- Email: [email protected]
Promotion of work ability at company level
International Congress Series 1280 (2005) 386 – 391
www.ics-elsevier.com
Promotion of work ability at company level Intention and performance, dreams and realities J. Nielsena,T, A. Andreasenb, A. Alexanderb a
Department of Occupational Medicine, Slagelse Hospital, Denmark b Centre of Work Environment, Elsinore, Denmark
Abstract. The study examined how well the written policies of retaining employees at work were in accordance with the local management’s attitudes, decisions, and activities. The management and employees at an ageing care centre answered a work ability questionnaire. A total of 189 of 289 participated and, among them, 67 were identified as vulnerable, which meant they had moderate or severe reduced work ability. 12 vulnerable employees were interviewed in depth to identify problems and discuss solutions to adjust work demand and individual resources. The implementation of the model was acceptable. However, the first year follow-up showed a gap between written policies and decisions, attitudes, and activities. It was partly explained by the organisational structure, lack of management competencies, and economic restrictions at the work place. The social security office did not initiate activities for work-active participants with deteriorated work ability. The lack of communication between the work place and the health care system was a barrier against comprehensive adjustment of work demand and individual resources. In the future, we recommend analyses of the current policies, attitudes, and activities as a basis for implementing changes in the organisation and for establishing routines for communications with relevant co-operators. D 2005 Elsevier B.V. All rights reserved. Keywords: Promotion of work ability; Retaining at work; Intervention model; Policies; Activities
1. Introduction The aim of this study was to examine the feasibility of an intervention model to promote work ability at both individual and collective levels. We expected this to facilitate the process of retaining at work. Previously, the model had been tested and proven useful T Corresponding author. Maglesoehus, Maglesoevej 9, Igelsoe, Holbæk DK 4300, Denmark. Tel.: +45 58559089. E-mail address: [email protected] (J. Nielsen). 0531-5131/ D 2005 Elsevier B.V. All rights reserved. doi:10.1016/j.ics.2005.02.093
J. Nielsen et al. / International Congress Series 1280 (2005) 386–391
387
[1,2]. In this presentation, the focus had been on how well written policies at company level were in accordance with the local management’s attitudes, decisions, and activities. External actors within this process were the health care system, the social office, and the unions. Therefore, we have examined the influence from the external actor’s attitudes, decisions, and activities in this process. 2. Population and methods The intervention model was introduced to all 289 employees at a municipal ageing care centre (ACC) through newsletters. Furthermore, the management and the representatives of the employees participated in a course in order to develop their competencies to promote the work ability of employees. The model included three tools: 1. a survey of the work environment including the self-assessed work ability of the employees through which vulnerable individuals are identified [3] 2. an interview with vulnerable individuals to identify activities needed to promote work ability 3. a work place assessment. The first two were conducted by the occupational health service centre (OHS) and the last one by ACC. To go through the intervention in a participatory way, a group was established, which included representatives from both management and employees. Furthermore, the local social security office and unions participated as advisors and cooperators. The local written policies concerning retaining of employees at the workplace were analysed by OHS. After the first year participants, key persons and external cooperators were interviewed to examine their attitudes, decisions, and activities to promote work ability and activities for retaining employees at work. 3. Results 3.1. Written policy The written policy described activities to reduce sick leave; they were supplemented with an instruction for retaining at-work activities. The work place was mentioned to be responsible for evaluating possibilities of improvement and no direct responsibility was mentioned. The internal co-operators were the employee, the local management, the head of the security committee, and the staff coach. The external co-operators were the social office, the union, and the health care system. The focus was directly allocated to the individual level and it was not easy to see the initiatives at the collective level (e.g., improvement of the work environment). The interviews showed that the policy and instructions were well known at the work place. 3.2. Implementation of the model The implementation of the model was acceptable. A total of 189 out of the 289 employees answered the questionnaire. Through the questionnaire, the 67 most vulnerable employees were identified. Among these, 12 employees were selected for in-depth examination in order
388
J. Nielsen et al. / International Congress Series 1280 (2005) 386–391
to establish plans and start activities to promote their work ability. At the follow-up, the participants expressed satisfaction with OHS as a neutral space where discussions on promoting work ability could take place before involving the management and the colleagues. However, their cooperation with the work place and the social security office was limited. 3.3. The 12 courses Through the 12 interviews, the problems were identified and possible solutions were discussed. Especially the participants were supported to initiate activities to clarify health problems and thereby know their own resources. Furthermore, through the discussions, they collected new ideas for use with different strategies to retain their work. In Table 1, the 12 participants were divided into two groups according to their pattern of contacts with OHS during the follow-up period. Group 1 included the participants who often and continuously contacted the OHS. They were younger and reported more deteriorated work ability than participants in group 2 who did not look for support by the OHS. They reported musculoskeletal disorders, which hindered some of their daily duties at work (e.g., shoulder pain hindered lift and support of patients in bed, or to push wheelchairs). The economic restrictions and limitations of flexibility of the work organisation meant that they had problems when they returned after sick leave periods because they had to work full time too early. All courses were dominated by single communication between the employee and the work place. Within group 1, the general communication lines were between the employee and the OHS, and the employee and the
Table 1 The 12 vulnerable employees—the characteristics of participants and their courses during 1 year Support from the Occupational Health Centre Age (years) Work ability index (number of employees) Severe reduced Moderate reduced Good Problems
Adjustments of demands and resources after 1 year Employment status after 1 year
Group 1 (seven participants)
Group 2 (five participants)
Continuous
At the start only
38–57
52–58
4 2 1 Current health problems had not been clarified Limited adjustments between health and work demand Not possible
0 4 1 Health
Two at work
All at work
Possible
The 10 employees had been identified through the work ability index and two of them had asked to participate. At the interview, their problems were identified and activities to promote their work ability were discussed. The course of events during 1 year was registered by an interview with the participant after 1 year.
J. Nielsen et al. / International Congress Series 1280 (2005) 386–391
389
external co-operators in order to examine possibilities (e.g., further education). Only two out of seven employees succeeded to retain their jobs. Within group 2, the employees mainly had communication lines with the management. They found solutions to stay at work (e.g., a reduced time schedule or limitation of tasks). Despite these solutions, they wanted to retire as soon as possible. 3.4. Follow-up of the 12 courses after 1 year 3.4.1. The internal co-operators After 1 year, the follow-up included an interview of the management, external cooperators, and the 12 participants. It aimed to examine the implementation of the intervention model. The focus had especially been on promoters and inhibitors of activities to retain employees at work (see Table 2). Lack of economic resources and lack of flexibility of the work organisation contributed to vulnerable employees becoming a burden to the healthy employees. The reason was, for example, that the healthy employees had to share the tasks of the returning employee until she was able to perform fully. Lack of clarification of the health problems had a negative Table 2 Summary of evaluation of the 12 courses to retain at work Internal co-operators Employee
External co-operators Management
Intention Want to stay at work Run the business Retain employee at work Attitude Worried about future Wanted persons work ability fit for fight Felt like a burden Employees had to the colleagues to fit to work tasks and social climate Adjustments were Activity Used OHS to limited to current clarify problems work organisation and to discuss and restricted due solutions; clarified the health problems; to the economic frame; examined the management possibilities of adjusting individual realised lack of resources and work competencies and resources; fired demand the employees Reality Owner of a problem Not open to after solving problems 1 year at the work place
Social security office
Health care system
People actively Health engaged at labour promotion market Reduce sick leave Patient pay Stay at work instead of social client
Fixed procedures due to political decisions; lack of experience due to new work organisation and new work method
Diagnosis and treatment
Limited cooperation No cooperation with work place and with the work other co-operators at place the early stage of deterioration of work ability
Union Secure the income
Member
Support the member during negotiations concerning salary and reduced work time
Cooperation with the work place concerning salary and establishing jobs with reduced work load
390
J. Nielsen et al. / International Congress Series 1280 (2005) 386–391
impact on the thoughts of their own possibilities. Lack of possibilities to adjust the work demands and individual resources at the work place for the youngest employees had led them to being fired. The management’s negative attitude to start activities meant that the employees experienced refusal by the local management. Especially, young employees with health problems but still at work had this experience. The situation contributed to the fact that they felt insecure and confused. Several employees had chosen sick leave as a strategy to solve their problems. Managers with positive attitudes found economic and organisational possibilities to retain their employees at work. However, they had problems initiating activities to educate and train employees, especially if they had to look for possibilities outside their department. 3.4.2. External co-operators The social office and the union were limited in support and advice when the participants were in the early phase of deterioration of work ability. At the social office, the social law and instructions according to return to work after sick leave and a pension system regulated the decisions. A new law and new instructions had resulted in reorganisation and new work methods. This had led to a shift in the values they used to evaluate the individual’s situation (e.g., shortening down the sick leave period and focusing on the individual’s resources instead of their health problems). However, the interviews showed lack of competencies to evaluate work demands and lack of activities to support the development of the individual’ resources at the early phase of deterioration of work ability. Furthermore, the social office’s activities did not included participants at work; even they were worried about future work ability due to health problems and lack of possibilities at the work place to adjust current work demand and individual resources. During the follow-up period, the reorganisation complicated communication, both internal and external. Still, the social office was responsible for managing the rules of sick leave and evaluating the applications of an early pension. Their intention was to keep people actively engaged in the labour market. Their attitude was to reduce sick leave pay (e.g., to short down sick leave pay periods and to push the persons to return to work). The union participated in negotiations concerning salary and jobs with reduced workload. Their intention was to support the members with clearly reduced work ability to get an acceptable work situation and salary. Young participants worried about their future work ability due to health problems and the lack of possibilities to adjust demand and resources at current job. The participants asked for advice and support to change the work situation. The health care system intended to promote the health of participants. They focused on diagnoses and treatments. Often the participants had single communications within the health system. There was little coordination; no routines existed to combine the knowledge of the health care system and the work place. This complicated the activities at the work place (e.g., one participant with an acute cervical slipped disc had been emphasised to participate in activities instead of a curing period and rehabilitation). This had happened because the management did not know about the risks and wanted to help her, and the management acted in accordance with their instruction for retaining the employees at work.
J. Nielsen et al. / International Congress Series 1280 (2005) 386–391
391
4. Discussion The results of the analysis of the written policies and the interviews of the key persons and the participants emphasised that a mismatch between written policies and attitudes, decisions, and activities existed. In a Danish study, the municipal institutions have been evaluated according to their policy of retaining employees at work [4]. The institutions were classified into four levels. At the first level, formulated policies existed; the work place behaved open-mindedly; and the management was active, investigative, and had a progressive attitude towards activities to retain people at work. The third level included institutions with a closed and selective attitude, and their strategy was to retain employees who fit the work tasks and social climate. The analysis of current written policy and instruction indicated the work place as level 1. However, the results of the 1-year followup of the current activities indicated that it is a level 3 institution. The mismatch between written policies and activities was partly explained by the organisational structure, lack of management competencies, and economic restrictions at the work place. It could be questioned why the work place did not involve the Occupational Health Centre at individual levels. At the social security office, the activities were directed towards participants with long-term sick leaves and early retirement, and did not contribute to the development of individual’s resources if they were still at work. The lack of communications between work place and health care system was a barrier against comprehensive solutions of adjustment of work demand and individual resources. Furthermore, the disorders of participants were not regarded as serious enough to initiate in-depth examination and treatment by the health care system, even the disorders hindered the daily activities at work. In the future, we recommend analysing current policies, attitudes, and activities to promote the work ability and retaining of employees at work as a basis for implementing changes in the organisation, and establishing routines for communication with relevant cooperators. References [1] J. Nielsen, J. Dyreborg, Work Environment and Work Ability—Development and Testing a Model to Promote Work Ability at Company Level, Arbejdsmiljøra˚dets Service Center, Denmark, 2001, (in Danish with English summary). [2] J. Nielsen, J. Dyreborg, Intervention model for promotion of work ability at company level—prerequisites and procedure for the use of it, Promotion of Health Through Ergonomic Working and Living Conditions, Nordic Ergonomics Society; 33 Annual Congress, University of Tampere, Finland, 2001, pp. 435 – 439. [3] K. Tuomi, et al., Work Ability Index, Finnish Institute of Occupational Health, Helsinki, 1998. [4] H. Hansen, S. Ipsen, M. Juul, Rummelighed pa˚ kommunale arbejdspladser. Casa rapport, København, 2002 (in Danish).
www.ics-elsevier.com
Promotion of work ability at company level Intention and performance, dreams and realities J. Nielsena,T, A. Andreasenb, A. Alexanderb a
Department of Occupational Medicine, Slagelse Hospital, Denmark b Centre of Work Environment, Elsinore, Denmark
Abstract. The study examined how well the written policies of retaining employees at work were in accordance with the local management’s attitudes, decisions, and activities. The management and employees at an ageing care centre answered a work ability questionnaire. A total of 189 of 289 participated and, among them, 67 were identified as vulnerable, which meant they had moderate or severe reduced work ability. 12 vulnerable employees were interviewed in depth to identify problems and discuss solutions to adjust work demand and individual resources. The implementation of the model was acceptable. However, the first year follow-up showed a gap between written policies and decisions, attitudes, and activities. It was partly explained by the organisational structure, lack of management competencies, and economic restrictions at the work place. The social security office did not initiate activities for work-active participants with deteriorated work ability. The lack of communication between the work place and the health care system was a barrier against comprehensive adjustment of work demand and individual resources. In the future, we recommend analyses of the current policies, attitudes, and activities as a basis for implementing changes in the organisation and for establishing routines for communications with relevant co-operators. D 2005 Elsevier B.V. All rights reserved. Keywords: Promotion of work ability; Retaining at work; Intervention model; Policies; Activities
1. Introduction The aim of this study was to examine the feasibility of an intervention model to promote work ability at both individual and collective levels. We expected this to facilitate the process of retaining at work. Previously, the model had been tested and proven useful T Corresponding author. Maglesoehus, Maglesoevej 9, Igelsoe, Holbæk DK 4300, Denmark. Tel.: +45 58559089. E-mail address: [email protected] (J. Nielsen). 0531-5131/ D 2005 Elsevier B.V. All rights reserved. doi:10.1016/j.ics.2005.02.093
J. Nielsen et al. / International Congress Series 1280 (2005) 386–391
387
[1,2]. In this presentation, the focus had been on how well written policies at company level were in accordance with the local management’s attitudes, decisions, and activities. External actors within this process were the health care system, the social office, and the unions. Therefore, we have examined the influence from the external actor’s attitudes, decisions, and activities in this process. 2. Population and methods The intervention model was introduced to all 289 employees at a municipal ageing care centre (ACC) through newsletters. Furthermore, the management and the representatives of the employees participated in a course in order to develop their competencies to promote the work ability of employees. The model included three tools: 1. a survey of the work environment including the self-assessed work ability of the employees through which vulnerable individuals are identified [3] 2. an interview with vulnerable individuals to identify activities needed to promote work ability 3. a work place assessment. The first two were conducted by the occupational health service centre (OHS) and the last one by ACC. To go through the intervention in a participatory way, a group was established, which included representatives from both management and employees. Furthermore, the local social security office and unions participated as advisors and cooperators. The local written policies concerning retaining of employees at the workplace were analysed by OHS. After the first year participants, key persons and external cooperators were interviewed to examine their attitudes, decisions, and activities to promote work ability and activities for retaining employees at work. 3. Results 3.1. Written policy The written policy described activities to reduce sick leave; they were supplemented with an instruction for retaining at-work activities. The work place was mentioned to be responsible for evaluating possibilities of improvement and no direct responsibility was mentioned. The internal co-operators were the employee, the local management, the head of the security committee, and the staff coach. The external co-operators were the social office, the union, and the health care system. The focus was directly allocated to the individual level and it was not easy to see the initiatives at the collective level (e.g., improvement of the work environment). The interviews showed that the policy and instructions were well known at the work place. 3.2. Implementation of the model The implementation of the model was acceptable. A total of 189 out of the 289 employees answered the questionnaire. Through the questionnaire, the 67 most vulnerable employees were identified. Among these, 12 employees were selected for in-depth examination in order
388
J. Nielsen et al. / International Congress Series 1280 (2005) 386–391
to establish plans and start activities to promote their work ability. At the follow-up, the participants expressed satisfaction with OHS as a neutral space where discussions on promoting work ability could take place before involving the management and the colleagues. However, their cooperation with the work place and the social security office was limited. 3.3. The 12 courses Through the 12 interviews, the problems were identified and possible solutions were discussed. Especially the participants were supported to initiate activities to clarify health problems and thereby know their own resources. Furthermore, through the discussions, they collected new ideas for use with different strategies to retain their work. In Table 1, the 12 participants were divided into two groups according to their pattern of contacts with OHS during the follow-up period. Group 1 included the participants who often and continuously contacted the OHS. They were younger and reported more deteriorated work ability than participants in group 2 who did not look for support by the OHS. They reported musculoskeletal disorders, which hindered some of their daily duties at work (e.g., shoulder pain hindered lift and support of patients in bed, or to push wheelchairs). The economic restrictions and limitations of flexibility of the work organisation meant that they had problems when they returned after sick leave periods because they had to work full time too early. All courses were dominated by single communication between the employee and the work place. Within group 1, the general communication lines were between the employee and the OHS, and the employee and the
Table 1 The 12 vulnerable employees—the characteristics of participants and their courses during 1 year Support from the Occupational Health Centre Age (years) Work ability index (number of employees) Severe reduced Moderate reduced Good Problems
Adjustments of demands and resources after 1 year Employment status after 1 year
Group 1 (seven participants)
Group 2 (five participants)
Continuous
At the start only
38–57
52–58
4 2 1 Current health problems had not been clarified Limited adjustments between health and work demand Not possible
0 4 1 Health
Two at work
All at work
Possible
The 10 employees had been identified through the work ability index and two of them had asked to participate. At the interview, their problems were identified and activities to promote their work ability were discussed. The course of events during 1 year was registered by an interview with the participant after 1 year.
J. Nielsen et al. / International Congress Series 1280 (2005) 386–391
389
external co-operators in order to examine possibilities (e.g., further education). Only two out of seven employees succeeded to retain their jobs. Within group 2, the employees mainly had communication lines with the management. They found solutions to stay at work (e.g., a reduced time schedule or limitation of tasks). Despite these solutions, they wanted to retire as soon as possible. 3.4. Follow-up of the 12 courses after 1 year 3.4.1. The internal co-operators After 1 year, the follow-up included an interview of the management, external cooperators, and the 12 participants. It aimed to examine the implementation of the intervention model. The focus had especially been on promoters and inhibitors of activities to retain employees at work (see Table 2). Lack of economic resources and lack of flexibility of the work organisation contributed to vulnerable employees becoming a burden to the healthy employees. The reason was, for example, that the healthy employees had to share the tasks of the returning employee until she was able to perform fully. Lack of clarification of the health problems had a negative Table 2 Summary of evaluation of the 12 courses to retain at work Internal co-operators Employee
External co-operators Management
Intention Want to stay at work Run the business Retain employee at work Attitude Worried about future Wanted persons work ability fit for fight Felt like a burden Employees had to the colleagues to fit to work tasks and social climate Adjustments were Activity Used OHS to limited to current clarify problems work organisation and to discuss and restricted due solutions; clarified the health problems; to the economic frame; examined the management possibilities of adjusting individual realised lack of resources and work competencies and resources; fired demand the employees Reality Owner of a problem Not open to after solving problems 1 year at the work place
Social security office
Health care system
People actively Health engaged at labour promotion market Reduce sick leave Patient pay Stay at work instead of social client
Fixed procedures due to political decisions; lack of experience due to new work organisation and new work method
Diagnosis and treatment
Limited cooperation No cooperation with work place and with the work other co-operators at place the early stage of deterioration of work ability
Union Secure the income
Member
Support the member during negotiations concerning salary and reduced work time
Cooperation with the work place concerning salary and establishing jobs with reduced work load
390
J. Nielsen et al. / International Congress Series 1280 (2005) 386–391
impact on the thoughts of their own possibilities. Lack of possibilities to adjust the work demands and individual resources at the work place for the youngest employees had led them to being fired. The management’s negative attitude to start activities meant that the employees experienced refusal by the local management. Especially, young employees with health problems but still at work had this experience. The situation contributed to the fact that they felt insecure and confused. Several employees had chosen sick leave as a strategy to solve their problems. Managers with positive attitudes found economic and organisational possibilities to retain their employees at work. However, they had problems initiating activities to educate and train employees, especially if they had to look for possibilities outside their department. 3.4.2. External co-operators The social office and the union were limited in support and advice when the participants were in the early phase of deterioration of work ability. At the social office, the social law and instructions according to return to work after sick leave and a pension system regulated the decisions. A new law and new instructions had resulted in reorganisation and new work methods. This had led to a shift in the values they used to evaluate the individual’s situation (e.g., shortening down the sick leave period and focusing on the individual’s resources instead of their health problems). However, the interviews showed lack of competencies to evaluate work demands and lack of activities to support the development of the individual’ resources at the early phase of deterioration of work ability. Furthermore, the social office’s activities did not included participants at work; even they were worried about future work ability due to health problems and lack of possibilities at the work place to adjust current work demand and individual resources. During the follow-up period, the reorganisation complicated communication, both internal and external. Still, the social office was responsible for managing the rules of sick leave and evaluating the applications of an early pension. Their intention was to keep people actively engaged in the labour market. Their attitude was to reduce sick leave pay (e.g., to short down sick leave pay periods and to push the persons to return to work). The union participated in negotiations concerning salary and jobs with reduced workload. Their intention was to support the members with clearly reduced work ability to get an acceptable work situation and salary. Young participants worried about their future work ability due to health problems and the lack of possibilities to adjust demand and resources at current job. The participants asked for advice and support to change the work situation. The health care system intended to promote the health of participants. They focused on diagnoses and treatments. Often the participants had single communications within the health system. There was little coordination; no routines existed to combine the knowledge of the health care system and the work place. This complicated the activities at the work place (e.g., one participant with an acute cervical slipped disc had been emphasised to participate in activities instead of a curing period and rehabilitation). This had happened because the management did not know about the risks and wanted to help her, and the management acted in accordance with their instruction for retaining the employees at work.
J. Nielsen et al. / International Congress Series 1280 (2005) 386–391
391
4. Discussion The results of the analysis of the written policies and the interviews of the key persons and the participants emphasised that a mismatch between written policies and attitudes, decisions, and activities existed. In a Danish study, the municipal institutions have been evaluated according to their policy of retaining employees at work [4]. The institutions were classified into four levels. At the first level, formulated policies existed; the work place behaved open-mindedly; and the management was active, investigative, and had a progressive attitude towards activities to retain people at work. The third level included institutions with a closed and selective attitude, and their strategy was to retain employees who fit the work tasks and social climate. The analysis of current written policy and instruction indicated the work place as level 1. However, the results of the 1-year followup of the current activities indicated that it is a level 3 institution. The mismatch between written policies and activities was partly explained by the organisational structure, lack of management competencies, and economic restrictions at the work place. It could be questioned why the work place did not involve the Occupational Health Centre at individual levels. At the social security office, the activities were directed towards participants with long-term sick leaves and early retirement, and did not contribute to the development of individual’s resources if they were still at work. The lack of communications between work place and health care system was a barrier against comprehensive solutions of adjustment of work demand and individual resources. Furthermore, the disorders of participants were not regarded as serious enough to initiate in-depth examination and treatment by the health care system, even the disorders hindered the daily activities at work. In the future, we recommend analysing current policies, attitudes, and activities to promote the work ability and retaining of employees at work as a basis for implementing changes in the organisation, and establishing routines for communication with relevant cooperators. References [1] J. Nielsen, J. Dyreborg, Work Environment and Work Ability—Development and Testing a Model to Promote Work Ability at Company Level, Arbejdsmiljøra˚dets Service Center, Denmark, 2001, (in Danish with English summary). [2] J. Nielsen, J. Dyreborg, Intervention model for promotion of work ability at company level—prerequisites and procedure for the use of it, Promotion of Health Through Ergonomic Working and Living Conditions, Nordic Ergonomics Society; 33 Annual Congress, University of Tampere, Finland, 2001, pp. 435 – 439. [3] K. Tuomi, et al., Work Ability Index, Finnish Institute of Occupational Health, Helsinki, 1998. [4] H. Hansen, S. Ipsen, M. Juul, Rummelighed pa˚ kommunale arbejdspladser. Casa rapport, København, 2002 (in Danish).