P.O. (2005). The impact of two organizational interventions on the health of service sector workers. International Journal of Health Services, 35(3), 529-549

Comments:

Since the decision on whether to implement the project was decided at the administrative level of the organisation and because employees were not consulted in regards to the types or content of the intervention, nor whether the intervention should be implemented, the evaluation does not indicate the potential benefit of the intervention.

Author(s): Hege R. Eriksen.,C. Ihlebæk, A. Mikkelsen, H. Grønningsæter, G. M. Sandal and H. Ursin           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.):

One of the main causes of sick leave is subjective health problems; defined as conditions with few or not objective findings. In Norway, more than half of the total sick leaves are based on such subjective statements and conditions; making managing and, moreover, reducing sick leave a national priority. In response to this national concern, Eriksen and colleagues have developed a worksite intervention aimed at decreasing subjective health complaints and reducing sick leave. This worksite intervention is a combined integrated health programme, which contains three main components: (a) physical exercise; (b) information regarding stress, coping, health and nutrition; and (c) a practical examination of the worksite.

Implementation:

The integrated health programme was conducted two hours once a week for 12 weeks. Each session consisted of two subsections, the first hour is dedicated to theoretical exercises (topics included the relationship between demands and exercise, anatomy, information about low back pain, stress theory, ergonomics, exercise physiology, pain and behaviour, musculoskeletal pain, nutrition, etc.) and the second part comprised of physical exercise. The physical exercise component of the integrated health programme consisted of: warm-up/aerobic, alternative working positions and strength training, stretching and relaxation. The level and intensity of the exercise programme were individually tailored to meet the capabilities of the individual. Two instructors, both physiotherapists, were present at each session. The worksite was visited twice (during the second and eighth week), where degree of static work, heavy lifts, repetitive motion, and so on were analyzed. On the second practical examination the focus was on identifying possible new ways of doing the job and job tasks.

Practical applications:

The intervention is standardized and based on detailed protocols, manuals and prepared teaching material (e.g., slides and transparencies). Professional instructions underwent training to hone skills and respective methods required for successful implementation. The integrated health programme has been successfully implemented in a variety of occupational sectors (specifically the public and healthcare sectors); and in medium to large-sized organisations.

Innovative aspects:

The integrated health programme uses a combination of education and physical exercise to promote and strengthen stress management within individuals; whilst, examining and addressing the larger working environment and design of work.

Evaluation (including process issues, outcomes and sustainability):

The integrated health programmes’ effectiveness has been assessed by randomly allocating participants to one of three interventions: physical exercise, a traditional stress management training approach, and the newly developed integrated health promotion programme. Measurements were taken at three time points: prior to intervention; directly following the intervention; and at a one year follow up. Several outcome variables were used to assess the intervention: namely, job stress, subjective health complaints, and sick leave. Additionally, a subjective evaluation of improvement after the intervention was measured by asking participants if the intervention had had any influence on their perceived health, work environment, work situation, physical fitness, muscle pain, ability to deal with stress, and knowledge of how to maintain good health.

Benefits (including cost effectiveness):

Based on the evaluation of the integrated health programme intervention, the following were the benefits observed.

• The integrated health programme had the best overall effect as compared to the stress management intervention and physical exercise.

• Individuals participating in the integrated health programme reported increased levels of physical fitness and health.

• The integrated health programme was found to improve the work situation and increase participants’ knowledge and capacity for dealing with stress; and decrease muscle pain and increase knowledge about how to maintain optimal health.

All observed improvements were maintained at the one year follow up.

References:

Eriksen, H.R., Ihlebaek, C., Mikkelsen, A., Gronninsaeter, H., Sandal, G.M., & Ursin, H., (2002). Improving subjective health at the worksite: A randomized controlled trail of stress management training, physical exercise, and an integrated health programme. Occupational Medicine, 52,383-391.

Comments:

While the intervention examines aspects of the work environment as well, it focuses on work and task design only (e.g. static work, heavy lifts, repetitive motion) and not on the full range of psychosocial hazards.