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Psychosocial risk management:The Dutch case
Irene Houtman
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
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
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
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
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
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
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
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%
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
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
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?)
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
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)
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
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
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)
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
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’
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).
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
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