Leadership and sickness absence

1. Leadership and sickness absence Hugo Westerlund, Ph.D. Stress Research Institue, Stockholm University / Hugo Westerlund, Ph.D., Stress Research Institute

2. Unemployment and sickness absence in Sweden 1990-2008 / Hugo Westerlund, Ph.D., Stress Research Institute

3. Swedish Sickness Absence Crisis • Low unemployment, high sickness absence • inclusion of unhealthy workers in the workforce • less discipline through fear of unemployment • broken coupling in recent years, both in Sweden and Norway • Shirking – a major issue in public debate • but the rise was mainly in long-term sickness absence • Attitudes and norms • changed collective norms • physicians’ sick-listing practices • more demanding private lives • Workplace factors • coincided with rise in perceived demands at work • consistent with recent research on business cycles and health • large differences between workplaces indicate managerial practices

4. Evidence in the literature • A systematic international review concluded that there was moderate evidence that good leadership was associated with decreased risk of sickness absence (RR=0.73; 0.70-0.89). • Kuoppala et al., JOEM 2008;50:904-915. • and scanty evidence on disability pension • ‘sickness absence’ not precisely defined • mostly support from supervisor

5. Organisational justice • Growing literature showing prospective association with health (Elovainio et al., Soc Sci Med 2004;58:1659-1669). • also shown in Whitehall II data (Head et al., J PsychosomRes 2007;63:433-440). • relational justice specifically about supervisor

6. Relational Justice • Your supervisor considers your viewpoint. • Your supervisor was able to suppress personal biases. • Your supervisor provided you with timely feedback about the decisions and their implications. • Your supervisor treated you with kindness and consideration. • Your supervisor showed concern for your rights as an employee • Your supervisor took steps to deal with you in a truthful manner.

7. A forest companyin Sweden and Finland • Authoritarian and laissez-faire conflict resolution associated with more sickness absence than democratic(Hyde et al., Soc Sci Med 2006;63:2218-2227). • Lack of attentive managerial leadership associated with more sickness absence(Westerlund et al., Work, accepted for publication).

8. The SLOSH studyadjusted prospective associations (ORs) Nyberg et al., Scand J Public Health 2008;36:803-811.

9. Leadership can affect:- • Health • likely, but not necessarily, reflected in sickness absence • Motivation to be present given a certain health status • positive motivation (pull) • fear of sanctions, e.g. job insecurity • Motivation to take sick-leave • push-factors, e.g. conflicts between boss and subordinate • Possibilities to work despite health problems • support and tolerance of non-optimal performance • task flexibility • provision of resources, e.g. occupational health care • Selection of employees (creating spurious associations) • hiring and firing policies • who are attracted vs. repelled

10. Leadership and IHDThe WOLF Stockholm study • My boss • gives me the information I need • is good at pushing through and carrying out changes • explains goals • shows that he/she cares for me • takes time to become involved in his/her employees’ development • encourages my participation in scheduling of my work • I • have a clear picture of what my boss expects of me • have sufficient power • receive praise if I have done something good • receive criticism if I have done something that is not good Nyberg A, Alfredsson L, Theorell T, Westerlund H, Vahtera J, & Kivimäki M. Managerial Leadership and Ischemic Heart Disease Among Employees: The Swedish WOLF Study. Occupational and Environmental Medicine, 2009;66:(1):51-55.

11. Good managerial leadership and risk of ischaemic heart disease Adj. 1: Education, supervisory status, social class, income, and physical work load Adj. 2: Smoking and physical exercise Adj. 3: BMI, systolic and diastolic blood pressur, total cholesterol, total LDL/HDL cholesterol ratio, triglycerides, fibrinogen, & diabetes

12. What characterises workplaces with low sickness absence • Swedish study of 2,063 companies with >74 employees each • classified into low, medium, and high absenteeism • companies with low absenteeism existed also in industries with overall high absenteeism, e.g. cleaning firms • qualitative interviews with managers & unions • Companies with low vs. moderate absenteeism: • focussed on early rehabilitation • had an active HR department • communicating with line managers • use occupational health care services more • have a preventive perspective / Fil.dr. Hugo Westerlund, Stressforskningsinstitutet

13. Limitations • Health and negative affect can influence ratings of leaders • causal inferences difficult • Leadership not well distinguished from other work environment factors • individual leader, managerial practices, or overall work environment? • external factors could influence both leadership and sickness absence, e.g. industry and local culture • Which aspects of leadership are crucial is poorly understood • leadership must be seen as a relational concept • how should interventions be designed?

14. Conslusions • Managerial practices are likely to influence sickness absence among employees • mainly through modifying behaviour and providing behavioural choices • Long-term exposure to poor leadership may cause severe health problems • Knowledge is still very unspecific • making interventions difficult • A structured company approach may help

15. THANKS FOR LISTENING! hugo.westerlund@stress.su.se / Hugo Westerlund, Ph.D., Stress Research Institute