presentation irene houtman

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


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


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


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


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


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


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


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%


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


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


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?)


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


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)


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


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


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)


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


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’


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).


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


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

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