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Incidence of work-related disorders and absenteeismas tools in the implementation of work environmentimprovements: the Sweden Post strategyBENGT KNAVE a , HANS PAULSSON b , BIRGITTA FLODERUS a , LARS GRONKVIST a , TAGEHAGGSTROM b , GUNBORG JUNGETEG a , HASSE NILSSON b , MARGARETHA VOSS a & ARNEWENNBERG aa National Institute of Occupational Health , S-171 84 Solna (Stockholm), Swedenb Sweden Post, Stockholm, S-105 00, SwedenPublished online: 06 Jul 2010.

To cite this article: BENGT KNAVE , HANS PAULSSON , BIRGITTA FLODERUS , LARS GRONKVIST , TAGE HAGGSTROM , GUNBORGJUNGETEG , HASSE NILSSON , MARGARETHA VOSS & ARNE WENNBERG (1991) Incidence of work-related disorders andabsenteeism as tools in the implementation of work environment improvements: the Sweden Post strategy, Ergonomics, 34:6,841-848, DOI: 10.1080/00140139108967355

To link to this article: http://dx.doi.org/10.1080/00140139108967355

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ERGONOMICS, 1 99 1, VOL 34, NO. 6.84 1-848

Incidence of work-related disorders and absenteeism as tools in the implementation of work environment improvements: the

Sweden Post strategy

BENGT KNAVE,$ ~ N S PAULSSON,~ B I R G ~ A FLODERUS,+ GR~)NKVIST,+ TAGE H ~ ~ G G ~ O M , ~ G ~ R G J U N G ~ J HASSE NILSSON,~ MARGARETHA VOSG and

ARNE WENNBERGS

$National Institute of Occupational Health, S-17 1 84 Solna (Stockholm), Sweden BSweden Post, S-105 00 Stockholm, Sweden

Keywords: Absenteeism; Work-related injuries; Work environment improvements.

In 1989, a comprehensive, five-year work environment project'(Posta1 Work Environment [PWE] 2000) was launched by Sweden Post (SP). Its purpose was to identify the jobs and employees with the most exposed work environments and, in conjunction herewith, to initiate remedial programmes.-Standardized interviews with a selection of employees and statistical and epidemiological evaluation of illness absenteeism and occupational injuries served as input data for devising different measures of work-elated ill health (subjective complaints, symptoms, illness, illness absenteeism, and occupational injury). The results provided an incentive to regional action programmes, in which 'risk areas and risk occupations' were correlated with the load factors, primarily in ergonomic and work organization areas, cited in interview replies. In its regional efforts, PWE 2000 served as a stimuluslcatalyst in the implementation of various regional action programmes.

1. Background Illness absenteeism has been high in the Swedish working population during the 1 980s. About 10 000 of the Sweden Post's (SP) 67 000 employees were absent from work due to illness every ' workday in 1 988. Moreover, occupational injuries (overload and musculoskeletal injuries) have increased each year. In view of these developments, the SP asked the Swedish National Institute of Occupational Health to conduct a research project whose task would be to attempt to identify hazardous post office jobs and, thence, to initiate practical programmes for improving the work environment.

The project (Postal Work Environment [PWE] 2000) was designed so standardized interviews of a selection of employees and statistical and epidemiological evaluations of illness absenteeism and occupational injuries could serve as input data in determining different measures of work-related ill health (subjective complaints, symptoms, illness, illness absenteeism, and occupational injury).

The results were to be an incentive to regional action programmes in which 'risk areas and occupations' would be correlated with load factors, primarily in ergonomics and work organization areas, cited in interview replies. The goal of the project's re&onal efforts was to serve as a stimulus/catalyrt in the implementation of the regions' own local change programmes.

00144139191 53-00 0 1991 Taylor & Francis Ltd.

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SIR

B. Knave et al.

. SIR 2.0 Tcchnicd

sta61 437

1.5

1 .o

05

0.0 I I I

* = Sick leave events 1986-88. Women Men

Figure la.

2. Incidence of iilness absenteeism and occupational injuries The project employed incidence figures as measures of illness absenteeism and occupational injuries. This means that the number of illness cases and occupational injuries respectively were related to the subject group's total work time, after deduction of illness absences and leaves-of-absence. These measures designate the average time worked before anyone in the subject group became afflicted by illness or occupational injury. If illness absenteeism and occupational injury are used as measures of the work environment, as is the goal of PWE 2000, incidence parameters are a more effective device for identifying susceptible employee categories than, for example, the commonly used illness parameter, which measures the number of illness absence days per employee.

The incidence for different employee categories was correlated with the incidence for SP employees as a whole (figures la and b). The calculated ratio designates the group's relative likelihood of becoming ill or sustaining an occupational injury (standardized incidence ratio [SIR]).

Office staff, mail-handling staff, and office cleaners were the most susceptible groups in respect to illness in the SP as a whole. Women displayed consistently higher

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Improvement programme for Sweden Post

s m m hcidtnce Ratio SIR 2.0

1 3

1.0

0.5

0.0 I

SIR 2.0 +

* = Number of reported occupational injuries 1986-88

Women Men

Figure lb.

Figure 1. Standardized incidence ratios (SIRS) of the 10 different SP employee categories as to illness absenteeism (a) and (b) for 1986-1 988.

ratios than men, and major cities produced higher values than provincial regions. Mail-handling staff, female office cleaners, rural postwomen, and male bus transport staff ran the greatest risk of occupational injury. There were no differences between major cities and the provinces. It is interesting to note that rural postwomen and male bus transport staff ran a rather considerable risk of occupational injury but did not belong to staff categories which often recorded illness absence. Illness absenteeism and occupational injuries were also analysed on a more detailed job title level. The idea was to utilize the analysis for identifying risk groups on a regional basis. Special three-dimensional diagrams were prepared for each region and each independent unit within SP as the basis of and in follow-ups of the regional action programmes. (Figures 2 a and b.)

3. Occupational overviews The standardized interview contained questions about the respondent's health, the employee's work from the health point of view, the way the work environment was

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B. Knave et a].

Groups of employees Jtitle codes) in region X

1 of Sweden Post with a nsk of occupational injuries (SIR*) >0.7. Reported occupational injuries 1986-88. TlUe codes with an average of less than 5 employees have not becn included In the diagram.

Figure 2a.

1 4

J.

perceived and evaluated, and improvement measures deemed important and desirable. A total of 9 1 employees in three different regions (Helsingborg, Umed, and Stockholm) were interviewed. Interview results were tabulated In 'occupational overviews' for each of the 23 different 'typical jobs' defined by the project. The 'occupational overviews', which resulted in concrete proposals by the employees, were discussed with regional managers and trade union representatives in certain rcgions (Helsingborg, Borlange, and Uppsala). The parties agreed that the 'occupational reviews' could serve as the basis for local talks on appropriate action programmes for improving the work environment in the regions.

"Rtsk In average" for Sweden Post employees [SIR = 1.0)

, m e fl.- .xx d i c e .e number of reported occupational Injuries during 1986-88

= Standark4 Incidence Ratio

4. Regional action programmes: analysis +acceptance +implementation =results In its initial inventory phase, therefore, the project determined, with the aid of various registers, where illness absenteeism and occupational injuries were most common in the SP and, following the interviews, how en~ployees viewed their work environment, what their complaints and symptoms were, and, with a view hereto, what suggestions they had for improving the work environment. Every region was visited for discussions and instituting local action programmes. The aim was to encourage the regions to conduct activities tailored to local condit~ons and needs.

To ensure that regional action programmes are the effective instruments intended, the project maintains continuous dialogues with the regions and other indcpcndent units within the SP. The models used for thcsc dialogues have emphasized regular, joint meetings with the SP's regional managers, head safety representatives, and contact people in work environment matters. Another approach advocated for reducing illness and occupational injuries was to start study circles in some groups running a high risk.

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Risk of illness absenteeism 1986-88 in staff groups in region X of Sweden Post. StarTgroups with an a v q c of less than 5 emplovees have not bccn Lncluded in the diagram.

Wsk In nverazc' for Sweden Post employees (SIl<' - 1 01 Grw 'roof lndlcatcs SIR < 1.0 U1.1ck 'roof lnd~cntes S:R > 1 0

The R p r e T d ) Indicates sick leave events durlnq 1986-88

SUIT groups and avoage number of I C ~ ~ I C Y M durinl: IQq{.Rn

[TV:>, \voz?ml.

Figure 2b.

Figure 2. Examples on the speciaI three-dimensional diagrams prepared for each region and independent unit within SP as the basis of and in follow-ups of the regional action programmes.

We have used the equation 'analysis+acceptance~implementation=results' to designate our wish for genuine improvement, i.e., achievement of desired changes. In an effort to achieve meaningful 'acceptance' of proposals for improvements in the work environment, we camed out training programmes (under the motto '4 good work environment really pays off,) in work environment economics for regional. personnel and finance managers. These programmes were followed by training days for supervisors at different manager levels at regional level.

5. 'A good work environment really pays off Long-term illness absenteeism almost always begins with isolated absences for brief periods of time, e.g., a few days or a week every now and then, which ultimately coalesce into long continuous absences. This absenteeism can often be viewed as an indication of the employee's dissatisfaction with herhis job, inability to cope with the job's physical demands, or a combination work-related and private problems. For the employee, short-term absences may be the start of a process culminating in the total loss of a foothold on the labour market, irrespective of whether the cause is job dissatisfaction or physical inadequacy. The impact of long-term absenteeism on an employer is well-known. Production is disrupted, fellow-workers are forced to cover. ovenime work increases, and temporaries have to be called in.

Illness absenteeism costs a great deal of money every year. Calculations have shown that short-term absenteeism currently increases the SP's basic pay-roll costs by up to 180%. A high incidence of illness absenteeism and occupational injuries can

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846 B. Knave et al.

be regarded as an indicator of a poor work environment. So improvements in the work environment make economic sense!

A 'test model', based on study circles and examples of the outcome of various measures/interventions (a postal 'toolbox') in economic terms is currently being prepared for the training of regional supervisors.

6. Rehabilitation: the sooner the better Sweden Post is now making particular efforts to rehabilitate employees who have been ill so as to reduce illness absenteeism and return such employees to productive work more quickly. Different, systematic models are being tried. Each supervisor has been made responsible for having a 'first talk' with subordinates who have only been ill for a few days. The point of this talk is to express interest in and sympathy for the employee and to discuss herlhis return to work. Another activity is to provide the employee with an opportunity to stay in touch with herhis job, e.g. by visiting the workplace. Specially modified work tasks could then be discussed as one phase in the rehabilitation back to work.

In March and April 1991, PWE 2000, in collaboration with the SP and the Swedish Foundation for Occupational Health & Safety for State Employees, held seminars on 'early rehabilitation' for the regions. The aim was to encourage increased rehabiliation measures on the basis of experience gained from different postal regions and units within SP. Action programmes for the various regions and units were then designed on the basis of this experience.

7. Work environment data bank The regional action programmes will be fine-tuned in the continuous dialogue between the regions and PWE 2000. The aim is to tabulate all the different regional action programmes in a data bank. This data bank is to be incorporated into a national postal data base anyone at SP will be able to use via a computer network. The data base would provide easy access to both evaluated results and new ideas with the aid of an index and glossary. The practical pre-requisitesfor establishing the database has been agreed upon and data entry work will start in 1 99 1.

8. Implementing work environment improvements As noted above, measures for identifying the relationship between a good work environment and good economics, holding rehab seminars and establishing a data bank on work environment matters are aimed at achieving widespread acceptance within SP of work environment improvements.. However, the hard part, i.e., development and implementation of local solutions to identified work environment problems, still remains.

Over the past few years, different research teams have made the implementation or change process the subject of systematic study. The subject field has been referred to as 'action' or 'implementation research'. PWE 2000 has established continuous contacts with leading Swedish scientists in the field, who have submitted proposals

. for different action alternatives. These proposals served as the foundation for development and refinement of the method we use. Both centrally initiated solutions and local proposals for action are examined in regional collaborative committees with which PWE 2000 meets and talks. We present facts and interpretations of present, relevant problems and describe experiences frbm the problem solving process in other, similar occupational settings.

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Year

Figure 3. Annual number of SP-reported musculoskeletal injuries developed between 1986- 1990.

As a result of applying incidence parameters to sick leave events and occupational injuries among SP's total staff some employee categories emerged as more exposed than others. PWE 2000 chose to focus on the top five of these categories. At every regional visit the local situation and planned remedial measures for these priority categories are included in the agenda and discussed with the regional collaborative committees. It happens that the regional situation does not correspond with the general picture of SP, and that a formerly exposed top five group, by means of successful measures, has reached a level of sick leave events or occupational injuries well below the average within SP. The knowledge of such successful solutions and experiences are, brought from one region to the other in the course of visits by PWE 2000, and will, as mentioned earlier, in the future be entered into the planned SP Work Environment Data Bank.

As a result of PWE 200's regional visits, remedial measures have already been started in some regions. An office cleaner project (one of the priority groups) in the Karlstad region and a 'Help women feel better on the job' project in Stockholm are examples. In one of the major city regions the personnel division has chosen to incorporate the incidence ratio as a routine in its processing of the statistics of sick leave and occupational injuries.

9. How can the effects of action be measured? The incidence of illness absenteeism and occupational injuries are some of the measures we use for evaluating the effects of action. Statistical analyses will continue to be performed as hitherto, for example, with travel accidents separated, thereby clarifying overload, musculoskeletal injuries, which dominate the illness panorama. The analyses will be made on a 'rolling' basis: the initial analysis was based on figures from 1986, 1987 and 1988. In the corresponding manner, the second covered

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848 Improvement programme for Sweden Post

1988, 1989 and 1990, etc. There are definite changes over the years. Figure 3 shows, for instance, the increase of reported chronic work related musculoskeletal injuries.

It should be mentioned that the absenteeism methods we use for evaluating the work environment are not free from objections. Illness absenteeism does not merely reflect work-related ill health. Other factors also play a role, such as the extent of unemployment in the country, changes in sickness benefits, etc. The incidence of occupational injuries may also vary with factors other than the work environment, for example, with the way in which the injuries are evaluated-and diagnosed.

I Attitude 90 1 A questionnaire study of occupational comfon and well-being

among Sweden Post employees. - ,

13) Chder O O 0 0 0

JLO Den lnlerne Inlorrrullonen 0 0 D 0 O 0

Do you like working in (J 0 O 0 Swcdcn Post? I I $ I .

, Figure 4. Example of questions from 'Attitude 90', a questionnaire study of occupational comfort and well-being among Sweden Post employees.

Thus, evaluating effects also with other instruments is important. One such instrument can be found in an annual attitude ('comfort and well-being') SP study (figure 4). Work environment issues and several of the job satisfaction queries in that questionnaire were found suitable for evaluation of effect and, thus, comparisons with the results of PWE 2000.

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