anna-liisa elo, prof. finnish institute of occupational health university of tampere impact of...

Anna-Liisa Elo, prof.Finnish Institute of Occupational HealthUniversity of Tampere

Impact of Psychosocial Interventions: From research to good practice

PRIMA-EF WorkshopHelsinki 20-21 May 2008

Impact of Psychosocial Interventions: From research to good practice © Anna-Liisa Elo 2

Why to investigate impact of psychosocial interventions at work

• Researchers validate the theories on wellbeing at work by showing that expected intervention effects exist

• Organizational consultants develop effective, especially cost-effective methods to satisfy their customers' needs

• Employees aim at better wellbeing including meaningfull challenge at work to stay healthy and productive

• Employers strive for high performance for which organizations' intellectual capital is a key element including health and wellbeing of personnel

• Policy makers emphasize more often the cost-effectiveness and cost-benefit of actions as criteria for decision making


Effectiveness of stress management and psychosocial interventions

Very few controlled field-experiments have been reported.

Lack of evidence does not mean ineffectivenenss!

1. Individual oriented interventions: effective; may lead to "blaiming of the victim"

2. Organization (& work unit) oriented interventions: effects on org. climate and performance; sometimes also on wellbeing, health, job satisfaction & sickness abasenteesim; buffering effects during org. changes?

3. Society level interventions:political agenda, legislation, agreements, national programs?

Murphy & Sauter 2004, Semmer 2006


EVALUATION OF A PROJECT'S (PROGRAM) IMPACT:

• Starting point of evaluation: values and goals

• Self- and external evaluation • Process and outcome evaluation

(impact, process, learning, future)• 'Realistic', 'pragmatic',

'empowering' evaluation Evaluation as promotor of

development and learning!

EXPERIMENTAL RESEARCH ON THE INTERVENTION'S EFFECT:

• Control group design & randomization (RCT)

• Individual level and work unit level?

• Commitment of the participants?• Management of turbulence and

flexibility at workplace

Effect as confirmation of theory !

Manualization of the intervention!

Intervention project as a consultative task and as scientific research


Deg

ree o

f con

sen

su

s

on

th

e d

irecti

on

of

goals

Knowledge about mechanisms of the effect

Multifaceted evaluation/interpretative models

Standard or goal evaluation

Effectiveness evaluation

Selection of evaluation model (Pollit 1991)


Evaluation of reaserch methodology (Murphy 1996)

* Evidence is based on description, anecdotal data, or authority

**Evidence has been obtained without interventions but it is based on significant results

*** Evidence has been obtained without control group and randomization but it is based on evaluation

**** Evidence is based on adequate research with control group design but without randomization

***** Evidence in based on adequate study design including randomized control group


Criteria of success of psychosocial interventions at work?

Improved• Health and wellbeing• (Psychosocial) working conditions • Professional competence• Leadership & management• Organizational performance

etc.


Success factors of work stress interventions

1. Stepwise and systematic approach

2. Adequate "diagnosis" or risk assessment

3. Work-oriented and individual oriented measures should be combined

4. Participative approach. Especially middle-management and employees should be involved

5. Support of top management

(Kompier & Cooper 1999, Kompier et al. 2000)

Impact of Psychosocial Interventions: From research to good practice © Anna-Liisa EloImpact of Psychosocial Interventions: From research to good practice/Anna-Liisa Elo / 11.04.23 9

Psychosocial interventions in Public Works Organization

of Helsinki CityLessions learned

1997-2008


Interventions:

• Survey-feedback in work units• Individual feedback on wellbeing• Participative work conferences• Group psychodynamic ledership training• Other minor intervetnions and training in different units

Registering of all participation (0.5 days)

Evaluation themes:

• Situational factors• Effectiveness• Learning• Future effects

Methods

• Pre- and post measurements• Interviews• Evaluation seminar• Documents

PROGRAM (n=1800) EVALUATION

STEERING GROUPS

1999 2001

IMPLEMENTATIONProgram-team, Personnel

representatives, Consultants

IMPLEMENTATIONResearchers, Program-team

Psychosocial interventions:Evaluation and effect studies in the Public Works of Helsinkiin 1997-2001 ja 2006-2008

2006

ANALYSIS

OF

NEEDS

PRE-MEASUREMENT

POST-MEASUREMENT

OTHER

DATA

FOLLOW-UP

MEASUR

INTERVIEWS

Evaluation themes:

Organizationaldevelopment-leadership-autonomy of the unitEconomic impactof the interventionsLongitunal effects


Outcome measure:

= increased = decreased

Changes.All PersonnelPre-measurement n=1353Post-measurement n=1293

Effect of work conferences.Non-supervisory employees n=525

Effect of psychodynamic leadership training on subordinates.n=145

Effect of active participation.Employees n=806

1. Overload

2. Clarity of goals

3. Job control

4. Information flow

5. Supervisor support

6. Work climate

7. Emotional exhaustion

8. Work ability

9. Management interested in well-being

Repeated measures ANCOVA, Models adjusted for demographics, and participation in other interventions.

10. Job security

11. Sickness absenteeism


LESSONS LEARNED: Implementation

• Success factors:– Internal WHP-team; Data collection process – Persistence & national awards – Commitment of the management and other

key-persons

• Drawbacks:– Committing entire personnel– Respecting earlier/on-going projects– Earlier conflicts in some work units


LESSONS LEARNED: Evaluation strategy

• Success factors:– Combining effect study design and program

evaluation approach– Empovering evaluation & feedback process – Realistic financing of the intervention and

evaluation research

• Drawbacks:– Randomization of the study groups– Registering of improvements on unit level


LESSSONS LEARNED: The actors

• When the intervention effects are weak or controversial, the participants may be disappointed

• As the evaluation cannot concern all possible effects, the decision makers and consultants may be disappointed

• As the study design does not hold, the researchers may be frustrated

• As concise reporting and publishing of a long-lasting extensive program is difficult, important experience may remain unpublished


LESSONS LEARNED: Expectations and reality

• Intervention effects were weaker than expected:

– Intervention theory & implementation?

– Organizational flexibility & study design?

– Maintaining a long-running process?

• Unobserved positive effects?

– Limited scope of outcome measures neglected possible effects on e.g. organizational performance and intellectual capital


Psychosocial interventions and organizational performance/productivity

• Wellbeing and performance are associated. However, especially in mental work research results vary (modifiers: commitment, time pressures, personality etc.) (Jacobs et al. 2007)

• Profits have been gained through reduced sickness absenteeism and improved performance (subjective eval.) (Ervasti, Elo 2006)

• A participative psychosocial intervention may turn into an organizational performance intervention especially during economic pressure (Ervasti et al. 2006)

• Economic situation of the unit/organization moderates the effects of a psychosocial intervention (Elo et al. 2007)


Associations of Climate Surveys and Psychosocial Interventions with Human Resource Management and Well-being at Work (n=2007, national representative data)

HRM:

-Interaction structures at work

-Personnel training

-Investments in Occupational Health Care

-Well-being

-Psychosocial Work

Environment

Control variables: line of business; number of personnel at the organization; SES of the respondent

Climate Survey

(70%)

Psychosocial Intervention

(58%)


SUMMARY OF RESULTS: climate surveys and psychosocial interventions at Finnish work places

• Both organizational Climate Surveys and Psychosocial Interventions were associated with good HRM

• Organizational Climate Surveys did not have any main effects on wellbeing or psychosocial work environment

• Psychosocial Interventions had a positive main effect on well-being

• Interaction effects:– Climate Surveys were associated with poorer psychosocial

work environment than "no-actions" (no survey, no intervention)

– Psychosocial Intervention improved the (negative) effects of Climate Surveys

Cross-sectional study design: Logistic regressions, two-way ANOVA (Elo et al. 2007)


...towards good practice

• Good intervention process (diagnosis, stepwise approach, participation, individ. & org. orientation, top management support)

• Link to risk assessment (monitoring & audit)• Clear goals and values: quality of working life and

wellbeing• National & EU-policy should support the increasing of

intellectual capital which includes worker's health and wellbeing

All interventions are not (cost)-effective butthere are various ways to succeed!


Thank you for your attention

[email protected]