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The future of organizational interventions: Addressing the challenges oftoday's organizationsKarina Nielsena; Toon W. Tarisb; Tom Coxc

a National Research Centre for the Work Environment, Copenhagen, Denmark b Department of Socialand Organizational Psychology, Utrecht University, The Netherlands c Institute of Work, Health, andOrganisations, University of Nottingham, Nottingham, UK

Online publication date: 20 October 2010

To cite this Article Nielsen, Karina , Taris, Toon W. and Cox, Tom(2010) 'The future of organizational interventions:Addressing the challenges of today's organizations', Work & Stress, 24: 3, 219 — 233To link to this Article: DOI: 10.1080/02678373.2010.519176URL: http://dx.doi.org/10.1080/02678373.2010.519176

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The future of organizational interventions: Addressing the challenges oftoday’s organizations

Karina Nielsena*, Toon W. Tarisb and Tom Coxc

aNational Research Centre for the Work Environment, Copenhagen, Denmark; bDepartment ofSocial and Organizational Psychology, Utrecht University, The Netherlands; cInstitute of Work,

Health, and Organisations, University of Nottingham, Nottingham, UK

Organizational-level interventions often fail to bring about the desired results, but the reasons

for this are still unclear. This introductory paper to a special issue of Work & Stress on

organizational interventions discusses three issues to be considered in future intervention

research if our understanding of the effectiveness of interventions is to be increased. First,

there is a need to understand how and why interventions work. This calls for an examination

of the processes connecting interventions to the desired outcomes. Second, attention should be

paid to the appropriateness of interventions. Problems may be difficult to address, for example

when they constitute inherent conditions of the job. Third, the use of a quasi-experimental

study design does not guarantee a valid picture of the effectiveness of an intervention. For

example, control groups may not be comparable to the experimental group, or participants

may not be reached by the intervention. Based on these considerations, we conclude that

mixed methods designs are needed to integrate process and outcome evaluation and increase

the generalizability of interventions. Whereas concurrent changes such as mergers and

downsizing may hinder the effectiveness of an intervention, they are part of today’s

organizations and should therefore be integrated into intervention designs.

Keywords: organizational-level intervention; evaluation; mixed methods; occupational healthpsychology; employee health; well-being

Introduction

During the previous two decades, researchers in the area of occupational health

psychology and related fields have put much effort into examining the antecedents of

employee health. Numerous risk factors and risk groups have been identified,

theories have been developed, and causal mechanisms have been examined. This has

led to a substantial body of knowledge regarding the factors that relate to employee

health and well-being; journals such as Work & Stress and the Journal of

Occupational Health Psychology testify to this. However, being an applied discipline,

the question of how this knowledge can be used to improve occupational health and

well-being is a central one, and not everyone will agree that our knowledge on the

design and implementation of organizational interventions is on a par with that on

*Corresponding author. Email: kmn@arbejdsmiljoforskning.dk

Work & Stress

Vol. 24, No. 3, July�September 2010, 219�233

ISSN 0267-8373 print/ISSN 1464-5335 online

# 2010 Taylor & Francis

DOI: 10.1080/02678373.2010.519176

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other factors that potentially endanger (or promote) employee health and well-being.

For example, in his keynote address at the 2010 Rome conference of the European

Academy of Occupational Health Psychology, Cary Cooper forcefully argued that

‘‘We have enough science on what causes people to get ill in the workplace . . . We

know the problems, what we now have to do is get the solutions’’ (Cooper, 2010).

This point was also made in 1993 by Tom Cox in a report to the UK Health and

Safety Executive (Cox, 1993). The priority can no longer be more studies on risk

groups and risk factors: rather, researchers in OHP should address the design,

implementation, and evaluation of interventions.

Although statements such as these can be dismissed as exaggerations, few can

deny that our considerable knowledge of the antecedents of work-related health and

well-being has not yet been translated into interventions that are guaranteed to

effectively, systematically, and substantively improve the health and well-being of

employees. Previous research has shown that the effects of interventions on the target

variables (i.e., the health and well-being of employees) are often modest (for example,

Bambra, Egan, Thomas, Petticrew, & Whitehead, 2007; Egan et al., 2007; Egan,

Bambra, Petticrew, & Whitehead, 2009; LaMontagne, Keegel, Louie, Ostry, &

Landsbergis, 2007; Richardson & Rothstein, 2008; Roen, Arai, Roberts, & Popay,

2006; Ruotsalainen et al., 2006; Taris et al., 2003). Therefore, one vitally important

issue in intervention research is how the effectiveness of interventions can be

improved. The aim of this special issue of Work & Stress is to contribute towards

enhancing the usefulness of organizational-level interventions in the area of

occupational health by discussing the design and implementation of interventions,

to present overviews of intervention research addressing factors that have to date

received relatively little attention (yet may produce sizeable effects on the target

variables), and to point to potentially useful avenues for future research.

In line with this objective, this introductory paper to the special issue focuses on

the conditions that relate to the effectiveness of organizational interventions. Such

interventions can be defined as planned actions that are designed to remove or

modify the causes of job stress and impaired health and well-being, and that target

relatively large groups of people in a relatively uniform way (cf. Mikkelsen, 2005).

They are often recommended due to their ability to address the root causes of

employee ill-health and poor well-being, and although they hold promise in this

respect, too often they fail to bring about the expected outcomes (Semmer, 2011).

This raises at least three issues: (a) Which process-related factors affect the outcomes

of an intervention? (b) Do interventions target the correct factors? (c) Do the

assumptions of current intervention designs and paradigms help us to understand

the (sometimes unexpected) outcomes of interventions? Other discussion papers have

covered similar issues, for example, sample sizes, sustainability and difficulties in

controlled designs (among others, Cox, Karanika, Griffiths, & Houdmont, 2007;

Kompier, 2003; Murphy & Sauter, 2004; Semmer, 2011). For brevity, we will not

repeat previous discussions here. Below we discuss these questions in more detail.

Process-related factors: The why and how of successful interventions

Although intervention research has primarily focused on what works, the why and

how of interventions has received less attention. Much intervention research has

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focused on describing the content of interventions at the expense of the processes by

which outcomes are brought about. There is a need to open the ‘‘black box’’ and

explore the processes that influence intervention outcomes (Cox et al., 2007; Lipsey

& Cordray, 2000). It is increasingly recognized that transferability of an intervention

from one organization to another does not guarantee that similar effects can be

achieved (Cooper et al., 2001). Simply focusing on outcomes may be inappropriate

when it comes to organizational-level interventions (Cox et al., 2007; Scharf et al.,2008). Not identifying the processes that lead to an intervention’s outcomes severely

limits the opportunities of transferring evidence to practice (Ruotsalainen et al.,

2006). In order to promote transferability of interventions, there is a need to know

how the intervention works (i.e., what are the working mechanisms of a particular

intervention) as well as why it worked (i.e., what were the drivers of change).

Expanding our knowledge of the how and why of interventions will provide valuable

information on how interventions should be implemented to result in optimal effects.

To date, only a few published studies have described in detail the processes by

which intervention outcomes have been brought about. Examples of such studies

are Kompier, Geurts, Grundemann, Vink, and Smulders (1999), Mikkelsen and

Saksvik (1999), Nielsen, Fredslund, Christensen, and Albertsen (2006), Nielsen,

Randall, and Christensen (2010b), and Tvedt, Saksvik, and Nytro (2009). Two

reviews have evaluated current knowledge on implementation processes that may

influence intervention outcomes. Based on Steckler and Linnan’s (2002) evaluation

framework, Murta, Sanderson, and Oldenburg (2007) provided an overview of theextent to which various types of occupational stress management intervention

studies described the factors concerning: context, the actual reaching of target

groups, the dose delivered (the amount of activities, materials et cetera provided by

the intervention programme), the dose received (the extent to which participants

use these materials or participate in these activities), whether the intervention was

delivered as planned, implementation (an average of reach, target delivered and

dose received) and how participants were recruited for the study. They concluded

that no single study described all six elements, and that most studies focused on

recruitment, dose received, participants’ attitudes towards the intervention and

reach. Also, the links between processes and intervention outcomes were often

poorly described. Nevertheless, some overall conclusions were reached regarding

important process factors. These included (1) the support and involvement of

supervisors and managers is essential; (2) the effects of the intervention were

contingent upon the dose received: the larger the dose delivered, the larger the

effects; (3) the more positive the attitudes held by the participants about the

intervention activities, the better the outcomes; and (4) the more frequently

participants’ attitudes towards the intervention were monitored, the higher theirawareness of the intervention.

Egan et al. (2009) identified 10 factors to be considered when implementing an

intervention: motivation of the organization to participate, the extent to which

intervention activities are driven by a programme theory, implementation context,

previous experience of the organization in handling occupational health issues,

collaboration between employee and employer representatives during planning and

implementation phases, manager support and employee support, available resources,

and the effects on different groups (e.g., were others affected than intended or were

there any unintended effects)? In agreement with the Murta et al. (2007) study, Egan

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et al.’s overall conclusion was that these factors were only sporadically described and

analyzed in existing research. They concluded that a detailed checklist for evaluating

the quality of implementation processes in organizational-level interventions still

remains a challenge due to the complexity of this type of intervention; research is not

yet at a stage where the relevant processes can be identified that bring about positive

results.

In conclusion, although we know that process issues are important, it is difficult

to establish the degree to which certain factors play an important role, whether the

guidelines suggested by Murta et al. (2007) are followed in practice, and whether

these can account for (part of) the (lack of) success of specific interventions. For

example, although there seems to be an increasing awareness of the importance of

middle managers in supporting interventions (Kompier et al., 1999; Murta et al.,

2007; Nielsen & Randall, 2009), the decision to engage in an organizational-level

intervention programme is often made by senor management with little considera-

tion of the motivation and competencies of middle managers to drive progress. We

must still find out how middle managers can be motivated to engage actively in such

change processes and how we can ensure that they have the competencies required to

manage them. Thus, it seems imperative for future research to examine the link

between process-related factors and the effectiveness of interventions.

Do interventions target the correct factors?

Current intervention research sometimes follows the biblical adage of ‘‘if thy hand

offend thee, cut if off ’’ (Mark 9:43). An initial risk assessment may reveal that, say,

the job demands in a particular department of an organization impose serious risks

to the health of those working in this department. In practice, this will usually lead to

interventions that are designed to address these job demands, for example, through

job redesign. However, it is possible that the underlying problems may be located

elsewhere; for example, a leader who fails to distribute the workload adequately, high

work-home interference, and so on (cf. Kompier, 2003). Addressing these other

factors may be more effective than targeting the ‘‘symptom’’ of high demands

(indeed, high demands may be inherent to a particular job and cannot be changed

easily, cf. Kompier & Kristensen, 2001). A related issue concerns the degree to which

work-related issues can actually be changed. For example, certain characteristics of

the job of a home care helper, such as the amount of time spent working alone and

interacting with clients, are inherent parts of the job and cannot be eliminated. In

such cases it may be worthwhile to explore interventions that could minimize the

impact of these demands, for example, by increasing personal and organizational

resources such as social support and help with handling violent clients.

If other factors are the real source of problems, then interventions that address

job demands may not be effective � rather, one should focus on targeting the actual

problems, which may lie elsewhere. This calls for a thorough risk assessment and

definition of the issues to be addressed (Kompier & Kristensen, 2001; Murphy &

Sauter, 2004). There is a need to expand risk assessment beyond the traditional risk

factors described in dominant job stress theories such as the job demand-control

(-support) model (cf. Hausser, Mojzisch, Niesel, & Schulz-Hardt, 2010; Karasek &

Theorell, 1990) and the effort-reward model (Siegrist, 2008). Such models may only

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hint at the underlying issues that need to be addressed. More comprehensive models

such as the job demands-resources model (Bakker & Demerouti, 2007; Hakanen,

Schaufeli, & Ahola, 2008) and the Demand-Induced Strain Compensation model

(De Jonge, Le Blanc, Peeters, & Noordam, 2008) provide broader frameworks and

may include factors at the individual, job content, and organizational level.

Including such broader frameworks would enable researchers to conduct risk

assessments to cover a wider range of factors, examining whether underlying

problems reside in the environment or within the individual resources (e.g., lack of

personal initiative or self-efficacy, Taris & Wielenga-Meijer, 2010).

Salanova’s (2009) Healthy and Resilient Organization (HERO) model proposes

that healthy organizations are defined by three characteristics: (a) healthy organiza-

tional practices and procedures, including organizational resources (such as human

resource management), social resources (e.g., communication flow, good leadership,

and social support), and task resources (such as challenging tasks and ongoing

feedback on progress); (b) healthy employees, having high levels of self-efficacy and

engagement, and (c) healthy organizational outcomes such as an image as employer of

choice and high quality services and products. Risk assessment and intervention

activities should consider targeting all three aspects of the organization.More recently, the importance of combining multi-level intervention activities has

been highlighted. A study by Nielsen, Randall, Brenner, and Albertsen (2009) found

that concurrent individual-level activities such as team building and training

increased the uptake of primary intervention activities. One possible explanation

for this may be that individuals who receive training may become better equipped to

handle the demands of organizational-level interventions (LaMontagne et al., 2007).

Another explanation may be that a ‘‘Hawthorne’’ effect may be at play. If individuals

receive special attention this may increase their motivation to participate in other

activities. Although the Hawthorne effect has been criticized (Kompier, 2006), others

have argued that the ‘‘special attention effect’’ should be considered to be a working

mechanism and used as such (Semmer, 2011). Recent approaches have advocated the

consideration of intervention activities at four levels: individual, group, leadership and

organizational, and emphasized the importance of all four levels in creating a healthy

working environment in which employees thrive and develop (Nielsen, Martini

Jørgensen, & Munch-Hansen, 2008). To summarize, ‘‘if your hand offends thee,’’ it

does not necessarily follow that it should be chopped off � perhaps some form of

training will suffice. Similarly, we feel that researchers and practitioners should look

beyond the traditional areas of interventions (demands, control and support). Other

factors may be at least as important, if not more so.

Designs and paradigms

A related but even more fundamental question is whether the designs and paradigms

that currently dominate research and theory on organizational-level interventions are

appropriate for examining the effects of interventions (Cox et al., 2007). The reality

of today’s organizations is that they face increasing demands due to globalization

and expectancies of a meaningful and engaging working life of employees due to

higher education levels. In the following sections we challenge four assumptions that

often underlie organizational-level occupational health interventions.

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1. The (quasi)-experimental design as the gold standard

Most published research, reviews, and meta-analyses focus on the assumption that

organizational environments can be easily controlled and suitable control groups are

easily found. However, it has been argued that (quasi-)experimental designs (that is,

designs in which participants are not randomly assigned to experimental conditions

and in which researchers usually have less than full control on the treatments and/or

the environment in which these are implemented) are best restricted to evaluating

simple, standardized and unvarying interventions (Rychetnik, Frommer, & Shiell,

2002). There are several reasons for this. First, it is often challenging to find suitable

control groups. Even if organizations belong to the same sector and produce similar

products and/or services, they have their own lives, cultures, and management

strategies. This means that apart from the intervention itself, there are usually

uncontrollable differences between the experimental and the control organizations.

Second, in specialized areas, even if control groups are found it is difficult to

prevent contamination. In today’s workplaces, turnover is high (Frese, 2009), with

employees and managers who move from one organization to another bringing ideas,

knowledge, and experiences from their previous workplaces. Also, networking has

become essential both within and across organizations, as work becomes a project

rather than only a means of income (Frese, 2009). For example, Nielsen, Fredslund,

Christensen, and Albertsen (2006) found that improvements in a control group were

due to informal communication between those involved in the intervention and a

newly employed manager in the control group. Thus, it is possible that the effects of

an intervention are not confined to the experimental organization but may affect the

control group as well.

Third, it is assumed that interventions reach the entire intervention group. This

may not always be the case (Randall, Griffiths, & Cox, 2005). Employees leave and

new workers are recruited who may or may not be aware of, or involved in

intervention activities. Furthermore, activities may not be implemented or imple-

mented according to the original strategy � thus either reaching only some of the

intended beneficiaries or having unintended side effects.

To summarize, we contend that control groups may offer added value in

determining the effects of whether interventions had an effect above ‘‘business as

usual’’ (see Nielsen et al., 2010b for an example of how a control group indicated that

the intervention had a buffering effect during organizational turbulence), but rather

that having a control group in itself does not guarantee valid conclusions about the

effects of an intervention. The limitations of control groups should be carefully

considered. Considering the difficulties in finding perfect controls that match

intervention groups in terms of sector, occupational groups, size, and geographical

location, it may be more appropriate to use groups that are referred to as ‘‘comparison

groups’’ or ‘‘reference groups.’’ Under all circumstances, the management structures

and culture, processes and activities of these groups should be scrutinized before

conclusions can be reached on their comparability with intervention groups.

2. A mixed methods approach to evaluation

Another implication of the quasi-experimental design is the emphasis on

quantitative methods and on summative evaluation (examination of the efficacy

224 K. Nielsen et al.

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of an intervention) at the expense of formative evaluation (examination of the

process during implementation to optimize implementation of the programme). If

we are to understand the how and why of successful interventions, we are forced to

also consider formative evaluation approaches in conjunction with outcome

evaluation (Nastasi et al., 2007). Through ongoing formative evaluation, systematic

modifications of the intervention and its activities may take place to increase the

likelihood of a successful outcome. Other advantages of process evaluation include

the interpretation of the outcomes of intervention programmes and the transfer-

ability of interventions to other settings (Goldenhar, LaMontagne, Katz, Heaney, &

Landsbergis, 2001).

Distinguishing between omnibus and discrete contexts, Johns (2006) provided an

essential guide to our conceptual understanding of context that may help us

understand and analyze the impact of contextual factors on organizational-level

outcomes. Omnibus refers to the overall context, that is, what is the culture within

this organization? What are the procedures and what is the content of the job? These

factors are all-important to understand under which conditions an intervention

programme may have an effect. For example, Dahl-Jørgensen and Saksvik (2005)

found that an intervention programme fared poorly in an organization because

health care assistants had little opportunity to integrate intervention activities into

their daily work with clients. Discrete context refers to the separate events that take

place throughout the project in terms of new management and organizational

restructuring (Johns, 2006). Certain organizational factors such as organizational

justice may be easily measured using quantitative methods; other contextual factors

call for qualitative methods. Qualitative methods may help reveal the context that

may hinder or facilitate programme implementation. To summarize, we argue that

the combination of various (quantitative and qualitative) approaches may help

researchers understanding the success of interventions � or the absence thereof.

3. Organizational stability as a requirement for organizational interventions to succeed

Most intervention studies are based on the assumption that concurrent changes are

absent in the organization, which may not be correct: some describe how

interventions failed to bring about the desired outcomes due to concurrent

organizational changes, such as mergers and downsizing (Mikkelsen & Saksvik,

1999; Nielsen et al., 2010b; Olsen et al., 2008). Organizations experience increased

demands to be flexible in order to survive in today’s competitive environment, and

organizational-level intervention researchers need to realize that this is the reality.

Petticrew (1990) warned against the myth of change being singular or linear and

considered arguments for the single source of change to be meaningless (p. 269), as

explanations of change are multi-faceted and influenced by context (Petticrew, 1990).

One consequence of an ever-changing environment is that there needs to be a match

between the context within which the organization operates and the intervention and

its activities; if there is no such match, the intended effects are unlikely to materialize.

This has implications both for risk assessment and for intervention activities to

address these concurrent changes. At the same time, theoretical evaluation frame-

works should be developed that can tease out which effects are due to which

activities, be they part of the intervention project or any concurrent changes.

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First, most risk assessment fail to take into account the consequences of

organizational change. To our knowledge, only the Management Standards

developed by the UK Health and Safety Executive include change in their assessment

tool (Cousins et al., 2004; Mackay, Cousins, Kelly, Lee, & McCaig, 2004). We need toexplore how we can include what is ‘‘business as usual,’’ that is, ongoing change for

organizations (Kieselbach et al., 2009) in risk assessment and the development of

intervention activities. One way forward may be to work towards an integration of

interventions to improve employee health and well-being into organizations’ strategic

management: When organizations reorganize and restructure, an inherent part of the

strategy should be to include considerations and strategies to manage employee

health and well-being.

Second, there is a need to develop theoretical evaluation frameworks that includeconcurrent changes in their evaluation of change. The actor-network approach

(ANT, Latour, 2005) presents a framework that may help us understand the

complexity of intervention outcomes. According to ANT, no object or individual

holds power in itself. Only through its relations with others does a certain object or

individual have power. The term ‘‘actor’’ is to be interpreted in a very broad term:

People, things, technology, groups, and events can all be acting entities. The effect of

an actor (such as a manager’s power over his/hers employees) only occurs because the

network is organized in a way that allows the actor to have this effect. This happensthrough ‘‘translation’’ � as one actor moves within the network, this influences the

entire network and the structure is changed. This type of methodology expands

the question of ‘‘Did the intervention have an effect?’’ to ‘‘What made it possible for the

intervention to work?’’ and more broadly the exploratory ‘‘Who/what made what

happen?’’. For instance, do employees, through ‘‘hidden’’ job crafting, work against

the planned intervention activities if they feel that these are in conflict with their

personal goals? Or did concurrent events hinder the correct implementation of the

intervention?

4. Employees as active agents

A fourth assumption of current intervention research seems to be that employees are

passive recipients of the intervention and its activities. This is reflected in the

predominant approach to organizational-level interventions which employs a top-

down approach to developing and implementing interventions. Prominent ap-

proaches suggest that intervention activities should be developed in a collaborationbetween manager and employee representatives, after which they are implemented

(Nielsen et al., 2010c; this issue). In other areas of organizational and occupational

psychology there is an increasing awareness that employees actively craft their own

jobs through their daily work practices (Berg, Wrzesniewski, & Dutton, 2010; Feij,

Peiro, Whitely, & Taris, 1995; Wrzesniewski & Dutton, 2001). This implies that

within the existing structure employees are actively adjusting their behaviours and

attitudes to pursue their own personal goals at work.

Based on their mental models (i.e., working cognitive maps that guide ourunderstanding of our surroundings and how we react to these surroundings),

employees actively interpret and react to their working conditions (Nielsen et al.,

2009; Nielsen, Randall, & Christensen, 2010a), and as a result they craft their own

jobs � openly or covertly. Such behaviours may inhibit intervention implementation.

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Some interventions have failed to show expected outcomes because employees were

resistant to the intervention and its activities (Randall et al., 2005); therefore

attention needs to be paid to the mental models and job crafting strategies of

employees. Participatory action approaches do advocate using the expertise of

employees to ensure that interventions activities are tailored to the needs of the

organization using employees’ expertise. We advocate that research should combine

top-down and bottom-up approaches (Grant & Parker, 2009) if we are to successfully

shape and understand the effects of organizational-level interventions.Several process factors may influence employees’ job crafting strategies. Com-

munication influences how people make sense of events and subsequently whether

they buy into them (Weick, Sufcliffe, & Obstfeld, 2005). When participants

understand the rationale behind specific activities and are made aware of progress,

this is likely to influence their appraisals of the intervention and the activities: they

are more likely to perceive that progress is being made and that activities together

inform an overall goal. This understanding is likely to influence their job crafting

behaviours; when employees perceive an intervention positively and believe their

activities to be of benefit to them, they are more likely to engage in intervention-

related activities (Nielsen et al., 2009). Initiatives to improve employee health and

well-being must have clear strategies for communicating the vision and concrete

goals and celebrating the small successes; thereby the shaping of employees’ mental

models is taken into account. Readiness for change (Weiner, Amick, & Lee, 2008) has

been widely examined in reorganization research, but has received less attention in

the occupational health literature. This concept provides a tangible measure of the

extent to which employees see the potential benefit of the intervention and its

activities and is therefore also likely to shape their job crafting behaviours. More

research is needed on how the mental models of employees (including their initial

motivation for participating) shape intervention outcomes.

Information is a necessary, but not in itself sufficient, requirement for achieving

desirable intervention outcomes. Job-crafting strategies can be used in participatory

action research such that employees join forces and using their day-to-day autonomy

to take responsibility for ensuring a healthy organization. To facilitate successful

interventions, the personal goals of individuals should be openly discussed and

realigned with the goals of interventions to minimize sabotage and covert job

crafting that may work against effective intervention development and implementa-

tion. Furthermore, the actual job crafting activities may be actively used in

participatory processes to use the expertise of employees in creating a satisfactory

job for themselves that does not work against the goals of the organization. There is

still research to be conducted to examine the interplay between individual job

crafting strategies and the activities developed in participatory interventions.

What we still need to know

Based on the issues so far discussed, there is a need for at least three types of

research. First, there is a need for research addressing the factors responsible for

success with regard to the process of implementing organizational interventions.

Currently, few studies report relevant information in sufficient detail. As a

consequence, systematic reviews of this research that could shed more light on these

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factors are difficult to conduct, and we mostly depend on case-study types of

research. Although such research can be useful in showing which factors could

potentially promote successful implementation, only more research in which various

studies are systematically compared can show whether these beneficial effects

generalize across occasions, under which conditions, and the magnitude of these

beneficial effects. Thus, our first recommendation for future intervention research is

that studies provide in-depth information about not only the specific intervention but

also about the details concerning its implementation (along the lines of the steps

described by Murta et al. (2007) and by Egan et al. [2007, 2009]). Exploring and

isolating the effects of interventions requires complex models that explore cross-level

linkages. Focusing on the content of the intervention without considering the role of

the context and the attitudes and behaviours of those targeted by the intervention, is

unlikely to bring about real understanding of why and how a specific intervention

has worked (Herold, Fedor, & Caldwell, 2007).

Second, intervention research should go beyond reports of studies in which

traditional risk factors (such as high demands and low control) are addressed.

Currently, many such studies are available, showing that although these factors are to

some degree open to change, the effect sizes of these interventions are usually modest

(e.g., cf. Egan et al., 2009; Richardson & Rothstein, 2008; Ruotsalainen et al., 2006;

Taris et al., 2003). We therefore encourage researchers to focus on non-traditional

factors � for instance, leadership (Kelloway & Barling, 2010) and work-family issues

(Brough & O’Driscoll 2010) � that can be linked to employee health and well-being

and that could potentially be more effective (Kompier & Kristensen, 2001).Finally, intervention researchers should not only be aware of the limitations of

standard designs and paradigms, but should also attempt to address those

limitations. In the present paper we have discussed this issue at length, arguing

that the standard quasi-experimental design has major limitations when it comes to

the evaluation of the effects of interventions (Cox et al., 2007) and that a mixed-

methods approach that integrates quantitative and qualitative information may be

more promising in this respect. Moreover, the assumptions that interventions usually

occur in a vacuum and that employees are passive recipients of the changes that are

brought about by them are often incorrect, which implies that intervention

researchers should try to take account of this. Top-down approaches in designing

interventions neglect the fact that employees may actively resist the consequences of

interventions. More research is certainly warranted on the degree to which employees

engage in behaviours that run counter to an intervention’s intention, in addition to

the factors that promote their cooperation.

This special issue on organizational interventions

The aim of this special issue is to bring together a number of novel and inspiring

papers that go beyond traditional intervention research. Rather than to solicit papers

presenting examples of specific (either successful or unsuccessful) interventions in the

OHP area, we aimed for contributions addressing intervention research at a more

general level, that is, reviews of novel and promising areas for intervention (dealing

with the ‘‘do we target the correct factors?’’ issue), as well as papers that focus on the

228 K. Nielsen et al.

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best way of evaluating interventions (addressing issues relating to designs and

paradigms).

In the first contribution to this special issue, Karina Nielsen and her colleagues

discuss the planning, implementation and evaluation of organizational-level

occupational health interventions (Nielsen, Randall, Holten, & Rial Gonzalez,

2010c). Such interventions are assumed to have the best chance of achieving

significant impact if they follow a structured and participatory intervention process.

Nielsen and colleagues discuss and compare several prominent methods that allow

for such a systematic process, showing that they share a number of phases that follow

the problem-solving cycle (i.e., preparation, risk assessment, action planning,

implementation, and evaluation of the results). Moreover, many of these approaches

emphasize employee participation throughout the intervention; such participation

could, for instance, improve the degree to which they are ‘‘ready’’ for the

intervention. Overall the methods reviewed have not so far been thoroughly

validated, underlining the need for more research to determine the factors that

make organizational-level occupational health interventions work.The second and third contributions to this special issue present overviews of

research on interventions that target risk factors for the health and well-being of

employees that have so far received little attention in intervention research. Kevin

Kelloway and Julian Barling discuss leadership development as a possible viable and

effective primary intervention in occupational health psychology (Kelloway &

Barling, 2010). Although few would be surprised to hear that the style and quality

of leadership affects the well-being of employees (e.g., Nielsen, Randall, Yarker, &

Brenner, 2008; Skakon, Nielsen, Borg, & Guzman, 2010), the breadth of these effects

is remarkable. However, leadership training is only rarely considered as an

occupational health and safety intervention. This may be due to the unique nature

of leadership development, in that it is ultimately intended to affect others (i.e.,

employees and subordinates), rather than the health and well-being of the leaders

themselves. The design and evaluation of leadership interventions is further

complicated by the fact that indirect and delayed effects are both likely and of

primary interest. In spite of these problems, Kelloway and Barling convincingly

argue that leadership development should be a main target for future research on

interventions in occupational health psychology.

In their paper, Paula Brough and Michael O’Driscoll present an overview of

research on interventions that focus on the work-family interface (Brough &

O’Driscoll 2010). Although a sizeable body of research on this issue has established

(absence of) work-family balance as one of the central risk factors for health and

well-being (Haines, Marchand, Rousseau, & Deemers, 2008), the published literature

on organizational interventions to improve work-life balance is surprisingly sparse.

In their contribution to the present special issue, Brough and O’Driscoll provide

examples of empirical research depicting work-life balance organizational interven-

tions and present a three-fold classification of such interventions. The specific

examples they present on the one hand show that research on the effectiveness of

work-life balance interventions is challenging, but on the other hand they

demonstrate that such interventions can be very effective in enhancing work-life

balance. Thus, interventions in this area hold considerable promise as a means to

improve employee health and well-being.

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Organizational interventions are not conducted in isolation, and the fourth

paper in this special issue reviews the regulations within the European Union that

are relevant for intervention research. In their contribution, Stavroula Leka and

colleagues discuss policy-level interventions (Leka, Jain, Zwetsloot, & Cox, 2010).

These are interventions that are focused on the regulations concerning the

management of work-related risk factors, and which provide the framework for

organizations managing this challenge and which shapes their interventions.

Clearly, both national and international regulations are crucially important, but

at present little research addresses the nature and effectiveness of this policy-level

approach. Leka et al. discuss these issues in the context of the PRIMA-EF

project, a policy-oriented research programme funded by the European Commis-

sion’s 6th Framework Programme for Research. It makes clear that although a

common policy context has developed in the European Union (EU), there is still

great variation in the way these initiatives translate into practice in the different

member states of the EU and that evaluation of the success of such measures is

sparse.

Together, these four contributions provide a broad overview of several both

challenging and promising topics in the area of intervention research. ‘‘Challenging,’’

in the sense that rather than provide a final answer to a research question, these

papers constitute a starting point for further research. ‘‘Promising,’’ in that the topics

discussed here (i.e., policy-level interventions, interventions in the areas of leadership

development and work-family balance, or developments in the design and

implementation of interventions) hold considerable practical potential to substan-

tially improve the health and well-being of employees. Research on the solutions to

problems related to work-related health is at least as important as discovering new

risk groups and risk factors. If anything, the research presented here shows that there

are still many relatively uncharted areas in intervention research; clearly, future

studies in these areas are likely to bring us closer to our ultimate goal of improving

employee health and well-being.

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