GrabovacI,MustajbegovićJ.Healthyoccupationalcultureforaworker-friendlyworkplace ArhHigRadaToksikol2015;6:-8

Mini-review

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DOI: 10.1515/aiht-2015-66-2558

Healthy occupational culture for a worker-friendly workplace 2 Igor Grabovac1andJadrankaMustajbegović

Institute for Occupational Medicine, University Clinic for Internal Medicine II, Medical University of Vienna, Austria1, Department of Environmental Health and Occupational Medicine, School of Public Health “Andrija Štampar”, School of Medicine, University of Zagreb, Croatia2 [Received in July 2014; CrossChecked in July 2014; Accepted in January 2015]

Workhasnumeroushealthandwellbeingbenefits,butitalsoinvolvesphysicalhazardsandpsycholo thescalehastippedtowardpsychosocialfactors.Workers’mentalhealthaffectstheirintelle growth,aswellasworkability,productivity,andultimatelyorganisationalproductivityandcompet Eventhoughcompaniesmayhaveaninternalhierarchythatlowersstressatwork,thereareoth social processes that can affect (positively or negatively) the cohesion within the work unit. Safety culture of an organisation is a product of individual and group values, opinions, competences, and behavioural patterns occupational health and safety are implemented. Organisations that nurture positive safety culture understand the importance ofhealthandsafetyandbelieveinpreventionratherthandealingwithconsequences.Jobsthat and reasonably physically and psychologically demanding are far more likely to lower work-related stress and boost workersatisfaction.Infact,employeeempowermentisoneofthebestwaystoachievegoodpsychosoci workplace. KEY WORDS: healthy organisations; mental health; organisational culture; stress; workers wellbeing

Approximatelyof % 58  theworldpopulation,that deaths is,4 at the workplace, respectively (2). Furthermor billion people, spend one third of their adult the mentallives health at issues are among the leading causes of workplace. Around 120 million workplace accidents and absenteeism and early retirement everywhere in Europe. 2.3milliondeathsarereportedeveryyear.About 318,0 These issuesareagreatandlong-lastingeconomicburd deaths are related to injuries at work and almost 2 million for employing organisations. A UK study (6) showed that to exposure to workplace hazards and unsafe mentalworking health illnesses cost employers almost 26 billion conditionsIn .)2 ,1( Croatia ,3102 sawwork697,31 related pounds a year: 8.4 billion for sick leave payments, 15. injuries, of which 1 , 7 0 were severe and 1 7 fatal. In billion forproductionlosses,and2.4billionforreplaci addition, 2 0 9 new cases of professional illness were wholeft.InCroatia,mentalhealthillne theemployees reported (3). arethesecondleadingcauseofdisability,neurosis,st andsomatoformdisorderinparticular(7). Mental health at the workplace Due to changes in job tasks and work organisation a relatively lownumberofjobsarestillphysicallydemand One out of four people will develop one or more mental as the demands haveshiftedtowardmentalandemotio orbehaviouraldifficultiesduringtheirlifetime.Psychiatric which makes psychosocial risk factors at the workplace conditionsaccount of % the for 4.7 totaldisability-adjusted even more prominent. Although the strength of evidence lifeyears(DALYs)with , thehighestlossinthepopulation about the relationship between psychosocial risk factors at betweenand 10 years. 29 Estimatespredictthattheirshare the workplace varies, almost all research confirms willreach   by % 51 theyearFour .)4( 02 outoftenleading psychosocial health of the employees correlates with reasons for disability and premature death worldwide are occupation inallmortalitycases,coronaryheartdis psychiatricconditionsIn .)5 ,4( industrialisedcountries and psychiatric illnesses (especially depression), and chr theEUmentalillnessesareresponsible and % 1  of % for 4  bronchitis (8).

culture of health and safety at work Correspondence to : P r o f J a d r a n k a M u s t a j b e g o v i ć , M D , POrganisational hD, Department of Environmental Health and Occupational Medicine, Ravasi andSchultzdefine (9) organisationalculturea School of Public Health Andrija Š tampar, Rockefellerova 4, 10 Zagreb, Croatia, E-mail: [email protected] combined mental assumptions that determine the way of

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GrabovacI,MustajbegovićJ.Healthyoccupationalcultureforaworker-friendlyworkp ArhHigRadaToksikol2015;6:-8

workingwithinorganisationsbydefiningwhat and behavioural Sweden, legislation goes a step further than the patterns are acceptable in different situations. legislation and stipulates that employers should actively Organisational culture involves a number of psychosocial work to reduce these risk factors. In the United Kingdom factors and mostly relies on informal aspects of work and stress management programmes are more often its organisation. Simply put, it is whatrecommended people in an thanobligatory,althoughhealthandsa organisation find appropriate or not. A colloquial lawsdoexpressconcernaboutstress(13-5). explanation would be: “it is the way we do things here” (10). Formal and informal organisational influences Organisations should encourage a “healthy” The Whitehall II Study ( 1 6 , 1 7 ) showed that civil organisational culture in order to increase productivity, servantsatthebottomofthehierarchyweresixtimes economic growth, and management efficacy, and to absent from work than others, which is related discourage behavioural patterns that lower productivity and perception of lower control over job tasks, low so increaseemployeeturnover(Table1).Organisationswith support, and higher incidence of mental health iss an adaptive organisational culture have better economic Authors suchasCarayon,Hoonakker,andSmith(18,9) performance than those without it (11). believe that in the centre of organisational design and While the awareness of health risks at the workplace is management growing among the worker population, in the managerial(ODAM) is the relationship between structures the lack of awareness is a serious obstacle to management philosophy, satisfaction, and productivit developing necessary measures to protect health at work. employees; employees accept managerial decisions more easily iftheytooholdthemnecessary,ifthedecisionsh Additionalobstaclesmaybethefearofhighcosts, shortage been clearly outlined,andifthelinesofresponsibili offunds,workfragmentation,andnewworkformssuchas clearly set. All this smallbusinesses,distanceworking,self-employment,and lowers stress that would otherwise arise the increasing gap between health care and economy sectors from conflicting roles. Technological innovations education that help with job tasks also tend to actively (1). in problem solving, decision making, F r o m t h e h e a l t h s e c t o r ’s p o i n t involve o f v i e w,employees poor and encourage them to speak their minds freely (20,1). organisational health and safety culture often leads to stress Research is now shifting focus on issues related to and adverse health effects in employees. Although none of organisational structure and the relationships between the EU member states has a specific legislation for stress superiors and subordinates. Organisational structures that at the workplace, all legal frameworks do refer to are based on a clear hierarchy are inexpensive, efficien psychosocial factors as those that can cause or aggravate and easily maintained; this is why they are most common stress at the workplace. According to the European Agency in the world. However, parallel to this formal struct forSafetyandHealthatWork(EU-OSHA)(12),80  %of the managers in the EU consider stress to be a problem in there is an informal social interaction between employees and the employers.As early as the 1920s, the Hawthorne their organisations, but % say that only 3 0  they have implemented some sort of stress management programme studies (22) have shown that people do not work for or a programme that deals with psychosocial issues at the financialgainalone,butalsobecausetheywanttobelo topsychosocial acollective,andproducesomethingmeaningful.Inoth workplace. Half the respondents claim that ( issues at the workplace are harder to manage than the more words,theyareequallyinfluencedbyintrinsicpsychological and social benefits) and extrinsic (payment and financia “traditional”hazards. workfactors. According to the same report by EU- OSHA benefits) (12), Informalsocialprocessesgreatlyaffecttheefficacyo Croatia is one of the least likely countries to take preventive measures against psychosocial issues; stress management work organisations and work in teams, even where th programmes are implemented in % of only the 2 5   formalorganisationalstructureisgood.Theycanaffect cohesion within and between work units and the relationship respondentorganisations,use % while psychologist only 32 services.InBelgium,Denmark,Germany,theNetherlands, between workers and the organisation and can undermine Table 1 Early signs of poor organisational culture of health and safety at work Individual

Organisation

Unusual behaviour

Growingbacklog,lowproduction,moreovertimehours

Poorworkresults

Lower work quality (more production errors)

Mood swings and changes

Less clients and inadequate service

Problemswithco-workers

Increase in sick leave

Increase in absenteeism due to illness

Inefficientcooperationbetweenemployeesanddepartmen

Cannot keep one job for long

Higheremployeeturnover

GrabovacI,MustajbegovićJ.Healthyoccupationalcultureforaworker-friendlyworkplace ArhHigRadaToksikol2015;6:-8

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the formal structure and decrease productivity. It is occupationalmedicinespecialistsandexpertswhores organisational development should focus on developing importanttoknowthatinformalprocesses havethesame, interventions that and encompass organisational culture through ifnotevengreaterpowertochangebeliefs,attitudes, behaviour of workers and ultimately lead to the establishment the perspectives of health of individual workers as well as of social norms within the work unit. Usually these are the whole organisations. mutually set social norms about the quantity of the work Increasingly important and driven by globalisation is that is to be done and the relationship with the superiors. the diversity management at the workplace. Many Every deviation from these norms leads to an increase in experiences are common to all minority groups a encompass stereotyping, discrimination, harass social pressure and stress, which disrupts productivity. Therefore it is necessary to match formalviolence, and informal andexclusionfromformalaninformalexchanges influencessothattheemployeescanactively atparticipate the workplace (32).in A working environment that is more improving productivity (23, 4). This can be achieved receptive in to diversity attracts better workers and has lower different ways that are all based on active communication employee turnover. Employee turnover may cost up to withworkers,suchasfocusgroupsandworkunits 150  of % that theregular are costoftheemployeewhohasleftthe dedicatedtosolvingaspecificproblem,thenposition. oneducation Therefore, successful organisations reg and safe working conditions, which all comes monitor down to employee turnover and report the findings ev creatingahealthyworkorganisation.Protecting year as a health measure ofand success (33). safety at the workplace is much more than just focusing on Thesuccessofentrepreneurshipdependsontechnolo formal aspects of prevention of harmful effects that result tolerance, and talent ( the “3 T”) , and developing ne f r o m w o r k p r o c e s s e s , w o r k t a s k s , a n dtechnologies w o r k p l and a c etalent depends on tolerance within an environment. At the core of ensuring health and safety at organisationResearch .)43( hasshownthatnon-heterosexual work are people; therefore all organisations who wish to individuals who feel safe enough to come out in the invest in and maintain human capital should pay close workplace are more efficient, more motivated, and fee attentiontobehavioural,social,andcultural better processes about their relationships .)42( with co-workers. Furthermore, hiding one’s sexual orientation Healthy work organisation concept: connecting workplace reduces productivity % , while up to 3 0   organisational culture and health organisations that provide their workers with support % higher 7-16  T h e h e a l t h y o rg a n i s a t i o n c o n c e p tgroups, e n c o mentoring m p a s s e s programmes, etc. have scores in questionnaires about satisfaction and productivity managerial and business understanding of health in relation to organisational culture. It is built on the simple premise at the workplace in comparison to those that do not (35). Sense of security is crucial for establishing good that a happy, content, and calm worker is a healthy and interpersonal relationships at the workplace (36). productiveworker.Healthyorganisationsarethosewhose Organisations that culture,management,workingenvironment,andbusiness value employee diversity and allow free of this diversity and those that are cul practice create an atmosphere thatexpression improves health, heterogenic have better results than those that are culturally efficiency, and quality of employee’s work (18, 25). A homogenous, as theyencouragecreativityandinnovat growing amount of data indicates that the most successful . ) 8 6 , 5 3 ( and competitive companies are those that have the highest

levels of health and safety and the most physically and Work satisfaction and productivity mentallyhealthyandsatisfiedworkersCrimmins (26). and Halbergdefine )72( “healthculture”asamixtureofattitudes In 1975, Katzell et al. (39) showed that increasing and beliefs of employees towards health promotion worker satisfaction did not necessarily increase productivity. programmes at the workplace. An optimal social Theysawtwoobstaclestothis:resistancetoimplemen environment is necessary in order to improve psychosocial change and focusing on just one approach instead of and physical health of the employees. The World implementing Health system- wide changes. Therefore, the Organization(WHO)initsnewmodelofhealthand suggested safety seven principles to increase both workers’ protectionattheworkplaceincludesthesatisfaction “internal and productivity: working environment”which ( encompassesbothindividual Critical1. physicalMassPrinciple:changesintheorganisatio health and psychosocial well-being) as well the need for need to be sufficiently deep and far reaching in order t connectionsbetweenworkorganisations,communities, have a lasting effect; and the environment that the workplaces are a part of (26). Such 2. Motivation Principle: development of a workforce a broad model of understanding health and safety at work that is dedicated to the concept of high productivity through makesitnecessarythatoccupationalmedicine financial physicians, and/orpsychologicalrewards; ergonomics and human factors specialists consider the 3. Shared Benefits Principle: workers need to see tha wider aspects of social policies, economy organisational and the changes that increase productivit environmentPeterson .)03-82( andWilsonsuggest )13( that them as well;

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GrabovacI,MustajbegovićJ.Healthyoccupationalcultureforaworker-friendlyworkp ArhHigRadaToksikol2015;6:-8

implement the agreed changes and policies. Workers can Job .4 DesignPrinciple:changesneedtobeimplemented so that the workers see them and actively participate in their be informed about the program via internet or monthly implementation.Theimplementedchangeshave toensure bulletins, regularmeetingsofworkinggroups,orspecifi optimal working conditions; task-oriented meetings. The importance of 5. Pattern of Control Principle: higher autonomy and is paramount. communication self-regulation can be key to increasing work satisfaction; organisations in which all workers have a certain level of 2. Recognition of needs control are more productive and motivated; Programmes should be clear about what needs t Patterns 6. ofCompensationPrinciple:adequatelypaid address,suchaspromotinghealthyattitudestowards workers generally like their job, are more satisfied, have at work, understanding and preventing stress and h lower absenteeism levels and more rarely leave their jobs. risk factors, supporting employees with health probl However,payneedstobeconnectedwiththeproductivity and including them back into the work environment. It is level; alsoto necessary to recognise the strengths and weaknesses 7. System-Wide Changes Principle: changes need of a specific health promotion programme. This analysis include the whole organisation and need to create “new” needs to be done in cooperation with all employe work systems) (40). regardless Newer studies seem to support the idea of happy and of their position in hierarchy. This canno healthy workers as productive workers. Organisations that repeated enough times. Approaches to determining the needs differ and promote healthy and safe working conditions ensure complement one another (10, 4). They broadly fall into economic growth through the trust that they build within three categories: academic(oranthropological)analyt , thecommunityQuick 41). (0, andQuicksuggest (42) that or ( psychological) and , pragmatic They . ) 0 1 ( also differ in creatingahappy,healthy,andproductiveworkforceshould rely on the principles and knowledge of occupational the observed timeline (past, present or future), kin that is derived (quantitative or qual medicine and public health (42). This in turninformation calls for form/ features oftheinformationdescriptive ( ornormat preventive health programmes that seek to develop the and strategies, methods, and instruments used (4). abilities of the worker population and eliminate conditions thatlowerthisability.Theseprogrammesshouldalsoplan and implement healthy practices following the principles 3. Determining objectives listedinTable2. Theobjectivesshouldbe“measurable”usingappropria

analyticalmethods;forexample,anobjectivecouldbe reduce perceived stress caused by a determined stressor by 1 0  % within a year or to reduce absenteeism due t psychosocial health issues % within by 5  2 years or to This process requires complete cooperation and consensus between the management and workers. One of reintegrate or hire a number of individuals who had a longer the most important ways to protect workers’ psychosocial period of sick leave or had health issues over the last two health is to empower the employees and include them in years. decision making (43). 4. Developing specific plans and measures According to several authors (29, 36, 43), the seven steps listed below are the fundamental building blocks for Afterdeterminingtheobjectivesandthetimefra any healthy organisation: isnecessarytodefinethemeanstoachievetheseobject They usually include informative campaigns that ra 1. Communication, consultation, and informing awareness about a certain issue within the organi It is necessary to obtain consent and make sure that all education and training for employees and employe organisational levels are devoted to protecting health of all actions aimed at reducing discrimination and violence at employees,regardlessoftheirstatusorposition inhierarchy.methods for removing stressors at the workplace, All organisation units need to activelyworkplace, shape, conduct, policiesaimedathelpingpeoplewhodevelo supervise, and evaluate adopted programmes. It is health problems, and discrimination- free employm recommended to form a group of workers to supervise and strategies. implement the adopted programmes in cooperation with It is necessary to adjust the strategies used in the outsideexpertssuchasunionmembers,psychologists, programme toand the culture and needs of the community as occupational medicine physicians. All the employees need wellastodifferentsegmentsoftheemployeepopulati to be clearly and regularly informed about the implementation as the success of new or already implemented programmes steps and need to be given an active role in implementation. depends on it (24). This will increase the perceived importance of the programme and their willingness to participate and Proposed procedures in developing a healthy organisation

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Table 2 Principles of healthy and productive organisations Importance of human resources

Organisations need to hold human resources at least as important as other resources (capital,structures,equipment,materials,etc.)

Relationship between worker's health and wellbeing and organisational health

Organisations need to be aware that health and wellbeing of their workers directly corresponds to the wellbeing of the organisation

Increasing motivation at the workplace The need for continuous monitoring and evaluation Importance of balancing personal life and work demands

Relationship between wellbeing and productivity

Workplaces should motivate workers to perform in an efficient and product Work tasks need to designed done in such a way that workers look forward to their time spent at work There are many different organisational cultures and ways of managemen promotes wellbeing and satisfaction in workers. Organisations need to keep track of employee attitudes and make timely changes in order to improve their wellbeing and satisfaction at work Organisationsneedtobeawarethatworkinfluencesdifferentaspectsoflife it is important that organisations create policies and programmes that allow workers to establish a good balance between work and personal lives Workers with good emotional wellbeing will be more productive and less likely to change workplaces. Also workers who are less stressed and more productive are those who: - are adequately paid for their work and have a degree of financial sec and whose pay is linked to the quality of their work and the economic growth of the organisation - have an active role in decision making and control over their work tasks - receive realistic demands, harmonised with their capabilities, expectations - are given the conditions to succeed - are given social support from co-workers and supervisors - work in conditions that accept diversity

Importance of trust, respect, and decency

Organisations need to implement activities and programmes that dev respect,andrighteousnessbetweenco-workers,supervisors,andmanagers

Adequate work hygiene

Organisationsneedappropriatesupervision,fairbenefits,safeemployment physical and social working conditions

5. Implementation of the programme

not. Evaluation should take place as previously scheduled duringprogrammeimplementation.Theresultsshould It is crucial to make a clearly written document about clearly communicated to everyone in order to increase the theimplementationoftheprogramme,measurestobetaken, interest of the workers and other planned changes within the organisation. This for the programme and introduce corrective measuresifneeded(18,47). document should be a joint declaration of employers and

workers as to what is and what is not acceptable, how to 7. Ensuring sustainability resolve possible disputes or conflicts, and what sort of disciplinary measures workers can expect. All workers The only way to ensure the sustainable plans a should be clearly informed and actively participate with programmes for preserving health at the workplace for long suggestions in the making of such a document. All should is to include them in the official work policies of t signitandberesponsibleforitsimplementation (45-7). (48). organisation When one considers the efficiency of the prevention Programmes that address several issues at the programme, special care should be taken to determine time, that increase physical, mental, and social aspec programme implementation standards that should be health are cost effective and usually the most appealing to sensitive to cultural norms, financial and research employers. Such programmes can lower the risk of a variety possibilities assuring its reimplementation on the basis of of disorders or illnesses and increase the overall health level the written documentation. of the workers. Theshiningexamplesaretheprogrammesincludedin 6. Evaluation the online databases made available to anyone interested by the UK Evidence for Policy and Practice Information Programmeevaluationhastoclearlyandunequivocally show whether the agreed objectives have been reached or andCo-ordinatingCentre,whodevelopedtheDatabase

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GrabovacI,MustajbegovićJ.Healthyoccupationalcultureforaworker-friendlyworkp ArhHigRadaToksikol2015;6:-8

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GrabovacI,MustajbegovićJ.Healthyoccupationalcultureforaworker-friendlyworkp ArhHigRadaToksikol2015;6:-8

Kultura zdravih organizacija – radna mjesta prijatelji radnika

Radniuvjeti,radniokolišisamnačinradaznatnoutječunazdravlje.Danasjerelativnomaloposlov zahtjevima,apunovišementalnimaiemocionalnima,pričemupsihosocijalnirizicipostajuznačajni.U utjecajeradanazdravljeiblagostanje,mnogisuradniciizloženiiopasnostima,štetnostimatee naprezanjima.Stanjementalnogzdravljazaposlenogomogućavarazvijanjeuemocionalnom,intelek pogleduteimaodlučujućeučinkenaradnusposobnost,zahvaćajućinesamonačiniishodenjegovarada poslovanjatvrtkeiliustanove,određujućinjenukompetitivnostnatržištu.Unatočdobrojorga tvrtke,štoumanjujestresnaradu,neformalnidruštveniprocesiutječu(pozitivnoilinegativno jedinica i na osjećaj povezanosti radnika i organizacije. Kultura sigurnosti neke organizacije grupnihvrijednosti,stavova,kompetencijaioblikaponašanja.To,pak,određujeodlučnostinačinvo očuvanjezdravljaizasigurnostuorganizaciji.Značajkeorganizacijakojeimajupozitivnukulturu percepcijavažnostisigurnostitepouzdanostupreventivnemjere.Radkojiomogućujeautonomij radnimzaduženjima,razumnetjelesneipsihološkezahtjevetesigurnostodiznenadnihotkazadovode radnikaismanjujustresnaradnomemjestu.Danassesvevišeističevažnostrazličitostinaradno istaknutikakojeupravoosnaživanjezaposlenikajedanodnajvažnijihnačinaočuvanjapsihoso KLJUČNERIJEČI:

blagostanje radnika; mentalno zdravlje; organizacijska kultura; stres; zdrave organizacije

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