Work organization and health: recent findings call for action

Sep 19, 2012

Work organization and health: recent findings call for actionTwo recent research reports add to a growing body of research showing that how we organize work can affect worker health. "For workplaces already investing in employee health," says Andrew Harkness, Workplace Safety & Prevention Services (WSPS)'s healthy workplace specialist, "these reports provide reassurance that you're on the right track. But for workplaces unaware of the relationship between work organization and worker health, take note that doing nothing could adversely affect your business."

Before looking at steps that workplaces can take, consider these recent findings:

• On August 21, the journal Occupational Medicine published an article by two Ontario-based research organizations, which found that women with low job control are at greater risk of diabetes.1 Over a nine-year period, researchers from the Institute for Work & Health (IWH) and the Institute for Clinical Evaluative Sciences (ICES) followed 7,443 actively employed 35- to 60-year old Ontario workers with no previous diagnosis of diabetes. IWH defines job control as the ability of individuals to make decisions about the way they work or use their skills.

"The proportion of cases of diabetes among women that could be attributed to low job control was 19%," reports the IWH. "This was higher than that for other health behaviours such as smoking, drinking, lack of physical activity and unhealthy eating, but lower than that for obesity, to which 42% of cases could be attributed." The researchers found no corresponding relationship between diabetes and low levels of job control among men.

Earlier studies have also cited low job control as a health factor. For instance:

  • previous research conducted by IWH found that workers with low job control reported lower health than other workers
  • the Whitehall II prospective cohort study, which examined 10,308 British civil servants aged 35-55, reported a significant link to heart disease

• On July 26, the British Medical Journal published an online report of research showing a link between shiftwork and major vascular problems, such as heart attacks and strokes.2 The report defines shiftwork as employment in any work schedule other than a regular daytime schedule, such as regular evening or night schedules, rotating shifts, split shifts, on-call or casual shifts, 24-hour shifts, irregular schedules, and other non-day schedules.

The shiftwork research was led by Daniel Hackam, a clinical pharmacologist at the Stroke Prevention & Atherosclerosis Research Centre in London, ON. Participating researchers conducted what the report describes as "the largest synthesis of shift work and vascular risk reported to date," involving 34 studies and 2,011,935 people.

The researchers found a link between shiftwork and an increased risk of

  • heart attack (23%)
  • coronary events (24%)
  • stroke (5%)

Night shifts were associated with the steepest increase in risk for coronary events (41%). All these risks remained consistent after adjusting for study quality, socioeconomic status, unhealthy behaviours in shift workers, and other factors.

Shifts a fact of work life

About one in four workers in North America and Europe performs shiftwork requiring working at night, reports Paul Demers, director of the Occupational Cancer Research Centre. Speaking at an April 2010 symposium organized by the centre and IWH, Dr. Demers indicated that 11% of Canadian workers work rotating shifts, 6% work regular evening shifts, and 2% work regular night shifts.

Canadian industry sectors with the highest number of shiftworkers are accommodation and food services, manufacturing, trade, and health care and social assistance. Each sector has more than 350,000 shiftworkers, representing at least 20% of their workforce.

Protecting worker health

Andrew Harkness views the findings from these two studies as further confirmation that how we organize work can directly affect the long-term health of employees.

“From a purely organizational perspective,” says Harkness, “there are at least two reasons why we should be paying attention:

  • working conditions such as shiftwork or lack of job control may already be costing our workplaces in terms of reduced productivity due to disability and greater use of corporate benefits such as drug plans
  • an increased incidence of health conditions such as diabetes likely indicates other possible work-related health problems affecting workers and organizational productivity

“In other words,” says Harkness, “we can expect researchers to identify additional links between work and the long-term health of employees. This means we have to rethink how we organize work.”

Harkness acknowledges that changing organizational behaviour can be a daunting task. “One of the challenges is we're just not good at thinking long term, especially about a hazard that we can't see. That's partly why musculoskeletal disorders (MSDs) - another recognized workplace health concern - continue to plague many workplaces.

“On the plus side, research is now giving us solid reasons for doing something now, as well as the means to effect change. So for employers who say, ‘Our people are our greatest asset,’ the next logical step is to ask, ‘What can we do to protect our people.’”

Improving control over our work

“How we organize work affects people’s sense of autonomy and ability to make decisions,” says Harkness, “and this in turn affects their sense of well-being.” Here are sample strategies that can help businesses improve workers’ sense of control:

  • encourage participation in decision-making
  • demonstrate fairness in management style and application of policies
  • minimize “perks” based on hierarchy
  • train and evaluate supervisors on communication and people skills
  • provide flexible work arrangements
  • provide work-life balance policies and practices
  • show appreciation for workers’ efforts
  • ensure the workplace environment is respectful to all workers
  • measure satisfaction regularly and act on findings
  • provide workers with the information and resources they need to do their jobs well
  • address work overload issues

Minimizing the effects of shiftwork

“There are things we can do around how we organize shiftwork,” says Harkness, “such as different types of rotation. For instance, some workers prefer straight nights than rotating shifts. Or changing the time at which shifts start. Do you need to run 24 hours a day? Do you need all the people currently on the night shift?

“Also, talk to your employees. What are they saying about the current shiftwork schedule? What suggestions do they have? There can be simple steps that workplaces can take, and often it starts with conversations.”

The Canadian Centre for Occupational Health and Safety (CCOHS)’s online “OSH Answers” suggests two strategies:

1) organizational, i.e., through the design of shift schedules, education and better facilities
2) helping workers to sleep better, eat better and reduce stress

Regarding shift schedule design, OSH Answers suggests that workplaces

  • rotate shifts forward from day to afternoon to night because circadian rhythms adjust better when moving ahead rather than back
  • consider when shifts begin and end. Since early morning shifts are associated with shorter sleep and greater fatigue, avoid shift start times as early as 5 or 6 a.m.
  • provide a minimum 24-hour rest period after each set of night shifts. The more consecutive nights worked, the more rest time should be allowed before the next rotation occurs
  • consider alternative forms of organizing work schedules, such as extended work days of 10 or 12 hours
  • provide time off at "socially advantageous" times like weekends whenever possible
  • start a special shift system if production demands result in extended periods of overtime work
  • inform shiftworkers of their work schedules well ahead of time so they and their families and friends can plan activities. Allow as much flexibility as possible for shift changes. Keep schedules as simple and predictable as possible.

Regarding facilities, OSH Answers suggests

  • providing good lighting and ventilation on all shifts
  • situating work stations so that workers at night can remain in contact with one another
  • providing rest facilities where possible
  • providing good cafeteria services so that workers can maintain a balanced diet
  • considering offering facilities for social activities; recreational opportunities for workers on non-day shifts are often minimal
  • considering offering access to quality day-care to alleviate strain on family members

Regarding education, OSH Answers suggests informing employees of potential health and safety effects of rotational shiftwork, and how to stop these effects.

How we can help

  1. Review WSPS's healthy workplace resources. Andrew Harkness also encourages workplaces to tap into resources available from "Guarding Minds @ Work", a free, evidence-based online resource that helps employers protect and promote psychological safety and health in their workplace. GM@W provides a comprehensive set of resources employers can use to minimize the impact of 12 psychosocial risk factors known to have a powerful effect on organizational health, the health of individual employees, and the financial bottom line. Among the tools available on the website are audit forms, employee surveys, action tools, and evaluation templates
  2. Talk to a WSPS consultant about what's involved in creating a healthy workplace. Ensuring a healthy and productive environment often involves addressing organizational culture and employee health practices. Unhealthy, unsafe and stressful workplaces cost Canadian employers billions of dollars annually in workers compensation, absenteeism, presenteeism, turnover, short- and long-term disability, mental illness and lost productivity.
  1. Attend related sessions at an upcoming Partners in Prevention conference near you. For example:
    • Sudbury, October 2
      • MINDing Your Business: Occupational Mental Health and Wellbeing in a Country of Fewer (and Much Older) Workers (keynote session)
      • Define, Recognize and Respond to Workplace Bullying
      • Stress in the Workplace
      • Wellness and Accommodations in the Workplace
    • Ottawa, October 18
      • Personalities at Work: risk and resilience reconsidered
      • The New Standard for Psychological Health and Safety
      • Workplace Bullying: Bullies That You Don’t Work For
    • Kitchener, October 30
      • Personalities at Work: risk and resilience reconsidered (keynote)

Check out other Partners in Prevention events as programs become available.

Related reading

1 “The psychosocial work environment and incident diabetes in Ontario, Canada,” Occupational Medicine, Volume 62, Issue 6, pp. 413-419;
2 “Shift work and vascular events: systematic review and meta-analysis,” BMJ 2012;345:e4800;