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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
Impact of Psychosocial Interventions: From research to good practice © Anna-Liisa Elo 3
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
Impact of Psychosocial Interventions: From research to good practice © Anna-Liisa Elo 4
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
Impact of Psychosocial Interventions: From research to good practice © Anna-Liisa Elo 5
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)
Impact of Psychosocial Interventions: From research to good practice © Anna-Liisa Elo 6
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
Impact of Psychosocial Interventions: From research to good practice © Anna-Liisa Elo 7
Criteria of success of psychosocial interventions at work?
Improved• Health and wellbeing• (Psychosocial) working conditions • Professional competence• Leadership & management• Organizational performance
etc.
Impact of Psychosocial Interventions: From research to good practice © Anna-Liisa Elo 8
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
Impact of Psychosocial Interventions: From research to good practice © Anna-Liisa Elo 10
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
Impact of Psychosocial Interventions: From research to good practice © Anna-Liisa Elo 11
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
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 12
Impact of Psychosocial Interventions: From research to good practice © Anna-Liisa Elo 13
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
Impact of Psychosocial Interventions: From research to good practice © Anna-Liisa Elo 14
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
Impact of Psychosocial Interventions: From research to good practice © Anna-Liisa Elo 15
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
Impact of Psychosocial Interventions: From research to good practice © Anna-Liisa Elo 16
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
Impact of Psychosocial Interventions: From research to good practice © Anna-Liisa Elo 17
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)
Impact of Psychosocial Interventions: From research to good practice © Anna-Liisa Elo 18
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%)
Impact of Psychosocial Interventions: From research to good practice © Anna-Liisa Elo 19
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)
Impact of Psychosocial Interventions: From research to good practice © Anna-Liisa Elo 20
...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!
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 21
Thank you for your attention