Organizations consist of complex networks of agents who each play an important

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,


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