Hi I would like you to write me 2 pages reflection paper on stress management. My class called Engineering organization development, and I'm in the third module called " Organization ". In this module

Some of the author s of this public ation are also w orking on these r elated pr ojects: On-Call Work and Sleep Vie w pr oject Rec over y fr om w ork str ess: Int egr ating per spectives of work and envir onmental psycholog y Vie w pr oject Michiel A J K ompier Radboud Univ ersity 203 PUBLICA TIONS    10,600 CITATIONS     SEE PROFILE Car y Cooper The Univ ersity of Manchest er 1,264 PUBLICATIONS    39,264 CITATIONS     SEE PROFILE Sabine Geurts R adboud Univ ersity 150 PUBLICA TIONS    7,160 CITATIONS     SEE PROFILE All c ontent f ollowing this p age w as uplo aded by Michiel A J K ompier on 02 July 2014. The user has requested enhanc ement of the do wnloaded file. WORK STRESS PREVENTI ON 371 © 2000 Psychology Press Lt d http: //www.tandf.co.uk /journals /pp /1359432X.htm l EUROPEAN JOURNAL OF WORK AND ORGANIZATIONAL PSYCHOLOGY, 2000, 9 (3), 371 – 40 0 A multiple case study approach to work stres s prevention in Europ e Michiel A.J. Kompie r Work and Organizational Psychology, University of Nijmegen , The Netherland s Cary L. Coope r University of Manchester Institute of Science and Technology , Manchester, UK Sabine A.E. Geurt s Work and Organizational Psychology, University of Nijmegen , The Netherland s Work stress has become a major issue among European employees. The curren t practice of its prevention seems disappointing, as work stress prevention pro - grammes are predominantly reactive and biased to the individual. The lack of organization-level intervention studies is a barrier to progress in reducin g work-related stress. In addition to the “ true experimental approach ” , multiple cas e studies may provide an adequate research strategy for addressing the potentia l impact of stress interventions in organizations. The study aim was to obtain mor e knowledge with respect to evidence-based work stress prevention in Europe, by focusing on both content (cause – effect relationships) and process (“ how ” ). Therefore it was decided: (1) to collect from each European Union member state a work stress intervention study; (2) to analyse each of these cases as to content an d process factors; and (3) to systematically compare these studies in a step-by-ste p approach. Through a network approach, 11 cases were identified. Nine project s received an acceptable methodological standard and were included in this study . Evaluation of these cases reveals that stress prevention is no “ one time event ” , no r merely a technical process. It is concluded that “ true prevention ” (i.e., preventiv e measures that are based on an adequate diagnosis identifying risk factors and ris k groups, which theoretically and logically fit in with the problems, and which ar e introduced and implemented in a proper way) may be beneficial to both th e employee and the organization . Requests for reprints should be addressed to M.A.J. Kompier, Department of Work an d Organizational Psychology, University of Nijmegen, Montessorilaan 3, 6525 HR Nijmegen, Th e Netherlands. Email: [email protected] l 372 KOMPIER, COOPER, GEURT S Due to the changing context and nature of work, work stress has become a common phenomenon for a growing number of European employees (Geurts & Gr ü ndemann, 1999). An extensive survey among a representative sample of 15,800 workers from 15 European Union member states (Paoli, 1997), reveale d that 28% of the European work force reported work-related stress complaints , and 20% reported overall fatigue as a work-related health problem. Whe n comparing the results of this survey with a similar study five years earlier (Paoli , 1992), time constraints in particular have increased sharply: A growing numbe r of European workers are spending most of their working time performin g high-speed work (35% in 1991 and 43% in 1996) and work with tight deadline s (1991: 38%; 1996: 45%). With the exception of Germany and Greece, thi s increasing work pace is perceived in all European Union member states. Th e highest number of workers to experience high-speed work is found in th e Netherlands. The study by Paoli (1997) further showed that at present for th e majority of workers (67%) the work pace is dictated more by customers an d clients than by machines (22%). This directly relates to the growing number of workers in the service sector (59% in 1991; 63% in 1996) . Stimulated by this increase in work stress and by the introduction of th e European Framework Directive on Safety and Health of Employees at Work (1 2 June 1989), there is an increasing interest at governmental level (both nationa l and European) in reducing workplace absenteeism and work disability due to adverse (psychosocial) working conditions and work stress (Geurts & Gr ü ndemann, 1999; Gr ü ndemann & Van Vuuren, 1997). In 2000, for example , the European Commission will issue “ Guidance on Work-Related Stress ” . On a global level as well, it has been widely recognized that improving th e psychosocial work environment may be an important step in improvin g employee health and organizational productivity (Griffiths, 2000; WHO, 1999) . Given the impressive body of knowledge that demonstrates adverse healt h effects of certain (combinations of) psychosocial work characteristics (e.g., Cox , 1988, 1993; Karasek & Theorell, 1990; Marmot, Siegrist, Theorell, & Feeney , 1999; Quick, Quick, Nelson, & Hurrell, 1997; Schaufeli & Enzmann, 1998 ; Siegrist, 1998; Uehata, 1991), and given the legal emphasis on risk assessmen t and risk management (“ rooting out the risks ” ), one might expect a flourishin g field of research into organizational-level stress interventions, i.e., studies tha t aim at changing work in order to make it less stressful. This, however, is not th e case. There is a large gap between theory and practice, as follows from an overview of the last two decades in the field of work stress prevention, that is , after the pioneering work of Newman and Beehr (1979). Based on the literatur e (see e.g., Cooper & Payne, 1998; C ox, 1993; DeFrank & Cooper, 1987; Kahn & Byosiere, 1992; Kompier, Geurts, Gr ü ndemann, Vink, & Smulders, 1998 ; Murphy, 1986; Van der Hek & Plomp, 1997), six interrelated conclusions may be drawn (Kompier & Kristensen, in press) : WORK STRESS PREVENTI ON 373 (1 ) Occupational stress is a rapidly expanding field and so is occupationa l stress management. There is a great deal of activity . (2 ) “ This activity is concentrated disproportionally on reducing the effects , rather than reducing the presence of stressors at work ” (Kahn & Byosiere, 1992 , p. 623). Stress reduction is primarily a “ band aid approach ” . (3 ) Related to this, the main target is the individual employee rather than th e workplace or the organization. Most programmes aim at the reduction of th e cognitive appraisal of stressors and their subsequent effects, rather than at th e reduction or elimination of the stressors themselves . (4 ) The majority of stress management programmes has a “ one size (or on e pill) fits all ” character. Many practitioners offer sovereign remedies regardless of the presenting symptoms (Kahn & Byosiere, 1992), which stands in the way of a systematic risk assessment (“ stress audit ” , “ stress analysis ” ) identifying ris k factors and risk groups. Such a systematic analysis is often lacking in stres s intervention studies . (5 ) There is a lack of evaluation research, and of strong designs in evaluatio n research. M any interventions are not evaluated in a systematic way, and, in cas e of evaluations, study designs are often characterized by serious methodologica l flaws. (6 ) Finally, the role of contextual and process variables, such as th e introduction and implementation of measures receives insufficient attention in evaluation research and in the literature. The “ true experimental approach “ — with its emphasis on control over important variables, on the random allocatio n of subjects to treatment or control groups and on identifying causal connection s between treatment (interventions) and effect — focuses attention on “ outcome ” at the expense of “ process ” (Griffiths, 2000). To elaborate on this final conclusion , we have to take into account that in organizations stress interventions are “ socia l experiments ” , in which researchers are guests, not autocrats, and wherein causa l relations are not simple but embedded within complex contexts (Griffiths, 2000 , p. 590).

In these contexts people have ambitions, attitudes, preferences, and individua l and collective interests. These contexts influence relations between intervention s and outcomes. Traditional stimulus – response schemata do not take into accoun t that the “ people under study ” (employees, supervisors, managers) are not passiv e study objects, but active organizers of their own working situation (Kompier & Kristensen, in press). Stress intervention research that focuses exclusively on th e relations between stimuli and responses (i.e., interventions and outcomes) limit s our understanding of the (impact) of stress interventions in field settings. In th e same vein, Goldenhar and Schulte (1994) conclude that the complexity of phenomena in occupational health intervention studies also means that inter - vention researchers should focus more on the process and the milieu of an intervention and not only on the outcomes (p. 770). With respect to wor k 374 KOMPIER, COOPER, GEURT S redesign, Parker and Wall (1998), while reviewing key issues for future research , arrive at a comparable conclusion: “ To this point we suggest a greater use of qualitative approaches to allow a better understanding of the complex, and ofte n highly political, dynamics that are involved in work redesign. We also advocat e the wider reporting of “ process issues ” (in most published work design studies , the focus is on outcomes rather than process) ” (p. 137). In a similar vein , Ovretweit (1998), while discussing the evaluations of health interventions , concludes: “ Traditional experimental evaluation design is not well suited to investigating social systems or the complex way in which interventions wor k with subjects or their environment ” (p. 99) . Given this somewhat disappointing present status of the core of stres s intervention research, it is still hard to provide answers to questions such as : Does work stress prevention work? Which programme types and components ar e effective, and which are not? Why do certain components work? And, how do they work, i.e., by which underlying mechanisms? Which are intended an d unintended side-effects? What are costs, benefits and limitations? What ar e stimulating and obstructing factors? This present situation is well summarized by Griffiths, Cox, and Barlow (1996): “ The lack of evaluation of such intervention s is a major problem and a significant barrier to progress in reducing work-relate d stress ” (p. 66) . A valuable research strategy to diminish this barrier is to collect data befor e and after some relevant change or intervention in the work situation (e.g., Parkes , 1982). As Kasl (1978) and Parkes (1982) emphasized, longitudinal studies of thi s type, designed as natural experiments around significant events and transitions , are more likely to throw light on causal relationships than are cross-sectiona l studies of stable work environments. Still, such natural experiments face thei r own threats to internal validity (such as history, maturation, selection, testing , statistical regression, mortality, competition by people receiving no treatment , and diffusion of treatments), and to external validity (e.g., interaction of selectio n and treatment) (see, for an overview, Beehr & O’ Hara, 1987; Yin, 1994) . Methodologically, this study approach fits in the tradition of the multiple cas e study (Yin, 1994). The case study has long been stereotyped as “ a weak siblin g among social science methods ” (Yin, 1994, p. xiii). This is not correct. A multiple case study approach is the adequate research strategy “ when how an d why questions are being posed, when the investigator has little control ove r events, and when the focus is on a contemporary phenomenon within som e real-life context ” (Yin, 1994, p. 1). The study of the impact of occupationa l stress interventions fits this definition, with occupational stress being th e “ contemporary phenomenon ” , and with “ how or why ” questions that are pose d with respect to its prevention. In terms of Yin ’ s definition, the organization is th e “ real-life context ” , in which stress researchers are guests with restricted “ contro l over events ” , since interventions take place in a dynamic and often quickl y changing context . WORK STRESS PREVENTI ON 375 In multiple case studies, research data can be treated cumulatively. Multipl e cases should be considered as multiple experiments or multiple surveys (i.e. , follow a replication logic), instead of as multiple respondents in a survey (Yin , 1994). Accordingly, the method of generalization is “ analytic generalization ” and not “ statistical generalization ” . In statistical generalization, inferences ar e made about a population on the basis of empirical data collected about a sample . Cases do not represent a “ sample ” : They are generalizable to theoretica l propositions and not to populations. Such a theoretical proposition, for example , is that increasing job control will reduce health complaints, or that the intro - duction of team-based work will increase the motivation for learning ne w behaviour patterns and productivity. This research strategy has also bee n characterized “ plausible rival hypothesis ” (Campbell, 1994), and is quite simila r to principles used in criminological investigations (Yin, 1994). As for the court , in stress intervention research “ full proof ” of (causal) relationships, for exampl e regarding the relationship between work redesign and sickness absenteeism, is hard to give. The essence of “ plausible rival hypothesis ” is that a researcher , similar to a prosecutor or lawyer, systematically brings up arguments and draw s conclusions with respect to plausibility by searching for converging (e.g. , triangulation) and diverging evidence (i.e., competing causes or artefacts tha t may otherwise account for the observed outcomes; see also Beehr & O'Hara , 1987, p. 82; Zapf, Dormann, & Frese, 1996, p. 147) . Summarizing, we have argued that (1) work stress has become a major issu e among European employees; (2) the current practice of its prevention seem s disappointing, as work stress prevention programmes are predominantly reactiv e and biased to the individual; (3) the lack of organizational-level interventio n studies is a significant barrier to progress in reducing work-related stress ; (4) the “ true experimental approach ” is very difficult to transfer to the practica l reality of modern quickly changing organizations and tends to focus attentio n on outcomes at the expense of process; and (5) in addition to this “ tru e experimental approach ” , multiple case studies may provide an adequate researc h strategy for addressing the potential impact of stress interventions in organizations. Hence the major purpose of this study is to contribute to both stress researc h and practice by reducing the gap between both fields. M ore in particular the stud y aim was to obtain more knowledge with respect to evidence-based work stres s prevention in Europe, through the study of multiple cases in prevention by focusing on both content (cause – effect relationships) and on process (“ how ” ). Therefore it was decided : (1 ) to collect from each European Union member state a work stres s intervention stud y (2 ) to analyse each of these cases as to content and process factor s (3 ) to systematically compare these studies, in a step-by-step approach . 376 KOMPIER, COOPER, GEURT S M E T HO D S Se lecti o n o f cas e s We tried to find (teams of) national experts in occupational stress and it s prevention in all European Union member states, with the exception of Luxembourg. Through a network approach (teams of) national experts wer e identified in 14 countries: Finland, The Netherlands, Belgium, United Kingdom , Denmark, Sweden, Germany, Ireland, Portugal, Greece, Italy, Austria, France , and Spain. Each of the (teams of) national experts was asked to identify an d present a national case study in stress prevention. Specialists from Austria , France, and Spain could not identify and present such a case study. This resulte d in 11 case studies. Selection criteria for inclusion in the present study were : (1 ) A prevention and intervention programme had to be carried out . (2 ) Cases should meet a minimum methodological standard. We followed th e research design rating proposed by Murphy (1996), who differentiated betwee n five research design ratings : (a ) evidence that is descriptive, anecdotal or authorative (* ) (b ) evidence obtained without intervention but that might includ e long-term or dramatic results from general dissemination of infor - mation or medical agent into a population (** ) (c ) evidence without a control group or randomization, but with an evaluation (*** ) (d ) evidence obtained from a properly conducted study with a contro l group but without randomization (**** ) (e ) evidence obtained from a properly conducted study with a randomized control group (*****) . In this study, a three-star (***) design rating (one-group pre-test – post-tes t design; Cook & Campbell, 1979) was considered a minimum standard . The case reports from Portugal (Graca & Kompier, 1999) and Greece (Petsetaki , 1999) did not meet this second demand. Table 1 lists the nine remaining case s that will be reported upon in this study . A n aly sis All cases were compared in a step-by-step approach (Cox, 1993; Kompier & Marcelissen, 1990) on the basis of detailed written reports by national specialist s (Kompier & Cooper, 1999). For each case, in order to find out “ why, what, whe n was done by whom ” , the following questions were answered with respect to bot h content and process : Step 1: Preparatio n • What were the motives for the project ? WORK STRESS PREVENTI ON 377 • How was the project organized ? • Were external agents involved (e.g., consultancy or research activities) ? • What was the duration of the project ? Step 2: Problem analysi s • What instruments were used to identify risk factors and risk groups ? • What risk factors and risk groups were identified ? Step 3: Choice of measure s • What measures (work directed, person directed) were selected and why ? Step 4: Implementatio n • How were these measures implemented? Who was responsible ? Step 5: Evaluatio n • What were (subjective, objective) effects of the programme ? • What were costs and benefits of the project (e.g., in terms of finances , productivity)? • Which were obstructing factors ? • Which were stimulating factors ? • Was there a follow-up ? RE S U L T S The Appendix provides an overview of the nine cases . Ste p 1: P re pa rati o n In two cases (The Netherlands and Sweden) high absence figures formed th e starting point of the project. In these cases sickness absenteeism was presumed to be a result of a high psychosocial and musculoskeletal workload. Among th e consequences of high absence rates were high costs, inefficiency in the organi - zation of work, disturbances in work processes, and a decreasing social climate . TABLE 1 Overview of nine European cases (country, company, authors ) Country Company Author(s) Finland Forest industr y Kalimo & Toppinen (1999 ) The Netherland s Hospita l Lourijsen, Houtman, Kompier, & Gr ü ndemann (1999 ) Belgium Pharmaceutical compan y Poelmans, Compernolle, De Neve , Buelens, & Rombouts (1999 ) United Kingdo m Public secto r Whatmore, Cartwright, & Cooper (1999 ) Denmark Bus compan y Netterstrom (1999 ) Sweden Mail sortin g Theorell & Wahlstedt (1999 ) Germany Hospital Beermann, Kuhn, & Kompier (1999 ) Ireland Airport management compan y Wynne & Rafferty (1999 ) Italy School of nursin g Bagnara, Baldasseroni, Parlangeli , Taddei, & Tartaglia (1999 ) 378 KOMPIER, COOPER, GEURT S In addition to these so-called “ internal ” motives, also “ external ” motives played a role, such as shortages at the labour market. For example, the Dutch hospita l explicitly chose to transform to a “ better than average hospital ” in order to be more appealing for new personnel. Other main motives for starting these project s were: paying attention to “ human capital ” , prevention of work-related healt h problems, prevention of stress symptoms, promotion of workers ’ health, jointl y improving working conditions and productivity, finding out whether there was a stress problem, and providing more social support to the staff (see Appendix) . Various organizations, especially the large-scale projects in Finland, Th e Netherlands, and Belgium, installed a project-structure (project group or steerin g committee) on a temporary basis. Such a project group formed a representation of the most important organizational “ parties ” , such as management, middle - management, and employees. In all cases, however, management remaine d responsible “ for the chain of events ” , and often chaired the meetings. In severa l projects (Finland, The Netherlands, Denmark, Sweden, Germany, and Ireland), a basic assumption was that employees whose “ work was in discussion ” needed to have an important role in the execution of the project. In eight projects (Finland , The Netherlands, Belgium, United Kingdom, Sweden, Germany, Ireland, an d Italy) external consultants or researchers, mostly from a university, wer e involved. Especially in Sweden, an active role was played by the occupationa l health service . Ste p 2: P ro b le m an al y si s A wide range of instruments was used in order to assess risk factors and ris k groups. Most projects combined several instruments, ranging from simpl e instruments used for “ first line monitoring ” (e.g., checklists and interviews) to more sophisticated “ professional ” ones. Examples of the latter were instrument s for task analysis and a psycho-physiological study in the Finnish study, and an instrument for analysing work organizational processes in the Dutch study. Als o questionnaires and analyses of administrative data (such as sicknes s absenteeism, turnover, work disability) were used. In identifying risk factors , four companies (Finland, The Netherlands, Germany, and Ireland) differentiate d between factors that affect the organization as a whole, and factors that affect on e or more specific departments or groups of employees. Accordingly, risk group s were mostly defined in terms of specific departments or positions, or involved al l employees in the organization (for example, United Kingdom, Denmark, Italy) . Such an approach may enable a company to make an assessment of its relativ e position (compared to “ the average employee ” and to specific norm-scores of th e branch), and to make internal comparisons between departments or groups in th e organization (on the basis of age, gender, blue versus white collar, and so on) , otherwise known as “ benchmarking ” . WORK STRESS PREVENTI ON 379 Ste p 3: C h o ice o f m ea sure s Table 2 provides an overview of work-directed, person-directed, and othe r measures from the nine projects. Among the work-directed interventions ar e work redesign (e.g., job enrichment, introduction of self-regulating teams) , changes with respect to work and resting time regulations (e.g., shift systems) , social support (e.g., changes in information flow and communication), an d ergonomic and technological actions. The most important person-directe d interventions relate to training of employees and of management. In the Belgia n project, for example, there was a obligatory training for managers in “ peopl e management ” , and a training course “ coping with stress ” . Furthermore , managers were trained in ergonomics . As demonstrated in the Appendix and Table 2, seven cases (Finland, Th e Netherlands, Belgium, Denmark, Germany, Ireland, and Italy) explicitly decide d on the combination of work-directed and person-directed measures. One cas e (United Kingdom) “ only ” opted for person-directed measures, whereas anothe r case (Sweden) “ only ” addressed work-directed measures . TABLE 2 Most important interventi ons, nine project s Intervention Project Work directe d * Work redesig n Finland, The Netherlands, Denmark, Swede n * Working time schedule s The Netherlands, Denmark, Sweden, Irelan d * Improved social suppor t Sweden, Germany, Italy, Irelan d * Ergonomics and technolog y The Netherlands, Belgium, German y * Small increase in staf f Sweden * Changes in interior climat e The Netherland s Person directed: human resources management and trainin g * Training Finland, The Netherlands, Belgium, Denmark , United Kingdom, Germany, Irelan d * Training of managemen t Finland, The Netherlands, Belgium, Irelan d * Promoting healthy life styl e The Netherlands, United Kingdom, Irelan d * Training modules personal stres s awareness, cognitive restructurin g United Kingdom, Irelan d * Career development trainin g Ireland * Coping with aggressio n The Netherland s * Performance appraisal syste m Ireland Other measure s * Development of occupational health servic e Finlan d * Improved registration of sickness absenc e and managing the sickness repor t The Netherland s 380 KOMPIER, COOPER, GEURT S Ste p 4: Im ple m en tati o n Most organizations have chosen to integrate the interventions in the regula r company and management structure. This implies that (line) management is responsible and that stress prevention (for example, introducing the inter - ventions) belongs to the “ normal daily duties ” of supervisors. Sometimes (fo r example, Finland) measures were pre-tested, before implementing measures on a larger scale . In various cases principles of worker participation were explicitly chosen, fo r example in the Finnish case, in the Danish bus company (where in fact worke r participation was the heart of the intervention), in the Swedish case, in th e German health circle, and in the Irish airport management company. Im - plementing improvements was not always easy and did not always procee d according to plan. In the final step, we will discuss both obstructing an d stimulating factors . Ste p 5 : E va lu ati o n Our overview of these nine cases demonstrates that stress monitoring and stres s reduction is not merely a technical process (based on a technical analysis and on the simple, straightforward realization of recommendations and receipts), bu t relates to changing and improving organizations and organizational processes . This may be a time-consuming process (as in the Finnish case), and often thi s does not seem to be a “ one-off event ” . Several organizations continued thei r efforts to reduce occupational stress after the evaluation step. In some case s stress prevention now seems to be “ business as usual ” , i.e., part of norma l company processes and related to the company ’ s aims (for example, Finland, Th e Netherlands, Belgium, Ireland). In other projects (United Kingdom, Sweden , Germany, Italy), it is not clear to what extent there existed a follow-up . O b je ctiv e effect s With respect to the effects of these intervention programmes we can differentiat e between more objective and more subjective effects. As to the more objectiv e data, changes in company-registered sickness absenteeism were measured in fou r cases (The Netherlands, Belgium, Denmark, Sweden). In The Netherlands th e sickness absence percentage was significantly lower post-intervention (1991 : 8.9%; 1994: 5.8%; p < .05). The absence percentage in the Belgian compan y decreased from 4.3% to 3.45% ( p < .05). Also in Sweden the reduction in absenc e percentage was significant ( p < .05; no exact numbers reported by Theorell & Wahlstedt, 1999). In the Danish bus company, the change in absence percentag e (from 15 working days on average to six days, two years later) was in th e expected direction, but not significant, probably due to the small number of employees. In the other projects more objective data on absenteeism could not be WORK STRESS PREVENTI ON 381 provided. Since the absence data in the United Kingdom were “ only ” self - reported, they have not been taken into account here. In addition to the absenc e data, other more objective outcome measures have hardly been studied. An exception is in the Italian case, where more student nurses from the experimenta l group passed the exam . Su b je cti v e e ffect s Regarding subjective, i.e., self-reported, effects more data are available . Subjective evaluations were recorded in all cases, with the exception of Belgiu m and Ireland. Mostly, these data relate to (changes in) subjective evaluations of work factors (Finland, The Netherlands, Sweden, Germany), to evaluations of changes that were implemented (Denmark, Germany), and to (changes in) healt h complaints (Finland, The Netherlands, United Kingdom, Sweden, Italy). Some - times pre- and post-intervention comparable questionnaires were administere d (for example, The Netherlands, Sweden, United Kingdom, and Italy). In general , positive self-reported results stem from these evaluations. In the Finnish stud y the overall subjective evaluation of work changes was positive, although tim e pressure had increased. When comparing pre-test and post-test in the Dutc h study, an improvement in working conditions, intensified attention for sic k employees and working conditions, and a better psychosocial work climate wer e reported. Post-intervention (after three months), in the United Kingdom projec t individual health variables were improved in the exercise group. Relative hig h levels of satisfaction (with respect to the project, the enriched job, the running of the service, and the election of the service drivers) were found among the Danis h bus drivers. Skill discretion and authority over decisions had improve d significantly in the Swedish case. According to the employees in the Germa n project, improvements had a high impact on stress reduction, and communicatio n and social support were improved. In the Italian study various positive effect s were reported both in the experimental and in the traditional group . Co sts an d b en efit s None of the projects involved in the current study was equipped with a specialized economist. Furthermore in only one project were the financial cost s and benefits assessed in detail (The Netherlands). In this Dutch hospital th e benefits clearly exceed the costs (see Appendix; for more detailed calculations , see Lourijsen et al., 1999, pp. 113 – 115) . Some organizations found it too difficult to estimate these figures. In th e Finnish corporation — in a project that lasted over 10 years — the constitution of the labour force changed over time (for example, due to mergers), and variou s sub-companies had different systems for the registration of sicknes s absenteeism. Still there are indications from several cases that these projects ma y be regarded as successful from a financial perspective. In the pharmaceutica l 382 KOMPIER, COOPER, GEURT S company in Belgium there is no doubt that the benefits related to the decrease in absenteeism did exceed the costs of the intervention programme. In the Danis h bus company the budget had been kept by the drivers, but they were able to hir e two new drivers from this same budget. Furthermore, it seems at least probabl e that the decrease in sickness absence in the Swedish case brought about financia l gains. In the other cases there is hardly any or no data in this respect . O b str u cti n g an d sti m u lati n g fact o rs Of course, “ en route ” there have been various obstructing factors, as listed by th e investigators of each case (see Table 3). The first factor seen in Table 3, “ tim e constraints ” , is paradoxical as it is directly coupled to the stress issue itself . Especially in those companies where psychosocial demands (for example , workplace, deadlines) are very high, and therefore stress may constitute a majo r problem, there is not much time for “ extra ” effort in a new stress-preventio n approach. For example, key persons who might be the right persons to participat e in a steering committee, are often overloaded with other tasks and state that the y simply lack the time to chair and prepare meetings. Another example is in th e case of high work-related sickness absenteeism, where it becomes difficult to organize training sessions during work time, since so many employees are sic k and “ production must go on ” . The second factor, “ everything takes a lot of time ” , follows on from the fac t that serious stress prevention relates to changing and improving organizations , which indeed often is a time-consuming process (see “ duration ” , in th e Appendix). Furthermore, especially “ when things take time ” , it may be difficul t to keep middle level supervisors and employees involved (factor 4). The thir d factor (“ differences in expertise ” ) points at sometimes conflicting demands , especially in large organizations, between on the one hand creating commitmen t from — and linking pins with — various organizational parties, and on the othe r hand creating a well-informed small and decisive professional task force. Th e fifth factor points at a general problem with respect to the assessment an d evaluation of risks in the psychosocial work environment. There are yet no evidence-based clear cut-off points or general rules in order to decide whether a TABLE 3 Main obstructing factors in the nine case s Obstructing facto r Project Time constraint s Belgium, United Kingdo m Everything takes a lot of tim e The Netherland s Differences in expertise in steering committe e The Netherland s Difficulty in keeping middle-level and employees involve d The Netherland s What is a constraint and what is not? (20% complaints?, 30%? ) The Netherland s Differences between practical and scientific aim s Finland WORK STRESS PREVENTI ON 383 certain level (e.g., percentage) of complaints constitutes a major risk factor or not. For example, if 60% of employees report that their supervisor “ does not giv e them enough feedback and information ” , many researchers would conclude tha t the communication between this supervisor and his / her employees should be improved. But would we draw the same conclusion in case the percentage wa s 20%, or 15%? Relative comparisons with reference groups may help, but bear th e risk that risk factors will be underestimated, in case not only the “ experimental ” group has a high score but also the “ comparison group ” . Let us, for example , suppose that 60% of the employees in company A reports “ to be working unde r high time pressure ” , and that a common score in this branche of industry is 65% . Let us also suppose that this difference is statistically significant. Althoug h employees in company A report less time pressure than in the comparison group , we would still argue that time pressure is a problem that should be dealt with in company A. Differences between practical and scientific aims (factor 6) constitute anothe r potential obstructing factor. Whereas scientific aims emphasize extensive an d detailed analyses of stressors and strains (e.g., triangulation), employees an d management often want changes. Therefore, the question “ When do we kno w enough? ” will be answered differently by scientists and by organizationa l decision-makers. In practice, further data gathering and data-analysis may eve n inhibit organizational improvement, “ letting the momentum fade away ” . A further example of competing demands between academic research an d organizational practice is that longitudinal data collection, to be preferred from a research angle, may inhibit further participation and leave intervention project s with a biased sample (Kalimo & Toppinen, 1999). All in all, based on thi s overview we would conclude that obstructing factors are natural. On the othe r hand, it follows from these cases that they can be overcome. Apart fro m these obstructing factors, several factors were mentioned as being stimulatin g (see Table 4). Stimulating factors fall in two broad categories: (1) projec t organization and process variables, and (2) analysis and instruments (see als o next section) . D ISC U SSIO N In a multiple case study approach European cases in work stress preventio n were collected, analysed and compared. We will now discuss two questions : (1) whether these cases were successful, and (2) “ which interventions work ” . Next we will hypothesize about success factors in work stress prevention . W ere th e se cases su ccessf u l? Generally speaking in most cases the answer could be “ yes ” . Four cases did offe r more objective data on sickness absenteeism. In three of these four cases (th e projects from The Netherlands, Belgium, Sweden) a significant reduction of 384 KOMPIER, COOPER, GEURT S sickness absence was demonstrated. In the fourth case (the Danish bus company ) the reduction did not reach significance, probably due to small sample size . Self-reported effects were available in all cases, with the exception of Belgium and Ireland. In general there were positive outcomes (e.g., less con - straints in the work situation, decreased health complaints, positive evaluation s of implemented measures). Furthermore there were clear indications fro m several cases (The Netherlands, Belgium, Denmark, Sweden) that they may be regarded as successful from a financial perspective . The next question that should be answered is the question into interna l validity: Might these predominantly positive effects be attributed to th e interventions? According to Cook and Campbell (1979 ) an untreated contro l group design with pre-test and post-test (****, *****; M urphy, 1996) is th e desirable option to answer this question. We may bear in mind that, although tru e experiments offer the best potential for causal inferences, they do not guarante e that causal references can reasonably be made, or that associations betwee n variables reflect causal relations between the higher order constructs that they ar e supposed to operationalize. “ Plausible rival hypothesis ” means that for eac h study (and research design) we should critically assess possible threats to interna l validity, i.e., potential third variables that can invalidate these relations. Overall , in two cases (United Kingdom, The Netherlands) a genuine control conditio n existed (rating ***** and ****). The other seven projects did receive a ** * rating. The high rating from the United Kingdom case may be related to th e TABLE 4 Main sti m ulating factors in the nine case s Factor Project 1. Project organization and process variables : *Stepwise and systematic approac h The Netherland s *Clear structure (tasks, responsibilities ) Belgium *Participative approac h Denmark, Germany, Irelan d *Co-operation between management and representative s of employee s Sweden *Recognition of employees as “ experts ” The Netherland s *Emphasizing the responsibility of management /critica l openness of senior managemen t Belgium *Combining monitoring and interventio n Italy 2. Analysis and instruments : *Proper risk assessment /adequate instrument s The Netherland s *Assessment of risks for whole company and certai n Finland, The Netherland s departments/positions Germany *Using direct assessments of employees and managemen t Finland *Using clear facts and figures to convince top managemen t Belgiu m *Combining monitoring and interventio n Italy WORK STRESS PREVENTI ON 385 content of the intervention which, in a United Kingdom tradition of emphasizin g interventions at the individual level, was primarily a training programme directe d at the employee. For such a programme, it is easier (although not easy!) to develop a randomized control condition than for a programme that puts th e emphasis on changing stressful working conditions (e.g., Finland and Sweden) . Although from a methodological point of view these *** designs may see m somewhat “ meagre ” , we considered them acceptable for the type of study we performed. First, the hectic organizational arena, rapid changes in companies , and the fact that managers and not scientists rule companies, do make it practically impossible to “ play fully by the methodological rules ” . Second , whereas randomization had proved a proper solution to the problems of confounding and selection in biomedicine and psychology, the method does hav e a number of limitations for psychosocial work environment research (se e Kompier & Kristensen, in press). In biomedicine and psychology the usual uni t of randomization is the individual, whereas in work environment interventio n studies the unit of intervention is often a work site or department. In suc h situations the number of potential intervention and control departments is usuall y very limited and randomization makes little sense. Third, we think there is som e “ methodological compensation ” in many of these cases. M any of them receiv e good marks on other methodological criteria: reliable and valid assessment of stressors and outcomes, appropriate statistical analyses of the data, and “ good ” sample or population size, ranging from 29 (Denmark) to 19,000 employee s (Finland). Although in various cases there are possible threats to internal validit y (e.g., history, regression to the mean, selection) and to external validity (e.g. , interaction of selection and intervention), our general conclusion is that — give n the systematic assessment of risks and risk groups, and the “ tailor-made ” interventions — it is at least plausible that the positive outcomes can largely be attributed to the intervention programmes. External and construct (theoretical ) validity are a matter of replication and variations of these “ experiments ” , an d especially a matter of more theoretically developed and well-designed inter - vention studies (i.e., studies with a research design rating of **** or more). In addition, it would make sense to learn from less successful cases in prevention . However, it is not common practice among companies to have unsuccessfu l outcomes published, since this may be regarded bad publicity. Also man y researchers prefer to publish positive results, whereas most editors of scientifi c journals prefer significant outcomes over no results . W h ic h interv en ti o n s w o rk ? A crucial question is: “ Which interventions work? ” That is, what specifi c measure had what specific effect? It is difficult to answer this question. Not onl y the starting situation but also the remedies and the outcome variables differe d over cases. Most (seven) companies preferred a cocktail of medicines, ofte n 386 KOMPIER, COOPER, GEURT S combining work-directed and worker-directed measures. It is the paradox of “ field ” intervention research that those intervention programmes that offer th e best preventive potential (e.g., addressing the real problems, multi-moda l treatments directed at work and the worker), make it difficult to answer th e question “ What works? ” In addition, as we argued earlier, the success of stres s prevention depends not only on the content of the intervention (“ what ” , i.e., th e specific measure taken), but also on the process (“ how ” , e.g., introduction an d implementation). The reason is, as we emphasized previously, that employees , supervisors, and managers are not passive objects of study but active subjects , shaping their own working situation. This implies that a potential adequat e intervention aimed at the reduction of a real constraint in the work situation (e.g. , a forward rotating shift schedule to replace a less healthier backward rotatin g schedule), may even have a negative impact on the health and motivation of employees when forced upon them by an authoritarian supervisor . Su cc e ss fact o rs in p re ve n ti o n ? Stress prevention thus relates to both content and process variables, which ofte n are intertwined. With Griffiths (2000) we hypothesize that such processes (i n terms of conceptualization, design, and implementation of interventions) ar e likely to be more generalizable than outcomes. Against the background of th e present study (Table 4), and other studies in this domain (Kompier, Aust, Va n den Berg, & Siegrist, 2000; Kompier et al., 1998), it is our hypothesis that a stres s prevention quality approach that combines “ content ” and “ process ” might be based on five key factors. These “ Big Five ” of stress prevention are: (1) A stepwise and systematic approach. In addition to the proper sequence in proble m solving, this involves a clear determination of aims, tasks, reponsibilities , planning, and financial means. (2) An adequate diagnosis or risk analysis , identifying risk factors and risk groups. “ An organisation needs to know it s starting point in order to assess the benefits derived ” (Cooper, Liukkonen, & Cartwright, 1996). Although this statement may seem trivial, the practice of stress prevention is different, as was argued earlier. (3) A package of interventiv e measures that theoretically and logically “ fit in ” with the problems identified in the risk analysis; mostly a combination of work-directed and person-directe d measures. (4) A participatory approach assuring involvement and commitment of both employees and middle management. Employees should be recognized as experts with respect to their own work situation. In addition, participation in itself may have a positive motivational effect. (5) The sustained commitment of top management. The success of the stepwise approach we suggest depend s largely on the sustained commitment of top management (see also Kopelman , 1985). It is important that top management incorporates preventive activities in regular company management. Paying attention to the psychosocial workin g environment should become “ business as usual ” , that is a regular task of supervisors. WORK STRESS PREVENTI ON 387 Only with such an approach can work stress management be regarded as a “ normal ” company phenomenon, i.e., a phenomenon that can be understood an d therefore dealt with . By analysing and comparing various European stress prevention projects, we have tried to contribute to both stress research and practice by reducing the ga p between both fields. This study suggests that “ true prevention ” (i.e., preventiv e measures that are based on an adequate diagnosis identifying risk factors and ris k groups, that theoretically and logically fit in with the problems, and that ar e introduced and implemented in a proper way) may be beneficial to both th e employee and the organization .

RE F E RE N C E S Bagnara, S., Baldasseroni, A., Parlangeli, O., Taddei, S., & Tartaglia, R. (1999). Italy: A school of nursing. In M.A.J. Kompier & C.L. Cooper (Eds.), Preventing stress, improving productivity : European case studies in the workplace (pp. 297 – 311). London: Routledge . Beehr, T.A., & O’ Hara, K. (1987). Methodological designs for the evaluation of occupationa l stress interventions. In S.V. Kasl & C. L. Cooper (Eds.), Stress and health: Issues in researc h methodology (pp. 79 – 112). Chichester, UK: Wiley . Beermann, B., Kuhn, K., & Kompier, M.A.J. (1999). Germany: Reduction of stress by healt h circles. In M.A.J. Kompier & C.L. Cooper (Eds.), Preventing stress, improving productivity : European cas e studies in the workplace (pp. 222 – 241). London: Routledge . Campbell, D.T. (1994). Foreword. In R.K. Yin (Ed.), Case study research: Design and method s (2nd edn). Thousand Oaks, CA: Sage . Cook, T.D., & Campbell, D.T. (1979). Quasi-experimentation: Design and analysis issues for fiel d settings. Chicago: Rand McNally . Cooper, C.L., Liukkonen, P., & Cartwright, S. (1996). Stress prevention in the workplace : Assessing the costs and benefits to organisation s . Dublin, Ireland: European Foundation for th e Improvement of Living and Working Conditions . Cooper, C.L., & Payne, R. (Eds.). (1988). Causes, coping, and consequences of stress at wor k . Chichester, UK: Wiley . Cox, T. (1988). Psychological factors in stress and health. In S. Fisher & J. Reason (Eds.) , Handbook of life stress, cognition and healt h (pp. 603 – 628). Chichester, UK: Wiley . Cox, T. (1993). Stress research and stress management: Putting theory to work (HSE contrac t Research Report no. 61 /1993). London: HSE . DeFrank, R.S., & Cooper, C.L. (1987). Worksite stress management interventions: Thei r effectiveness and conceptualization. Journal of Managerial Psycholog y , 2 , 4– 10. European Commission (2000) (preparation by L. Levi & J. Levi). Guidance on work-related stress . Spice of life or kiss of deat h ? Luxembourg: Office for Official Publications of the Europea n Communities. Geurts, S., & Gr ü ndemann, R. (1999). Workplace stress and stress prevention in Europe. In M.A.J . Kompier & C.L. Cooper (Eds.), Preventing stress, improving productivity: European cas e studies in the workplac e (pp. 9– 32). London: Routledge . Goldenhar, L.M., & Schulte, P.A. (1994). Intervention research in occupational health and safety . Journal of Occupational Medicin e , 36 (7), 763 – 775 . Graca, L., & Kompier, M.A.J. (1999). Portugal: Preventing occupational stress in a ban k organisation. In M.A.J. Kompier & C.L. Cooper (Eds.), Preventing stress, improvin g productivity: European case studies in the workplac e (pp. 264 – 284). London: Routledge . Griffiths, A. (2000). Organizational interventions: Facing the limits of the natural scienc e paradigm. Scandinavian Journal of Work Environment and Healt h , 6 , 589– 596. 388 KOMPIER, COOPER, GEURT S Griffiths, A., Cox, T., & Barlow, C. (1996). Employer ’ s responsibilities for the assessment an d control of work-related stress: A European perspective. Health and Hygien e , 17 , 62– 70. Gr ü ndemann, R.W.M., & Van Vuuren, T. (1997). Preventing absenteeism at the workplace : European research repor t . Dublin, Ireland: European Foundation for the Improvement of Living and Working Conditions . Kahn, R.L., & Byosiere, P. (1992). Stress in organizations. In M.D. Dunnette & L.M. Houg h (Eds.), Handbook of industrial and organizational psychology (2nd edn., vol 3, pp. 571 – 650) . Palo Alto, CA: Consulting Psychologists Press . Kalimo, R., & Toppinen, S. (1999). Finland: Organisational well-being. Ten years of research an d development in a forest industry corporation. In M.A.J. Kompier & C.L. Cooper (Eds.) , Preventing stress, improving productivity: European case studies in the workplace (pp. 52– 85). London: Routledge . Karasek, R.A., & Theorell, T. (1990). Healthy work: Stress, productivity and the reconstruction of working lif e . New York: Basic Books . Kasl, S.V. (1978). Epidemiological contributions to the study of work stress. In C.L. Cooper & R. Payne (Eds.), Stress at work (pp. 3– 48). Chichester, UK: Wiley . Kompier, M.A.J., & Kristensen, T. (in press). Organizational work stress interventions in a theoretical, methodological and practical context. In J. Dunham (Ed.), Stress in the workplace : Past, present and futur e . London: Whurr Publishers . Kompier, M.A.J., & Marcelissen, F. (1990). Handbook of work stres s (in Dutch). Amsterdam , Nederlands: Instituut voor Arbeidsomstandiglreden . Kompier, M.A.J., Aust, B., Van den Berg, A.-M., & Siegrist, J. (2000). Stress prevention in bu s drivers: Evaluation of thirteen natural experiments. Journal of Occupational Healt h Psychology , 5 (1), 11 – 31 . Kompier, M.A.J., & Cooper, C.L. (Eds.). (1999). Preventing stress, improving productivity : European case studies in the workplac e . London: Routledge . Kompier, M.A.J., Geurts, S.A.E., Gr ü ndemann, R.W.M., Vink, P., & Smulders, P.G.W. (1998) . Cases in stress prevention: The success of a participative and stepwise approach. Stress Medicine , 14 , 155– 168. Kopelman, R. (1985). Job design and productivity: A review of the evidence. National Productivity Revie w , 237– 255. Lourijsen, E., Houtman, L., Kompier, M.A.J., & Gr ü ndemann, R. (1999). The Netherlands: A hospital, “ Healthy working for health ” . In M.A.J. Kompier & C.L. Cooper (Eds.), Preventing stress, improving productivity: European case studies in the workplace (pp. 86 – 120). London : Routledge. Marmot, M., Siegrist, J., Theorell, T., & Feeney, A. (1999). Health and the psychosocia l environment at work. In M. Marmot & R. G. Wilkinson (Eds.), Social determinants of healt h (pp. 105 – 131). Oxford, UK: Oxford University Press . Murphy, L.R. (1986). A review of organizational stress management research. Journal Organizational Behavior Managemen t , 8 , 215 – 227 . Murphy, L.R. (1996). Stress management in work settings: A critical review of the health effects . American Journal of Health Promotio n , 11 (2), 112 – 135 . Netterstrom, B. (1999). Denmark: Self-rule on route 166. An intervention study among bu s drivers. In M.A.J. Kompier & C.L. Cooper (Eds.), Preventing stress, improving productivity : European case studies in the workplace (pp. 175 – 194). London: Routledge . Newman, J.E., & Beehr, T.A. (1979). Personal and organizational strategies for handling jo b stress: A review of research and opinion. Personnel Psycholog y , 32 , 1– 43. Ovretweit, J. (1998). Evaluating health intervention s . Buckingham /Philadelphia: Open Universit y Press. Paoli, P. (1992). First European survey on the work environment 199 1 – 1992 . Dublin, Ireland : European Foundation for the Improvement of Living and Working Conditions . WORK STRESS PREVENTI ON 389 Paoli, P. (1997). Second European survey on working conditions 199 6 . Dublin, Ireland: Europea n Foundation for the Improvement of Living and Working Conditions . Parker, S., & Wall, T. (1998). Job and work design: Organizing work to promote well-being an d effectiveness . Thousand Oaks, CA: Sage . Parkes, K.R. (1982). Occupational stress among student nurses: A natural experiment. Journal of Applied Psycholog y , 67 (6), 784 – 796 . Petsetaki, E. (1999). Greece: Stress management in the health care sector. In M.A.J. Kompier & C.L. Cooper (Eds.), Preventing stress, improving productivity: European case studies in th e workplace (pp. 285 – 296). London: Routledge . Poelmans, S., Compernolle, T., De Neve, H., Buelens, M., & Rombouts, J. (1999). Belgium: A pharmaceutical company. In M.A.J. Kompier & C.L. Cooper (Eds.), Preventing stress , improving productivity: European case studies in the workplac e (pp. 121 – 148). London : Routledge. Quick, J.C., Quick, J., Nelson, D.L., & Hurrell, J.J. (1997). Preventive stress management in organizations . Washington: APA . Schaufeli, W.B., & Enzmann, D. (1998). The burnout companion to study and practic e . London: Taylor & Francis . Siegrist, J. (1998). Adverse health effects of effort-reward imbalance at work. In C.L. Coope r (Ed.), Theories of organizational stress (pp. 190 – 204). New York: Oxford University Press . Theorell, T., & Wahlstedt, K. (1999). Sweden: Mail processing. In M.A.J. Kompier & C.L. Coope r (Eds.), Preventing stress, improving productivity: European case studies in the workplac e (pp. 195 – 221). London: Routledge . Uehata, T. (1991). Karoshi due to occupational stress-related cardiovascular injuries amon g middle-aged workers in Japan . Japanese Science Labou r , 67 (1), 20– 28. Van der Hek, H., & Plomp, H.N. (1997). Occupational stress management programmes: A practica l overview of published effect studies. Journal Occupational Medicin e , 47 (3), 133 – 141 . Whatmore, L., Cartwright, S., & Cooper, C.L. (1999). United Kingdom: Evaluation of a stres s management programme in the public sector. In M.A.J. Kompier & C.L. Coope r (Eds.), Preventing stress, improving productivity: European case studies in the workplac e (pp. 149 – 174). London: Routledge . World Health Organization. (1999). Health 21: The health for all policy framework for the WH O European Region. Copenhagen: WHO Regional Office for Europe . Wynne, R., & Rafferty, R (1999). Ireland: Stress prevention in an airport management company. In M.A.J. Kompier & C.L. Cooper (Eds.), Preventing stress, improving productivity: Europea n case studies in the workplace (pp. 242 – 263). London; Routledge . Yin, R.K. (1994). Case study research: Design and methods (2nd ed.). Thousand Oaks, CA: Sage . Zapf, D., Dormann, C., & Frese, M. (1996). Longitudinal studies in organisational stress research : A review of the literature with reference to methodological issues. Journal of Occupationa l Health Psycholog y , 1 (2), 145 – 169 . Manuscript received January 200 0 Revised manuscript received April 200 0 390 KOMPIER, COOPER, GEURT S A P P E N D IX Ch a racteri zati o n o f n in e E u ro p ea n ca se s 1 Finla n d (n = c. 19 ,0 0 0) S te p 1: P re pa ra tio n Motives : paying attention to “ human capital ” , prevention of work related health problems, stres s and promotion of workers ’ healt h Organization : complex action-research programme; Programme Advisory Committee, Pro - gramme Management Committee; outside consultanc y Research design ratin g : *** Duration : > 10 year s S te p 2 : Pro b le m a na ly si s Instruments : questionnaires, job analysis, psycho-physiological stress stud y Risk factor s : e.g., little possibilities for advancement and for participation, lack of feedback , time pressur e Risk group s : some factors: the total personnel; other factors: specific groups, e.g., offic e personnel (most women), and foreme n S te p 3 : C hoice o f m e as u re s Two basic approaches chose n : reorganization of work and training of management ; implementation of specific development project s Work directe d : reorganization of work (e.g. reorganization of monotonous tasks, integration of maintenance and support functions with production) and training of management (e.g., leadershi p style); development of work and training of foremen; development of cooperation of offic e personnel and management; development of psychosocial services in occupational health, and of personnel developmen t Person directe d : training (workshops, seminars ) S te p 4 : Im pl e m e nt a tio n Well-planned seminars (after piloting ) Principles of participatory action researc h 1 Parts of this Appendix have been reproduced with kind permission from Table 15.2 in M.A.J . Kompier and C.L. Cooper (Eds.), Preventing stress, improving productivity: European cas e studies in the workplac e (1999). London: Routledge . WORK STRESS PREVENTI ON 391 Action plans carried out on nine important topics, e.g., reorganization of monotonous work ; personnel development; encouragement of shopfloor participation; increasing psychologica l resources and preventing stres s Responsibility : managemen t S te p 5 : Ev a lu a tio n Comprehensive survey studies. (Scientific) analyses are still being carried out. Mainly proces s evaluation, more than outcome evaluatio n Absence % : not clea r Subjective evaluation of work change s : overall positive, but time pressure had increased for bot h office personnel and foremen, and also (10-year follow-up study) for total compan y Health complaint s : no difference s Costs and benefit s : hard to assess in such an extensive project, e.g., due to changes over time in workforce, unit-differences in recording absenteeism. The fact that the process still goes on afte r 10 years is seen as an indicator of its valu e Obstructing factor s : sometimes differences in interests between company and consultants / researchers (more practical versus more scientific aims ) Stimulating factor s : using direct assessments of employees and managemen t Follow-up : yes, actions taken with respect to management procedures, personnel development , performance of the personnel, and work and workplace change s T h e N e th e rla n d s (n = 85 0) S te p 1: P re pa ra tio n Motives : high sickness absenteeism, difficult to hire new personne l Organization : initiative by management, steering committee, external consultant, participativ e approach, comparison with “ control hospital ” Research design ratin g : **** Duration : 4 years S te p 2 : Pro b le m a na ly si s Instruments : interviews, checklists, questionnaire, analysis of sickness absenteeism and turnove r Risk factor s : high psychosocial workload, interior climate, leadership style, physical workload , shift system, insufficient training and career opportunitie s 392 KOMPIER, COOPER, GEURT S Risk group s : some factors: total organization; others: certain department s Control conditio n : other hospita l S te p 3 : C hoice o f m e as u re s Work directe d : changes in interior climate, work and resting times schedule, technical devices , reduction in physical workload, work organization, job enrichmen t Person directe d : managerial information with regard to sickness absenteeism figures an d procedures with regard to sickness absenteeism, training for supervisors, better guidance in case of sickness, health promotional initiatives, various trainings (a.o., coping with aggression, individua l stress management, alcohol, smoking ) S te p 4 : Im pl e m e nt a tio n Organization : various subprojects with a participative approac h Responsibility : final responsibility by top management; coordination by steering committee ; practical implementation of subprojects by (line) management in department s S te p 5 : Ev a lu a tio n Comparing pre-test and post-tes t : improvement in working conditions, intensified attention fo r sick employees and for working conditions, better psychosocial work climat e Comparison with "control hospital " : control hospital scores better at some variables in questionnaire (post-test ) Absence % : 8.9% (1991) ® 5.8% (1994) (significant, p < .05) now below average hospital leve l and below control hospita l Costs and benefit s : Total costs due to technical measures, courses /training programmes , organizational measures add up to NLG 1,171,725 (A). Benefits only include cost savings due to reduction of absenteeism in 1992, 1993 and 1994, and account for NLG 2,618,000 (B). Tw o approaches were chosen to estimate the costs – benefits ratio: (1) B– A=c. NLG 1.4 million; (2) th e second approach takes account of the decreasing sickness absenteeism in the sector (Dutc h hospitals). After this adjustment the benefits total NLG 1,632,000 (C), and the difference betwee n costs and adjusted benefits is C– A=c. NLG 460,000. In both cases there is a positive resul t Obstructing factor s : difficult to keep middle management committed, differences in steerin g committee, unclear what are the responsibilities of the steering committee, "everything takes a lo t of time", difficult to keep employees involved in a four-year project, difficult to assess objectivel y "which is a serious constraint and which is not " Stimulating factor s : stepwise approach, adequate instruments, course in guidance in case of absenteeism, employees very committed in subprojects, information and discussion day for al l employees Follow-up : yes, increasing responsibility for supervisor s WORK STRESS PREVENTI ON 393 Be lg iu m (n = 3 26 1) S te p 1: P re pa ra tio n Motives : unions and works council considered stress as a topic; employees asked for measures to be taken against stress; signals to medical officers; need to know whether there was a stres s problem Organization : taskforce with important role for health department and training manager ; questionnaire study evaluated by universit y Research design ratin g : *** Duration : 2 years S te p 2 : Pro b le m a na ly si s Instruments : questionnaire study (personal data, experience of stress, psychosomati c complaints, work factors) on representative sample of 324 employee s Risk factor s : e.g., poor job content, social relationships at work, terms of employmen t Risk group s : (a ) men, senior (> 15 years), no management responsibilities ; (b ) women, medium seniority (5 – 15 years), no management responsibilitie s S te p 3 : C hoice o f m e as u re s Work directe d : ergonomic intervention s Person directe d : information session for senior management; training course "coping wit h stress"; obligatory training for managers in "people management" and recognition of stress signals ; managers trained in ergonomic s S te p 4 : Im pl e m e nt a tio n Action plan approved by senior management, unions, works counci l Many information and discussion sessions in compan y Circa 1000 workplace analyses (ergonomics) by two company nurse s Special task force on "work family interface" planned but never starte d S te p 5 : Ev a lu a tio n Absence % : significant reduction of sickness absenteeism (from 4.3% to 3.45%; p < .05) Other effect s : stress is no longer a taboo and is now on the company agenda. A lot of positiv e attention in medi a 394 KOMPIER, COOPER, GEURT S Costs and benefit s : no detailed calculations but benefits from decrease in absenteeism clearl y exceeded the extra cost s Obstructing factor s : time constraint s Stimulating factor s : critical openness of senior management; using clear facts and figures to convince top management; drive of taskforce to assess and reduce stres s Follow-up : yes, in compan y U n it e d K in g d om (n = 27 0) S te p 1: P re pa ra tio n Motives : senior management wanted to decrease reported strain among employees and to improve their coping skill s Organization : initiative: senior management; important, independent, role for externa l researcher (university) being the “ motor ” of the study; attempt to combine “ good researc h methodology ” with company wishe s Research design ratin g : ***** Duration : c. 1 yea r S te p 2 : Pro b le m a na ly si s Instruments : pre-test and post-test with reliable questionnaires. Individual variables: e.g. , anxiety, depression; mental and physical health. Organizational variables; organizationa l commitment, job satisfaction. Also biographical data. Self-reported sickness absenteeis m (frequency, days ) Risk factor s : (from previous stress audit) volume of work, reduction in staff numbers, copin g with chang e Risk group s : all employee s S te p 3 : C hoice o f m e as u re s Work directe d : no specific initiative s Person directe d : three training programmes : (a ) Personal stress awarenes s (b ) Exercis e (c ) Cognitive restructurin g Participants (managerial and non-managerial employees) were volunteers, and were randoml y allocated into one of these three training programmes. There was also a wait-list control group an d a full control group (non-volunteers) (groups 4 and 5) Training programmes consisted of one one-hour general session and one two-hour worksho p WORK STRESS PREVENTI ON 395 S te p 4 : Im pl e m e nt a tio n Responsibility : senior management, but central role for researche r Duration ; after base line recording, first measurement after 3 months and second measuremen t after 6 month s S te p 5 : Ev a lu a tio n Questionnaires : no pre-test differences between conditions. Post-intervention: after 3 month s exercise group improved on all “ individual health variables ” . Some improvements in “ awarenes s group ” , no changes in “ cognitive group ” . After 6 months some positive effects left in exercis e group, but not in awareness group or cognitive group. No changes after 3 or 6 months in organizational commitment or job satisfactio n Absence % : self-reported absence frequency decreased in exercise group, but increased in othe r two groups. Doubts about quality of sickness data (self-report, retrospective ) Costs and benefit s : no detailed analysis. Costs are reported to be smal l Obstructing factor s : lack of time (time pressures and heavy work loads); lack of contact wit h participants during the stud y Stimulating factor s : some concern among employees about their own levels of stres s Follow-up : no follow-up dat a D en m ark (n = 2 9) S te p 1: P re pa ra tio n Motives : jointly improving working conditions and increasing productivit y Organization : development workshops, seminars for drivers, management, and labou r organizations Research design ratin g : *** Duration : c. 5 year s S te p 2 : Pro b le m a na ly si s Instruments : previous studies on bus drivers, discussions among bus driver s Risk factor s : e.g., management style, running of the service, ergonomic s Risk group s : all bus driver s S te p 3 : C hoice o f m e as u re s Work directe d : introduction of self-regulating (autonomous) team; drivers were free to organiz e as they wished within the limits of the budge t Person directe d : three-week full-time introductory cours e 396 KOMPIER, COOPER, GEURT S S te p 4 : Im pl e m e nt a tio n Eight working groups were established (e.g., rota planning, advertising and design of the buses , personnel management, and uniforms); quarterly general meetings, where decisions were made ; service drivers electe d S te p 5 : Ev a lu a tio n Absence % : decrease from 15 working days on average to 6 days (after 2 years ) Passengers complaints decrease d Relative high levels of satisfaction among drivers (with respect to project, job, running of th e service, elected service drivers ) Costs and benefit s : budget had been kept, and two extra drivers could even be employe d Obstructing factor s : tendering-syste m Stimulating factor s : participative approac h Follow-up : yes, in some other companies, but “ less far reaching ” Sw e de n (n = 13 6) S te p 1: P re pa ra tio n Motives : high sickness absenteeism, decreased productivity, demands for effectiveness an d speed Organization : management initiated changes; active occupational health care team; academi c support for evaluatio n Research design ratin g : *** S te p 2 : Pro b le m a na ly si s Instruments : valid questionnaire s Risk factor s : monotony Risk group s : mail sorter s S te p 3 : C hoice o f m e as u re s Work directe d : Smaller more autonomous production units; small increase in staff (+2.5%) ; introduction of small working groups; improved information systems; change in shift systems; ne w food vending machine /microwave oven s Person directe d : not specifie d WORK STRESS PREVENTI ON 397 S te p 4 : Im pl e m e nt a tio n Employees participated in planning of organizational change s Important role for occupational health care tea m S te p 5 : Ev a lu a tio n Two follow-up measurements, valid questionnaires on work and health (e.g., job demands , control, social support); sickness absence data; first follow-up represents final stage of intervention; second follow-up one year after star t Questionnaires : after one year skill discretion and authority over decisions had improve d significantly Absence % : significant reduction of sickness absenteeism (full-time and part-time employees ) ( p < .05) Costs and benefit s : no detailed analysis made, but it is clear that decrease in sick leave mean s financial gain s Obstructing factor s : not specifie d Stimulating factor s : cooperation between management and representatives of employee s Follow-up : not know n G e rm a n y (n = 23 0) S te p 1: P re pa ra tio n Motives : workplace health promotio n Organization : central role for health work group. External consultancy. Installation of healt h circle Research design ratin g : *** Duration : c. 2 year s S te p 2 : Pro b le m a na ly si s Instruments : questionnaire on work and health; workplace observations; discussions an d interviews Risk factor s : high musculoskeletal work load (e.g., lifting and carrying) and high psychosocia l work load (stress, e.g., through patients, supervisors ) Risk group s : all nurses, and on certain factors also other employee s 398 KOMPIER, COOPER, GEURT S S te p 3 : C hoice o f m e as u re s Work directe d : amongst others, changes in information flow and communication, bette r coordination, ergonomic and technical improvement s Person directe d : amongst others, training of personne l S te p 4 : Im pl e m e nt a tio n The health circle identified stressful work situations and suggestions for improvement. Th e hospital management approved of these measures and the planning with respect to implementatio n of these measure s S te p 5 : Ev a lu a tio n Subjective effect s : after 6 months the project was evaluated by means of a questionnaire study . Improvements were said to have a high impact on stress reduction; communication and socia l support had improve d Absence % : no data availabl e Costs and benefit s : unknown Obstructing factor s : the “ original ” questionnaire needed to be adapted since it did not includ e questions about wor k Stimulating factor s ; participative approac h Follow-up : not know n Ir e la n d (n = 95 3) S te p 1: P re pa ra tio n Motives : to investigate stress and identify stressors, ambition to formulate a prevention plan ; wish to disseminate relevant information on stress management among staf f Organization : “ stress working group ” installed. External consultancy. Support by management , representatives of employees, and union s Research design ratin g : *** Duration : since 198 8 S te p 2 : Pro b le m a na ly si s Instruments : extensive survey, after piloting, among all employees; demography, sources of stress at work and outside of work, social support, outcomes of stress, health /coping behaviou r Risk factor s : amongst others, working time pressures, responsibilities, overwork; pay ; promotion, permanency, job security; supervision difficulties; lack of resources; poor managemen t support; lack of information; work environmen t WORK STRESS PREVENTI ON 399 Risk group s : some factors: total organization; specific groups at risk were amongst others: 30 – 39 years of age; certain departments (airport police /fire services, trading department); shiftworkers ; lower grades (these factors are not independent of each other ) S te p 3 : C hoice o f m e as u re s Before starting, two approaches were chosen: (1) organizational development, and (2) healt h promotion approach (examining and improving the health and welfare services of the company to address stress). From a long list with respect to both areas several measures were selecte d Work directe d : improving shift work regulations (amongst others, redesign of shift rosters) ; improve communications (amongst others, increase access to information, update managemen t development programme); performance appraisal for all staf f Person directe d : career development (training for staff, encourage internal work experience) ; health awareness and health promotion programme (amongst others, development of awareness of stress through training courses; increase awareness of negative effects of smoking; healt h screening; healthy eating policy ) S te p 4 : Im pl e m e nt a tio n After the analysis and after the list of recommendations was made, the involvement of th e external consultants ended. The approach taken was a participative one (employee involvement) . Two new “ high level action teams ” were set up: one for the organizational developmen t programme (track 1) and one for the health promotion programme (track 2). It was recognized tha t not all recommendations could be acted on at once. Both teams developed an action plan (wit h criteria such as feasibility, importance and resources). In all, 20 distinct actions were undertake n S te p 5 : Ev a lu a tio n Of those 20 actions, six years after the analysis, 14 are still ongoing or in progres s The programme was undertaken as a pragmatic exercise. The tasks of the external consultan t ended after the analysis. Formal evaluation was not a high priority. Still there are some clea r positive outcomes, such as better shift regulations, a support manual for shiftworkers, training fo r new shiftworkers and supervisors, and improvements in communication practice s Absence % : not know n Costs and benefit s : not know n Obstructing factor s : not specifie d Stimulating factor s : the two intervention teams (and not the external consultants) took effectiv e ownership of the implementatio n Other effect s : the project has created an awareness of occupational stress and a set of skill s within the company which did not exist befor e Follow-up : yes, ongoing project (14 out of 20 “ original ” actions are still ongoing or in progress ) 400 KOMPIER, COOPER, GEURT S Ital y (n = 12 8) S te p 1: P re pa ra tio n Motives : preventing risks of stress and burnout by developing effective coping style s Organization : cooperation of nurse school supervisors, occupational health professionals an d university Research design ratin g : *** Duration : 6– 12 month s S te p 2 : Pro b le m a na ly si s Instruments : validated questionnaires on work and (psychological) healt h Risk factor s : based on “ nurse burnout ” literatur e Risk group s : all student nurse s S te p 3 : C hoice o f m e as u re s Difference work directed versus person directed hard to assess: controlled programme of suppor t and supervisio n Work directe d : experimental group; regular group discussions, control group: non e Person directe d : experimental group: individual supervision, support from older nurse; contro l group: support from older nurse onl y S te p 4 : Im pl e m e nt a tio n For both the experimental and the traditional group measures were implemented and combine d with “ ward activity ” S te p 5 : Ev a lu a tio n Absence % : not measure d Questionnaires : in general various positive effects from Time 1 to Time 2 in both th e experimental and the traditional group (e.g., decrease of anxiety, better psychological condition , higher self esteem ) Other benefit s : significantly more students from the experimental group passed the exam s Costs and benefit s : not known, presumably positiv e Obstructing factor s : not specifie d Stimulating factor s : combining monitoring and intervention; making use of already availabl e resources Follow-up : unknown View publication statsView publication stats