Chapter 2: The Business Case for the Integration of Employee Assistance,Work-Life and Wellness Services

SUMMARY

Employee assistance programs (EAP), work-life programs and wellness programs are three commonly provided kinds of interventions that have the goals of reducing healthcare costs, improving employee performance and fostering a healthier workplace culture. The integration of these kinds of programs is a recent trend that has the potential to offer additional synergistic benefits. New studies have linked comprehensive delivery services that support human capital needs with bottom-line financial success of the company. This evidence can be used to make the business case for offering EAP, work-life and wellness services in an integrated capacity. However, while promising, the scientific evidence thus far in this area has methodological limitations and there are critical aspects that require further study.     

李贺诗歌悲剧意识的审美分析

李贺的出现是中国文学史上的一个奇迹。他似乎不循任何理路,不遵任何规范。像雨后的彩虹,凭空而来,又倏尔逝去。但是,当我们试图超越生命或深人生命时,我们又是那样真实地感受到李贺的存在,他的诗歌素来以悲凄、怪诞著称,诗作从里到外都渗透着一股浓重的悲剧意识。本文着重从审美角度来分析李贺诗歌的悲剧意识：以病为美、以悲为美、以寒为美、以怪为美。     

Chinese Rural Health-Seeking Behaviour and the Dilemma of Sufferers of Chronic Sickness: A Case Study from Inner Mongolia

Chinese society is entering a ‘period of chronic sickness’, especially hypertension, hyperglycemia and hyperlipidemia, resulting from a more easily available diet rich in animal fat and protein. The damage is greatest in rural areas where medical and welfare facilities are limited and patients present late, which they justify as needing to continue farming despite sickness. Thus, contrary to Parsons’s observation regarding Western medical treatment, a patient’s sick role is neither ‘deviant’ nor separated from their everyday social role and lifestyle. Villagers might however be officially encouraged to regard biomedical, religious and traditional folk therapies as neither old-fashioned nor in conflict, but as a spectrum providing emotional/psychological and sometimes physical benefit, reinforced by returning to the greater community and family care existing before village social fragmentation. This recreation of a holistic perspective could enhance the quality of rural life, especially of chronic sickness sufferers.     

Controlling Access to Sick Leave Programmes: Practices of Physicians in the Netherlands

Policymakers in industrialized countries attempt to contain the costs of sick leave and disability schemes by limiting access to include medically proven cases only. However, a person's incapacity to work cannot be fully deduced by referring to his or her medical condition. It is the question whether using more restrictive eligibility criteria that focus on medical evidence actually reduces the number of benefit recipients and makes access to employee benefit arrangements fairer. This ethnographic study shows that physicians working in Dutch illness certification practices use alternative methods to restrict access to sick leave programmes. Doctors do not control their clients in a restrictive sense of the word. Rather, they exercise control over their clients by inciting them to internalize norms about being active and responsible. While we do not claim that this is good per se, we do contend that this control style may have some advantages over and above more restrictive control mechanisms. Elaborating on policy that supports this alternative notion of control, therefore, seems worthwhile.     

Fit for Work? The Influence of Sick Pay and Job Flexibility on Sickness Absence and Implications for Presenteeism

Recent developments in UK policy on health and employment have sought to change perceptions about what constitutes ‘fitness for work’. With the aim of reducing the incidence and duration of sickness absence, a range of initiatives, including the introduction of the ‘fit note’, are challenging the belief that it is necessary to be 100 per cent well in order to be at work. However, this article suggests that contextual factors independent of health may also influence people's decisions about whether or not to attend work at times of reduced wellness. Drawing upon data from a qualitative study of mental health and employment, this article illustrates how the terms and conditions of a person's employment may influence sickness absence decisions in a number of ways. It is argued that sick pay provisions, size of employer and nature of work may influence both decisions to take time off and decisions about when to return to work. The degree of flexibility to manage one's workload around times of poorer health may also have a bearing on whether people feel able to carry on with their work without recourse to sickness absence. Therefore, it may be important for policy interventions to consider not only health circumstances but also structural/contextual influences on conceptualizations of being ‘fit for work’. The implications of such contextually‐influenced decision‐making for ‘presenteeism’ are also considered. It is suggested that current conceptualizations of presenteeism are somewhat ambiguous; employees coming to work despite ill health is simultaneously presented as a problem and an aspiration.     

Employee correlates of sickness presence: A study across four European countries

The model of sickness presence (SP) proposed by Aronsson and Gustafsson consists of two parts. The first postulates SP as an employee's reaction to his/her general state of health, and as depending on employee correlates relating to the individual and the job. The second proposes longitudinal relationships between SP and future health. The present study is the first to test the first part of the model outside Scandinavia. Positive sickness presence factors studied were work involvement and job satisfaction; negative presence factors were financial household contribution, time pressure at work, and perceived job insecurity. Control variables were general health, age, gender and autonomy. Data (N=2348) were gathered from a total of 110 organizations in four European countries (Belgium, Spain, Sweden and the UK) with differing welfare state regime, degree of employment protection, labour market and sickness absence-related indicators. The data were analysed by hierarchical multiple regression per country. The findings partially confirmed the Aronsson and Gustafsson model. In all countries, employee general health status was a prerequisite of SP, and time pressure at work related to SP. In Sweden and the UK, job satisfaction related to SP. In the UK, work involvement related to SP.     

The effect of objective job demands on registered sickness absence spells; do personal,social and job-related resources act as moderators?

Abstract

This study applied Karaseks demand-control model, using sense of coherence (SOC), social support and job control as moderators of effects of job demands on ensuing sickness absence spells in a 3-year follow-up of 856 municipal employees. Among men the results supported the active learning hypothesis. Passive jobs predicted a high number of sickness absence spells and active jobs predicted a low number of spells. for short spells (1-3 days), the demand-control interaction, however, depended on SOC. In active jobs SOC was negatively associated with sickness absence spells; in passive jobs no such association was found. For long spells (3 days), the demand-control interaction depended on occupational level; active jobs were predictive of low absence spells among blue collar men. Among women, the results supported the strain hypothesis. The demand-control interaction, however, depended on household size. In small households, high-strain jobs predicted a high number of spells, while no increase in spells was found in active versus low-strain jobs. In larger households, the number of spells correlated positively with increasing demands even when control was good. The demand-control interaction, however, depended on SOC and spouse support. With strong SOC or spouse support, absence spells in active jobs remained on a relatively low level, otherwise active jobs led to a high number of spells. This suggests that SOC and spouse support may act as protective factors against female role conflicts associated with active jobs     

The relationship between transformational leadership and follower sickness absence: the role of presenteeism

The impact of transformational leaders on employee health and well-being has received much attention. Less research has focused on the relationships between transformational leaders and followers’ sickness absenteeism. Transformational leaders promote a group climate that may lead to absenteeism, especially among vulnerable employees (those with high levels of presenteeism). In the present study we examined the relationships between presenteeism, group-level transformational leadership and sickness absence rates in a three-year longitudinal study of postal workers and their leaders in Denmark (N?=?155). Group-level transformational leadership in year 1 predicted sickness absenteeism in year 2, but not in year 3. In examining conditions under which transformational leadership may be linked to higher levels of sickness absenteeism, we found that presenteeism in year 1 moderated the link between transformational leadership in year 1 and sickness absenteeism in year 3, such that followers working in groups with a transformational leader and who were high in presenteeism reported higher levels of sickness absenteeism. Our results suggest a complex picture of the relationship between transformational leadership and sickness absenteeism; transformational leaders may promote self-sacrifice of vulnerable followers by leading them to go to work while ill, leading to increased risks of sickness absence in the long term.     

Previous sickness presence among long‐term sick‐listed in Norway and Sweden: A retrospective study of prevalence and self‐reported reasons

The aim of the present study was to analyse previous sickness presence among long‐term sick‐listed individuals in Norway and Sweden and the reasons given for sickness presence. The study was based on survey data for 3,312 persons in Norway and Sweden who had been sick‐listed for at least 30 days. Two questions were used. One measured prevalence: During the last 12 months prior to your current sick leave, did you go to work even when feeling so ill that you should have taken sick leave? The second question concerned reasons for sickness presence. Large differences were found between Norway and Sweden in the prevalence of sickness presence. More long‐term sick‐listed Norwegians than Swedes reported sickness presence [adjusted odds ratio (OR) for Sweden 0.65 (0.53–0.80)]. The Swedes more often reported financial reasons for sickness presence [adjusted OR 2.77 (2.1 to ?3.54)], while the Norwegians more often gave positive reasons related to work. The national differences may be related to differences in sickness insurance strategies.     

Job characteristics as predictors of ill-health and sickness absenteeism in different occupational types--a multigroup structural equation modelling approach

The objective of the present study was to test for multigroup invariance in measurement models and structural models between job characteristics, psychosocial intervening variables, health outcomes and sickness absenteeism. Four types of occupation were represented in the study: blue-collar workers ( n = 241), white-collar workers ( n = 209), elderly-care workers ( n = 338) and child-care workers ( n = 336). A first-order, six-factor multigroup confirmatory factor analysis model (i.e. measurement model) composed of two perceived job characteristics ( job autonomy and skill discretion), appraised workload, job satisfaction, stress-related ill-health and sickness absenteeism provided a good model fit. Invariance tests showed that the six-factor model fits well for all occupations. A partially recursive mediated multigroup structural model showed both similarities and differences across occupations as regards the relationships between independent latent variables ( job autonomy, skill discretion), intervening latent variables (appraised workload, job satisfaction) and dependent latent variables (stressrelated ill-health, sickness absenteeism). By comparing a generic model with occupation-specific models across occupations, this study showed that occupation-specific models were more plausible. The results indicate that it is important to examine different occupational contexts in detail to better understand how certain psychosocial factors at work influence strain in different occupations. Since job characteristics can potentially be amended, the findings have important implications for the differentiation of prevention and intervention in different occupations.