Stakeholder Dialogue on Workplace Dilemmas as a Workplace Health Promotion Intervention, Including Employees with Low MS: A Reactive Evaluation | BMC Public Health

The results are presented in two parts, according to the research objectives. Part I describes the central themes that have been defined with the stakeholders. Part II describes desired changes before the intervention and perceived changes during and after the intervention.

Part 1 – Central Themes

Two relevant health-related themes stood out throughout the evaluation period: high workload and mental health.

High workload

This recurring theme has often been attributed to the unpredictable nature of the work, resulting in high peaks and understaffing. For operational employees, the high physical demands of the job (working with dangerous goods) and the mental demands of the job (multitasking, prioritizing on the spot) also contributed to a perceived high workload. According to employees, a high workload influenced health by disrupting work-life balance, working less safely, reducing job satisfaction or mental pressure from the potential consequences of mistakes and unsafe work (e.g. example, losing customers). According to supervisors, working in a less safe manner (not entirely according to safety rules) was of particular concern for young employees with little experience:

“These young boys who have just been hired, you have to tell them: man, calm down. They think: how can I do this as quickly as possible? And then they start running and flying, but you shouldn’t not do that. Because by doing that in this job, you risk your safety. They’re like oh I forgot to put my helmet on because I was too busy.—Supervisor, initial interview 1.

The consequences of errors, i.e. non-compliance with safety rules or other errors due to a perceived high workload, could be considerable. Employees seemed to have a sense of responsibility for the organization’s reputation.

“We sometimes talk about shipments of more than a hundred million. If you make a mistake because you’re mentally out of this world for a while, yes then…” … “If something happens in our factory, [name organization] will take the blame. – Operational employee, initial interview 2.

Mental Health

Employees and management have noticed an increase in the number of colleagues absent due to burnout or symptoms of stress. The Periodic Medical Assessments (EPMs) that were carried out during the project (June 2018 and April 2019), showed that employees with low MS scored below national averages on aspects of mental health such as commitment to work and superiors on burnout and stress. Masculine norms have been reported as a contributing factor to burnout. Maintaining the image of a strong worker and preferable not to show vulnerability prevented employees from speaking out at an early stage, although it was mentioned that the organization is helpful when someone is struggling mental,

“They are, after all, somewhat young guys, uh yes how do you say that politely? Hard working people, you know? That’s really what you see in the news, the Rotterdam mentality. – Supervisor, initial interview 1.

“We’re here with tough guys and it’s not cool of course to say yes, it’s not well at home or I’m not feeling well. »… « We usually see it when it’s too late. You notice people are mentally absent, and then all of a sudden they burn out. – Operational employee – reference interview 2.

Topics for Moral Case Deliberation

Based on the general themes high workload and mental health, topics for the dialogues were formulated. The researchers looked for concrete examples of the central themes articulated in the data. Topics were discussed with the contact person of the organization. Table 1 provides an overview of the topics and dilemmas each session is presented.

Table 1 Topics and dilemmas in dialogue sessions

Part 2 – Perceived Changes

Desired changes before intervention

Stakeholders were asked what they considered to be relevant changes to the intervention [20]. Respondents were interested in learnings, either unspecified (i.e. cross-pollination on how other departments deal with issues) or more specific (e.g., on how employees from other departments experienced the high workload). Additionally, employees from various departments indicated that the dialogues could help define shared experiences and/or structural issues that needed improvement. Dialogues could be a way to jointly come up with ideas for improvement for decision-makers, creating bottom-up support:

I mean, if everyone’s saying the same thing… then the organization has something to work on. – Operational employee, initial interview 6.

The leadership team also focused on learning for improvement. For example, they indicated that it was relevant for them to learn how to communicate more effectively with the ‘shop-floor’.

Perceived relevant changes after the intervention

Changes were seen at all four levels (case, individual, team, organizational). Table 2 presents an overview of all the perceived changes with a detailed description of the context showing the relevance of the changes for the stakeholders.

Table 2 Perceived changes in dialogues [ MCD = Moral Case Deliberation]

Below, one change per level is described in detail. We selected changes that were not a one-time event, such as the purchase of a means of security, but were assumed to have a longer duration (eg, perceived better mutual understanding).

Case level

Calendar setting

Some dialogues led to follow-up discussions on topics similar to those covered in the dialogue. These follow-up discussions were initiated by the organization rather than the researchers. For example, after a dialogue in which the peak workload at this time was discussed, “toolbox” sessions were organized on the experience of a high workload. During these sessions, it was discussed how to prioritize tasks and psychologically manage high workloads.

An operational employee who participated in a dialogue mentioned in the evaluation that the effort to reduce (the experience of) high workloads increased sharply directly after the dialogue. However, it was pointed out that this attention decreased after a while when the workload increased again. Nevertheless, changes occurred at other levels which were also related to the experience of high workload.

Individual level

Recognition and learning

The dialogues led to the recognition of the problems for the participants in the dialogues. Participants realized that colleagues, whether in the same department or in different departments, were experiencing similar issues, such as high workload. It was reassuring for participants from various departments to realize that their department was not the only one experiencing a high workload, but that it was a company-wide problem. Additionally, the dialogues revealed that dominant male norms like being a strong worker, preferably not showing vulnerability, prevent employees from asking for help. Participants reported that they realized during the dialogue that asking for help in times of very high workload is a legitimate thing to do. Participants also realized that it can also be helpful for other employees not participating in the dialogues to know that it is not a problem to ask for help and that this should be communicated more actively.

Team level

Perception of better mutual understanding

Participants mentioned that the sessions helped improve mutual understanding between departments. Tensions between departments, which are highly interdependent for their core business, were a contributing factor to the experience of high workloads. Participants in the dialogues indicated that they were sometimes surprised by the views of employees from other departments. Insight into their perspectives and working conditions enhanced understanding of some situations that contributed to the high workload experience. In addition, the organization has established an exchange program between departments to further enhance mutual understanding.

Organizational level

Organizational learning process

The dialogues helped management better understand the underlying factors of the central themes, high workload and mental health. From management’s point of view, there was no sign of an increase in workload; there has been no increase in customer requests. However, over the course of the project, members of the management team began to learn through the dialogues what were the underlying reasons for the perceived high workload. Understanding these reasons, such as sometimes compelling communication and tensions between departments, enabled management to take targeted action. For example, management has implemented communication training for supervisors to foster respectful and proactive employee communication to engage them more in daily practice. Other actions undertaken by the management were the establishment of an exchange program with the aim of getting to know each other’s work, initiatives aimed at strengthening the commitment of employees in organizational changes and stimulate a more preventive approach to burnout by making supervisors aware that they are the ones who can report symptoms at an early stage.

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