1. Interventions to improve psychosocial work environment. Research challenges and solutions Martin L. Nielsen National Institute of Occupational Health, Copenhagen, Denmark ICOH 2003, Free paper session 35.4, Feb. 26

2. Intervention Project on Absence and Well-being IPAW A controlled study of the effect on absence of interventions to improve the psycho- social aspects of work environment

3. 51 Workplaces in IPAW Municipality of Copenhagen –15 Nursing homes for the elderly –7 Institutions for mentally handicapped –16 “Technical services” (workshops, roadworkers, cemeteries, parks, etc.) Pharmaceutical company –5 Production units –3 Laboratories –5 Catering and cleaning departments

4. Project plan for IPAW High absence n=1181 N=22 High absence n=535 N=14 Low absence n=351 N=15 Intervention 12345 Years ???? 0 Follow-up by registers

5. What happened in IPAW? 51 work- places 22 inter- vention 29 com- parison 3 closed 3 gave up 5 closed 16 implemented interventions 24 left for comparison

6. Intervention Strategy I Organization –Working groups at the workplaces –Process consultants –Researchers not present Problem mapping –Baseline questionnaire –Interviews by consultants –Existing problems and knowledge at workplace

7. Intervention Strategy II Prioritizing –Working group –Workplace meetings –Support by process consultants Plans and action –Working group/subgroups –Workplace meetings –Support by process consultants

8. Psychosocial factors at work = Intervention targets in IPAW Organizational, not individual level! Psychological demands Influence/decision authority Possibilities for development/skill discretion Social support from management Social support from colleagues Meaningfulness of work Information/predictability

9. Examples of interventions Self-governing groups Softening strict divisions of tasks Education and training of supervisors Increased worker participation in decisions Improving management, communication, co-operation, influence, support, information etc.

10. Examples of resistance to change Workers: –”If absence is reduced, colleagues will be fired” –”Just another useless management initiative” Supervisors: –”Are the working groups going to take the decisions I used to take?” Management: –”The project will cost many unproductive work-hours”

11. Answers to resistance I Workers’ fear of cutbacks and firings –Agreements, that savings are used for further improvements of work environment Workers’ expectations of useless project –This is not like earlier, half-hearted projects – in this project, we take the workers proposals seriously

12. Answers to resistance II Supervisors’ fear for loss of power –Supervisor competencies are not changed – better dialogue provide better basis of decisions Supervisors’ fear of redundancy –Education and training of supervisors for new role – more motivation and support, less control and orders

13. Easy to say – hard to do What are the challenges? Workplaces and consultants –Keep the promises –Convince the workers –Meet criticism openly, react properly Researchers –Wholehearted workplace participation –Alliance with workers AND management on common interest

14. Common recommendations Diagnosis before cure –Proper analysis of problems before discussion of solutions. No solutions fits all Learn from critique –Resistance often has good reasons – listen, and improve the solutions and results Local ownership of change –If the project is perceived to be for the sake of researchers or consultants – no enthusiasm –All parties must gain to support the project

15. Psychosocial work environment interventions reduced absence Martin L. Nielsen, Tage S. Kristensen, Lars Smith-Hansen National Institute of Occupational Health, Copenhagen, Denmark ICOH 2003, Free paper session 35.5, Feb. 26

16. 5.3 Legend 1.Managers and academics 2.Higher salaried workers 3.Middle salaried workers 4.Skilled workers 5.Lowest salaried workers 6.Unskilled workers 8.4 14.8 13.2 17.0  Absence days pr. year Absence days per year by social status Mean 12.7 11.0 Absence days per year by social statusAbsence days per year by social status

17. Psychosocial work environment and absence  Absence days pr. year Psychosocial work environment (decision authority, skill discretion, meaning) 10.8 13.5 15.5 Mean 12.7 Psychosocial work environment and absence Workplace means

18. Development in absence days at intervention and comparison workplaces  Absence days pr. year 11.1 15.3 12.8 11.4 Development in absence days at inter- vention and comparison workplaces

19. Development of absence in employees with reduces work ability Development of absence in employees with reduced work ability Absence days pr. year    Best psychosocial work environment at baseline Middle psychosocial work environment at baseline Poorest psychosocial work environment at baseline Intervention workplaces 18.3 47.6 39.2 56.6 11.3 15.5 11.0 36.6 15.8 19.6 9.4 40.3 Comparison workplaces

20. The presentations can be seen and downloaded at: www.ami.dk/presentations For baseline results, read: Nielsen, M.L., Kristensen, T.S., Smith-Hansen, L. The Intervention Project on Absence and Well-being (IPAW): Design and re- sults from the baseline of a 5-year study. Work & Stress 2002; 16,3:191-206. Contact e-mail: mln@ami.dk