Indicators of Healthy Work Environments

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Indicators of healthy work environments a systematic reviewPer Lindberga,b* & Eva Vingrda a Occupational and Environmental Medicine, Department of Medical Sciences, Uppsala University, Sweden b Centre for musculoskeletal research, Faculty of Health and Occupational Studies, University of Gvle, Sweden

Abstract. The purpose of this study was to systematically review the scientific literature and search for indica-tors of healthy work environments. A number of major national and international databases for scientific publica-tion were searched for research addressing indicators of healthy work environments. Altogether 19 768 publica-tions were found. After excluding duplicates, non-relevant publications, or publications that did not comply withthe inclusion criteria 24 peer-reviewed publications remained to be included in this systematic review. Only onestudy explicitly addressing indicators of healthy work environments was found. That study suggested that the presence of stress management programs in an organization might serve as indicator of a good place to work, asthese organizations were more likely to offer programs that encouraged employee well-being, safety and skill de-velopment than those without stress management programs. The other 23 studies either investigated employeesviews of what constitute a healthy workplace or were guidelines for how to create such a workplace. Summarizing,the nine most pronounced factors considered as important for a healthy workplace that emerged from these studieswere, in descending order: collaboration/teamwork: growth and development of the individual; recognition; em-

ployee involvement; positive, accessible and fair leader; autonomy and empowerment; appropriate staffing;skilled communication; and safe physical work.

Keywords: Healthy work, healthy workplace, healthy organization, guidelines, employee

* Corresponding author. E-mail: [email protected]; Phone: +46 26 64 87 59Postal address: University of Gvle, SE-801 76 Gvle, Sweden

1. Introduction

The interest in medical science has until nowmainly focused on how and why certain individuals become diseased, i.e. on pathogenesis. For the indi-vidual, the workplace and society, there would beconsiderable gains if the number of people sufferingfrom physical and mental disorders could be reduced.Traditionally within occupational health this has beendone by treating illnesses and, by suspicion of causa-tive elements, eliminating or reducing identified riskfactors at work. This is still the first choice in tryingto achieve a sustainable working life. However, de-spite legislation in the field of work environment, both on national and international level, a century of

labour inspections, and the efforts of thousands ofoccupational health personnel, still 21% of the Swed-ish women and 15% of the Swedish men reported in2010 to have had work-related disorders other thanaccidents during the last twelve months [1]. It seemsthat the endeavours do not reach all the way.

Moreover, throughout many countries in the de-veloped world the population is ageing, largely be-cause of increasing life expectancy. One of the eco-nomic implications of this demographic change isthat workers may need to work longer and retire laterthan they have done in recent years. Much needs to be done to ensure that work remains a positive expe-rience for workers throughout their career trajectories,and that it does not damage their health [2].

Work 41 (2012) 3032-3038 DOI: 10.3233/WOR-2012-0560-3032

IOS Press

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A different and additional way of approaching the

problem of work related morbidity is to look at andlearn from what characterizes organisations with alow rate of long term sick listed. Some studies andreports have dealt with this [3-6]. Another approachhas been to summarize empirical evidence from dif-ferent research fields and create models of work en-vironments supporting health , e.g. Danna and Grif-fin[7] and Grawitch et al [8].Although several au-thors have tried to identify and describe the job andorganizational characteristics associated with healthyorganizations, there has been relatively little directempirical research and no systematic analysis of amodel of healthy work organization conducted [9].

Moreover, the specific dimensions comprising themajor components of previous models have beeneither only minimally specified or not specified at all[ibid].

There does not seem to be any internationalagreement how to define the concept healthy workenvironment or rather there are different designa-tions and aspects of this concept. For example, inSweden this notion is more often called good workenvironment, including physical, psychosocial andorganizational conditions, and where the focus has been on the health of the employees. Thus, goodwork environment could then be defined as work

environments that on both short and long term do notcause work-related morbidity and adds to the indi-viduals wellbeing. Lately there has also been a po-litical approach in Sweden to integrate economical benefits of good work environments [10].

In international contexts concepts like healthywork, healthy workplace or healthy organiza-tions are more often discussed.These concepts cen-ter on the premise that it should be possible to identi-fy the job and organizational characteristics ofhealthy organizations and that such organizationsshould have healthier and more productive workers.It also presupposes that it should be possible to dis-

tinguish healthy from unhealthy work systems. Thereseem to be some evidence for this, as well coherencein definitions. For example Sainforth [11] notes thatresearch on healthy work organizations shows thatsome of the same work organization factors that af-fect employee outcomes such as quality of life andsafety can also affect organizational outcomes suchas profits and performance, and defines a healthywork organization as an organization that has bothfinancial success and a healthy workforce. Sauter etal. [12] put it very clear and define a healthyworkplace as any organization that maximizes theintegration of worker goals for wellbeing and com-

pany objectives for profitability and productivity.A

similar but more extensive definition is presented byWilson et al [9]: A healthy organization is one cha-racterized by intentional, systematic, and collabora-tive efforts to maximize employee well-being and productivity by providing well-designed and mea-ningful jobs, a supportive socialorganizational envi-ronment, and accessible and equitable opportunitiesfor career and worklife enhancement.

As far as the authors of this study are aware therehas been no systematic approach to summarize pre-sent knowledge of what constitutes a healthy workenvironment and what might be its indicators.Knowledge of such indicators may serve as tools for

e.g. employers, safety delegates, occupational healthservices, and labour inspectorates to operationalizeambitions to achieve healthy work places.

2. Aim

The purpose of this study was to systematicallyreview the scientific literature and search for indica-tors of healthy work environments.

3. Methods

Regarding the diversity the concept healthy workenvironment encompass and that no real consensuson a definition seems to exist, it was decided to havea broad and explorative approach for conducting theliterature search. This position was also supported by personal experiences that there probably would bevery few publications that directly would answer ourresearch question. Hence, searches were designed to be inclusive, but at the same time a rigorous approach was required when it came to assessing thescientific worth of retrieved publications. Some ini-tial pilot searches verified the appropriateness of thestrategy.

As a consequence of this, databases covering dif-ferent disciplines, methodologies and literature werechosen. The included databases were AcademicSearch Elite, ASSIA, Cinahl, Cochrane Library, Em-erald, PubMed, PsychINFO, Scopus, SwePub, andWeb of Science. These databases were systematicallysearched with different combinations of the keywords healthy OR good OR sound AND work ORworkplace* OR work place* OR workforce* ORwork force* OR worksite* OR work site* OR or-

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ganization* OR work organization* OR work envi-

ronment* OR working environment* OR business*separately and in combinations with AND indica-tor* OR predictor*. The Swedish databases Libris,

Scopus and SwePub were additionally searched with

god arbetsmilj (eng. good work environment)separately and in combination with AND

indikator* OR prediktor*. The search was limited tothe years 1990 2011, humans, and following lan-guages: English, Danish, German, Norwegian, andSwedish.

To be included in the study following criteria hadto be fulfilled:

the study involved work environmental issues.Papers about health promotion activities like di-et, smoking cessation and physical activitieswere excluded;

be published in peer-reviewed journals; original data or review articles, but excludingconference abstracts and proceedings because ofa mostly shallow reviewing process. However,exceptions were made regarding policy papers,statements and guidance documents dealingwith how to create good or healthy workplaces.Even if these were not original research papersthey should be based on scientific data and ofspecial interest for this study.

4. Results

Through the broad search strategy and partly over-lapping databases 19 768 publications were found.After excluding identical duplicates 7191 publica-tions remained. Further, titles and abstracts of theidentified articles were reviewed to determine the potential relevancy of the articles for our systematic

review. By uncertainty the full article was retrievedand read. After excluding further duplicates and non-relevant publications 24 articles remained and wereincluded in this systematic review, see figure 1. Sub-sequently, references given in included publicationswere further examined.

Using content analysis, the included publicationswere grouped into three categories: 1. Indicators, 2.Employees views, and 3. Guidance documents. Foreach category a table is compiled displaying includedarticles and respective factors suggested to be asso-ciated with healthy work environments. (Due to li-mited space a summary of the included articles is notincluded, but can be obtained from the correspondingauthor.)

Figure 1 Results of the literature search

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4.1. Indicators

An indicator can be defined as a quantitative orqualitative factor or variable that provides a simpleand reliable means to measure achievement, to reflectchanges connected to an intervention, or to help as-sess the performance of a development actor [13].

Only one study was identified that explicitly in-

vestigated indicators of healthy work environments[14]. The authors found that organizations that of-fered stress management programs also offered other programs to facilitate worker safety, health, well- being, and skill development. In this respect the pres-ence of a stress management program appeared to bean indicator of a better place to work.

Table 1Factors at work described essential for a healthy work environment as described by employee

Publication

Factor A g e r v o l d , 1 9 9 1

A r n e t z e t a l , 2

0 0 7

A r o n s s o n e t a l , 1

9 9 9

B a p t i s t e , 2 0 0 9

H e a t h e l a l , 2

0 0 4

H j a l m e r s e t a l , 2 0 0 4

K r o t h e t a l , 2

0 0 7

L i n d i n A r w e d s s o n e t a l ,

2 0 0 7

L o w e e t a l , 2

0 0 3

M a c D e r m i d e t a l . 2

0 0 8

N i l s s o n e l a l , 2

0 0 9

P a r s o n s e t a l , 2 0 0 5

P a r s o n s e t a l , 2 0 0 6

T h o m s e n e t a l , 1

9 9 8

W r e d e r e t a l , 2 0 0 7

Use of personal qualities xIn line w. personal values x x x x xRecognition x x x x xTreated w. respect x x x x x xAutonomy, empowerment x x x x xControl at work xRole clarity xClarity of expect. & goals x x xReward strategies x xGrowth & development x x x x x x x x x x x Intellectually stimulating xEmployee involvement x x x x x x xCollaboration/teamwork x x x x x x x x x x Skilled communication x x x x x xQuick problem solving xPos. accessible, fair leader x x x x x x x Positive & social climate x x x x x xReasonable work load X x xWork content x x xSafe physical work x x x x xAppropriate staffing x x x x xAdm./personal support x x x

Working time schedule x x xWork life balanceRelations to stakeholders x x Benefit to society x

4.2. Employees views

These studies encompass what different profes-sional groups considered to characterize healthy

work environments [15-29], see table 1. According tothese studies the most frequently addressed factorsimportant for a healthy workplace were, in descend-ing order: growth and development of the individual;collaboration/teamwork; employee involvement; pos-



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itive, accessible and fair leader; being treated with

respect; positive and social climate; work in line with personal values; recognition; autonomy/empower-

ment; skilled communication; safe physical work;

and appropriate staffing.

Table 2Guidelines for factors at work essential for creating a healthy work environment

.

Publication

Factor A A C N S t a n d a r d s , 2 0 0 5

C l a r k , 2 0 0 4

G r a w i t c h e t a l . ,

2 0 0 6

K u e h n , 2 0 1 0

L o w r y & H a n g e s , 2

0 0 8

M i r a c l e , 2

0 0 8

S c h m a l e n b e r g &

K r a m e r ,

2 0 0 7

L i n d s t r m , 1

9 9 4

Use of personal qualities In line w. personal values Recognition x x x xTreated w. respectAutonomy, empowerment x x xControl at work x xRole clarityClarity of expect. & goals Reward strategiesGrowth & development x x xIntellectually stimulating Employee involvement x x x x xCollaboration/teamwork x x x x x xSkilled communication x xQuick problem solvingPos. accessible, fair leader x x xPositive & social climate Reasonable work loadWork content xSafe physical work xAppropriate staffing x x xAdm./personal support x x xWorking time scheduleWork life balance xRelations to stakeholders x xBenefit to society

4.3. Guidance documents

This category includes articles that advocate strat-egies how to achieve, and opinions about what cha-racterize healthy work environments, but also somemodels what creates a healthy workplace based on previous research [8, 30-36], see table 2. The mostfrequently mentioned work place factors importantfor creating a healthy work environment were, indescending order: collaboration/teamwork; recogni-tion; employee involvement; autonomy/empower-ment; growth and development of the individual;

positive, accessible and fair leader; appropriate staff-ing; and administrative and personal support.

Summarizing the results of what employees con-sider important for a healthy workplace and whichfactors the guidance documents point out as impor-tant the nine most pronounced components identified

to achieve a healthy workplace are, in descendingorder: collaboration/teamwork: growth and develop-ment of the individual; recognition; employee in-volvement; positive, accessible and fair leader; au-

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tonomy and empowerment; appropriate staffing;

skilled communication; and safe physical work.

5. Discussion

Despite an extensive and inclusive search only onestudy explicitly dealing with indicators of healthywork environment was identified. Because of the lackof indicator studies it felt natural to include otherstudies in the field which could help to define thenotion healthy workplace and give a base for futureresearch. The included studies either investigatedemployees view of what constitute a healthy

workplace or were guidelines for how to create sucha workplace.Ideally an indicator or set of indicators for healthy

work environments would be all inclusive and basedon evidence, preferably longitudinal studies. Consi-dering this, the results of the present study was meag-er. A contributing factor for this could be that workenvironment issues are multi-factorial and compli-cated to research. As this study has shown there are probably a combination of different factors contribut-ing to a healthy workplace and to find one single in-dicator for this might be very difficult. Wilson et al.[9] note, although several authors have tried to iden-tify and describe the job and organizational characte-ristics associated with healthy organizations, therehas been relatively little direct empirical research andno systematic analysis of a model of healthy workorganization conducted to date.

A general reflection is that in most of the studiesinvestigating healthy organizations exposures to bio-mechanical factors at work play a subordinate role, inmany cases total absence. An explanation might bethat these studies are conducted by researchesrepresenting social sciences being more focused on psycho-social issues as predictors of well-being.Considering that work related musculoskeletal dis-orders are a major health issue in most countries andthat physical ergonomics can play an important role both for health and productivity, this calls for a mul-tidisciplinary approach in future research on healthywork organizations.

The studies exploring what factors employees con-sider as crucial for considering the workplace ashealthy are mainly qualitative studies investigatingthe views of employees in different professions aswell as at different hierarchical job levels. This is asubstantial contribution to our knowledge. Howeverdisproportionately many of the studies in this catego-

ry deal with health care workers and their work envi-

ronments, particularly in Northern America, whichmight have biased the results of this review. Morestudies from other areas of working life are wanted.Having taken this proviso, it is striking how somefactors frequently recur indicating the importancethese seem to have.

In general, the guidance documents studies are ofsomewhat lower scientific quality, e.g. the methodsare often inadequately reported or the reviews under- pinning the recommendations more of a narrativecharacter, but there are also documents relying on asolid base of science. In some cases the guidancedocuments seem to have a hidden political agenda

aiming at improving the working conditions e.g. fornurses. If this is the case, the objectivity might have been blurred, in order to achieve certain professionalgoals or benefits. As these studies dont contradictfindings from the ones based on original researchthey were considered to have some empirical valueand were included.

6. Conclusion

In conclusion this systematic review shows that itwould be beneficial for further research to come tosome consensus about the concept of healthy workenvironment/workplace/work organization, andsecond to put forward longitudinal studies testingsome of the models proposed in the literature. Tomake the idea of a healthy workplace a successfulcourse of action for a sustainable working life therealso has to be some well designed practical tools toassess such a work place or the impact of it on theemployees.

Acknowledgement

This study was funded by the Swedish Work Envi-ronment Authority.However, its contents are solelythe responsibility of the authors and do not necessari-ly represent the official views of the authority.

References

[1] Sveriges officiella statistik. Arbetsorsakade besvr 2010(Work-Related Disorders 2010). Arbetsmiljstatistik.Stockholm: Arbetsmiljverket och Statistiska centralbyrn(Swedish Work Environment Authority and StatisticsSweden) 2010. Report No.: 2010:4.



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