1. Anna-Liisa Elo, prof. Finnish Institute of Occupational Health University of Tampere Impact of Psychosocial Interventions: From research to good practice PRIMA-EF Workshop Helsinki 20-21 May 2008

2. Impact of Psychosocial Interventions: From research to good practice © Anna-Liisa Elo 2 Why to investigate impact of psychosocial interventions at work Researchers validate the theories on wellbeing at work by showing that expected intervention effects exist Organizational consultants develop effective, especially cost-effective methods to satisfy their customers' needs Employees aim at better wellbeing including meaningfull challenge at work to stay healthy and productive Employers strive for high performance for which organizations' intellectual capital is a key element including health and wellbeing of personnel Policy makers emphasize more often the cost-effectiveness and cost-benefit of actions as criteria for decision making

3. Impact of Psychosocial Interventions: From research to good practice © Anna-Liisa Elo 3 Effectiveness of stress management and psychosocial interventions Very few controlled field-experiments have been reported. Lack of evidence does not mean ineffectivenenss! 1.Individual oriented interventions: effective; may lead to "blaiming of the victim" 2.Organization (& work unit) oriented interventions: effects on org. climate and performance; sometimes also on wellbeing, health, job satisfaction & sickness abasenteesim; buffering effects during org. changes? 3.Society level interventions: political agenda, legislation, agreements, national programs? Murphy & Sauter 2004, Semmer 2006

4. Impact of Psychosocial Interventions: From research to good practice © Anna-Liisa Elo 4 EVALUATION OF A PROJECT'S (PROGRAM) IMPACT: Starting point of evaluation: values and goals Self- and external evaluation Process and outcome evaluation (impact, process, learning, future) 'Realistic', 'pragmatic', 'empowering' evaluation Evaluation as promotor of development and learning! EXPERIMENTAL RESEARCH ON THE INTERVENTION'S EFFECT: Control group design & randomization (RCT) Individual level and work unit level? Commitment of the participants? Management of turbulence and flexibility at workplace Effect as confirmation of theory ! Manualization of the intervention! Intervention project as a consultative task and as scientific research

5. Impact of Psychosocial Interventions: From research to good practice © Anna-Liisa Elo 5 Degree of consensus on the direction of goals Knowledge about mechanisms of the effect Multifaceted evaluation/ interpretative models Standard or goal evaluation Effectiveness evaluation Selection of evaluation model (Pollit 1991)

6. Impact of Psychosocial Interventions: From research to good practice © Anna-Liisa Elo 6 Evaluation of reaserch methodology (Murphy 1996) *Evidence is based on description, anecdotal data, or authority **Evidence has been obtained without interventions but it is based on significant results ***Evidence has been obtained without control group and randomization but it is based on evaluation ****Evidence is based on adequate research with control group design but without randomization *****Evidence in based on adequate study design including randomized control group

7. Impact of Psychosocial Interventions: From research to good practice © Anna-Liisa Elo 7 Criteria of success of psychosocial interventions at work? Improved Health and wellbeing (Psychosocial) working conditions Professional competence Leadership & management Organizational performance etc.

8. Impact of Psychosocial Interventions: From research to good practice © Anna-Liisa Elo 8 Success factors of work stress interventions 1.Stepwise and systematic approach 2.Adequate "diagnosis" or risk assessment 3.Work-oriented and individual oriented measures should be combined 4.Participative approach. Especially middle-management and employees should be involved 5.Support of top management (Kompier & Cooper 1999, Kompier et al. 2000)

9. Impact of Psychosocial Interventions: From research to good practice © Anna-Liisa Elo Impact of Psychosocial Interventions: From research to good practice/Anna-Liisa Elo / 11.9.20149 Psychosocial interventions in Public Works Organization of Helsinki City Lessions learned 1997-2008

10. Impact of Psychosocial Interventions: From research to good practice © Anna-Liisa Elo 10 Interventions: Survey-feedback in work units Individual feedback on wellbeing Participative work conferences Group psychodynamic ledership training Other minor intervetnions and training in different units Registering of all participation (0.5 days) Evaluation themes: Situational factors Effectiveness Learning Future effects Methods Pre- and post measurements Interviews Evaluation seminar Documents PROGRAM (n=1800) EVALUATION STEERING GROUPS 19992001 IMPLEMENTATION Program-team, Personnel representatives, Consultants IMPLEMENTATION Researchers, Program-team Psychosocial interventions: Evaluation and effect studies in the Public Works of Helsinki in 1997-2001 ja 2006-2008 2006 ANALYSIS OFNEEDSANALYSIS OFNEEDS PRE-MEASUREMENTPRE-MEASUREMENT POST-MEASUREMENTPOST-MEASUREMENT OTHER DATAOTHER DATA FOLLOW-UPMEASURFOLLOW-UPMEASUR INTERVIEWSINTERVIEWS Evaluation themes: Organizational development -leadership -autonomy of the unit Economic impact of the interventions Longitunal effects

11. Impact of Psychosocial Interventions: From research to good practice © Anna-Liisa Elo 11 Outcome measure: = increased = decreased Changes. All Personnel Pre-measurement n=1353 Post-measurement n=1293 Effect of work conferences. Non- supervisory employees n=525 Effect of psychodynamic leadership training on subordinates. n=145 Effect of active participation. Employees n=806 1. Overload 2. Clarity of goals 3. Job control 4. Information flow 5. Supervisor support 6. Work climate 7. Emotional exhaustion 8. Work ability 9. Management interested in well- being Repeated measures ANCOVA, Models adjusted for demographics, and participation in other interventions. 10. Job security 11. Sickness absenteeism

12. Impact of Psychosocial Interventions: From research to good practice © Anna-Liisa Elo Impact of Psychosocial Interventions: From research to good practice/Anna-Liisa Elo / 11.9.201412

13. Impact of Psychosocial Interventions: From research to good practice © Anna-Liisa Elo 13 LESSONS LEARNED: Implementation Success factors: –Internal WHP-team; Data collection process –Persistence & national awards –Commitment of the management and other key-persons Drawbacks: –Committing entire personnel –Respecting earlier/on-going projects –Earlier conflicts in some work units

14. Impact of Psychosocial Interventions: From research to good practice © Anna-Liisa Elo 14 LESSONS LEARNED: Evaluation strategy Success factors: –Combining effect study design and program evaluation approach –Empovering evaluation & feedback process –Realistic financing of the intervention and evaluation research Drawbacks: –Randomization of the study groups –Registering of improvements on unit level

15. Impact of Psychosocial Interventions: From research to good practice © Anna-Liisa Elo 15 LESSSONS LEARNED: The actors When the intervention effects are weak or controversial, the participants may be disappointed As the evaluation cannot concern all possible effects, the decision makers and consultants may be disappointed As the study design does not hold, the researchers may be frustrated As concise reporting and publishing of a long- lasting extensive program is difficult, important experience may remain unpublished

16. Impact of Psychosocial Interventions: From research to good practice © Anna-Liisa Elo 16 LESSONS LEARNED: Expectations and reality Intervention effects were weaker than expected: –Intervention theory & implementation? –Organizational flexibility & study design? –Maintaining a long-running process? Unobserved positive effects? –Limited scope of outcome measures neglected possible effects on e.g. organizational performance and intellectual capital

17. Impact of Psychosocial Interventions: From research to good practice © Anna-Liisa Elo 17 Psychosocial interventions and organizational performance/productivity Wellbeing and performance are associated. However, especially in mental work research results vary (modifiers: commitment, time pressures, personality etc.) ( Jacobs et al. 2007 ) Profits have been gained through reduced sickness absenteeism and improved performance ( subjective eval.) ( Ervasti, Elo 2006 ) A participative psychosocial intervention may turn into an organizational performance intervention especially during economic pressure ( Ervasti et al. 2006 ) Economic situation of the unit/organization moderates the effects of a psychosocial intervention ( Elo et al. 2007 )

18. Impact of Psychosocial Interventions: From research to good practice © Anna-Liisa Elo 18 Associations of Climate Surveys and Psychosocial Interventions with Human Resource Management and Well-being at Work (n=2007, national representative data) HRM: -Interaction structures at work -Personnel training -Investments in Occupational Health Care -Well-being -Psychosocial Work Environment Control variables: line of business; number of personnel at the organization; SES of the respondent Climate Survey (70%) Psychosocial Intervention (58%)

19. Impact of Psychosocial Interventions: From research to good practice © Anna-Liisa Elo 19 SUMMARY OF RESULTS: climate surveys and psychosocial interventions at Finnish work places Both organizational Climate Surveys and Psychosocial Interventions were associated with good HRM Organizational Climate Surveys did not have any main effects on wellbeing or psychosocial work environment Psychosocial Interventions had a positive main effect on well-being Interaction effects: –Climate Surveys were associated with poorer psychosocial work environment than "no-actions" (no survey, no intervention) –Psychosocial Intervention improved the (negative) effects of Climate Surveys Cross-sectional study design: Logistic regressions, two-way ANOVA (Elo et al. 2007)

20. Impact of Psychosocial Interventions: From research to good practice © Anna-Liisa Elo 20...towards good practice Good intervention process ( diagnosis, stepwise approach, participation, individ. & org. orientation, top management support ) Link to risk assessment (monitoring & audit) Clear goals and values: quality of working life and wellbeing National & EU-policy should support the increasing of intellectual capital which includes worker's health and wellbeing All interventions are not (cost)-effective but there are various ways to succeed!

21. Impact of Psychosocial Interventions: From research to good practice © Anna-Liisa Elo Impact of Psychosocial Interventions: From research to good practice/Anna-Liisa Elo / 11.9.201421 Thank you for your attention anna-liisa.elo@ttl.fi