How effective are organization-level interventions in preventing workplace stress?
The issue
Worldwide, governments and employers are increasingly interested in workplace mental health, as the economic burden of depression, in terms of loss in productivity from occupational stress, becomes more apparent. The health care sector is particularly affected.
There are many determinants of occupational stress; some are not work related and have a wide range of modifying variables. Outcomes such as burnout, psychological and physical illness, absenteeism, presenteeism (lost productivity from being unwell in the workplace) and turnover of staff make occupational stress and depression costly to organizations.
A number of organization-level interventions can help to address and mitigate the burden of workplace stress, but there is limited evidence on their impact as compared to no-intervention controls.
Findings
Six systematic reviews of organization-level intervention strategies to reduce the outcomes of stress were assessed. These strategies were categorized as: job redesign or restructuring, participation and autonomy, training and education, co-worker support groups, physical and environmental characteristics, communication or role issues. Three of the reviews focused exclusively on health care workers.
Limited evidence indicates that organization-level interventions reduce stress, psychological symptoms or absenteeism in the workplace when compared to no intervention or other interventions. Participation and autonomy, job redesign or restructuring, and training and education strategies were the most effective interventions, although this may simply reflect their overrepresentation in the literature. Employee turnover decreased when organization-level interventions were implemented, but the statistical significance of the change was usually not reported. With the current evidence, the effectiveness of one intervention relative to another could not be determined.
From the reviews relating only to health care workers, no conclusions were possible on the effectiveness of one organization-level intervention over another. Limited evidence indicates that work-directed or organization-level interventions effectively reduce symptoms of stress and burnout in health care workers when compared to no interventions, although strategies to enhance social support, and improve managerial support and supervision may potentially improve staff well-being. For example, a psychological training session with theory and role playing significantly reduced stress immediately following the intervention, but the difference was not significant six months afterwards.
One of the reasons given for the limited effectiveness of organization-level interventions is that differences between individuals (in age, sex, socioeconomic status and psychological variables, for example) may dilute this effectiveness. The perception of a stressor may vary from one person to another, as can the manner in which an individual copes with a stressor. Further, interventions to prevent stress can vary widely in objectives, strategy and level of focus and measurement.
Policy considerations
The comparative effectiveness of organization- versus individual-level interventions in preventing workplace stress is not yet known. Nevertheless, the reviews suggest intuitively that pursuing organization- and individual-level interventions to reduce or modify the causes of stress, as well as teaching staff to cope better with it, should have positive effects. Indeed, many authors recommend implementing comprehensive programmes in which individual- and organization-level strategies are used in a single intervention.
Transferring and generalizing the results from organization-level stress prevention interventions is difficult even between countries, as differences in strategies, worker populations and environmental, cultural or political contexts may influence interventions’ effectiveness.
Target groups should be considered when determining the true potential of stress interventions. Individuals with lower levels of stress may show little or no change, in comparison to those with higher levels; this dilutes the results.
Research shows that methods to prevent workplace stress have improved over the years, although more rigorous study design and analysis are imperative to determine which strategies are the most effective for which populations and what components of interventions ensure or increase the likelihood of success. A framework for classifying the different types of interventions is recommended, so that common measures can be incorporated for all contributing determinants.
Adequate resources are needed for the proper evaluation of any workplace interventions, including major changes in policies and procedures, at both the individual and the organization levels.
Type of evidence
This report summarizes six systematic reviews conducted to assess the effectiveness of organization-level interventions to prevent stress. These reviews refer only to primary prevention strategies to address the work environment and workers’ exposure to sources of stress, as opposed to secondary strategies to address individual-level changes in the employee.
Three reviews focused on health care workers; the others included workers from all sectors. Differences between reviews were found in the classification of interventions, and the types of strategies and instruments used to measure outcomes.
