Organizational interventions: A research-based framework for the evaluation of both process and effects Karina Nielsena* and Johan Simonsen Abildgaardb

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

Copenhagen, Denmark

(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

circumstances.

Keywords: process evaluation; organizational interventions; effect evaluation; evaluation framework

Introduction

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

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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

management procedures.

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

(Pawson, 2006).

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

evaluation.

282 K. Nielsen and J.S. Abildgaard

Organizational actors

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

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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?

Mental models

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

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

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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 &

Saksvik, 1999).

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

intervention programme.

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

implemented.

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

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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

employees.

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,

1995).

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

(Semmer, 2011).

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

current problems.

290 K. Nielsen and J.S. Abildgaard

Discussion

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

evaluation.

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

successful outcome.

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.

Conclusion

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.

Acknowledgements

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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