Description of the condition
The workplace and especially the psychosocial work environment are important determinants of the health and well-being of employees (Brunner 2006; Joyce 2010; Marmot 2006; Marmot 2012). Trends such as increased work pace, more highly skilled jobs, and the increased use of information and telecommunication technology have been placing increasingly higher demands on the mental functions of employees (European Agency for Safety and Health at Work 2007; Nieuwenhuijsen 2010). Psychosocial risk factors in the working environment are associated with higher levels of work stress, which is reported to be experienced by about 22% of European workers (Houtman 2005). In addition, an online-survey conducted in 2001 in more than 30.000 workers worldwide revealed that globally 26% (range 17-35%) of workers felt to be under unreasonable work stress (D'Mello 2011).
While successful coping with work stress may have positive effects on performance and quality of life, unsuccessful coping may in the long run lead to coronary heart disease, musculoskeletal problems, adverse health-related behaviour (e.g. smoking, substance abuse), impaired mental-health (e.g. anxiety, burnout, depression) or other stress-related symptoms (Fransson 2012; Heikkilä 2012a; Kivimäki 2012; Kuper 2002; Lang 2012; Siegrist 2006; Stansfeld 2006). Importantly, feeling stressed should not only be seen as a risk factor or intermediate variable alone, but also as a condition of reduced quality of life in itself.
To our knowledge, there are no generalisable data on rates of sick-leave that could be solely and specifically attributed to work-related psychomental stress or consecutive stress-related symptoms. Likewise, it should be taken into consideration that the total rate of absence from work is not always due to illness alone, that is, justifiable sick leave, but also due to unjustifiable absenteeism, which can be defined as the practice of regularly staying away from work without good reason (Darr 2008; Oxford Dictionaries 2013). Therefore, the over-all rate of absence from work should be seen as a combined measure influenced by a mixture of medical, psychological, and social factors as well as individual work attitudes like withdrawal, commitment, work-engagement or job satisfaction (Darr 2008; Johns 2007). A survey conducted by the European Union (EU) in 2007 revealed that 23 million people, representing 8.1% of current or former workers reported to have had a work-related health problem within the preceding year (European Commission 2010; European Commission 2011). It was estimated that these problems resulted in at least 367 million calendar days of sick leave (European Commission 2010; European Commission 2011). The overall rate of sickness absence ranged from about 3.5% to 8.0% within the EU during the 1990s (Eurofound 1997). Where as in 2011 it was 4.7% in Germany (WIdO 2012), 1.8% in the UK (Office for National Statistics 2012), and 3.0% in the USA (Bureau of Labor Statistics 2012). The economic burden caused by absence from work (due to all causes) in the EU countries was estimated between 1.5% and 4% of the gross domestic product (GDP) in the 1990s (Eurofound 1997; Livanos 2010).
After musculoskeletal problems, mental (stress-related) disorders like burnout, anxiety and depression (14%) have been the second most frequent work-related health problems in this survey (European Commission 2010; European Commission 2011). In Germany, all mental diseases accounted for about 10% of all sick-leave days but may also include non stress-related cases (e.g. personality disorders, substance abuse) (WIdO 2012). This number has increased by nearly 60% since the year 2000 in Germany (WIdO 2012). In particular, it should be mentioned that the rate of sick leave due to burnout syndrome has increased more than 10-fold in Germany since 2004 (WIdO 2012). In 2011, burnout syndrome caused more than 94 days of sick leave in 1000 people (WIdO 2012).
Description of the intervention
This review will include studies on all human resource management (HRM) training programs that aim to enhance the knowledge, the attitude, the skills and the behaviour of supervisors. HRM training programs are widely used to improve leadership in organisations (Yukl 2012). Training can take many forms, from self-helping activities to developmental activities (e.g. 360° feedback, coaching), from short workshops to programs that last for a year or more, from programs focused on skills needed in the current position to training preparing managers for promotion to higher positions, or from programs tailored to a company's needs to workshops imparting generic skills (Yukl 2012). We classify the interventions relevant for this review based on the following two dimensions (Table 1).
— Self-help activities (textbook-based, video-based, web-based)
— Formal training (face-to-face lecture, classroom lecture), case analysis and discussion— Simulations— Role playing — Behavioural role modelling — Developmental assessment centres
Training on-the-joba, (real time/things/situations)
— Executive Coaching — Mentoring — (360°) Feedback — Job rotations — Action learning
— Communication (e.g. active listening, clear instructions, role clarity, clear and ethical organisational and personal goals, etc.)
— Justice (interactional)
— Recognition and immaterial reward (appreciation, respect, etc.)
— Supervisory support (emotional)
— Leadership style
|(A1) e.g. web-based teaching of how to improve active listening, role-playing simulation for improving active listening skills||(A2) e.g. personal coaching concerning active listening while working|
Design of working environment b
— Justice (procedural and distributive, including material reward)
— Autonomy (e.g. working time/schedule)
— Decision latitude and control
— Supervisory support (instrumental)
|(B1) e.g. classroom lecture for improving knowledge on positive health effect of participative leadership, case-analysis simulation for improving participative leadership behavior||(B2) e.g. 360°-feedback session for assessing and improving the leaders participative leadership behavior|
First, we distinguish between HRM training programs (i) aiming to improve the dyadic interaction (e.g. relationship, communication) between supervisors and employees, and (ii) aiming to improve the capabilities of supervisors to change the psycho-social working environment in a health-promoting way.
Second, we classify interventions according to their proximity to real life by distinguishing between (i) training off-the-job such as in simulated conditions and (ii) training on-the-job while working with real people on real problems (adapted from Australian Public Service Commission 2011 and Nohria 2010).
The combination of both dimensions results in four categories of interventions (Table 1). The table presents practical examples of what HRM training programs may look like.
How the intervention might work
The linkage between HRM training for supervisors and health outcomes of employees is rather complex, often indirect and influenced by a plethora of contextual factors (Figure 1). According to Brunner 2006, employee health is related to the social structure and work environment via several psychological factors and health-related behaviours. Thus, HRM training programs might work by influencing the following two pathways.
Reduction of work-related stressors: Important work-related psychosocial risk factors and possible sources of work-related stress (work stressors) are listed in Table 2. Supervisors may influence some of these stressors, but this also depends on the organisational, structural, cultural and other environmental conditions. For example, 360°-feedback sessions could identify such work-related stressors as communication deficits between supervisors and employees that manifest as unclear or contradictory instructions. These deficits may be worked through during personal coaching sessions for supervisors.
Work-related stressors and resources
The list is neither exhaustive nor does it make any claims about completeness. Some factors can be both, a work-related stressor and a resource depending on whether they are present/pronounced or absent/less pronounced (Cropanzano 2005; Eurofound 2010; Houtman 2007; Kals 2012; Lohmann-Haislah 2012; Semmer 2010; Stadler 2003; WHO 2013; WHO Regional Office for Europe 2010).
Work-related stressors Work-related resources
Bullying, harassment and violence
Emotionally distressing human services work
Ethical conflicts (e.g. illegitimate task assignments, carrying out task conflicting with personal values)
High demand and low control
Imbalance between effort and reward
Injustice and unfairness
Lack of autonomy and poor decision-making latitude
Lack of participation
Lack of respect and recognition
Organisational change, job insecurity
Poor communication and information
Poor prospects for career or personal development
Poor social relationships (low social support, lack of role clarity, poor leadership, adverse social behaviour)
Unclear or ambiguous instructions and role, unclear organisational and personal goals
Autonomy and decision latitude of employee
Good supervisor-employee relationship
Possibility of personal growth and development, career perspective
Respect and recognition
Social support (emotional, instrumental)
Promotion of work-related resources: As a dimension of mental health, well-being has been defined as a state in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community (WHO 2005). Therefore, it is crucial to encourage positive psychological or salutogenic approaches (Diener 1999; Ryff 1996; WHO 2005), for example by promoting work-related resources as listed in Table 2. In the absence of any work stressors, work-related resources themselves are unlikely to significantly influence health status, but when employees are exposed to stressful situations resources may improve the capability of employees to successfully cope with stress. For example, a role-playing simulation that aims to improve the ability of active listening and giving social support to the employee may lead to improved considerative and supportive behaviour of the supervisor. In turn, the employee's perception of altered supervisor behaviour (being recognised, receiving consideration and support) will act as a resource as described above.
In addition, supervisors may indirectly influence employees' behaviours as a consequence of coping with work stress (Knoll 2011; Siegrist 2006). Behaviours that can be affected include for example smoking, alcohol use, drug abuse, presenteeism (meaning attending work while ill) (Johns 2010), physical activity, diet, and adherence to regular check-ups or health-promotion programs (Bamberger 2006; Heikkilä 2012a; Heikkilä 2012b; Kelloway 2010).
Furthermore, supervisors' support of work-place health programmes is a critical determinant of the success of employee-focused health promotion interventions in organisations (Kelloway 2010). Concurrently, HRM training programs may also influence several context variables or modifying factors, which in turn influence coping with stress. However, we will not explicitly analyse these complex interactions between HRM training, the behaviour of supervisors and the context in this review. In order to identify the specific effect of HRM training as compared to everything else going on in the complex work environment, we will carefully document intervention components and any relevant contextual information provided.
Why it is important to do this review
As mentioned above, about one quarter of workers who had participated in an EU-wide and global survey suffered from work-related stress and are therefore at considerably increased risk for work-related cardiovascular, musculoskeletal, and mental disorders (Ariens 2001; Belkic 2004; D'Mello 2011; Hoogendoorn 2000; Houtman 2005; Kivimäki 2002; Kivimäki 2012; Lang 2012; Marmot 2006; Stansfeld 2012).
There is consensus that onset of stress, stress consequences and degree of well-being could be influenced by leadership behaviour (Gregersen 2011; Kuoppala 2008; Nieuwenhuijsen 2010; Nyberg 2005; Skakon 2010). A number of studies have been conducted to analyse leadership behaviours in detail but their predominant purpose was to prove the eligibility of these models to predict work performance or job satisfaction. A part of these studies investigated the impact of leadership training on employee health and well-being. Recent reviews have been performed in a more or less systematic way but they have included predominantly non-experimental studies (Gregersen 2011; Kuoppala 2008; Nieuwenhuijsen 2010; Nyberg 2005; Skakon 2010). Two of these reviews contain randomised controlled trials (RCTs) but only one each (Kuoppala 2008; Nyberg 2005). Thus, we can derive only associations rather than true causal relationships between leadership interventions and health outcomes from these reviews. The most recent review of the literature by Tsutsumi 2011 focused on three RCTs and four quasi-experimental studies. However, the authors did not assess included studies' risk of bias nor did they perform a meta-analysis of results data.