Presentation irene houtman
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Psychosocial risk management:The Dutch case
Irene Houtman
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Irene Houtman, Psychosocial risk management: the Dutch case, March 2 & 3, 2011
This presentation
• Psychosocial risk exposure in the Netherlands
• Active policies in the last two decades and their results
• The policy shift: from managing risks towards reducing absenteeism & disability and increasing participation
• Towards sustainable employability & an all inclusive labour market
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Irene Houtman, Psychosocial risk management: the Dutch case, March 2 & 3, 2011
Working conditions profile NL against EU
Total NL
-1,0 -0,8 -0,6 -0,4 -0,2 0,0 0,2 0,4 0,6 0,8 1,0
Ambient conditions
Ergonomic conditions
Job demands
Job control
Skilled work
Social support (colleagues/boss)
Physical violence
Discrimination
<--- favourable -------reference-------- unfavourable --->(Source: EWCS 2005)
ns
p<0,05 & d≥0,20
p<0,01 & d≥0,20
p<0,001 & d≥0,20
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Irene Houtman, Psychosocial risk management: the Dutch case, March 2 & 3, 2011
Trends in EU-data on psychosocial risks covering1990-2005
1990 1995 2000 2005 Work pace Working at high speed (% very fast) NL 58 70 75 61 EU-15 47 *) 54 56 61 Working with tight deadlines (% very often) NL 36 43 65 61 EU-15 50 *) 56 59 62 Autonomy Lack of autonomy (schale 3 items; % no autonomy = 'no' on all three questions) NL -- 7 7 10 EU-15 -- 15 18 19 Learning opportunity in work Learning new things (% very high) NL -- 80 81 84 EU-15 -- 77 71 70 Complex work (% very often) NL -- 61 63 65 EU-15 -- 60 56 59 Physical violence in work Over the past 12 months, have you personally been subjected at work to physical violence from other people?’ (%"yes"). NL -- -- 9 7 EU-15 -- -- 4 5
Source: EWCS
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Irene Houtman, Psychosocial risk management: the Dutch case, March 2 & 3, 2011
Period of 1990 - 1998
1990 National legislation on OSH was implemented with specific attention to ‘well being at work’
1990-1998
• Handbook(s) on management of work-related stress
• Description of good practices• Guidelines for maintenance (‘objective’, expert
opinion: WEBA method)• Research:
• Monitor on Stress and Physical Load• Priority program on mental fatigue
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Irene Houtman, Psychosocial risk management: the Dutch case, March 2 & 3, 2011
Some findings of the Monitor on Stress and Physical Load –linked survey on +1000 companies-
Companies who are active in ‘Psychosocial RIsk MAnagement’(PRIMA) characterize themselves by (multivariate):
Employers: ORWork-related stress recognized as a problem 3.1Large size 2.1
Employees:Low on autonomy 1.8Many short cycled work 1.5Low physical load 2.1
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Irene Houtman, Psychosocial risk management: the Dutch case, March 2 & 3, 2011
1998 – 2007: Work and Health Covenants
Characteristics & aim:
• Sector wise approach• Ministry subsidizes (50%)• Large scale OSH interventions:
• psychosocial risks in NL highly prevalent• …so psychosocial risk management often ‘core’
• Aim: 10 % risk reduction in three years• Proper (quantitative) evaluation
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Irene Houtman, Psychosocial risk management: the Dutch case, March 2 & 3, 2011
An example: the police
Total 1999 and 2004 (n=2489)
-0,30 -0,20 -0,10 0,00 0,10 0,20 0,30
quantitative job demands
complexity
job autonomy
time autonomy
skill decretion
organizing tasks
contact opportunities
feedback
relations at work
fit work-education
fit work-experience
emotional demands
intention to leave job
work satisfaction
2004
1999
favourable <------------ difference compared to reference group -------------> unfavourable
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Irene Houtman, Psychosocial risk management: the Dutch case, March 2 & 3, 2011
Changes in risk exposure
High quantitative demands - 12%Problems with time autonomy - 11%Problems with opportunity for contact - 12%Problems with feedback - 17%Problems with emotional load - 10%Problems with supervisor and colleagues - 20%
High emotional exhaustion - 11%High depersonalisation - 20%Dissatisfaction with work - 20%
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Irene Houtman, Psychosocial risk management: the Dutch case, March 2 & 3, 2011
Effectiveness of the measures I (imputation)
Measures work pressure
0,20
0,25
0,30
0,35
0,40
0,45
1999 2004
Pro
ble
ms
wit
h jo
b
au
ton
om
y
yes
no
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Irene Houtman, Psychosocial risk management: the Dutch case, March 2 & 3, 2011
Effectiveness of measures II (imputation)
Measures work pressure
0,25
0,30
0,35
0,40
0,45
0,50
1999 2004Pro
ble
ms
wit
h f
ee
db
ac
k
yes
no
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Irene Houtman, Psychosocial risk management: the Dutch case, March 2 & 3, 2011
After the Work and Health Covenants
• In 2007 the Working Conditions Act was updated• Employers obligated to make a risk assessment (RIE)• Well being as specific issue was skipped from the act.• Companies <25 employees can use a RIE at sector level,
approved by social partners• Employers are encouraged to compile a ‘Health and Safety
Catalogue’ at sectoral or organisational level
• This catalogue is often a digital instrument including e.g.:• What are (e.g. psychosocial) the risks present • Legislation (demands to meet)• Measurement (general & specific tools)• Good practice (what worked?)
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Irene Houtman, Psychosocial risk management: the Dutch case, March 2 & 3, 2011
Amidst the Covenant period: a shift towards absence and disability reduction –’the Dutch worker is sick’
Self reported long term absence > 30 days in Europe
0 1 2 3 4 5 6
EU-total
Greece
Ireland
Italy
Great Britain
Spain
Germany
Belgium
Portugal
France
Austria
Luxembourg
Denmark
Finland
Sweden
Netherlands
% women
% men
Source: EWCS
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Irene Houtman, Psychosocial risk management: the Dutch case, March 2 & 3, 2011
Sickness absence trend in the Netherlands
0%
1%
2%
3%
4%
5%
6%
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Sic
kne
ss a
bse
nce
pe
rce
nta
ge
Sickness absence (large) company registers
National Absence Register
Employer survey
Employer survey on quarterly absence figures
National Working Conditions Survey (employees)
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Irene Houtman, Psychosocial risk management: the Dutch case, March 2 & 3, 2011
Absolute figures on disability in The Netherlands – until 2004 steady rise 100.000 a year -> legislative change
Source: UWV
0
100.000
200.000
300.000
400.000
500.000
600.000
700.000
800.000
900.000
2004 2005 2006 2007 2008
WAO WGA IVA
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Irene Houtman, Psychosocial risk management: the Dutch case, March 2 & 3, 2011
Disability inflow by diagnosis
Arbeidsongeschiktheidde 3 meest voorkomende diagnoses
(1993-2004 WAO, 2006 WIA)
0
5
10
15
20
25
30
35
40
1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
%
Psychische stoornissen Bewegingsapparaat Hart- en vaatziekten
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Irene Houtman, Psychosocial risk management: the Dutch case, March 2 & 3, 2011
Estimated costs of work-related drop out (for 2001)Costs of drop out from work Euro % of total
x1000)
Work-related costs of absence 3.785 29,8
Work-related costs of disability 4.371 34,4
Costs on operational management unknown
Costs of health care, Legislation & enforcement 2.869 35,8
Total (work-related costs) 12.690 100
For work-related mental health: 5.457 43%
Source: Zwinkels et al, 2004)
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Irene Houtman, Psychosocial risk management: the Dutch case, March 2 & 3, 2011
Research directed at determinants of, and intervening effectively in drop out because of ill mental health
Lessons learned from that research:
• Early contact occupational health physician facilitates return to work
• Partial work resumption is instrumental to return to work• Employers who facilitate partial return to work obtain a lot higher
(up to 9 times higher) return to work after drom out from mental health reasons
• In NL depression appears to be a major factor prehibiting return to work
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Irene Houtman, Psychosocial risk management: the Dutch case, March 2 & 3, 2011
Final conclusions for the Netherlands -1
• In NL there were relatively high levels of psychosocial risks and drop out for reasons of mental health Costs were high.
• The high work pace appears to have been addressed quite effectively Work & Health Covenants?
• The Work and Health Covenants have stopped. Now the Work and Safety Catalogue (is hoped to) maintain the gains and experiences from these Covenants – no explicit monitoring
• Attention shifted to counteract the high drop out (for large part) due to mental health problems this is mirrorred by legislative changes
• Now the policy attention is mainly directed at participation and inclusion, particularly of specific groups at risk (e.g. elderly, women) towards an ‘all inclusive labour market’
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Irene Houtman, Psychosocial risk management: the Dutch case, March 2 & 3, 2011
Take home message
Conditions for psychosocial risk management to be effective:
• Participative approach (both employer AND employee involvement)• Use a stepwise approach (inventory –passive-active-, plan, act,
evaluate)• Employer has to ackowledge psychosocial risks to be a problem• Acknowledge workers/employees as experts• Management has to act on changes in the organizational structure• If many companies are small, try to organize sector wise
When employees become absent: individual approach necessary:• Early contact with (occupational health) physician discussing R2W• Partial work resumption is instrumental to a full return to work• Employer should temporarily and activily lower the threshold for
(partial) return to work (adjustment in tasks, working times etc).
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Irene Houtman, Psychosocial risk management: the Dutch case, March 2 & 3, 2011
Results: RTW per country (Time 2)
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
AU FI IR NL UK Total
Returned to work Partial return
Percentages after excluding full RTW at Time 1
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Irene Houtman, Psychosocial risk management: the Dutch case, March 2 & 3, 2011
Results (continued): RTW and social security system
Interaction between social system and education on return to work
0,0%
10,0%
20,0%
30,0%
40,0%
50,0%
60,0%
70,0%
0 Welfare (IR/UK) 1 Integrated (FI/NL)
1 Up to lower professionaleducation
2 Intermediate general andprofessional education
3 Completed highschool
4 Higher professional education
5 Academic education and higher