Interventions for musculoskeletal disorders in computer-intense office work: A framework for evaluation

Workplace interventions for work-related musculoskeletal disorders (WMSDs) are usually multifaceted. These interventions tend to deal with multiple work organizational and physical risk factors and have components occurring at different organizational levels. The organizations are often changing, with shifting initiatives and priorities. Evaluation of such interventions poses challenges in documentation of implementation, reduction in exposures, and assessment of improved health outcomes. We describe a means-outcomes framework for evaluating field interventions that includes strategies, activities, objectives and metrics for outcomes using quantitative and qualitative methods. We demonstrate application of the framework to our work with a large newspaper, which builds on existing laboratory, aetiological and best practice evidence to improve musculoskeletal health. The newspaper had adopted several organizational strategies aimed at improving financial performance, including restructuring into teams, a major set of moves/renovations and introduction of new software. Concomitant WMSD-related organizational strategies include an ergonomics policy, human resources activities, promotion of team work, changes in environment and equipment specifications and development of information systems. We have found the framework useful for focusing the purpose of data collection and ensuring coverage of important components. At the same time, it provides sufficient flexibility to respond to the changing process of implementation.     

How the psychosocial work environment of motor vehicle mechanics may influence coping with musculoskeletal symptoms

A number of studies have shown that musculoskeletal symptoms are related to the physical and psychosocial work environments. Workers with musculoskeletal symptoms are often advised to cope by such measures as changing working technique, using lifting equipment and discussing health and environmental problems with supervisors and colleagues. Intervention studies at the individual level, however, have shown that such advice has limited effects in reducing the prevalence of musculoskeletal symptoms. The hypothesis for this study was that negative social and organizational factors may prevent workers from implementing such coping strategies. All 103 motor vehicle mechanics surveyed in 12 different garages responded to a questionnaire on coping with musculoskeletal symptoms and the psychosocial work environment. Positive and significant relationships were shown between how mechanics coped with their musculoskeletal symptoms and such psychosocial factors as work demands, social support, control, manager's involvement in health and safety work, and whether the garages had regular meetings between management and workers. Achieving positive results from preventive work through back schools and other ergonomic interventions seems to require that an organization with positive attitudes towards health and safety work be created before such interventions are implemented.     

Editorial: Cognitive science,occupational stress and organizational health

A number of studies have shown that musculoskeletal symptoms are related to the physical and psychosocial work environments. Workers with musculoskeletal symptoms are often advised to cope by such measures as changing working technique, using lifting equipment and discussing health and environmental problems with supervisors and colleagues. Intervention studies at the individual level, however, have shown that such advice has limited effects in reducing the prevalence of musculoskeletal symptoms. The hypothesis for this study was that negative social and organizational factors may prevent workers from implementing such coping strategies. All 103 motor vehicle mechanics surveyed in 12 different garages responded to a questionnaire on coping with musculoskeletal symptoms and the psychosocial work environment. Positive and significant relationships were shown between how mechanics coped with their musculoskeletal symptoms and such psychosocial factors as work demands, social support, control, manager's involvement in health and safety work, and whether the garages had regular meetings between management and workers. Achieving positive results from preventive work through back schools and other ergonomic interventions seems to require that an organization with positive attitudes towards health and safety work be created before such interventions are implemented.     

Assisting employees with drinking problems: Changes in mental health, job perceptions and work performance

A sample of 104 British transportation employees with alcohol-related problems were examined for changes in mental health and job perceptions before and after a company-based counselling programme. Data was mainly obtained by means of structured interviews. When clients were assessed at a 6-month follow-up, significant positive changes were found for the group as a whole in terms of context-free mental health, self- and supervisor ratings of work performance as well as measures of absenteeism. Small positive differences were observed for measures relating to perceived work demands. However, no significant differences were observed for the measures of job satisfaction and job commitment. The findings are discussed in relation to the expected client and organizational outcomes of workplace counselling interventions.     

Control at work: a generalized resource factor for the prevention of musculoskeletal symptoms?

During the last two decades two potent groups of predictors for work-related musculoskeletal problems have been identified: physical work load and poor psychosocial working conditions. However, little is known about their combined effects. In this study the buffering effect of control at work with respect to the negative effects of psychological demands and physical work load on musculoskeletal problems is examined. All study variables were sampled from 431 people working in geriatric nursing homes in Germany by means of questionnaires. Main effects and interactions were tested with multiple regression analysis. The results showed that control buffered the effects of high psychological demands, but not of high physical work load; the buffering effect of control was observed only when physical work load was low. The combined effects of demands and physical work load were over-additive. Thus, the power of different predictors for musculoskeletal symptoms depended on the level of other predictors. This suggests that the efficiency of certain strategies for the prevention of musculoskeletal problems is likely to depend on the level of risk factors, with different strategies being appropriate for different levels of risk.     

Personality and organizational health: the role of conscientiousness

Organizational health research identifies processes through which the work environment and individual differences combine to influence both individual and organizational outcomes. This study investigated the contribution of conscientiousness to organizational health. Research in the areas of occupational stress, work performance, and organizational climate was used to develop a framework for integrating different elements of organizational health. Within this framework, the work environment was assessed by perceptions of workload and role clarity ; individual well-being was assessed by psychological distress and job satisfaction ; and behaviour important for organizational success was assessed by contextual performance. Conscientiousness was investigated within the framework using self-reports from a sample of 104 Australian employees. Conscientiousness directly influenced contextual performance but did not influence well-being or perceptions of the work environment. Conscientiousness also reduced the impact of role clarity on both psychological distress and job satisfaction. The role of conscientiousness in a comprehensive model of organizational health is discussed.     

Organizational interventions: A research-based framework for the evaluation of both process and effects

Abstract

Organizational interventions are often recommended when organizations want to improve employee psychological health and well-being. Research, however, has revealed inconsistent results and reviewers have called for research on why interventions either bring about desired change or fail to do so. Answering the “how” and “why” of intervention outcomes requires a close examination of the elements that hinder or facilitate desired outcomes, thus moving beyond evaluation of only the overall effects. In this paper, we present an evaluation framework based on recent intervention research and process-oriented organization theory. The framework offers suggestions for which elements to include when evaluating organizational interventions. Within the framework, elements crucial to intervention evaluation are grouped into four overarching categories that we argue are crucial to evaluation over the five phases of an intervention programme. These categories are: the organizational “actors”; the mental models of those actors; the context of the intervention; and intervention design and process. Evaluation during the process as well as of the overall effects, as recommended by this framework, should throw light on what works for whom, why, how and under which circumstances.     

The validity of the occupational stress indicator

During the last two decades two potent groups of predictors for work-related musculoskeletal problems have been identified: physical work load and poor psychosocial working conditions. However, little is known about their combined effects. In this study the buffering effect of control at work with respect to the negative effects of psychological demands and physical work load on musculoskeletal problems is examined. All study variables were sampled from 431 people working in geriatric nursing homes in Germany by means of questionnaires. Main effects and interactions were tested with multiple regression analysis. The results showed that control buffered the effects of high psychological demands, but not of high physical work load; the buffering effect of control was observed only when physical work load was low. The combined effects of demands and physical work load were over-additive. Thus, the power of different predictors for musculoskeletal symptoms depended on the level of other predictors. This suggests that the efficiency of certain strategies for the prevention of musculoskeletal problems is likely to depend on the level of risk factors, with different strategies being appropriate for different levels of risk.     

Intrinsic motivation: the case for healthcare systems in Malaysia and globally

The intrinsic motivational aspects that improve the psychological well-being of health practitioners have been usurped by an insulated reliance on financial incentives and other external factors. This paper examines issues pertinent to the motivation of doctors in the healthcare system in Malaysia. The article also attempts to identify problem areas that could benefit from interventions focusing on intrinsic motivation. Financial incentives and the deterioration in intrinsic motivation levels partly influence the exodus of healthcare workers from public healthcare organizations to private practice. A multidimensional approach is required to improve intrinsic motivation amongst healthcare workers. Leadership strength, organizational citizenship, modification of job design, career management, and a democratized work environment are seen as crucial factors to remedy work morale in healthcare systems. A prospective conceptual framework described in this article could serve as the foundation to analyse motivational outcomes through research in the future.     

From start to finish: Flexi-time as a social exchange and its impact on organizational outcomes

We employ arguments from social exchange theory to develop a framework explicating the relationship between flexi-time and employee absenteeism, employee turnover, and organizational profitability. Then, employing data from 1,064 private sector organizations located in France, Germany, Hungary, Ireland, Italy, Sweden, and the United Kingdom, we test our hypothesized model via path analysis. We found flexi-time to have a significant negative relationship with employee turnover and a significant positive relationship with organizational profitability, controlling for organizational, industry, and country factors, as well as other flexible work arrangements. The relationship between flexi-time and absenteeism did not reach significance in our estimations. We highlight the implications of our work and outline directions for future research.     

Organizational identification and workplace behavior: More than meets the eye

Organizational identification is a theoretically profound and practically important construct. It fundamentally transforms the relationship between employees and their work organizations, because highly identified employees integrate their organizational memberships with their sense of who they are. This transformation enhances highly identified employees’ work performance and contributions to the organization. However, despite considerable research on the benefits of organizational identification for employee behavior, theorizing about this effect and its underlying mechanisms remains underdeveloped. In particular, there has not been sufficient theoretical development regarding the specific types of work behaviors that follow from organizational identification, the psychological mechanisms that underlie these behavioral consequences, or observers’ evaluations of these behaviors and those enacting them. To address these issues, we present a framework of the behavioral consequences of organizational identification as well as observers’ reactions to them. Our framework highlights two distinct motivational orientations that underlie organizational identification, one that reliably leads to conformist work behaviors and one that may lead to deviant work behaviors that violate the status quo to advance organizational interests. Moreover, our framework highlights that reactions to these behaviors will differ depending on the organization’s emphasis on means versus ends. Overall, we emphasize that the benefits of organizational identification for work behavior are not as straightforward or as widely recognized as implied in prior research.     

Different strategies for managing the work non-work interface: a test for unique pathways to work outcomes

Scientific evidence linking employers' efforts to help workers to manage the work non-work interface to actual outcomes at work remains scarce. In this study of 200 women employed in a Canadian school district, a research model was devised to explain how two strategies for managing the interface may affect stress symptoms, absenteeism and turnover intention. Several features distinguish this model from earlier models of the work non-work interface. That is, two directions of work non-work conflict, a mediator between the strategies and work outcomes, are specified, each strategy is set to relate directly to only one direction of conflict, and each direction is set to relate directly to stress symptoms and either absenteeism or turnover intention. LISREL analysis supported the superiority of the research model to a general model incorporating more common conceptualizations of the work non-work interface.     

'Management Standards' and work-related stress in the UK: policy background and science

In the late 1990s, the Health and Safety Commission, as the lead authority in the UK responsible for Health and Safety at Work, conducted an extensive consultation exercise to elicit views about how work-related stress should be tackled. The Commission subsequently decided that regulation was not justified and opted for an approach with four strands. One of these was to work with stakeholders to develop clear, agreed standards of good management practice. This paper describes and discusses the rationale behind a standards-based approach that is essentially based on a method of controlling hazards. The Management Standards approach uses a taxonomy of six stressors that has evolved out of extensive research carried out on behalf of the UK's Health and Safety Executive (HSE) and in conjunction with stakeholders, and a three-phase risk assessment methodology. Further developmental work on the standards (which are to be subjected to public consultation) and associated measurement tools is described in a companion paper in this issue of Work & Stress (Cousins, Mackay, Clarke, Kelly, Kelly, & McCaig, 2004). The emphasis is on prevention towards reducing stress in the UK working population. We review current thinking on models of work stress, consider evidence linking workplace psychosocial factors and various health and organizational outcomes, and examine the effectiveness of organizational interventions. We argue that the literature supports an approach that aims to move organizational states (represented by the current situation) to more desirable ones (represented by the six Management Standards), and that this is an effective 'population' based approach to tackling workplace stress and promoting individual and organizational health.     

The medical practice as business organization

Medical practices historically have not been examined in terms of their organizational structures and of the appropriateness of their structures for survival as business entities. In this paper, we propose a model for the typical medical practice and discuss its fit with current organizational theory. It is apparent that the medical practice organization does not fit with the demands of a rapidly changing and complex environment. To survive and grow, the medical practice organization must align itself with others that have an interest and stake in the health care system, develop teamwork among physicians, bridge the gap between physicians and others in the organization, and recognize that the work done in the organization depends on other components of the organization.     

Understanding the Antecedents of Effective Knowledge Management: The Importance of a Knowledge‐Centered Culture*

Within the context of knowledge management, little research has been conducted that identifies the antecedents of a knowledge‐centered culture—those organizational qualities that encourage knowledge creation and dissemination. In this study, the existing literature on organizational climate, job characteristics, and organizational learning (in the form of cooperative learning theory) are linked with the current thinking and research findings related to knowledge management to develop a theoretical model explaining the relationships among organizational climate, the level of cooperative learning that takes place between knowledge workers, and the resulting level of knowledge created and disseminated as measured by team performance and individual satisfaction levels. The study goes on to empirically test the proposed research model by investigating the climate of organizations, and seeks to understand the linkage between a set of organizational and individual characteristics and knowledge‐related activities found in cooperative learning groups and the resulting work outcomes. The hypothesized research model is tested using LISREL with data collected from 203 information systems (IS) professionals engaged in systems development activities. The paper concludes with a discussion of the implications the results have for future research and managerial practice.     

‘Management Standards’ and work-related stress in the UK: policy background and science

In the late 1990s, the Health and Safety Commission, as the lead authority in the UK responsible for Health and Safety at Work, conducted an extensive consultation exercise to elicit views about how work-related stress should be tackled. The Commission subsequently decided that regulation was not justified and opted for an approach with four strands. One of these was to work with stakeholders to develop clear, agreed standards of good management practice. This paper describes and discusses the rationale behind a standards-based approach that is essentially based on a method of controlling hazards. The Management Standards approach uses a taxonomy of six stressors that has evolved out of extensive research carried out on behalf of the UK's Health and Safety Executive (HSE) and in conjunction with stakeholders, and a three-phase risk assessment methodology. Further developmental work on the standards (which are to be subjected to public consultation) and associated measurement tools is described in a companion paper in this issue of Work & Stress (Cousins, Mackay, Clarke, Kelly, Kelly, & McCaig, ). The emphasis is on prevention towards reducing stress in the UK working population. We review current thinking on models of work stress, consider evidence linking workplace psychosocial factors and various health and organizational outcomes, and examine the effectiveness of organizational interventions. We argue that the literature supports an approach that aims to move organizational states (represented by the current situation) to more desirable ones (represented by the six Management Standards), and that this is an effective ‘population’ based approach to tackling workplace stress and promoting individual and organizational health.     

A Hybrid Methodology for Modeling Risk of Adverse Events in Complex Health‐Care Settings

In spite of increased attention to quality and efforts to provide safe medical care, adverse events (AEs) are still frequent in clinical practice. Reports from various sources indicate that a substantial number of hospitalized patients suffer treatment‐caused injuries while in the hospital. While risk cannot be entirely eliminated from health‐care activities, an important goal is to develop effective and durable mitigation strategies to render the system “safer.” In order to do this, though, we must develop models that comprehensively and realistically characterize the risk. In the health‐care domain, this can be extremely challenging due to the wide variability in the way that health‐care processes and interventions are executed and also due to the dynamic nature of risk in this particular domain. In this study, we have developed a generic methodology for evaluating dynamic changes in AE risk in acute care hospitals as a function of organizational and nonorganizational factors, using a combination of modeling formalisms. First, a system dynamics (SD) framework is used to demonstrate how organizational‐level and policy‐level contributions to risk evolve over time, and how policies and decisions may affect the general system‐level contribution to AE risk. It also captures the feedback of organizational factors and decisions over time and the nonlinearities in these feedback effects. SD is a popular approach to understanding the behavior of complex social and economic systems. It is a simulation‐based, differential equation modeling tool that is widely used in situations where the formal model is complex and an analytical solution is very difficult to obtain. Second, a Bayesian belief network (BBN) framework is used to represent patient‐level factors and also physician‐level decisions and factors in the management of an individual patient, which contribute to the risk of hospital‐acquired AE. BBNs are networks of probabilities that can capture probabilistic relations between variables and contain historical information about their relationship, and are powerful tools for modeling causes and effects in many domains. The model is intended to support hospital decisions with regard to staffing, length of stay, and investments in safety, which evolve dynamically over time. The methodology has been applied in modeling the two types of common AEs: pressure ulcers and vascular‐catheter‐associated infection, and the models have been validated with eight years of clinical data and use of expert opinion.     

Evaluating organizational-level work stress interventions: Beyond traditional methods

Since the early 1990s, there has been a growing literature on organizational-level interventions for work-related stress, and associated calls for such interventions to be evaluated. At the same time, doubts have been expressed about the adequacy of traditional scientific research methods in applied psychology (the natural science paradigm) in providing an effective framework for such evaluations. This paper considers some of the philosophical and methodological issues raised by evaluation research in relation to organizational-level interventions for work-related stress. Four key issues are discussed: the concept of a study being “fit for purpose” in relation to research designs and the nature of acceptable evidence; the issue of control of research conditions in real-world studies; the need to evaluate process as well as outcome, including the interrelated nature of process and outcome; and the interpretation of imperfect evidence sets. The starting point of this paper is the reality of organizational life, which is complex and continually changing. Its main objective is not to offer an alternative to a scientific approach but to argue for a more broadly conceived and eclectic framework for evaluation that acknowledges the limitations of the traditional approach. It espouses an approach that is reflective of the reality of organizational life and in which the methods used for evaluating an intervention are fit for purpose. The paper concludes by offering an outline framework for this broader approach to the evaluation of interventions.     

Organizational-level interventions to reduce occupational stressors

Occupational stress research continues to grow, and is increasingly being used to inform national policy on worker health and well-being. Most models of occupational stress emphasize notions of person-environment fit. Two approaches for intervention to minimize adverse consequences of occupational stress follow from such models. One emphasizes the strengthening and enhancement of indwiduals and their resources, the other emphasizes the reduction ofcommon workplace-based sources ofoccupational stress. This paper reviews 10 organizational-level interventions to reduce stress at work which have been examined in various field studies. These interventions were generally found to have positive effects, and, given the limited success of individual-level interventions in addressing occupational sources of stress, should be encouraged.     

Organizational-level interventions to reduce occupational stressors

Abstract

Occupational stress research continues to grow, and is increasingly being used to inform national policy on worker health and well-being. Most models of occupational stress emphasize notions of person-environment fit. Two approaches for intervention to minimize adverse consequences of occupational stress follow from such models. One emphasizes the strengthening and enhancement of indwiduals and their resources, the other emphasizes the reduction ofcommon workplace-based sources ofoccupational stress. This paper reviews 10 organizational-level interventions to reduce stress at work which have been examined in various field studies. These interventions were generally found to have positive effects, and, given the limited success of individual-level interventions in addressing occupational sources of stress, should be encouraged.