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A multiple case study approach to work stress prevention in europe

This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution CC BY license http: Abstract Effective interventions to prevent work stress and to improve health, well-being, and performance of employees are of the utmost importance.

This quasi-experimental intervention study presents a specific method for diagnosis of psychosocial risk factors at work and subsequent development and implementation of tailored work stress interventions, the so-called DISCovery method. This method aims at improving employee health, well-being, and performance by optimizing the balance between job demands, job resources, and recovery from work.

The aim of the study is to quantitatively assess the effectiveness of the DISCovery method in hospital care. Specifically, we used a three-wave longitudinal, quasi-experimental multiple-case study approach with intervention and comparison groups in health care work.

Positive changes were found for members of the intervention groups, relative to members of the corresponding comparison groups, with respect to targeted work-related characteristics and targeted health, well-being, and performance outcomes. Overall, results lend support for the effectiveness of the DISCovery method in hospital care.

Introduction Health care staff is widely regarded as a group that is at high risk of work stress and job dissatisfaction [ 12 ].

A multiple case study approach to work stress prevention in europe

High levels of work stress are related to higher sickness absenteeism rates [ 3 ] and decreased performance [ 4 ], thereby jeopardizing patient safety [ 3 ]. Hence, effective interventions to prevent work stress and to improve health, well-being, and performance of health care employees are badly needed [ 5 ]. Although stress prevention has received considerable attention over the last a multiple case study approach to work stress prevention in europe decades, there is still a gap between theoretical knowledge regarding work stress prevention and corresponding practical applications [ 56 ].

Scientifically well-performed studies on work stress and performance interventions are still scarce, and organization-level interventions often fail to achieve the desired results [ 78910 ]. In other words, there is a lack of proper diagnosis of risk factors at work i.

The current intervention study presents a specific method for diagnosis of risk factors at work and subsequent development and implementation of tailored work stress and performance interventions, the so-called DISCovery method [ 11 ].

Accordingly, the aim of this study is to quantitatively assess the effectiveness of the DISCovery method in hospital care. Following the recommendations of Kompier and Kristensen [ 9 ], we use a multiple-case study approach, in which the context is different for each of the cases.

This provides the opportunity to explore holistic explanations within and across settings, taking into account the dynamic and process nature of unfolding events that are embedded in an organizational context [ 12 ]. As such, this intervention study contributes to bridging the gap between theory and practice in work stress prevention.

The DISCovery method has been developed by De Jonge and colleagues [ 11 ] and is a method to improve employee health, well-being, and performance, through development and implementation of tailored work stress interventions that are based on a proper diagnosis of risk factors at work.

We will address these principles consecutively.

Work, Stress, Coping, and Stress Management

The DISC-R Model is a work stress model that is used as a theoretical framework for the identification of risk factors and risk groups at work. The model comprises three central components: In other words, job demands place a certain amount of strain on employees. Job resources, on the other hand, are instrumental or psychological means at work that can be used to deal with job demands, such as job control and workplace social support [ 18 ].

Stress management techniques: evidence-based procedures that reduce stress and promote health

As such, the use of job resources can counteract negative strain effects of job demands. By detaching from work, functional bodily systems that were activated during work can return to baseline levels [ 15 ]. In general, it can be seen as a promising strategy to recover from work-related strain [ 20 ].

Thus, similar to job resources, detachment from work has a mitigating function with respect to detrimental effects of high job demands. First, the a multiple case study approach to work stress prevention in europe proposes that a balance between job demands, job resources, and detachment from work will lead to favorable outcomes in terms of employee health, well-being and performance, whereas an imbalance will lead to unfavorable outcomes, such as job dissatisfaction or emotional exhaustion.

Put differently, job demands can lead to negative strain effects unless employees 1 have sufficient job resources to deal with the demands and 2 can recover sufficiently from effort expenditure. Because job demands often cannot easily be reduced, the focus in this study is on combatting work stress by enhancing job resources and detachment instead.

Second, in line with the DISC-R Model, stress-buffering effects of job resources and detachment from work are expected to be the strongest if they are specific and targeted, rather than broad and general [ 15 ]. Job demands, job resources, and detachment from work can each be divided into cognitive, emotional, and physical elements.

Prior studies have shown empirical support for this assumption [ 1521 ]. For example, health care employees often have to carry out complex tasks under time pressure cognitive demandsdeal with suffering patients emotional demandsor lift heavy objects physical demands. Similarly, examples of different types of job resources are decision authority cognitiveemotional support from co-workers emotionaland lifting devices physical.

In sum, unlike other job stress models, the DISC-R Model incorporates both job resources and recovery from work as means to counterbalance high job demands. Applying these DISC-R propositions to real practice, we expect that interventions are most likely to be effective if they are tailored to specific job demands i. The approach towards development and implementation of the interventions in this study is based on principles of Participatory Action Research, or PAR [ a multiple case study approach to work stress prevention in europe ].

The philosophy of PAR is that organizational interventions designed to promote employee health cannot take place without the participation and experience of the subjects under study. This is in line with Nielsen et al. Moreover, Dollard and colleagues [ 16 ] argued that PAR has the potential to contribute to organizational sustainability, as organization members learn to solve self-identified problems. Previous studies have shown the effectiveness of PAR approaches in intervention research e.

The aim of the DISCovery method is optimizing the balance between job demands, job resources, and recovery from work through three successive steps, which will be discussed later in the method section. Using this method within a multiple-case study approach with intervention and comparison groups, we expect tailored work-oriented interventions to have positive effects on job resources and recovery from work, and on employee health, well-being, and performance outcomes for the intervention groups.

In this particular context, a distinction can be made between two types of outcomes cf. Job resources and recovery from work can be viewed as more acute or proximal outcomes of the interventions, as these work-related characteristics are directly targeted by the interventions, and, therefore, expected to be most sensitive to the intervention process [ 24 ]. Improved employee health, well-being, and performance, on the other hand, are referred to as more chronic or distal outcomes, as it may take more time for such effects to unfold compared to proximal outcomes [ 25 ].

Hence, two main hypotheses guided our study: Relative to members of the comparison groups, members of the intervention groups show positive changes in targeted work-related characteristics after intervention implementation proximal outcomes. Relative to members of the comparison groups, members of the intervention groups show improvements in targeted employee health, well-being, and performance outcomes after intervention implementation distal outcomes.

Investigating aspects of unique, tailor-made intervention programs within multiple cases inherently yields an extensive amount of information. Throughout this paper we will, therefore, focus on the main points of the study and refer to appendices for more detailed information.

Materials and Methods 2. Study Design, Data, and Procedure The research was conducted in a multi-located Dutch general hospital over the course of two years using a three-wave longitudinal, quasi-experimental, multiple-case study design. Initially, three existing organizational departments situated at two different locations agreed upon participation in the study: At the start of the study, each department consisted of two or more separate work units at different locations, thereby allowing a subsequent division into intervention and comparison groups within each department.

However, due to unforeseen organizational changes, the comparison group within the emergency room department merged with the intervention group a few months after baseline data collection Time 1. Because no other suitable comparison group existed for this department, we decided to adjust the study design and to continue with two rather than three cases.

They received an email with a unique link to an online survey on three occasions: Intervention development and implementation started after Time 1. This time frame was based on the estimated time needed to complete the DISCovery method in this particular study. In addition, it allowed for the evaluation of intervention effects at two different time points Time 2 and Time 3as to investigate possible differences between proximal and distal outcomes of the interventions.

Everyone in the sample was invited to fill out the surveys at Time 2 and Time 3, regardless of whether they had completed the survey at the previous time point. Table 1 shows more detailed information about the response rates for each subsample. To guarantee confidentiality of the data, the identification information was only available to the researchers and exclusively used for data-management purposes.