Empowering self-direction in return to work of employees with low and high levels of education: A qualitative comparative study.

BACKGROUND: Dutch legislation encourages active participation of employees in their return-to-work (RTW) process. Empowering leadership may support employees' self-direction in this process (i.e. by allowing and enabling their involvement in decision-making). OBJECTIVE: Building upon a previous study, we aimed to study (1) how representatives of a university, i.e. an employer for employees with high levels of education (EH), manage RTW, (2) the similarities and differences between the RTW management of employers (or representatives thereof) of employees with low (EL) and high levels of education, and (3) the degree to which the employers' roles resemble empowering leadership. METHODS: Qualitative methodology was applied. A thematic analysis of interview transcripts (rq1) was followed by a comparison of themes (rq2) and pattern matching (rq3). RESULTS: (1) EH tend to engage in dialogue and accommodate their employees as much as possible. (2) EL and EH showed several similarities, such as aiming to meet legal requirements on RTW management. Compared to EL, EH tend to focus more on facilitating employees. (3) Empowering leadership seems to be more common among EH. CONCLUSIONS: Compared to employees with low levels of education, those with high levels of education may be granted more opportunity to self-direct their RTW. The study results provide starting points for employers for employees with both low and high levels of education who aim to enable employees' self-direction in RTW, and help them to develop empowering leadership styles.

Return to work of employees with low levels of education: The employers' role and perspective.

BACKGROUND: To achieve adequate return to work (RTW) after sickness absence, Dutch legislation prescribes cooperation between absent employees and employers. Yet, we lack insight into how employees with low levels of education exercise influence over (i.e. self-direct) RTW. OBJECTIVE: This study aimed to enhance our understanding of: (A) the role that employers play in the self-direction of employees with low levels of education over their RTW; (B) how employers perceive these employees' efforts (or lack thereof) to self-direct their own RTW; and (C) how employers understand and interpret the behaviours of these employees. Social cognitive theory served as a framework. METHODS: A qualitative study was conducted with 13 employer representatives using semi-structured interviews. Data were analysed in NVivo12 using a template approach. RESULTS: Employers tend to play a guiding, directive role in employees' RTW. According to employers, employees generally comply with the employers' decisions and suggestions, whether or not they have tried to realise their own preferences regarding mode and timing of RTW. Employers interpret such employee behaviours from the perspective of environmental (e.g. financial pressures to RTW) and person-related factors (e.g. sickness and RTW perceptions). CONCLUSIONS: Employers, rather than employees direct the employees' RTW. Employers should give voice to employees and enable them to have more control over their RTW. Future research should acquire more insight in the employees' perspective.

Examining the mediating role of resources in the temporal relationship between proactive burnout prevention and burnout.

BACKGROUND: Employees who engage in proactive burnout prevention can prevent burnout by changing aspects of the work, home, and personal domain. However, these proactive behaviors may be impeded by high initial levels of burnout. Based on the conservation of resources theory and the dual-pathway proactivity model, resources were expected to play a vital role in the relationship between proactive burnout prevention and burnout through two distinct processes: a resource-generation process in which proactive burnout prevention negatively affects burnout through an increase in resources, and a resource-depletion process in which proactive burnout prevention is hindered because high initial levels of burnout negatively affected resources. METHODS: A two-wave longitudinal panel design was used in which 617 employees, mainly employed in government agencies, healthcare and education, were asked to complete an online survey twice with an interval of 1 month. RESULTS: Results of structural equation modelling showed clear evidence for the resource-generation process in the work, home, and personal domain, and only limited evidence for the resource-depletion process. Solely in the personal domain a small negative indirect effect of burnout on proactive burnout prevention through personal resources was found. CONCLUSIONS: The findings of this study confirm that employees can proactively prevent burnout by investing in resources, yet proactive actions should be taken before increased burnout-complaints impede employees to do so. This study contributes to scientific knowledge on proactive behaviors and burnout prevention by investigating the mechanism underlying the temporal relationship between proactive burnout prevention and burnout. An important practical implication of this study is that it highlights that more attention should be given to employees' self-initiated actions to prevent burnout, as proactive burnout prevention can effectively reduce levels of burnout.

Investigating the temporal relationship between proactive burnout prevention and burnout: A four-wave longitudinal study.

Given the detrimental effects of burnout for individuals and organizations, it is of crucial importance to better understand the self-initiated actions employees take to prevent burnout. While such proactive burnout prevention is likely to reduce burnout complaints, these activities may also be frustrated by high burnout levels. This means that proactive burnout prevention and burnout can negatively affect each other over time. The present study used a four-wave longitudinal panel design to investigate temporal relationships between proactive burnout prevention and burnout over 3, 6 and 9 weeks. Participants were 165 employees in the financial services industry who provided data on all four measurement occasions. The outcomes of structural equation modelling provided support for the hypothesized combined effects model compared to the lagged and reversed effects models. The findings suggest that proactive burnout prevention can help to prevent burnout, while engagement in these behaviours may be hindered by high initial levels of burnout. Employees should therefore intervene before their resource pool becomes too depleted and they lack the energy or mental strength to invest resources, in order to proactively retain or regain resources.

The Development of a Proactive Burnout Prevention Inventory: How Employees Can Contribute to Reduce Burnout Risks.

Proactive burnout prevention refers to a set of proactive behaviors employees may engage in to prevent burnout. Findings of a previous exploratory qualitative study indicated that employees who had to deal with high demands engaged in specific proactive behaviors in the work, home, and personal domain in order to prevent burnout. To further examine proactive burnout prevention in longitudinal quantitative research and to be able to investigate its effectiveness, an inventory for assessing these kinds of behaviors is necessary. The goal of this study was twofold: 1) to develop an inventory to assess employees' proactive burnout prevention behaviors and examine its factorial validity, 2) to explore the broader nomological network of proactive burnout prevention behaviors by examining its convergent, discriminant, and predictive validity. A two-wave longitudinal survey (T1: N = 343; T2: N = 201) was conducted. The results of exploratory and confirmatory factor analysis showed that proactive burnout prevention can be reliably assessed with 40 items that load on 12 factors, indicating 12 separate proactive burnout prevention behaviors. Moreover, exploration of the convergent, discriminant, and predictive validity of the proactive burnout prevention inventory showed promising results, as expected relationships were confirmed for most behaviors. Further research is needed to substantiate the findings and examine the effectiveness of proactive burnout prevention.

Self-directing return-to-work: Employees' perspective.

BACKGROUND: Dutch legislation stimulates active participation of employees in their own return-to-work (RTW). In addition, RTW professionals encourage sick-listed employees to self-direct RTW. It remains unclear, however, how employees give meaning to and shape their self-direction. OBJECTIVE: This study aims to conceptualize self-direction using the components of Self-Determination Theory (autonomy, competence, and relatedness) as a framework. METHODS: Semi-structured interviews were conducted with three long-term sick-listed employees. These results were combined with 14 existing transcripts of semi-structured interviews with long-term sick-listed employees and employees who experienced long-term sick leave during the previous calendar year. All interview transcripts were analyzed thematically. RESULTS: Employees generally think of self-direction as making their own decision regarding RTW. They wish to decide by themselves how to shape their RTW-process. Several environmental factors play a role in employees' self-direction. Proximal factors are satisfaction of the need for autonomy, competence, and relatedness. Distal factors are legislation regarding RTW, organizational culture and clarity regarding the roles of various stakeholders in the process of sickness absence and RTW. CONCLUSIONS: Exercising self-direction in RTW seems to contribute to a personalized RTW-process that takes into account individual needs and wishes. Preconditions for effective self-direction are a supportive environment and good cooperation between employee, employer, and occupational physician.

Exploring Proactive Behaviors of Employees in the Prevention of Burnout.

Extensive evidence indicates that burnout can have detrimental consequences for individuals as well as organizations; therefore, there is a great need for burnout prevention. While burnout prevention interventions initiated by the employer have previously been studied, the proactive behaviors employees deploy themselves to prevent burnout have received less research attention. The purpose of this exploratory qualitative interview study was to enhance our understanding of the self-initiated actions employees undertake to prevent burnout, using the model of proactive motivation and conservation of resources theory as theoretical frameworks. Findings indicated that most participants reported to engage in specific kinds of proactive burnout prevention behaviors. The reported self-initiated proactive actions were aimed at maintaining and/or increasing resources and/or reducing demands in the work, home, and personal domain. The study contributes to the literature by linking the proactive motivation process to the prevention of burnout and by focusing on both work and non-work factors. Results of this study can be used in further research into the (effectiveness of) employees' proactive burnout prevention behaviors and serve as a starting point for developing interventions aimed at enhancing proactive burnout prevention.

If it isn't finished at five, then I'll continue until it is. A qualitative study of work pressure among employees in vocational education.

BACKGROUND: Prolonged work pressure can contribute to burnout. The Job-Demands Resources model (the health impairment process and the roles of job and personal resources in it) provides a framework for studying work pressure. OBJECTIVE: The study aims were to understand the experiences of employees in the career services and a teaching department of a school for vocational education regarding the following: A) work pressure; B) its negative consequences; and C) how job resources and D) personal resources play a role in the employees' experience of work pressure or in helping to cope with it. METHODS: A qualitative study based on 11 in-depth interviews with teachers (5) and supporting personnel (6) was performed at a Dutch organization for vocational education. The interviews were analyzed interpretatively. RESULTS: A) The teachers and supporting personnel generally experienced work pressure, which had both qualitative and quantitative aspects. B) The consequences included working overtime and lower job performance. Factors such as autonomy and social support from colleagues were C) job resources, and moving from idealism towards realism was D) a personal resource. CONCLUSIONS: Both the teachers and supporting personnel who were interviewed experienced work pressure and its related consequences, as well as job and personal resources. Work pressure may threaten the sustainable employability of these employees.

A process evaluation of a return-to-work intervention to improve Cooperation between Sick-listed employees and their Supervisors (COSS).

BACKGROUND: This is a process evaluation of an intervention to improve Cooperation regarding return-to-work (RTW) between sick-listed employees and their supervisors (COSS, which consists of a conversation roadmap, monitoring of cooperation using questionnaires and, if necessary, extra support by an occupational physician (OP). OBJECTIVE: Objectives were to study (1) the adoption of COSS by a banking organization and (2) its implementation among individual employees, supervisors and OPs. METHODS: We used quantitative data (online questionnaire, project administration, conversation minutes, emails) and qualitative data (semi-structured interviews). We analyzed quantitative data descriptively (by calculating sum scores, percentages, mean scores and standard deviations). The coding system to analyze the qualitative data was data-driven. RESULTS: The organization's representatives reported positively (e.g. fit with existing policy) and negatively (e.g. high intensity) about COSS. At least one OP (out of five) used the monitoring information. Project administration data show a modest reach of COSS among employees and supervisors. The roadmap was used by a minority (35% of the employees and 25% of the supervisors). Relatively many (40% of the employees and 100% of the supervisors who used COSS to evaluate conversations) were satisfied with COSS as a  tool to evaluate conversations with the employee/supervisor afterwards. Interview results indicate that the roadmap was considered useful in specific situations (e.g. psychological complaints). All employees and supervisors participated in the monitoring. The majority of the responding employees and supervisors received OP support and was satisfied about this support. CONCLUSIONS: Despite the good adoption of COSS by the organisation, it was only partially implemented by professionals, employees and supervisors. We hypothesize that our implementation approach did not fit completely with the culture at the bank. Also, the results illustrate the need for other intervention methods for improving cooperation between employees and supervisors and a more specific target population.

The Effectiveness of an Intervention to Enhance Cooperation Between Sick-Listed Employees and Their Supervisors (COSS).

Introduction Early return-to-work (RTW) after sick leave is considered to support employees' quality of life. Successful RTW requires adequate cooperation between absent employees and their supervisors. This study assesses the effectiveness of an intervention for COoperation regarding RTW between Sick-listed employees and their Supervisors (COSS; i.e. 'conversation roadmap', monitoring of cooperation and, if necessary, extra occupational physician support). Methods In this field study, employees on sick leave for 2-10 weeks, aged 18 up to and including 60, and performing paid labour for at least 12 h per week were included. Terminally ill were excluded. Multivariate regression (correcting for baseline quality of life) was used to compare 6-months follow up data regarding quality of life between the groups. Using Cox regression analyses, time until first-, full-, and sustainable RTW was compared between groups. Results In total 64 employees received COSS or common practice. No significant group differences were found regarding all study outcomes. The COSS group had a higher chance of work resumption than the common practice group. The hazard ratio was 1.39 for first RTW (95 % CI 0.81-2.37), 1.12 for full RTW (95 % CI 0.65-1.93) and 1.10 for sustainable RTW (95 % CI 0.63-1.95). Conclusions COSS has no significant effects. Yet, the results regarding work resumption show a tendency towards effectiveness. Therefore, COSS can be further developed and applied in practice. Researchers should try to prevent some limitations of the present study in future research, for instance by finding a more common research setting.

Economic Evaluation of a New Organizational RTW Intervention to Improve Cooperation Between Sick-Listed Employees and Their Supervisors: A Field Study.

OBJECTIVE: The purpose of this study is to assess the cost-effectiveness, -utility, and -benefit of a new organizational return-to-work intervention to improve COoperation between Sick-listed employees and their Supervisors (COSS). METHODS: A field study with 6 months follow-up comparing COSS with common practice randomized participants aged 18 to 60, working at least 12  hours/week and absent for at least 2 weeks. Outcomes were initial return-to-work, quality-adjusted life years, and productivity gains. RESULTS: After 6 months, COSS generated less costs when compared with common practice. Participants in the COSS group returned to work earlier, improvement in quality-adjusted life years were uncertain. Net benefits of COSS versus common practice yielded a productivity gain of €395.89. CONCLUSIONS: Implementing COSS for sick-listed employees has potentials to reduce costs and improve productivity, and potentially quality of life. Longitudinal research might detect whether COSS also has the potential reaching sustainable return-to-work.

Environmental and personal factors that support early return-to-work: a qualitative study using the ICF as a framework.

BACKGROUND: Occupational health professionals such as occupational physicians (OPs) increasingly understand that in addition to health improvement, environmental factors (such as work adaptations) and personal factors (such as an employee's attitude towards return-to-work (RTW)) may stimulate employees on sick leave to return to work early. To target their professional interventions more specifically according to these factors, occupational health professionals need further insight into environmental and personal factors that stimulate RTW. OBJECTIVE: The objectives of this study are (1) to identify which and how environmental and personal factors support RTW, and (2) to examine whether the International Classification of Functioning, Disability and Health (ICF) can be used to describe these factors. METHODS: We performed interviews with 14 employees, 15 employers and 4 OPs from multiple organisations with varying organisational sizes and types of industry such as healthcare and education. We used a qualitative data analysis partially based on the Qualitative Analysis Guide of Leuven. RESULTS: The following environmental factors were found to support early RTW: 'social support from relatives', 'belief that work stimulates health', 'adequate cooperation between stakeholders in RTW' (e.g., employees, employers and OPs) and 'the employers' communicative skills'. One personal factor stimulated RTW: 'positive perception of the working situation' (e.g. enjoyment of work). Most factors stimulated RTW directly. In addition, adequate treatment and social support stimulated medical recovery. Environmental factors can either fully (social support, belief that RTW stimulates health), partially (effective cooperation), or not (employers' communicative skills) be described using ICF codes. The personal factor could not be classified because the ICF does not contain codes for personal factors. CONCLUSIONS: RTW interventions should aim at the environmental and personal factors mentioned above. Professionals can use the ICF to describe most environmental factors.

Work resumption at the price of distrust: a qualitative study on return to work legislation in the Netherlands.

BACKGROUND: Return to work (RTW) after sick leave is considered necessary to support the employees' health. Cooperation between employees and employers may encourage employees' RTW, but is hampered by bottlenecks that we do not completely understand. Dutch legislation means to support this cooperation and allows trying RTW during two years. The Resource Dependence Institutional Cooperation (RDIC) model has been developed for studying cooperation in public health. Study aims were to get insight into the degree of cooperation between Dutch sick-listed employees and employers, how this (lack of) cooperation can be understood, and how valid the RDIC model is for understanding this (lack of) cooperation. METHODS: This qualitative study was based on in-depth interviews with 8 employees and 8 employers. Employees reported sick for 1.5-20 months for various reasons. Interviews were analysed using an interpretative approach and pattern matching. RESULTS: Cooperation was lacking early during sick leave. Later on there were regular meetings, but employers decided about RTW without consulting the employees. Particularly employers were motivated to cooperate during the first year, while employees were especially motivated during the second. This could be understood by experienced dependence; employees (first year) and employers (second year) did not consider cooperation to be important for achieving medical recovery (employees) or RTW (employers). These divergent goals may be understood by personal norms about the timing of medical recovery and RTW. Legislation was particularly effective regarding employer behaviour in year 1 and employee behaviour in year 2. Employees distrusted their employers during the first year, while employers reported to distrust the employees during the second year. Besides, employees and employers experienced a moderate ability to cooperate. This could be understood particularly by having moderate knowledge about legislation. The RDIC model appeared to be valid to understand the cases studied, but the additional factor distrust also played a role. CONCLUSIONS: Legislation appeared to support cooperation, but awareness of a mutual dependence, trust, knowledge about the legislation and personal norms regarding recovery and RTW are also important. Professionals such as occupational physicians should support this to attain a degree of cooperation that is necessary for effective RTW.

Intervention characteristics that facilitate return to work after sickness absence: a systematic literature review.

INTRODUCTION: In many Western countries, a vast amount of interventions exist that aim to facilitate return to work (RTW) after sickness absence. These interventions are usually focused on specific target populations such as employees with low back pain, stress-related complaints or adjustment disorders. The aim of the present study is to detect and identify characteristics of RTW interventions that generally facilitate return to work (i.e. in multiple target populations and across interventions). This type of knowledge is highly relevant to policy makers and health practitioners who want to deliver evidence based care that supports the employee's health and participation in labour. METHODS: We performed a keyword search (systematic literature review) in seven databases (period: 1994-2010). In total, 23 articles were included and assessed for their methodological quality. The characteristics of the interventions were evaluated as well. RESULTS: Early interventions, initiated in the first 6 weeks of the RTW process were scarce. These were effective to support RTW though. Multidisciplinary interventions appeared effective to support RTW in multiple target groups (e.g. back pain and adjustment disorders). Time contingent interventions in which activities followed a pre-defined schedule were effective in all physical complaints studied in this review. Activating interventions such as gradual RTW were effective in physical complaints. They have not been studied for people with psychological complaints. CONCLUSIONS: Early- and multidisciplinary intervention and time-contingent-, activating interventions appear most effective to support RTW.