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,