Managing psychosocial risks: Drivers and barriers
Stavroula Leka and Aditya Jain, University of Nottingham, Juliet Hassard, and Tom Cox , Birkbeck, University of London, United Kingdom.
- 1 Introduction
- 2 Psychosocial risks: definition, prevalence and impact
- 3 The policy context to the management of psychosocial risks
- 4 Psychosocial risk management
- 5 Drivers and barriers to psychosocial risk management
- 5.1 Key drivers
- 5.2 Key barriers
- 5.2.1 Economic climate of enterprise and availability of resources
- 5.2.2 Organisational restructuring
- 5.2.3 Organisational culture and organisational readiness for change
- 5.2.4 Level of awareness and acknowledgement of psychosocial issues
- 5.2.5 Availability of training and expertise, tools, and guidance
- 5.2.6 The implementation process
- 5.2.7 Time required for psychosocial risk management interventions to show benefits
- 6 Conclusions
- 7 References
- 8 Links for further reading
Psychosocial risks have been identified as one of the major contemporary challenges for occupational safety and health and are linked to such workplace problems as work-related stress , workplace violence and harassment . This article discusses the process of psychosocial risk management, presenting good practice approaches. It outlines the key principles and stages that underpin such approaches and provides a discussion on drivers and barriers for psychosocial risk management at the organisational level.
Psychosocial risks refer to the likelihood that work-related psychosocial hazards will have a negative impact on employees’ health and safety through their perceptions and experience . Psychosocial hazards concern aspects of the design and management of work, and its social and organisational contexts that have the potential for causing psychological or physical harm . They have been identified as one of the major contemporary challenges for occupational health and safety and are linked to such workplace problems as work-related stress and workplace violence and harassment (also referred to as bullying or mobbing).
Psychosocial risks can have a negative impact in terms of human, social and financial costs. Negative outcomes on the individual level include poor health and well-being , and problems with interpersonal relationships, both at the workplace and in private life. In the wider perspective, psychosocial risks are associated with serious economic implications for society and all types of enterprises, irrespective of size and sector. International organisations, as well as EU and national agencies, have published reports and guidance on ways to deal with psychosocial risks .
Psychosocial risk management is among employers’ obligations to assess and manage all types of risk to workers’ health as stipulated in the European Council Framework Directive on the Introduction of Measures to Encourage Improvements in the Safety and Health of Workers at Work, 89/391/EEC. Two agreements that have been concluded by the European Social Partners are also relevant: the framework agreement on work-related stress (2004)  and the framework agreement on harassment and violence at work (2007) . More recently, two standards of relevance to psychosocial risks and their management have been developed in the UK and in Canada. The first (PAS1010: Guidance on the management of psychosocial risks in the workplace) was developed in 2011 for the British Standards Institution by a consortium of European experts with the support of the World Health Organisation and EU-OSHA . The second (Psychological health and safety in the workplace - Prevention, promotion, and guidance to staged implementation) is the first national standard in this area and was developed in Canada in 2013 . Both the available guidance and the newly developed standards highlight several aspects of good practice, stressing that good psychosocial risk management goes beyond legal requirements and offers many opportunities for businesses.
Psychosocial risk management is the application of the risk management framework to psychosocial risks in the workplace. As such it is based on the principles of prevention in line with occupational health and safety legislation, and it aims at risk elimination or reduction. As with all risk management processes, psychosocial risk management should be systematic and on-going so that hazards are identified, risks analysed and managed, and workers protected. This is particularly important when it comes to managing psychosocial risks as their relevance to subjective perceptions and the dynamic nature of the work environment make their continuous assessment very necessary. It is also important that the assessment and management of psychosocial risks is considered when new processes or functions are implemented within the organization (e.g. in the case of organisational restructuring).
In managing psychosocial risks, organizations should adopt a comprehensive, long-term strategy. This strategy should consider the organization’s policies, structure, resources, existing systems and operations, and practices. Organizations should consider whether a synergistic fit exists among different organizational policies and whether they adhere to existing legislation and standards. For example, organizations should consider how health and safety, human resources and corporate social responsibility (CSR) policies fit together to achieve common goals and promote organizational learning and development .
A number of key principles underpin the psychosocial risk management process.
Table 1: Key principles of psychosocial risk management
|Good psychosocial risk management is good business||Good practice in relation to psychosocial risk management essentially reflects good practice in organizational management, learning and development, social responsibility and promotion of quality of working life and good work|
|Worker and management commitment||It is very important that managers and workers have “ownership” of the psychosocial risk management process. Top management should demonstrate leadership and commitment for psychosocial risk management to be successful.|
|Participative approach||The psychosocial risk management process recognizes the validity of the expertise that working people have in relation to their jobs and seeks to involve employees in the prevention of psychosocial risks and not by requiring them to change their perceptions and behaviour.|
|Evidence-informed practice||Psychosocial risk management is a systematic, evidence-informed, practical problem-solving strategy. Risk assessment provides information on the nature and size of possible problems and their effects, and the number of people exposed. This data should be used to inform the development of an action plan that prioritizes measures to tackle problems at source.|
|Identification of key factors||For psychosocial risk management to be effective it is important to understand the most important underlying causal factors before solutions are selected. As a consequence, there are usually no quick-fix solutions at hand; a continuous management process is required.|
|Context relevance||As workplace contexts differ, there is a need to optimize the design of the risk management activities, to guide the process and maximize the validity and benefit of the outcome. Tailoring improves the focus, reliability and validity of the risk management process as well as the utilization of the results of the risk assessment and the feasibility of the results, and helps to make effective action plans|
|Solutions that are fit for purpose||Psychosocial risk management is an action-led process. It is important to make the problems at the workplace the starting point for action, and to develop knowledge and solutions that are “fit for purpose”.|
|Ethics||The management of psychosocial risks is about people, their health status, and business and societal interests. Protecting the health and safety of people is not only a legal obligation but also an ethical responsibility.|
|Relevance for organizational policy agendas||Psychosocial risk management is central to occupational health and safety policy and practice. Psychosocial risk management can contribute to the creation of positive work environments where commitment, motivation, learning and development play an important role and sustain organizational development.|
|Consideration of capabilities required||The implementation of the psychosocial risk management process requires capabilities that comprise: adequate knowledge of the key agents (management and workers); relevant and reliable information to support decision-making; availability of effective and user-friendly methods and tools; ownership and participation of managers and employees or their representatives; availability of competent supportive structures (experts, consultants, services). Competence should be developed by appropriate training when lacking.|
Source: World Health Organization: Psychosocial Risk Management – European Framework 
Psychosocial risk management involves five main steps:
Hazard identification and risk assessment
For psychosocial risk management to be effective, it is important to understand the most important underlying causal factors and assess the risk they pose to workers’ health and safety before solutions are selected. The risk assessment provides information on the nature and severity of the problem, psychosocial hazards and the way they might affect the health and safety of those exposed to them and the healthiness of their organization (in terms of issues such as absence, commitment to the organization, worker satisfaction, intention to leave and productivity). A well-conducted risk assessment not only identifies challenges in the work environment but also positive aspects of the work environment that should be promoted and enhanced.
When the nature of the problems and their causes are sufficiently understood, a reasonable and practical action plan to reduce risk (interventions) should be developed. This involves deciding on: what is being targeted; how; by whom (who is responsible); who else needs to be involved; what the time schedule will be; what resources will be required; what will be the expected (health and business) benefits; how they can be measured; and how the action plan and its effects will be evaluated. It is preferable that actions/intervention chosen are “fit for purpose” and give priority to modifying psychosocial risk factors at source, focusing on the organization or groups within it.
Risk reduction (interventions/controls)
Interventions to manage psychosocial risks fall within three broad categories: primary (targeting risks at source at the organisational level), secondary (aiming at developing individual knowledge and skills), and tertiary (aiming at reducing the negative effects of psychosocial risks through return-to-work and rehabilitation programmes). The effective implementation of psychosocial risk management interventions depends on the readiness of an organization for change, the nature of the intervention plan (in terms of how realistic, practical and comprehensive it is to address key problem areas effectively), and the fit between the intervention plan and day-to-day business activities in order to avoid the intervention being disruptive and to promote continual improvement of the work environment.
Evaluation and review
It is essential for any action plan to be evaluated to determine how well and in what respects it has worked. The process of implementation as well as the outcomes of the action plan should be evaluated and reviewed. Evaluation should consider a variety of types of information and draw it from a number of relevant perspectives (e.g. staff, management, stakeholders). The results of the evaluation should allow the strengths and weaknesses of both the action plan and the implementation process to be assessed. This information should inform a reassessment of the original problem and of the overall risk management process, as well as providing feedback on the outcomes.
Organizational learning and development
The organization should use the evaluation for continual improvement and also as the basis for sharing (discussing and communicating) learning points that may be of use in future risk management. Evaluation can also inform the (re)design of work organization and workplaces as part of the normal organizational development process. A long-term orientation is essential and should be adopted by organizations. Psychosocial risk management can contribute to the creation of positive work environments where commitment , motivation, learning and development play an important role and sustain organizational development.
Examples of good practice approaches
A number of psychosocial risk management approaches have been developed in different countries  . These include: the Istas21 (CoPsoQ) Method (based on the Copenhagen Psychosocial Questionnaire for psychosocial risk assessment), Trade Unions’ Institute of Work, Environment and Health (ISTAS), Spain; the Management Standards for Work-related Stress, HSE, UK; Work Positive pack with HSE’s Management Standards, Health and Safety Authority, Health and Safety Executive and National Health Service, Ireland, Scotland, England and Wales; Health circles – adapted to psychosocial factors at work, Federal Association of Company Health Insurance Funds (BKK), Germany; The Prevenlab-Psicosocial methodology, UIPOT, University of Valencia, Spain; the SOBANE Strategy applied to the management of psychosocial risks, Catholic University of Louvain, Belgium.
In reviewing the literature on psychosocial risk management it is not surprising that specific issues have been identified both as drivers and barriers to the process . These are discussed in more detail next.
The legal case
As outlined before, psychosocial risk management is stipulated in EU legislation and associated guidance. In specific EU member states, legislation may include more specific provisions in relation to psychosocial risk management (for example, in Italy, the Czech Republic). Fulfilment of legal obligation was shown to be a powerful driver for psychosocial risk management according to EU-OSHA’s ESENER results . With the development of additional forms of non-binding policies on the management of psychosocial risks, it is expected that more organisationsal will engage in good practice (as is the case with the development of the aforementioned standards in the UK and in Canada). This is because they make the link between the legal and the business case for psychosocial risk management more obvious.
The business case
Many studies have reported the link between high levels of absence and worker ill-health which impacts on productivity and performance  . As such, sickness absence has been found to be a strong motivator for enterprises to address psychosocial risks . Another study further re-iterated the business case in relation to managing psychosocial risks in terms of absence, performance and turnover intention . More recently, the list of business benefits of a healthy workforce has been expanded to include reduced sickness absence, fewer accidents, improved retention, higher commitment, higher productivity as well as enhanced employer ‘Brand’ . This last benefit is also relevant to the ethical case for psychosocial risk management.
The ethical case
In the competitive world of business, it is essential to maintain and enhance business reputation and influence and in the global marketplace; a basic requirement, is to not harm people or degrade the environment. This is part of the Corporate Social Responsibility agenda influencing many organisations . The scrutiny of all aspects of business performance is not just a matter for enforcers but is more intensively done by investors, NGOs, society, and, particularly business competitors. For any company, OSH outcomes, such as accident and injury rates and work-related absence, are the most visible and concrete corporate measures of CSR. It is clear that the caring employer, who demonstrates that they take employee well-being seriously, is most likely to attract good candidates, have fewer vacancies left unfilled for long periods and – if they can deliver on the promise – lose fewer staff to competitors . The business case and employer image have been found to be strong drivers for psychosocial risk management, especially in SMEs . Recent research has discussed in detail the ethical case for psychosocial risk management and offer key CSR indicators of good business practice in this area .
Employee readiness for change
Readiness for change is an important prerequisite for the successful process of a psychosocial risk prevention programme. Readiness of organisations or employees means the extent to which they recognise the need for change and are prepared to implement psychosocial risk management programmes. The two main types of individual change processes, also in the management of psychosocial risks at work, are cognitive change processes, which involve changes in the way employees, managers, and employers think and feel about risk factors (increasing information), and behavioural change processes, which involve changes in employees', managers’, employers’ behaviour . It has also been suggested that people progress through a series of five stages (pre contemplation, contemplation, preparation, action and maintenance) when intentionally modifying their own behaviour or with the help of formal interventions. Each new stage follows when people are ready to step forward and requires readiness for change at the structural (organisation or community) and personal (behavioural) level . Recognising that people in different stages of change are ready for different types of interventions is important for the effective implementation of the psychosocial risk management process.
A participatory approach
Linked to the previous driver, a key element which has been emphasised as integral to a comprehensive and successful preventive practice for psychosocial risk management is the continuous involvement of employees and their representatives . Inclusion of all parties in prevention efforts is essential as it can reduce barriers to change and increase their effectiveness. It can also help increase participation and provide the first steps for prevention. In fact, employee requests are one of the stronger drivers for psychosocial risk management according to ESENER findings . Access to all the required information is also facilitated with a participative approach. However this does not apply to employees alone.
Top management support and commitment
The importance of ‘buy-in’ at all levels has been stressed from the top level to the shop floor worker . There is general agreement in the literature that in order for an organisation to successfully plan, implement and evaluate a psychosocial risk management programme there must be good management support  . Empirical studies have validated this recommendation    .
Economic climate of enterprise and availability of resources
Research indicates that a company’s expenditure in health and safety is strongly determined by economic performance . A company's financial structure substantially affects its real operating decisions and the amount of risk the company is willing to bear, which have an impact on firm's input choices. Both safety and occupational health services are such inputs for a company. In making decisions on health and safety investments the company is balancing the costs and benefits of occupational health and safety . It has also been found that declining company finances lead to lower pay and to lower safety levels as indicated by abolishment of "restrictive practices" such as restrictions to hours of work, manning ratios on machines, and inflexibility of working practices . It is quite clear that investments in safety and health may compete with other investments in the company. This affects any organisation but may be particularly relevant for SMEs. ESENER findings  indicate that this is the most important barrier to OSH practice for SMEs that more than 35% of their managers reported. However, investing in psychosocial risk management does not always require many resources   . In fact, in the long term, neglecting psychosocial risks may contribute to further deterioration of the performance and the financial situation of the organisation  . Economic crises affecting companies are associated with organisational restructuring that can represent another barrier to psychosocial risk management.
Restructuring is a permanent feature of today’s economy. Through restructuring firms want to enhance their competitiveness and profitability in regional and global markets. Restructuring can be defined as an organizational change that is much more significant than a commonplace change and affects at least a whole organisational sector or an entire company rather than focusing on peripheral changes in work practices . Forms of restructuring include relocation, delocalisation, outsourcing, bankruptcy, merger/acquisition, internal restructuring and business expansion. The PSYRES project summarised several negative effects of various types of restructuring :
- Employees who undergo a change in organisational ownership experience more job insecurity even five years later compared to those with no such experience.
- Prolonged restructuring (i.e. restructuring experienced over at least two years) has a negative impact on well-being. It leads to lower job satisfaction, lower dedication, poorer general health, higher emotional exhaustion and higher sickness absenteeism. Results indicate that people do not get accustomed to the experience of restructuring (for example when entering a restructuring phase for a second time) so its effect on well-being can remain detrimental.
- Experience of a declined position leads to lower well-being: increased emotional exhaustion, stress and cynicism, as well as decreased work ability.
Restructuring affects employees’ well-being not only directly but also indirectly through several work-related factors. For example, restructuring increases the job demands, emotional demands and time pressures for employees, and which, in turn, decreases employees’ well-being. It was also found that the change process is a challenge for social relations within the organisation. Supervisory support decreases during change, while conflicts in supervisor-subordinate relationships and between colleagues become more common. Another consequence of an organisational change is an increase in job insecurity among employees, especially during downsizing. Restructuring may also negatively affect employee perceptions of psychosocial risk management efforts that are put in place to deal with its negative effects and limit their readiness to be actively involved in them. Restructuring can also affect the effectiveness of psychosocial risk management interventions since these are usually tailored to specific work group needs that may change in composition following a restructuring process .
Organisational culture and organisational readiness for change
Psychosocial risk management demands organisations to be ready for change   whereby a comprehensive plan to prevent and/or to manage psychosocial risks needs to consider the broader context (economic situation, industrial relations, labour market, etc.) within which organisations operate. As such, readiness for change is an important prerequisite for the successful process of psychosocial risk management. Readiness for change is closely linked to organisational culture . A key element of successful organisational change is the existence of an appropriate organisational culture   . Organisational culture can be evaluated at various levels: national culture  , business sector culture  , professional culture  and it may also include organisational subcultures. In addition, the culture of an organisation comprises values, norms, opinions, attitudes, taboos and visions of reality that have an important influence on the decision making process and behaviour in organisations  . This is also linked to acknowledgement of psychosocial issues.
The level of awareness and perception of psychosocial risks and their impact on workers' health and safety can have an important impact on prioritisation of these issues in practice. For example, managers might perceive psychosocial issues as being too sensitive to tackle or psychosocial risk management as being an expensive process. However, both these perceptions are not necessarily true and have been shown not to act as barriers in those organisations that engage in psychosocial risk management .. Awareness is linked to issues such as training, availability of expertise, research and also relates to fulfilment of legal obligations by employers . Studies have examined, for example, awareness of psychosocial risks and their perceived significance and impact among key stakeholders   and found this to differ among EU member states and stakeholder groups. ESENER also identified lack of awareness and acknowledgement of psychosocial issues to be an issue of concern, especially for smaller enterprises in Europe . However, these issues might also be related to availability of expertise and appropriate tools to promote good practice.
Availability of training and expertise, tools, and guidance
Capabilities for psychosocial risk management at the enterprise level are an important element that needs to be considered and comprise: adequate knowledge of the key agents (management and workers); relevant and reliable information to support decision-making; availability of effective and user friendly methods and tools; availability of competent supportive structures (experts, consultants, services and institutions, research and development) . In addition, training is often held to be a primary element of an organisation's strategy for combating work-related psychosocial risks  . Where adequate capabilities are lacking, the psychosocial risk management programme will fail both in its implementation and its outcomes. This has also been supported by ESENER findings .
The implementation process
The integration of process considerations into the overall evaluation of psychosocial risk management interventions has been emphasized by research studies . A failure of implementation (in terms of awareness, development of relevant skills, crucial support from key actors, availability of resources etc.) often defines the outcomes of a psychosocial risk management programme . As such experts agree that there is a need to examine process issues and mechanisms underlying both successful and unsuccessful psychosocial risk management interventions .
Psychosocial risk management intervention evaluation lags have been criticised, in general, as being too short . In a review of 48 studies, the average length of post-intervention assessment was 9 weeks for interventions with a focus on the individual (3 weeks short of the recommended duration as noted by the authors) and 38 weeks for interventions with an organisational focus ; falling below the recommended two year evaluation period . Intervention effects may be of a cumulative nature and require a longer period of time before one can observe measurable results ; additionally, the results obtained in the immediate post-intervention period may, given the context of a continuously changing organisation, not be sustained at a later stage .
Psychosocial risk management is central to occupational health and safety practice as psychosocial risks underpin every business activity. The management of psychosocial risks is about people, their health and safety status, and business and societal interests. For psychosocial risk management to be effective it is important that it is a systematic, part of normal business operations and that managers and workers assume ownership of the process.
- Cox, T., & Griffiths, A., ‘The nature and measurement of work-related stress: theory and practice’, In J.R. Wilson & N. Corlett (Eds.), Evaluation of Human Work (3rd ed.), CRS Press, London, 2005.
- EU-OSHA – European Agency for Safety and Health at Work, ‘Drivers and Barriers for Psychosocial Risk Management: An analysis of findings of the European survey of enterprises on new and emerging risks’, Publications Office of the European Union, Luxembourg, 2012. Available at: 
- European Social Partners, ‘Framework Agreement on Work-related Stress’, European social partners -ETUC, UNICE(BUSINESSEUROPE), UEAPME and CEEP, Brussels, 2004. Available at: 
- European Social Partners, ‘Framework Agreement on Harassment and Violence at Work’. European social partners - ETUC, BUSINESSEUROPE, UEAPME and CEEP, Brussels, 2007. Available at: 
- BSI - British Standards Institution, ‘Guidance on the Management of Psychosocial Risks in the Workplace: PAS1010’, British Standards Institution, London, 2011.
- BNQ, CSA Group and MHCC. (2013). ‘Psychological health and safety in the workplace - Prevention, promotion, and guidance to staged implementation’ (CAN/CSA-Z1003-13/BNQ 9700-803/2013). Ottawa, Ontario: Standards Council of Canada.
- Leka, S., Cox, T., & Zwetsloot, G., ‘The European Framework for Psychosocial Risk Management (PRIMA-EF)’, In: S. Leka & T. Cox (Eds.), The European Framework for Psychosocial Risk Management: PRIMA-EF, I-WHO Publications, Nottingham, 2008, pp. 1-16.
- WHO - World Health Organisation, ‘PRIMA-EF: Guidance on the European Framework for Psychosocial Risk Management: A Resource for Employers and Worker Representatives’, Protecting workers’ health series; no. 9, World Health Organisation, Geneva, 2008. Available at: 
- Leka, S., Hassard, J., Jain, A., Makrinov, N., Cox, T., Kortum, E., Ertel, M., Hallsten, L., Iavicoli, S., Lindstrom, K., & Zwetsloot, G., ‘Towards the development of a psychosocial risk management framework, SALTSA’, I-WHO Publications, Nottingham, 2008a. Available at: 
- Nielsen, K., Randall, R., Holten, A.L., & Rial Gonzalez, E. ‘Conducting organizational-level occupational health interventions: What works?’, Work & Stress, 24, 2010, pp.234-259.
- EU-OSHA – European Agency for Safety and Health at Work, ‘European Survey of Enterprises on New and Emerging Risks: Managing safety and health at work’, Office for Official Publications of the European Communities, Luxembourg, 2010. Available at: 
- Bakker, A. B., Demerouti, E., de Boer, E., & Schaufeli, W., ‘Job demands and job resources as predicators of absence duration and frequency’, Journal of Vocational Behaviour, 62(2), 2003, pp.341-356.
- Hardy, G. E. , Woods, D., & Wall, T. D., ‘The impact of psychological distress on absence from work’, Journal of Applied Psychology, 88 , 2003, pp.306-314.
- Zwetsloot, G. & van Scheppingen, A., ‘Towards a Strategic Business Case for Health Management’, In: U. Johansson, G. Ahonen & R. Roslander (eds), Work Health and Management Control, Thomson Fakta, Stockholm, 2007, pp. 183-213.
- Bond, F., Flaxman, P., & Loivette, S., ‘A Business Case for the Management Standards for Stress,’ HSE Books, Sudbury, 2006. Available at: 
- Bevan, S. M., ‘The Business Case for Employees’ Health & Wellbeing’, The Work Foundation, London, 2010.
- EU-OSHA – European Agency for Safety and Health at Work, ‘Corporate social Responsibility and Safety and Health at Work’, Office for Official Publications of the European Communities, Luxembourg, 2004. Available at: 
- Jain, A., Leka, S., & Zwetsloot, G. ‘Corporate social responsibility and psychosocial risk management in Europe’, Journal of Business Ethics, 101(4), 2011, pp.619-633.
- Oetting, E.R., Donnermeyer, J. F., Plested, B. A., Edwards, R. W., Kelly, K., & Beauvais, F., ‘Assessing community readiness for prevention’, The International Journal of the Addictions, 30, 1995, pp.659-683.
- Prochaska, J.O., & DiClemente, C.C., ‘Transtheoretical therapy: Toward a more integrative model of change’. Psychotherapy: Theory, Research and Practice, 19, 1982, pp.276-288.
- Bourbonnais, R. Brisson, C., Vinet, A., Vézina, M., & Lower, A. ‘Development and implementation of a participative intervention to improve the psychosocial work environment and mental health in an acute care hospital’. Occupational and Environmental Medicine, 62, 2006, pp.326-334.
- Aust, B., & Ducki, A., ‘Comprehensive health promotion interventions at the workplace: experiences with health circles in Germany’, Journal of Occupational Health Psychology, 9 (3), 2004, pp. 258-270.
- Cox, T., Griffiths, A. J., Barlow, C. A., Randall, R. J., Thomson, L. E., & Rial-Gonzalez, E., ‘Organisational interventions for work stress’, HSE Books, Sudbury, 2000. Available at: 
- Cox, T., Karanika, M., Mellor, N., Lomas, L., Houdmont, J. & Griffiths, A., ‘Implementation of the Management Standards for Work-Related Stress: Process Evaluation’, SIP1 Technical Report T/6267, Institute of Work, Health and Organisations, University of Nottingham, 2007.
- Dahl-Jørgensen, C., & Saksvik, P. Ø., ‘The impact of two organisational interventions on the health of service sector workers’. International Journal of Health Services, 35, 2005, pp.529–549
- Nielsen, K., Randall, R., & Albertsen, K., ‘Participants’ appraisals of process issues and the effects of stress management interventions’, Journal of Organisational Behavior, 28, 2007, pp. 793–810.
- Nytrø, K., Saksvik, P. Ø., Mikkelsen, A., Bohle, P., & Quinlan, M., ‘An appraisal of key factors in the implementation of occupational stress interventions’, Work & Stress, 14, 2000, pp. 213–225.
- Filer, R. K., & Golbe, D. L. ‘Debt, Operating Margin, and Investment in Workplace Safety’, Journal of Industrial Economics, 51(3), 2003, pp. 359-381.
- Kankaanpää, A,, Suhonen, A. & Valtonen, H. Does the company's economic performance affect access to occupational health services? BMC Health Services Research, 9, 2009, p.156.
- Nickell, S., & Nicolitsas, D., ‘Wages, restrictive practices and productivity’, Labour Economics 1997, 4(3), 1997, pp. 201-221.
- Kieselbach, Th., Armgarth, E., Bagnara, S., Elo, A-L., Jefferys, S., Joling, C., Kuhn, K., Nielsen, K., Popma, J., Rogovsky, N., Sahler, B., Thomson, G., Triomphe, C.E. & Widerszal-Bazyl, M., Health in Restructuring: Innovative Approaches and Policy Recommendations. München, Mering: Rainer Hamper Verlag, 2009.
- Wiezer, N., Nielsen, K., Pahkin, K., Widerszal-Bazyl, M., De Jong, T., Mattila-Holappa, P., Mockałło Z. ‘Exploring the link between restructuring and employee well-being’, CIOP-PIB, Warsaw, 2011.
- Parkes, K.R., & Sparkes, T.J. ‘Organizational interventions to reduce work stress: Are they effective? A review of the literature’. HSE research report 193 Norwich, UK: Health and Safety Executive books, 1998.
- Leka, S., Vartia, M., Hassard, J., Pahkin, K., Sutela, S., Cox, T., Lindstrom, K., ‘Best Practice in Interventions for the Prevention and Management of Work-Related Stress and Workplace Violence and Bullying’, In: S. Leka & T. Cox (Eds. ), The European Framework for Psychosocial Risk Management: PRIMA-EF, I-WHO Publications, Nottingham, 2008b, pp. 136-173.
- Hofstede, G., ‘Culture’s Consequences: International Differences in Work-Related Values’, Sage, Beverly Hills, 1980.
- Schein, E., ‘Organisational culture and leadership (3rd ed.)’. Jossey-Bass, San Francisco, 2004.
- Dollard, M. F., & Bakker, A. B., ‘Psychosocial safety climate as a precursor to conducive work environments, psychological health problems, and employee engagement’, Journal of Occupational and Organisational Psychology, 83, 2010, pp.579-599.
- Hofstede, G. & Peterson, M. F., ‘National values and organisational practices’, In N. M. Ashkanasy, C. P. M. Wilderom & M. F. Peterson (Eds.) Handbook of organisational culture & climate, Sage, London, 2000, pp. 401-405.
- Hofstede, G., ‘Dimensions do not exist: A reply to Brendan McSweeney’, Human Relations, 55(11), 2002, pp.1355-1360.
- Gordon, G., ‘Industry Determinants of Organisational Culture’, Academy of Management Review, 16(2), 1991, pp.396-415.
- De Witte, K. & van Muijen, J., ‘Organisational culture: critical questions for researchers and practitioners’, European Journal of Work and Organisational Psychology, 8(4), 1999, pp.583–595.
- McDonald, N., Corrigan, S., Daly, C., & Cromie, S., ‘Safety management systems and safety culture in aircraft maintenance organisations, Safety Science, 34, 2000, pp.151-176.
- Iavicoli, S., Deitinger, P., Grandi, C., Lupoli, M., Pera, A. & Petyx, M. (Eds), ‘Stress at work in Enlarging Europe’, ISPESL, Rome, 2004.
- Iavicoli, S., Natali, E., Deitinger, P., Rondinone, B.M., Ertel, M., Jain, A., & Leka, S., ‘Occupational health and safety policy and psychosocial risks in Europe: the role of stakeholders' perceptions’, Health Policy, 101, 2011, pp. 87-94.
- Daniels, K., ‘Perceived risk from occupational stress: a survey of 15 European countries’, Occupational and Environmental Medicine, 61, 2004, pp. 467-470.
- Leka, S., & Cox, T. ‘The European Framework for Psychosocial Risk Management’, I-WHO publications, Nottingham, 2008. Available at: 
- Beech, B., & Leather, P., ‘Workplace violence in the health care sector: A review of staff training and integration of training evaluation models’, Aggression and Violent Behaviour, 11(1), 2006, pp. 27-43.
- Chappel, D., & Di Martino, V., ‘Violence at Work (3rd Ed.)’, International Labour Office, Geneva, 2006.
- Semmer, N. K., ‘Job stress interventions and organisation of work’, In L.Tetrick & J. C. Quick (Eds.), Handbook of occupational health psychology, APA, Washington, DC, 2003, pp. 325–353.
- Nielsen, K., Fredslund, H., Christensen, K. B., & Albertsen, K., ‘Success or failure? Interpreting and understanding the impact of interventions in four similar worksites’, Work & Stress, 20, 2006, pp. 272–287.
- Saksvik, P. Ø., Nytrø, K., Dahl-Jørgensen, C., & Mikkelsen, A., ‘A process evaluation of individual and organisational occupational stress and health interventions’, Work & Stress, 16, 2002, 37–57.
- Van der Klink, J.J.L., Blonk, R.W.B., Schene, A.H., & van Dijk, R.J.H., ‘The benefits of interventions for work-related stress’, American Journal of Public Health, 91(2), 2001, pp.270-276.
Links for further reading
EU-OSHA – European Agency for Safety and Health at Work, ‘Drivers and Barriers for Psychosocial Risk Management: An analysis of findings of the European survey of enterprises on new and emerging risks’, Publications Office of the European Union, Luxembourg, 2012. Available at: 
Leka, S., & Cox, T. ‘The European Framework for Psychosocial Risk Management’, I-WHO publications, Nottingham, 2008. Available at: 
WHO - World Health Organisation, ‘PRIMA-EF: Guidance on the European Framework for Psychosocial Risk Management: A Resource for Employers and Worker Representatives’, Protecting workers’ health series; no. 9, World Health Organisation, Geneva, 2008. Available at: