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Rationalization in garages in theNetherlands and its effects onoccupational healthGerard J. Houben a , Jos P. M. Diederiks a , Ymer Tkant b &Jos V. H. Notermans ca Department of Medical Sociology , University of Limburg ,P.O. Box 616, 6200 MD, Maastricht, The Netherlandsb Department of Occupational Medicine , University ofLimburg , Maastricht, The Netherlandsc Occupational Health Service South Limburg , Heerlen, TheNetherlandsPublished online: 27 Sep 2007.

To cite this article: Gerard J. Houben , Jos P. M. Diederiks , Ymer Tkant & Jos V. H.Notermans (1990) Rationalization in garages in the Netherlands and its effects onoccupational health, Work & Stress: An International Journal of Work, Health & Organisations,4:2, 179-189

To link to this article: http://dx.doi.org/10.1080/02678379008256979

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WORK & STRESS, 1990, VOL. 4, NO. 2, 179-189

Rationalization in garages in The Netherlands and its effects on occupational health

GERARD J. HOUBEN, JOS P. M. DIEDERIKS Department of Medical Sociology, University of Limburg, P.O. Box 616, 6200 MD Maastricht, The Netherlands

YMERT KANT Department of Occupational Medicine, University of Limburg, Maastricht, The Netherlands

and JOS V. H. NOTERMAWS Occupational Health Service South Limburg, Heerlen, The Netherlands

In this study, various hypotheses were tested in relation to car mechanics working in a sample of domestic car garages in South Limburg, The Netherlands. These concerned the negative relationships between the degree of control over the work process, and occupational strain, blood pressure, skin disorders and problems in the locomotor system. The relevant intermediate variables used were task latitude, social support from supervisor and colleagues, and positive appreciation (which were expected to weaken the major hypothesized relationships), and time pressure, mental load, and involuntary task interruption (which were expected to strengthen the major hypothesized relationships). The analysis also included the possible effects of age and seniority. Controls based on craft methods, blood pressure and skin disorders were measured through observation. The effect of controls based on craft methods, and occupational strain were demonstrated. Effects were also shown of occupational strain on diastolic blood pressure and on problems in the locomotor system, and of positive appreciation on non-contact skin disorder.

Keywords: Control of production; Occupational strain; Skin diseases; Car mechanics; Blood pressure; Locomotor behaviour.

1. Introduction In garages, as in many other work organizations in T h e Netherlands, a process o f expansion is underway, which increases the complexity of the technology involved and involves the rationalization of the production process. In this usually gradual evolution, social control based on craft methods dwindles and industrial structures develop. Garages currently operate at different stages in this historical process and consequently show a ‘mixed’ structure with elements from both craft and industrial-like control. In South Limburg a research project has been set u p in garages for domestic cars based on sociological insights into industrial evolution and on hypotheses about the possible effects of control on health outcomes.

An important theme in this study was: ‘to what extent does social control of the work process affect the occurrence of occupational stress, an increase in blood pressure and health problems such as skin diseases and problems of the locomotor system?’

Small garages, where repairs and maintenance represent the bulk of the work, often have a craft structure. This type o f organization is characterized by a patriarchal master

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180 C.J . Houben et a].

craftsman-journeyman relationship and by peer control. The owner of the garage does his share as a car mechanic, and the mechanics have relatively independent tasks (Blauner 1964). However, once a garage specializes in the sales, repair and maintenance of one or more specific makes of motor car a more explicit distribution of work ensues. As a consequence, sales and stock control eventually call for a restructuring of tasks. Current expectations and notions ofplanning and timing induced by car suppliers often take root. The introduction of time limits based on a flat-rate basis means that the time available for repairs and maintenance is liable to diminish. For this reason, occasional time pressure, usually caused by the client, adopts a more permanent character.

Rationalization as inherent in the central programming and evaluation of work activities, tends to eliminate production control based on craft methods and often occurs in combination with an increase in technical complexity (Scott 1981, Clegg 1981, Woodward 1965, Meissner 1969, de Haan 1975, Mintzberg 1979, Houben 1986). The change in the social control of major activities brings about a shift in the nature of required skills from motor and craft orientated skills to mental and perceptual activities (Davis and Taylor 1976). This is accompanied by a decrease in the decision latitude of the mechanics and, hence, less control over theirjobs and direct work environment. However, as the individual has less say in the work process, it is easier to move him or her from one job to the next, but therefore involuntary task interruption may occur more frequently.

As a result of these changes garages turn into less cohesive organizations, with their workers feeling less integrated and relationships with the management becoming more formal and impersonal.

As control of production is to a lesser degree based on craft methods, the all-round responsibility a car mechanic has for the repair and maintenance cycle is also diminished. This may be accompanied by a relatively small task latitude, time pressure, increased mental load and more frequent task interruption. The car mechanic may also receive less social support from his supervisor and colleagues and less positive appreciation from his social environment.

These mechanisms underlie the main hypothesis for the present study: the more that industrial control of production in garages replaces craft methods, the more car mechanics will be prone to occupational stress. Furthermore, relationships are expected to exist between occupational stress on the one hand and blood pressure and hypertension (Shapiro et al . 1979, Weyer and Hodapp 1979, Van Ameringen et al. 1988), skin disease (Wittkower and Lipowski 1966, House et al. 1979, Engels 1982}, and problems with the locomotor system (Wittkower and Lipowski 1966), on the other.

Figure 1 presents the model used in the present study which distinguishes: independent variables, i.e., control based on craft methods (I) and life history (11), intermediate (task specific) variables (111 and IV) and health outcomes (V).

The role of the intermediate variables is based on Waltz’s (1 981) ‘additive model’. Here it is assumed that both inadequate social resources and social stressors have a negative influence on health. Therefore task-latitude, social support from supervisor and colleagues, and positive appreciation, as social resources, are related to health outcomes. Occupational strain is also seen as an intermediate factor with negative effects for blood pressure, non- contact skin disease (as a psychosomatic disorder) and problems of the locomotor system. It is assumed that strain (as work-based anxiety) is an indication of inadequate coping behaviour.

‘Job demand’, composed of time pressure and mental load, is also used in this study to create a variable comparable to that employed by Karasek (1979, 1989). In his research Karasek demonstrated that heavy job demands are only harmful if task latitude is relatively

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Rationalization in garages in T h e Netherlands

INOEPENDEHT V A R I A B L E S I N T E R I I E D I A I E ( T A S K - S P E C I f I C l V A R I A B L E S

181

HEALTH OUlCOHES

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poor (see also: Aronsson 1989). He included job and life satisfaction, exhaustion and depression as dependent variables. In a study on coronary heart disease (Karasek el al. 1981), effects of task-latitude and demand were found but the interaction hypothesis was not tested. There is little published on the relationship with blood pressure in this context. By means of occupation-based aggregated data, Pieper et al. (1989) made a study of job characteristics and individual blood pressure measurements performed in the conventional way. Harenstam and Theorell (1988), Theorell et al. (1988) and Theorell et al. (1985 b) obtained their results using other methods. These publications give no basis for the theory that task- latitude, as a self-reported individual measure, plays a role in relation to blood pressurc. Furthermore, previous studies, on an individual level, have shown that psychological demands (for example, Theorell et al. 1985 a) and skill utilization are more important for blood pressure than is task-latitudc.

2. Method 2.1. Subjects O f a total of 403 garages in South Limburg, a sample of 42 were chosen, stratified for size: a population of 1-74 car mechanics. After screening for part-time mechanics working less than 2-5 days a week, a total sample of 149 car mechanics participated in the study. However, only data from 143 mechanics could be used: 6 men did not complete the strain measurement (rate of participation 96%). The distribution for size yielded the following breakdown: 20 garages had a crew o f 2 4 persons, 13 had 5-9,6 had 1&19, and 3 employed morc than 20. The sample included 23 owner-mechanics. They were not included in the analysis because thcorctically they belonged to a different field of workers and their data proved to be greatly at variance with that of the rest of the group. For example the average age of the owners was substantially higher and they had longer service records, but more

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182 G. _I. Houben et al.

importantly, they did not have a supervisor. The final number of subjects in the study was therefore 120.

2.2. Measures Table 1 lists the measuring instruments employed. It shows whether the measurement was based on observation or self-report, the number of items, its reliability, mean value, standard deviation, scale range and the basic literature sources. Control based on craft methods, blood pressure and skin disease(s) were measured through observation. The task- specific and life-history variables (see figure 1: 111, IV and 11) were measured as objectively as possible by asking the mechanics to evaluate the frequency with which certain events occurred in the (recent) past. The scoring categories used were: (almost) always, most of the time, now and then, seldom, never.

2.2.1. Control of workf low based on craft methods Control of work flow refers to normative (cultural) processes directed at stimulating performance and at the allocation and control of technology. In the construction of the observational measure, the focus was therefore on the use of organizational methods (division of labour, planning) and technical strategies. The instrument consisted of five, four-point questions on the division of work, use of technical appliances and timing approaches. Scores were calculated after a period of partly systematic observation of the mechanic’s behaviour.

2.2.2. Task latitude This was the control by the mechanic over (direct) work environment. It included the degree of freedom in selecting the succession of task activities, the degree of freedom to set the work pace and the freedom to leave the workplace for private purposes.

2.2.3. Social support from supervisor (or colleagues) This involved the degree to which supervisor (or colleagues) was (were) inclined to listen and/or help in the case of problems which were specific to the mechanic’s task.

2.2.4. Positive appreciation This covered the (overall) positive appreciation and reward (equity) for the mechanic for task performance.

2.2.5. Time pressure This consisted of the items: ‘How often do you have very much to do at work?’, and ‘How often do you lack the time to finish your work?’

2.2.6. Mental load This was related to the extent to which the task required mental concentration or was mentally tiring; e.g. ‘For what part of your working time does your work require great mental concentration?’ (‘or does your task performance require great precision?’) In addition, the variable ‘job demand’ was used in the analysis. Job demand was related to time pressure and mental load to create a variable comparable to that employed by Karasek (1 979).

2.2.7. Task interruption This involved the question: ‘How often do you have to interrupt your work reluctantly?’

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184 G.J. Houben et al.

2.2.8. Occupational strain This instrument was devised and its reliability and validity studicd during previous investigations (Houben 1981). It was employed for single-unit and small-batch production in the metal industry. It was necessary to make some modifications for use in garages. These concerned direct contact with the client as a possible stressor. The instrument included thc following: problems with physical climate (2 items); adequacy of technical equipment (1 itern); dificulty of work (3 items); reasonability and fairness of demands (2 items); satisfaction with technical organization (3 items); quality of contacts with clients (1 item); social support from supervisor (1 item) and colleagues (2 items); degree of positive appreciation (3 items); and inequity and injustice (2 items). The respondent had a choice between three response categories. These were: ‘I am greatly worried’ (code = 2); ‘I am rather worried’ (code= 1) and ‘it hardly, if ever occurs or I am a bit worried’ (code=0).

2.2.9. Blood pressure Systolic and diastolic blood prcssures were taken using a random-zero sphygmomano- meter. This instrument eliminates observer bias. The blood pressure is measured while the subject is seated, with the arm outstretched at heart level (Wright and Dore 1970, Kirkendall et al. 1980). Systolic and diastolic blood pressurcs werc measured twice: at the beginning and a t the end of the medical examination. In this study, the results of the second measurement were used as subjects had had the opportunity to relax during the interval.

2.2.20. Sk in diseases ‘i‘hcsc were studied through question and observation. The physician who carried out the assessment had previously taken a course in dermatological diagnosis.

2.2.1 1. Problems of the locomotor system A total score was determined for every mechanic from a list of 20 possible problems (based on self rcport).

3. Procedure The 42 garages were each visited scparately by a technician and a physician. The former studied the ergonomic and physical circumstances on the shop floor, e.g., safety standards and behaviour, which are not reported here. He also made observations regarding social control of the work flow. The physician put the mechanics through a medical examination. In addition, he interviewed them and made them fill out a questionnaire in order to collect data on stress and their reactions to stress and subjective evaluations of work conditions. The fieldwork took place between August 1986 and June 1987.

Multiple regression was used in two steps in the analysis. Relevant variables (see figure 1 ) wcrc entered simultancously after selection of the adcquate model.

4. Results With a mean age of31.9 years, participants wcrc relatively young. Strain ratings were not in cxccss of those found among workers in single-unit and small-batch rnctal production (Houben 1981). Also, blood pressure values were not extremely high. Only 10 out of 120 subjects produced systolic and diastolic blood-pressure readings of more than 140 and 90 mm Hg respectively. However, problems of the locomotor system were obvious: from a list of 20 ailments, an average of 2.4 was actually presented with only 33 subjects having no complaints at all. Contact skin disorders were widespread; the physician detected symptoms in 72 subjects. Unfortunately no comparative data were available.

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186 G.J. Houben et al.

Table 2 presents the Pearson correlations between independent, intermediate and health-outcome variables (see figure 1). Occupational strain was related to: control based on craft methods (-); task-latitude (-); support from supervisor (-); support from colleagues (-); positive appreciation (-); time pressure (+); mental load (+); task interruption (+); non-contact skin disorder (+); and problems of the locomotor system (+). A multiple regression analysis on strain indicated that 51% of the variance was predicted by job demands, control based on craft methods, involuntary task interruption and task latitude (table 3) .

The relationship between control based on craft methods and occupational strain proved curvilinear; therefore, a quadratic term was added to the variables. This means that until a turning point is reached a decrease in control based on craft methods is accompanied by an increase in occupational strain. Surprisingly it was found that a decrease beyond the score of 1.9 resulted in a reduction of strain. In the explanation of occupational strain, the role of task latitude and job demands, and their antagonistic function confirms Karasek’s principal views (see, e.g., Spector 1987).

In table 2 diastolic blood pressure and problems ofthe locomotor system are both related to age (+) and time pressure (+). Furthermore, there are interesting relationships between diastolic blood pressure and control based on craft methods (-), on one hand, and between problems of the locomotor system and mental load (+), task interruption (+) and occupational strain (+) on the other. Systolic blood pressure is only related to time pressure ( + ) .

Table 4 shows the results of a multiple regression analysis of diastolic blood pressure and problems of the locomotor system on the independent and intermediate variables. In both

Table 3. Regressions of occupational strain on independent and intermediate variables (see j g u r e 1 )

Beta 1

Control based on craft methods? (quadratic term) -1.06 -2.22*

Control on craft methods 0.99 2.04* Task-latitude -0.39 -4.01* Job demands 0.25 2.92* Task interruption 0.19 2.22*

adjusted R square 0.51

* p < 0.05. The use ofa quadratic term of control based on craft methods leads to interpretational diffkultics

for Beta (see Marsden 1983: 92vv).

Table 4 . Regressions of diastolic blood pressure and deviations in the locomotor system on independent and intermediate variables (seefgure 1).

Diastolic blood pressure Deviations in locomotor system

Beta t Beta f

Age 0.36 3.66* 0.39 4.47* Occupational strain 0.20 2.00* 0.28 2.89*

adjusted R square 0.15 adjusted R square 0.23

* p < 0.05

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Rationalization in garages in T h e Netherlands 187

cases, age and occupational strain combined were responsible for 15% and 23% of the variance. A multiple regression analysis of systolic blood pressure did not produce any significant results. Time pressure had a partial correlation of 0-19 with systolic blood pressure. The relationships between time pressure and diastolic as well as systolic blood pressure as shown in the correlation matrix (table 2) and the regression analysis confirmed the expectations based on the individual studies mentioned earlier in this article. This was also the case for the Karasek hypothesis: task-latitude was not of any importance in the explanation of blood pressure deviations. Nor has the influence of control based on craft methods been demonstrated for either blood pressure or problems of the locomotor system.

The correlation matrix of table 2 presents significant relationships between symptoms of non-contact skin disorders and occupational stress (+), social support from supervisor (-) and positive appreciation (-). Symptoms of contact skin disorders also proved to be related to mental load (-).

This was confirmed by a multiple regression analysis. Task interruption and positive appreciation also had a weak positive effect in predicting contact skin disorder. By contrast, positive appreciation had a significant negative effect on non-contact skin disorder. Control based on craft methods showed a weak positive relation with non-contact skin disorder (table 5 ) . A logistic multiple regression analysis was also conducted because of the dichotomous character of skin disorder scores. This confirmed the above results.

5. Discussion and conclusions The present study is one of only a few to use organizational sociology in the study of occupational stress and other health outcomes.

The primary goal of our garage research project was to describe the health status of car mechanics in South Limburg. The possibility of testing hypotheses was therefore limited. Nevertheless, interesting results have been found, for example the relation between objectively measured control based on craft methods and occupational strain. Control based on craft methods as a variable at organizational level, together with production aspects inherent in the task such as job demands, task-latitude and involuntary task interruption accounted for 51% of the variance in occupational strain (table 2).

The relationship between control based on craft methods and occupational strain proved curvilinear. In our opinion there are at least two possible explanations for this phenomenon.

(1) Standardization, division of work and more intensive use of technology in larger garages have a critical level after which the benefits outweigh the disadvantages for

Table 5. Regressions of contact and non-contact skin disorder on independent and intermediate variables (seefigure 1).

Contact skin disorder Non-contact skin disorder

Beta t Beta t

Mental load - 0.26 - 2.71 * Task interruption 0.20 1.87 Control based on craft methods 0.17 1.80 Positive appreciation 0.19 1.70 - 0-25 - 3.29 *

adjusted R square 0.05 adjusted R square 0.09

* p t0.05.

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188 G . 1 . Houben et al.

the workers. ‘Larger’ in this context refers to the relatively small-scale work situations in garages where problems like social isolation, deskilling of tasks and alienation are almost absent, while adequate technical resources and a better co- ordination may play a substantial supporting role.

(2) Furthermore it is possible that there is a more homogeneous organizational culture in the two extremes of the curvilinear relationship. Garages are currently in a state of transition from a craftlike to a more industrial control structure in the middle region of this curvilinear relationship. This causes problems such as cultural based conflicts, uncertainties about work demands and rewards, inequities and injustice, etc., which may be a source of occupational strain.

Control based on craft methods stems from a rich theoretical tradition, but there is little experience with its measurement. In addition to studying the validity of the instrument, it is especially interesting to analyse the curvilinearity of the relationship between control based on craft methods and occupational strain in small work organizations (which are often under strong pressure to industrialize and rationalize).

The results also show the influence of occupational strain on diastolic blood pressure and on problems of the locomotor system, and an interesting effect of positive appreciation on non-contact skin disorder. This relationship underlines the value of the variable ‘positive appreciation’ in the study of stress in work organizations (see also Houben 1981). It was impossible to demonstrate the influence of control, based on craft methods, on blood pressure, problems of the locomotor system and skin disorders.

The difference between the groups with contact and non-contact skin disorders is very interesting. Could it be that a non-critical attitude towards a potentially hazardous environment is psychologically related to the careless handling of harmful materials?

In this research, we have made an effort to test Karasek’s hypothesis. For the explanation of occupational strain, the antagonistic relationship between task-latitude and job demands confirmed the principal views of Karasek.

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Manuscript rcccivcd 17 April 1989 Manuscript accepted 26 January 1990

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