Author(s): Inga-Lill Petterson and Lena Backman                   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?

Yes, the intervention promotes responsible business practices. All three stages of the interventions are based on employee participation and require impetus from the management of companies to be successful.

Does the intervention promote social dialogue and how?aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa

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

The Worksite Profile method is a self-instructive tool (in a CD-package) with a questionnaire and instructions to improve the work environment and health of employees in occupational settings. It facilitates Systematic Work Environment Management (SWEN), which involves:

·         Making such decisions and taking such measures in the course of everyday work that employees are not injured, do not become ill and are not harmed in any other way.

·         This means observing and considering both psychological and social conditions, as well as work environment issues of a “technical” nature.

·         Work environment management also applies to work not done at a permanent workplace, e.g. transport work or work in other people’s homes.

According to the Swedish Work Environment Act, SWEN is the responsibility of the employer. The aim of the Worksite Profile is to get employees and managers involved to participate in the development and improvement of their own work conditions. The questionnaires have been developed based on extensive research. The intervention is easily applicable and used at a practical level. The method is prepared for self-administration. All instructions needed are included in the CD-package. The self-instructive method has been used by for example Occupational Safety and Health Services, the Swedish Church and smaller enterprises.  

Implementation:

The intervention is carried out in three steps:

(a) Competence programme: The first activity, a competence and training programme, is directed towards a selected group of employees.

(b) Worksite competence circles: The second activity is directed to all worksite staff, the aim of the competence circles is to initiate a learning organisation, &

(c) Local worksite projects: The target of the third activity is the separate worksites and the organisation. As part of the third step, worksite improvement projects, project plans are elaborated jointly by the participating employees.

Each step is a separate activity, connected by a main thread, and implemented successively, each activity being a necessary basis for the next step. Different activities are directed towards the individual, the worksite, and the organisation. As a tool to initiate and stimulate discussions across occupational groups and to assess the stressors, each unit uses the feedback of their baseline questionnaire results, presented as local work quality profiles. The questionnaire is comprehensive, including more than 100 questions about work demands, job control, support, evaluations of quality of care, musculoskeletal, psychosomatic, and stress symptoms, well-being, and measures of personal resources, such as coping, self-esteem, and mastery. Most of the questions have been used in research and some of the scales are internationally known and well established.

Local reference groups, consisting of the unit manager, the project co-ordinator, the innovation leaders (those who undergo the competence and training programme), and representatives of employee groups, support the projects on the worksite level. A support network of all innovation leaders and unit managers is created at the organisational level. The started projects generally refer to issues such as introduction of new employees, quality development, the meaning of quality to employees, customers, routines for staff meetings and communication, and communication between personnel.

Practical applications:

The method can be handled within an organisation. It is easily applicable and used at a practical level. The method is prepared for self-administration and all instructions needed are included in the CD-package.

Innovative aspects:

The questionnaire has been designed so that it can be distributed as a web-based questionnaire if required.

Evaluation (including process issues, outcomes and sustainability):

The Worksite Profile method has been tested in different occupational sectors and at different organisational levels. The method has been evaluated regarding the validity of the questionnaires and regarding the usefulness of the method for Systematic work environment management. The questionnaires have face validity. Using the method, two key factors have been found to be important; time for discussions at the worksite and manager engagement. The method has also been found to be less useful in organisations that faced lack of time and non-engaged managers.

The intervention effects have evaluated in some studies by a comprehensive questionnaire prior to (baseline) and after (follow-up) the intervention. In some cases, research teams, not involved in the implementation, have evaluated the effects of the intervention by questionnaires before and after the programme, using a wide range of measures. The method has been found to be effective leading to sustainable outcomes.

Benefits (including cost effectiveness):

The method is flexible and can be tailored to suit the organisation. The CD-package is economical thereby making it possible for smaller workplaces to buy it.

References:

Petterson, I.L., Donnersvärd, H.Å., Lagerström, M. And Toomingas, A. (2006). Evaluation of an intervention programme based on empowerment for eldercare nursing staff', Work & Stress, 20(4), 353- 369.

The Swedish Work Environment Authority (2003). Systematic work environment management: Guidelines. Work Environment Authority, Publication Services. ISBN 91-7464-432-7. Also available at: http://www.av.se/dokument/inenglish/books/h367eng.pdf

Comments:

Time for discussion at the worksite and manager engagement are essential for the success of this intervention.  Employee feedback is an essential element of the method and is required in all three stages of the intervention. The Worksite Profile method requires impetus from management of companies to be successful. The authors recommend the user to do investments in special consultations to make improvements of the work situation if needed. 

Author(s):  Hanna Arneson & Kerstin Ekberg                              Level of Intervention:  Secondary

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

Author(s):  Marina Heiden, E. Lyskkov, M. Nakata, K. Shlin, T. Shalin & M. Barnekow-Bergkvist                 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.):

The focus of the programme was to use cognitive restructuring and behavioural modification techniques to improve participants’ self-care strategies, namely coping with negative emotions, increase health promotion behaviour (regular relaxation and physical exercise), improve eating and sleeping habits, and social support through building support networks. The intervention contained a series of seminars, group discussions and required daily practice of skills. Additionally, participants were asked to formulate a life-guiding plan and to participate in the support network for the group.

Implementation:

The cognitive behavioural training programme comprised of 2 three-hour group sessions per week for 10 weeks, and was based on a manual that was distributed to all participants. Each session contained an educational element with an additional task given as homework. A variety of topics relating to stress, its causes, consequences, and management strategies were outlined and discussed (for full content of cognitive behavioural training programme see Heiden et al., 2007). The majority of sessions were structured with a group discussion in regards to the assigned homework at the beginning, followed by an educational part, followed by the assignment of new homework. Over the course of the 10 week programme, participants were asked to keep a homework diary.

Practical applications:

The sessions were led by a stress management consultant with extensive experience and knowledge of rehabilitation of patients with stress-related illnesses. Additionally, the cognitive behavioural training programme was not conducted within a given workplace. Individuals participating in the intervention came from a large variety of occupational sectors, professions, and sizes of enterprises.

Innovative aspects:

The programme uses cognitive restructuring and behavioural modification techniques to improve participants’ self-care strategies, coping strategies and the return to work of individuals on sick leave due to stress-related sick leave.

Evaluation (including process issues, outcomes and sustainability):

The effects of the cognitive behavioural training programme were comparatively assessed to a physical activity programme and with usual care. Both objective (including autonomic activity, pressure-pain threshold) and subjective measurements of ratings of health and behaviour were made. Assessments of patients occurred at four time points: pre-intervention, post-intervention, 6 months and 12 months.

Benefits (including cost effectiveness):

Directly following the intervention minor differences were observed in the objective (physiological) measures that were found between groups. Patients in the cognitive behavioural training group improved their ratings of general health as compared with the physical activity group throughout the study.

References:

Heiden, M., Lyskkov, E., Nakata, M., Shlin, K., Shalin, T., & Barnekow-Bergkvist, M. (2007). Evaluation of cognitive behavioural training and physical activity for patients with stress-related illnesses: A randomized controlled study. Journal of Rehabilitation Medicine, 39, 366-373.

Comments:

Several of the minor differences observed during the evaluation of the intervention were not maintained at follow-up assessments (at 6 and 12 months).

Author(s):   L. Havewald, K. Österburg, G. Abjornsson, B. Malmberg, B. Larsson, & B. Karlson                 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.):

The overall aim of this intervention is to reduce the mismatch between the individual and their working conditions. The target group for this intervention are individuals on sick-leave due to stress reactions or exhaustion; due to chronic occupational stress or a combination of occupational stress and private stress. The core element of the intervention is dialogue between the patient and their manager/supervisor, which is solution-orientated, but also considers both the causes of stress and possible hindrances within the patient’s work environment.

Implementation: 
 

The intervention consisted of five steps:

• Firstly, an interview was conducted to determine whether the sick leave is work-related or not.

• Secondly, if the individuals’ sick leave is determined to be work-related, the individual is assessed by a team of professionals: a doctor, psychologist and the project coordinator.

• Thirdly, a semi-structured interview with the patient’s manger is conducted.

• Fourthly, a common dialogue between the patient and the manager is initiated, with an overall focus on deriving solutions and an overall action plan for return to work, whilst also considering both the possible causes of stress and hindrances in the successful return-to-work. The aim of this meeting is to facilitate and establish common goals through communication in complex or difficult situations.

The final stage of the intervention is a 3-hour education about work, stress and coping strategies for prevention for a group of patients, and for groups of managers from the patient’s worksite.

Practical applications:

A multidisciplinary team of professionals is required to conduct the employee’s sick leave assessment; additionally, a trained professional to facilitate the dialogue between the employee and their manager. Individuals that participated in the intervention were from a large variety of occupational sectors; indicating the intervention’s applicability across occupational sectors.

Innovative aspects:

The intervention uses the concept of social dialogue to initiate a solution-orientated approach; developed through active communication between patient and manager.

Evaluation (including process issues, outcomes and sustainability):

The following intervention was evaluated by matching intervention participants with individuals with similar ailments and characteristics (albeit not participating in the intervention). The individuals were assessed pre-intervention, and at 6 and 12 months following its completion: both subjective (namely, the patients’ perception of his or her work prior to sick leave, subjective health, sleep and sleep quality, role conflict between work and private life, and personality) and objective measurements (saliva cortisol measurements) were collected. Additionally, interviews were conducted with both the patient and his or her manager to assess their perceptions surrounding the causes of the sick leave, and what elements could/should be changed to facilitate increase work capacity.

Benefits (including cost effectiveness):

The evaluation of the current intervention is currently ongoing and only preliminary results can be provided. Six months following the end of the intervention 70% of individuals had returned to work and after 12 months 75%.

References:

Havewald, L., Österburg, K., Abjornsson, G., Malmberg, B., Larsson, B. & Karlson, B.  To facilitate return to work – Evaluation of an early intervention program to reduce sick-leave due to work stress and increase work capacity. In S. McIntyre & J. Houdmont Occupational Health Psychology: Key Paper of the European Academy of Occupational Health Psychology 7^th ed. (p107-108). Edicoes ISMAI: Castelo da Maia, Portugal

Comments:

A team of trained professions is required for the successful implementation of this intervention.