Exploring Individual and Organizational Stress-reducing Interventions across Industries

Posted on by Ann Marie Dale, PhD, OTR/L; Stephanie Kibby, OTD/S; Skye Buckner-Petty, MPH; Jaime R. Strickland, MA; Bradley A. Evanoff, MD, MPH; and Sarah Mitchell, MPH

Physical and mental job stress are critical drivers of individual health problems and organizational and societal costs. Health effects of stress lead to higher absenteeism, turnover, and loss of productivity for organizations, as well as higher healthcare expenditures. Long-term impact of stress on employees leads to chronic health conditions. Workplace interventions can help working adults reduce stress which in turn may reduce the impact of chronic health conditions. In May 2018, research on stress-reducing interventions was presented at the 2nd International Symposium to Advance Total Worker Health®. The purpose of this project was to describe stress interventions delivered in the workplace and report the health effects of implementation. A scoping review of more than ten thousand studies from 2007 through 2017 found 37 articles that met eligibility and reported outcomes; the summary of analysis results is below.

Results showed most studies on stress intervention in the workplace were conducted in the healthcare industry (40%), followed by education (11%), and in groups of general workers (11%), with 73% of the studies in white collar jobs. Most studies (33) involved individual-level strategies. The most common individual strategies were mindfulness, cognitive behavioral therapy, and coping strategies. Only two studies were delivered to the organization and two combined individual and organizational level strategies via a participatory program.

Studies with the largest effect used meditation, coping strategies, cognitive behavioral therapy, and multicomponent strategies, but use of these strategies did not consistently produce strong effects. Effect sizes varied by type of strategy and industry. Coping strategies produced a large effect in general workers but a small effect for healthcare. The health effect of physical activity strategies varied widely by the type of work and there was a tendency for high attrition of participants. Multi-component strategies had large effect in some studies, while others showed high attrition and low participation. Work organization interventions were multi-component. All of these studies were conducted in healthcare and results were limited by inadequate power and attrition from turnover; none showed a meaningful effect.

Most workplace stress reducing strategies in the published literature focused on increasing individual tolerance to stress rather than reducing the source of stress created by the job and organization. This is perhaps the most striking finding of this review, and reflects a widespread approach to job stress that runs counter to the approach taken to reduce health effects from all other occupational hazards, where the focus is on reducing worker exposures via the hierarchy of controls. Organizational interventions are more complex to deliver, and often require longer term assessment to determine effectiveness, but may be necessary to reduce stress and improve worker well-being at an organizational level.

Intervention studies should measure employee engagement and sustainability with the intervention as well as long-term health effects. Some interventions are more challenging to deliver at the workplace and some industries are more challenging to deliver interventions, particularly service oriented industries like healthcare. Multi-component strategies offer better health outcomes but also suffer from greater attrition and less engagement with employees.

The mixed results indicate that most workplaces may benefit from a tailored approach considering the needs of the particular work environment and worker population. Additionally, more research is needed on best practices within industries. With the growing concern for stress in the workplace, there is a need to know which stress reducing strategies are more likely to produce an effect. Preferred strategies appear to differ by industry. Offering multiple forms of strategies and targeting both individual and organizational levels may be needed to reduce stress in the workplace and help employees cope with their stress.

While research continues, there are many different strategies that organizations can begin implementing to reduce stressful working conditions and promote better mental health in the workplace. The NORA Healthy Work Design and Well-being Cross-sector Council works with partners to improve the design of work, work environments, and management practices in order to advance worker safety, health, and well-being. Additionally, the NIOSH Total Worker Health® program integrates workplace interventions that protect safety and health with activities that advance the overall well-being of workers. For more information, check out resources below.

We would like to hear from you. How has your company taken steps to promote better mental health or implemented stress prevention programs? What challenges does your organization face in implementing programs that reduce stress and promote better mental health in the workplace? Please share them in the comment sections below.

Ann Marie Dale, PhD, OTR/L, is an Associate Professor of Medicine and Occupational Therapy at the Washington University School of Medicine.

Stephanie Kibby, OTD/S; Skye Buckner-Petty, MPH; Jaime R. Strickland, MA;  Bradley A. Evanoff, MD, MPH are all in the Division of General Medical Sciences, Washington University School of Medicine.

Sarah Mitchell, MPH, is an ORISE Fellow working in Research Translation and Communication in the NIOSH Office for Total Worker Health®.

Posted on by Ann Marie Dale, PhD, OTR/L; Stephanie Kibby, OTD/S; Skye Buckner-Petty, MPH; Jaime R. Strickland, MA; Bradley A. Evanoff, MD, MPH; and Sarah Mitchell, MPH

10 comments on “Exploring Individual and Organizational Stress-reducing Interventions across Industries”

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    Very interesting and useful article, will serve as a guide to evaluate the psychosocial risk interventions that are carried out within the company

    Thanks for a great blog post summarizing some of the literature on organizational interventions to reduce job stress. There are many more than 4 organizational-level interventions that have been published and reviewed (e.g., LaMontagne et a., 2007; Bambra et al., 2007). However, the authors are correct that “Organizational interventions are more complex to deliver, and often require longer term assessment to determine effectiveness…” They may be “limited by inadequate power and attrition from turnover”.

    In addition, their impacts often vary depending upon organizational context, and intervention processes and mechanisms. There is often difficulty finding appropriate control groups. Many published studies lack details of the process and context of the intervention, or an assessment of intervention fidelity (Nielsen & Miraglia, 2017). Combining studies of differing fidelity, contexts and processes, contributes to reviewers’ conclusions that organizational intervention studies have limited or “mixed” results (Nielsen & Miraglia, 2017; Kompier & Aust, 2016).

    Also, we need to conduct more research on primarily non-worksite-based interventions to reduce job stressors — legislation, regulation, contract language, cooperatives and worker advocacy efforts. With a few exceptions (e.g., Dollard & Neser, 2013; Landsbergis et al., 2017; Leigh et al., 2015), research studies have not evaluated such interventions for their impact on job characteristics or on worker health. However, many of those are legally binding interventions, and thus hold promise to reduce job stressors.

    We welcome everyone to explore our new website, https://healthywork.org/, which contains a variety of resources on documenting and reducing job stressors. The intervention toolkits included on the site are in the process of development.

    Bambra C, Egan M, Thomas S, Petticrew M, Whitehead M. The psychosocial and health effects of workplace reorganisation. 2. A systematic review of task restructuring interventions. J Epidemiol Community Health. 2007;61(12):1028-1037.

    Dollard MF, Neser D. Worker health is good for the economy: Union density and psychosocial safety climate as determinants of country differences in worker health and productivity in 31 European countries. Social Science & Medicine. 2013;92:114-123.

    Kompier M, Aust B. Organizational stress management interventions: Is it the singer not the song? Scand J Work Environ Health 2016;42(5):355–358.

    LaMontagne AD, Keegel T, Louie AM, Ostry A, Landsbergis PA. A systematic review of the job stress intervention evaluation literature: 1990—2005. Intl J Occup Environ Health 2007;13(3):268-280.

    Landsbergis P, Zoeckler J, Rivera B, Alexander D, Bahruth A, Hord W. Organizational interventions to reduce sources of K-12 teachers’ occupational stress. In: McIntyre T, McIntyre S, Francis D, eds. Stress in educators: An occupational health perspective. Springer 2017:369-410.

    Leigh JP, Markis CA, Iosif A-M, Romano PS. California’s nurse-to-patient ratio law and occupational injury. Int Arch Occup Environ Health 2015;88:477-484.

    Nielsen K, Miraglia M. What works for whom in which circumstances? On the need to move beyond the ‘what works?’ question in organizational intervention research. Human Relations 2017;70(1):40–62.

    The article is spot on about the need for more and effective organizational intervention research to address workplace stress and well being. Healthcare is an instructive example that illustrates some of the structural barriers to developing effective interventions to address workplace stress. For example, despite tremendous evidence about the negative impact of short staffing on patients and workers, only one state in the nation has passed a nurse to patient ratio law. The recent defeat of the Massachusetts proposal for ratios shows the power of the industry in resisting any attempt to change the organization of work, even when the proposal is evidence based and clearly would benefit patients and worker well being. The arguments used in the Massachusetts battle defy the peer reviewed literature on RN staffing and its negative impact on patient mortality, infection, readmission, etc. Another example, is the resistance of the industry to move away from the infernal 12 hour or double shift. Studies on fatigue show that its impact is similar to alcohol intoxication. Clearly, working long and double shifts is a threat to both patient and healthcare worker well being. However, the industry refuses to address it, even at a time when its claims to be committed and focused on patient safety. Other examples are the lack of a national safe patient handling standard even though the peer reviewed literature shows that instituting these programs is cost effective and it is well documented that large percentages of nurses and aids are injured doing manual patient transfers and many leave the industry due to low back pain and workplace environmental conditions. Similarly, the industry lacks a national standard on workplace violence prevention or hazardous drugs. These fundamental issues must be addressed if we are truly going to deal with the negative impact of workplace stress on healthcare workers and patients. Mindfulness, resilience, and self care are no substitute for addressing the structural organizational sources of stress. And this example could easily be constructed for other high stress industries such as retail, warehousing, etc. So what is the solution? We need to identify progressive employers who will partner with workers, their unions, and researchers in participative intervention research. Unfortunately, in today’s climate these partnerships are few and far between. Additionally, we should increase resources devoted to research that evaluates the impact of laws and regulations in states where they have been promulgated and develop tools and resources that can be used by others who want to emulate best practices and promulgate standards and regulations.

    Interesting examples, though healthcare is a hot mess for a host of reasons! Unfortunately, until priorities shift – basically, it becomes too expensive whether through employee costs, lawsuits, patient deaths, etc. – it will be hard to change these institutional practices. It seems to me that developing collaborative relationships and alliances and setting the stage for research will be good steps for the time when people will be willing to consider change to the status quo. Thanks for your comment; it was useful.

    My impression was that there was some success in Germany with health circles. https://pdfs.semanticscholar.org/cdbd/c5a8418d42adf13a75fbe5f522fbc5498ba1.pdf
    Most of the studies were promising but inconclusive, and then I’ve heard little about them for the last 10 years (except for an interesting case study from Canada: “Long-term effects of an intervention on psychosocial
    work factors among healthcare professionals in a hospital setting” https://pdfs.semanticscholar.org/aa5a/9522fb35f5809e699a73b2a46e66933f8260.pdf ). I’d appreciate others’ thoughts about the health circles approach.

    I’m struck by the observation that this scenario where the burden of dealing with stress falls on the individual rather than the workplace is different than other workplace health and safety interventions. (Kind of a ‘smack my forehead’ moment because I so readily accepted the individual’s responsibility for their own wellbeing and, conversely, the assumption that the workplace would not be accountable for its working conditions.) My organization provides “Coping with Stress” trainings that – just as you point out – arm employees with tactics for managing the impact that stress has on them. (We also cover anxiety and depression, and we are able to tailor the content to reflect the particular factors of a workplace.) The trainings fit within the Massachusetts Strategic Plan for Suicide Prevention at the individual level by increasing self-awareness of risk and protective factors, encouraging help-seeking, and developing resiliency and skill-building. Recently, however, we have begun to produce and incorporate material about employers’ ability (even if for their own benefit through higher productivity, reduced health care costs, etc.) to promote mental wellness and institute tailored suicide prevention programs. It’s reassuring to know we are on the right track! As a suicide prevention organization, even though we are very small, we try very hard to walk the walk of respecting and promoting employees’ mental wellness in our collaborative and flexible office.

    The irony that this study was produced in 2019 pre-pandemic. I can only imagine the differences found 4 years later.

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Page last updated: February 6, 2019