It has been hypothesized that working in an active situation stimulates the anabolic restoring and protective processes in the body (Karasek & Theorell, 1990), whereas working under job strain inhibits anabolism. In both active jobs and job strain, psychological demands are high. This means that mobilization of energy has a high priority. Long-lasting energy mobilization may lead to catabolism, the breakdown of protein for the provision of energy “at any cost”. Due to the high level of anabolism taking place in the active jobs, the body will be able to stand these periods of energy mobilization well. In flexibility terms, this means that the active jobs enhance the body’s capacity to stand periods of energy mobilization. This could be one way of describing flexibility in physiological terms. However, in the job strain situation, anabolism is inhibited and the body’s capacity to stand periods of energy mobilization is therefore limited.
Anabolic processes correspond predominantly to certain hormones such as testosterone, growth hormone and insulin, which stimulate restoration and repair of worn-out tissue material in the body. The activity of this type of hormone typically peaks during deep sleep, when restoration and reparation activities are at maximum levels, whereas typical endocrine counterparts of energy mobilization are cate-cholamines and thyroid hormones.
Few studies have been published that have explored empirically the relationship between psychosocial job factors, on the one hand, and the balance between energy mobilization and anabolism, on the other. In a study performed by our group, working men and women were followed longitudinally during one year at three-month intervals, and spontaneous variations in job strain were recorded by means of questionnaires. It was shown that spontaneously occurring periods of job strain (according to the person’s own standards) were associated with elevated blood pressure levels during working hours, increased sleep disturbance and lower testosterone concentration levels in plasma, findings compatible with increased energy mobilization and decreased anabolism (Theorell et al., 1988). These results illustrate that there may be physiological mechanisms linking an increased rigidity (from the employee’s point of view) under demanding conditions to changes in health.
COMBINING THE INDIVIDUAL’S NEED FOR FLEXIBILITY WITH THAT OF THE WORK ORGANIZATION
The above review indicates that hard health outcome criteria, as well as mortality, covary with factors that are relevant to flexibility for the individual, and can be summarized under the heading of decision latitude with the two components:
1. Opportunity to develop and use one’s own skills.
2. Opportunity to issue control over one’s own situation.
Some of our empirical findings give a hint that long-term exposure to low decision latitude jobs creates even more pronounced health risks than does short exposure and, furthermore, that a sudden deterioration in decision latitude may be followed by increased health risks within a couple of years.
Although slightly less well established, good social support atwork, which may be associated with flexible solutions from the individual’s point of view(good social interactions may increase the number of options in difficult working situations), may protect the individual from the adverse effects of a rigid work environment. In at least two of our studies of personnel in adverse job conditions—prison personnel and airport freight handlers (H¨arenstam et al., 1988, Theorell et al., 1990)—it became evident that personnel working under bad conditions can stand lowdecision latitude more easily if they derive support from colleagues. The central question in this contribution is howflexibility in the biological and psychological sense and from the perspective of the individual—in the long term, in particular—can be obtained in work organization. It is likely that organizational changes favouring the development of increased intellectual discretion and authority over decisions in individuals may stimulate flexibility in coping patterns.
Flexibility for the individual may not always be the same as flexibility for the organization. It is important to make this distinction. Organizational flexibility may mean, for instance, that employees should be able to change workplace and work hours at short notice. This may, of course, imply a lack of decision latitude for employees and their families. Such a development has been studied very recently by our research group in a large, prosperous international corporation with rapid technological development. In this company, expansion has made it impossible for the company to build sufficient office space for all employees. This has stimulated the development of alternative strategies for constructing offices. These alternative strategies are intertwined with changes in work organization. Employees do not work in jobs, but instead in projects, which last for only three months on average. As a consequence of their moves between projects, employees also make many geographical moves. Accordingly, it is meaningless for them to have offices of their own. In this situation, employees have a very stimulating work situation with good opportunities to develop and use their skills. They also feel that they have good opportunities to exercise control in their work situation. However, a basic sense of belonging and social support may be lost, and this may be a threat to the individual’s possibility of exercising flexibility. Furthermore, we may be facing an era that goes too far in emphasizing the benefits of active work (see above). Our evidence does, indeed, indicate that active work is associated with good health. However, if demands are pushed excessively, with extreme working hours, for example, social support from the family may be lost; if this is combined with loss of continuous support from workmates, we may face serious problems.
In a pilot study of the consequences of the first version of these sociotechnical changes, two different departments were studied. The same change was perceived very differently by the staff in the two departments. In one case, the work contents suited the proposed organization; the staff had asked for the change and they felt mentally prepared for it. In the other case the management had decided that the change should take place, the staff had no mental preparation for it and the change did not suit thework contents.Obviously, the change was perceived as good in the first department and as bad in the second. This enforces the importance of good preparation and democratic processes preceding any change. However, the long-term consequences of these new ways of organizing work are largely unknown. A large study of work sites in Sweden based upon line managers and personnel managers has shown that a number of changes have taken place in the management of Swedish working life during recent years (Edling & Sandberg, 1994). The analysis of the effects of decentralization in this study showed that the correlation between decentralization and skill utilization is highly complex. In Sweden, in general, the perceived skill utilization among employees has, contrary to expectations, become lower inwork sites in which a flat hierarchy had been introduced than in those with a pyramidical hierarchy. This may reflect differences in management changes in different sectors of society. It may also illustrate that management interventions aiming at increased decision latitude for the employees cannot be achieved by one and the same solution in different sectors. This important result may also be due to too short a time perspective in the follow-up. It may take many years before the introduction of a flat hierarchy becomes functional, and in the Swedish case most of the work organizational changes have lasted for shorter periods. Furthermore, if the organizational changes are not paralleled by corresponding changes in the financial framework, the organizational changes may not function in an optimal way and complications may arise. Perhaps the disappointing results based upon randomly selected working Swedes may be explained on such grounds.
Work Organization Changes that Induce Flexibility
What characterizes work organization changes that induce flexibility, both for the company and for the individuals, and how does this relate to health? There are a few examples of work organization changes that have been evaluated in relation to changes in health or physiology of the employees. Some of these are described here, with the goal of exploring what characterizes changes that are successful for both the employees and the company. One of the first controlled evaluations using a pre- and post-test design with two randomly selected groups of work sites was Jackson’s (1983) study. The work change offered in the experimental group was aimed at improving both decision latitude and social support. No systematic changes were instituted in the control group. The groups studied were outclinic departments. Regular staff meetings every second week were instituted, with the specific aim of examining work organization and trying to improve it. These meetings may have affected both the employees’ authority over decisions and the social climate in the ward. The other component of the evaluation was a teaching programme for solving interpersonal conflicts—a social support orientated measure. The results showed that the experimental outclinic wards had diminished sick-leave rates as well as decreased personnel turnover rates after the institution of these changes. There were also indications of improved quality of care. No similar changes took place in the comparison wards.
Another controlled evaluation was performed in a service institution for the elderly in Stockholm, by Arnetz et al. (1982). The basic idea underlying the intervention programme focused on one aspect of the quality of care given: it was felt that the elderly tenants were excessively passive and isolated from one another. The service institution was relatively new—only two years old—and the tenants, who had not known one another in advance, had been recruited from a large area, frequently with the implicit understanding that they would receive all kinds of service and “would have to do nothing” themselves. The first component in the method for changing this pattern was exploration of hobbies and interests among the tenants, with subsequent formation of activity groups. One activity group, for example, studied the history of the region; a second one grew plants during the summer and studied this topic during the winter; a third group jointly constructed a work of art; and a fourth went to theatre performances together. The other component was teaching the staff about various aspects of the importance of social activity among the elderly. The members of staff were also activated in the data collection for the evaluation of this programme. A longitudinal study was performed, with measurements of social activity, psychological states, and endocrinological and metabolic conditions in the tenants before, during and after the programme. Parallel measurements were performed in a comparableward, which served as a control group.
The results indicated that the tenants in the experimental ward improved with regard to endocrinological and metabolic conditions (improved carbohydrate metabolism and anabolic/ catabolic balance), social activity (more contacts with other tenants and more social activities for the elderly outside the home) and psychological state (less feelings of restlessness and more evidence of activity rather than passiveness, according to observations) (Arnetz, 1983; Karasek&Theorell, 1990). During the first year of follow-up an unfavourable trend with regard to sick-leave rates was broken in the staff in the experimental ward but not in the control ward. Personnel turnover was reported to decrease in the experimental ward but, again, not in the control ward. The experience in this case seemed to indicate that a more variable work content with increased mental stimulation and increased attention to the social activities of the tenants—which required more imagination and creativity on the part of the personnel—is associated with improved health among the employees. Several other examples have been described. Karasek has summarized several recent efforts and analysed the characteristics of successful and unsuccessful programmes (Karasek, 1992). PUBLIC HEALTH PERSPECTIVES
An observation of a more general nature was made by Karasek (1990) in a group of Swedish employees who had participated in a national longitudinal survey of living conditions in Sweden, with questionnaire measurements in 1968 and 1974. This particular study was focused on employed men and women who had gone through major changes in their job situation. As a group, these individuals had developed more health problems at the time of the second observation than at the time of the first one. However, when the group was divided according to reported changes in work organization leading to changes in decision latitude, it was shown that those employees who had had increased decision latitude did not report increased health problems. Deteriorating health was reported mainly among those employees who had reported decreased decision latitude atwork to have been a consequence of the changes they had gone through. This observation indicates that spontaneously occurring, decreased decision latitude in working life may result in marked deterioration in public health. The Swedish nationwide longitudinal study of health and working life (Szulkin & T˚ahlin, 1994) has indicated that job strain became an increasingly frequent problem from the 1970s to the end of the 1980s in working women—but not in men—in Sweden. During the same period sick-leave rates increased markedly in Swedish women but not in men. Multivariate analyses indicated that these findings could not be explained by increasing total work hours in women, and pointed at the interpretation that they were due to changes in work contents. The most pronounced changes were found in the health care and service sectors. Sweden underwent dramatic changes during the study period, with increasing emphasis on effectiveness and productivity in these sectors. Cardiovascular symptoms increased particularly in these groups of female employees.
Marked and frequent fluctuations in financial climate is an increasingworldwide problem for enterprise. As pointed out by Brenner (1983), recessions create problems, not only because enterprises may have to decrease the number of employees, but also because a period of marked financial activity may follow shortly after the recession, which means that the remaining employees in the enterprise will have to work very hard to meet the demands from the customers. These unpredictable short-cycle swings may be one of the more important mechanisms behind the relationship between rising unemployment in a country and subsequent rise in cardiovascular and other mortality. This relationship has been discussed extensively (see Janlert, 1991), and most authors claim that it exists, although the time lag between recession and mortality has been a point of debate. The important argument for the flexibility discussion in this post is that rising unemployment is a multifaceted problem, which affects not only those who become unemployed but also those who remain employed. It is one of the most important tasks for governments and management to find flexible solutions to this problem.
Unfortunately, a common belief in management is that during financial crisis there is a need to take more control—and hence to decrease the decision latitude of employees—and at the same time increase psychological demands in order to increase the company’s ability to compete. The arguments that have been formulated in this post clearly speak against this common wisdom—in the long run, the ultimate result will be increasing health problems, and productivity will not increase.
The demand–control–support model has proved educationally useful. In an interactive process involving managers, unions and employees, it is a tool that can be used to initiate a dialogue. In this post I have given some examples indicating that it is the balance between the three components that is important. For instance, if demands are increased excessively, with extreme working hours, this may have secondary effects on the individual’s total social support system. If the long working hours are combined with work outside the office, social support from workmates may be lost. This may jeopardize flexibility and may also be a threat to health. An excessive number of projects and activities will also decrease the individual’s ability to experience control in his or her own situation, since the likelihood that complications will arise increases with the number of projects. When complications arise in one of the projects, this takes time and energy and the individual will have gross difficulties in managing all of the other activities. Thus, lack of flexibility is an inevitable consequence of an excessive number of activities (as well as of any form of task overload). If biological chaos theory is correct, the human organism needs to play with as many possibilities as possible. Although highly speculative, if we limit the possibilities to respond by restricting the number of options, the number of spontaneous variations may decrease and health may deteriorate.
Finally, analyses of the national surveys in Sweden indicate that simplistic solutions aiming at increased authority over decisions for the employees—such as flattened hierarchy— may not always be a good way of achieving increased flexibility.
Tags: Anabolic processes, anabolism, cate-cholamines, DEMAND CONTROL SUPPORT MODEL, growth hormone, restoration and repair of worn-out tissue, thyroid hormones