Author(s):   Saskia Duijts, Ijmert Kant, Piet van den Brandt, & Gerard Swaen                     Country:  Netherlands

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.):

The aim of ‘preventative coaching’ is to target employees ‘at risk’ for sickness absence due to psychosocial health complaints. It is an approach that can be used to enhance employee wellbeing and performance, and to improve overall functioning, achievement of goals, and management of stress. It aims to:

• assist individuals by promoting strengths and minimising weaknesses,

• gain a better understanding of underlying individual behaviour,

• and successfully manage changes.

   

The role of the coach, during this process, is not to provide advice or solutions; but rather to facilitate the process by attempting to improve internal reflection.

Implementation: 

The initial stage of this intervention begins by identifying those employees ‘at risk’ of sickness absence due to psychosocial health complaints; this is accomplished by using a screening instrument. Those employees identified ‘at risk’ of sickness absence are invited to participate in the preventive coaching intervention. The preventive coaching intervention consists of 7 to 9 one-hour sessions within the time period of six months. The intervention begins with an introductory interview (between coach and employee) where an outline of personal and coaching objectives are discussed and an overall problem is formulated. Following this, an introductory 3-way consultation with the employee, his/her supervisor, and the coach is conducted; outlining the aim and process of coaching. The next four to six meetings are individual meetings between the employee and the coach where underlying behavioural characteristics are identified in the employee, and methodologies and instruments are discussed and identified to help facilitate change. The programme ends with a final 3-way consultation meeting with the employee, supervisor and coach; where a discussion and overall evaluation of the coaching programme transpires. During this final meeting, future plans are outlined to support and promote the continuation of the initiated changes to the workplace setting. Following the completion of the intervention, follow up meetings are arranged with the coach to exchange experiences and provide a general update.

Practical applications:

The preventive coaching intervention has been standardized and outlined in a fully developed intervention protocol. A checklist for coaches has been developed. This checklist provides a general outline of all the main features of each session; and is a useful resource tool for the effective implementation of preventive coaching.  A trained professional is required to support the successful implementation of preventive coaching. Preventive coaching has been successfully implemented in both the healthcare and education sectors with large-scale organisations. However the authors emphasise that medium and small companies can utilize this intervention.

Innovative aspects:

This intervention provides an instrument to identify/successfully screen ‘at risk’ employees of sickness absence due to psychosocial health complaints; and provide these individuals with an early intervention in order to reduce the risk, and the overall level of sickness absence.

Evaluation (including process issues, outcomes and sustainability):

The present intervention was assessed by comparing a reference group (non-intervention group) to the intervention group; at baseline and follow up (12 months, 24 months, and 36 months).

Benefits (including cost effectiveness):

The authors conclude that preventive coaching is an appropriate intervention for employees ‘at risk’ for sickness absence. Preliminary evidence, as the evaluative research of this intervention is currently ongoing, demonstrated that preventative coaching was significantly effective at lowering sickness absence days; a reduction of 14% as compared to the control group.

References:

Duijts, S., Kant, I,  can den Brandt, P., & Swaen, G. (2007). The compatibility between characteristics of employees at risk for sickness absence and components of a preventive coaching intervention. International Journal of Evidence Based Coaching and Mentoring, 5, 19-29.

Comments:

This intervention primarily focuses on the individual level and does not consider risk sources (hazards) at the organisational level.

Author(s):   B. Aust, R. Peter, & J. Siegrist                                                                 Country:   Germany

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):  Vittorio Di Martino, David Gold and Annette Schaap                                     Country:   International - International Labour Organisation

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.):

SOLVE (Stress, tobaccO, alcohoL & drugs, HIV/AIDS, ViolencE) is an educational programme with an interactive element; with the overall aim of  assisting the integration of work-related psychosocial issues (including stress, alcohol and drugs, workplace violence and harassment, HIV/AIDS and tobacco use) into the development of:

·         a comprehensive action-based organisational policy promoting employee health and wellbeing;

·         and the development of an occupational safety and health management system to assure smooth development, implementation and evaluation of the developed policy.

The SOLVE programme supports a proactive approach, accomplished through education and training, in effectively addressing the development and negative consequences resulting from a poor/inadequate psychosocial working environment on both the health of the individual and on the resiliency and productivity of an organisation. The SOLVE programme has been used in a large variety of occupational sectors and sizes of enterprises.

Implementation:

The SOLVE programme is a 32-hour interactive course for operational managers. It is designed to provide essential knowledge and tools necessary for participants to develop a comprehensive corporate policy; including psychosocial factors. This programme consists of eight different modules.

·         An introductory module, which identifies the problems found in a poor psychosocial working environment (stress, drugs and alcohol, violence, HIV/AIDS and tobacco), the economic ramifications and consequences of such an environment, and the goals and objectives of the SOLVE programme.

·          The second module, discusses managing emerging health-related problems at work. This module demonstrates the interrelationship between the five health-related problems (stress, drugs and alcohol, violence, HIV/AIDS and tobacco) presented in the SOVLE approach and the application of a management model to address these problems through a common policy and coherent action.

·         The following five modules discuss, in more detail, the five health-related problems due to the psychosocial working environment: stress, alcohol and drugs, violence, HIV/AIDS, and tobacco. The focus of these modules is to demonstrate the prevalence of the problem, and educate participants on its causes and consequences to the individual and the organisation. The principle aim of these modules is to educate and enable participants to describe the elements of a policy statement, which will constitute the foundation of an organisational strategy allowing for a response to combat these five health-related problems.

·         The final module, entitled ‘action’, requires participants to develop an action plan, whilst integrating the learned SOVLE concepts into a comprehensive workplace policy.

The SOLVE programme is a highly interactive programme, which uses case study analysis, simulation exercises and policy development activities to reach its objectives. This course is usually conducted over four days; however, this time period can be longer, if the course is divided into smaller units. The programme is designed to work optimally with a group of 16 participants. Ideally the group should consist of four workers’ representatives, four government officials, and eight employers or their representatives. During the course, six simulation exercises are conducted; these simulations are linked together by a story line, which begins on the first day and ends of the last day of the programme. The story is an on-going scenario with problems that require high level of participation of management decision-making for resolution. The last element of the SOLVE programme is dedicated to action planning. At the end of the course participants are required to develop an action plan, indicating how the learned and acquired SOLVE concepts will be applied in the participants’ respective organisation within three months following the completion of the programme. Employees, and/or their representatives, are integral in this last phase of the SOLVE programme; in the development a suitable action plan to address psychosocial issues in the workplace.

Practical applications:

The SOLVE programme is designed as an interactive tool and educational programme that uses stimulation exercises and role-plying to engage participants to increase knowledge and awareness of psychosocial issues, and develop knowledge-based strategies for preventative action and management. The SOLVE programme is led by a trained facilitator and has a fully developed training manual; thus, facilitating the ease in which to administer the programme.

Innovative aspects:

The SOLVE programme is an educational programme that examines both policy and shop floor action to address psychosocial problems at the workplace in a comprehensive manner.

Evaluation (including process issues, outcomes and sustainability):

SOLVE has been evaluated from an educational perspective. A pre-session and post-session questionnaire assessing participants’ knowledge, attitudes, perception and beliefs following each module is conducted. Additionally, participants in the SOLVE programme are interviewed; assessing their degree of satisfaction with the programme and the perceived applicability and importance of its content. A three month post-course report on the developed action plan is submitted and reviewed.

Benefits (including cost effectiveness):

The subjective assessment of participants’ satisfaction of the programme has been overwhelmingly positive. Additionally, participants have noted the use of the SOLVE course as a useful tool in the development of comprehensive policy and to initiate action to address psychosocial issues in the workplace. Participants demonstrate a large degree of acquisition of knowledge; as result from participating in the SOLVE programme.

References:

Di Martino, V., Gold, D., & Schaap, A. SOLVE: Managing Emerging Health Related Problems at Work. Available at www.ilo.org/safework/solve. 

Comments:

The SOLVE programme is an adaptable programme, which offers a multiple course package meeting the needs of various stakeholders: including, managing directors, mid-level manager, peer counsellors, and workers. Employees and supervisors participate in the SOLVE programme during the action planning stage; and are an integral in the translation of the developed comprehensive organisational policy into effective action.

Author(s):   Caroline Hoedemakers                                                                     Country:  Belgium

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.):
 

The aim of ‘Collective Coping’ is to help managers cope collectively and more effectively with common issues and related problems experienced at work. It is a method that uses team training and team building exercises. Underpinning the structure and the overall rationale of the training programme for collective coping are that:

• group members must see the problem as a common problem;

• they must feel collectively responsible for the solution;

• and they should share a commonly desired solution.

Implementation:

The collective coping intervention, involves team training for 5 days; where every two weeks there is 1 full time day of training. The team training involves 4 stages:

• In the first stage, common problems experienced by managers are examined in the specific organisation: a work-related problem is chosen.

• In the second phase of the training, the group proceeds to analyze the problem collectively by exploring possible causes and consequences of the identified problem; and, in turn, reflecting on the different parties involved in the problem and in its solution. Thus the collective problem is redefined.

• In the third phase, collective actions and strategies are developed and outlined by the group, in order to address the defined problem.

In the final stage of the intervention, the fourth phase, the actions and strategies outlined are implemented. 

Practical applications:

Collective coping is aimed specifically at the managerial level and requires a trained expert to facilitate the successful administration of training sessions. Collective coping has been successfully implemented and evaluated in a large organisation in the public sector; however, the method is adaptable and applicable, as noted by the author, to a variety of occupational sectors and sizes of enterprises.

Innovative aspects:

The use of collective coping among managers through team training to identify work related problems and develop solutions, and consequently, an action plan.

Evaluation (including process issues, outcomes and sustainability):

The intervention was delivered to four groups over four divisions in a section of local government in Belgium. Measurements were taken prior to and following managers’ participation in the collective coping training. Additionally, interviews were conducted with participants, following the training, to assess the overall effectiveness of the interventions.

Benefits (including cost effectiveness):

The managers that participated in the collective coping training exercise articulated an extremely positive response to the team training. Specifically, managers outlined that during the training they learned to identify prevalent problems in the workplace, to see their potential impact on their colleagues, and how to develop a common vision within the team of mangers on how to address these issues more effectively. Managers spoke of ‘collective coping’ training as an effective team building exercise.

Following the completion of the training exercise, the organisation and managers that participated in ‘collective coping’ training expressed their overall level of satisfaction; and articulated their strong interest to continue with further and more advanced team training in ‘collective coping’.

References:

Hoedemakers, C., & Pepermans, R. (2007). Stimulating collective coping: Conceiving training for managers.. In S. McIntyre & J. Houdmont Occupational Health Psychology: Key Paper of the European Academy of Occupational Health Psychology 7^th ed. (p111-113). Edicoes ISMAI: Castelo da Maia, Portugal.

Comments:

This approach is aimed at the managerial level; and consequently does not promote employee participation and social dialogue.

Author(s):  Dorota Zolnierczyk-Zreda                                                                             Country:   Poland

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.):

At the Polish Central Institute for Labour Protection a worksite stress management intervention has been developed, implemented and evaluated. The aim of the worksite stress management intervention is to enhance and promote the use of positive coping styles (i.e. specifically defined as problem-focused/solution-orientated coping¹ and developing/promoting increased social support); and, in turn, decrease/discourage the use of negative coping styles (i.e., emotion-focused coping² and use of distraction techniques). In so doing, it aims to help employees manage stress more effectively and to promote an increased sense of wellbeing and overall health.

Implementation:

The intervention involved a total of ten 4 hour-weekly sessions that were held over a 10 week period. Employees participated in group sessions and various experience-orientated exercises. Sessions were structured to cover several specific topics: issues surrounding stress, and different types of coping styles (both positive and negative) and their respective elements. Cognitive methods and techniques were introduced to develop self-awareness in employees concerning both workplace stressors that existed and personal abilities and limitations in coping with these stressors. Thus, participants were encouraged to begin with identifying personal and environmental features that lead to strain; and, in turn, to formulate and implement strategies to change those features.

This was accomplished by training employees in assertiveness skills, behaviour rehearsal, and role-playing exercises. Additionally, one important task during the stress management training was to enhance the participants’ coping through developing ‘social networks’; this was accomplished by teaching employees how to seek social support and how to provide it to others.

Practical applications:

The worksite management training intervention was implemented and evaluated in the public sector; however, as noted by the author, this approach can be tailored and adapted to be applicable in a variety of occupational settings. The successful implementation of this stress management programme requires a trained expert to facilitate its implementation. Additionally, as this stress management programme requires a strong time commitment by employees, it is suggested by the author that to increase its respective success this would require its administration during working hours. 

Innovative aspects:

This intervention seeks to train employees to cope and manage stress more effectively by teaching employees how to enhance positive forms of coping and social support through cognitive-restructuring and behavioural training exercises, whilst minimizing the use of negative forms of coping.

Evaluation (including process issues, outcomes and sustainability):

To assess the effectiveness of the intervention employees were randomly assigned to either an intervention group or a comparison (non-intervention) group. Measurements of employees’ coping styles and general wellbeing were collected prior to and one month following the intervention.

Benefits (including cost effectiveness):

The evaluation of the intervention yielded the following findings, in regards to the effectiveness of the intervention.

• Firstly, a significant increase in positive coping styles was observed.

• Additionally, a decrease in negative coping styles was observed in particular groups.

• Due to the stress management intervention, persons who overused one form of negative style coping (emotion-focused coping), reported a significant decrease in this particular form of negative coping; and were found to demonstrate a more proportional balance between negative and positive coping styles.

References:

Zolnierczyk-Zreda, D. (2002). The effects of worksite stress management intervention on changes in coping styles. International Journal of Occupational

Safety and Ergonomics, 8, 465-482.

Comments:

Styles of coping have often dichotomy classified into: problem-focused or emotion focused coping.

¹ Problem-focused coping refers to efforts made by the individual to improve the troubled person-environment relationship by actively changing things; such as seeking information about what to do, and by confronting an individual or individuals responsible for one’s difficulty.

² Whereas, emotion-focused coping is defined as thoughts or actions with the primary goal of relieving the emotional impact of stress; these strategies are apt to be mainly palliative as they do not seek to change or alter the threatening or damaging conditions, but rather seek to make the individual feel better. 

This approach is focused on the individual level and does not address organisational level issues or solutions.

Author(s): Judith Sluiter, Albert P. Bos, Dirk Tol, Mart Calff, Margot Krijnen, & Monique H. W. Frings-Dresen         Country:  Netherlands

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.):

The overall objective of the intervention was to enhance team communication by way of using multidisciplinary structured work shift evaluations. In so doing, by increasing and facilitating increased communication within the worksite and among work colleagues; an ‘emotional pressure valve’ during working hours would be developed resulting in stimulating recovery from work and decreasing the persistence of unnecessary worries and accompanying bodily stress reactions after working time for employees.

Implementation:

On two predetermined days per week, the remaining 30 minutes of the day shift were allocated for the multidisciplinary structured work shift evaluation within the department. During this meeting, all members of staff working on that shift gathered and assessed how well the working day went and what had occurred during the shift. These meetings were facilitated by the evaluation leader (staff members were provided training in leading these discussion) who structured the process, ensured the proper time span, guided the type of interaction between team members (i.e., ensuring a safe environment for feedback) and organised the communication (in regards to emotional events, teamwork, work roles, and organisational aspects) using predefined models of communication.

Two training courses were conducted to prepare for the implementation phase of the multidisciplinary structured work shift evaluation:

• firstly, a 1-day training course was provided for all staff members, with the overall objective of improving their interpersonal communication skills;
• secondly, a 2-day course to train eight selected staff members to supervise the structure of the multidisciplinary work shift evaluation

Practical applications:

Prior to designing the intervention a risk assessment was conducted; in so doing, it identified communication within the targeted worksite/and among various staff members as the central issues. Additionally, the administration of the two training courses was provided by a professional communication trainer. This particular intervention was implemented and evaluated in the healthcare sector; major components of the intervention were designed to address the concerns identified in the risk assessment previously conducted in the department.

Innovative aspects:

The intervention used a structured communication process using predefined communication models as a means of increasing effective communication within a multidisciplinary worksite; and thereby increasing employee health and wellbeing.

Evaluation (including process issues, outcomes and sustainability):

To assess the effectiveness of the intervention, employees were assessed prior to and following the intervention using a series of self-report questionnaires: examining (a) the quality and process of the intervention, assessed during the first 3 months of implementation; (b) the perceived effectiveness of the intervention and work organisation; and (c) staff health (ie., work-related fatigue and emotional exhaustion).

Benefits (including cost effectiveness):

Based on the results of the evaluation of the intervention, several benefits were observed:

• The improvement of team communication was reported by the majority of intervention participants.

• Emotional exhaustion problems significantly decreased during the course of the intervention.

• A trend towards a decrease in work-related fatigue was also observed.

• Almost all of the participating employees reported experiencing satisfying communication with colleagues following the intervention.

In general, the authors conclude, based on the evaluation of the collected evidence, that the multidisciplinary structured work shift evaluation was successful in improving communication and decreasing problems relating to emotional exhaustion.

References:

Sluiter, J.K., Bos, A.P., Tol, D., Calff, M., Krijnen, M., & Frings-Dresen, M.H.W. (2005). Is staff well-being and communication enhanced by multidisciplinary work shift evaluations? Intensive Care Medicine, 31, 1409-1414.

Comments:

The predefined models for communication used are as follows:

Author(s): Simo Taimela, A. Malmivaara, S. Justen, E. Läärä, H. Sintonen, J. Tiekso, & T. Aro          Country:   Finland

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.):

The overall objective of the intervention was to identify ‘high’ risk employees of sickness absence; and for those employees identified to provide early treatment and rehabilitation. This was accomplished by conducting a health survey within the organisation. This form of health survey has been used in a large variety of sectors (both public and private), and has been used in predominantly large and medium-sized organisations.

Implementation:

The health survey was administered throughout the organisation. Based on the results of the survey, ‘high risk’ employees were identified. Individuals were classified as ‘high risk’ if they reported one or several listed impairments (musculoskeletal pain, high levels of depression, fatigue, and/or sleep disturbance or problems). Following the health survey identified ‘high risk’ participants were provided with personal feedback on questionnaire results and were invited to a consultation with occupational health services. The consultation was conducted by the occupational nurse, lasting 90 minutes; an occupational physician joined the consultation if and when required. The overall objective of the consultation was to develop an action plan in collaboration with the medical team; and if-and-when needed appropriate referral to a further consultation by a specialist or psychologist was provided. The occupational nurses created a file on each participant throughout the intervention process: regarding attendance and compliance, referrals to further evaluation or interventions, health advice received, and considerations of occupational health services if not further action was required.

Practical applications:

This was a pragmatic trail of interventions that work within the pre-existing structure of an organisation within a human resource framework.

Innovative aspects:

This pragmatic approach to reducing sickness absence provides corporations with the tools to identify risks and risk groups within their given organisation. Expert consultation is provided on how to improve the occupational wellbeing of employees within either the existing framework of occupational health services or within human resource management.

Evaluation (including process issues, outcomes and sustainability):

To assess the effectiveness of the intervention, individuals classified within the ‘at-risk’ group were randomly assigned to either the intervention group (consultation with occupational health services) or to a ‘treatment as usual’ condition. ‘Treatment as usual’ consisted of an optional consultation with the organisations’ occupational nurse or physician on request. The primary outcome measure used to assess the intervention effectiveness was sickness absence collected through organisational records following one year. Additionally, an economic evaluation of the intervention was conducted, using sickness absence as its primary outcome.

Benefits (including cost effectiveness):

The results of the evaluation of the intervention, demonstrated that the occupational health intervention was effective in controlling sickness absence within employees classified as ‘high risk’. The observed difference between sickness absence between the intervention condition and usual care was 11 days. The results of the cost-effectiveness evaluation demonstrated a saving of 43 euro per sickness absence day avoided with available direct total cost data, and 17 euro with missing total cost data imputed.

References:

Taimela, S., Malmivaara, A., Justen, S., Läärä, E., Sintonen, H., Tiekso, J., & Aro, T. (2007). The effectiveness of two occupational health intervention

programs in reducing sickness absence among employees at risk. Two randomised controlled trails. Occupational Environmental Medicine, published on 6

August.

Taimela, S., Justen, S., Aronen, P., Sintonen, H., Läärä, E., Malmivaara, A., Tiekso, J., & Aro, T. (2007). An occupational health intervention program for workers at high risk for sickness absence. Cost-effectiveness analysis based on a randomised controlled trail. Occupational Environmental Medicine, published online Oct. 12, 2007

Comments:

The implementation of this intervention requires the availability of occupational health experts at the organisational level and as such might not be readily applicable to SMEs.

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

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.

Author(s):   Paul. E. Flaxman & Frank W. Bond                                                       Country:  United Kingdom

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.):

The overall aim of Acceptance and Commitment Therapy (ACT) is to enhance psychological flexibility; a psychological construct that has two related components: (a) a willingness to experience all internal events (thought, feelings, etc), and include those that are undesirable without trying to control, change or remove them; and (b) a commitment to engage in goal–orientated action, even when faced with difficult psychological content. This approach promotes and teaches, through a fully developed intervention protocol, mindfulness strategies to promote acceptance, rather than change or modify difficult psychological content, and commitment and behavioural strategies to help people build larger patterns of values-based action. There is a growing body of research to demonstrate that ACT is an effective method of stress management, and has been demonstrated to significantly improve employees’ mental health and to improve work-related outcomes: such as, increased learning at work (Bond & Bunce, 2000; Dahl et al., 2004; Flaxman & Bond, 2006; Hayes et al., 2004).

Implementation:

The ACT programme can be delivered during working hours to small groups of employees at the organisation. In recent ACT research, participants received three sessions of training on two consecutive weeks, and the third, and final, session three months later. Each training session lasted approximately half a day. The training consisted of a mixture of group discussion, didactic teaching and practice of ACT techniques. Additionally, participants were also encouraged to complete homework assignments between sessions. The content of the intervention was based on the fully developed ACT protocol, and additionally two subsequent ACT manuals that have a concentrated focus on group worksite interventions.

Practical applications:

ACT has a standardized protocol manual; thus making it easily applicable at a practical level. However, the authors note that in order to implement the protocol effectively, the trainer requires a good understanding of ACT’s underlying processes (see Hayes et al., 2006). ACT has been successfully implemented in a variety of occupational sectors, including both the public and private sector; and in both medium and large scale organisations.

Innovative aspects:

Many traditional cognitive behavioural approaches are designed to instruct employees on how to change or modify ‘dysfunctional’ or (stress-related) cognitions; and , in turn, how to reduce unpleasant emotional arousal. In contrast to the traditional change-orientated cognitive behavioural approach, a ‘third-wave of cognitive behavioural therapy has emerged, which places greater emphasis on ‘acceptance’ and ‘mindfulness’. One such approach, at the forefront of this ‘third-wave’ movement in cognitive behavioural approaches, is ACT.

Evaluation (including process issues, outcomes and sustainability):

Participating individuals were randomly assigned to one of three groups: (1) acceptance and commitment training (ACT) – a mindfulness-based approach; (2) stress inoculation training (SIT) - a cognitive restructuring approach; or (3) a wait list control group. Participants were asked to complete a questionnaire assessing overall levels of wellbeing at three time points: pre-intervention (baseline), 3 months later; and at a 6 month follow up.

Benefits (including cost effectiveness):

The aforementioned evaluation of ACT demonstrated the following benefits:

• Participating employees, with high levels of distress prior to the intervention, experienced large statistically (and clinically) significant improvements in mental health

  and these observed benefits were maintained at the 6 months follow-up assessment.

The authors conclude that there is a lot of evidentiary support for the use of cognitive behavioural therapy-based interventions in improving employees’ psychological well-being. Additionally, the evidence supports the efficacy of using ACT in the workplace

References:

Bond, F. W., & Bunce, D. (2000). Mediators of change in emotion-focused and problem-focused worksite stress management interventions. Journal of Occupational Health Psychology, 5, 156-163.

Dahl, J., Wilson, K. G., & Nilsson, A. (2004). Acceptance and commitment therapy and the treatment of persons at risk for long-term disability resulting from stress and pain symptoms: A preliminary randomized trial. Behavior Therapy, 35, 785-801.

Flaxman, P. E., & Bond, F. W. (2006). Acceptance and commitment therapy in the workplace. In R. A. Baer (Ed.), Mindfulness-based treatment approaches. San Diego, CA: Elsevier.

Flaxman, P.E. & Bond, F.W. (2006). For whom, and to what extent, is worksite stress management effective? In S. McIntyre & J. Houdmont Occupational Health Psychology: Key Papers of the European Academy of Occupational Health Psychology (pg.92-93).Edicoes ISMAI: Castelo da Maia, Portugal.

Flaxman, P.E. & Bond, F.W. (2006b). Cognitive-behavioural therapy (CBT) – based stress management interventions (SMIs): Investigating the mechanisms of change. Retrieved from http://www.ejtassociates.co.uk/Cognitive.pdf.

Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment theory: Model, processes and outcomes. Behaviour Research and Therapy, 44, 1-25.

Hayes, S. C., Bissett, R., Roget, N., Padilla, M., Kohlenberg, B. S., Fisher, G., et al. (2004). The impact of acceptance and commitment training and multicultural training on the stigmatizing attitudes and professional burnout of substance abuse counselors. Behavior Therapy, 35, 821-835.

Comments:

The authors note that ACT has been demonstrated as an effective method to address both the management of occupational stress (secondary level intervention) and in the rehabilitation of employee experiencing stress-related illness (tertiary level intervention).

Author(s):  Hanna Arneson & Kerstin Ekberg                                                             Country:  Sweden

Is the intervention sector specific?

Is the intervention usable with different enterprise sizes?

Yes

Is the intervention equally applicable to both genders?

Is the intervention based on theory?

Yes

Can the intervention approach be adapted/ tailored?

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

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

The aim of the developed workplace health promotion programme by Arneson and Ekberg, is to promote empowerment and health among employees within an organisation. The intervention is based on a pedagogic method known as the problem-solving approach. Problem-based learning is a structured approach, based on learning theories; it is a process-orientated method that requires active participation by all group members. The problem-based method engages participants in an active, self-directed and continuous problem-solving process which facilitates learning. In each group, the problem-based work process is supported by a facilitator whose role is to ensure that the work is goal-directed, and, moreover, to support the participants in developing a constructive group process. The aim of the intervention, using a model of problem-based learning as a method, is to promote change; specifically, to promote health of the individual within the context of the workplace, whilst empowering employees.

Implementation:

This intervention was used in small groups (6-8 individuals); these groups met once a week for 2-hours over the period of 4 months. A trained facilitator or tutor was normally present to facilitate and lead group discussions. During the course of these 2 hours, the working group determined and prioritized problems (hindrance and possibilities) and prepared action programmes for the implementation of changes involving the organisation, work tasks, the work group and individual conditions. The following are the steps of the problem-based learning model used in the intervention:

1. the group selects a topic of relevance and interest with the frame of health promotion in the workplace;

2. the topic generates a process of brainstorming;

3. classify the concepts from the brainstorming into sub-themes (the group defines how the concepts are interrelate);

4. the group selects one of the sub-themes to work on;

5. the group work proceeds with the chosen sub-theme, discuss goal setting and strategies to achieve the goals;

6. the group reflects upon the work of the day in terms of content;

7. written documentation challenges the participants to be more concrete;

8. the following meeting is opened with an exchange of experiences that should focus on process and strategies to achieve the goal, following which the group starts back at step one again.

This is a cyclic process; whereby, new goals, problems, and strategies are continuously identified. Part of the learning process, and in turn the change process, is learning how to identify problems, generate possible solutions to address these issues, and identify which strategies are successful and which are not. Following the formal end of the intervention, groups were encouraged to continue group sessions, in an informal capacity.

Practical applications:

The intervention occurred during working hours, thus facilitating participation of employees. This workplace health promotion programme has been successfully implemented in both the public and private sector; and in both small and large-scale organisations. Additionally, this methodology has been used to address specific problems in the workplace: such as, return to work or for people with long term sickness leave.

Innovative aspects:

This workplace health promotion programme views learning as a process of change; that is teaching people to look at and examine problems and issues in new and innovative ways. The model of problem-based learning was tailored and adapted to facilitate the process of change within an organisation; with the overall objective of promoting individual health and organisational health.

Evaluation (including process issues, outcomes and sustainability):

The process, content and effectiveness of the intervention were examined via focus group. Two members of the intervention groups were strategically selected, with respect to their sex, age, position, and duration of employment, to participate in the focus groups. In total 30 participants were selected, to contribute to 7 focus groups. Individuals were asked to discussion their experiences of participating in the intervention and consequences of the intervention in terms of workplace and organizational changes and health.

Benefits (including cost effectiveness):

The following were the observed benefits of the problem-based learning intervention:

• Firstly, the majority of participants reported increase self-consciousness and self-awareness improved, conveying increased self-esteem and enhanced health.

• Secondly, participants reported having greater awareness and insight, in part due to group discussions and overall reflection, of informal workplace conditions and increased sense of social support.

• Thirdly, participants reported feeling a greater sense of self-direction and self-management in relevant problems they experience in the workplace.

• Fourthly, participants reported an improve sense of group coherence in the workplace both on a formal and informal level.

Finally, the participants expressed a belief that the problem based learning was an affect method in improving working conditions for employees.

References:

Areneson, H. & Ekberg, K. (2005). Evaluation of empowerment processes in a workplace health promotion intervention based on learning in Sweden. Health promotion international, 20(4), 351359.

Comments:

Although this intervention has been identified as a secondary-level intervention, it can also be demonstrated to be a effective as a tertiary level intervention