Organizational interventions: A research-based framework for the evaluation of both process and effects
Karina Nielsena* and Johan Simonsen Abildgaardb
aNorwich Business School, University of East Anglia, UK and National Research Centre for the Working Environment, Copenhagen, Denmark; bDepartment of Psychology, University of
(Received 4 June 2012; final version received 8 October 2012)
Organizational interventions are often recommended when organizations want to improve
employee psychological health and well-being. Research, however, has revealed inconsistent
results and reviewers have called for research on why interventions either bring about desired
change or fail to do so. Answering the ‘‘how’’ and ‘‘why’’ of intervention outcomes requires a
close examination of the elements that hinder or facilitate desired outcomes, thus moving
beyond evaluation of only the overall effects. In this paper, we present an evaluation
framework based on recent intervention research and process-oriented organization theory.
The framework offers suggestions for which elements to include when evaluating organiza-
tional interventions. Within the framework, elements crucial to intervention evaluation are
grouped into four overarching categories that we argue are crucial to evaluation over the
five phases of an intervention programme. These categories are: the organizational ‘‘actors’’;
the mental models of those actors; the context of the intervention; and intervention design and
process. Evaluation during the process as well as of the overall effects, as recommended by this
framework, should throw light on what works for whom, why, how and under which
Keywords: process evaluation; organizational interventions; effect evaluation; evaluation framework
In recent years there has been an increasing interest in the use of organizational
interventions when aiming to improve employee psychological health and well-being,
and they have been widely recommended (ETUC, 2004; EU-OSHA, 2010; ILO,
2001). Organizational interventions can be defined as planned, behavioural, theory-
based actions that aim to improve employee health and well-being (e.g. Nielsen,
Randall, Holten, & Rial González, 2010c). While a design with a simple pre-and
post-measurement design with randomized controls has been considered the ‘‘gold
standard’’ for evaluating organizational interventions (e.g. Richardson & Rothstein,
2008), recent reviews have identified challenges in evaluating the total effects of
such interventions in the complex and multi-faceted context within which such
*Corresponding author. Email: K.Nielsen@uea.ac.uk
Work & Stress, 2013
Vol. 27, No. 3, 278�297, http://dx.doi.org/10.1080/02678373.2013.812358
# 2013 Taylor & Francis
interventions reside (Egan, Bambra, Petticrew, & Whitehead, 2009; Murta,
Sanderson, & Oldenburg, 2007). It has been suggested that organizational interven-
tions require elaborate evaluation frameworks due to their embeddedness in complex
social structures (Nielsen, Taris, & Cox, 2010d; Nielsen & Randall, 2012a) in order to detect what works for whom, why, how and under which circumstances (Pawson,
2006). Such a framework would require a consideration of the context within which
the intervention takes place, an examination of which intervention components are
effective, and an examination of how the design and implementation process of the
intervention helped to ensure a successful outcome (Murta et al., 2007).
In this article we present a framework of how organizational interventions may be
evaluated, taking into account the challenges of determining the total effects of such
interventions. We base this framework on an overview of the lessons learned from existing organizational intervention research. In their article, Grant and Wall (2009)
discussed the ‘‘why to’’ and ‘‘when to’’ of conducting intervention research. The
contribution of the present article is to provide insights into the ‘‘what to’’ look at
when evaluating organizational interventions. We present a research- and theory-
based framework for how to evaluate organizational interventions based on process
oriented organization theory (e.g. Tsoukas & Chia, 2002; Weick 1979). To our
knowledge, this is the first evaluation framework to combine both process and effect
evaluation and identify which elements should be looked at during each phase of an organizational intervention.
Based on existing organizational intervention research, we introduce the elements
that may have an impact on the outcomes of interventions, either directly through the
role they play in the implementation of the intervention and its activities or indirectly
through how they influence the behaviours of those involved. We also argue that the
impact of interventions must be evaluated at several levels: changes in attitudes,
values and knowledge, changes in individual resources, changes in organizational
procedures, changes in working conditions, changes in psychological health and well- being, changes in productivity and quality and changes in occupational safety and
Process organization theory as a theoretical framework
Our intervention framework is built on the foundation of the current focus on
‘‘organization as process’’ in the field of organization studies. In recent years scholars
have taken an increasing interest in viewing organizations as a continuous collective of processes that connect various players, or ‘‘actors’’ (Stengers, 2011). This is a
conceptual reformulation from the ‘‘social psychology of organizations’’ (Katz &
Kahn, 1978) to the ‘‘social psychology of organizing’’ (Weick, 1979). From a process
theoretical perspective, common constructs in intervention such as ‘‘resistance to
change’’, ‘‘managerial support’’ and ‘‘power relations’’ (Saksvik, Nytrø, Dahl-
Jørgensen, & Mikkelsen, 2002; Nielsen, Fredslund, Christensen, & Albertsen, 2006)
should be studied as on-going events occurring in the organization rather than seen
as generally stable intrinsic characteristics of the workplace (Hernes, 2008). When this perspective is applied to intervention evaluation it involves a shift in
focus from evaluating change as the certain movement from one fixed state (pre-
intervention) to another fixed state (post-intervention). The focus is instead directed
to the process aspects of change and specifically to how organizational interventions,
Work & Stress 279
as any other planned change activity, must be adapted to the routines and contextual
conditions within the organization (Tsoukas & Chia, 2002). There is a need for
organizational interventions to be understood as a collective of initiatives and change
activities, competing and intertwining with a multitude of concurrent events.
It has further been argued that organizational change should be seen as both a
ubiquitous given, and at the same time as an episodic occurrence in organizations
(Tsoukas & Chia, 2002). For example, when conducting an organizational interven-
tion, change becomes something specific and to some degree bounded in time and
space by the frame of the intervention, even though continuous adaptation and
change occurs before, during and after the change episode. This view of change as
both an episodic and a continuous phenomenon is an important factor in describing,
evaluating and understanding attempts to improve organizations. In our view, in
order to evaluate interventions aiming to achieve planned change we need to design
evaluation frameworks that are attentive to how change programmes are causing
effects in the organization. This can be done by such frameworks providing
an opportunity for action, but at the same time taking into account how intervention
activities are transformed and adapted to the contextual events and local culture in
the organization (Tsoukas & Chia, 2002).
We emphasize the link between the planned change of an organizational
intervention and concurrent changes within the context of the organization, as
these are in our view inseparable and a key element in understanding the complexity
and difficulties of intervention research. This would imply that an evaluation
framework should not focus on the activities set in motion by the intervention as
isolated events, but rather see them as situated in an environment containing forces
for both change and continuity. This leads us to include the mental models of actors
within the organization in our evaluation framework, because not only the
intervention processes themselves, but also the ongoing changing sentiments of
those actors towards the intervention programme and its elements play an important
role in influencing intervention process and outcome.
In summary, our framework, drawing on process organization theory, focuses on
documenting specific processes initiated by intervention programmes and on how
organizational actors and processes interact with the intervention activities to
influence intervention outcomes. To achieve a detailed understanding of change, it
should be borne in mind that concurrent events, such as budget cuts or mergers,
(shared mental) models, appraisals of intervention phases and events, management
and organization strategies, and the type of job can all influence an intervention, and
thus should be given attention in an evaluation.
The evaluation framework
We believe that process and outcome evaluation issues are irrevocably intertwined
(Nielsen et al., 2010d). Therefore, we should expand the view of the mechanisms that
can explain intervention outcomes (Pawson, 2006). Rather than merely focusing on
intervention activities (during the action planning and implementation phases) we
need to consider the phases and processes through which such activities are
developed and implemented. Pawson and Tilley (1997) developed the Context
Mechanism Outcome (CMO) model for realistic evaluation, emphasizing the need to
280 K. Nielsen and J.S. Abildgaard
look at what conditions in the Context are needed to bring about change, the
Mechanisms by which an outcome is brought about in the given context, and which
practical Outcomes are produced by these mechanisms. Our framework is structured
around four interlinked categories that are relevant to evaluation, as inspired by
the CMO model (Pawson & Tilley, 1997). However, our framework differs from the
Pawson and Tilley (1997) model in that we conceptualize Mechanisms differently.
Also, in contrast to previous proposals, we recommend that evaluation is carried out
at every stage of the process rather than only at the end of the intervention. The four
interlinked categories in our proposed framework are as follows. Firstly, as the
mechanisms to bring about change, we define the organizational actors who may
drive it (they include all key stakeholders who may influence the intervention process
and therefore the intervention outcomes, e.g. employees, line and senior managers,
researchers, Occupational Health and Human Resource consultants). The second
category is the mental models of those actors, which include cognitive schemata of
the organization, of working conditions and of the intervention including its purpose
and likely outcomes (Weick, Sutcliffe, & Obstfeld, 2005) that can help explain the
behaviours of the organizational actors. The third category is the contextual factors
surrounding the intervention activities that influence intervention outcomes, includ-
ing both the discrete contexts and the overall (omnibus) context. The fourth category
is the intervention design and processes. The framework is shown in Figure 1.
Figure 1. Proposed framework for the evaluation of organizational health interventions,
showing the various elements of an intervention, including both process and outcomes, that
need to be tracked and assessed within both the discrete contexts of individual phases and the
omnibus (overall) context of the intervention.
Work & Stress 281
In our framework we divide this last category, the evaluation of the intervention
design and process, into the phases commonly observed in organizational interven-
tions (Nielsen et al., 2010c). These are: initiation, screening, action planning,
implementation and effect evaluation. This latter category refers to Pawson and
Tilley’s (1997) Outcomes; however, based on the phased approach of organizational
interventions (Nielsen et al., 2010c), we suggest an approach where each phase can be
seen as the outcome of the previous phase, as shown in Figure 1. For instance,
the procedures for screening and the subsequent response rates are the result of the
planning that has taken place in the initiation phase; the outcomes of the action
planning phase depend on the quality of screening and the feedback provided based
on screening; and implementation depends on the level of detail in the action plans.
We believe that it is important to evaluate each of these phases separately to detect
how the decisions made and actions taken at one phase influence subsequent phases,
i.e. the mechanisms through which progress is made from one phase to the next
In developing our evaluation framework we used four sources of information.
First, we reviewed frameworks from other disciplines, e.g. in public health,
participatory ergonomics and organizational development. In public health research,
the focus of evaluation is primarily on whether individuals change their own
behaviours (e.g. Rossi, Lipsey, & Freeman, 2004; Steckler & Linnan, 2002). While
this research is not directly transferable, useful information on implementation
fidelity can be transferred to intervention evaluation frameworks. In organizational
development, the focus is primarily on intervention outcomes. Valuable information
may be obtained about different levels of outcomes and targets of interventions (e.g.
Anderson, 2012; Cummings & Worley, 2009). From the participatory ergonomics
literature we can get valuable information on the phases of participatory intervention
and the factors needed to ensure successful implementation (Wells, Norman, Frazer,
& Laing, 2001). Second, we identified two reviews focusing on process factors (Egan
et al., 2009; Murta et al., 2007) and from here we identified relevant elements. Third,
we identified a number of papers discussing intervention implementation and
outcomes (Cooper, Dewe, & O’Driscoll, 2001; Guastello, 1993; Lipsey, 1996; Nytrø,
Saksvik, Mikkelsen, Bohle, & Quinlan, 2000; Pettigrew, 1990; Semmer, 2011;
Shannon, Robson, & Guastello, 1999; Vedung, 2006; Nielsen & Randall, 2012a).
Fourth, we conducted a thorough review of the existing research on organizational
interventions that includes information on the three areas of focus: the mental
models of the various actors, context and/or intervention design and implementa-
tion. (Full information on the systematic literature search can be obtained on request
from the authors). These are the papers that form the basis for the elements included
in our framework. Organizational interventions are a particular class of intervention,
but lessons learned from evaluating other sorts of interventions might be applicable
to them. However, this paper is focused on the knowledge derived from organiza-
tional intervention research. In the following sections we first introduce the three
categories that play a role in moderating and mediating the link between the
intervention and its outcomes � organizational actors, mental models and context � and then move on to describe the phases that should be considered in intervention
282 K. Nielsen and J.S. Abildgaard
Organizations consist of complex networks of agents who each play an important
role in determining the outcomes of an intervention. While their roles may be defined at the outset of the intervention programme, these definitions do not predict their
behaviours over time: involvement and commitment may change throughout the
intervention process. Organizational actors include employees and managers, who
are discussed in the following sections.
Employees. Employees are targets of the intervention but also play a role in
developing and implementing the intervention programme in participatory inter-
vention designs (Nielsen et al., 2010c). Participation of employee representatives is
widely used and generally recommended in major approaches to organizational
interventions (Nielsen et al., 2010c) and by the World Health Organization and the
European Network for Workplace Health Promotion (European Network for Workplace Health Promotion, 2007). Employee participation is believed to: (1)
ensure ownership of the intervention and use of the employees’ local knowledge; (2)
ensure integration of intervention activities into existing organizational structures
and initiatives, securing sustainable changes in existing procedures and (3) empower
employees (Nielsen & Randall, 2012b). The importance of turning the target
population into empowered employees who work actively to improve their working
conditions has been documented, with such participation being linked to interven-
tion outcomes (Nielsen, Randall, & Albertsen, 2007; Nielsen & Randall, 2012b). Participation, however, can take many forms. The various degrees and types of
participation throughout the intervention programme and the developments and
changes over time should be documented at intervals during the intervention.
Participation ranges from completing a questionnaire to prioritizing areas of action,
developing action plans and being responsible for implementation of intervention
activities (Hurrell, 2005; Rosskam, 2009). Differences in the level of participation are
likely to influence intervention outcomes. Important questions to ask are: What is
the level of participation overall and at the different phases throughout the programme? Are all employees involved or only a smaller group of representatives?
It has been argued that only through involving all employees can the advantages of
participatory approaches can be achieved (Hurrell, 2005; Nielsen & Randall, 2012b).
Most often a steering group consisting of employee and manager representatives
is established (Nielsen et al., 2010c). It is important to document not only
activities of the steering group but also how it is formed, the level of decision
latitude, its constituency (i.e. the representativeness of the entire organization) and
selection criteria for including members. The consequences of malfunctioning steering groups have been well documented (Mikkelsen & Saksvik, 1999; Mikkelsen,
Saksvik, & Landsbergis, 2000).
Management. Both middle managers and senior managers play an important role in
supporting a successful intervention programme.
Senior management. For an organization to successfully plan, implement and
evaluate interventions, senior management support is vital (Aust & Ducki, 2004).
Senior managers have the means to allocate resources to plan, implement and
Work & Stress 283
evaluate the programme, and to allocate economic resources to intervention activities
(e.g. training) (Nielsen et al., 2010c). Senior managers also act as role models
(Randall, Cox, & Griffiths, 2007) and possess the power to make structural changes
as part of the intervention programme and to integrate learning from the programme into future occupational safety and health procedures and initiatives (Kompier,
Geurts, Grundeman, Vink, & Schmulders, 1998). Senior manager support may
change over time. While senior managers may initially support the programme, their
support may diminish over time if the programme fails to progress according to
expectations or other events divert the senior managers’ attention from the
intervention (Nielsen, Randall, & Christensen, 2010a, 2010b). The role of senior
managers in ensuring the success of intervention programmes has been documented.
Both senior managers’ allocation of resources to run the process (Lindquist & Cooper, 1999; Saksvik et al., 2002) and their attitudes (Dahl-Jørgensen & Saksvik,
2005) have been found to influence intervention outcomes.
Middle managers as drivers of change. The roles and behaviours of middle managers
are often overlooked in organizational intervention evaluation (Nielsen & Randall, 2009; Randall et al., 2007). While senior managers usually make the strategic
decisions, middle managers are often those responsible for progress by communicat-
ing and implementing intervention activities (Kompier, Cooper, & Geurts, 2000).
Both the active (Randall, Griffiths, & Cox, 2005) and passive resistance (Saksvik
et al., 2002) of middle managers have been found to influence intervention outcomes,
as has middle managers as the drivers of change (Nielsen et al., 2006; Nielsen &
Randall, 2009). To study the driver of change role, it can be useful to break the role
down to the actual behaviours and processes carried out in order to study at which phase they influence intervention outcomes. For example, do middle managers
inform employees about what can be achieved through the intervention, thus trying
to mobilize commitment to the intervention? Do middle managers allow employees
time to participate in workshops?
The mental models of the organizational actors indirectly influence intervention
outcomes through how the models influence the actors’ behaviours. Mental models
are used to make sense of the world, and explicit efforts at sense-making take place when the state of the world is perceived to be different from expected, i.e. when
changes are occurring (Weick et al., 2005). Individuals develop mental models that
guide their understanding of the surroundings and how they react to them (Johnson-
Laird, 1983). In this section, we focus on how actors’ cognitions may drive their
behaviours, whereas in the previous section we focused on the actors’ actual roles and
behaviours, i.e. how mental models have been translated into actual behaviours and
actions. For example, having a shared mental model among a group of employees
that it is the responsibility of management to ensure psychological health and well- being at work may result in those employees not being willing to participate in
steering groups and ad hoc working groups.
Although mental models are individual, shared mental models may develop over
time as organizational members share experiences (Pillai & Williams, 2004). Mental
models govern how situations are interpreted, how individuals react to these
284 K. Nielsen and J.S. Abildgaard
situations and how they cope with the demands put on them in the situation
(Daniels, 2011). Transferred to an intervention context, mental models determine
how participants react to the intervention and its activities and may explain the roles
and behaviours of key stakeholders throughout the intervention project. It is relevant to examine two types of mental model when evaluating organizational interventions:
that is, perceptions of the phases of the intervention, and specifically perceptions of
the quality and sustainability of intervention activities developed at the action
planning phase (intervention content).
Mental models of the intervention programme. Employees and managers should be
seen not only as being targets of organizational interventions but also as actors who
interpret their surroundings, including the intervention and its activities: these
interpretations govern the actors’ behaviours.
If a group of employees have a joint understanding that the intervention may be of
benefit to them they will as a unit work towards the success of the intervention (Nytrø et
al., 2000). Conversely, they may resist the intervention if a shared mental model exists that the intervention will not be of benefit to them (Hurrell & Murphy, 1996). Individual
members of the group who have unfavourable perceptions of the intervention may try to
sabotage it. A number of studies have implicitly examined how mental models drive
actors’ behaviours, thereby influencing intervention outcomes (Dahl-Jørgensen &
Saksvik, 2005; Mikkelsen & Saksvik, 1998; Nielsen et al., 2010b).
Mental models of intervention activities (intervention content). In an intervention
evaluation, the mental models of specific aspects of the intervention phases and its
process should be examined (Nielsen & Randall, 2012a). Examining the mental
models of employees will help rule out alternative explanations for the intervention
not achieving the desired change, such as middle managers being unwilling to delegate additional tasks. For example, Biron, Gatrell, and Cooper (2010) found that managers
did not use a stress management assessment tool because they believed it to be
unnecessary, and Nielsen et al. (2007) found that individuals’ positive appraisals of the
quality of an intervention’s activities (during the implementation phase) were
associated with higher levels of job satisfaction and fewer symptoms of stress.
Organizational context can be defined as ‘‘situational opportunities and constraints
that affect the occurrence and meaning of organizational behaviour as well as
functional relationships between variables’’ (Johns, 2006, p. 386). Johns’ (2006)
definition highlights the salience of context in every aspect of organizational life,
with its impact varying over time and across situations. Contextual factors can have a
mediating or moderating effect on the link between an intervention and its outcomes
(Heaney et al., 1993) and may help rule out alternative explanations for intervention outcomes (Cook & Shadish, 1994; Johns, 2006).
The overall context of the intervention (its ‘‘omnibus’’, Johns, 2006) should be
evaluated. The participants in the intervention, the driving forces behind it, the time
and place where it is implemented, and the nature of the work that is carried out by
participants, all influence the intervention process and outcomes. Examples of the
Work & Stress 285
omnibus context that may hinder successful intervention implementation may
include the nature of the job (e.g. being required to have much face-to-face contact
with customers or clients) (Dahl-Jørgensen & Saksvik, 2005) and bureaucratic
organizational structures (Saksvik et al., 2002). Numerous particular, or discrete contextual events have been cited as possible
reasons for unexpected intervention outcomes. These events include the implementa-
tion of new organizational structures concurrent to the intervention (Nielsen et al.,
2006), other conflicting change initiatives (Guastello, 1993; Nielsen et al., 2010a),
lack of integration of the intervention with corporate strategic planning (Schurman
& Israel, 1995) or macro-economic factors, e.g. economic recession and subsequent
organizational downsizing (Landsbergis & Vivona-Vaughan, 1995; Mikkelsen &
Intervention design and implementation
In the following we describe the phases of an organizational intervention (Nielsen
et al., 2010c) as shown in Figure 1, and describe which elements should be considered
under each phase in our evaluation framework in order to identify how these
elements may influence the later phases and subsequently the outcomes of the
Initiation: Developing the intervention strategy
In the initiation phase, the intervention strategy is developed. The role of formal
actors (e.g. consultants, employees, manager and middle managers) is determined at
this phase. Also, a communication strategy for the programme is likely to be
developed (Nielsen et al., 2010d). Although the roles of actors and the communica-
tion strategy are formulated in the initial phase, roles and behaviours may change over time. For example, while the senior manager may play an active role at
the outset, for instance, by communicating the importance of the programme, he or
she may withdraw and leave the practicalities to middle managers or union
representatives. In ways like this the relative importance of actors can shift during
the project. Communication shapes how people make sense of events (Weick et al.,
2005). Information at meetings or through newsletters can have a substantial impact
on the mental models of organizational interventions and subsequently drive the
behaviours of actors. It has been shown that the amount of communication about a programme (Nielsen et al., 2007), communication about the rationale behind a
programme and its progress (Mattila, Elo, Kuosma, and Kylä-Setälä, 2006; Nytrø et
al., 2000), communication to ensure participants’ understanding of any new roles
and responsibilities resulting from the programme (Øyum, Kvernberg Andersen,
Pettersen Burvik, Knutstad, & Skarholt, 2006) and communication about progress
(Landsbergis & Vivona-Vaughan, 1995) may influence intervention outcomes.
Screening: Identification of problem areas
Screening not only forms the basis for developing intervention activities (content) but
also serves as the baseline measurement in evaluating intervention outcomes,
286 K. Nielsen and J.S. Abildgaard
through pre- and post-measurements of expected outcomes. It is important to
document the basis and type of screening on which activities are prioritized and
planned. Screening may influence the progress of the intervention programme. The
type of method employed, the measures used and the type of feedback all influence actors’ (e.g. managers or occupational health practitioners) views and behaviours
regarding the subsequent steps in the intervention. For example, if the results of
screening were difficult to understand for organization members they may
misinterpret the results or ignore these when developing action plans.
Action plans: Developing intervention activities
How action plans are developed and what they contain should be studied and
recorded. This documentation includes a description not only of the planned
intervention activities, their purpose, the expected working mechanism (Nielsen
et al., 2006), but also the process (e.g. meetings) of action plan development.
Documentation should include how intervention activities were planned (e.g. the number of meetings, who were invited and who showed up) and who decided on
which activities (managers or joint decision making), and should note both conflicts
and agreements regarding the final plan of action. Why and how participating
stakeholders expect an activity or initiative to have a given effect (programme theory)
should also be noted. The level of detail of action plans should also be documented.
Action plans differ in detail from vague statements such as ‘‘We want to be better
at . . .’’ and should clearly outline the activities, their aims, responsibility, resources, deadlines and methods of evaluating its success (Cox, Randall, & Griffiths, 2002). These differences are likely to impact the extent to which action plans are used and
Traditionally, intervention activities have been divided into three categories on
the basis of their working mechanism. These categories are primary interventions
(aimed at reducing or eliminating the problem at source), secondary interventions
(aimed at increasing the resources of the individual to deal with the demands of the
job) and tertiary interventions (aimed at helping employees suffering from ill-health)
(Randall & Nielsen, 2010). However, in order that a detailed evaluation of organizational interventions can be conducted, we propose instead using a taxonomy
of interventions at four levels that emphasizes the content of each type of
intervention: intervention activities targeting the individual, the group, the leader
and the organizational procedures and structure (Nielsen et al., 2010d). Separating
the planned activities into these four levels enables the evaluator to identify which
mechanisms drive the outcomes at each level, e.g. changes in organizational
procedures may be the responsibility of the Human Resources Department, whereas
intervention activities targeting the work group requires group members themselves taking responsibility for changing how they work together.
Implementation: Implementing planned activities
Another significant and often understudied aspect of organizational interventions is
the implementation phase (Nielsen et al., 2010d). Empirical evidence indicates that
documenting the implementation activities before, during or after the intervention
can substantially improve the understanding of the intervention outcomes. In a study
Work & Stress 287
by Nielsen et al. (2006) differences in intervention outcomes could partly be
explained by the level of implementation of planned activities. Randall et al. (2005)
found that employees who had not been informed of a change in the responsibility of
middle managers experienced significantly poorer well-being than those informed about the change. The documentation of the plans for intervention activities should
be held up against documentation of the activities and initiatives that were actually
implemented (Nielsen et al., 2006). It is also important to document who makes
intervention activities happen. Kompier et al. (2000) found that in 11 case studies
across Europe, middle managers were responsible for implementation of intervention
programmes in most cases. Dahl-Jørgensen and Saksvik (2005) reported that middle
managers resisted change by restricting the time spent on intervention activities by
Evaluation effects: Discovering the effects of the intervention programme
Evaluation is the final phase of an intervention programme, and is where the data are
analyzed to determine the effects of the programme (e.g. Biron et al., 2010; Nielsen
et al., 2006, 2010a). For this, usually a second round of the initial screening survey is used, sometimes together with measures of the process (e.g. Nielsen et al., 2007;
Nielsen & Randall, 2009) and any qualitative data collected. Some researchers
advocate the use of psychological health and well-being as outcome measures when
evaluating organizational interventions (Richardson & Rothstein, 2008), whereas
others argue that there is a need to examine the level of effects at which the intervention
programme brings about changes (e.g. Semmer, 2011); however, both recommend
assessing the changes from baseline to follow-up. Griffin (1991) argued that the chain
of causality of effects should be examined in order to establish whether observed changes are brought about by the intervention programme and alternative explana-
tions for change can be ruled out; this means studying whether the intervention
activities that are implemented lead to changes in working procedures, and whether
such changes lead to changes in working conditions, and whether changes in working
conditions lead to changes in health, well-being and performance. Taking this
approach, which is the one we advocate in our evaluation framework, attention
should be paid as to when effects at different levels can be detected: changes in practices
may be detected at a relatively early stage, whereas changes in health may not be detected until much later (Grant & Wall, 2009; Semmer, 2011). Only by establishing
this chain of events can we plausibly link the intervention to the observed changes in
health, well-being and performance (Cook & Shadish, 1994).
In our evaluation framework we propose following a line of progression to
determine the chain of effects in organizational interventions. This involves
monitoring changes in attitudes, values and knowledge, development of individual
resources, changes in procedures, changes in working conditions, changes in
employee health and well-being, changes in quality and productivity and finally, changes in occupational safety and health practices. In the following sections we will
deal with each of these in turn.
Changes in attitudes, values and knowledge. Just as mental models are developed
about the intervention programme and its activities, individuals also develop broader
288 K. Nielsen and J.S. Abildgaard
mental models of the work that drive their working practices and behaviours.
Studying changes in participants’ mental models may help understand why changes
occur in one individual but not in another (Taris & Kompier, 2003).
In order for real changes to happen as a result of an organization intervention, the actors must unlearn old mental models and learn new ones (Schurman & Israel,
1995). Argyris (1991) introduced the concept of theories of action. Such theories are
governed by a set of values that guide the individuals’ actions and reactions to
changes. An important distinction is between theories-in-use and espoused theories.
Theories-in-use are the mental models that guide our behaviour whereas espoused
theories are the attitudes and beliefs that we tell others guide our behaviour.
According to Argyris, real change only happens when individuals change their
theories-in-use. Mikkelsen and Saksvik (1999) reported that a participatory intervention led to a change in perceived responsibility; where employees had felt
that ensuring a good working environment had previously been the responsibility of
managers they now realized that they were also responsible.
Development of individual resources. A key element in organizational interventions is
participation (Kompier et al., 1998, 2000). The underlying assumption is that
through participation employees become empowered and gain resources (Nielsen &
Randall, 2012b). Such resources include increased self-efficacy (the employees’ beliefs in their own competencies; Bandura, 1997), including their beliefs in their
ability to identify, address and manage the improvement of working conditions.
Another possible resource that may be developed is collective employee job crafting.
Recent research has started to investigate the extent to which employees craft their
jobs to ensure good job characteristics and maintain their well-being (Nielsen &
Abildgaard, 2012). It is likely that participatory intervention designs enable
employees to identify ways in which they can collectively improve their working
conditions (Nielsen, 2013).
Changes in working procedures. Organizational interventions aim at changing the way
work is organized, planned and managed, yet few studies have investigated whether
changes in existing working procedures actually take place. The above mentioned
espoused theories (the attitudes, values and beliefs) need to become theories-in-use
that are enacted. Significant, noticeable and sustainable changes in existing values
and practices should lead to changes in behaviours (Argyris, 2004). This is what
Argyris (2004) labelled double-loop organizational learning. Argyris (2004, p. 44) stated that ‘‘double-loop learning and effective implementation are tightly linked’’. A
recent study by Nielsen and Randall (2012b) found that actual changes in procedures
during a teamwork intervention were associated with post-intervention working
conditions and well-being.
Changes in working conditions. The next link in the chain of change is whether
changes in perceptions of working conditions can be observed. According to Lazarus
and Folkman (1984) poor well-being is the result of an individual’s appraisals of a mismatch between the individual’s resources and the demands of the environment. It
should be evaluated whether employees’ appraisals of targeted working conditions
have changed (whether resources have increased and/or demands have decreased)
(Daniels, 2011; Semmer, 2011). To ensure that changes are caused by the
Work & Stress 289
intervention, perceived working conditions targeted by the intervention should be
compared with those not targeted by the intervention. If only the perceived working
conditions directly targeted by the intervention have changed (for example, if social
support has increased in a teamwork intervention), the likelihood that working
conditions improved due to the intervention programme is greater.
Changes in employee health and well-being. Central to the evaluation of the effects of
interventions is the evaluation of the effects on employee health and well-being.
These effects are often evaluated in terms of reductions of stress symptoms or
improvements in mental health and well-being (Bambra, Egan, Thomas, Petticrew, &
Whitehead, 2007; Egan et al., 2007; Richardson & Rothstein, 2008). While up to now
the focus primarily has been on negative outcomes such as stress and strain (Murta et
al., 2007), it is also important to examine how interventions may enhance health and
well-being in terms of ensuring positive health and well-being and how employees
may thrive at work (DeJoy, Wilson, Vandenberg, McGrath, & Griffin-Blake, 2010).
Most often these outcomes are measured by means of surveys; however, a few studies
have documented the physical health effects of an intervention by measuring cortisol,
prolactin and testosterone (Theorell, Orth-Gomér, Moser, Undén, & Eriksson,
Evaluating a wide range of effects of an intervention can reveal both positive and
negative effects. For example, job enrichment may have a positive effect on
autonomy, which may on the one hand lead to increased psychological well-being
but on the other hand lead to increased demands, thereby increasing anxiety
Changes in organizational health: Quality and performance. The business case for
conducting organizational interventions is the return-on-investment argument that
improvements in the way work is designed, organized and managed will also lead to a
healthier organization economically (Cox, Karanika, Griffiths, & Houdmont, 2007).
This assumption is in accordance with the happy worker-productive worker thesis
suggesting that happy employees are more productive (and vice versa) (Taris &
Schreurs, 2009). Although rarely examined, employee health and performance have
been found to improve post-intervention (e.g. DeJoy et al., 2010). The focus on the
economic benefits of intervention has to date been rather narrow; however, return on
investment may include reduced turnover, reduced absenteeism, lower healthcare
costs and fewer accidents.
Changes in occupational safety and health management. The aim of organizational
interventions is to improve employee health and well-being. During such a process,
learning may be acquired on how best to monitor adverse working conditions in the
future and take appropriate action. In line with Argyris’ (1991) differentiation
between single-loop learning (e.g. learning to do things differently) and double-loop
learning (changing the way one learns things), a change in health and safety routines
is essential. If the routines regarding managing health and safety are improved then a
change is more likely to be sustainable than if the changes only deal with solving
290 K. Nielsen and J.S. Abildgaard
Organizational interventions are often recommended for improving employee health
and well-being, but unfortunately there is a scarcity of published studies, possibly due
to the complexity of conducting such studies and teasing out their effects (Semmer,
2011). The framework presented here is comprehensive in that it does not prioritize
which elements to look at. We feel that with this type of research still in its infancy
we are unable to determine which elements are more important to focus on. Rather
we hope to provide guidance on which elements intervention researchers may
consider when developing evaluation models for their intervention programmes.
We believe the framework can help answer the question that may be posed following
an intervention: If the hypothesis is supported and desired changes are observed, are
these changes due to the intervention programme or due to other events and activities
concurrent with the intervention programme (Cook & Campbell, 1979; Grant & Wall,
2009)? The framework may serve to ensure external validity and maintain internal
validity in that it proposeswhich elements should be looked at when trying to determine
the conditions under which an intervention may be successful, and how we can
determine whether changes in outcomes can be referred back to the intervention. The
best method of obtaining this information may be through the (multiple) case study
that allows us to explain the causal mechanism in real-life interventions, by combining
quantitative and qualitative methods to explore the importance of process and context
in determining intervention effectiveness (Yin, 1994). In doing so, we may also
determine whether disappointing intervention outcomes may be due to poor theory or
to failure of the programme (Nielsen et al., 2006).
Challenges in evaluating organizational interventions
One of the challenges of evaluating organizational interventions according to this
framework is that it is very time-consuming and requires skilled researchers. To
obtain the kind of data proposed in this framework requires collecting both
qualitative and quantitative data over a long, continued period of time. It requires a
high level of anticipation in the initial planning of the programme in order to identify
at the outset which elements should be included. It also requires the researcher to
stay sensitive to changes that may warrant studying other actors and processes that
emerge throughout the course of the intervention programme. To conduct an evaluation such as the one we outline in this article, researchers
should use the most appropriate mix of methods. While we do not argue against the
(quasi-)experimental design using questionnaire data to measure pre- and post-
intervention, we propose an expansion of methods to include keeping minutes of
meetings relevant to the intervention, conducting interviews with employees,
managers and stakeholders, recording field study notes from workshops and other
key events and obtaining experience sampling or diary data (Nielsen & Daniels,
2012). All that will allow us to collect data on the processes and decipher what it is
about the intervention that makes it work at which phase (Pawson, 2006). Collecting
rigorous data is both time- and resource-consuming. We recommend that at the
planning stage, researchers construct a model of which elements to include in their
study and how each element may be measured to ensure a systematic, coherent
Work & Stress 291
Implications for research and practice
We hope that this evaluation framework, with some adaptation to the individual
situation, can be used by managers, HR and occupational health practitioners and
that it will raise awareness of how self-initiated organizational interventions may be
evaluated. While it may be unrealistic to expect organizations to engage in the level
of evaluation proposed here, the framework may help create an awareness of the
importance of integrating organizational interventions into other organizational
practices and evaluating their outcomes. The framework may serve as a sense-making
tool (Weick et al., 2005) whereby organizations can start to develop an understanding
of the complexity of improving employee psychological health and well-being, and
how such initiatives may interact with other initiatives, and their prerequisites for a
For researchers, the framework emphasizes the necessity to investigate the whole
process, from beginning an intervention programme to post-intervention evaluation.
Such an investigation includes studying which mechanisms can explain intervention
outcomes. We suggest that researchers develop working models at each phase of the
intervention process to detect which mechanism makes change happen (e.g. what
are the working mechanisms that enable the development of an action plan based on
the screening phase). At each phase it is also necessary to analyze the mental models
of all actors in the intervention and the context that influences those models and
either facilitates or hinders progress from one phase to the next (Pawson, 2006).
Limitations of the proposed framework
It is important to note that we are not proposing a ‘‘one size fits all’’ evaluation
framework, because each individual programme has its own areas of importance and
is embedded in an organizational context. Therefore the categories, elements and
actors described in the present framework should be seen as rough guidelines for the
evaluation of interventions. The framework can be seen as a blueprint for evaluation
that has to be adapted to fit a given intervention programme. The framework is
based on a review of recent research in the field of organizational interventions.
However, there will most likely be elements or actors that play a role which have not
been identified in current research. Given the large number of studies reviewed from
many different countries, particularly Europe and North America, we are, however,
confident that the most common central elements have been included in the
framework. In this paper, we focused on organizational interventions; other
disciplines may face similar challenges and it should be examined to which degree
the framework can be transferred to other areas.
In our framework we have not provided time lines for when which kinds of data
should be collected, or what appropriate follow-up times may be. Nor do we provide
guidance on which methods should be used to collect data on the different elements
in the framework: we have focused on the elements to include.
The framework may be criticized for underplaying aspects of organizational life,
such as the different interests of various groups (employees/managers), power
relations and other factors. We chose to focus on an open approach to evaluation of
the process and outcomes of an intervention. We argue that an evaluation including a
292 K. Nielsen and J.S. Abildgaard
focus on the mental models of roles and behaviours of the various actors will reveal
such conflicts and power relations should they be relevant to study.
Grant and Wall (2009) highlighted the scarcity of organizational intervention studies
and this is still true. It is our hope that in this article we have provided ideas on how
researchers may develop and evaluate organizational interventions that focus on
improving employee psychological health and well-being. Our evaluation framework
provides an overview of how researchers may increase the internal and external
validity of organizational interventions and take the next steps towards teasing out
the mechanisms of such interventions and in the longer term increase the likelihood
of them having the desired outcomes. In so doing, it is hoped that they will provide
answers to the crucial questions of what works for whom, under which circum-
stances, and how does it work.
This research was funded by the Danish National Work Environment Research Fund, grant
no. 14-2009-09. The research fund had no involvement in the development of this framework,
or in the decision to submit this work for publication.
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