Welcome! This work received support from KT Canada funding from the Canadian Institutes of Health

Research (CIHR)

Organizational interventions for the prevention of workplace

stress: Evidence and implications for public health

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A Model for Evidence-Informed Decision Making

Source: National Collaborating Centre for Methods and Tools. (revised 2012). A Model for Evidence-Informed Decision-Making in Public Health. [fact sheet]. Retrieved from http://www.nccmt.ca/pubs/FactSheet_EIDM_EN_WEB.pdf

1. Cultivate a culture of inquiry, critical thinking and evidence-based practice “culture”

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Evidence-Informed Decision Making

Review Bergerman, L., Corabian, P., and Harstall, C. (2009). Effectiveness of organizational interventions for the prevention of workplace stress (Report). Alberta, Canada: Institute of Health Economics. Retrieved from: http://www.ihe.ca/documents/Interventionsforpreventionofworkplace_stress.pdf.

Importance of this Review

• 1 in 4 Canadian workers described their daily lives as highly stressful (General Social Survey, 2010)

• High level of workplace stress results in a loss of productivity through absenteeism, reduced work output, and increased disability claims

• 3 in 4 short-term disability claims in Canada are related to mental health problems

Poll Question #1

Who has heard of a PICO(S) question before?

1.Yes 2.No

Searchable Questions Think “PICOS”

1. Population (situation)

2. Intervention (exposure)

3. Comparison (other group)

4. Outcomes

5. Setting

Evidence Summary: Greco (2013)

Objective: To evaluate the effectiveness of organizational-level interventions for the prevention of occupational stress in terms of reducing stress, psychological symptoms, absenteeism, presenteeism, and turnover.

P Employed adults I Organizational-level interventions including: job redesign or

restructuring, participation and autonomy, training and education, coworker support groups, physical and environmental characteristics, communication, role issues

C Other intervention or no intervention O Stress, burnout, psychological wellbeing, sickness or

absenteeism, and turnover or retention

Overall Considerations • Quality Rating: 9 (strong) Methodologically strong

review based on 6 systematic reviews (including 105 studies), varying in quality: 1 high, 4 moderate and 1 low quality

• No firm conclusion can be drawn about most effective type of interventions or strategies due to variability in study population, intervention, and outcomes

The evidence summary only provides data for effective interventions in high quality studies.

What’s the evidence - Outcomes reported in the review

1. Interventions aimed at reducing stress (2 SR; 11 interventions assessed in 37 studies)

2. Interventions aimed at reducing burnout (6 SR; 10 interventions assessed in 105 studies)

3. Interventions aimed at improving psychological

wellbeing (5 SR; 28 interventions assessed in 95 studies)

What’s the evidence - Outcomes reported in the review

4. Interventions aimed at reducing absence and

absenteeism (2 SR; 11 interventions assessed in 76 studies)

5. Interventions aimed at reducing turnover (2 SR; 4

interventions assessed in 39 studies

What’s the evidence - Reducing Stress

1. Training and Education with theory, role playing and

experiential exchanges (TRA) (1 SR, 1 high quality study): moderate to small effect on stress immediately following intervention (MD -0.34, 95% CI -0.62 to -0.06) but no effect at 6 months (MD -0.19, 95% CI -0.49 to 0.11)

2. Action teams with management and employees to improve team communication and cohesiveness, working scheduling, conflict resolution and recognition of good work (PAR/COM/JRD) (1 SR, 1 good quality study) were effective at reducing stress compared to no-intervention control groups (P= 0.02)

No Impact for: two job redesign or restructuring interventions (JRD), two co-worker support

groups / education and training interventions (CSG/TRA), job redesign or restructuring/ training and education (JRD/TRA), training and education (TRA), two co-worker support group interventions (CSG), and participation and autonomy/ training and education (PAR/TRA)

What’s the evidence - Reducing Burnout

1. A participatory intervention to identify psychological stressors and solutions (PAR) (1 SR, 1 high quality study) had a large to small effect on work-related burnout compared to control (MD -1.83, 95% CI -3.58 to -0.09)

2. Job redesign or restructuring/co-worker support groups/

communication interventions (JRD/CSG/COM) (4 low quality SR and one study) produced inconsistent results

No Impact for: job redesign or restructuring/ communication/ co-worker

support groups (JRD/COM/CSG), two job redesign or restructuring/ education and training interventions

What’s the evidence - Improving Psychological Wellbeing

1. A participatory stress reduction committee, more and smaller teams with sub-supervisors, more on-the-job training, and ergonomic improvements (JRD/PAR/PEC) (2 SR, 1 high quality study) significantly improved mean depression scores in the short term (pre 41.1, post 38.6) compared to controls (pre 41.5, post 42.3) (P = 0.025) 2. Control over production transferred to employee work groups with a steering group of representatives responsible for overseeing change (1 SR, 1 good quality study) significantly improved mental health (P <0.05)

What’s the evidence - Improving Psychological Wellbeing

3. A participative action research intervention (1 SR, 1 good quality study) significantly improved mental health 4. Flexible working hours (1 SR, 1 good quality study) significantly improved mental health compared to controls (P <0.05) No impact for co-worker support groups/ training and education, participation and autonomy/ communication/ role issues (PAR/COM/RIS), job redesign or restructuring, training and education/ co-worker support groups/ participation and autonomy, job redesign or restructuring/role issues, participation and autonomy interventions, participation and autonomy/ training and education, and participation autonomy/ job redesign or restructuring interventions

What’s the evidence - Reducing Absence and Absenteeism

1. A participatory stress reduction intervention (2 SR, 1

high quality study) significantly reduced absenteeism compared to controls (P <0.05)

2. An intervention of more teamwork, more personnel, role clarification, production goals, fewer supervisors, a partial change in shift system, increased feedback and a new vending machine and microwave (JRD/RIS/COM/PEC) (1 SR, 1 high quality study) significantly reduced sick leave (P <0.05)

What’s the evidence - Reducing Absence and Absenteeism

3. A participative action research intervention (1 SR, 1 high quality study) significantly reduced absenteeism compared to a control group (P <0.05) No impact - of job redesign or restructuring, job redesign or restructuring/ training and education, participation and autonomy/ job redesign or restructuring

What’s the evidence - Reducing Turnover

No impact - Change to a primary care nursing model with support from

managers, advice on core skills and promotion of effective interprofessional communication

General Implications

• Workplace stress reduction interventions should be rigorously evaluated

• Rigorous research should:

1. Continue to assess the effectiveness and potential harms of workplace interventions

2. Determine which interventions or strategies are most effective

Questions? Poll Questions # 2 and 3

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