Sx0597422enc 001

PREVENTING
ABSENTEEISM AT
THE WORKPLACE
EUROPEAN RESEARCH REPORT
.*'.
&'
* A k * EUROPEAN FOUNDATION
** . ** for the Improvement of Living and Working Conditions
PREVENTING
ABSENTEEISM AT
THE WORKPLACE
European Research Report
Robert Grndemann (sociologist) is working as a senior researcher/consultant at

NIA TNO in Amsterdam (The Netherlands). He has done a large number of national
and international research and consultancy projects in the field of work and health
(absenteeism, disabililty, reintegration, workplace health promotion etc.) for
governments, business organisations, private companies and public organisations. He
participated in a workgroup which developed a new standard for the registration of
absenteeism in the Netherland and he is the first editor of a periodical on absenteeism
policy for companies.
Dr. Tinka van Vuuren (psychologist) also works as a senior researcher/consultant at
NIA TNO. Before she worked as senior consultant for the Dutch Ministery of
Environment and Housing and as a lecturer at the Free University of Amsterdam. She
has written a number of articles on organisational change, worker participation and
workplace absenteeism.
PREVENTING
ABSENTEEISM AT
THE WORKPLACE
R.W.M. Grndeinann
C.V. van Vuuren
+ + +
EUROPEAN FOUNDATION
*yWW*
for the Improvement of Living and Working Conditions
Wyattville Road, Loughlinstown, Co. Dublin, Ireland

Tel: +353 1 204 3100 Fax: +353 1 282 6456/282 4209
E-mail: postmastereurofound.ie.
+
* * *
Cataloguing dala can be found at the end of this publication

Luxembourg: Office for Official Publications of the European Communities, 1997
ISBN 92-828-0418-6
European Foundation for the Improvement of Living and Working Conditions. 1997
For rights of translation or reproduction, applications should be made to the Director. European Foundation
for the Improvement of Living and Working Conditions. Wyattville Road. Loughlinstown, Co. Dublin.
Ireland.
Printed in Ireland
Contents
PREFACE
1.
1.1
1.2
1.3
1.4
THE COSTS OF ABSENTEEISM RELATED TO ILL HEALTH

The socio-economic situation in Europe
Demographic developments
The seale of the issue
What stake do the different parties have?
9
9
10
1I
12
2.
2.1
2.2
2.3
2.4
THE EUROPEAN STUDY ON ABSENTEEISM

AND ILL HEALTH
Aim and content of the study
The definition of absenteeism
Workplace absenteeism and ill-health
The structure of the report
15
15
16
18
18
3.
3.1
3.2
3.3
3.4
3.5
ABSENTEEISM AS AN ISSUE
Introduction
The perspective of national governments
The perspective of the employers' organisations
The perspective of the trade unions
Summary and discussion
21
21
22
32
34
36
4.
REGULATIONS AND STATISTICS ON

WORKPLACE ABSENTEEISM
4.1 Characteristics of the social security systems
4.1.1 Characteristics of the regulations on temporary
work incapacity
39
39
39
4.1.2 Characteristics of the regulations on extended or

permanent work incapacity
4.2 Statistical Data
4.2.1 The availability of statistical data
4.2.2 The scale of absenteeism
4.3 Summary and discussion
5.
5.1
5.2
5.2.1
5.2.2
5.2.3
5.2.4
5.3
STRATEGIES TO REDUCE WORKPLACE ABSENTEEISM

The underlying framework for the absenteeism and reintegration
process
The daily practice of absenteeism reduction at the workplace
Procedural measures
Preventive work-oriented measures
Preventive person-oriented measures
Reintegrative measures
6.
6.1
6.2
6.3
6.4
6.5
6.6
6.7
6.8
6.9
6.10
MODELS OF GOOD PRACTICE

Introduction
Systematic examination
Description of cases country by country
Characteristics of the organizations involved
Getting started
Identifying needs and problems
Organizing solutions and implementation
Evaluation and consolidation
Preconditions for success
7.
CONCLUSIONS AND RECOMMENDATIONS
7.1 Conclusions
7.2 Recommendations
7.3 Overview of the recommendations for specific bodies
REFERENCES
APPENDIX
Overview of the case studies
47
49
49
50
53
57
57
60
60
63
65
66
69
71
71
72
73
77
79
90
98
111
126
128
135
135
141
150
153
157
Preface
Within the Foundation's programme of work on 'health and safety', increasing

attention has been directed in recent years to measures for prevention of illhealth. While initially the focus was upon prevention of occupational accidents
and diseases, recent studies, for example on workplace health promotion, have
emphasised the significance of strategies at the workplace to maintain and
improve general health. The project reported in this publication puts
absenteeism from work in the centre of our attention, but specifically considers
ill-health as the main cause of this absenteeism. It is the first report to present
results on the situation regarding absenteeism, and measures for its reduction,
for all Member States of the European Union (EU).
The project has involved collection of data on absenteeism by a network of
researchers and correspondents in all the Member States. The gaps and
difficulties in use of national statistics have been evident from the start, but one
aim of the study has been to describe patterns of absence. An understanding of
these patterns requires knowledge of the large number of factors influencing
absence; particular efforts have been made to analyse the complex and varied
social security regulations of the different Member States.
The presentation of the national situations, insofar as information was available,
provides the context for the assessment of initiatives to reduce workplace
absenteeism, based upon detailed case studies from eight countries. These cases
form the main material for the assessment of organisational, worker's health
promotion and reintegration initiatives designed to combat the causes of illhealth and absenteeism from work. The studies document the process of
establishing such initiatives at the workplace, the participation of different
groups in the workforce, and analyse the costs and benefits of the measures.
These analyses lead to the identification of key factors influencing the success
of the absenteeism initiatives. The report concludes with recommendations for
Preventing absenteeism at the workplace
action to improve worker's health and attendance, outlining implications for

information, training, occupational health practice, and policy -at the company,
national and European levels.
The report was evaluated in December 1996 by representatives of the
Foundation's Administrative Board. This group has acted as an Advisory
Committee throughout the research, providing valuable input and experience.
They provided guidance and encouragement both in general and from their
particular viewpoints as representatives of employers (Bernard Le Marchand,
Roland Waeyaert), unions (Marcel Wilders, Jaap Hoolveld) governments (Jose
Dos Santos Leito) Committee of Experts (Jean-Paul Demuth) and EU (Susan
Mawer). The Committee approved the report subject to minor modification. It
acknowledged the lack of systematic and comparable information, both on
absence rates and on the effectiveness of measures to reduce workplace
absenteeism due to ill-health. Similarly, the terms and conditions of legislation
were not always comparable. Although this made the research difficult, the
Evaluation Group welcomed the study as innovative and important.
The conclusions and recommendations were regarded by the Committee as a
good starting point for further work. In future, there will be a need for more
information and reflection on the absenteeism situation in small and medium
enterprises, which is where most workers's are employed: the SMEs face
specific challenges and often lack knowledge, within the organisation, about
how to address issues of ill-health and absenteeism. In the changing workplace
environment-with increasing numbers of workers on atypical contracts, more
women workers and new health stressors - there is a need to reconsider ways to
reach all of the workforce with effective measures. Although absence will never
reach zero, it is essential to consider the main health reasons for absence, and Io
distinguish what actions are relevant to improving the work environment or the
promotion of the worker's general health and well-being. As the conclusions to
the report emphasise, there are important contributions to be made by all parties
in the workplace.
The Foundation expresses gratitude to Rob Grundemann and Tinka Van Vuuren
as authors of this European synthesis report, and also io the authors of the eight
national reports as wel! as the correspondents who provided information for the
Member States not involved in the main research. The members of the Advisory
Committee are also thanked for their support and guidance.
Clive Purkiss
Director
Eric Verborgh
Deputy-Director
The costs of absenteeism

related to ill health
/// this chapter current social and economic developments in Europe are
presented, which include a process of rethinking arrangements for social
security and a shift of (financial) responsibility from governments to
employers and employees. Other considerations include demographic
developments and the economic costs of workplace absenteeism and ill
health. Finally the perspectives of the different parties on reducing
absenteeism and ill health, and the differences in proposed solutions are
discussed.
1.1
The socio-economic situation in Europe
The socio-economic situation in Europe continues to change at a rapid pace. In

many countries there is substantial government debt and a deficit in current
budgets. During the economic recession at the end of the 1970s and the
beginning of the 1980s many governments allowed their debts to mount up and
financed them through (state) borrowing. The annual interest payments on the
debt are a substantial item in current budgets. Most countries have been engaged
for some time in cosi containment and reducing the financial deficit, principally
through cuts in social security and in the costs of the civil service. Increasingly
the preconditions for benefit are being tightened up and the benefits themselves
reduced. In addition there is a shift in responsibility from the government to
business itself. As a result employers and employees are increasingly confronted
with the costs of workplace absenteeism and work incapacity. More and more
employers themselves have to pay the costs of absenteeism and disability in
their company, at least for some time, while in the past this burden was mostly
carried by the collectivity (society). Employees are confronted with more
stringent qualifying conditions and lower levels of benefit. Private insurance
companies are the newcomer in the market, (re)insuring the risks of employers
and employees.
1.2
Demographic developments
The reduction of absenteeism and disability as a result of current measures at

national level will come under pressure in the years ahead as a result of the
changing age and sex structure of the (working) population, with an increasing
proportion of women and rising average age. Women are usually found to have
higher levels of absences than men. This could be caused by the kind of work
women do. Women are mostly found in lower status, and often also more
physical demanding, jobs at the workplace. There is also an indication that
gender-related diseases affect more women than men. Women often also have
more family responsibilities (children and parents) than men. The growing
labour force participation of women may therefore increase the overall level of
absenteeism.
Older employees are generally absent less often than younger employees, but
when they are absent this is usually for much longer periods than younger
people. Older employees therefore have a greater chance of finding themselves
in schemes for long-term or permanent invalidity than younger employees do.
In part the higher absenteeism of older workers arises as a result of a longer term
exposure to unfavourable working conditions and because they have more
health problems than younger people as a result of the general process of
ageing. In very demanding (physical and/or mental) jobs the relationship
between age and absenteeism may produce a healthy worker effect. When too
many workers drop out of work before the retirement age as a result of health
problems, the 'surviving' older workers could even have to be more healthy that
the middle-aged workers and as a result could also have lower levels of
absenteeism. However it should be noted that the relationship between age and
absenteeism is mainly based on research among male workers, because of the
previously low labour force participation of older women.
As the average age of the working population rises absenteeism and disability
are very likely to increase; but the financing of work incapacity schemes and
pensions provisions has become increasingly difficult. A greying workforce is
therefore an important reason to take measures to maintain and improve the
health of the workers.
10
The costs of absenteeism related to ill health
1.3 The scale of the issue

There are a range of expensive direct and indirect costs from absenteeism and
disability. For example although workplace absenteeism decreased in the UK
from 5.05% in 1987 to 3.6% in 1994, still 177 million working days were lost
in 1994 as a result of sickness absence. This has been assessed at over 11
billion ( 13.2 billion ECU) in lost productivity and a cost of 525 (630 ECU) per
employee (Balcombe & Tate, 1995). German employers paid in 1993 up to DM
60 billion (30.5 billion ECU) for the social security insurance of their workers
to cover the payments during absence from work (Doukmak & Huber, 1995).
Belgium, with an absenteeism rate of about 7%, paid 93 billion BFR (2.4 billion
ECU) on sickness benefits in 1995 and 21 billion BFR (0.6 billion ECU) for
benefits on work accidents and occupational diseases, which is altogether about
1.000 ECU per employee (Van Damme, 1995). The two thousand largest
enterprises in Portugal lost 7.731 million working days as a result of illness and
1.665 million working days as a result of accidents in 1993. This is 5.5% of all
working days at these companies (Graa, 1995). In the Netherlands the
absenteeism rate was 8.3% in 1993, and the number of persons on a disability
benefit increased up to 921,000 (14.2 % of the workforce). The costs of the
benefits for these conditions were about 35 billion NLG (16.6 billion ECU; 4.1
billion ECU for benefits on sickness absenteeism and 12.5 billion ECU for
disability benefits). Change in legislation (see chapter 3) led to a decrease in
registered absenteeism to 4.4% in 1995 and a reduction in social security costs
of 2.1 billion ECU (Grndemann, 1995). This illustrates how beneficial a shift
in financial burden can be for national governments.
The figures above are - with the exception of the UK figures - related to the
benefits paid through the social security schemes. Figures about the other costs
of ill health of workers are more difficult to obtain. Some information is
available about the costs of work-related diseases and accidents, which are those
directly related to the work environment. Jensen (1996), for example, estimated
that, in Denmark, the working environment accounts for 15% of the total
sickness behaviour among 15-66 years olds and 20% if only sickness absence
is considered. The socio-economic costs (including e.g. sickness absence costs,
health care costs and early retirement costs) of these work-related diseases and
accidents in Denmark in 1992 were estimated between 3 and 3.7 billion ECU
(for a working population of 3 million persons). Davies & Teasdale (1994)
estimated the total costs to the British economy of work accidents and workrelated ill health in 1990 to be between 11 billion and 16 billion, which is
equivalent to between 2% and 3% of total Gross Domestic Product, or a typical
year's economic growth. These costs include the property damage incurred by
industry, loss of potential output from the reduction in the available labour
11
force, the costs of medical treatment, and administration costs incurred by

firms, insurance companies, and the Department of Social Security.
Although the methods used to calculate the costs of absenteeism and ill health
vary, it is evident that a lot of money could be saved by even a small reduction
in absenteeism caused by ill health. In the next paragraph it will be argued that
all parties - governments, employers, employees, insurance companies and
society as a whole - have an interest in reducing workplace absenteeism and ill
health. Ethical considerations are important, as they play a role in the selection
of specific measures to reduce absenteeism and in the implementation process
itself.
1.4
What stake do the different parties have?
Although the burden is not equally divided among the different parties governments, employers, employees, insurance companies and society as a
whole - they all bear a part of the burden (costs) related to absenteeism and ill
health. The individual worker (and his/her dependents) often has a reduced
income as result of absenteeism related to ill health (see chapter 4), especially
when the absence is extended. Furthermore he or she could have additional
expenditure, for example payment for health care services or equipment and
suffer a loss of welfare in the form of pain, grief and suffering. In addition
frequent or long-term absenteeism can lead to loss of jobs or disturbed relations
with colleagues and superiors.
Employers are affected by the unpredictable nature of workplace absenteeism,
which makes it necessary to adjust schedules or to take steps to replace the
absent worker. In addition workplace absenteeism increases the company's
costs and hence has a negative effect on the company's competitive position.
The Industrial Society (1994) asked UK employers - who calculated the costs
of absence - to give information about the factors they took into account (see
below).
direct costs:
12
indirect costs:
statutory sick pay
effects on
productivity
occupational sick pay
management time
overtime
low morale of colleagues
temporary staff
effect on quality
extra staff kept on payroll
loss of customers
The costs of absenteeism related to ill health
Insurance companies often insure both the absenteeism risk and the health of the
workers and their families. Usually they have to pay the benefits in case of
absenteeism and the health care costs of the employees.
Workplace absenteeism also has a negative effect on the national economy as a
result of the loss of potential output from the reduction in available labour force
and an increase in costs of medical treatment and of social security. Therefore
national governments have an interest in keeping absenteeism low and limiting
the costs of social security and the cost of health care. Governments cannot
sustain the high costs of disability and early retirement. For society it is
important that people can work healthily up to retirement age and can contribute
to the gross national product.
Although all parties have an interest in reducing absenteeism related to ill
health, they appear to have different preferences for the way this should be
achieved. In general, unions would welcome any measures which encourage
employers to reduce absenteeism related to ill health. However, they would
prefer activities directed at the improvement of working conditions, rather than
focusing upon workers' behaviour. Although employer organisations could
support such workplace activities, they would rather see it accompanied by the
introduction of financial incentives for the workers to reduce absenteeism.
Probably governments would prefer changes in legislation in the field of social
security. Additionally they would support preventive activities at the workplace
as indicated in the European Framework Directive on Health and Safety at
Work.
Improvement of individual health behaviour cannot be inflicted on employees
from above. Employees have to be informed about and voluntarily involved in
preventive activities. Ethical considerations play an important role in the
selection of interventions directed at the reduction of absenteeism related to ill
health. There is also a danger that the victim (the employee) is made responsible
for high levels of absenteeism and blamed or discriminated against. Employees
have a right to be absent from work as a result of work incapacity or illness.
They also have rights to protection from poor working conditions as outlined in
the European Framework Directive. On the other hand, when employers provide
a healthy working environment for their employees, they may expect
responsible absenteeism behaviour. They can encourage the employees to
improve their lifestyle behaviour, but they cannot compel such a behaviour.
Furthermore all parties are interested in the reduction of waiting lists in the
health care system, but this should not give priority to workers above nonworking people.
13
The next chapters give an overview of how measures to reduce absenteeism

related to ill health are implemented in European practice. First some
background to the project is given, including information on the aim and the
focus of the study (chapter 2).
14
The European study on

absenteeism and ill health
This chapter offers information on the context of the European study on

absenteeism and ill health. It gives information on:
- the aim and content of the study
- the definition of absenteeism which has been used in the study
- the connection between ill health and absenteeism.
In the last paragraph an overview of the structure of the report is
presented.
2.1 Aim and content of the study

This report is the first European study on workplace absenteeism and ill health
which includes all fifteen Member States of the EU (and Norway). It offers a
fairly detailed overview of social security regulations in these countries and
gives the main statistical data from these regulations. It also contains the lessons
from 23 case studies of initiatives to reduce absenteeism related to ill health,
which were analysed in eight countries (Austria, Belgium, Germany, Italy, the
Netherlands, Norway, Portugal and the United Kingdom (UK)).
The publication is the main European report from the project 'Ill-health and
workplace absenteeism: initiatives for prevention' of the European Foundation
for the Improvement of Living and Working Conditions in Dublin. The aim of
the project is to document and assess organizational, health, rehabilitation and
other initiatives designed to improve workers' health and attendance at work.
In the first phase of the project TNO Prevention and Health produced a
background paper in which existing data on sickness absence were analysed for
patterns in different Member States, sectors and demographic groups (Grndemann, De Winter & Smulders, 1994). National information was provided by
15
a network of experts coordinated by TNO. The results showed major differences

in the regulations and in the way these are applied, within as well as between
countries. Although the methodological deficits and difficulties are evident, the
report highlights the causes and costs of absenteeism for different groups of
workers and for different categories of enterprise.
In the second phase of the project eight national reports have been produced.
These involve descriptions of the situation in Austria (Noack & Noack. 1996),
Belgium (Van Damme, 1995), Germany (Doukmak & Huber. 1995). Italy
(Mirabile & Carrera. 1995), the Netherlands (Grndemann, 1995), Norway*
(Nytr, 1995), Portugal (Graa, 1995) and the UK (Balcombe & Tate, 1995).
The reports focus on the strategies to address the causes of absenteeism. They
include a review of absenteeism and measures to reduce rates in each of the
Member States. In these national reports the process of establishing such
initiatives at the workplace, the participation of different groups in the workforce and the costs and benefits have been analysed in case studies.
The present European synthesis report updates information from the earlier
phases of the project and presents lessons from the initiatives to reduce the
incidence of ill-health and related workplace absenteeism, illustrated by
examples from the national case studies. Additional information has been
assimilated, especially with respect to information for the new Member States
of the EU, so that analyses from national correspondents in all Member States
of the EU are described in this report (see Table 2.1 ). This synthesis report also
contains information about experience in Norway, which is one of the most
innovative countries in Europe in the field of absenteeism reduction.
2.2 The definition of absenteeism

In this study - as in the social security systems of most Member States absenteeism is defined as: temporary or permanent incapacity for work as a
result of sickness or infirmity. Absenteeism from work for other reasons is
included in this study only when it cannot be excluded from the absenteeism
data, and this will be indicated. Absenteeism is taken in a broad sense, i.e. it
deals with temporary, extended and permanent work incapacity, including that
due to accidents at work and occupational diseases. The classification according
to duration is also related to the definitions used by national social security
systems. Temporary work incapacity refers to the first period of absenteeism; in
most countries limited to the first 52 weeks of disability. Only Italy (26 weeks)
and the UK (28 weeks) have a shorter period for temporary disability in the EU.
The Norwegian contribution was largely financed by The Wnrk Environment Fund of the Norwegian Confederation of
Business and Industry (NHO).
16
The European study on absenteeism and ill health

Tabic 2.1 : The network of national correspondents
Country
Correspondent
Organization
Austria
Richard Horst Noaek
Belgium
Jacques van Damme
Denmark
Jan Hgelund
Finland
Jorma Jrvisalo
France
Marc Poummadre
Germany
Bassam Doukmak
Greece
Ireland
Italy
Emmanuel Velonakis
Richard Wynne
Maria Luisa Mirabile
Luxembourg
Jean-Paul Demuth
Netherlands
Norway
Portugal
Robert Grndemann
Kjell Nytr
Luis Graa
Spain
Antonio Daponte
Sweden
Finn Diderichsen
United Kingdom
Jean Balcombe
Universitt Graz. Institut fr

Sozialmedizin. Graz
Interbedrijfsgeneeskundige Dienst
voor Werkgevers IDEWE, Antwerp
The Danish National Institute for
Social Research, Copenhagen
Social Insurance Institution,
Research and Development Centre.
Turku
Ecole Normale Superieure de
Cachan. Cachan
IMAR Uiiternehmensberatung
GmbH, Bonn
Ergonomia Ltd, Athens
Work Research Centre. Dublin
Istituto di Ricerche Economiche e
Sociali (1RES). Rome
Association d'Assurance contre les
Accidents, Luxembourg
TNO Prevention and Health, Leiden
SINTEF IFIM, Trondheim
New University of Lisbon, National
School of Public Health. Lisbon
Escuela Andaluza de Salud Pblica,
Granada
Karolinska Institute. Department of
Public Health Sciences, Sundbyberg
The Industrial Society. London
Extended or permanent disability relates to arrangements after the first period

of absenteeism, i.e. the first 26, 28 or 52 weeks of incapacity for work.
Additionally temporary absenteeism has been divided into short- (1-7 days),
medium- (8 to 42 days) and long-term (more than 42 days) absenteeism.
Benefits relating to work accidents and occupational diseases are strictly limited
in most countries. In this study the national definitions of these accidents and
diseases are followed.
17
2.3 Workplace absenteeism and ill-health

Although there is some cynicism and scepticism about the issue, it is absolutely
clear that ill health is the main reason for workers to be absent from work. In
most countries in the EU workplace absenteeism is defined as incapacity for
work as a result of illness or disability (see the official statistics). However, in
some countries reasons other than illness or disability are classified as
absenteeism. In Italy, for example, the following categories of absenteeism are
distinguished by the government: special leave: hydrothermal and similar treatments; study, marriage and other causes; statutory and optional maternity leave;
strike action; trade-union reasons; leave of absence for family reasons: leave of
absence for elective duties. This means that in the national absenteeism data
absences related to ill health cannot always be distinguished from absence from
work for other reasons.
Ill health does not necessarily means absence from work. Although employees
with health problems are in general more frequently and for longer periods
absent from work than 'healthy' employees, there are employees with health
problems who are not more absent at all. So, ill health does not necessarily
mean incapability for work.
In addition not all activities aimed at reducing workplace absenteeism have an
effect on the health of employees. Workplace absenteeism can for example also
be reduced by making changes in the provisions of the social security system.
A company can also try to reduce workplace absenteeism by tightening up
procedures relating to control of absenteeism and by intensifying checks on
absent employees. However, in this study the emphasis is on initiatives in which
workplace absenteeism has been decreased by addressing the health problems
of employees and by tackling the underlying causes of health problems in the
workplace.
2.4 The structure of the report

The perspectives of the governments and the social partners in the EU are
discussed in more detail in the next chapter. The characteristics of the social
security systems and the available national statistical data on levels of
absenteeism will be presented in chapter 4. What is being done in Member
States to reduce absenteeism; which general patterns can be distinguished and
what is known about the results of these strategies? These questions will be
answered in chapter 5. The central part of this report describes models for
initiatives to reduce the incidence of ill health and related workplace absenteeism (chapter 6). This chapter is based on the results of analyses of the case
18
The European study on absenteeism and ill health
studies from the national reports. It gives the main strategies and approaches to
reduce ill health and absenteeism. One approach will be reviewed which is
merely directed at reducing absenteeism by tightening up procedures relating to
absenteeism and to intensified checks on absent employees. Next to that three
different approaches to diminish absenteeism related with ill health will be
discussed: actions directed at the work environment, actions aimed at changing
individual health behaviour and actions focused on the reintegration of long
term absentees. In the appendix the national case studies are presented in a
systematic summarised way. The last part of this report (chapter 7) presents the
conclusions and recommendations for future actions by the key parties
involved: the EU, national governments, employers, unions, professional
groups, insurance companies and the academic community.
19
Absenteeism as an issue
This chapter describes the extent to which workplace absenteeism and

disability are at present under discussion within the EU (and Norway)
and to what extent the health of employees is being examined in this
process. This includes consideration of the attitudes of national
governments, employers' organisations and trade unions towards
absenteeism related to ill health and the motives for action that these
players mention in this context.
3.1
Introduction
The material for this chapter has been produced by the national correspondents
(see 2.1). They were asked to describe the perspectives of their national
governments, employers organisations and unions and to send information
about the significance of sickness absenteeism and the prevention of ill health
associated with absenteeism in their country. It was pointed out that reduction
of absenteeism related to ill health could be part of several policy programmes,
such as workplace health promotion, health and safety, elderly workers or work
ability. They were also asked to refer to specific rules or regulations if possible.
The correspondents used documentary evidence such as articles, general
publications and other reports. Some of them also tried to get a formal statement
of the view point of these key players. It is important to distinguish between the
range of information for countries with a national report (Austria, Belgium,
Germany, Italy, the Netherlands, Norway, Portugal and the UK) and that from
the countries where information has been supplied by questionnaire only
(Denmark, Finland, France, Greece, Ireland, Luxembourg, Spain and Sweden).
In this second set of countries the information often has a more exploratory
character.
21
Most information was available about the perspectives of the governments. It

appeared to be much more difficult to get a detailed picture of the perspectives
of the social partners. Governments may be more used to specifying policies on
paper, while social partners are more accustomed to discuss these topics in their
collective bargaining. However, as a result it is almost impossible to give a
differentiated picture of the attitudes of employer organisations and unions in
the EU Member States. However the principal goal of this chapter is to describe
the main trends in awareness of and action against absenteeism related to ill
health in the EU, and to emphasize the different perspectives of the major key
players. This study is not intended to offer a detailed comparison of the different
perspectives within the 15 countries of the EU and Norway.
3.2 The perspective of national governments

In Europe one can perceive an increasing interest at government level in
reducing workplace absenteeism and premature exit from the workplace as a
result of health problems. This increased attention is a rather recent
phenomenon. In most European countries absenteeism related to ill health did
not get very much attention during the 1980s. There are various factors which
play a role in this changed attitude. Firstly, there are the growing costs of social
security due to the increasing number of unemployed persons, which makes
unemployment at this moment the most prominent problem within the EU.
Secondly, there is the growing international competition inside and outside the
EU. The third point is the globalisation of the production process, where
international companies shift out jobs to cheaper developing countries. All three
aspects point in the same direction. The costs of labour have to be competitive
to retain (industrial) employment in Europe. The costs of social security have a
great effect on the labour costs and on the ultimate price of products. Countries
must review expenditure in the field of social security with regard to both its
efficiency and to competitivity in the international market.
Another aspect is the financing problem (budgetary deficits) of national
governments. The costs of social security form a substantial part of public
expenditure. Governments have been using the introduction of European
Monetary Union (EMU) as an argument to make an extra effort to put their
government finances in order. However the financial sustainability of the system
is also questioned in the light of the rising average age of the working
population, with fewer young and more elderly people. This issue is mainly
related to paying for prolonged incapacity for work or invalidity and the old-age
pension. The funding of these benefit schemes is under pressure as a result of
these population trends.
22
In addition to all the financial and economic arguments, more social and ethical
arguments also feature to a limited extent. Observers point, for example, to the
undesirable situation whereby large groups of the population are outside the
labour process and hence socially excluded. This results in a waste of the human
resources present in society and the situation also has an adverse effect on the
health and welfare of this group and their families.
The next section offers an overview of the situation and government
perspectives in the different countries.
In Norway, Sweden, Finland, the UK and the Netherlands absenteeism has
already been discussed as a social problem for a somewhat longer time.
In Norway there was an intense debate in 1989-1990 on the increase in
workplace absenteeism. In the course of this debate there were divergent views
on the relative importance of worker attitudes and working conditions. A large
research project examined the various causes of absenteeism and found that
structural conditions affected the level of absenteeism in Norway, as did the
large proportion of women in the working population and the high retirement
age (67). The government then established a broadly-based review body which
assessed various possible changes in the absenteeism regulations, such as the
introduction of qualifying days, the extension of the employers' excess period
and the reduction in the level of benefits. Finally all these methods of
intervention were rejected and the government, together with the employers'
associations and the trade unions, set up a national absenteeism project. Its aim
was to reduce workplace absenteeism by 20% within three years. A call went
out to managers and trade union officers to set up absenteeism projects in their
own companies. The project was directed by a national project group consisting
of representatives of the employers' associations and the trade unions. Money
was available for information, research evaluations and handbooks. At the end
of the project the desired reduction in workplace absenteeism had been almost
achieved. Absenteeism had been reduced by 15.4%. The social partners decided
to continue this process of reducing workplace absenteeism, but without target
figures. Government organizations as employers are now more actively involved
with reducing workplace absenteeism. The responsibility for tackling
workplace absenteeism rests with senior management, line management and the
trade union officials, and must be integrated in the quality control and health
and safety management systems. Moreover, matters such as the difference in
absenteeism between men and women, the role of company medical services
and the high level of absenteeism among shift workers remain to be
investigated. In 1994 the government spent NOK 25 million (approx ECU 3
23
million) on information and research in order to support the reduction of

absenteeism.
In Sweden the perspective of the government is strongly related to the general
conditions of the national economy. In the 1960s and the 1970s with economicgrowth, growing employment and balance in public finances, absenteeism was
regarded as an outcome directly related to both health problems (created at the
workplace) and problems of work satisfaction (related to the organisation of the
work, etc.). Legislation and agreements between unions and employers were
aimed at improving these conditions and thereby decreasing absenteeism.
In the 1980s when economic growth was levelling off. the demand for labour
still high, but costs for absenteeism growing sharply, absenteeism became an
issue mainly discussed as a cost problem. The causes of absenteeism were
considered to be related to a lack of rehabilitation. The emphasis was on the
prevention of long-term absenteeism through early intervention in individual
cases and on case management of workers with chronic problems such as low
back pain. Absenteeism was no longer seen as a problem to be solved at the
workplace, but as a problem to be solved by the health care organisations in
collaboration with the companies.
In the first half of the 1990s, when unemployment grew sharply and the state
ran large budgetary deficits, the issue of absenteeism was regarded again as a
financial problem to be solved by social and economic restrictions in the rules
related to the cash benefits. The actions taken were concentrated on reducing
levels of benefits, introducing waiting days, and sick-wage paid for the first two
weeks by the employer.
The picture is of course an oversimplification and the different models all
coexists to some extent throughout this period but it is obvious that the way the
problem is presented by the state in Sweden has changed and the actions taken
have gone from mostly preventive to curative and now regulatory.
In the 1970s and 1980s there was consistent economic growth in Finland which
made it possible to increase the coverage of social security for illness, accidents,
early retirement resulting from incapacity for work, pregnancy and parental
leave. At the end of the 1980s the early retirement scheme turned out to be more
popular than anticipated. The Government started to develop a reform of
rehabilitation legislation, which was passed in 1991. One act. for example,
stipulates that the Social Insurance Institution is obliged to determine the
24
potential needs for rehabilitation of someone who has been a recipient of the
sickness allowance for 60 days.
From 1990 onwards economic growth entered a deep decline and there was a
rapid growth in the rate of unemployment. Since the end of the 1980s there had
been an interest to modify the early retirement schemes. A committee then
examined what options there were for keeping older employees at work for
longer. The committee recommended achieving this through modifications of
the early retirement schemes and adaptation of work, intensification of health
care, and reintegration activities. By 1996 most of the proposals of this
committee were translated into legislation. Occupational health services were
assigned an important role in these 'maintenance of work ability' activities. In
order to keep control of social costs, changes had been made previously - in
1993 - in statutory regulations. The number of waiting days for the sickness
allowance was increased from seven to nine. Because - according to statutory
regulations - the employer continues to pay the salary, this means, in practice,
an increase in the excess paid by the employer. In addition parental leave has
been reduced from 275 days to 263 days.
In the United Kingdom, the government has recently increased the employers'
accountability for workplace absenteeism. Since April 1994, the great majority
of companies are no longer re-imbursed by the government for statutory sick
pay (which is paid for up to 28 weeks). Thus during this period employers bear
all the costs of workplace absenteeism themselves. In addition, for employees,
the qualifying standards for Incapacity Benefit have become significantly more
rigorous.
In May 1995 the Health and Safety Executive launched a health campaign
designed to increase employers' awareness of health risks at work. In addition
the government encourages health promotion at work through the Health
Education Authority. The Management of Health and Safety at Work
Regulations of 1992 specified the duty to conduct a risk assessment and to
control or remove any risks. The statutory basis for health and safety in the
workplace is the Health and Safety at Work Act 1974. This Act requires
employers to provide a working environment which is 'as far as is reasonabjy
practicable' safe and without health risks. In addition employers are obliged to
provide the information, training and supervision necessary to guarantee the
health and safety of their employees. For their part, employees are required to
take reasonable care not to expose themselves or others to danger.
25
Against the background of the changes in the payment of sick pay and the rising
number of legal actions against employers in the field of health and safety, the
British Government expects employers to take more steps to combat workplace
absenteeism. For many reasons, such as increased management attention,
recession and fear of losing jobs, and selection of poor attenders for redundancy,
workplace absenteeism has slowly fallen in the UK since 1987 from 5% to
3.6%.
Until recently there was a high level of workplace absenteeism in the
Netherlands (approximately 8%) and a very large number of employees who
were incapacitated (approx. 15% of the working population). The reasons for
this must be sought partly in the tolerance with which regulations were applied
and the relatively high level of benefits (see also Chapter 4). The benefit costs
of the absenteeism and incapacity regulations amounted to approximately 30%
of GNP. In addition there was a large deficit in the government budget in the
Netherlands. Restriction of the enforced expenditure on social security was
deemed to be urgently necessary in order to reduce the financing deficit. This
situation led to a number of statutory measures by the government aimed at
increasing the individual responsibility of employers and employees.
Employers are made responsible for the guidance and monitoring of sick
employees and are required to do everything to facilitate the resumption of work
by a sick or incapacitated employee. In addition they must implement a policy
on working conditions and workplace absenteeism. In the first instance,
employers incurred an excess period of either the first two or six weeks of
employees' absenteeism through illness (depending on the size of the company).
Later the Sickness Benefits Act provisions were completely abolished for
regular employees and employers were made (financially) responsible for
workplace absenteeism for the first year of absence. The legislature has also
opened up the possibility of financial incentives for employees. These relate, for
example, to the possibility of non-payment of the first two days of illness, the
forfeiting of holiday days, and not supplementing the benefit (70% of gross pay)
in the case of absence through illness. The legislature has left the introduction
or otherwise of these measures to be settled between the employers and
employees. However from recent collective bargaining negotiations (1996) it
appears that the retention of qualifying days is under great pressure. In addition
there is increasing support for reducing the level of benefits.
Finally, the calculation of invalidity benefit has been revised, leading mainly to
lower benefits, previously. At the same time long-term invalids are periodically
re-examined with the aid of a broadened criterion relating to incapacity for
26
Absenteeism as an issile
work, in which no account is taken of someone's education and previous

occupation.
Since the introduction of these measures, workplace absenteeism has fallen by
between 15% and 20%. The figures on incapacity for work show a reversal of
the trend. For the first time since the introduction of these regulations a decrease
(6%) can be seen in the number of those incapable of working in the
Netherlands (from 920,000 to 860,000). Although no firm figures are available,
it can be assumed that a large number of those leaving have not resumed work,
but have transferred from one benefit scheme (incapacity for work) to another
(unemployment). The Dutch debate on the reduction in workplace absenteeism
and incapacity for work has been significantly determined by financial and
economic motives. The effect of the measures on the health of those in work is
doubtful.
The Spanish government is increasingly concerned with absenteeism related
costs. In the context of measures to reduce social security costs, legislative
changes have recently been introduced. Since 1992 employers have had to pay
the first 15 sick days instead of the first three sick days. Government benefits
take over after the 16th day. This change in legislation caused a downward curve
in the annual spending on temporary unfitness for work, as costs were
transferred to employers.
The Spanish health administration is responsible for the certification of
temporary and permanent work incapacity. The measures taken by health
administration authorities consisted mostly in strengthening the role of health
inspectors, as controllers of sickness certification, and in introducing among
physicians a more restrictive culture regarding absenteeism. The Spanish health
administration could have a major role in implementing health promotion at the
workplace, since the Spanish General Health Law (1986) puts great emphasis
on health promotion, and it contains a chapter on occupational health. However
the Spanish health administration has only developed activities at the
community level, not in occupational settings.
In Germany the government until recently occupied itself only to a limited
extent with workplace absenteeism. The minimum sickness benefit was
stipulated and traditional health protection measures in companies were
regulated. In recent years the government has focused on a number of matters.
For example, in 1993 a bill was presented to parliament on the introduction of
qualifying days, which, however, was not approved. In addition the government
turned its attention to the definition of industrial accidents and occupational
27
diseases. Changes in legislation have finally led to the health service and the
medical insurers being able to undertake measures to reduce absenteeism. Most
recently, as a result of financial problems and the imminent introduction of
EMU, the government announced that it wished to reduce the costs of social
security. In this instance it was again a question of introducing qualifying days
and lowering the level of benefits. New legislation will be implemented at 1
November 1996. The continuation of payment during the first 6 weeks of
absence will be reduced from 100% to 80% and the benefit level after 6 weeks
of absence from 80% to 70%. The rapid introduction of the changes in
legislation in the neighbouring Netherlands has been presented as an example
of the desirable development in Germany.
In the other European Member States (Denmark. Ireland. Belgium. France.
Portugal, Austria, Italy and Greece) there has been less of a national debate
regarding workplace absenteeism and the future of the social security system,
although at this moment there is a growing attention for these topics.
In Denmark a particular cause of concern is the low level of participation of
(partial) invalids. In this context the government has developed various
initiatives over the last few years. In 1994 a campaign was conducted under the
motto 'Social engagement of companies'. This campaign focused on
encouraging companies to use more manpower so that employees who were
temporarily or permanently partially incapacitated could keep their job.
Previously - in 1991 - a parliamentary decree from the government and social
partners required them to draw up a plan to reduce repetitive and monotonous
work so that the number of cases of repetitive strain injury would be halved by
the year 2000. Finally, a centre was set up in Denmark for the development of
work adaptations for employees with a permanent or temporary partial
disability. However, the level of absenteeism is not seen as an immediate
problem.
In Belgium there is at the moment concern about excessive control of workers
who are ill. The government believes that employees should be protected
against pressure by controlling organizations and that sickness control must not
lead to repression and the infringement of the privacy of employees.
Government intends to elaborate clear procedures on absenteeism control; for
example controlling organizations will need a license, which implicates a
contract involving ethical codes. In addition the Belgian government is working
on the principle that much absenteeism is related to the working environment
and to family circumstances. Legislation should take account of this. For
28
example a law has been enacted giving employees the opportunity of being
present during the last days of a dying member of their family.
In France absenteeism is not on the immediate political and social agenda.
Workplace absenteeism has a negative connotation, pointing to 'shirking' rather
than illness and its causes. However, measures have been taken aimed at the
prevention of risks in the workplace. The co-ordination of this rests with the
CSPRP (Conseil Suprieur de la Prvention des Risques Professionnels), the
national council for the prevention of occupational risks. This is the most
important advisory body of the Minister of Employment. Employers'
associations and trade unions also have a part to play in the CSPRP. The trade
unions and the employers each occupy a quarter of the seats; the rest are taken
by experts and representatives of the ministries. In the regions there is a wide
range of decentralized bodies responsible for implementation. In the annual
report of the CSPRP the following priorities are mentioned: a sustained action
plan in order to reduce the causes of the most serious or most frequent industrial
accidents/occupational diseases; modernization of legislation; technical and
methodological support of companies and the development of international
aspects. This last aspect is becoming increasingly important: there is a desire to
co-ordinate regulation and action programmes with what is happening in
Europe. This is the reason why a moratorium has been agreed on further
changes in legislation.
Despite the high level of workplace absenteeism in Portugal (see chapter 4),
this subject does not appear to have a high priority with the government and the
social partners. This also applies generally to the area of the safety and health
of employees at work. The only exception are industrial accidents, traditionally
high in Portugal, but counting now for only 7% of the total number of days lost
by absences in the two thousand largest companies. Until 1995 the government
did not see an active role for itself and preferred to leave this field to discussion
between employers and employees. More recently however, there appears to be
increased interest in controlling workplace absenteeism, mainly due to the
growing costs of sickness benefits and the perceived abuse of social security
regulations. Reform of the national social security system is now on the political
agenda, but apparently there is no pressure to make the employers more
responsible for the counselling and monitoring of sick employees. Only
companies active in the export sector point to an increasing absenteeism
problem, partly because of the scarcity of trained and skilled labour, and the
necessity of rationalizing production and making it more flexible in order to
cope with international competition. Attendance at work is encouraged in these
sectors by offering substantial bonuses.
29
Although the absenteeism topic has recently been discussed more regularly in
the public media, it does not seem to be an important issue at government level
at this moment in Austria. The levels of absenteeism and disability are
relatively low, and other social problems like a growing number of unemployed
and budgetary deficits are considered to be much more significant. However, in
the current economic situation the topic of absenteeism has become more
important for employer organisations and unions. Recently in Austria individual
companies have sought to reduce levels of absenteeism by workplace health
promotion (see also chapter 5).
In Italy the debate on workplace absenteeism is not directly linked to concern
for the health of employees or the prevention of occupational diseases and
industrial accidents. Workplace absenteeism was generally linked with the lack
of motivation on the part of the employee and poor company organization. In
Italy, as in Portugal and in France, absenteeism is not immediately on the
political agenda; on the contrary prevention of illness and accidents at work is
strongly discussed by social partners because of the implementation of the
European framework law.
In the public sector there has been a relatively high level of absenteeism for
decades. Interest in this topic is a rather recent development (since the end of
the 1980s). It fits in with the general discussion on the effectiveness of the
government apparatus. In 1992 an Act was passed aimed at reforming the public
sector. In 1993 the benefit for the first day of absenteeism was reduced by 30%.
The effect of these measures is still being discussed. One important problem is
the lack of reliable absenteeism figures.
In the market sector absenteeism fell sharply in the course of the 1980s. As a
result the registration of absenteeism was suspended in 1992. The reduction in
workplace absenteeism is the result of the economic crisis in the 1980s and a
careful strategy (including bonuses) on the part of employers to encourage
employees to attend work or at least to be as absent as little as possible. Willi
this reduction in the size of the absenteeism problem further attention to the
subject has disappeared.
In Greece, too, there appears to be no real national debate on the issue of
workplace absenteeism. Although the direct cost of absenteeism in private
companies is relatively high, the topic does not have priority. In the publicsector there is substantial absenteeism, which it is anticipated can be reduced by
increased monitoring. Developments in health care are considered important for
a more general reduction in workplace absenteeism. In addition the present
30
economic recession plays a part, as a result of which it is believed that

unemployment will increase and absenteeism reduce. On the other hand,
economic developments may have a negative effect on company health care and
working conditions in Greece.
In most countries in the European Union (and Norway) there is an increased
interest in working conditions. The introduction of the European Framework
Directive (the Directive on Safety and Health of Employees at Work of 12 June
1989) was a stimulus in this. Its (compulsory) implementation in national
legislation varies greatly in the 15 Member States (Zwaard, 1995). Moreover
introduction of the Framework Directive into national legislation does not by
any means mean application and maintenance of the new statutory obligations.
The translation of the Framework Directive into national legislation proceeded
in all states in consultation with representatives of employers and employees. In
most countries national legislation had to be changed or expanded.
Finland made parallel changes in its Labour Protection Act which came into
force in 1994, even before the country joined the EU. One of these changes
specifies that the employer is responsible for setting up an action programme for
promotion of safety and health, including improvement of working conditions.
The text also stresses the role and responsibilities of the workers in workplace
safety and health and the collaboration between the employer and the workers
in the maintenance and enhancement of safety at the workplace.
In the Netherlands the government made an explicit link between companies'
working conditions policy and absenteeism policy. In the Working Conditions
Act the reduction of absenteeism is an explicit aim. The employer must make
clear what he or she intends to achieve in the field of working conditions and
absenteeism, making public the intention to work systematically and
structurally towards the improvement of working conditions and the reduction
in workplace absenteeism (Ministry of Social Affairs, 1995). The obligation to
pursue an absenteeism policy relates mainly to two things: the prevention of
absenteeism caused by inadequate working conditions and the provision of
sound guidance for sick employees. In these tasks the employer must have the
support of an authorized health and safety service.
In the other countries in the EU working conditions and workplace absenteeism
are not so emphatically linked. The most important aspects of the Framework
Directive relate to the listing and evaluation of risks, the assignment of
employees to preventative tasks and the support of expert services in protection
31
and prevention. In some countries this obligatory support is linked to the result
of the risk assessment.
3.3 The perspective of the employers' organisations

In general, employers in the EU support an active government policy directed at
the reduction of workplace absenteeism. In some countries, such as Ireland,
Portugal, Germany and Austria, for example, the employers are (were) even
more concerned about this topic than the governments.
Employers, like the Portuguese Industrial Confederation, emphasize the costs of
workplace absenteeism and the effect of it on their competitive position. They
draw attention to the misuse of social provisions and call for changes to
legislation. Employees could be confronted with the costs of their own
absenteeism (through illness) to a greater extent by the introduction of
contractual incentives and disincentives, for example.
Spanish employers generally consider the mismanagement of the health care
system to be a major cause of the high absenteeism rates. Firstly, because the
primary health care level issues temporary work incapacity certificates which in
the view of the employers are often not warranted. Secondly, because of the
waiting lists to undergo surgery. This causes a significant lengthening of
episodes of temporary work incapacity.
In the view of Irish employers absenteeism has become a disease of the
industrial system and has caused great harm to Irish industry's cost effectiveness
and competitiveness. The employer organisations argue that Irish business loses
hundreds of millions of pounds a year as result of employee absenteeism: 65
times more man days were lost in 1992 due to absenteeism than to industrial
disputes in the same period. The Irish employer organisation IBEC encourages
the formulation by employers of a coherent policy which will create a culture
where casual absenteeism is seen to be unacceptable because it increases the
workload of colleagues, threatens the organisation's prosperity and costs jobs.
It appears that employers generally acknowledge the effect of working
conditions on absenteeism. In Belgium, for example, employers are looking for
a differentiated approach to absenteeism, in which preventive measures linked
to work have priority. Other measures may be considered insofar as they reduce
absenteeism efficiently.
In some European countries there are joint (national) programmes of employers
and employees - and generally also national governments - in order to combat
32
workplace absenteeism in companies. In Portugal an agreement was signed

between the government and the social partners relating to the EU Framework
Directive on Health and Safety at Work. The most important topics of this
agreement relate to: ( 1 ) prevention of occupational diseases and accidents; (2)
compensation for work invalidity and (3) rehabilitation and reintegration of
incapacitated employees. However, until now (5 years later) little appears to
have come of the good intentions. The Framework Directive is not yet fully
enforced, especially relating to the more controversial matters like workers'
participation. Employers point to a large number of statutory regulations
relating to health and safety at work and the lack of technical and financial
support for this. Trade unions are more concerned with questions like the risk
of abuse of work flexibilisation and job rotation, or with the increase of
precarious employment and of non-standard work forms. They also demand the
implementation oflegislation with the help of the Labour Inspectorate, but apart
from that seem to undertake few activities of their own. Employees'
representatives are very critical concerning the financial incentives to assure
work attendance and are conscious of the potential side effects.
In Denmark the employers' associations agreed with the trade union
organizations, through a social chapter, to promote employment for the partially
incapacitated. In addition the employers' associations, like the trade unions,
participate in the implementation of the plan to prevent repetitive and
monotonous work and in projects to improve the working conditions and
reintegration of the partially incapacitated.
In Norway in 1991 employers and employees, together with the government, set
up a national absenteeism project designed to reduce workplace absenteeism by
20% over 3 years (see 3.2). The project was continued after 1993, but without
further targets.
In the Netherlands, too, the government, employers and employees have taken
a first step towards the revision of policy relating to workplace absenteeism and
incapacity for work. These activities took place in a tripartite working party
which aimed to identify practical measures to limit entry into work incapacity
schemes and to re-integrate partially incapacitated workers into the labour
process. The most important recommendations of the working party concern:
the prevention of work incapacity and the promotion of the quality of work;
increasing the financial involvement of industry in work incapacity schemes;
and the (re)integration of the partially incapacitated in the labour process.
33
In Finland employers' organizations report that they are particularly concerned

about controlling unemployment, keeping control of expenditure on social
security (both at company level and at national level), and improving the
economic situation of the country. The 'maintenance of workability' programme
- which aims at prevention and reintegration in order to allow ageing employees
to continue to participate in the labour process for as long as possible (see
3.2), amongst other things - is high on the agenda of Finnish employers in this
connection. In addition, solutions are being sought, partly because of the rising
average age of the working population, in which the achievements of the social
system remain, but employees are also encouraged to continue to take an active
part in the labour process for as long as possible. According to the employers
this can only be achieved if working is made financially more attractive than
receiving social benefits, in other words if there is a sufficient differential
between wages and benefits.
3.4
The perspective of the trade unions
In most EU Member States the trade unions regard absenteeism from a health
perspective. Trade unions suspect that a significant proportion of sickness
absenteeism is related to the workplace and occupational ill health or accidents.
High levels of absenteeism are often seen as an indicator of a bad workplace
environment and poor workplace practices. Because employers carry the
primary responsibility for working conditions, they must ensure that damage to
employees' health is avoided by taking preventive measures at work.
Consequently trade unions are, in general, strongly opposed to the introduction
of financial incentives for employees, because these have little or no effect on
working conditions. On the other hand, trade unions are generally prepared to
make a contribution toward the improvement of working conditions and the
reduction of workplace absenteeism, as emerges from the programmes
described in the previous section and joint activities of employers, employees
and national governments in Portugal, Denmark, Norway, the Netherlands and
Finland (see 3.3).
Another factor causing absenteeism - in the view of the unions - is a mismatch
between domestic obligations and working time. Insistence upon rigid
adherence to traditional time based systems exacerbates this problem.
In the Nordic countries there seems to be a generally harmonious relationship
between employers and employees. In Finland, for example, both the trade
unions and the employers' associations have participated to a large extent in the
development of the Finnish working life regulations and social security.
Negotiations on conditions of employment have been co-ordinated with the
34
government's fiscal budgets. The Central Organization of Finnish Trade Unions

feels that workplace absenteeism can be reduced and must be reduced by
various prevention programmes such as that for the 'maintenance of
workability'. In addition they believe that there is a need for an improvement in
working conditions, etc. They also believe that employees should be encouraged
to feel responsible for their own health and working capacity.
In France the trade unions do not place any special emphasis on reducing
workplace absenteeism. However, they do concern themselves with the workrelated causes of absenteeism. They criticize employers who discourage
employees to raise questions about poor working conditions in the company. In
addition they point to the rise in the number of industrial accidents since 1991,
which is greater than the growth in the number of those in employment in
France. In other countries, too, such as Germany, the United Kingdom, Spain,
Italy and Greece, the trade unions have been pleading for some time for better
working conditions.
The Belgian trade unions see a clear role for occupational physicians in the
search for good working conditions. They believe that occupational physicians
should carry out workplace analyses and risk evaluations. In addition they are
asking for new regulations which will permit family circumstances to be taken
into account through flexibility in working hours, infant care etc, and better coordination between work and private life.
The Irish trade unions do not view absenteeism as a major issue effecting
productivity or competitiveness. Besides they argue that the vast majority of
absenteeism is as a result of certified sick leave. They believe that health
promotion at the workplace can help to reduce sickness related absenteeism and
made a submission on this subject to a Working Party established by the
Department of Health.
In addition to concern about working conditions there is growing concern in the
trade unions about the situation of employees in poor health. Examples of this
are schemes like the 'maintenance of workability' in Finland, the 'social
engagement of companies' in Denmark and the agreement between government
and social partners relating to health and safety at work in Portugal. These
programmes have been described in previous sections. In Norway, too, as part
of the national absenteeism programme, attention was paid to long-term
absentees and incapacitated employees. The Ministry of Health contributed to
this by trying to reduce waiting times in hospitals. In addition local insurance
offices were given more responsibility for the reintegration of long-term sick
35
employees. In the Netherlands the trade unions have expressed their concern,
when there have been changes in the regulations on absenteeism and work
incapacity, about the position of individual sick and incapacitated employees. It
has been established that these changes have a substantial effect both on entry
into and exit from the working incapacity schemes (Van Breukelen et al., 1995).
However, this has not yet led to renewed participation in the labour market by
the employees concerned, but mainly to recourse to unemployment schemes.
The Dutch trade unions therefore believe that (re)integration must be given
more weight in the policy of the legislature, of the labour organizations and of
the executive agencies. This perspective has been reinforced following the
recent withdrawal of legislation which had demanded a financial contribution
from employers if their workers entered disability schemes.

There is a growing interest in workplace absenteeism among the Member States
of the European Union. Although the 1980s were generally characterized by a
widespread passivity on this issue among the major players in most European
countries, this situation has changed at the end of the 1980s and in the 1990s.
The process started in the Northern part of Europe, but gradually interest in
absenteeism is also growing in the Southern part of the EU. The costs of social
security have a significant effect on labour costs and on the ultimate price of
products. Countries with a relatively high expenditure in the field of social
security are concerned to maintain competitiveness in the international market.
The budgetary problems of governments also play a role; these arose during the
1970s and the beginning of the 1980s, but public finances are now under
increasing pressure in part due to the approaching introduction of EMU. In this
situation many governments are changing legislation in the field of absenteeism
and disability, and shifting responsibility to individual employers and
employees. The preconditions for benefits are being tightened up and the
benefits themselves reduced. Employers increasingly have to pay the costs of
absenteeism and disability in their company themselves. However they are
evidently not keen to absorb too much financial responsibility. The unions are
worried about the development of selection processes which exclude workers in
poor health. Furthermore they emphasize the work environment as a main cause
of (long-term) absenteeism and disability.
The current pressures upon social protection budgets, including those for
sickness and disability benefits, offer good opportunities for preventive
activities at the workplace. All major players have a interest in prevention of
health problems of the workers: governments welcome a decline in the general
36
level of absenteeism; employers are pleased to decrease the financial costs to the
company; and employees enjoy the benefits of better health and well-being. The
implementation of the EU Framework Directive also encourages increased
attention to safety, health and wellbeing at work. In some countries government
and business (employers and workers) already work together in national
programmes directed at the improvement of working conditions and the
reduction of (long-term) absenteeism. At the same time the role of the
occupational health services is under discussion in Europe. These organisations
could play an important supporting role when they incorporate prevention and
health promotion in a more integrated approach with traditional occupational
medicine. This means that besides health risks coming from the workplace they
will consider factors outside the workplace that influence health.
37
Regulations and statistics on

workplace absenteeism
This chapter describes the current legislative regulations on temporary

and extended or permanent absenteeism in the Member States of the EU
and in Norway. This includes aspects such as the obligation to submit a
medical certificate, waiting times, the level of benefit, the required
minimum loss of earning capacity and maximum duration of benefit. In
describing these an attempt will be made to indicate not only the formal
rules, but as far as possible also the way these are applied in daily
practice. In the second part of this chapter the statistical data will be
discussed. Finally in this chapter, problems with the interpretation of the
national differences in absenteeism will be emphasized.
4.1 Characteristics of the social security systems

Table 4.1 gives a summary of the current official social security regulations for
absence due to illness and disability in the Member States of the EU (and
Norway). It is evident that very great differences exist in the regulations
governing absences due to illness and disability in the various Member States.
However, as indicated in the notes to the Table, general practice often differs
substantially from the official regulations.
4.1.1 Characteristics of the regulations on temporary work incapacity
If the regulations are examined in more detail, beginning with the regulations
governing temporary unfitness for work, the following may be observed. In
most countries (Austria, Belgium, Finland, France, Germany, Greece, Italy, Luxembourg, Norway, Portugal, Spain, Sweden and the UK) a certificate from a
medical practitioner is required in cases of temporary sick-leave.
39
4-
Table 4.1 : Summary of the main characteristics of the social security systems relating to sick4eave in the Member States of' the European
Union and Norway (part 1)
Austria
Belgium
Regulations for temporary

work incapacity:
Yes
Yes(l)
- certificate needed
1 day (4)
None
- waiting days
4-12 weeks (2) 7-30 days (5)
- full pay
- benefits level
60%
(pere, of gross earnings )
60%
52 weeks
78 weeks
- maximum duration
maternity leave included:
No
18 months (3)
- leave period
Regulations for
extended or permanent
work incapacity:
None
- waiting period
20%
- minimum loss of
earning capacity
up to 66%
- benefits level
(pere, of gross earnings ) unlimited
- maximum age
Separate regulations
for work injuries and
occupational diseases:
Yes
Yes
15 weeks(7)
Denmark
Finland
France
Germany
Greece
Ireland
No
None
no (6)
Yes
9 days(8)
no (8)
Yes
3 days
no
Yes(12)
None
6 weeks (13)
Yes
3 days(14)
no
No
3 days
no
up to 100%
52 weeks
70%
300 days
50-66% (10)
12 months (11)
80% (13)
78 weeks
50-70% (15)
360 days
fixed (16)
375 days
No
16 weeks
Yes
14 weeks
Yes
12 weeks
No
14 weeks
Yes
28 weeks (7)
No
263 days (9)
1 year
66%
None
50%
300 days
40%
None
66%
None
50%
None
33%
1 year
None
40%-65%
60/65 years
pension
67 years
pension
65 years
30%-90%
60 years
pension
unlimited
pension
60/65 years
fixed rales
unlimited
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Table 4.1: Summary of the main characteristics of the social security systems relating to sick-leave in the Member States of the European
Union and Norway (part 2)
Italy
Luxembourg
Netherlands
Norway
Yes
No
Yes
3 days
3 days
Yes(29)
1 day
Yes(33)
3 days
no
Yes(22)
None
52 weeks(23)
Yes
2 days (20)
no
no
no
no
70% (21)
52 weeks
100%
52 weeks
65% (25)
365 d.(26)
60/75% (27)
12 months (28)
Portugal
Spain
Sweden
United
Kingdom
Regulations for temporary

work incapacity:
-
certificate needed
waiting days
full pay
benefits level
(pere, of gross earnings)
- maximum duration
no
Yes(19)
None
52 weeks
50/66% (17)
26 weeks
100%
52 weeks
maternity leave included:

- leave period
No
Yes
Yes
No
No
Yes
5 months (18)
16 weeks
16 weeks
42 weeks (24)
98 days
16 weeks
None
1 year
I year
1 year
1 year
1 year
None
52 weeks (38)
3 days
75% (30)
not applied (31)
No
fixed (34)
28 weeks
No
50 days(32) 14-40 weeks (35)
Regulations for extended

or permanent work
incapacity:
- waiting period
- minimum loss of
earning capacity
- benefits level
(pere, of gross earnings)
- maximum age
74%
None
15%
50%
50/66% (36)
33%
25%
None
pension
60/65 years
pension
65 years
max. 70%
65 years
pension
67 years
pension
62/65 years
pension
unlimited
pension (37)
65 years
fixed (39)
60/65 years
Separate regulations for

work injuries and
occupational diseases:
Yes
Yes
No
Yes
Yes
Yes
Yes
Yes
Notes of Table 4.1:

( I ) A doctor's certification is only required from the 4th day of absence.
(2) The continuation of full payment depends on the length of employmenl and differs for manual workers and white
collar workers. Manual workers with 0-5 years employment get 4 weeks; 6-15 years gel 6 weeks; 16-25 years get S
weeks and more than 25 years 10 weeks full paymenl. White collar workers get full payment 2 weeks more in each
category.
(3) Maternity leave falls under the parental leave scheme and provides a partially paid IS months leave. 12 months for the
mother and 6 months for the father.
(4) The waiting period of one day is waived when the absence lasts 14 days of more.
(5) Manual workers get full payment for the first 7 days and white collar workers for the first 30 days. In practice the
employer makes up the blue collar workers" benefit to full pay for up to 30 days also. After the first month both
groups of workers fall back to a benefit (paid by the social insurance fund) of 60% of gross pay.
(6) According to the Danish legislation the employer is obliged to pay sickness benefit during the first two weeks. Often
the benefit amount will be considerably lower than the salan.' because there is a ceiling above the sickness benefit.
However in practice many employees receive full wage from their employers during the first two weeks (or longer).
(7) Maternity leave includes 28 weeks for the mother and 2 weeks for the father.
(8) Officially the waiting period is 9 days; but based on collective bargaining agreements the employer normally pays full
salary for 4 to 8 weeks sick leave. The employer gets a refund from the sickness allowance scheme of 70% of gross
earnings after the waiting period.
(9) Maternity leave falls under the parental leave scheme, which provides a benefit for parents for 263 days. Additional
the father is allowed to have a 6 days leave after the birth of the child .
(10) The benefits level depends on the family situation; from standard (50%) to 3 or more children (66%) of gross pay.
(11) In exceptional circumstances, for example in case of certain 'slow' illnesses, the benefit may be extended to a
maximum of 36 months and, if the employee is follow ing a reintegration course, even up to a maximum of 48 months.
( 12) Manual workers require a doctor's certificate from the 1st day of absence; this does not apply to white collar workers
until the 4th day of absence.
(13) Regulations will change at 1 November 1996. The continuation of payment during the first 6 weeks of absence will be
reduced to 80% and the benefit level after 6 weeks of absence to 70%.
( 14) The waiting period of 3 days is not applied if the absence lasts longer than 3 days.
( 15) The benefit amounts to 50% of income in the category in which one is employed, plus 10% for each person who is
financially dependent on the absentee, with a maximum of 70% o\' the pay category. For the I st month the employer
usually pays the difference between the benefit and the original earnings. Thereafter, workers are usually dependent on
the benefit.
116) Workers receive a fixed amount of benefit plus an income related benefit. Many employers top up these benefits for
their employees. In this manner many employees receive full pay for the first 2 weeks.
(17) During the first 3 weeks benefit amounts to 50% oi' last-earned pay; after this period it is increased to 66%. Some
employers top up this benefit for their employees.
(18) Besides the maternity leave scheme with 5 months benefit (80%) there is an additional patentai leave scheme with 6
month benefit (30%).
( 19) Manual workers require a doctor's certificate from the 1st day o\' absence; this docs not apply to while collar workers
until the 4th day of absence.
(20) As result of collective labour agreements the majority of the employees receive a normal pay during the waiting
period.
(21) The official benefit is 70% of gross earnings, but most employees have this benefit topped up to I009{ of their original
pay until the maximum duration of 52 weeks.
(22) A doctor's certification is only required from the 4th day of absence.
(23) The employer must pay full salary for the first 14 days of absence. From 15 to 365 days, it is the responsibility of the
public authorities to provide a ( 100%) benefit.
(24) Absence for maternity is 100% compensated tor up to 42 weeks or 52 weeks with 80% of compensation. The lather is
obliged to use 4 of the 42 weeks.
(25) The benefit amounts to 65% of medium-earned pay in the last 180 calender days. This benefit cannot be less than 30%
of the minimum daily wage paid by the worker's business sector. In case of tuberculosis the benefit amounts even up
to 80% or 100%. depending on the size of the worker's family. The benefit of 65% is sometimes topped up by the
employer, especially in the larger companies.
(26) The maximum period of benefit for temporary unfitness for work is 365 days. This period may be extended to a
maximum of 1095 days for those in paid employment and who meet the following two requirements: ( I ) a first
uninterrupted sick-leave spell of 365 days; and (26 the employee is not yet eligible for an ageing or invalidity pension.
After one year the employee will receive a benefit amount of 70% of gross pay.
(27) From the 4th to the 21st day the employee receives a benefit of 60% of the last-earned pay; after this period the
benefit rises to 75%. Most workers receive a topping up allowance from their employer up to 909 or 100% of their
last-earned pay (including for the waiting period).
(28) The maximum period of 12 months may be extended with 6 months if it is anticipated that the employee will cease to
be unfit for work within this period.
(29) A doctor's certification is only required from the 7th day of absence.
42
Regulations and statistics on workplace absenteeism
(30) After oiiL* waiting day without benefit, the absent employee receives a benefit of 75% of the last-earned pay. which is
usually lopped up by lhe employer to 85%. The first two weeks of absence are paid by the employer.
(31 ) Formally the duration is unlimited, but usually a maximum of one year is applied.
(32) Besides the maternity leave scheme (50 days) there is a parental leave scheme, which allows parents to be away from
work to a maximum of 450 days per child up to the child's 8th birthday. The tlrst 360 days are paid at the level of a
sickness benefit scheme, the other () days at a fixed rate.
(33) doctor's certification is only required from the Sth day of absence.
(34) Many employees yet an extra sum from their employer.
(35) The scheme governing maternity leave provides for fourteen weeks unpaid leave or. if the woman has 26 weeks
continuity of employment and meets other conditions, up to 18 weeks paid leave and. if the woman has two years
employment, up to 40 weeks leave in total.
(36) 'fhe minimum loss of earning capacity is 66_9r after I year work incapacity and 50% after 3 years of work incapacity.
(37) 'fhe basic pension is a general social security pension. This is supplemented by a supplementary pension. The benetlt
is based on the number of pension years, in practice usually 65%. Most workers receive a topping up allowance from
their employer up to 7597 of their last-earned pay.
(38) During the first 28 weeks of absence statutory sick pay or short term incapacity benefit is paid. Between 28 weeks and
52 weeks employees get a middle rate incapacity benefit after a medical test at 28 weeks of absence.
(39) Some employees receive an extra sum from their employer.
In Austria and Norway a doctor's certificate is only required from the 4th day
of absence, in Sweden from the 7th day and in the UK from the 8th day. In
Luxembourg manual workers require a doctor's certificate from the 1st day of
absence, which does not apply to white collar workers until the 4th day. The
German employer can ask all employees for a doctor's certificate from the 1st
day of absence, but in practice the situation is the same as in Luxembourg and
only manual workers require a certificate from the 1st day; white collar workers
need a certificate from the 4th day. In three countries (Denmark, Ireland, and the
Netherlands) medical certification is not required in case of absence.
The requirement to produce a doctor's certificate in case of temporary sickleave is usually intended as a threshold in order to make 'reporting sick' less
easy. In practice, a medical certificate does not seem to mean much. Employees
will go to a doctor if they know that he/she will sign a certificate without too
much bother. If the doctor will not cooperate, one can always go to another.
Nevertheless, research shows that the duty to produce a medical certificate is
generally linked to a somewhat lower incidence of absenteeism (e.g. Baum,
1978; Winkler, 1980).
In regard also to the waiting period for employees there are divergent
regulations. In most countries the employee who is on temporary sick-leave can
expect to have to wait one or more days, that is to say, no benefit applies to the
first day(s) of absence. Only in Austria, Denmark, Germany, Luxembourg and
Norway are no waiting days applied. In the other countries employees are not
paid for the first day (Belgium and Sweden), the first two days (the
Netherlands), the first three days (France, Greece, Ireland, Italy, Portugal, Spain
and the UK) or the first nine (Finland) days of absence. In some countries the
waiting period is waived if the illness is protracted. In Belgium, for example, the
43
waiting day is waived in the case of an absence of more than 14 days. In Greece,
the waiting period of three days will later qualify for benefit if the illness lasts
longer than three days. In Portugal there is no waiting period when the
employee is admitted to a hospital or has tuberculosis. In other countries, there
are official waiting periods but in practice these days are usually paid normally
by the employer. In Finland, for example, the salary during the waiting period
(9 days) is normally covered by the employer. In the Netherlands the two
waiting days were usually re-insured by the industrial insurance board. This
meant in practice that the employee was simply paid his usual wage. With the
introduction of new legislation governing sick-leave and disability - on 1
January 1994 - it is no longer possible to re-insure with the benefit-paying body.
The Netherlands legislator wishes to confront employers (and employees) more
directly with the level of absenteeism in the company. Employers and
employees can now agree that the first two days of sick-leave will not be paid.
Recent discussions between employers and employees in industrial sectors on
conditions of employment show an growing number of collective agreements
with an introduction of one or two waiting days for employees.
Waiting days are also often used as a type of threshold in absenteeism. The
literature shows, too, that while it is true that waiting days are accompanied by
a lower frequency of absenteeism, at the same time the average length of
absence is greater, so that the ultimate effect on percentage absenteeism is practically nil (Smulders, 1984).
In eleven countries (Denmark, Finland, France, Greece, Ireland, Italy, the
Netherlands, Portugal. Spain, Sweden and the United Kingdom) there is
officially a loss of income in the case of temporary sick-leave, in the sense that
salaries are not paid or that the benefit percentage paid is less than 100% of the
last wage earned (see Table 4.1). In this case, too. practice is usually less
negative than the official rules would suppose. In most countries a lesser or
greater number of employees receive a top-up from their employers for a shorter
or longer period. In Finland the employer normally pays full salary for 4 to 8
weeks sick leave. The employer gets a refund from the sickness allowance
scheme of 70% of gross earnings after the waiting period (nine days).
According to the Danish legislation the employer is obliged to pay sickness
benefit during the first two weeks. Often the benefit amount will be
considerably lower than the salary because there is a maximum level to sickness
benefit. However in practice many employees receive full wage from their
employers during the first two weeks (or longer). According to the Salaried
Workers Act white collar workers receive full payment during sickness absence.
Blue collar workers are often covered by collective agreements which entitle
44
them to full wage during a period. In Greece, for the first month, the employer
usually pays the difference between the benefit and the original wage. In
Ireland, too, many employees receive the extra from their employer. Thus, many
Irish employees receive a normal salary for the first two weeks of their absence.
In the Netherlands the difference between the benefit and 100% of gross pay
was re-insured with the industrial insurance board. This solution has been
forbidden in recent changes in regulations. Employers and employees within an
industrial sector still can agree that the employee receive more than the legal
minimum of 70% of gross pay, but such a top-up cannot be insured by the
industrial insurance board anymore. Most employees still get their usual wage
for the whole period of sick-leave (52 weeks) at this moment. But employers
have started to question this top-up in the discussions on conditions of employment with the unions. In Spain, most employees - on the basis of collective
agreements - receive for shorter or longer periods the difference between the
benefit and their last-earned wage (up to 90% or 100% of last-earned pay). In
France, the UK, Italy and Portugal, too, the employer tops up the benefit to a
greater or lesser extent.
In Austria, Belgium, Germany, Luxembourg and Norway there is officially a
shorter or longer period of full payment of salary which is partly linked to an
own-risk period for the employer. In Belgium, white collar workers receive full
benefit for the first 30 days of absence and manual workers for the first 7 days.
Manual workers, however, also receive a top-up to 100% from the employer for
the next 23 days. In Germany the employer still pays the first 6 weeks of
absence at this moment. But regulations will change in the near future. From 1
November 1996 the continuation of payment during the first 6 weeks of absence
will be reduced to 80%. In Austria continuation of full payment depends on the
length of employment and differs for manual workers and white collar workers;
it ranges from 4 to 10 weeks for blue collar workers and from 6 to 12 weeks
for white collar workers. In Luxembourg and Norway absent workers get 100%
of last earned wages for up to 52 weeks of absence. In Norway the first two
weeks of absence are paid by the employer.
After the first period of absence, in most countries the percentage benefit
decreases. In practice, there is a continuation of full payment of wages in only
four countries (Denmark, Luxembourg, the Netherlands and Norway).
Furthermore, in Denmark the sickness benefit may be reduced in case of partial
work incapacity. In the other countries the percentage benefit is between 50%
(France, Greece and Italy) and 80% (Germany) of the last-earned wage. The
percentage in Germany will be reduced to 70% at 1 November 1996. In Sweden
the absent employee receives a benefit of 75% of the last-earned pay, which is
45
usually topped up by the employer to 85%. In the UK the amount of benefit is

fixed and in Ireland there is a combination of fixed benefit and an incomedependent benefit (12%). In three countries (France. Greece and Ireland) it is
possible to obtain additional benefit for dependent relatives. Lower benefits
should be regarded as a form of 'own risk' for the employee and are often aimed
mainly at shortening the period of absence. In a number of schemes, on the
other hand, an extended period may mean that the percentage benefit is increased, such as in Italy and Spain. Research indicates that, generally speaking,
higher benefits are linked to higher levels of absence and lower benefits to lower
levels. An increase in the benefit usually also leads to an increase in the period
of absence (e.g. Dalton & Perry, 1981; Doherty, 1979; Fenn, 1981; Thomas.
1981). But these results are based upon absence data of workers within a
country and not to cross-national data.
Eleven countries (Belgium, Denmark, Finland. France, Greece, Ireland. Luxembourg, the Netherlands, Norway, Portugal and Spain) operate with a maximum
period of temporary unfitness for work of approximately one year (see Table
4.1). In some countries and under certain circumstances it is even possible to
have this period extended. In Spain the sickness benefit may be extended after
one year for a further six months if an end to the sick-leave is to be expected
within this period. In Portugal the maximum period of benefit for temporary
unfitness (365 days) may be extended to a maximum of 1095 days in the case
of permanent unfitness for work and if the worker is not yet eligible for an
ageing or an invalidity pension. In France, certain 'long-term patients' may
receive benefit for up to 36 months. If they participate in a 'reintegration
programme' the maximum period in France can even be extended to 48 months.
In Austria and Germany the maximum period is 78 weeks. In the Swedish
system there is no formal maximum benefit period, but usually a maximum of
one year is applied. Only a small proportion of the absence (a few percent) in
Sweden exceeds a period of one year. Two countries have a shorter maximum
period: Italy and the UK with 26 and 28 weeks respectively. The maximum
period of absence has an important influence on the length of the sick-leave.
The Netherlands' statistics, for example, show that only 2% of absences due to
illness last for more than six months. This group of absentees, however, account
for about one-third of the total number of days lost through illness.
Regulations for maternity leave are (perhaps surprinsigly) a subsection of the
regulations governing temporary sick-leave in seven countries (Belgium.
Denmark, Germany, Greece, Luxembourg, the Netherlands and Spain). In the
other countries (Austria, Finland, France, Ireland, Italy, Norway, Portugal,
Sweden and the UK) there are separate - although more or less comparable 46
regulations covering maternity leave. The duration of maternity leave varies

greatly from country to country. The most favourable are the Nordic and
Austrian systems. In Denmark the mother can take 28 weeks and the father 2
weeks. Norway (42 weeks or 294 days), Sweden (450 days) and Finland (263
days) have parental leave schemes, which offer both parents paid leave to take
care of their young children. In Denmark, there is also a parental leave scheme,
which offers parents paid leave for up to one year, beyond maternity leave.
Austria offers parents 18 months leave (12 months for the mother and 6 months
for the father); but this is only a partially paid benefit. Italy and the UK, too,
have a relatively long period of paid maternity leave. In Italy the maternity
scheme provides 5 months benefit (80%) for the mother and the parental leave
scheme 6 months benefit (30%) for the mother or the father. In the UK women,
with a minimum of two years employment, are entitled to a maternity leave of
up to 40 weeks (of which up to 18 weeks paid leave). The length of maternity
leave in the other countries of the Union varies between 12 weeks (Greece) and
16 weeks (France, Luxembourg, Spain and the Netherlands). The percentage
benefit in the case of pregnancy is generally a little higher t and Spain han for
temporary absence due to illness or disability. In comparing the data on absenteeism it is important to know whether maternity leave is included in the
statistics. In particular, if many women under 40 years are involved in the group
concerned, maternity leave could account for a significant part of the
absenteeism. For example: in the Netherlands health care system, an average of
1% to 1.5% of work-time is taken up by maternity leave.
4.1.2 Characteristics of the regulations on extended or permanent work

incapacity
In eight countries (Belgium, Finland, Ireland, Luxembourg, the Netherlands,
Norway, Portugal and Spain) the regulations on extended or permanent
disability are linked, time-wise, to the regulations governing temporary sickleave. In these countries there is a waiting period for the former which is
equivalent to the maximum period applicable to the latter. In the UK absent
workers get a middle rate incapacity benefit (after a medical test) between the
28 weeks of absence in which a short term incapacity benefit is paid and the 52
weeks waiting period for the permanent disability benefit scheme. In the other
countries (Austria, Denmark, France, Germany, Greece, Italy and Sweden) it is
not essential for the maximum period for temporary sick-leave first to have
elapsed before a person is entitled to permanent benefit.
47
The definitions and conditions of payment are rather diverse. They are often
based on the minimum loss of earning capacity or a minimum percentage
unfitness for work. This varies between 1% (no minimum) and 74%. A
minimum loss of working capacity or a minimum percentage unfitness for work
of 74% means for example that an employee can be entitled for a permanent
disability benefit when the social security organisation has assessed that this
person has lost at least 74% of his earning capacity or that this person is
disabled for 74% or more.
In most countries (Austria. Denmark. Finland. Germany. Greece. Ireland.
Luxembourg, the Netherlands. Norway, Spain. Sweden and the UK) the
minimum loss of earning capacity/unfitness for work is 50% or less. In Ireland.
Luxembourg and the UK no minimum loss (1%) is applied. In Belgium. France.
Portugal (all 66%) and Italy (74%) the minimum losses of earning
capacity/unfitness for work are the highest. In Portugal the minimum percentage
of 66.2/3% only counts for the situation after 1 year of work incapacity: after
three years this limit is less high (50%).
In ten countries (Denmark. Finland, Germany. Greece. Italy, Luxembourg.
Norway, Portugal, Sweden and Spain), where it is a case of permanent disability
an invalidity pension is paid. This scheme is generally unfavourable to
employees who become disabled at a young age since the level of pension paid
is mostly dependent on the number of years for which premiums have been
paid. In Austria, Belgium, France and the Netherlands the amount of the
payment is a percentage of the pay already earned. In Austria the maximum
level of benefit is 66.%. In Belgium the benefit percentage (40%-65% of the
last-earned wage) is dependent on family circumstances. In France the level of
benefit (30%-90%) is determined by the degree of unfitness for work (partially
or completely disabled) and whether the person needs daily assistance with
basic needs. In the Netherlands the level of payment (15%-70%) is dependent
on the degree of disability (loss of earning capacity).
In Sweden the disability pension is a general social security pension,
supplemented by an additional pension. The benefit is based on the number of
pension years. In practice disabled employees usually get a benefit of 65%.
which is for most employees topped up by the employer to 75% of the lastearned pay. Finally, in Ireland and the UK fixed amounts of benefit apply to
permanent disability. In the UK the family situation is also taken into
consideration in fixin the amount.
48
In general, the maximum age for benefit for permanent disability is tied to the
age for receipt of the old age pension. In four countries (Austria, Germany,
Ireland and Spain) the disability benefit also continues after this age, but
includes the old age pension.
In the regulations on extended or permanent work incapacity in the EU, there
are no separate regulations for blue and white collar workers.
4.2 Statistical data

4.2.1 The availability of statistical data
It is not very easy to establish figures for absenteeism and disability in the EU.
As far as is known at present, national statistics for temporary sick-leave exist
in eleven countries (Austria, Denmark, Finland, Germany, Greece,
Luxembourg, the Netherlands, Norway, Portugal, Sweden and the UK). In
addition, these statistics are not always complete and some do not look very
reliable. In Portugal, for example, the statistics refer only to the two thousand
largest companies, which represents about a quarter of the working population.
Some economic sectors, like agriculture and fisheries or other services (e.g.
health, education) are insufficiently, or not at all, represented in these statistics.
In Norway the statistics cover a sample of 700 enterprises and 130,000
employees (about 6% of all employees in Norway). This sample is somewhat
biased because it consists of many enterprises with piece rate production. In
Denmark and Sweden this statistic does not cover the first two weeks of absence because this period is paid by the employer. The Finnish absence statistics do
not include sick leaves shorter than the waiting period (9 days). The figures in
the Greek statistics - with a yearly frequency rate of 0.15 spells per person and
a percentage absenteeism days per person of 1.3% - are surprisingly low. In
some countries (France and Italy) national employer surveys are used to obtain
national absenteeism figures. In other countries, one is dependent on large-scale
research projects which usually only take place incidentally. In Ireland, for
instance, the Irish Business and Employers Confederation (DEC) carried out an
absenteeism survey of 350 companies in 1992. Information on important
features of absenteeism in Ireland became available in this way. It must,
however, be realised that it is usually only the better companies which are
willing to cooperate in research of this nature. In Belgium there are currently no
national research figures available and use must be made of the results of
incidental research projects which include statistics on absenteeism. The most
recent figures in Belgium are the result of research on absenteeism in the health
care sector carried out by the Interbedrijfsgeneeskundige Dienst voor
Werkgevers (IDEWE).
49
Publications from Eurostat give a summary of the available data on permanent

disability and on occupational diseases and industrial accidents in the
former 12 Member States of the European Union. These publications show that
in practically all these Member States national statistics exist in relation to
extended or permanent disability (invalidity) and to occupational diseases/industrial accidents. It is, however, very difficult to compare these
statistics because of the great differences in the legislation and regulations on
which they are founded. In addition, in a number of countries, e.g. Belgium.
Ireland, France, Luxembourg and the UK, the total number of permanent
disabled cannot properly be ascertained because disabled employees may be
included in different sets of statistics at the same time. In other countries the
figures for disability are combined with other social security figures. In
Denmark, for example, the statistics for disability benefits shown by Eurostat
also include those who have taken early retirement. In the Netherlands, no
distinction is made between the causes of disability. As a result, no separate
regulations exist for occupational diseases and industrial accidents and the
statistics for those on disability benefit include both those whose disability is
work-related and those for whom it is not work-related. Information from the
new Member States and Norway gives comparable results for these countries.
Also in Austria, Finland, Norway and Sweden national statistics exist in relation
to permanent disability (invalidity) and to occupational diseases and industrial
accidents.
4.2.2 The scale of absenteeism
In contrast to the information on the characteristics of the social
security systems, the national figures on temporary and extended or
permanent work incapacity in the EU (and Norway) will not be presented in an overall table. Such a table could easily be misinterpreted. The
nature of the information is rather diverse and the figures are not
always very reliable. Besides national figures are not comparable without additional information on the regulations (including the way these
are applied in practice) on absenteeism and on alternative benefit
schemes, such as unemployment and early retirement.
The proportion of workers absent on temporary sick-leave lies - according to
the available data - between 3.5% (Denmark) and 8.0% (Portugal). An
unexpected score, in fact, for both countries. In Denmark there is a relatively
favourable benefit climate (no medical certificate; no waiting days; and a benefit
level up to 100% of gross earnings) and in Portugal this is significantly less
favourable (medical certificate needed; 3 waiting days; and a benefit level of
65%). On this basis, just the opposite percentages had been expected for these
50
countries. However, the Portuguese figures include not only absences due to
illness but also absences for other reasons. These reasons account for about a
quarter of the total number of days lost by absence. In the Danish figure the first
two weeks of absence are not counted, because these are at the employer's risk;
and the scheme operates with a quite low maximum benefit amount.
The Italian figures (7,3% for the public sector and 6.9% for the industrial sector)
are rather high. The arrangements for temporary work incapacity are not very
favourable in Italy (3 waiting days; a benefit level of maximum 66%; and a
maximum duration of 26 weeks). The percentages for Belgium (5.8%, based on
research in the health care sector), France (5.6%) and the UK (3.6% with a
maximum duration of 28 weeks) are more in line with expectations. Austria
(4.1%) and Germany (5.6%) are relatively low, particularly if the maximum
period of 78 weeks is taken into consideration. Also the Netherlands (5,5%),
Norway (5.0%) and Luxembourg (with an average duration of 10,2 days per
spell) are surprisingly low considering that, in all three countries the
absenteeism regulations are rather flexible and favourable for employees.
Recent changes in legislation in the Netherlands have increased the activities of
companies directed at reduction of absenteeism and have influenced the Dutch
figures on absenteeism. In 1992 the absenteeism percentage in the Netherlands
was 7.7%. Finland (4.6% for blue collar workers and 2.0% for white collar
workers) also has low absenteeism rates, but this figure does not include sick
leave shorter than the waiting period (9 days). Sweden had a relatively high
level of absenteeism in the 1980s, but regulations have been changed since that
time and the level of absenteeism has declined significantly. In 1995 Sweden
had an absenteeism percentage of 4.4%, including absenteeism within the
waiting period, but excluding statutory leave for other reasons such as parental
and maternity leave. The Irish figures (4.5% with a frequency of 2.5 per person
and an average time of 4.4 days) at least indicate a good deal of short-term
absenteeism. This is explained by the fact that the Irish figures include -just as
the Portuguese figures - not only absences due to illness but also absences for
other reasons.
The figures for extended or permanent disability also give a varied picture.
Concentrating on the figures which include occupational diseases and industrial
accidents one may conclude that the percentage of the work population unfit for
work varies between 3.0% (Ireland) and 13.3% (the Netherlands). In view of the
favourable benefit climate in the Netherlands, this is not an altogether unexpected percentage. But this situation has changed recently and has decreased the
number of disabled workers. The Irish percentage, in view of the existing
regulations, is surprisingly low. Other countries with a relatively high
51
percentage of disability are Sweden (12.7%), Luxembourg (11.9%), Portugal

(11.2%), France (11.1%), Spain (10.77c) and Norway (10.4%). The percentages
for Luxembourg, Portugal and Spain are, in view of the regulations (disability
attracts a pension), on the high side. The proportion in Sweden is not
unexpected in view of the favourable benefit climate (most disabled workers get
75% of their last earned pay as result of a topping up by their employer).
Likewise, the Norwegian figure is not completely unexpected given the benefit
(a pension scheme with a complex formula, but resulting in an income
somewhat lower than the prior salary). The French figure is mainly determined
by the high number of benefits related to occupational diseases and industrial
accidents. The UK (5.5%), Italy (5.7%), Germany (6.5%) and Belgium (6.6%)
have relatively low percentages which is, however, in line with their practice of
awarding benefits. This applies also to the slightly above average level of the
number of those on disability in Finland (9.4%), Denmark (9.1%, including
those on early retirement) and Greece (8.9%).
In spite of the differences in the extent of absenteeism and disability in the EU,
there are some general patterns to be found in the additional data provided by
the national correspondents. In the case of temporary sick-leave these include
characteristics such as age, gender, position in company and sector. Younger
employees usually have a lower level of absences than older ones, associated
with the health situation of workers and with long-term exposure to risks at
work. In addition, women are usually found to have higher levels of absences
than men. There is also an indication that gender-related diseases affect more
women as well as the double or treble burden (work/home/dependents) that
women carry. Where position in the company is concerned, the following
pattern can be found: blue collar workers generally have higher levels of
absenteeism than white collar workers and the higher the position in the
company, the lower the level of absenteeism. The differences in working
conditions appear to be the main explanation for these differences. It is also an
indication that those in higher positions have better chances of working on, even
though ill. Furthermore, white collar workers may have access to private health
care and therefore speedier treatment. Differences between the sectors arc
closely linked with the differences according to company position referred to
above. Sectors involving much physical work and poor working conditions
(such as the mining and industrial sectors) often exhibit higher levels of absenteeism than sectors involving much administrative work and services (such as
the trade, banking and insurance sectors).
The patterns in the case of schemes for extended or permanent disability are
closely linked - as far as information is available - to those for temporary sick52
leave. Here too, there is more disability among older workers and in the sectors
where the work is more physically burdensome and the working conditions are
more demanding. Only the difference between men and women is less
systematic. This probably has something to do with the fact that the greater
participation of women in the production process is still a fairly recent
phenomenon in many countries and that permanent disability occurs mainly
among older employees. In most countries 80-90% of disability occurs in the
group
of over-40s, and 20-25% in the over-60s. In countries where under the
6
regulations there is no maximum age for permanent disability, the lastmentioned percentage is even higher. In Germany 62% of those on disability are
over 60 and in Spain 70%.

Great differences have been found in the regulations governing absences due to
illness and disability in the various Member States. The European employee
who has to interrupt work, temporarily or for a long period due to illness or
disability is - depending on the country in which he or she works - confronted
by very diverse regulations. In one country a person unfit for work will be paid
normally for a period (Austria, Belgium, Denmark, Finland, Luxembourg, the
Netherlands, Norway and currently Germany but this will change as result of
new legislation), while temporary unfitness for work in another country may
mean a halving of the person's income (France, Greece, Italy). This does not
mean that countries which have a favourable system of benefits for temporary
absences also have favourable regulations on extended or permanent disability.
Some countries with favourable arrangements for temporary sick-leave
(Denmark, Finland, Germany and Luxembourg) have a pension scheme to cover
extended or permanent disability. With such a scheme the benefit is mostly
dependent on the number of years for which one has paid the premium. If a
person becomes disabled at a young age, this is often accompanied by a
substantial decrease in income. If the illness concerned is the result of an
occupational disease or accident at work, there is, in most of the EU countries,
a more favourable arrangement. Civil servants have also, in most of the countries, more favourable arrangements than those employed in the private sector.
A large discrepancy is evident between the formal regulations and the way they
are handled in practice. In most countries practice is much more favourable than
the official regulations. In many countries groups of employees receive a top-up
from their employers for a shorter or longer period in case of absenteeism. In
some countries (Austria, Belgium, Denmark, Luxembourg, Norway and
Germany at this moment, but this will change in the near future) there is
53
officially a shorter or longer period of full payment of salary which is partly

linked to an own-risk period for the employer.
There are a lot of missing data on absenteeism, especially on short term absenteeism. National statistics on absenteeism exist in eleven countries (Austria,
Denmark, Finland, Germany, Greece, Luxembourg, the Netherlands, Norway,
Portugal, Sweden and the UK). However these statistics are often neither
complete nor reliable. Although the data on extended or permanent disability
are a lot better, it is still very difficult to establish the total number of disabled
persons because in a number of countries disabled employees may be included
in different sets of statistics at the same time.
Available data show great differences in levels of absenteeism (between 3.5%
for Denmark and 8% for Portugal) and disability (between 3% for Ireland and
13.3% for the Netherlands). It is very difficult to explain these differences. One
might conclude that workers in the country with a high level of absenteeism are
less healthy than the workers in another country with low levels of absenteeism.
This may be true, but workplace absenteeism is a complex and multi-causal
phenomenon, which is influenced by many factors. These factors operate at
different levels, such as the societal level, the company level and the individual
level. At the societal level aspects such as the social security system, the
economic situation, the quality of health care, and the general standards and
values relating to work and illness are relevant. At company level the sector, size
of the company, company health policy, organizational structure, company
culture and treatment of sick employees all play a part. Workplace factors such
as the quality of work, the content and organization of work, working
conditions, industrial relations and employment conditions also have an
influence at this level. Finally, at the individual level, personal characteristics,
lifestyle and biological and psychological factors such as the physical
constitution and mental resilience of an employee are relevant. The most
important personal characteristics which are associated with levels of workplace
absenteeism and incapacity for work are age, sex and education.
When considering levels of absenteeism and disability the impact of adjacent
regulations on unemployment and (early) retirement should be assessed. These
regulations act partly as communicating vessels, depending on the admission
criteria and the level of benefit. For example, at the beginning of the 1980s
schemes for early retirement were introduced in many European countries and
the pressures on schemes for permanent work incapacity and invalidity were
relieved. At this moment many of these schemes are under discussion. Their
abolition or the raising of the age at which the workers becomes eligible for
these early retirement schemes, should cause appeals to invalidity schemes to
54
increase again. However all the main social protection benefits currently face
demands for cost containment, perhaps therefore emphasising corresponding
needs for health maintenance and improvement (as well as the availability of
jobs).
This introduces another aspect which affects the level of absenteeism in the
various countries and this concerns the structure of the working population.
Many of these pressures on benefits are partly a response to demographic
changes, particularly ageing of the working population. In general older
employees have a higher percentage of absenteeism than younger employees
and have a greater chance of finding themselves involved in the schemes for
extended or permanent invalidity than younger employees do (see chapter 1.2).
The nature of the work also affects absenteeism. Employees in industrial
production companies generally have higher levels of absenteeism than
employees working in the service sector. The construction industry also
generally has a high level of absenteeism related to ill health and a relatively
large exodus into the invalidity schemes. As a result absenteeism is more a
problem of blue-collar workers. White-collar workers generally have lower
levels of absenteeism.
From the current research it is clear that national statistics on absenteeism are
only available to a limited extent. Furthermore these statistics often only relate
to a portion of the working population. For example many statistics only include
employees working in big companies. It is much more difficult to find
absenteeism data on employees working in SMEs and moreover such data are
often not complete; this is particularly a problem with data on short spells which
are often missing in statistics of SMEs. And yet most European employees are
working in companies with less than 10 employees. Data on absenteeism among
self employed persons are almost completely lacking. Furthermore the methods
of data collection and classification are not always clearly specified. For
example is absenteeism within the waiting period included in the data? And how
is partial resumption of work dealt with? Finally, as already noted, the
absenteeism data from some countries do not distinguish absenteeism related to
ill health from absence from work for other reasons.
At present it is not possible to make a proper valid comparison of absenteeism
and disability in the EU. To improve this situation national absenteeism data
would need to be available in a much more detailed form, including information
on how the data were recorded and what aspects were included and what not.
The implications of these points will be further discussed in the final chapter
(chapter 7) with contains the conclusions and recommendations of this study.
55
Strategies to reduce
workplace absenteeism
/// the first paragraph of this chapter the underlying framework for the
absenteeism and reintegration process will be presented. Four types of
workplace activities have been derived from this framework: procedural
activities, preventive work-oriented activities, preventive person-oriented
activities and reintegrative activities. These types of interventions will be
used to describe what is taking place in European companies in the daily
practice to reduce absenteeism related to ill health at the workplace. The
description is based upon information from the national correspondents.
Because empirical data were lacking in most countries, only general
patterns will be presented as an impression of the experts in this field.
5.1 The underlying framework for the absenteeism and

reintegration process
Workplace absenteeism related to ill health is a phenomenon which is
influenced by a large number of factors, as discussed in the last paragraph of
Chapter 4. In this study the process of becoming ill, being absent from work,
recovering and resuming work, is viewed as a result of a (mis)fit between the
person and the environment (Van Dijk et al., 1990, Caplan, Cobb, French,
Harrison and Pinneau, 1975; French, Caplan & Harrison, 1982). This means
that health problems may arise as a result of a discrepancy between the
workload (demands and requirements) and the capacity of the worker (abilities
and skills). Depending on the attendance motivation and the pressure to attend
- which refer to the opportunity and the need for absenteeism - health problems
result in incapacity for work or absenteeism (Nicholson, 1977, Steers &
Rhodes, 1978). These last factors are reflected in the so called 'absenteeism
barrier'. Return to work depends on the course of the illness and the
'reintegration barrier'. By the reintegration barrier is meant the totality of the
57
factors which affect the course of the illness and the return to work (for example
the actions of the doctor acting for the insurance company, attachment to the
company, the availability of specially adapted work, waiting times in medical
care sector, etc.). This whole process is in turn influenced by individual factors,
company and workplace factors, and societal factors (see 4.4). For instance at
the individual level, biological and psychological factors such as the physical
constitution and mental resilience of an employee influence his or her capacity.
Illness not derived from the workplace is one of these factors which diminish
the capacity of an employee and leads to a misfit between the workload and the
capacity of an individual. This framework deals therefore with absenteeism
related to ill health caused by the work as well as with absenteeism related to ill
health not linked to work. In figure 5.1 this framework (based on De Groot.
1958, Philipsen, 1969, Van Dijk et al., 1990. Veerman, 1991) is represented
schematically.
Figure 5.1: The process of becoming ill, being absent from work, recovering and return to work.
workload
"
balance
health
problems
il
absence from
work
return to
work
i t
capacity
V_
V
reintegration
barrier
absenteeism
barrier
individual facte
UUIII| Dany/workplace
tauu. IS
__y
sociel alt actor s
Four types of interventions can be distinguished, which address different

elements in this framework. The first kinds of intervention are procedural
measures, which are aimed at raising the absenteeism barrier; these are
measures for the monitoring and control of absenteeism. This could be keeping
detailed attendance records, requiring medical verifications for reported
illnesses, employing a sick visitor, using financial incentives such as forfeiting
58
Strategies to reduce workplace absenteeism
a day's holiday in the event of illness and giving a bonus in the event of no
absenteeism, and disciplinary measures like warnings and punishment. The
measures are therefore aimed at reducing the need for absenteeism in employees
and/or the opportunity for absenteeism. Contrary to the other three types of
interventions discussed here, the use of procedural measures will in general not
have an effect on the health of the employees. These measures may only
encourage employees - with or without health problems - to report sick earlier
or later depending on how tight the procedures are; or to attend work despite
feeling unwell.
The second and third kinds of intervention are intended to prevent employees
from getting ill. These preventive measures are work-oriented and personoriented respectively. Preventive work-oriented measures aim to reduce the
discrepancy between workload and capacity by reducing the workload. This is
done by removing the work-related causes of the problems in the area of safety,
health and well-being. This means that aspects are tackled, for example by
acquiring safer equipment, climate control, rotation of tasks, better information
system, work organisation, safety management etc.
Preventive person-oriented measures are those in which employees are
supported to work (and live) in a safe and healthy way. These person-oriented
measures aim to improve the balance between workload and capacity by
increasing the capacity of individuals. Here one can make a distinction between
training courses which are more in the field of safety and others which are more
in the field of health or well-being. These measures include activities such as
training in the use of personal protection equipment, lifting courses, lifestyle
activities (food, smoking, alcohol, exercise), cancer screening, physiotherapy,
training courses on work organisation and courses on stress management.
The last types of intervention aimed at reducing workplace absenteeism are
reintegration measures. These reintegration measures aim to lower the
reintegration barrier and to accelerate the return to work of sick employees. This
can be achieved through support by managers (maintaining contact,
participating in a socio-medicai team; meetings between the company
management, company doctor and personnel officer on cases of absenteeism
and absenteeism policy), medical care by the company medical service (medical
surgery, physiotherapy, treatment by private specialists) and direct reintegration
activities (drafting a return plan, offering specially adapted work,
rehabilitation).
59
5.2 The daily practice of absenteeism reduction at the

workplace
With reference to the four types of intervention, general practice in reducing
absenteeism related to ill health can be described for the Member States of the
EU and Norway. This description is based on the information from the national
correspondents. They have been asked to answer the following questions:
What is being done to reduce absenteeism related to ill health?
Which general patterns can be distinguished?
Which strategies are most widespread?
What is known about the results of this strategies?
What works and how adequately do you know effects of interventions
on either health or absenteeism?
What is known about the costs and benefits of these initiatives?
The correspondents were also asked to use available empirical data. In most
countries such data were lacking and the correspondents could only give their
own impressions as experts in this field. As a result of this only general patterns
of strategies to reduce workplace absenteeism will be discussed in this chapter.
The reports of the national correspondents indicate that in a number of countries
one can talk of a combined approach, which means that all kinds of intervention
are used in combination, but in most countries the emphasis is on two or three
activities (see Table 5.1 ).
Table 5.1 Strategies to reduce workplace absenteeism
Type of
measure
Aus Bel Den Fin Fra Ger Gre Irl
Procedural
Preventive
work-oriented
Preventive
person-oriented +
Reintegration
Ita Lux NI Nor Por Spa Sw UK

+
+ +
+
+
5.2.1 Procedural measures

According to the correspondents procedural measures are most common and
take place in all EU Member States and in Norway. Sometimes companies start
60
or intensify such activities as a reaction to changes in national legislation on

sickness benefits and absenteeism policy.
In the Netherlands, the UK, Spain, Germany and Luxembourg, legislation to
make changes in this area has been introduced recently. For example, the
Reduction of Sickleave Act was introduced in the Netherlands in 1994. This
transferred the costs of the first two or six weeks (depending on the size of the
company) of employees' absence through illness to the employer. From 1996
onwards this period was even extended to one year, irrespective of the size of
the company. Dutch employers are now obliged to continue paying the wages
of their employees for a year in the event of illness. As a result of this first
revision, checking on the first day of absence has increased in the Netherlands
from 19% to 36% (Goudswaard et al, 1995). The reduction in wages, through
qualifying days or incomplete supplementation to the original wage, has risen
from 10% to 21% of companies. Financial incentives in the form of sanctions
and/or rewards in the form of money or days off, in the case of (too) high a level
of absenteeism or low level of absenteeism, were used by 9% of companies after
the introduction of the excess period as opposed to 6% before it. Companies
have also begun to monitor absences more systematically (up from 41% to
56%), and concern about absenteeism in company management has increased
(from 43% to 53%). Following the extension of the excess period to a year there
was a further expansion of these measures. For example, in an increasing
number of Dutch CWAs (collective bargaining agreements), negotiations were
concluded in respect of one or two unpaid qualifying days in the event of illness.
However, after these qualifying days, the full salary is still paid under the terms
of almost all CWAs.
In April 1994 the UK government shifted the social security costs of the first 28
weeks of sickness onto employers. In the UK workplace absenteeism is seen as
a problem which has to be 'managed'. In attempts to reduce absenteeism the
greatest emphasis lies on management techniques. So these procedural
measures mean that UK line managers have a critical role in managing
absenteeism, even when it is due to illness.
From 1992 onwards Spain extended the excess period for employers from the
first 3 days of illness to the first 15 days. After this period the government is
responsible for providing a benefit. Most Spanish companies concentrate their
absence policy on control and monitoring of the workers. Typical procedural
activities in Spanish programmes include activities such as creation of an
absenteeism department, strengthening the hierarchical lines, passing over the
control on absentees to middle management and line supervisors, and
61
introduction of incentives. Furthermore they may inform their workers about the
impact and costs of the absenteeism problem at the workplace.
In Luxembourg two laws were introduced relating to procedural measures
designed to reduce workplace absenteeism. In 1992 a law came into force in
respect of the insurance company medical service (rztlicher Kontrolldienst der
sozialen Sicherheit). This law is aimed both at preventing fraud in absenteeism
and taking preventive measures in order to avoid absenteeism. In 1994, as a
result of the European Framework Directive, a law was introduced which gives
more concrete form to the responsibilities of the occupational health services
(OHS). The occupational health services are responsible for carrying out risk
inventories and evaluations, improvement of working conditions, the provision
of first aid, reintegration activities, and periodic examinations.
From November 1996 German employees will experience a reduction in their
sick pay. Instead of 100% of their last-earned pay they will receive 80%. At this
moment it is too early to say if this change in legislation will lead to new
procedural measures. An example of a procedural measure which was already
used is that German employees, like many other European employees (see
chapter four), are required to submit a medical certificate in order to be eligible
for sick pay.
In recent years there has been a debate in Sweden and in Norway on the
introduction of legislation as a result of the rising cost of sickness benefits. In
1989/90 the Norwegians conducted an intense debate on the rise in workplace
absenteeism (see Chapter 3). Various kinds of changes in the absenteeism
regulations were considered at the time, such as the introduction of qualifying
days, the extension of the excess period for employers and a reduction in the
level of benefit. Ultimately all these methods of intervention were rejected. The
Norwegian government, however, did introduce regulations as of 1 January
1992 concerning internal monitoring of health, environment and safety (Internal
Control of Health Environment and Safety: IC HES). The regulations require
every employer to initiate systematic activities in order to ensure that the health
and safety legislation is complied with and to report these activities. The new
measures were introduced because the health and safety authorities believed
that the high level of absenteeism was partly the result of poor working
conditions. In addition to the introduction of IC HES, the Norwegian
government addressed employers' responsibility in industrial accidents and
occupational diseases through the introduction of an occupational injury
insurance act in 1990. This act requires the employer to insure himself so that
employees can be compensated in full for industrial accidents and occupational
62
diseases instead of obtaining compensation through the national insurance

scheme. In order to avoid further intervention, employers and employees agreed
to launch a large-scale national absenteeism prevention project in which many
companies participated in order to combat absenteeism as a result of illness
among the workers in companies.
Companies also take procedural measures without changes in legislation. In
Belgium the attempts to reduce absenteeism traditionally restrict themselves to
checks by a monitoring physician who ensures that the absenteeism is justified.
The Belgian monitoring physicians are generally grouped in a private
organization. In 1993 a service of this kind was set up to monitor and control
120,000 civil servants and the measure resulted in a marked reduction in
absenteeism. The Irish strategies also appear mostly administrative in character.
The Irish Business and Employers' Confederation (IBEC) takes the view that
absenteeism must be monitored, managed and controlled. It stresses that the
mere fact of keeping records on absenteeism sends a clear message throughout
the workforce that management attaches importance to attendance. In 1992 a
report of the IBEC was published which showed that a third of the companies
used review and monitoring of individual cases to discourage absenteeism and
15% invoked disciplinary procedures.
In Portugal, Italy and France the procedural measures include also the use of
financial incentives, from bonuses to encourage attendance, to reductions in
benefits, to potential dismissal because of disruption of the normal course of
production.
5.2.2 Preventive work-oriented measures
In general European companies use preventive measures to reduce workplace
absenteeism related to ill health less often than procedural measures. When
preventive measures are reported it mostly relates to both work- and personoriented measures. Only in Belgium do these measures appear to be focused on
work-related preventive measures while in France and Portugal these measures
seem mainly focused on person-oriented preventive measures.
Preventive measures directed at the work-related causes of ill health were
mentioned by correspondents from eleven countries. Only in Ireland and in the
Southern European countries (with the exception of Italy) are these measures
used less by companies. It is apparent that in the Southern European countries
work-oriented preventive measures are more aimed at the protection of safety
and health; while in the Northern European countries work-oriented measures
63
are deployed more explicitly to improve the health and well-being of

employees.
In Norway many companies take measures in order to improve working
conditions, through the rotation of tasks, improvement in work consultation,
and improving the quality of managers. In Sweden many projects and initiatives
to reduce workplace absenteeism by work-oriented measures have take place
and are still going on. Several improvements of physical and chemical working
conditions have been achieved, but less has been done yet in relation to the
psychosocial working conditions (psychological demands, low decision
latitude, social support etc.). A few but successful projects have been undertaken
in Sweden within the public sector to reduce absenteeism through shorter
working hours.
The Finnish government has strongly encouraged preventive work-oriented
measures. Many programmes are introduced which include such measures
amongs others. The National Work Environment Programme established in the
latter part of the 1980's contained programmes to prevent musculoskeletal and
mental disorders. Currently ( 1993-1998) the Ministry of Labour is coordinating
a research and development programme. Workplace Finland, aiming to combine
in its interventions productivity, quality of working life, flexibility and
competence. In 1991-1995 legislative reform has introduced regulations on
promotion of workability (see 3.2). Based on the European Framework
Directive, workplaces are stimulated to run action programmes for promotion
of safety and health at work. In 1996 a Committee established by the Cabinet
proposed several further actions to respond to the concerns and consequences
that are caused by the rapidly ageing workforce of the country.
In Luxembourg the banks have taken measures to improve VDU screen work
and the design of the workplace. Other work-oriented measures taken by
Luxembourg companies are activities aimed at improving shift work: instead of
the usual change of shift after seven days, there is a two-day rotation with a
day's rest in between. Additionally, a large Luxembourg construction company
offers protective clothing made of Goretex which gives better protection against
cold and damp.
Research among 1100 Dutch companies (Ministerie van Sociale Zaken en
Werkgelegenheid, 1992) showed that about a third of these companies had over
the last two years introduced technical measures for improving working
conditions, as well as making ergonomie improvements and taking steps in the
areas of air-conditioning and noise. Organizational measures were applied by
64
12% of the companies. This is understood as including the provision of

information and instruction, the drafting of directions concerning the use of
machines and the adaptation of working methods, the setting up of works
consultations, the avoidance of monotonous work (work structuring) or the
appointment of a safety officer.
In Belgium and United Kingdom preventive work-oriented activities are not
(yet) found on a large scale. Examples of activities in this field are, however,
found in areas such as climate control, ergonomie measures to reduce physical
stress, the institution of task groups and modification of working rosters.
In Germany work-oriented measure are undertaken, but to a lesser extent than
person-oriented measures. Although the Health Insurance Funds prefer workoriented measures, their influence is not big enough to promote these on a larger
scale. The German Health Insurance Funds introduced two instruments to
support preventive work-related measures: company health reports and health
circles. A company health report is a quantitative analysis for locating problem
areas in the company: is there a link between the diagnosis of incapacity for
work and workplaces? In health circles employees work together with their
immediate manager, the works council, the management and a health and safety
expert under the leadership of an external expert in listing and solving health
problems at work.
In Austria improving working conditions and organisational climate by
communication, organisational development and training is one of the strategies
used to reduce absenteeism related to ill health.
5.2.3 Preventive person-oriented measures
Preventive measures directed at the improvement of individual capacity were
mentioned by correspondents from twelve countries. Only in Belgium, Ireland,
Greece and Spain are these measures less used by companies. Furthermore, the
same regional tendencies have been found as with the work-oriented preventive
measures. In Southern European countries the measures are more aimed at the
protection of safety and health and in the Northern European countries more at
the improvement of the health and well-being of the employees.
In Portugal the preventive activities seem to be focused mainly on the reduction
of work accidents. An important part of this is convincing staff that safety is the
responsibility of the company and the people working in it. The emphasis lies
in providing information on the use of personal protective equipment. In Italy,
attention is also focused chiefly on industrial accidents and occupational
65
diseases. Most attention is directed at training employees in the use of personal

protection equipment. Interest in health and safety matters was recharged in
Italy with the introduction of the European Framework Directive on Health and
Safety. In Spain a positive and very recent development is the organisation by
some employers associations of training in health promotion at the workplace
for occupational physicians; this may stimulate person-oriented preventive
measures directed at safety, but also at health and well-being.
In the Northern European countries preventive person-oriented measures also
relate to lifestyle activities such as healthy eating, physical exercise, and not
smoking or drinking. For example, in the most progressive British companies
the prevention of absenteeism and incapacity for work now includes health
promotion in addition to the traditional focus on occupational health and safety.
German companies increased use of these kind of measures as a result of a new
law giving health insurance funds more opportunity to undertake activities to
reduce absenteeism related to ill health in companies. Also in Austria, health
insurance funds stimulate person-oriented preventive measures. For example an
initiative of the Obersterreichischen Gebietskrankenkasse (health insurance
fund) resulted in a network of organisations which all use workplace health
promotion. Workplace health and prevention by medical, behavioural and
environmental interventions has been developed as an active and innovative area
in Austria. In Finland, too, individually oriented lifestyle programmes are set up
in order to improve the health of employees. The enhancement of health and
working capacity of employees goes together with the development of work and
working conditions in the maintenance of work programmes. In Luxembourg
health programmes are also being developed in companies, for example a 'back
school', and lifestyle activities such as sport and nutrition.
Other preventive measures deployed to increase the well-being of employees
include training sessions for employees in communication skills found, for
example, in the Netherlands and Denmark.
5.2.4 Reintegrative measures
Reintegrative measures are even less used by European companies as a means
to reduce absenteeism related to ill health than preventive measures. These
measures were mentioned by correspondents from eight countries, namely
Belgium, Denmark, Finland, Germany, the Netherlands, Norway. Spain and
Sweden. In the other countries reintegrative measures seem to be less common
in the daily practice of absenteeism reduction at the workplace.
66
Finland is probably the country where most activities take place in this field at
this moment. Since the end of the 1980s many new acts relating to reintegration
have come into force (see chapter 3). Because of increasing social costs, the
need arose to reduce expenditure on the early retirement scheme as a result of
work incapacity (early disability pensions). Many reintegrative activities
designed to maintain the work ability of employees were subsequently made
obligatory through legislation. Maintenance of work ability is defined as
activities in the workplace taken by the employer, employees, occupational
health service and other bodies in a united effort to promote and support the
work ability and functional capacity of all persons throughout their working
careers. The occupational health service is obliged by law to add to their tasks
rehabilitation counselling and to contribute to the maintenance of work ability
at the companies where they work. The maintenance of work ability may vary
in approach depending on the needs of the employees and the situation of the
workplace. Not only reintegrative activities, but also preventive activities may
be necessary for employees at risk of losing their work ability. The starting point
for the actions is that individual employees can continue their own work.
Examples of maintenance of work ability measures are adaption of work (e.g.
ergonomie improvements, changes in working time, re-assignment at work),
vocational on-the-job training, medical rehabilitation like analysis of
rehabilitation needs, intensive health care, and strengthening the occupational
competence of the employees. The maintenance of work ability is based on
team work at the workplace (management, occupational health service,
occupational safety and health organisation at the workplace, representatives of
the works council etc.). Experience in Finland has shown that reintegrative
activities can best take place in large, stable organizations. Often activities are
supported by an Occupational Health Service (OHS), of which there are around
1,000 in Finland. A very well-known example is the 'FinnAge Programme' of
the Finnish Institute of Occupational Health.
Finland is closely followed by Denmark and Sweden. In Denmark the
government actively supports all kinds of activities designed to promote the
return of incapacitated employees to the labour process. Examples of this
include a campaign on the 'Social engagement of companies' in 1994, to
promote the deployment of manpower among companies so that workers who
are temporarily or permanently partially disabled can keep their jobs. The
Danish employers' associations have also agreed with the trade unions through
a social chapter to promote employment of the partially incapacitated. In Danish
companies numerous projects are underway aimed at reducing workplace
absenteeism. Many different parties are involved in this including local
government, companies, doctors and convalescent institutions. A large number
67
of these are participants in the 'Social engagement of companies' campaign. For

example, projects have been set up to look into the improvement of contact
between the various employees and the bodies concerned (the company, the
municipality, trade union and doctors), keeping the partially disabled at work or
creating work for them. The projects are taking place in Danish municipalities,
counties, private companies, trade unions, and consultancies. At the same time
individual companies are pursuing an active reintegration policy. The Danish
company Lego, for example, has a separate department for those with reduced
working capacity. Also in Sweden a huge number of projects have taken place
directed at better rehabilitation. Most of them concern physiotherapy in early
phases of musculoskeletal conditions. The long term effect on absenteeism can
be however doubtful - at least when the employer is not involved in the
rehabilitation process.
In a few other European countries reintegrative activities are found, but to a
lesser extent. In Norway the government has turned its attention to the
reintegration of the long-term sick. For example, local insurance offices were
made more responsible for the reintegration of the long-term sick. Norwegian
companies are gradually undertaking more reintegration activities. In the
Netherlands adaptation of work in order to promote the return of the long-term
sick is (as yet) taking place only a small scale. The majority of reintegrative
activities in the Netherlands are focused on the counselling of sick employees
by, for example, keeping contact with the sick person and offering medical care
such as consultation for employees, periodic medical checks and treatment such
as physiotherapy. In Luxembourg the law passed in 1994 on occupational health
services (OHS) mentions reintegration activities as one of their responsibilities.
At this moment (1996) it is still too early to state that those activities are in fact
being initiated and leading to a reduction in absenteeism in Luxembourg. In
Spain an increasing tendency is for companies to use external health care
physicians to supervise absent workers and to replace primary health care
physicians. These occupational physicians make home visits or control workers
by phone, control the length of episodes, suggest clinical explorations and
suggest alternative treatment methods. There have been a considerable number
of experiments in Belgium with reintegration and the offering of adapted work.
In most cases the offer of adapted work follows an occupational accident, but
here and there an initiative goes a little further.
In the other countries of the EU reintegrative measures hardly seem to be taken.
Nevertheless, in one of them, in Portugal, government and social partners have
agreed to put in practice concrete measures in order to reintegrate and
rehabilitate at the workplace the long-term sick and disabled workers. However
68
the ongoing process of re-engineering, downsizing and outsourcing in the

Portuguese companies is not the most favourable for reintegration activities.

On basis of the descriptions by the national correspondents a slightly
fragmented picture emerges of the strategies used in the Member States of the
EU and Norway to reduce workplace absenteeism. Almost nowhere was
substantial research available to enable any definite statement about the
strategies applied to tackle absenteeism related with ill health. The national
correspondents based their answers on their own knowledge as experts in the
area of workplace absenteeism. The data presented must be acknowledged as
their impression of the situation.
It is striking that in all countries great emphasis is placed on procedural
measures to reduce workplace absenteeism. These measures are also found in
the proposed and existing changes in legislation on sickness benefits and
absenteeism policy in the majority of the EU countries.
Although on the subject of reducing absenteeism the employers' organisations
often argue in favour of the introduction of financial incentives for employees
to prevent misuse of social regulations (see chapter 2), these kinds of measures
do not occur very frequently in practice. Bonuses to encourage attendance and
reductions in benefits were mentioned by the Portuguese, Italian and the
Belgian correspondents. Research has shown that one must not have
exaggerated expectations of the effects of these incentives. Generally there is a
short-term effect. In various investigations counter-productive effects were also
noted. In the Belgian case study of Volkswagen for example (see chapter 6),
where the introduction of attendance bonuses was part of the absenteeism
project in the company, absenteeism had fallen markedly, but at the same time
social conflicts arose. In the Netherlands more detailed research was done some
years ago into the frequency of contractual incentives/disincentives in the
Netherlands and the impacts in the view of the labour organisations involved
(Andriessen & Reuling, 1992). Contractual stimuli appeared to be used only on
a limited scale in the Netherlands. Furthermore only a minority of companies
reported a fall in absenteeism as a result of such stimuli. Moreover, virtually
nowhere could these effects be backed up with absenteeism statistics.
Procedural actions can also be aimed at monitoring and control like the absence
strategy in Belgium which is limited to a check on the legitimacy of the absence
by an independent monitoring physician. These procedural activities do not
automatically help the employees to recover earlier, they may even make the
69
health of the workers worse as was the fear of the Norwegian trade union
representatives. Procedural actions can make employees reluctant to stay off
work or make them return to work too early and therefore the employees risk
that in the end they will be sick (again) for a longer period than was necessary.
In general, procedural measures may prevent misuse of absenteeism
regulations, but at most do not prevent ill health. Combating absenteeism related
to ill health by tackling the underlying problems by way of preventive activities
and encouraging resumption of work by long-term absentees therefore seems to
offer greater prospects than the use of these kinds of procedural measures.
Despite the introduction of the European Framework Directive on Health and
Safety in almost all Member States (see chapter 3), prevention activities at the
workplace are still taking place only on a modest scale in most European
countries. There appear to be some regional differences, such that, in Southern
European countries preventive measures are aimed more at the improvement of
work environments for safety and health, while in Northern European countries,
more emphasis is put upon promoting the health and well-being of employees.
Preventive measures are often limited to person-oriented activities such as
education and not directed at the work-related causes of ill health. This is a
missed opportunity, because work-oriented preventive measures can reduce
absenteeism to a large extent. For example, it emerged from a Norwegian
evaluation into the large-scale national absenteeism project that the twenty to
thirty per cent of companies which had focused clearly on improving working
conditions were most successful in reducing absenteeism. In those places the
level of absenteeism fell on average by 10% a year.
Reintegration activities are not very common (yet) as an intervention strategy at
the workplace to reduce absenteeism related to ill health in the Member States
of the EU and Norway. This is remarkable, because the absence percentage is
most influenced by the scale of long-term absenteeism. Consequently support
of early resumption of work by long-term absentees could have an important
impact on the level of absenteeism within a company (see also 6.10).
Experience in the Nordic countries shows that much could be achieved through
reintegration measures as a means of reducing absenteeism. Interesting
initiatives include the establishment by the Danish government of a centre for
work adaptation for partially disabled workers and the endorsement of the
maintenance of work ability programme by the Finnish government.
70
Models of good practice
In almost all countries in the EU and in Norway initiatives are being

undertaken to promote health at work and to reduce workplace
absenteeism. This chapter describes and analyses examples of good
practice in seven Member States and in Norway. The processes and
methods underlying the activities undertaken are examined in detail
based upon two or three case studies for each country. The chapter
concludes with lessons for successful prevention projects.
6.1
Introduction
The aims of the description of initiatives to reduce absenteeism related with ill
health are to:
document the processes and mechanisms of workplace initiatives to
reduce absenteeism, by identifying the methods used and the role
played by the different groups;
elaborate the barriers and supporting factors for successful initiatives;
establish the relative costs and benefits.
The main criterium the national correspondents used for selection of the case
studies is that the initiatives could be called examples of good practice in
reduction of absenteeism related with ill health. By this is meant that the
initiatives are directed at combating absenteeism by reducing the incidence of
ill-health and attacking the underlying causes in the workplace. Further aspects
of good practice are a systematic approach; absenteeism data- and problem
analysis; focus on active worker participation; and regular evaluation (Wynne &
Clarkin, 1992). Finally it has been decided to include if possible from each
country a case in the public sector and a case with 'female' work. The cases are,
71
of course, not representative of the attempts to reduce absenteeism related with

ill health in their countries.
The information on these case studies derives from the national reports. The
national reports include descriptions of case studies in Belgium (Van Damme.
1995), Germany (Doukmak & Huber, 1995), Italy (Mirabile & Carrera. 1995).
the Netherlands (Grndemann, 1995), Norway (Nytr, 1995). Portugal (Graa.
1995), the United Kingdom (Balcombe & Tate. 1995) and Austria (Noack &
Noack, 1996) (see chapter 2). Information about the case studies is based on
interviews with representatives of employers and employees. Interviews were
generally conducted with the head of personnel affairs, the company doctor and
a member of the works council or a trade union representative. As far as possible
an attempt was made to speak to those who were primarily responsible for the
activities undertaken in the organization or those who were most closely
involved. Interviews were also conducted with the relevant management and
others who might possibly be involved, such as an external counsellor. In
addition use was made of available documentation relating to the initiatives in
the case studies. A topic list was used to orient the interviews and the
description of the project. The list consisted of four parts: part one concerned
the background of the informant: part two related to the demographic
background of the company and the working conditions and absenteeism policy
of the company; part three concerned the nature of the processes and activities
undertaken to reduce absenteeism related with ill health; and part four dealt with
the evaluation of the project and follow-up activities.
6.2 Systematic examination

The case studies will be reviewed systematically in this chapter. Many authors
believe that methodical and well-planned processes increase the success of
preventive activities at work (Molleman et al., 1995, Janssen & Geelen. 1994.
Janssen et al., 1996. Kompier et al., 1996, Wynne et al., 1996). Wynne et al.
(1996) describe in a report for the European Union five phases of activities in
relation to health promotion in the workplace, namely:
getting started
identifying needs and problems

organizing solutions and planning health programmes
implementation
72
evaluation and consolidation.
In broad outline this classification will be retained in describing the case studies.
A systematic approach does not of course, guarantee the success of a health and
absenteeism initiative. For that other factors are necessary. For example Wynne
et al. (1996) mention the following factors as essential for the successful
development and implementation of workplace health promotion programmes:
participation of employees; marketing of the health-promoting activities;
communication and feedback; focus on the overall health of the employee (not
only physical health but also mental and social health and well being); a
balanced approach to both employee-oriented and work-oriented activities; an
integrated approach (effective measures can come from many directions industrial design, ergonomics, psychology, management theory, education, etc.)
focused on the causes of ill health, not only on the consequences; and based on
the needs of employees.
Many of these factors are also relevant for the subject of our study. The field
being researched here is, however, wider than workplace health promotion.
Many initiatives relate not only to the improvement of health, but also to
improving an unhealthy situation. This means that not only is a proactive
preventive policy pursued, but also that reintegrative and procedural measures
are taken (see chapter 5). A balanced approach of activities or an integrated
approach to absenteeism related with ill health means that four types of
intervention are found. Procedural measures raise the absenteeism barrier,
which makes it less simple to report oneself sick. In addition preventive
measures which can be focused both on the person and on work, aim at
prevention of health problems. Finally, there are reintegrative measures in order
to lower the reintegration barrier, which facilitates the return to work of the sick
employee.
In the description of the case studies we shall examine the extent to which these
conditions are met and whether they do in fact contribute to success in
initiatives to improve health and reduce absenteeism due to illness. However
before examining this, a short description will be given of the case studies
examined country by country.
6.3 Description of cases country by country

In total 23 initiatives are described; in the Appendix a short summary is given
of the background to, and the course of, each case study.
Netherlands
In the Netherlands initiatives are described in the Waterland Hospital
(approximately 800 employees), the construction company Nelissen van
73
Egteren Bouw BV (approximately 150 staff) and the metal working company
Thomassen en Drijver Verblifa (approximately 375 production workers). A
common approach to workplace absenteeism emerges from these three Dutch
case descriptions. This approach combines a procedural approach to
absenteeism with preventive measures focused on both work and person and
with reintegrative measures to promote the return of the long-term sick. The
three projects are based on active participation by employees, a cost-benefit
analysis, a systematic approach (first diagnosis, then intervention), a
comparison with control companies, and are all externally financed. It is also
striking that the works council - not the trade union - represents staff in the
Dutch projects. It emerges from all three projects that the involvement of middle
management is a problem. Nevertheless the three projects are successful.
Absenteeism related with ill health in the three companies has fallen
demonstrably and the cost-benefit analysis of these attempts to reduce
absenteeism shows a positive balance.
Belgium
The Belgian companies which took part in the research project are two
subsidiaries of multinationals, namely Du Pont de Nemours Belgium NV in the
chemical industry field and the motor car manufacturing company Volkswagen
Brussels NV. In addition the cleaning service of the Belgian Ministry of
Employment and Labour was included in this evaluation. The size of these
organizations (organizational units) varies markedly, employing approximately
5,800, 950 and 66 staff respectively. The initiatives describe new forms of
absenteeism strategies. In the two subsidiaries the measures were initiated by
the multinational mother company. In the chemical company Du Pont de
Nemours the activities focused upon workplace health promotion. In the
Volkswagen works the accent was on the reintegration of absentees offering
special adapted work. Alternative work was initially presented in case of
absence due to an occupational accident, later also in case of absence due to
illness. Attendances bonuses were also introduced. While it is true that in this
company absenteeism has fallen markedly, social conflicts also arose. In the
Ministry cleaning service, employees have participated in the inventory of the
work problems and in finding solutions. The solutions chosen, however, are not
very radical and are limited by administrative obstacles.
United
Kingdom
The approach described in the three UK projects seems to be typical of the

approach in progressive British companies. The three very large profit making
companies, the utilities company East Midlands Electricity (4,200 employees),
the Post Office (200,000 employees) and the car components company Unipari
74
(1,800 employees), all take preventive measures focused on work in order to

improve the safety and health of employees. In addition they undertake
preventive measures in order to increase the well-being of employees, mainly
through measures related to the individual. In the projects almost no measures
were described which attempted to reduce stress by means of a work-oriented
approach. The companies appear to value promoting the health of their
employees more than reducing the cost of absenteeism from the point of view
of efficiency; they undertook no extensive cost-benefit analyses.
Germany
The German examples derive from one non-profit-making organization and two
profit-making companies, namely the local public transport company for
Nrnberg (approximately 2,300 employees), a subsidiary of the chemical
company Beiersdorf AG in Hamburg (approximately 5,500 employees) and the
small porcelain company Sinterit GmbH with 125 staff. In all three projects the
introduction of measures was preceded by thorough analysis. At Beiersdorf and
Sinterit use was made of health circles (analysis and solutions to health
problems through participation of the employees concerned). In both companies
the health circles led to the identification and implementation of new measures.
It is only in the small earthenware company that explicit attention was given to
the procedural approach to absenteeism by setting up monitoring procedures
and training managers in absenteeism interviews. In the transport company
mainly reintegrative measures are taken. There is an active reintegration policy
being pursued there and the measures taken are only preventive in the sense of
preventing further harm through, for example, reduction in working hours for
older employees. Other preventive measures were not taken. Nor is much
attention paid to safety measures in these three companies, because safety is no
longer regarded as a major problem in Germany.
Portugal
The three Portuguese studies are: a copper mine (1,000 employees); a local
authority (approximately 1,300 staff); and a subsidiary of a multinational in the
field of electronics (approximately 350 employees). The activities undertaken
focus largely on improving safety (reducing industrial accidents and
occupational diseases) and health (periodical checks, medical care). Among
safety measures more use is made of person-oriented measures (personal
protective equipment) than work-oriented measures. The copper mine and the
local authority provide basic health facilities as a part of the measures. The local
authority and the electronics company pay considerable attention to
reintegration. In addition all three companies use procedural measures. The
copper mine applies financial incentives in the form of attendance bonuses, for
75
example. Participation occurs to only a limited extent in the Portuguese case

studies; it is mainly a top-down approach.
Italy
The three Italian cases are all local plants of industrial companies, namely the
glass factory Bormioli Rocco Casa (approximately 300 staff), the meat
processing company Inalca (approximately 600 staff) and the tile works Ragno
SpA (approximately 700 employees). The examples described are not specific
absenteeism projects. Attention in the projects is focused mainly on reducing
occupational diseases and industrial accidents. The emphasis lies on training
employees in the use of personal protective equipment (automation of lifting
operations, safer equipment and machines, etc.). The measures are not based on
an examination of needs among employees, but on analysis of accidents (and
absenteeism). Only in the meat processing industry Inalca were the employees
involved in risk analyses. Apart from that there is little direct participation of
employees in the selected projects. Generally it is a matter of a top-down
approach. Contact between the companies and the trade union is regular and
based on broad participation; industrial relations are progressive and allow the
various problems involved in protecting workers' health and safety to be
managed by means of collaboration and the exchange of information and
knowledge among the interested parties.
Norway
The participants from Norway in the evaluation study are the municipality of
Trondheim (7,700 employees) and the food plant As Rora Fabrikker (74
employees). In these two organizations the majority of the employees are
women. Both Norwegian projects are good examples of how absenteeism can
be reduced in an organization. However, one of the projects appears not yet to
have led to the desired result. Both use a systematic approach, are (reasonably)
balanced in their design, have a participatory approach and in addition a high
involvement of management, trade unions, medical service and middle
management and are centrally directed by the national project set up by the
central employers' associations and trade unions. One striking feature is the
large amount of attention paid to preventive work-oriented measures to improve
the well-being of employees. A procedural approach to absenteeism exists, but
few measures are aimed at improving safety. In both projects the effects of the
approach to absenteeism can only be indicated in general terms and there is a
lack of detailed cost-benefit calculations.
76
Austria
The three Austrian cases are: a large administration department of the Bank of
Austria (1,700 employees a majority of whom are women); the printing and
packaging materials factory Alfred Wall (570 employees); and the sewage and
waste treatment company Entsorgungsbetriebe Simmering EBS (300
employees). All three cases are in the private sector. The examples are not
exclusively absenteeism projects. The initiative in the Bank of Austria is part of
the health policy of the company and relates to a broad workplace health
promotion programme in this company. The other two initiatives are part of a
more general workplace activity directed at the reduction of ill health. EBS for
example introduced the obligation to produce a medical certificate already after
one day of absence, while according to the national regulations a certificate has
to be presented after three days. But also EBS and the Alfred Wall company
combined procedural measures with work- and person-oriented preventive
measures.
6.4
Characteristics of the organizations involved
In the following sections the background and the course of the case studies is
described. We begin with a description of the characteristics of the organization
before the case studies are examined.
In Table 6.1 an overview is given of the characteristics of the organizations
where the initiatives took place.
Nature of the organization
With regard to the nature of organizations, a distinction is made between profitmaking and non-profit-making companies. Of the 23 companies examined, only
live are non-profit organizations. In the UK the Post Office, as a public
company, does seek to make a profit. Only in Italy and Austria was it not
possible to include one public and/or non-profit company in the research. The
profit-making companies are mainly subsidiary companies or local plants of a
bigger firm, four of them (partly) of a multinational company.
Number of employees
Small companies with less than 50 employees are not represented in this
evaluation study. The number of employees varies between 200,000 (the UK
Post Office) and 66 (cleaning service of a Belgian Ministry). Four companies
have less than 250 employees, ten between 250 and 1,000 staff and nine over
1,000 employees.
77
Table 6.1: C haracteristics of the organizations
78
Cases
Type of organization
Company size
Production staff
Pro port i u
of women
N L : Hospital:
Waterland (1991-1995)
non-profit; independent
800
430 nursing stati
823
N L : C onstruction company:
Nelissen van Egteren Bouw BV
(1991-1995)
profit; local plant
25(k\<l(HX)
HK)
5'
N L : Metalworking industry:
Thomassen on Drijver
VERBLIFA (1989-1991)
profit; local plant
not known
100%: 373 staff in 3

production departments
main!) men
: C hemical industry:
Du Poni de Nemours
Belgium NV (1987-1994)
profil; subsidian
998
247
247 women
B: Metalworking industry:
Volkswagen Brussel .V.
(1991-1994)
profit; subsidiary
5755
5153
285 women
B: Ministry of Labour and

Employment
cleaning service < 1993-i994)
non-profit; part of
ministry
Of)
100';
05 women
UK: Utility company:

East Midlands Electricity
profit; independent
4200
SIM
not known
UK: Postal service:

Post Office (1984-present)
profil; government-owned
200 (XX) (in 2 pilots:

c. 7000 per pilot)
not known
not known
UK: Molor vehicle parts industry:

Unipari ( 1992-present)
profil; independent
1800
>50'i
nol known
D: C hemical industry:
Beiersdorf AG 1 lamburg
(1992-1997)
profit; subsidiary
5500
2(XX)
40'
1): Regional transport:

Verkehrs-Aktiengesellschaft
Nrnberg (1987-1988)
non-profit; municipal
service
2200
IS40
<5S
D: Earthenware industry (sanitary):

Sinteril GmbH (1991-1992)
profit: subsidiar)
125
100
< io';
P: C upper mine:
(1989-presenl)
profit: 51 ' governmentowned. 49', British

multinational
1000
53' {
12';
P: Municipality and
municipal waterworks:
(1989-presenl)
1266 (municipality) plus

499 (municipal waterworks
d.v; (municipality)
34';
l municipality)
P: Electrical engineering industry:

(1991-present)
profil; subsidiary.
German multinational
347
69';
2 3'
1: Glass industry:
Boriinoli Rocco C aSa 11992-1998)
profit; local plant
3(H)
5/6
1/3
1: Meat processing industry:

Inalca (1990-present)
profit: local plant
580
3/4
2 3'
1: Ceramics industry:
Ragno SpA ( 1990-present)
profit: local plani
719
5/7
41
N: Municipality:
Trondheim(1993-1994)
7700 (including 500 staff

involved in project.
300 in 1 district)
95';
74';
: Pood industry:
As Rora Fabrikker (1991-1994)
profit; subsidiary
74
72';
63.5%
Au: Bank Austria:

Central Administration
Vienna (-present)
profil; subsidiary
1700
< l(Mf
55';
Au: Printing and packaging materials:

Alfred Waif AG Gra/ (-present)
profit: independent
570
fi8<;
2'
Au: Sewage and waste treatment:

Entsorgungsbetriebe Simmering
Wien (-present)
profit: independem
Number of production workers

In the case of 22 companies we know the proportion of production workers in
the total number of staff. With the exception of three companies, half or more
of the staff belong to the production side. In ten of the cases examined over 70%
of the staff involved were production staff.
Proportion of women
In the choice of companies, one of the criteria was the proportion of women in
the company. It was desirable that each country should include one case of a
company where the majority of the employees were women. In the case of 20
companies the proportion of women is known. On the basis of this it is possible
to check to the extent to which this criterion has been achieved. In the case of
five companies the proportion of women was above 50%; these were the Dutch
Waterland Hospital, the Belgian Ministry cleaning service, the Norwegian
municipality of Trondheim and food plant As Rora Fabrikker and the Austrian
central administration of the Bank Austria Wien. In the other countries it was
not possible to find a case study concerning typically "female" work. In two
companies the proportion of female workers was around 40% (the German
Beiersdorf chemical plant and the Italian ceramics factory Ragno Spa). In six
companies it was between 20% and 33% and in seven companies it was below
15%.
6.5 Getting started

''Well begun is half done" says a Dutch proverb, and that also applies to tackling
absenteeism. In the preparatory phase a number of important activities must be
undertaken, which are crucial for the successful development of a preventive
project (Wynne, et al., 1996, Kompier et al., 1996). In this phase information
should be gathered on the absenteeism policy in the organization, the reasons
for tackling absenteeism, the decisions made on the way in which the project is
to be set up and who is to be involved in it. Table 6.2 indicates how this phase
was implemented in the various sample projects.
Workplace absenteeism policy
In most companies a workplace absenteeism policy has been formulated. Its
content varies from company to company. For example the Belgian chemical
company Dupont de Nemours states that giving a great deal of attention to
prevention of absenteeism and work incapacity is the best means of reducing
them. In the absenteeism policy of the Dutch Waterland Hospital, the
construction company Nelissen Van Egteren Bouw and the three British
companies the role of the line managers is central to absenteeism monitoring.
79
oc
Table 6.2: Getting started
Cases
[-health absenteeism policy
Prompting factors
Project plan
Participants
NL: Hospital:
Waterland (19911995)
absenteeism can be affected by

action:
department head plays important
role
absenteeism above average (8.9%

cf. 6.5%) and aims to be better than
average
steering committee
external supervisors
participatory approach
systematic
comparison with control hospital
higher management
management of care sector
middle management
personnel
organizational expert
staff
works council
external supervisors (financed by
government)
NL: Construction
company:
Nelissen van
Erjteren Bouw BV
(1991-1995)
policy on both short and long-term

absence due to ill-health, though
reporting procedure, contacts with
environmental health service, sociomedical team and training for
managers formulated in annual
mental health plan
high level of absenteeism and large

take-up of Invalidity benefit
steering committee
systematic
comparison with control companies
branch manager
middle management
personnel
company doctor
works council
external supervisors(financed by
government)
NL: Metalworking
industry:
Thomassen en
Drijver VERBLIFA
(1989-1991)
absenteeism policy formulated, but

insufficiently implemented
high level of absenteeism, dissertation

led to author being asked to tackle
absenteeism in the company
coordination by personnel in
consultation with oranch manager
systematic
alternate experimental and monitoring
control
branch management
personnel
insurance doctor
works council
external supervisors (financed by
government)
B: Chemical
industry:
Du Pont de
Nemours Belgium
NV (1987-1994)
prevention the best method

of keeping down
absenteeism
initiative of US mother company
operation of occupational health

service participation of staff in workrelated problems
management
occupational health service
trade union
staff
Table 6.2: Gettili started
(continued)
i.
Cases
l-health absenteeism policy
Prompting factors
Project plan
Participants
B: Metalworking
industry:
Volkswagen
Brussel N.V.
(1991-1994JUK:
Postal service:
Post Office (1984present)
human beings central: new policy,

under which frequent absence no
longer leads automatically to
dismissal
high level of absenteeism, improper

use of sandwich courses, arbitrary
checks and poor economic state of
company
institution of industrial relations

service; reactive
involvement of representatives of
employees' organizations
industrial relations service

industrial health service
trade union representatives
B: Ministry
cleaning service:
Employment and
Labour (19931994)
no ll-health/absenteeism policy,
specific industrial medical service no
longer exists
high level of absenteeism and poor

quality of work, threatening abolition
of service
external advisors and 'company'screening
project group
internal supervisors
management domestic services

management training service
internal occupational psychologist
management of security service
occupational medical inspector
staff
UK: Utility
company:
East Midlands
Electricity
integrated approach to absenteeism

through checks by management and
supervision of sick staff and
prevention through training and
education
managers responsible for
attendance, keeping in touch and
conducting return-to-work interviews
long waiting times in the National

Health Service
large number of organizational
changes combined with domestic
worries have led to high degree of
stress
occupational health service convinced
that prevention helps
coordination by occupational health

service
management
staff volunteers (health liaison
officers)
UK: Postal
health of workforce directly relevant
service:
to profitability of company
Post Office (1984- company pays great attention to prepresent)
vention through lifting courses, ergonomie workplace design, information
campaigns, stress courses, etc.
managers keep records of
absenteeism which are monitored for
each division
desire to reduce take-up of Invalidity

Benefit due to psychological problems
more attention to tackling stress
required
project group
introduced in 2 pilot regions
comparison with control companies

management
personnel officers
oc
hi
Table 6.2: Getting started (continued)

Cases
ll-health absenteeism policy
Prompting factors
Project plan
Participants
UK: Motor vehicle

parts industry:
Unipari (1992present)
prevention better than cure

staff are principal resource
involvement of staff essential
aim for high degree of involvement,
good morale and good health
desire to reduce risk of back complaints,

cardiovascular diseases and stress
continually changing organization
leads to physical and mental
problems
project group
top management
15 staff volunteers from all levels
of the organization
external experts
D: Chemical
industry:
Beiersdorf AG
Hamburg (19921997)
economic, image and social and

legal reasons for promoting health
through individual and work-related
activities
new legislation enables medical

insurance institutions to undertake
activities to reduce ill-health
absenteeism in companies
steering committee
2 project groups
external experts
participation through health circles
management
personnel
staff
works council
external experts
medical insurance institution
D: Regional
transport:
VerkehrsAktiengesellschaft
Nrnberg
company pays great attention to

working conditions and decreasing
health of ageing workers. Both the
economic costs of absenteeism for
the company and the social costs of
ill health for the individual workers
are recognized
only 5% of drivers reach retirement

age in this job
working party
management
company doctor
middle management
works council
D: Earthenware
industry
(sanitary):
Sinterit GmbH
(1991-1992)
no definite ill health/absenteeism

policy
medical service geared mainly
towards promoting safety and
individual cases
sharp rise in demand for sanitary

fittings was reason why absenteeism
led to an immediate fall in production
and failure to meet delivery deadlines
project group
external supervisor
management
middle management
external supervisor
staff
works council
P: Copper mine:
(1989-present)
continuous improvement of working

environment;
encouraging all staff to feel
responsible for prevention and
reduction of accidents;
promotion of health, well-being and
social welfare protection of the
environment
desire to excel in the field of health

and safety as in other fields of
working life
no project
measures are current policy
implemented top-down
management,
middle and lower management
personnel
occupational health and safety
service
oh&s committee
oh&s employee representatives
underground work groups
Cases
l-health absenteeism policy
Prompting factors
Project plan
Participants
P: Municipality:
(1989-present)
aim is to improve health and quality

of working life as part of the
municipality mission ("to build up a
city for its citizens")
company health policy has been
implemented since 1989 by the
occupational health service, which
was set up jointly with an insurance
company
unacceptably high economic and

social cost of absenteeism (including
low staff morale, poor quality and
public mage)
one third of absenteeism is part of
"black economy": staff take sick leave
to work elsewhere
high level of blue collar workers'
turnover
no project
measures are current policy
information given to works council
insurance company
management
works council
P: Electrical
engineering
industry:
(1991 -present)
there is an integrated action plan for

1994-1995 which aims at promoting
the health of the whole workforce,
mainly by means of preventive
action leading to both a reduction in
occupational diseases and workrelated illnesses, and a reduction in
industrial accidents and work-related
disability, as part of the quality
assessment and assurance system
as a component of quality
certification, the introduction of Total
Quality Management, a reduction in
absenteeism is also implicitly
necessary
six years ago company doctor pointed
out need to expand and integrate the
safety function guidelines of the
German mother company
introduction of environmental expert
into company
no project
measures are part of current policy
participation in TQM discussion
groups
management
middle and lower management
occupational health and safety
no explicit absenteeism policy, but

conviction that for an effective
preventive policy it is necessary to
develop effective strategies in the
field of accident prevention, hygiene
and company medicine and to take
environmental measures
the company was taken over in 1992

measures to reduce absenteeism by
improving health and safety are a
component of reorganization by new
management
reasons for the reorganization:
economic situation, high level of
absenteeism, environmental pollution
and compliance with legislation
component of top-down reorganization

no direct staff participation
management
safety specialist
I: Glass industry:
Bormioli Rocco
CaSa (19921998)
service
employees in TQM discussion
groups
oc
4-

Cases
ill-health absenteeism policy
Prompting factors
Project plan
Participants
I: Meat
processing
industry:
Inalca (1990present)

component of total reorganization

which was begun in 1990 and will
continue for an indefinite period
the reason for tackling absenteeism is
its high level and the large number of
accidents
component of general reorganization

introduced top-down
participation of staff in making risk
inventories
working party on safety set up
(personnel officer, production manager
and safety officer)
management
personnel
staff
employee representation (from
works council)
I: Ceramics
industry:
Ragno SpA
(1990-present)

desire to monitor and protect

employees' health and to reduce
absenteeism
no project
Integral part of company policy
indirect participation of staff
management
middle management
"environment" committee
works council representatives sit
on this committee
N: Municipality:
Trondheim (19931994)
1 of the 5 principal aims of the

municipality is to make the working
environment better and safer
through regular evaluation of the
physical and social working
environment and the setting up of
environmental groups in order to
improve the working environment
where necessary
the district's policy is that more
openness and communication
should give more sense of security
at work and cause absenteeism to
disappear
trade union representatives consider
absenteeism too low and aim for
short-term absenteeism to increase
in proportion to long-term
absenteeism
desire to reduce budget by bringing

down absenteeism on health grounds
high level of absenteeism (7.7%)
improvement of working conditions
managers themselves responsible for

project
steering committee
working parties for each unit
phased approach: interviews with
long-term invalids (tertiary prevention),
survey of staff on factors which
endanger health (secondary
prevention) and working conferences
for each unit (primary prevention)
information on project
conference starting days
senior management
unit management
project officer
employee representatives
external researcher
political representative
T a b l e 6 . 2 : G e t t i n e s t a r t e d (continued)
Cases
oc
ill-health absenteeism policy
Prompting factors
Project plan
Participants
N: Food industry: working condition and

As Rora Fabrikker ill-health/absenteeism policy part of
(1991-1994)
striving for constant improvement in
quality and productivity (ISO 9001)
an understanding attitude to those
who are ill is essential
negative operating results in 1988 and

1989.. high absenteeism in 1988
(10%) and 1991 (16%)
uncertainty and poor communication
between management and workforce
tragic events (illness, death, etc)
among staff and their children
part of national project

health and safety committee acts as a
project group
management, esp. operations

manager
health & safety committee
senior safety representative
senior trade union representative
(shop steward)
external expert (related to trade
union) staff
Au: Bank Austria:

Central
Administration
Vienna (present)
comprehensive policy; integrated

health promotion, prevention and
occupational health care
rising absenteeism rate; further

development of comprehensive health
policy; new health centre
no project; continuous programme

coordinated by personnel department
regular meetings of "work place
committee"
higher management
steering committee
personnel department
health centre
internal and external experts
works council representees
Au: Printing and

packaging
materials:
Alfred Wall AG
Graz (-present)
company uses social services for

employees mediating between
company physician, management
and workers; to show workers that
the company respect them, but that
they have their own responsibility,
also for their health; a workeroriented ill-health absenteeism
project is to be deve (
high level of absenteeism in

packaging materials division (7-8%)
as compared with printing division (56%); new management following
reorganisation of company; high level
of work stress due to growing
production
until December 1996 no project, but

continuous programme
higher management
company nurse
company physician
works council
Au: Sewage and

waste treatment:
Entsorgungsbetrie
be Simmering
Wien (present)
company is prepared to invest in their rising absenteeism rate; change in

workers; investments are made in the personnel department; moderate
occupatonal health service and in the success of training middle managers
activities of the personnel department
to develop the workers; monitoring and
control of absenteeism takes place;
a new staff promotion system is planned
no project
continuous efforts
occupational physicians
works council
external expert
An example of this kind of health and absenteeism policy is found at East

Midlands Electricity.
East Midlands Electricity in the UK recognises that absence can be
caused by a whole variety of interwoven factors, ranging from ill health
to domestic problems. 'Our job,' says the company medical adviser, 'is to
sort out these causes and provide as much help to employees as possible.'
The company takes an integrated approach to the problem of
absenteeism, combining management control with the provision of
support for sick employees and preventative action such as education and
training. Managers have primary responsibility for
attendance,
maintaining contact with sick employees and conducting return to work
interviews. They work closely with the occupational health team and any
problems are referred to the qualified medical staff.
In most companies the absenteeism policy is chiefly directed at reducing
absenteeism. On the other hand the trade union representatives in the
Norwegian municipality of Trondheim aim to achieve an increase in short-term
absences. This is because they believe that long-term absenteeism will
otherwise eventually rise.
Trondheim's employee representatives feel that the staff do not have a
particularly high level of ill-health absenteeism in relation to the jobs
that they are doing, eg home helps having to clean several houses per day.
They ask whether absenteeism is in fact too low to allow the body to
recover properly. Ill-health absenteeism is lower in the District
Department than in others with which this department would naturally be
compared. The department does not record the costs of ill-health
absenteeism. The aim is that short-term absenteeism should increase in
relation to long-term absenteeism.
In five companies there is a lack of an explicit absenteeism policy. This applies
to all the case studies from Italy, the German ceramics factory Sinterit and the
Belgian Ministry cleaning service.
Prompting factors
The trigger for tackling absenteeism in most of the case studies is a high level
of workplace absenteeism. The situation in the Italian Bormioli Rocco Casa
glass industry gives an illustration of this prompting factor.
86
A factor that have determined the launching of the Bormioli Rocco

Casa 's initiatives is the high level of absenteeism. Apart from being
extremely costly for the company, absenteeism causes resentment among
workers who are present, who have to work harder to cover for those who
are absent. Levels of absenteeism in the company, especially under its
previous management, have always been very high. In the 1980s, rates of
absenteeism reached as much as 28%. This was because of poor
organization of the leave system: because of the difficulty of securing
leave, workers would take the sick leave to which they were entitled. Up
to 1992, there were cases of workers who were absent for 74% of their
potential working days.
It is striking that high absenteeism levels are no trigger in the UK, but rather the
desire to offer help in the case of stress and mental problems. Nor is the level of
absenteeism the immediate cause in Germany, but rather the new statutory
opportunity for health insurance companies to undertake activities to reduce
absenteeism in companies, or a very large manpower shortage or the absence of
a buffer in production to cope with absenteeism. In the case of the Portuguese
copper mine there is also the wish to excel in this area. The introduction of Total
Quality Management plays a major role in the other Portuguese transformer
factory in its intention to reduce workplace absenteeism.
The Portuguese transformer factory sees certification as not an end in
itself but as simply a (large) step towards guaranteed quality and
customer satisfaction. The next step was the introduction of TQM (Total
Quality Management). The objectives to be reached are, explicitly,
improvement in qual it}', reduction in costs, optimization of deadlines and
increased competitiveness. And, implicitly, a reduction in absenteeism. As
regards absenteeism, the transformer factory prides itself on having
"perhaps the best or, at least, the second best record for the Group in
Europe" (Director of Human Resources). This notwithstanding, the rate
of absenteeism among blue-collar workers is still very high (more than
10% in 1994). The aim is to cut this to 4%. In the certification phase of
the quality-guarantee system, "the factory's management is now paying
greater attention to the area of health and safety at work" (Industrial
doctor).
Project design
The reduction of absenteeism and working incapacity in the organization can be
tackled in various ways. Clear national differences appear to exist. In countries
like Norway, UK, the Netherlands and Germany a separate project organization
87
is more commonly set up. On the other hand, the Belgian, Portuguese. Austrian
and Italian companies examined tried to reduce workplace absenteeism through
the existing structures. Only in the Dutch metalworking company TDV and the
British East Midlands Electricity is the existing organization charged with
devising and implementing measures to reduce absenteeism. In all the other
case study companies in Norway, Germany, UK and the Netherlands, use is
made of a separate project and/or steering committee. In the "Health is a
winner" project, a joint project run by the international concern Beiersdorf AG
Hamburg and the AOK health insurance fund for Hamburg both a steering group
and project groups were instituted.
The "Health is a winner" project was conceived under the overall control
of AOK and the Corporate Personnel Programmes department at
Beiersdorf AG. This department is responsible across all sectors for
implementing personnel management projects. The post of Project
Manager was created in this department specially for the project and a
specialist from the field of health promotion was taken on. A member of
staff was also made responsible for co-ordination at AOK. In order to
lead the project and to organize co-operation between those involved in
it a steering group was formed at the beginning of 1992, made up as
follows: 2 people from Beiersdorf Corporate Personnel Programmes
department, 2 from the works council, 2 from AOK and 2 external experts.
Two project groups were formed to implement the results of the analyses
of the health and safety problems.
The use of a project and/or steering committee is generally linked with direct
participation by employees; in nine out of eleven cases the institution of a
steering or project committee implies the possibility for employees to take part
in the steering committee or working parties. Meanwhile, in other cases
attempts to reduce workplace absenteeism by the existing organization seem to
entail a top-down implementation in which the employees have at most the
ability to participate indirectly through their trade union representatives. The
setting up of a project organization also frequently goes hand in hand with a
systematic approach (interventions based on diagnoses) and the recruitment of
external experts in tackling workplace absenteeism. In cases where the existing
organization has the responsibility for reducing absenteeism, only in the three
Austrian case study companies and the Dutch metal industry company TDV has
the management opted for a (more or less) systematic approach and the
involvement of external experts. Finally, in the three Dutch companies and in
the UK Post Office, use was made of control companies in order to evaluate the
88
effect of the measures to be taken. The Dutch Waterland Hospital was compared
for instance with another Dutch hospital.
The project in the Waterland Hospital aims at improving the health, safety
and welfare of workers, thus reducing sickness absence and unfitness for
work. Furthermore the project was intended to provide a scenario for
occupational health services, to enable them to initiate and carry out
similar projects among other firms and companies. In order to obtain a
clear picture of the effect of this approach a 'control' hospital was also
selected in addition to the 'experimental' hospital. This was the
Diaconessenhuis in Leiden which is comparable to the Waterland
Hospital in size, staff structure, training facilities and turnover. The
Diaconessenhuis is not completely passive in terms of absenteeism and
unfitness for work. The activities in this area however are not directly
related to the project and are less extensive.
Participants
Here national differences are also important. In the Northern European Member
States more different participants are involved in tackling workplace
absenteeism than in the Southern European Member States (and Austria). In
almost all cases a representative of the general management or of the branch or
unit takes part in consultations. Only in the case of the Austrian sewage and
waste treatment company do management not participate in the process of
change. In the case of the Dutch TDV only the branch management participate.
At the British company Unipari, senior management is directly involved in the
health project.
Unipari's board of directors decided to improve working life by applying
'the type of creative thinking which had already led to the establishment
of the successful Unipari University (which aims to provide employees
with access to learning)'. They decided to investigate the feasibility of
some form of health centre which would help employees get fit in order to
cope with stress and deal with stress-related problems. A project team of
15 employee volunteers from all levels of the organisation was formed to
investigate what Unipari employees wanted and what was currently on
the market. This core team then sought the views of many members of the
workforce and reported back to the board.
Participation of senior management is also the case in the Dutch Waterland
Hospital and the Norwegian municipality of Trondheim. Middle management is
present in less than one-third of the sample companies as a separate party. The
89
personnel department is involved in the process of change in more than the half
of the companies. The company medical service participates rather more
frequently in the projects, namely in 15 out of the 23 case studies. The
occupational health service offered in many cases advice and support, as the
company health service of the Norwegian municipality of Trondheim illustrates.
The running of the ill-health absenteeism project at the Norwegian
municipality of Trondheim was organized on a hierarchical basis and
anchored at the highest administrative and political levels. This proved
important in legitimizing the project's significance and seriousness in the
eyes of the employees. The fundamental concept was that management at
every level should bear responsibility for the work, with the company
health service to provide advice and support. The company health service
is a part of the municipality's environment department and has 7.5 manyears distributed amongst 12 posts. The section is managed by a
principal company medical officer. The company health service is a
support service and a resource for preventive care in the work
environment, but responsibility lies with line managers in departments
and units in the municipality. No regular health checks are carried out on
employees, because importance is attached to preventive health care.
An external supervisor was involved in the Dutch, German, Austrian and
Norwegian absenteeism projects. The Belgian Ministry cleaning service makes
use of the expertise of other units in the Ministry. In all initiatives to reduce
absenteeism related with ill health the staffare represented in a direct or indirect
way. As mentioned above, direct representation of employees generally occurs
in the case of a project organization which is often instituted in the case studies
in the Northern countries (UK, Germany, the Netherlands and Norway), while
the personnel are mostly only indirectly represented through a works council or
a trade union delegate in case no project organization is used, which is usually
the case in the companies in Belgium. Austrian. Portugal and Italy. Only in the
Portuguese transformer factory, a subsidiary of a German multinational, staff
was encouraged to participate in suggestions programmes and in Total Quality
Management discussion groups. In the Netherlands, Germany, Austria and
Portugal the staff is indirectly represented by a works council or safety, health
and welfare committee. In the other countries a trade union representative
safeguards the interests of the staff.
6.6
Identifying needs and problems
At this stage the organization investigates the relationship between work and the
health of its employees. A good analysis of the problems ensures that the
90
Table 6.3: Identifying needs and problems

Cases
Method
Main risk factors
NLHospital:
Waterland (1991-1995)
interviews with key figures

checklists
questionnaire
measurement of stress risks (WEBA)
analysis of absenteeism
physical workload
working hours and rosters
pressure of work
organization of work
inside temperature
management style
training and career opportunities
whole organization
risk groups
NL: Construction company:

Nelissen van Egteren Bouw BV (1991-1995)
questionnaire
monotonous work
pressure of work
physical working conditions
insufficient support
attachment to company and colleagues
career opportunities
remuneration
whole company
NL: Metalworking industry:

Thomassen en Drijver VERBLIFA (19891991)
questionnaire
quality of work
physical working condition (eg noise)
climate
job security
B: Chemical industry:
Du Pont de Nemours Belgium NV (19871994)
listing of risks for safety and health aspects for

each service
whole company
B: Metalworking industry:
Volkswagen Brussel N.V. (1991-1994)
- 7000 individual absenteeism files analysed

- inventory of all possible alternative jobs
whole company
B: Ministry cleaning service:

Employment and Labour (1993-1994)
analysis of industrial accidents and absenteeism

listing of risks for products and workplaces
ergonomie analysis
analysis of quality of the service
analysis of work situation and discussion
groups
dissatisfaction
high level of absenteeism
quality of work
heavy loads
isolated work
lack of safety (eg no fire drills)
relations with policy staff (white collar)
Target groups
whole cleaning service
NC
IJ
Table 6.3: Identifying needs and problems (continued)

Main risk factors
Target groups
Cases
Method

East Midlands Electricity
analysis of absenteeism (according to

diagnosis)
questionnaire on stress
UK: Postal service:

Post Office (1984-present)
- analysis of medical retirement

- feedback from senior occupational health
staff
aggression and violence

overload through organizational change
combination of work and caring responsibilities
whole company
UK: Motor vehicle parts ind jstry:

Unipart (1992-present)
drawing up inventory of workers' opinions on

desirability of health centre
back complaints, cardiovascular diseases and

stress
physical and mental problems
whole organization
D: Chemical industry:
Beiersdorf AG Hamburg (1992-1997)
interviews with experts

questionnaire on staff needs
group discussions on the work situation
analysis of absenteeism (according to
diagnosis)
mobility, airways
work situation (eg management)
overload through reorganizations
mental overload
irregular shifts
production workers
women
D: Regional transport:
Verkehrs-Aktiengesellschaft Nrnberg
questionnaire
interviews with experts
group interviews
mental stress
physical stress (sitting position)
environmental nuisance (noise, harmful
substances)
irregular shifts (nights, weekends, etc)
drivers
staff unfit for driving work
the long-term sick
D: Earthenware industry (sanitary):

Sinterit GmbH (1991-1992)
analysis of work situation through group
organization
work
information flow
management
isolated workplace piece work system
whole company
moulding shop
P: Copper mine:
(1989-present)
analysis of absenteeism, frequency and

seriousness of accidents, questionnaire on
organizational climate, social audit report,
evaluation and monitoring of working
conditions
back complaints
accidents (including traffic accidents)
stress
shift and night work
underground work
lifestyles (includina drua use)
whole company
discussions
production workers
Table 6.3: Identifying needs and problems
ve
OJ
Cases
Method
Main risk factors
P: Municipality and municipal waterworks:

(1989-present)
analysis of absenteeism, interviews with longterm absentees, annual report on occuaptional

health and safety, health status questionnaire
survey
weather constraints, heat/cold

painful working positions, heavy loads
dyslipidaemias
back pain
alcohol abuse
poor pay
ageing
low status (blue collar workers)
vdu work, organizational stress (white collar
workers), accidents
whole company, with

special attention for long
term absentees and
disabled workers
P: Electrical engineering industry:

(1991-present)
questionnaire survey of staff opinions on

organization
description of characteristics of staff and
general determining of state of health of
workforce
annual report on llhealth/absenteeism
determining and monitoring of working
conditions
noise
painful working positions,
work accidents
dangerous substances,
stress, lack of autonomy and participation
job content
whole company
I: Glass industry:
Bormioli Rocco CaSa (1992-1998)
analysis of absenteeism and accidents
noise
temperature
accidents
back complaints
position (repetitive movements)
production department
I: Meat processing industry:


risk inventory
accidents
draught
temperature
tuberculosis (also transmitted by animals)
brucellosis
Target groups
VC
4-

Target groups
Cases
Method
Main risk factors
I: Ceramics industry:
Ragno SpA (1990-present)
analysis of accidents
dust
lead
noise
temperature
eye fatigue
accidents
occupational diseases such as silicosis and
hypoacusis
short-term absenteeism
N: Municipality
Trondheim (1993-1994)
interviews with long-term sick staff

questionnaire on work responsibilities,health
and stress to all members of staff concerned,
annual work conference in each unit on
improvement in working conditions
physical conditions
organization of work
communication
openness
relates to 500 staff in 26

units (300 and 11 units
within 1 district
department)
social climate
reintegration of long-term sick staff
N: Food industry:
As Rora Fabrikker (1991-1994)
questionnaire on functioning of organization

sent out in 1988, reported back at
departmental level
interpersonal aspects
gossip, "bullying", dissatisfaction with work, little
say in decisions, little feeling of attachment
whole company
Au: Bank Austria:

Central Administration Vienna (-present)
medical examinations
group discussions
interviews of employees and experts
psychosocial stress due to work load,

organisation of work and time pressure
psychosocial problems
lifestyle
whole organisation
risk groups
units with high
absenteeism rate
Au: Printing and packaging materials:

Alfred Wall AG Graz (-present)
monitoring of chemical pollution and noise
discussions with experts and employees
work load
time pressure
working hours
chemical pollution
noise
shift work
organisation of work
whole organisation
risk groups
division with high
absenteeism rate
Cases
Method
Main risk factors
Au: Sewage and waste treatment:

Entsorgungsbetriebe Simmering Wien
(-present)
monitoring of chemical pollution
chemical pollution
heat
risk
difference in temperature inside-outside
work load
organisation of work
Target groups
whole organisation
groups
measures chosen are tailor-made for the most important problems. The
information which is made available in this phase lays the foundation for the
decisions which have to be taken concerning the measures to be selected. Table
6.3 deals with the method used for this in the case studies, the most important
problems which emerged for each company, and the existence of possible risk
groups which required special attention in the attempts to reduce absenteeism
related with ill health.
Method
In almost all companies an analysis of the problems preceded the introduction
of measures for reduction of workplace absenteeism and promotion of health.
Only in the case of the British company Unipart was this not the case. Here
employees were asked what they thought about the desirability of the
introduction of some form of health centre, but not whether this was a solution
for a significant absenteeism problem in the organization. In the case of Unipart
the aim of the project was however not primarily the reduction of absenteeism,
but increasing involvement and promoting the health and welfare of its staff. In
the Belgian subsidiary of the multinational Dupont de Nemours it is true that
risk analyses were made, but these turned out to be separate from the measures
introduced. The measures undertaken at Dupont de Nemours were adjusted to
the reasons for absence mentioned by the workers. In the three Italian
companies the inventory of problems was limited to the analysis of absenteeism
and accident statistics. The Italian meat processing enterprise Inalca used
questionnaires to analyse these accidents.
Inalca in Italy introduced a model for the internal declaration of
accidents, which makes it possible to analyse every injury that has
occurred at work. When an accident occurs, the worker concerned
completes, in the presence of the personnel officer, a questionnaire whose
main purpose is to ask the worker to identify the causes of the accident
and accept his responsibility to declare it.
In the other companies the opinion of the staff was sought on the problems
which they experienced (analysis of needs). In approximately one in two
companies there was a more extensive inventory. In those cases additional
interviews were conducted with experts or key persons and often use was made
of instruments such as work content analysis or ergonomie analysis. The
German local public transport network in Nrnberg gives an example of such an
extensive inventory to provide a basis for improvement in the work situation of
their drivers.
96
The project at the local public transport company in Nrnberg instigated

first an information-gathering phase as a basis for working out the
measures needed. This 'stock-taking ' exercise also formed the basis for a
later evaluation study. The information gathering exercise was based on
three main elements: 1) Evaluation of company data, 2) Questioning of
drivers and staff unfit for driving duties and 3) Expert and group
discussions of management, works council, company doctor and drivers.
It was not the aim of the information-gathering exercise to determine any
causal links. The depiction of the work and health situation was of a
purely descriptive nature.
Main risk factors
In most companies analysis of the problems led to formulation of a number of
points of special interest. In many cases these related to the physical and/or
mental load (overload, work pressure, etc.). It is striking that in the case of the
three Italian companies only points of special interest in the area of physical
working conditions are mentioned. Also in the three Portuguese case study
companies concerns about physical working conditions abound, but risk factors
concerning health and well-being are present as well. Points in the area of job
content, industrial relations and conditions of employment occur however
mainly in the Dutch, British, German, Austrian and Norwegian companies. For
example, the Norwegian municipality of Trondheim pointed to the organization
of work, communication, the degree of openness and the social climate as risk
factors. Also in the Dutch project "building for healthy work", implemented at
Nelissen van Egteren Bouw BV in Heerlen (NVE Bouw Heerlen) many
psychosocial risk factors were indicated as of importance.
NVE Bouw Heerlen identified as the most serious problems: the content
and organization of the work (lack of variety, fast rate of work, time and
work pressure, mental pressure, and insufficient support from the relevant
bodies); working conditions (temperature,
humidity, noise, dust,
vibrations, odours, physical work load, safety); working relations
(reduced company ties, lack of unity, atmosphere within the company,
reduced contacts with colleagues, distancing from management and the
absence of any positive feedback); working requirements (job description
and salary not matching actual work, absence of function and assessment
interviews or any of sufficient content, inadequate career possibilities, illdefined policy with regard to training and no clear policy concerning
compensation for overtime). Also aspects concerning the life style of
workers (smoking, alcohol, healthy eating, exercise, stress at work)
seemed to be relevant.
97
Target groups
In nine of the 23 cases the absenteeism projects were aimed at a part of the
organization. Here the attention was mainly focused particularly on the
production departments. This can also be seen from the points of special interest
which are mentioned in the case of these companies. These refer mainly to the
physical working conditions which are often more relevant for production
departments. In the German Beiersdorf company women are recognized as a
special risk group beside production workers.
6.7 Organizing solutions and implementation

At this stage the generation and the implementation of solutions are discussed
together. In Table 6.4 the various measures taken in the case studies are
described. In this description a distinction is made between four types of
measures, namely procedural, person-oriented and work-oriented preventive
measures and reintegrative measures (see also Chapter 5).
Procedural measures
By a procedural approach to absenteeism measures are meant intended to
institute better procedures concerning the monitoring and control of
absenteeism. It is striking that in a third of the case descriptions no information
is given on this kind of measures. In some companies this is because these
measures have already been introduced previously and are so axiomatic that
they no longer need to be mentioned separately, as may perhaps be the case in
the Norwegian As Rora Fabrikker. In a few cases it is known that there was a
conscious decision to take measures directed at the discipline or monitoring.
This latter element plays a part in the Austrian case study companies and the
other Norwegian case, the municipality of Trondheim. In Trondheim a measure
had just been introduced which meant that less monitoring was possible.
All those who took part in the project in Trondheim had lhe righi lo extend
the number of self-certifications within a trial period of 7 months (5 days
instead of 3 days). The number of self-certification periods, however,
remained the same - 4 periods per year. The intention behind the common
initiatives was to focus on the relationship between organization and illhealth absenteeism, to combat the negativity which often accompanies a
"project" and to link motivational factors to participation in the project.
The initiative of increased self-certification focuses on the individual
employee's ability to adapt to the situation at work.
In the Belgian motor car plant Volkswagen Brussels N.V. and in all three
Portuguese case studies, use was made of financial incentives. In the case of the
98
Table 6.4: Organising solution and implementation
S.
vC
VC
Cases
Procedural measures
Preventive person-oriented measures Reintegrative measures
NL: Hospital:
better procedures and information on

absenteeism
introduction of sick visitor
training for managers in absenteeism
counselling
reduction in physical workload

better technical aids
better work rosters
better work organization
modification of working climate, etc.
lifestyle activities
various courses (eg dealing with
aggression)
better absenteeism
counselling
NL: Construction
company
Nelissen van Egteren
Bouw BV (19911995)
better procedures and monitoring of

absenteeism
training managers in absenteeism
interviewing
changing consultative structure

ergonomie modifications
training for managers:
absenteeism interviews
stress management
communication and work consultation

training for building site staff:
work consultation
ergonomie lifting
more opportunities for

reintegration
setting up socio-medical
team
NL: Metalworking
industry:
Thomassen en
Drijver VERBLIFA
(19891991)
better procedures on absenteeism

training managers in absenteeism
interviewing
setting up steering committee to draw up
annual plan on working conditions
quarterly inspections on safety, health
and welfare
integration of monitoring responsibilities

into executive functions
improvement in climate
better ventilation
sound dampening measures
training for managers:
quality of management
interview skills
B: Chemical industry:
Du Pont de Nemours
Belgium NV (19871994)
risk oriented approach

health education
responsibility for safety matters given to
line managers
safety training for managers

systematic analysis of near accidents
better absenteeism
counselling
ergonomie training fork-lift truck drivers alternative work is offered

cpr training for all workersperiodical
check-ups (risk profile assessment)
computer-assisted health and safety
information
fitness and sports opportunities
courses for prevention of back
complaints for VDU workers
support for alcohol and drug problems,
mental health, high blood pressure,
stress management, giving up
smoking
e
Table 6.4: Organising solution and implementation (continued)
Cases
Procedural measures
B: Metalworking
industry:
Volkswagen Brussel
N.V. (1991-1994)
establishment of attendance bonus

sick employee is checked by doctor
establishment of random absenteeism
checks
B: Ministry cleaning
service:
Employment and
Labour (1993-1994)
none
less heavy working materials

functional office design
better archives
clear job descriptions
safer cleaning products
training and education

protective clothes
first aid training
back school
None

East Midlands
Electricity
managers primarily responsible for

attendance of staff
better communication
hearing protection
information and training
eg video on physical workload
individual counselling for stress
problems (employee assistance
programme)
information for management on stress
training for management in managing
change
health information (smoking, diet, etc)
information on women's and men's
specific health problems
keeping contact with sick

staff
conducting return-to-work
interviews
treatment by specialists
(avoiding waiting list)
physiotherapy
reintegration course
phased reintegration
(gradually increasing
workload) or offering
alternative work
UK: Postal service:

Post Office (1984present)
managers primarily responsible for

attendance of staff
offering alternative work

for long-term sick
return-to-work interview
with line manager,
personnel (industrial
relations) and trade union
representative
introduction of policy and procedures to

reduce problems in the workplace
individual counselling for

individual counselling for stress
stress problems
problems
training of occupational health staff and
personnel officers in counselling on
stress problems
stress information: time management,
assertiveness and management style
in order to reduce stress
SL
Cases
Procedural measures
UK: Motor vehicle

parts industry:
Unipart (1992present)
not part of this project
good ergonomie furniture

opening of fitness centre: fitness, sport
clean production
and treatment and therapy (eg
alert safety policy
physiotherapy), nutritional advice and
risk inventories in order to prevent motor beauty parlour
system complaints
distribution of working conditions
handbook
course in defensive driving
information on safety through
newsletters and training
periodic check-ups

physiotherapy
offer of alternative work
D: Chemical industry:
Beiersdorf AG
Hamburg (19921997)
health circles (kind of quality circles on

improvement of working conditions) are
leading to improvements in the working
situation
courses eg on movement and

relaxation, back classes, stress, lifting
and carrying, stopping smoking, cancer
screening
D: Regional
transport: VerkehrsAktiengesellschaft
Nrnberg
better roster and statutory reduction in

working hours for older staff
course for managers of those unsuited
to administrative work
course on stress prevention health

promotion for 60 administrators based
on age
support for supervised

move to alternative
employment
better roster and
reduction in working
hours as work adaptation
for returning long-term
sick staff
discussion groups on quality of work

introduction of measures of improving
working conditions
none
none
D: Earthenware
industry (sanitary):
Sinterit GmbH (19911992)
new sickness/absenteeism procedure

(who is responsible for what,
managements conduct absenteeism
interviews with frequent absentees)
training of managers in absenteeism
interviews
.
-
IO

Cases
Procedural measures
P: Copper mine:
(1989-present)
conditions of employment incentives like

performance bonuses, no absenteeism
and complying with safety regulations
(up to 20% of basic salary)
immediate line managers responsible lor
personnel affairs
management training for young

managers
socio-technical design of industrial
personal protective equipment (helmet,

goggles, hearing protection)
periodical examinations, flu and
hepatitis vaccinations, HIV test at
commencement of employment,
information on improving lifestyle
(smoking, alcohol and drugs), drug and
alcohol test, company magazine,
training on occupational health and
safety, cultural, sporting and
recreational activities, social facilities in
the communities close to the mine
surgery
medical care for urgent
possible reductions of up to 1/6 of salary

in cases of short-term absenteeism (
30 days),
medical ceritficate issue by the
occupational physician has been en
couraged
ergonomie modifications (lifting, VDU

work)
noise reduction, ventilation, light, climate
control
setting up network of health and safety
coordinators
safety instructions
placing of first-aid boxes in various
locations
personal protective equipment

preventive examinations:
cardiovascular diseases, prostate
cancer, intestinal, uterine and lung
cancer
stress treatment
vaccinations
oral hygiene
prevention of back complaints
psychosocial counselling
vdu ergonomy
health promotion
additional social protection
surgery, including family

members
support for treatment of
drug addiction
treatment of alcohol
problems
reintegration of long-term
sick staff
absenteeism reported to immediate line

managers
career opportunities based on
attendance and performance
risk inventories and discussion forums

as part of quality guarantee
protection of works and plant
participation in TQM

periodic medical examination of staff
health promotion
training in safety & health at work
surgery
supervision of long-term
sick staff
return-to-work check
P: Municipality and
municipal
waterworks: (1989present)
: Electrical
engineering industry:
(1991-present)
facilities
continuous monitoring and improvement
of working conditions
cases
treatment of alcohol and
drug addiction
return-to-work check

Cases
Procedural measures
I: Glass industry:
none
Bormioli Rocco CaSa
(1992-1998)
replacement of product lines

introduction of automated lifting
sound insulation
temperature insulation
introduction of mechanical monitoring,
reduction in work pressure
dust extraction system
new furnace using clean fuel
new floors and better cleaning of them

information on use of personal
protective equipment
external doctor (surgery

twice a week)
I: Meat processing
industry:
safer equipment and machines

more maintenance
placing of warning notices
personal protective equipment (eg

elbow-length steel gloves)
training of staff in use of personal
external doctor (comes

twice a week) for periodic
examinations
staff with health problems
can be referred to
specialists at company's
expense
first-aid station
tele-alarm service with
nearest hospital for help
in emergencies
I: Ceramics industry:
Ragno SpA (1990present)
safer, less noisy and cleaner equipment

systematic cleaning of machines with eg
vacuum cleaning equipment
reduction of lead level in products
more ventilation
sound insulation measures
placing warning notices/warning stickers
reduction of working hours to 33 hours
and 36 minutes

training of safety experts and heads of
departments (everyone is involved:
suppliers, managers, staff, trade
unions, medical service)
information for staff on use of personal
company's own medical service carries
out periodical examination
reintegration of staff
returning after an
industrial accident
-:
-
4-

Cases
Procedural measures
N: Municipality:
Trondheim (19931994)
opportunity to increase number of days

of 'self-certification' from 3 to 5 days of
illness without doctor's certificate being
necessary (up to 4 times a year)
eg ergonomie improvements (working

position, equipment, workplace design)
ventilation
aids
maintenance of buildings
new division of responsibilities
clarification of role, job rotation, better
replacement arrangements, safer round
of checks by nightwatchman, etc.
outings, contact between different
services, better relations with
management
introduction of flexible working hours
fitness
relaxation techniques
conflict management
sending flowers and

visiting, keeping
informed, inviting to
(social) gatherings,
return-to-work reception,
work modified
N: Food industry:
As Rora Fabrikker
(1991-1994)
introduction of occupational health

service
increasing safety in canteen

introduction of system of reporting
accidents
information bulletin for staff suggestions
for improvements in working conditions
ergonomie improvements
protection against cold and draught
job rotation
training of a few staff as working
conditions experts
information and training of the
"supervisors" on dealing with
subordinates and working conditions
matters
training of management in interpersonal
skills
job rotation
improved production planning
procedures
periodical examinations
information on "bullying"
greater openness: talking with rather
than about each other: publication of
status report: on developments in
tragic events involving staff in order to
avoid gossip
reintegration of long-term
sick staff combined with
information and
openness towards
colleagues
a rehabilitating female
alcoholic even appeared
on radio and in the local
newspaper, etc.
a.
a
!.1
S
8.
Cases
Procedural measures
Au: Bank Austria:

Central
Administration
Vienna (-present)
monitoring of absenteeism
group discussion and individual
interviews in high absenteeism units
better organisation of work

ergonomie workplace design
discussion groups about improvements
in the working situation
health examinations
personal prevention and counselling
stress management
physical activity and sport
return-to-work meetings
physiotherapy and
psychological treatment
Au: Printing and

packaging materials:
Alfred Wall AG Graz
(-present)
planning of and pilot activities for
absenteeism project
better work safety and pollution control
health food in canteen

counselling support
and advice
Au: Sewage and

waste treatment:
Entsorgungsbetriebe
Simmering Wien
(-present)
medical certificate after one day of sick
leave instead of 3 days
better work safety

better pollution control
health information campaigns

education and training courses
personel protective equipment (cloths)
preventive medical advise
selective medical
treatment
Portuguese copper mine, the employees can receive a bonus of up to 607r of

their basic salary if they perform well, meet the safety regulations -including the
(statutory) periodic health screenings- and have not been absent.
Although the copper mines has 'a pay scale that is considerably higher
than that set out in the collective agreement for the mining industry ', this
system of bonuses linked directly to production is a clear form of
peiformance-based pay, which has traditionally been opposed by the
trade unions. In the case of a miner the production bonus may, over a few
months, amount to as much as 60% of basic pay. Overall (and
particularly) as regards blue-collar workers), fringe benefits of a direct
pecuniary nature represent, on average, more than 45% of basic salary,
according to an estimate amde by the Director of Personnel and Training.
Rather than rewarding workers merely for their presence or attendance
at work, "the aim, clearly, is to reward the overall quality of work in the
two vital areas of underground work and ore-washing and, at the same
time, to penalize deliberate breaches of the health and safety rules,
absenteeism and lack of discipline".
The reason for this policy, which has been in force since at least 1989,
lies, before all else, in the vital need "to be increasingly competitive on
the world ore market, by cutting unnecessary costs that are very often
invisible and, above all, unrecognised". And, secondly, this policy derives
from the very principles the enterprise has adopted with regard to health
and safety at work.
Other procedural measures were also taken in the Portuguese copper mine and
electronics company in the form of assigning a role to the direct line managers
in absenteeism management (reporting to the chief, absenteeism interviews and
return interviews carried out by them, in some cases also by the personnel
director; the company occupational physician only plays the role of technical
consultant). In the Dutch and UK case study companies and in the German
Sinterit ceramics factory similar procedural measures were also a significant
part of the initiatives. The project "possibility of influencing individual
absenteeism" at TDV in the Netherlands paid a lot of attention to the absence
monitoring procedures.
TDV tried to improve the absence monitoring procedure. For lhe
purposes of the project the workers were required to report in as sick to
reception at least an hour and a half before the time they were due lo
commence duty. The new procedure meant thai reception had to conned
106
the worker by telephone with the gang foreman. The gang foreman in
conversation with the worker in question would then determine the type
of sickness, the possible cause and background and the probable duration
of absence. This information would be passed on to the social medical
team. The workers were informed about the new procedure through work
consultations and by means of the company news sheet.
The aim of preventive measures which are focused on work is to remove the
cause of problems in the field of safety, health and well-being. Examples of
work-oriented preventive measures are ergonomie and technological measures,
an improved service roster, changes in the working climate, better
communications and method of management. In the project which took place at
the company of Ragno SpA ceramics industry in Italy many work-oriented
preventive measures were taken.
Since 1990, Ragno SpA has boosted investment to 6% of the overall
budget in preventing the occupational accidents and illnesses that are the
main causes of absences. The company has launched a series of actions
to improve the environment both in and outside the company and to
protect workers' health. The company has purchased plant and
machinery designed and constructed to remove the risk of accidents and
prevent the emission of noise or other pollutants such as dusts and gases.
The new plant and machinery have been placed in appropriate
environments, with account being taken of the need to ensure that
workers have sufficient room to operate them easily and safely. Filters
and extractor equipment to remove dusts have been installed in some
departments. Clean environments have been created in areas where
workers spend their breaks and where they may also eat. Ragno SpA has
also introduced changes in working hours. Management has, in
collaboration with trade-union representatives, agreed to cut working
hours to 33 hours and 36 minutes a week.
In almost all case studies work-oriented preventive measure were taken in part
at least to reduce absenteeism . Only in the Volkswagen Brussels NV motor car
plant were such measures omitted. When a distinction is made between
measures which increase the safety, health or well-being of employees, it
emerges that the more Northern countries (the Netherlands, Belgium, Germany,
Austria, the UK and Norway) focus mainly on improvements which promote
health (for example ergonomie measures to reduce physical load) and wellbeing (better work organization, courses for managers, excursions). In Italy and
107
Portugal on the other hand most measures are focused on safety and health, such
as the introduction of personal protection equipment, the placing of warning
signs and also health protection measures. This is of course a difference of
degree. Both in the Northern case study companies and in the Southern case
study companies measures directed at safety and well-being do take place. For
example in the Portuguese copper mine an integrated approach to health and
safety exists, including the socio-technical design of industrial facilities, high
standards of technology and production systems and environmental protection.
In the Belgium company Dupont de Nemours, and in the Austrian printing and
packaging firm Alfred Wall AG and the Austrian sewage and waste treatment
company EBS, safety activities are undertaken. In addition it is striking that a
number of measures serve to track problems (structurally): risk analyses, health
circles, discussion groups and quality circles. These measures are taken in
Belgium, Germany, Austria and Portugal.
In the Bank of Austria a workplace team has been established, which
consists of the company doctor and representatives of the works council,
the personnel department, the construction department, the business
department and the department of ergonomie workplace design, together
with a safety and a work expert. This team meets once a month and aims
to ensure that developments in three areas take employees into account
as far as possible. These areas are working environment, working tools
and materials and workplace design (in particular work tables, chair,
VDUs, lighting, noise and climate). This team represents a kind of health
circle and is considered to be a permanent fixture which can limit
sickness-related absenteeism.
Preventive person-oriented measures
By preventive person-oriented measures are meant activities in which
employees are taught to work (and live) in a manner that promotes safety, health
and well-being. These measures can also be subdivided into training courses
which are more concerned with safety and those which are more in the field of
health or well-being. As with the preventive work-oriented measures, it emerges
that companies in the Southern Member States pay less attention to measures
promoting individual well-being than the Northern countries. The UK Post
Office's stress reduction programme is an example of preventive personoriented measures focused at the improvement of the well-being of employees.
The English Post Office decided that stress counselling should be
provided in-house on an in-depth basis in two pilot areas of the business
for three years. Stress and associated conditions account for nearly one
108
third of the Post Office's medical retirements. Two specialist counsellors

were appointed as members of the occupational health service. They
developed a counselling skills programme which was later offered to
welfare and personnel staff Also two-hour seminars are run in the
workplace. These seminars include sessions on how to recognise stress
and its causes and how to reduce it by physical and mental activities.
Time management and assertiveness skills and a management style which
encourages participation are seen as means to reduce workplace stress.
Specific training in such topics as listening and responding skills is also
offered to managers.
Health-promotion measures in the sense of the periodical examination of
employees and/or lifestyle activities (stopping smoking, healthy eating or
exercise) are found in almost all companies. Only in the Italian companies are
such activities not undertaken. In the British autoparts company Unipart
concern for the physical condition of employees goes furthest: a beauty salon
and a course in defensive driving feature amongst the facilities offered. But also
the Belgium subsidiary of the multinational Du Pont de Nemours provides its
workers with many person-oriented measures in its Integrated Health Care
Programme.
Du Pont's Integrated Health Care Programme consists of the following
elements: 1) evaluation of computer guided risk profile. The results are
discussed with the medical attendant and/or the company doctor. This is
to determine what, in the areas of physical exercise, smoking, alcohol,
diet and stress, the employee can take on. If necessary, the employee will
be directed to specific health groups (for example, a programme for
giving up smoking) or to his GP. 2) Health promotion by computer is
directed to the prevention of cardiovascular disease, cancer and back
problems and to global health campaigns. An employee can consult
fiches in the computer of the medical service. 3) The health centre offers
employees and resident family members the possibility of certain fitness
training. A back school is on offer, as are figure training, self-defence,
condition training, jogging and gymnastics for older employees. Skiing is
under preparation, and regular tournaments (football, volleyball) are
organized. 4) Examinations on recruitment, examinations on transfer and
periodic examinations are carried out. Attention is paid above all to
occupational risks, such as noise, materials, solvents, ergonomie defects
and also to the prevention of illnesses in travel to tropical or remote
regions. 5) Programmes are running for employees who cany out
activities that threaten the back and for VDU workers. 6) Support
109
programmes have been developed, such as those for alcohol and drugs
problems, for mental health, for high blood pressure and for stress.
Within the Austrian printing and packaging company Alfred Wall AG a special
employee service has been created when the company's social welfare service
was restructured.
This employee service acts as a link between the personnel department,
the industrial medical sendee, the works council and the workforce. The
task is carried out by a former nursing sister who is part of the industrial
medical service. She listens to employees and is seen as someone in
whom it is safe to confide. It is the employee service which people notify
when they are reporting sick and it gives employees information and
advice on personal problems and social issues. Its tasks also include
services such as obtaining concert and theatre tickets. The aim is to make
it clear to employees that the company's management "takes them
seriously" and that it expects them to take a high degree of responsibility
for themselves, including responsibility for their own health.
Reintegrative measures aim to promote the swift return to work of sick
employees. This can be achieved through guidance by managers (keeping
contact, participating in the social medical team), medical care by the company
medical service (medical surgery, physiotherapy, treatment by private
specialists), and redeployment/rehabilitation activities (the drawing up of a
return plan, offering adapted work, analysis of rehabilitation needs,
strengthening the occupational competence of the employees etc.). Extra efforts
in the field of absenteeism guidance seem to be taken only in a minority of lhe
sample companies, namely the Dutch companies, the UK utilities company East
Midlands Electricity and the Norwegian municipality of Trondheim. East
Midlands Electricity for instance takes an integrated approach to the problem of
absenteeism, combining management control with the provision of support for
sick employees and preventative action such as education and training. Medical
care in the sense of treatment takes place mainly in the United Kingdom,
Austria, Portugal and Italy. In Portugal it is striking that the local authority
covers not only its employees in its health care plan but also members of their
families.
Measures in the field of reintegration of the long-term sick are certainly taken
in every country, but are not implemented by any means in all companies. Most
reintegration activities relate to offering alternative work. The most extensive
110
reintegration activities were undertaken in the Norwegian companies. For

example, activities in the food plant As Rora Fabrikker also focused on
informing colleagues about the state of health of the long-term sick in order to
prevent gossip. In this context an employee with alcohol problems even
appeared in the local papers and on the radio.
The problem of the female alcoholic illustrates the approach that As Rora
Fabrikker had to reintegrating the long-term sick. She was considering
suicidal and had major family and financial problems, and had lost her
driving licence after driving with excess alcohol in her bloodstream. Her
long-term sick-leave (ie absence over 14 days) represented 25-30% of the
total absenteeism in the company. Her experiences were also documented
on the local radio, in newspapers, information leaflets, on a video about
the start of internal control systems, and she herself took part in meetings
on the work environment held outside the company, presenting her own
and the company's experiences. After several periods of long-term illhealth absenteeism, the operations manager contacted the industrial
health service for advice and contacted a resource person (a former
alcoholic) for joint meetings and discussions with the woman. She soon
entered a treatment centre for a stay lasting 5 weeks. After this, she stayed
at home for 14 days before returning to work. To start with, the employee
did not want the rest of the staff to know where she was, but after some
time, she allowed her closest colleague to tell them about it. This led to
the company's placing alcoholism on the daily agenda (including
discussing it as an element of the work environment) with information
and openness as the two key words.
6.8 Evaluation and consolidation

Evaluating the activities undertaken is necessary in order to establish whether
these have led to the required results, what the positive and obstructive factors
were in the process and whether possible supplementary activities are desirable
in order to consolidate the approach used. With regard to the results there are
differences in the effect of the project on workplace absenteeism and on other
matters such as fewer accidents, a better atmosphere amongst the staff, and a
better image of the company. It is particularly difficult to give a concrete form
to these latter intangible matters in a cost-benefit analysis of the whole project.
Often the benefits indicated are limited to savings as a result of reduced
absenteeism and fewer accidents. In Table 6.5 an overview is given of the results
found, the enabling factors and barriers, and follow-up activities.
Ill
Table 6.5: Evaluation and consolidation

Cases
Effects on absenteeism
Other results
Costs and benefits Enabling factors
NL: Hospital:
sharp fall to below

sector average and
control hospital (5.8%
cf. 5.3% and 4.9%
respectively)
- improvements in
work situation
- more attention to
sick staff and
working conditions
positive:
benefits (NLG
3250 pp)
exceed costs
(NLG 1500
PP)
NL: Construction
company:
Nelissen van
Egteren Bouw BV
(1991-1995)
NL: Metalworking
industry:
Thomassen en
Drijver VERBLIFA
(1989-1991)
- percentage fall of
almost
30%
- 20% fall in
frequency
- percentage fall of
30%
- 50% fall in
frequency
motivation of management step-bystep approach

extensive analysis
course on absenteeism supervision
participatory approach in individual
projects
theme day for staff
growth in problemsolving capacity

- motivation and
commitment staff
increased
- staff see health as
their own
responsibility
positive:
role of external project group
benefits (NLG length of project
1667 pp)
exceed costs
(NLG 1333
- reduction in job
satisfaction and
health-related
complaints
- increase in
organizational
commitment and
satisfaction with
management
positive:
benefits (NLG
6434 pp)
exceed costs
(NLG 2681
PP)
PP)
- great deal of attention paid to actual implementation and maintenance

- link between staff reaction survey
and absenteeism survey gives good
base
- single liaison person between
project team and company
- high degree of motivation to tackle
absenteeism
Barriers
Follow-up
- involvement of middle
management
role of steering committee
(takes too much out of the
hands of rest of management
and management
subsequently shirks
responsibility)
- slow progress because of
limited brief of steering
committee
- involvement of staff in
steering committee
- prioritizing of problems
difficult
- priority given to
continued
increase in
responsibility of
management
- steering committee
dissolved
- measures integrated
in existing organization
- lack of support from senior

management, so that middle
management less committed
- quality certification activities
required too much time and
attention
- large size of steering
committee
- continued attention
- non-committal attitude of
management, personnel
officer and works council
because project imposed on
them
- alternating experimental and
control function
- continued attention
- further fall in i
health/absenteeism
- action integrated into
existing structure
ri
=.
era
!>J
Cases
Other results
B: Chemical
industry:
Du Pont de
Nemours Belgium
NV (1987-1994)
- absenteeism
already low: 2%
fall in middle
management, slight
rise in lower and
higher positions
- total remains at
around 2%
- changed attitudes
regarding accident
prevention and
health promotion
costs: 56
USS per
worker per
year in 1987
: Metalworking
industry:
Volkswagen
Brussel N.V.
(1991-1994)
- sharp fall from 9/

to 2.3%
social conflict
B: Ministry
cleaning service:
Employment and
Labour (19931994)
- in the years
preceding project
absenteeism ran at
10%, 10.5% and 18%
- since the project at
11% and 12% and
11%
Barriers
Follow-up
- fear of invasion of privacy in

trade unions
-cuts
- health programme
continued
- shift in emphasis to
primary prevention
annual
- fear of loss of job (rotating
benefits, etc. unemployment)
estimated at
almost 1591
ECU pp fall
in wage bill
costs: strikes
which may
result from
absenteeism
policy
- lack of clarity on monitoring

and arbitration procedures
- alternative work imposed
- slight increase in
absenteeism
- social tensions
remain high
annual
benefits
estimated
883 EC U pp
- cumbersome, inert
organizational structure
- many measures
introduced
subsequently
- setting up of
occupational health
- acceptance of alternative work is

employee's choice
- fear of unemployment
- agreement that measures
proposed would actually be
implemented
- support from board and trade
unions
- information to all involved
- quality of external supervisors
- participation of those involved
Table 6.5: Evaluation and consolidation (continued)

Cases
Other results
UK: Utility
company:
East Midlands
Electricity
- apparent sharp fall

in ill-health/
absenteeism
- reduction in
duration of sickness
periods (organization
reticent in interpreting
sickness f igures)
exact figures not
available
- staf f appear more

prepared to admit
that they have
problems and how
they deal with them
- managers more
aware that they can
cause stress and try
to avoid unnecessary
pressure
- positive attitude to
measures taken
benefit is
lower
absence and
a dramatic
reduction in
injury
recovery
time
UK: Postal
service:
Post Office
(1984-present)
- two-thirds reduction
in average duration
of absence through
illness of 117 cases
- reduction in extra
leave
- reduction in
disciplinary measures
benefits:
approx.
102.000
saved in 6
scheme
performance of those the pilot

scheme in
participating in
counselling
1987
- improved
psychological health
- reduction in
consumption of
alcohol, tobacco and
coffee
- rise in use of
relaxation exercises
among cases
Barriers
involvement of top management

- slow progress because all
inf ormation on new developments levels keen to be involved in
decision-making (average
implementation time 18
months)
- willingness to act
- counsellors f amiliar with
organization
guarantee of conf identiality
Follow-up
- planned inf ormation
on diet and movement
- planned "cold-care"
initiative
- large-scale individual
- insuf f icient resources
- employees not interested in health examination on
voluntary basis now
prevention as long as they
have experienced no problem begun
- based on risk
assessment
employees are given
health inf ormation or
advised to visit the
doctor
7.

Cases
Other results
UK: Motor vehicle

parts industry:
Unipart (1992present)
fitter and healthier

workforce, longterm
effects on
absenteeism not
measureable
of the 1800 staff

1300 make regular
use of facilities
costs: over
1 million
- financial success of company

organizational culture of care for
and investment in staff
- establishment of staff needs
proximity of health specialists
D: Chemical
industry:
Beiersdorf AG
Hamburg (19921997)
0.5% drop in
absenteeism from
1992 to 1993
(34% lower than
control group)
in 1994 one in three

employees had taken
part in course on
health promotion
10 health circles
have been set up
benefits:
between
ECU 170
and ECU
290 pp
participation of health insurance and - management insufficiently

project is still running
external consultants
involved (only in project group,
not on steering committee)
- mutual cooperation
sometimes awkward
D: Regional
transport:
VerkehrsAktiengesellschaft
Nrnberg
lower level of
absenteeism where
new roster had been
introduced than in
control group for
older employees and
long-term sick staff
resuming their duties
no other differences
with control group
benefits: DM
293 000
(including
DM 57 000
subsidy)
costs: DM
280 000
large measure of agreement

between interested parties on aim
the many conditions which had - course for executives

to be met to be able to change discontinued
the rosters
- counselling activities
for those unsuitable for
administrative service
discontinued
- four-day working
week for older staff
generally introduced:
very popular
D: Earthenware
industry
(sanitary):
Sinterit GmbH
(1991-1992)
- total absenteeism
fell by 13% from
9.4% in 1991 to 8.3%
in 1992 (target was
15% reduction)
- however, in the
moulding shop
absenteeism rose
(large number of
older Turkish staff)
in all departments
discussion groups
led to increase in
motivation
costs equal
benefits
(ECU 335
per
employee)
management easily approachable
- strong involvement of senior

management obstacle to staff
participation and to
contribution from middle
management (especially
because the works council
was so weak)
- passive attitude of older
Turkish staff
Barriers
Follow-up
none, given the commitment of centre still exists, no

the chief executive
new activities planned
discussion groups
have become quality
circles for T.Q.M.

Barriers
Follow-up
- young average age of staff, many

protective measures taken
- staff motivated
- delegation of personnel
responsibilities to immediate line
managers
- corporate culture
- written health policy and yearly
action plan
too much pressure from team

not to take time off work so as
not to miss bonus
continued
- willingness to act
- large health team
- human resource management
feels responsible
action plan
continued
- ageing
- low status
- poor pay
- blue collars's poor living and
working conditions
- lack of participation
- top-down management
- non-profit organisation;
public administration culture
Cases
Other results
P: Copper mine:
(1989-present)
- absenteeism had
been running at 3.6%
(compared with an
average of 9% in all
business sectors and
an average of 4.5%
in banking and
insurance)
- absence due to
illness and/or
accidents totalled
2.7%
number of accidents
per million manhours worked has
been decreasing
from 48 in 1989 to 7
in 1995.
proportion of hours
lost due to accidents
is now lower (13%)
than in 1989 (27%)
benefits:
compared
with 7%
absence
through
illness the
savings in
wages total
ECU 450 pp
against
costs: ECU
250 pp paid
out in
bonuses:
positive
balance ECU
200 pp
P: Municipality
and municipal
waterworks
(1989-present)
- total absenteeism
remained high in the
period 1990-1995
- absence due to
illness and accidents
in municipality
remained almost
constant at around
6.3%
- the offering of
alternative work to
103 long-term sick
cases led to a
reduction in absenteeism from 25% to
15% for this group
absence due to
accidents decreased
from 2% in 1990 to
1% in 1995
alternative work for
71 former long-term
sick-cases
costs are
part of OH&S
budget,
including
assurance
premiums
(equal to 300
ECU pp)
0
7"
-i

Cases
Other results
: Electrical
engineering
industry:
(1991-present)
- absenteeism due to
illness and injury
among blue collar
workers was around
10% at the last
quarter of 1994
(introduction of TQM)
- in mid 1996 it was
- employee
commitment to TQM
- improved
participation
- improvement of
working conditions
and work
organization
- reduced nonquality costs
costs: 225
ECUpp
(salary of
company
doctor and
nurse,
personal
protective
equipment,
periodic
examination,
medicines,
etc)
- quality and quantity

of products improved
- motivation
increased through
reduction in pressure
and improved job
content for sorters
costs include - new property of the company

LIT 118
- market requirements and pressure
motivation
to perform
increased
through
reduction in
pressure and
improved job
content for
sorters
million (ECU
5.900) for
personal
protective
equipment
6%
I: Glass industry:
Bormioli Rocco
CaSa(19921998)
- total absenteeism
in the 1980s
sometimes 28%
-1991 absenteeism
(before new
management) was
5.3% due to illness
and 1.5% due to
accidents
- b y 1994
absenteeism had
fallen to 4.0% due to
illness and 1.0% due
to accidents

- market requirements and pressure
to perform
- quality certification
- participatory methods through
TQM
- written policy
- budget and information systems
for health and safety (h&s)
- involvement of personnel + safety,
health and welfare committee
- no industrial conflict
action plan
Barriers
Follow-up
- resistance to change
- lack of motivation to take
part in discussion groups
- lack of satisfaction with pay
- waiting lists in public
hospitals
- continued
- plan to train
personnel in safety and
health at work to
enhance quality and
productivity
- health and work
circles to be
implemented within
TQM
- continued
intention to fit
soundproof booths,
intention to train
personnel in
prevention and safety
at work,
a (statutory) trade
union officer for safety
will be appointed
-.
-

Cases
Other results
I: Meat
processing
industry:
Inalca (1990present)
absenteeism among
production staff fell
by more than half
from 1991 to 1994
from 3.2% (3210
days' sick leave
divided by 455
employees 220
working days) to
1.5% (1632 days'
sick leave divided by
486 employees 220
working days)
fall in number of
accidents between
1991 and 1994 from
211 to 114
I: Ceramics
industry:
Ragno SpA
(1990-present)
absence due to
among production
staff has run at
around 4.4% since
1992. Previous data
for absence through
illness are known
only for the 1970s,
when absence stood
at around 20%.
Nationally the
absenteeism due to
in the ceramics
industry stands at
16.5%
decrease in number not

of accidents between calculated
1991 and 1994 2129-26-13.
costs include
LIT 100
million (ECU
5.000) on
personal
protective
equipment
Barriers
Follow-up
resistance among employees

to using personal protective
equipment
new premises being

built in which a great
deal of attention will be
paid to working
conditions,
risk inventory will be
concluded, in which all
employees should be
consulted on possible
work problems
- resistance to using personal

closely following
development of new
technologies for
improvement of
internal and external
environment,
staff training on safety
planned
table t o : hv,l l u a t i o n
Cases
a n d consc M i d a t i o n (continued)
Other results
N: Municipality:
fall in absenteeism
Trondheim (1993- from 8.5% in Sept.
1994)
1993 to 7.2% in
Sept. 1994 in units
involved compared
with fall in
municipality as a
whole from 7.2% to
6.4% in the same
period (monthly
figures)
number of "selfcertifications" 68%

higher in trial period
than in control
periods
greater
understanding for
long-term sick staff,
more aware that
prevention of
problems is
important,
shift in emphasis
from monitoring to
trust; individuals
themselves
responsible for health
and working
environment and
management also
responsible
N: Food
processing
industry:
As Rora Fabrikker
(1991-1994)
improvement of
not
physical environment calculated
improvement of
information supply
improvement of the
atmosphere in and
image of the
company, more
openness and
satisfaction
improvement in
safety
absence through
illness: 1991-19921993-1994: 12%-7%10%-13%
respectively,
previously fall in
absenteeism and rise
in production from
1988 onwards
costs: 12
million NOK
(1,4 million
ECU)
Barriers
Follow-up
- agreement that workplace

absenteeism was too high
- employee's representatives were
encouraged to participate
- had an opportunity to utilize a
systematic approach that:
1. focused on long term
absenteeism
2. eliminating potential harmful
stressors
3. continuous improvement of
working conditions
management did not feel

responsible for absenteeism,
language used too academic,
staff saw no connection
between sickness and working
conditions,
work conference phase
delayed too long, only in this
phase was general awareness
created,
staff frightened that interviews
and questionnaires were being
used as a means of monitoring
three-phase strategy
extended to all units.
trial self-certification
extended to all units.
project must now be
implemented in
everyday practice;
district department is
doing this by
establishing action
plans for each unit for
internal control
- food and beverage industry in

Norway could point to many
successful projects that had
prevented workplace absenteeism
- an active project group involving
many employees
- support from consultants of the
central union and expertise in the
no particular difficulties in
progress of project
planned participation in
national project on
reintegration of longterm sick staff
IJ

Other results
Barriers
Follow-up
Cases
Au: Bank Austria:

Central
Administration
Vienna (-present)
reported high level of health

following the
promotion
foundation of Bank
work satisfaction
and
Austria a slight
prevention
increase at an very
activities are
low level (2.5%-2.8%)
judged to be
cost-effective
lack of systematic evaluation

comprehensive health policy
high motivation of management and
works council
new health centre
comprehensive workplace health
promotion
medical care
highly experienced and professional
staff
sufficient resources
Au: Printing and

packaging
materials:
Alfred Wall AG
Graz (present)
no change in
absenteeism rate
not
calculated
motivation of managers
motivation and experience of
company physician and nurse
responsible for counselling support
new project to reduce

absenteeism
continued effort to
strenghten company
health policy
Au: Sewage and

waste treatment:
Entsorgungsbetrie
be Simmering
Wie (-present)
decline of
absenteeism rate
following new
regulation about
certificate
assumed
benefit of
regulatory
measures
change in personnel department

support from management, works
council and company physician
continued effort to
control absenteeism
new staff promotion
project
good organisational
climate
new effort to monitor

and analyse
absenteeism rates
continued effort to
maintain low level of
absenteeism
Effect on workplace absenteeism

In order to evaluate the effects of the measures undertaken, every case was
checked to see whether workplace absenteeism has decreased amongst staff. In
18 of the 23 cases absenteeism has been reduced. In nine companies this
reduction in workplace absenteeism could be supported by annual figures, in the
other nine companies this observation rests on an overall impression or on a
number of monthly figures.
For example the Austrian waste disposal plant Simmering made a change
in the sick-leave regulations on the initiative of the personnel department.
A doctor's certificate was required after one day of incapacity for work
owing to illness instead of three days. This change in regulations resulted
in a reduction in sickness related absenteeism among both blue-collar
and white collar workers. It was concluded that a tightening up of the
monitoring system reduces absenteeism, at least in the short term. It is
not known what effect the measure had on health and well-being and job
satisfaction.
In the case of the British auto components manufacturer Unipart, the effects on
absenteeism could only be estimated since this company deliberately does not
disclose absenteeism figures because this conflicts with the ethics of the
company.
Unipart's initiatives are not directed specifically at absence reduction.
The very act of measuring their effect in such terms would, in the chief
executive's view, contradict Unipart's core belief that 'as stakeholders in
our business, concern for the well-being and quality of life of our
employees is part of our responsibility'. Unipart also believes that such
misinterpretation of the company's motives would lower the morale of the
workforce and discourage participation in the health facilities.
In five cases absenteeism has remained at the same level. In three companies
this was because absenteeism was already low: in the chemical company
Dupont de Nemours, where absenteeism stood at around 2%, the central
administration of the Austrian bank, where absenteeism went from 2.5% to
2.8%, and at the Portuguese copper mine where absenteeism (including
maternity leave and other reasons) was only half (3,5% in the last four years)
what was expected initially (7%) for a high-tech underground copper mine. In
one other organization, where absenteeism did fall in the first instance but rose
again afterwards (the Norwegian food company), one factor may be that this is
a small company in which an occasional long-term sick employee creates a
121
significantly higher level of absenteeism. The other company where

absenteeism did not decline was the Austrian printing and packaging firm
Alfred Wall.
Other results
The other gains resulting from the measures undertaken must be sought in an
improvement in the working situation (in 5 cases improved physical
environment, information provision, job content, decrease in work pressure,
improved safety), relative participation in the measures (2 cases), decrease in
accidents (4 cases ), improved performance, reduction in extraordinary leave
and disciplinary measures, increase in problem-solving capacity, positive
attitude towards the measures undertaken (2 cases), increase of the insight of
employees and managers into their own role in reducing workplace absenteeism
(3 cases), increased satisfaction and/or motivation among staff (7 cases). With a
few companies, however, negative effects were (also) noted. For example the
sharp fall in absenteeism in the Belgian subsidiary of Volkswagen went hand in
hand with social conflicts.
The evaluation of the measures taken at Volkswagen Brussels showed that
the effect of attendance premiums was notable but weakened - according
to the personnel service - over a period of time. Curiously enough, a large
number of employees were not opposed to the abandonment of the
attendance premiums. This measure together with the monitoring of
absence and the offer of alternative work led to a spectacular fall in the
rate of absenteeism, from nearly 9 to 2.3%. However one must also take
the losses into consideration, such as the stoppages that have taken place
at Volkswagen and in which the "profit" from these measures has almost
come to nothing. The question is naturally to what extent the management
of absenteeism should be seen as an influence on the mechanism of origin
of a social conflict. It is not possible to answer this in lite framework of
this study, but it is reasonable to see a certain influence.
The absenteeism measures in the Dutch TDV also led to some other negative
results, such as a decrease in work satisfaction, but also to a fall in ailments and
an increase in involvement in the organization and satisfaction with the
management. In the case of two companies it is not known what other results
the absenteeism project has produced.
Costs and benefits
The costs and benefits of the approaches described have only been established
in a limited number of cases. In the three Dutch companies, two German
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companies and the Portuguese copper mine, both the costs and benefits have
been mapped. It emerges that they calculate cost and benefit in a very different
way. In the project run by the local public transport company in Nrnberg,
besides the decrease in the degree of absenteeism and working incapacity for
the bus service, a subsidy from the government was also counted as a benefit.
The Waterland Hospital and the ceramics company Sinterit GmbH included on
the benefit side the savings achieved through the fall in absenteeism (as a
percentage of the gross wage bill). The Portuguese copper mine compares the
actual absenteeism in the organization with the average absenteeism in the
underground mining sector, according to international standards, and takes this
difference as a percentage of the wage costs saved as a benefit of the activities.
In the case of the Dutch TDV direct and indirect (wage) costs of decreased
absenteeism were counted as benefits. For the sake of convenience the same
amount has been counted for the indirect absenteeism cost as for direct costs.
With NVE Bouw Heerlen on the other hand, only 30% of the reduction of
absenteeism through illness (a percentage of the average wage costs) was
counted as a result of the project. On the basis of statistical analyses (regression
analysis) it was established that approximately 30% of the fall in absenteeism
in the company could be attributed to the absenteeism activities. The difference
in these methods of calculation between the most cautious (the construction
company) and the most generous variant (local public transport in Nrnberg)
amounts to at least a factor of six.
These differing cost-benefit analyses led, in the case of the three Dutch
companies and the Portuguese company, to a positive balance, varying from
ECU 150 to ECU 1800 per employee over the course of the whole project. The
two German companies more or less broke even: the German local public
transport company Verkehrs-Aktiengesellschaft Nrnberg had a positive result
if the subsidy obtained was counted as a benefit and a negative one if this
subsidy was not counted. The Sinterit ceramics company had, in the first year,
as many costs as benefits. However if the absenteeism level at Sinterit remains
low due to the project in the coming years the benefits will be higher than the
costs.
Of the other companies, six still had only estimated the costs and five had only
made an estimate of the number of benefits, mostly on the basis of savings in
wage costs. Finally, in six cases no cost or benefit had been established.
Enabling factors
Various factors may have had a positive effect on the course of tackling
absenteeism. In the description of the projects many enabling factors are
123
mentioned. The enabling factors concerning the attempts to reduce absenteeism

at the cleaning service of a Belgian Ministry illustrate what aspects promote
these initiatives.
Some important factors for achieving the result at the cleaning service
were: 1) pressure arose through the cleaners' fear of unemployment; 2)
the previous agreement with the management that the recommendations
arising from the initiative should be later implemented; 3) the support of
both the management and the unions. 4) information to the interested
parties in all phases of the initiative. 5) the qualities of the animators
(leadership qualities and experience of working with groups). 6) the
participation of those who will cany it out ensures good motivation.
Many of the enabling factors concern the way in which the project was set up.
A favourable effect is visible in areas such as a systematic approach (mentioned
in two cases), a theme day for employees, institution of a project group (three
times), a contact person, participatory approach (four times), information
supplied to all those involved (twice), involvement of personnel department,
company health service and of safety health and well-being committee or works
council (four times) and the quality of the external supervisors. In addition,
support from the management of the organization was mentioned as a positive
factor in one-third of cases. Other factors which affect the course of the project
positively are motivation of the staff, the method used to make an inventory of
problems, the methods chosen and external factors such as market demands and
pressure of performance, the closeness of health specialists, etc.
Barriers
Set against the enabling factors are barriers to the development of the project.
Sometimes these are the same as the enabling factors mentioned above. For
example, support from the management has a positive, and lack of support a
negative, effect. However, excessive participation of the management can be
unfavourable for tackling workplace absenteeism. In the German company
Sinterit the high involvement of senior management turned out to be an obstacle
for participation of employees and middle management.
The problems that appeared in the course of the project at Sinterit can
also be described as typical for small and medium-sized
enterprises.
Strong commitment on the part of the managing director, which is crucial
for the success of the project, can become a problem if he is so dominant
that it prevents staff from opening up. Thus the managing director had to
learn, at the beginning of the project work, to restrain his input so that all
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the different interest groups could really be successfully integrated. This

applies in particular in the case of works councils, which are
traditionally weak in small and medium-sized enterprises, and whose
corrective influence is often lacking. In this respect the employment of
external consultants on the project was an essential requirement for the
successful integration of the various interest groups. In addition, senior
staff within the company (sector managers, foremen) proved to be
relatively weak, which was partly the result of the dominance of the
strong managing director.
Other negative factors were related to the design of the project. For example, too
great a role of the steering party was mentioned, too low an involvement of
employees (four times), the length of time that activities stagnated because of a
changing experimental and monitoring role (this was a factor at the Dutch
metalworking company TDV), too many levels in decision-making, too little
information, and in the Norwegian municipality of Trondheim the work
conference phase should have been placed at a much earlier point. Thus the
same factors are mentioned here as in the instances of positive factors, except
that now they are too little or too much present. A low level of staff motivation
or resistance to the measures chosen also have a negative effect on tackling
absenteeism. In the three Austrian companies the lack of systematic evaluation
appeared to be an hindrance for the attempts to reduce workplace absenteeism.
External factors which were also seen to have a negative effect are too small a
budget, ponderous bureaucracy, the salaries of employees and the lack of
national model companies. In two companies it emerged that the fact that
employees feared that the questionnaires would be used for monitoring
hampered the course of the project.
Follow-up
activities
In most of the companies the measures for tackling absenteeism and working
conditions were continued. Only in one company, the German local public
transport company, were two of the measures undertaken discontinued, but a
third measure, the introduction of the four-day working week for older
employees, was introduced generally. In the case of two Dutch companies and
the Norwegian municipality of Trondheim there is an explicit policy that the
measures must now be fitted into the existing organization and introduced into
everyday practice. In twelve of the 23 companies there are still completely new
activities planned, in some cases because the projects were not complete when
described. In these companies the period described could be seen as a part of the
total assault on absenteeism which the companies are undertaking. The new
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measures to be undertaken range from the construction of a new factory to

safety training for the staff.
6.9 Preconditions for success

In the preceding paragraphs the case studies have been described in detail and
the main conclusions have been drawn. Of course these cases have been selected
because they could be described as examples of good practice. Consequently it
is not a representative sample of workplace initiatives in these countries.
However, the preconditions for success can be derived from these workplace
experiences and the evaluation of these studies. These elements give a quite
clear picture of the aspects which are of importance to successfully reducing
absenteeism related to ill health.
Systematic app roach
It is important that workplace initiatives directed at the reduction of absenteeism
related to ill health go beyond a piecemeal response to health problems as they
arise, so that they address problems before they become serious through a
systematic and comprehensive approach to improve the health of the workforce.
An approach based on the 'policy cycle of problem solving' seems to work well
in practice. This includes different steps such as: preparation of the project;
investigation of the health problems; organising solutions before interventions
are carried out; and evaluation of the impact.
Co-ordinating project team
The success of a workplace project on absenteeism and ill health depends on a
number of factors, of which the main one is the building of a committed project
team which has a clear brief to manage and implement the project. This project
team can be established by adapting the existing workplace structures or by
setting up a new team. This first approach looks more common in Belgium.
Austria, Portugal and Italy. The establishment of a specific project team seems
to be more typical in Norway, the UK, the Netherlands and Germany.
Clear tasks and responsibilities
An essential feature of any workplace activity is an explicit agreement at the
beginning of the project concerning its scope, the resources that are needed and
the tasks and responsibilities of the project team and other stakeholders. These
agreements may be formal or informal, depending on the culture of the
company.
126
Support of senior and line management

Active involvement of higher management is a key for the success of workplace
initiatives; not only at the beginning of the project but also at the later stages.
This increases the identity of the project within the organization, facilitates
decision-making and is of decisive importance for the implementation of
measures and the cooperation of middle management and workers.
Active worker participation
Employee participation should be an explicit goal in designing a prevention
project, because it is a condition for programme effectiveness. Workers are the
primary experts on their work and work environment. Furthermore they are the
first and most effected persons by good or bad working conditions. So they are
the experts and they have a major interest. It is efficient and effective to make
use of their creative and problem solving capacity. Furthermore, health benefits
- as the objective of the prevention project - can only be achieved through
employee participation. Health improvement cannot be inflicted on employees
from above.
Good information and communication
There are two groups who must be informed of the progress of the absenteeism
initiative. Firstly there are the participants themselves who should be informed
about the developing programme. Secondly there is a need to communicate
progress to management structures within the organisation. Good communications are an essential requirement for integrating health improvement
measures into organisational policy and practice.
Active involvement of personnel management, occupational health service and
external guidance
The participation of the personnel department and the OHS can help middle
management to reduce ill-health absenteeism, but should not absolve middle
managers from responsibility for the handling of absenteeism. The involvement
of outside parties may increase the credibility of the project and enhance the
sense of objectivity. It often makes it easier to initiate a project and promotes
closer collaboration between the different parties within an organization. During
the project outside experts must, however, endeavour to build upon the existing
know-how and help the organization itself to identify and resolve problems.
Involvement of work councils, health & safety committees and trade unions
In the Netherlands, Germany, Portugal, Italy, Austria and Norway members of
the works council or health & safety committee participate in (most of) the
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projects to diminish ill-health absenteeism. In the case studies from Belgium.

Italy and the United Kingdom the workers are (also) represented by the trade
unions. It appears that participation of the works council or H&S committee
members contributes to good results, while the participation of trade unions
may be less significant for positive effects. It may be that works council
members and H&S committee members are more involved with matters of
content, while the trade unions are more involved as formal representatives.
Balanced package of measures
A balanced package of measures also appears to be related to the successful
reduction of workplace absenteeism. A balanced approach involves procedural
measures to raise the absenteeism barrier and to make it less simple to report
oneself sick, but also preventive measures focused on both the person and the
work, through which health problems can be prevented. Finally reintegrative
measures are important to lower the reintegration barrier and to facilitates the
return to work of the sick employee.
7776? treatment of absenteeism related to ill-health as a normal company
phenomenon
111 health and absenteeism confront every workplace. They can have a great
impact on the productivity and the competitive position of companies. It is
important that companies realise this, and integrate measures to reduce
absenteeism and ill health into their organisational policy and practice.

In this chapter 23 case studies have been described in which, at company level,
activities have been developed to reduce absenteeism related with ill health. The
main criterion for selection of case studies was that the initiative was directed at
combating absenteeism by reducing the incidence of ill health and tackling the
underlying causes in the workplace. The cases have been selected by the
national correspondents. They chose these cases because they had information
that these companies were dealing with the absenteeism problem in a more
systematic way than other companies in their country. These cases are
consequently not a representative selection of workplace activities in these
countries. Key elements of good practice include: a systematic approach, an
analysis of absenteeism and the underlying problems, a focus on an active
participation of employees and regular evaluation. These elements have been
derived from the workplace health promotion study of the European Foundation
(Wynne & Clarkin, 1992).
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The case studies derive from eight European countries, namely Norway, the
UK, the Netherlands, Belgium, Germany, Austria, Portugal and Italy. Compared
with the national strategies described in chapter 5 the case studies take place in
companies which are more active then others in the field of absenteeism
reduction and improvement of working conditions. The companies often opt for
new innovative activities to reduce ill-health absenteeism. Moreover 'being
ahead of one's time' at the national level does not necessarily mean doing
something which is innovative at an international level. In this way the
companies also demonstrate the fact that the various countries in Europe can
learn from each other how to reduce absenteeism related with ill health.
Although 'hard facts' are often missing the analyses gave quite a clear picture
of the aspects which are of importance to reduce absenteeism in a successful
way at the workplace. These factors are:
systematic approach
co-ordinating project team
clear tasks and responsibilities for the persons involved in the activities
active support from senior and line management
an active role for employees and the recognition of employees as experts

good information to and communication with all staff
involvement of the personnel department, the company medical service
(OHS) or external guidance
involvement of the works council, health and safety committee or trade
unions
a balanced package of measures
the treatment of absenteeism related with ill-health as a normal company

phenomenon.
The positive influence of some of these factors seem to be contingent on the

national context. The use of a project team and the participatory approach
appeared to be more important in the Norwegian, UK, Dutch and German case
studies. In the Belgian, Austrian, Portuguese and Italian case studies the
companies mostly used the existing structure in the organisation to coordinate
the absenteeism activities and used participation by representation. But it must
be clear that a workplace initiative can only be successful, when the activities
are in line with the specific problems in the company and fit with the culture of
the organisation and the country.
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In the last part of this chapter three aspects (worker participation, reintegration
of long-term absentees and costs and benefits) will be discussed in more detail.
Information on these aspects relates to the main lessons from the case studies.
Although differences between countries have been established, it is evident that
participation is one of the key elements in workplace activities related to ill
health. That is why participation should be an explicit goal of workplace
activities directed at the reduction of absenteeism related to ill health.
Reintegration of long-term absentees is an underrated aspect of workplace
activities directed at the reduction of absenteeism. It has a major influence on
the level of absenteeism and there are a lot of possibilities to reduce long-term
absenteeism and to reintegrate long-term absentees. Increasingly questions are
raised about the costs and the benefits of workplace activities. In view of the
large amount of money which is involved in absenteeism and disability (see
Chapter 1) this is also an interesting question for workplace absenteeism
activities. That is why this subject has been included in the case study
questionnaire. From this material can be learned that 'pace-setting companies'
look further than the direct financial benefits of workplace activities directed at
the reduction of absenteeism related to ill health and are prepared to invest in
the health of their staff.
Participation
In all case studies employees participated - directly and/or indirectly - in the

activities aimed at the reduction of ill health and absenteeism. This participation
ranged from being informed to joint decision-making. Direct participation was
more common in the case studies companies which established a special project
group for these activities. Such a type of project organisation is more usual in
the Northern European countries. In the companies which used the existing
structures within the organisation (for example health and safety committees) to
address absenteeism related with ill health, forms of indirect participation have
been found more often. In these companies the employees were often
represented by member of a works councils or by trade union representatives.
In most companies workers were asked to contribute to a health needs or problem analysis as a basis for the intervention. In eight case studies the employees
participated in the steering group of the absenteeism project and were also
involved in the selection of interventions. But participation of workers in a
project group or steering committee is not always successful. In some
companies workers lack experience to discuss matters of company policy and
the quality of working life on a higher level. Perhaps in such cases worker participation should be divided into formal participation from the works council in
a steering committee, and active participation of executive staff in working
130
groups on specific and more concrete subjects. In these working groups the
participants should take part in all phases of the process from the definition of
the problem (and the discussion about the solutions) to the (final implementation and) evaluation. A more general lesson from these experiences is that
workers should be better prepared to participate in preventive activities at the
workplace. This could be achieved by setting up training courses for workers.
A participatory approach has been mentioned as an important enabling factor
which, especially in the Northern European countries, positively influenced the
start of the initiative and the continuity of the process. The significance of
participation for workplace initiatives directed at absenteeism related to ill
health is not surprising. Their daily work experience makes workers the primary
experts on their work and their work environment. However most companies are
not aware of this creative and problem solving capacity of their employees and
make hardly any use of it (Johannes, 1993). Worker participation promotes the
effectiveness of a prevention project. Health improvement, for example, cannot
be inflicted on employees from above (Wynne et al, 1995). Organisational
change in companies is much more easy when all parties involved - including
the workers - participate in the decision-making about the change of the
organisation, the direction and the time table.
Reintegration of long-term absentees
Reintegrative activities - even among these national 'pace-setters' in the field of
combating absenteeism - are not yet taking place consistently. Guidance of sick
employees, by keeping contact and by return-to-work interviews, is not much
mentioned. The same applies for utilisation of rehabilitation/redeployment
activities. In some countries (Portugal, Italy and the UK) medical care is given
in the case study companies to the employees as a part of the reintegrative
activities (surgery, treatment by company physiotherapists and specialists.).
This might be related to a lack of experienced staff or a lengthy waiting period
for national health care in these countries.
The low level of reintegration measures needs attention, because it is from these
activities in particular that the greatest gains can be expected in a relatively short
period. The level of (temporary) absenteeism is mainly determined by long-term
absences. Long-term absences are only a very small part of the number of
spells, but cause the majority of the number of days. By long-term absenteeism
we mostly mean absence lasting over six weeks. Short-term absence generally
is a big nuisance for the companies. It disturbs the planning of the work and asks
for direct action. Long-term absence is less of a hindrance to many companies,
because the consequences for the work have often been dealt with already. The
economic costs of long-term absenteeism are however much greater than those
131
of short-term absenteeism. Nonetheless, because in most countries the benefits

for long-term sickness absenteeism are paid by the social security system, the
companies do not feel this burden directly. This may explain why not that many
reintegration activities are undertaken.
In tackling long-term absenteeism it is particularly important to keep good
contact with the sick employee and to make plans at an early stage for the
resumption of work. One must see whether resumption of the employee's own
work - whether or not adapted - is possible, or whether other work - temporary
or permanent - is necessary. Of course it may also be found that resumption of
work cannot be expected for the present or at all. In any case these matters must
be brought up periodically, in order to encourage a successful resumption of
work. Rehabilitation services at work or outside the workplace can be part of
these reintegrative activities. Therapeutic resumption of work also fits into such
a perspective. This means a partial resumption of one's own work or other work
in order to make the eventual full resumption of work easier. The employee is
already getting into the swing of things and in addition has the necessary social
contacts, thus reducing a potential barrier for resumption of work. In adapting
jobs one's thinking should be focused more on what the employee concerned is
capable of and less on what he or she is not capable of (the limitations).
Costs and benefits
Facts on the costs and benefits of the projects turned out to be difficult to
retrieve. In the literature also it appears that there is only a limited amount of
data about costs and benefits of absenteeism activities. It is striking that
companies often set up such large-scale projects without a sound insight into the
financial perspectives of these activities and that such an evaluation does not
even take place after the event. This may be connected with the fact that
establishing the exact costs and benefits of these kinds of activities is in itself a
labour- intensive and therefore costly chore, although recently some simulation
models have been developed to assess the costs and benefits of health and safety
activities at the workplace (Oxenburgh, 1991; NEI, 1995). In addition the cause
(absenteeism activities) and effect (trends in absenteeism) cannot be linked
together axiomatically. Even without targeted absenteeism activities there are
changes from year to year in absenteeism. In addition many other activities are
taking place at the same time which may affect absenteeism. The question also
presents itself how long the effects of the measures taken will persist.
Companies involved calculate costs and benefits in widely differing ways. This
leads to widely differing conclusions, so that companies - in comparable
circumstances - can arrive at gains which vary by a factor of six.
The extent to which companies attach importance to such calculations is open
to question. Might it be that companies which require fuller substantiation of the
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costs and benefits of absenteeism and health activities, are actually looking for
arguments to enable them not to get involved in such activities? For companies
which do wish to develop those activities, a notion of a positive gain may be
sufficient for them to set those activities in motion. Another factor is that a large
proportion of the gains, such as a better motivated workforce, an increased
problem-solving capacity, better industrial relations, etc. cannot be immediately
expressed in money terms. A broadly-based survey in eight countries in the
European Union (Wynne & Clarkin, 1992) showed that many companies
develop activities focusing on the health of their employees. The principal
motives for undertaking these activities related to regulations and legislation
and to promoting the motivation of the workforce. Many companies also
reported positive gains as a result. Almost two-thirds of companies noted a
reduction in absenteeism through illness as a result of the activities in the field
of work and health. Other gains related to better motivation in the workforce
(78% of companies), better health among employees (76%), increased
productivity (62%) and a better company image (64%).
This supports the assertion that companies which initiate absenteeism and
prevention activities do not generally require detailed statistical support. These
companies often launch such activities based on a broader vision, in which
immediate costs and benefits are not the primary concern. An example of this is
the UK case study of Unipart described in this chapter. This company is
investing in its workforce by means of health-promotion activities, while
absenteeism through illness is low. The costs of the measures are considerable,
totalling over ECU 1.1 million (over ECU 600 per employee). In the company
the motive cited for the health-promotion activities is that great value is attached
to the workforce and that by investing in employees the company expects to be
able to produce competitively. Unipart expects increasing numbers of changes
in the work in the years ahead. The rapidly changing working conditions will
lead to more stress and more physical and mental problems. The company's
strategy aims to teach employees how to deal with this stress and to view change
as a symptom of progress. In the Dutch case study of the Waterland Hospital
management argues that it wishes to be an above-average hospital, both for
patients and for staff. So that the image of the organisation is an important
stimulus for initiating the absenteeism activities. One of the gains of the project
is that the Waterland Hospital has no longer any problems in recruiting new
staff, despite a tight labour market in the region. One can observe that 'pacesetting companies' regard their staff highly and are prepared to invest in the
health of their staff, even if the financial benefits cannot be precisely quantified
in advance.
133
Conclusions and
recommendations
The previous chapters have documented and analysed developments in

Europe to reduce workplace absenteeism and ill health. In this chapter
the more detailed information is drawn upon and put into context to
present conclusions and make recommendations. These involve issues
such as promotion of preventive and reintegrative activities at work,
dissemination of information, development of special training modules
for practitioners and professionals and transferring absenteeism and
health issues into mainstream company policy. The chapter concludes
with implications for action by the major key players.
The present report is the first European study on workplace absenteeism (and ill
health), which includes all fifteen Member States of the European Union. The
study describes and assesses regulations and statistics, the perspectives of
governments and social partners, strategies to reduce workplace absenteeism
(daily practice) and models of good practice. These analyses constitute the basis
for the following conclusions and recommendations.
7.1
Conclusions
/. There is a major disparity between the human and economic scale of
the issue and the priority given to it in practice by the key players
There is a paradox at the heart of these analyses of workplace absenteeism in

Europe; vast amounts of money are involved in paying for absenteeism due to
ill health, but major players have been relatively inactive for a long period. In
each of the Member States the social security schemes pay out billions of ECUs
yearly as benefits for absenteeism and disability. Additional large amounts of
money are spent on medical treatment as a result of the workers ill health (partly
135
related to the work environment). Furthermore, temporary and extended or

permanent absenteeism and health problems of the workers lead to significant
losses in productivity. The level of absenteeism is thus a major factor in the
national competitiveness of industry. Attention to this problem within national
governments is growing at this moment, but this phenomenon is rather recent.
Likewise employer organisations and unions have not been very engaged by the
issue until recent years. The impression is that the key players were content with
a situation in which premiums were paid to cover expenditure for absenteeism
and ill health and none of them was really confronted with the implications of
this attitude. If absenteeism increased, government paid the losses and
premiums were raised.
2. Governments are shifting the burden
The situation has changed since governments have become more concerned
about public spending and the reduction of the public sector national debt. Other
significant factors are the creation of the open European market, increasing
international competition, the growing numbers of unemployed persons and the
globalisation of the production process, where (international) companies
relocate jobs to (cheaper) developing countries. In this situation efforts are
being made to reduce the costs of labour to remain competitive and to keep
industrial employment in Europe. International companies increasingly take
into account the national regulations on social security and the level of
absenteeism and disability as important aspects of the cosls of labour, when they
look for countries to establish new plants.
Governments are shifting the financial responsibility for absenteeism and
disability to employers and employees. This policy has a double-sided effect: il
relieves pressure on the public sector budget and it is an incentive to employers
and employees to reduce absenteeism. In particular the increasing financial
responsibility of employers seems to have positive effects on the levels of
absenteeism. Too much financial burden however, may lead to risk avoiding
behaviour by employers and discriminatory selection processes (based on
health) and an increased number of temporary work contracts with employees.
Such processes can already be seen for example in the UK and in the
Netherlands. In the UK changes in legislation (1994) led to an own risk period
for employers in case of absenteeism of 28 weeks. New legislation in the
Netherlands (1996) resulted in abolition of the Sickness Benefits Act for most
workers. As a result the first year of absenteeism (52 weeks) of an employee in
the Netherlands is now on the employer's account.
136
Conclusions and recommendations
Governments are employers too and are also challenged by the changes in
legislation to reduce the absenteeism related to ill health of their civil servants.
In most countries these staff have (or had) separate regulations, which are (or
were) often more favourable than the regulations for employees working for
private companies. Civil servants also often have (or had) higher levels of
absenteeism than employees in other sectors. Since these higher levels of
absenteeism are often linked with the higher benefits, these differences may
disappear in the near future.
Employer organisations are also worried about the competitive position of
national industry. In general they support an active government policy regarding
workplace absenteeism, but are against too much financial responsibility for
companies. The trade unions are opposed to increasing financial responsibilities
for employees; they emphasise the relationship between ill health and aspects of
work and argue that employers are responsible for the working environment.
Still unions mainly respond to policies and initiatives from governments and
employers organisations and essentially do not take a different position on the
issue of absenteeism and ill health.
i. Regulations on absenteeism and disability vary markedly between the
European countries
Great differences have been found in the regulations governing absences due to
illness and disability in the various Member States. In one country a person unfit
for work will be paid normally for a period, while temporary unfitness for work
in another country may mean a halving of the person's income. However
countries which have a favourable system of benefits for temporary absences do
not necessarily have favourable regulations on extended or permanent disability.
If the illness concerned is the result of an occupational disease or accident at
work, there is, in most EU countries, a more favourable arrangement. Civil
servants have also, in most countries, more favourable arrangements than those
employed in the private sector.
At the same time there is a big difference between the formal regulations and
real experience; practice in most countries is much more favourable than the
official regulations. In many countries employees receive a top-up from their
employers for a shorter or longer period in case of absenteeism. The proportion
of workers covered by these financial contributions of employers differ from
country to country and mostly concern employees working for the bigger
137
companies. In SMEs top-ups by employers are usually less common in case of

absenteeism.
On the other hand a growing number of employers are looking for possibilities
to increase the number of workers on temporary work contracts, which makes
it possible to decrease the financial risks of absenteeism and disability. This can
easily lead to 'benefits' under the official level.
4. Statistical information is lacking
In spite of the financial significance of the issue of absenteeism and ill health
there is relatively little national information on levels of absenteeism and the
factors which influence this. National data on absenteeism are only available to
a limited extent. Furthermore these statistics often only relate to a part of the
working population; for example most statistics only include employees
working in large companies. It is difficult to obtain absenteeism data on
employees working in SMEs and such data are often not complete; this is
critically important when most European employees are working in companies
with less than 10 employees. Data on absenteeism among self employed
persons are almost completely lacking. Furthermore, absenteeism related to ill
health cannot always be distinguished from absence from work for other
reasons. In different countries different reasons other than illness or disability
are counted towards absenteeism. Finally there are few analyses of absenteeism
in relation to gender, age or economic sector. From the research literature it is
known that these factors have a great influence on the different absenteeism
indices. Social Security Institutes often have detailed information on the total
number of benefit days or the average duration of spells of absenteeism, but lack
information on the denominator, the employees who are registered in these
benefit systems.
5. Interpretation of national differences in levels of absenteeism is
difficult
The available data on levels of absenteeism and disability show great
differences between countries. It is however very difficult to explain the causes
of these differences. One might conclude that the workers in the country with a
high level of absenteeism are less healthy - or have lower life expectancy levels
- than the workers in another country with low levels of absenteeism, but this is
not necessarily so. Levels of absenteeism and disability do not relate clearly to
characteristics of the national regulations. There is a fundamental problem that
the available national data are not presented in a comparable or complete way.
138
Obviously absenteeism is a multi-causal phenomenon, which is influenced by

many factors. These factors operate at different levels: the societal level, the
company or workplace level and the individual level. An example can illustrate
this point. Norway had a high level of absenteeism at the beginning of the
1990's. In a large research project all potential factors were examined. Finally
it was concluded that the high level of absenteeism in Norway was the result of
a high proportion of women in the working population and a high retirement age
(67 years). This also shows the influence of the adjacent regulations such as
unemployment and (early) retirement.
6. Companies focus on absence control procedures to reduce
absenteeism and ill health
In most European countries employers try to reduce absenteeism by tightening
up procedures and checks on absent workers (regulatory and disciplinary measures). In spite of the implementation of the EU Framework Directive on Health
and Safety at Work, preventive activities are still not very common within
companies in the EU. Most preventive activities are limited to person-oriented
measures in the field of occupational accidents and diseases - such as training
and information, use of protective equipment and stress management - and are
not directed at work-related causes of ill health and accidents. Norwegian and
other research shows that preventive work-related measures are most effective
to reduce absenteeism in the longer term. It also appears that reintegrative
measures, directed at the redeployment of long-term absentees, are not much
used at this moment by European employers. This is a significant issue when
the absence percentage is most influenced by the spells of long-term
absenteeism. Although long-term absences are only a small proportion of the
number of spells, they account for the majority of days lost due to sickness
absence. Thus reduction of long-term absenteeism, or support of early resumption of work, could have an important impact on the level of absenteeism
within a company.
7. Case study companies illustrate an alternative approach
The case studies illustrate company level activities focused on the health of the
employees and on work-related aspects, in order to reduce workplace
absenteeism in the company. These companies are dealing with the absenteeism
problem in a more systematic way than most other companies in their country,
and are not representative examples of workplace initiatives to combat
absenteeism. Key elements of 'good practice' included a systematic approach;
interventions based on needs assessment; a focus on active worker
139
participation; and evaluation. The case study companies show that an alternative
approach is feasible and fruitful.
Although 'hard' impact data are often lacking the analyses give a rather clear
picture of the aspects which are of importance to successfully reducing
absenteeism. These factors are closely related to criteria for health promotion at
work, as these have been discussed in previous publications of the European
Foundation (see for example Wynne & Clarkin, 1992) and are supported by
Norwegian (Andersen & Nytrf, 1994) and Dutch (Kompier et al, 1996) research
in this field. Success factors are:
systematic approach;
a co-ordinating project team;
clear tasks and responsibilities for the persons involved in the activities;
active support from senior and line management;
an active role for employees and the recognition of employees as experts;
good information and communication with all staff;
involvement of the personnel department, the company medical service or
external guidance;
involvement of the workers council, the safety, health and well-being
committee or trade unions;
a balanced package of measures and
the treatment of workplace absenteeism as a normal company
phenomenon.
Within the EU, regional differences have been identified with regard to the use
of a project team and the participatory approach. In the Southern European case
studies both aspects were less evident. The establishment of a specific project
team to co-ordinate the absenteeism and health activities does not seem to be
necessary for a successful result in the Southern countries. Southern European
case study companies mostly used existing structures in the organisation to
coordinate the absenteeism and ill health activities in the company.
The case study companies in the Southern part of Europe also had more
participation in the workplace activities by representatives, rather than direct
forms of participation. However, and in conclusion, a workplace initiative can
only be successful, when activities address specific health problems in the
company and fit into the culture of the organisation and the country.
140
7.2
Recommendations
/. Awareness raising
Absenteeism and its causes should be placed much higher on the
agenda of the EU, national governments, employers organisations and
unions. This attention should go beyond financial and economic aspects
to include health aspects (healthy workers and healthy workplaces).
The current report should be used to place absenteeism and ill health much
higher on the agenda of the major key players. Awareness of the major
economic and human significance of absenteeism caused by ill health has to be
raised. At the same time the key players should become aware of the potential
and practicality of reducing absenteeism.
This understanding should lead to improved monitoring and recording systems
for absenteeism and ill health (recommendation 2), to national action
programmes, directed at the improvement of the health of the workers and the
work environment, to reduced long-term absenteeism and to the extension of the
working life of older workers (recommendation 3.1 to 3.5) as well as to
practical activities at the workplace (recommendations 4.1 and 4.2). It is
possible that reduction of absenteeism can also have a negative effect on
unemployment in the short term, which is one of the other major problems at
this moment in the EU. However the case studies show that in the longer term
the reduction of absenteeism related to ill health increases the competitive
capacity of companies and can increase employment.
2. Monitoring systems for absenteeism and ill health
Standardised data on absenteeism and ill health need to be made
available on the national and European levels. This will make it
possible to make a proper comparison of absenteeism and ill health in
the EU, to analyze national trends in absenteeism, to assess the impact
of legislative changes and to evaluate the effects of national action
programmes.
This project has demonstrated the difficulty of collecting and using the existing
statistical information on absenteeism and disability. The available data show
great differences in levels of absenteeism and disability. They evoke questions
about the influence of specific characteristics of the social security system as
well as regarding the influence of the composition of the working population in
terms of age, gender, education, industrial sector and company size. However
141
these questions cannot yet be answered definitely. The registration of absences

by the social security organisations is generally not appropriate for this purpose;
these organisations have other interests in absenteeism data and often have no
information of the population at risk. In addition recent changes in regulations
which allocate greater financial responsibility to employers make social security
information less adequate.
More detailed and valid data are required in relation to absenteeism in the
fifteen countries of the EU. As a start reliable national statistics on absenteeism
and disability have to be generated for all the Member States. International
agreements should be made for the collection of comparable data in all fifteen
countries. At a minimum, data should be gathered about the size (percentage)
and the frequency (number of spells) of absenteeism related to ill health. It is
important that absences for reasons other than ill health (for example maternity
leave) are excluded from these figures. It should also be possible to analyse the
absenteeism data by age, gender, sector and diagnosis. Finally information is
required for all working people, including persons working in small companies
and self-employed persons, or from a representative sample of the working
population. A new European standard for registration of absenteeism related to
ill health could be presented here, but it is doubtful if such a standard could be
decreed unilaterally or that it would be used in practice. All parties involved in
the registration of absenteeism data - the companies (employers and
employees), the occupational health services, the insurance funds, the social
security organisations, the academic community, the statistical offices, the
national governments and the EU - should have the opportunity to contribute to
the discussions about a new standard. Only in this way can a new standard be
developed, which is really supported and applied in practice, leading to
meaningful national and international bench marks.
Useful analysis of absenteeism could also be based upon international
arrangements to add comparable questions, regarding the volume of absences
from work due to illness or accidents during a specified period, in national surveys of the working population. This offers a possibility to look in more detail
at the relationships between absenteeism, aspects of health and aspects of the
work itself. In this way, both general and more specific national patterns of
absenteeism could be documented. The WHO Regional Office for Europe has
started such an initiative (de Bruin & Picavet, 1996). Together with Statistics
Netherlands they organized a series of consultations, which have resulted in
internationally agreed methods and instruments for health interview surveys. It
includes a question on temporary disability ('Think about the two weeks ending
yesterday. Have you cut down on any of the things you usually do about the
142
house, the work or in your free time because of illness or injury?').

methods and instruments are likely to become standards.
These
The Foundation should also consider adding such questions to the European
Survey on the Work Environment. Eurostat could make possible the collection
of comparable data on absenteeism and ill health within the European Union.
The academic community could contribute to the development of standard
measures, although implementation would depend upon support from
employers organisations. It would be helpful if these standards were incorporated into management information systems. In this way more valid and
reliable data will become available, which could also be used to evaluate the
effects of national programmes.
3.1 National action
programmes
Governments, employers organisations and unions together should

establish national action programmes to address absenteeism and ill
health. The aim of these programmes should be to encourage companies
and workers to start preventive activities at the workplace, to extend the
active work participation of older workers and to reintegrate long-term
absentees.
The changing social-economic context calls for a dialogue between
governments, employers organisations and unions at national level. The aim of
this dialogue is to develop an action programme to encourage companies and
workers to start preventive workplace initiatives, to extend the active work
participation of older workers and to reintegrate long-term absentees. A special
effort should be made to support SMEs. All parties have an interest and a
responsibility in an integrated approach to absenteeism, the work environment,
health and safety, ageing and economic expenditure. Such an integrated
approach involves extension of preventive activities directed at the individual
and the work environment. To avoid early disability companies should develop
an age-specific personnel policy, which considers the work capacities of the
ageing worker and their potential need for less physically and/or mentally
demanding tasks and jobs. Reintegration measures should be extended to guide
long-term absentees and to support early resumption of work. A national
programme - supported by the government, the employers organisations and the
unions - could improve the health of workers and the quality of the working
environment, while reducing the costs for absenteeism, disability and (early)
retirement pensions.
143
Some European countries such as Finland and Denmark have already initiated
programmes to maintain health during working life and to avoid exclusion from
the workforce due to reduced work capacities. In Norway the government and
the social partners agreed on a national programme to reduce absenteeism in
1991. In Portugal the government and the organisations of employers and
employees signed a historical agreement on health and safety at work in 1991.
This agreement included activities directed at the prevention of occupational
diseases and the rehabilitation and reintegration of disabled workers. In the
Netherlands a tripartite working group - composed of representatives of the
main organisations of employers and unions and representatives of the
government - was set up in 1989 to work out practical steps which might be
taken to cut down absenteeism and disability and ways to reintegrate the
partially disabled in to the workforce. These discussions are the bases of the
legislative changes in the Netherlands during recent years (see chapter 3).
Governments can support workplace health activities with financial resources
and information. Public health authorities and (health) insurance funds could
also play a role by reducing barriers in the health care system (for example
reducing the waiting lists for medical treatments). In companies which have no
relationship with occupational health services - which applies to most SMEs public health institutes could also support the introduction of workplace health
promotion activities. Insurance companies (private and public) could also
contribute by developing incentives for preventive and reintegrative activities.
Employers (including government organisations) could contribute to the
increased emphasis on health and safety at work by using only suppliers who
can demonstrate good health and safety practice. Employers and employee
organisations could use the collective bargaining process to propose workplace
health promotion activities in companies, including specific demonstration
projects.
It is possible that occupational health services (OHS) could play an important
initiating role, but this depends on some rethinking of their role. They cannot
take the lead in workplace health initiatives as long as they remain bound by the
traditional role of medical 'expert' and do not move to prevention and health
promotion on a participatory basis. Occupational health personnel would also
need additional training to organise preventive and health promotion projects
(see recommendation 3.3). OHS should start or increase cooperation with
general practitioners and other health specialists to support the rehabilitation of
144
long-term absentees. In a complementary way, community based physicians

should receive training in diagnosis of work-related sickness and diseases so
that work aspects can be integrated into prevention and treatment.
3.2 Dissemination
Employers and employees require information about the ways
(methodologies, tools and practical experiences) to reduce absenteeism
related to ill health by preventive activities and reintegration of long
term absentees.
This report illustrates that there is a wealth of experience in workplace
initiatives directed at the reduction of absenteeism related to ill health. It is
evident that companies can learn a lot from the experiences of other companies
in and outside their own country. However there is a lack of well documented
examples of successful absenteeism initiatives. An additional problem is that
some of the best examples are only described in the national language and are
not accessible for an international audience. As a results of this situation many
companies are not aware of enabling factors and barriers they will meet when
they start activities to reduce absenteeism related to ill health.
This dissemination of information should include information on
methodologies for the establishment of workplace health actions as well as
practical information from employers and employees based on experiences. The
description of the case studies in the appendix of this report and the presentation
of the results of the analysis (chapter 6) may be seen as a first dissemination
initiative.
The EU could play a role in the dissemination of information about models of
good practice for reduction of absenteeism related to ill health. For example
there could be a European book (or video) on good practice, including some
examples of reintegration of long-term absentees: the European portfolio of
cases, produced as a complementary volume to this report, offers one approach
to this exchange of practical information. At the national level, workplace
activities of government and the social partners, would be supported by this
kind of information. Exchange of practical experiences within industrial sectors
will contribute to the development of special models for these sectors and could
also support SMEs in their activities. The academic community could contribute
to learning about good practice by an ongoing evaluation of activities and giving
feedback on their results.
145
3.3 Development of training
programmes
Training modules on workplace activities to reduce absenteeism related

to ill health need to be developed for practitioners and for (health)
professionals at the workplace.
Workplace initiatives to combat absenteeism can be started and implemented by
a wide range of people within or outside the organisation. Key staff in the
workplace could be a human resources manager, a line manager, a health and
safety specialist, an occupational health nurse or the occupational physician and
staffortrade union representatives. In SMEs individual employers or employees
may have to 'carry the burden'. External consultants could be health and safety
agencies, occupational health agencies, local health authorities or management
consultants. However most groups require additional training and education to
manage a successful absenteeism project, which not only influences the level of
absenteeism in the company but also the health of the workers. At the EU level
it would be appropriate to consider support for the development of special
training modules and the dissemination of these modules. The Foundation's
training activity on workplace health promotion - which includes a users
network - is a good example of such an initiative (Wynne, 1994). At the national
level, government and the social partners should address the shortage of
sufficiently trained personnel. Special attention has to be given to a 'training of
the trainers' programme. These recommendations on training are generally in
line with the EU Framework Directive on Health and Safety.
3.4 Support of SMEs
SMEs have to be supported and encouraged to reduce ill health
associated with absenteeism and to start workplace activities.
SMEs are more vulnerable to the effects of workplace absenteeism, and in
particular by long-term absenteeism, than larger companies. An employee
absent from work for a period of six months represents an absenteeism
percentage of 25% in a company with two employees; while in a company with
200 employees this spell would register an absenteeism percentage of only
0.25%. In addition SMEs seldom have the in-house expertise to prevent
workplace absenteeism related to ill health. Diffusion of health and safety
activities into small and medium sized companies has been, and still is, very
problematic in all the Member States of the EU. Typical problems faced by
SMEs include lack of resources and lack of skills (Wynne & Clarkin, 1992).
SMEs need support to initiate activities to reduce absenteeism related to ill
health. This support includes dissemination on information on relevant models
146
of good practice, provision of infra-structural measures on a local or regional

level or for industrial sectors, and financial incentives. The Health and Welfare
Canada Small Business Programme shows that SMEs can be reached when
appropriate methods are used. In Europe similar experiences have been reported
in Finland (Finnish Institute of Occupational Health; Rantanen, 1993) and in the
UK (Health Education Authorities). Employer organisations, unions and the
occupational health services could offer practical support to SMEs, for the
development and implementation of workplace absenteeism initiatives.
Solutions and models designed for bigger companies will probably not work in
SMEs. Tailored solutions should be developed in close co-operation with the
social partners.
3.5 Research
Specific research activities are necessary to support absenteeism
projects at the workplace. This includes e.g. analyses of the processes
through which ill health and absenteeism can be influenced at company
level, research into the transferability of the experiences of big
companies into small companies, and studies on the real costs and
benefits of workplace activities to reduce absenteeism related to ill
health.
Although much research has been done into the relationship between aspects of
health and work on the one hand and absenteeism and disability on the other,
many practical questions still cannot be answered satisfactory. For example
which parts of absenteeism or disability can be attributed to work related
aspects and which part to health problems outside the work? What aspects of
absenteeism can be addressed at enterprise level and what level has to be
accepted as a natural phenomenon. Furthermore the results of a research project
in one country cannot simply be generalized to other countries. There are a lot
of complicating aspects, which have to be taken into account. One pertinent
question concerns the role of participatory approaches in Southern European
practice. Likewise, the potential to build the experiences of big companies into
a methodology for SMEs needs further research. Other relevant research
questions coming from this study relate to the real costs and benefits of workplace activities to reduce absenteeism related to ill health, and to the potential
role of health insurance/sickness funds in the reduction of ill health and
absenteeism at work. Answers to these questions should contribute to a better
understanding of the processes by which ill health and absenteeism can be
influenced at the workplace.
147
4.1 Activities at the workplace

Employers and workers have a knowledge base to start preventive and
reintegrative activities at the workplace. These activities should:
use a systematic and comprehensive approach
be based on the needs of the work force
aim at active employee participation
be applied across all workers in the company
Although this is one of the last recommendations of this report, it is certainly
not the least important. Sustainable improvement of health and an associated
reduction in absenteeism can only be accomplished at the workplace itself.
Employers and employees can learn from this report how to set up preventive
and reintegrative activities and to reduce absenteeism related to ill health. The
experiences from the case studies present a broad picture of how to establish
these activities and what barriers and enabling factors may be encountered. The
success factors are effectively the main principles for these activities.
It is important to use a systematic and comprehensive approach to reduce
absenteeism related to ill health at the workplace. There are three key types of
activities: those directed at the health of the individual worker; work
environment activities directed at the work-related causes of ill health and
absenteeism; and reintegrative activities directed at the redeployment of longterm absentees. These activities not only reduce absenteeism related to ill
health, but also contribute to the extension of working life of older workers.
Prevention activities should be based on the needs of the workforce. It is
important to have a good picture of all aspects which influence the worker's
health, but above all of the worker's preferences for action. It is pointless
starting actions directed at the worker's health, when the employees are not
really interested in these activities. Health improvement cannot be compelled
from above. Consideration of the employees preferences contributes to the
credibility of the activities and is an essential basis for higher levels of
participation.
Employee participation should be an explicit goal of the activities. Employees
have the right to be informed about planned preventive activities and to give
their consent. It is easier to implement organisational change when all parties
148
participate in the decision-making process; and it should be acknowledged that

employees are the primary experts on their work and their work environment.
Activities for the reduction of absenteeism related to ill health should be
directed at all workers in the company. It may be sought to reduce the financial
risks of absenteeism and disability by increasing the number of workers
employed on atypical contracts. These employees may be neglected in
absenteeism and health projects, but they should also be protected against
inferior working conditions and many of these employees will also have an
interest in preventive activities. The EU Framework Directive on Health and
Safety asks for specific attention for these groups of workers, and for their
inclusion in the preventive and reintegrative activities at the workplace.
Measures to reduce absenteeism related to ill health should also take into
account the following points, which have been learned from detailed analysis of
absenteeism behaviour at the workplace:
Short-term absenteeism may sometimes be considered as good coping
behaviour and can prevent long-term absenteeism. Excessively restrictive rules
on reporting oneself absent from work because of sickness or infirmity can
lead to higher levels of absenteeism in the longer term.
In reintegrative activities it is essential to take account of the social and
competence barriers which hinder the reintegration of these workers who have
been absent for longer periods.
Social relations at work are important causes of absenteeism. Relation
between superiors and subordinates can have a serious impact on absenteeism;
good relations generally go together with lower levels of absenteeism and bad
relations with higher levels. This is not only a matter of motivation; work
conflicts can lead to serious mental and physical health problems and to longterm incapacity for work.
4.2
Integration into company policy and practice
Sooner or later activities to reduce absenteeism should be integrated

into ongoing company activities. Occupational health staff and human
resource management should work together to integrate absenteeism
measures into management, and to integrate health promotion activities
into organisational policy and practice.
It is important that human resources management (HRM) and occupational
health services (OHS) work tosether in reducing absenteeism related to ill
149
health. They can learn from their different perspectives on this issue. However,
the reduction of absenteeism and ill health cannot be the exclusive responsibility
of these staff services. As argued before there is a lot of money involved in
absenteeism and ill health at the workplace, not only for the society but also for
companies. An absenteeism percentage of 6% means that 6% of working time
is lost by absenteeism and ill health. Reduction of absenteeism related to ill
health can have a great impact on the productivity and the competitive position
of the company. Furthermore many management decisions have a direct
influence on absenteeism and the health of the workers. Although there is a lack
of awareness within enterprises of the potential of many activities to influence
health (Wynne & Clarkin, 1992), particularly in relation to organisational
interventions, reduction of absenteeism and ill health should primarily be
management responsibilities. HRM and OHS could of course support
management on this issue. Management should use their knowledge and
experience when they start workplace activities to reduce absenteeism related to
ill health. Line management should be responsible for the level of absenteeism
related to ill health in their department. By incorporating measures of
absenteeism and ill health into quality and other systems, these issues could be
integrated into organisational policy and practice.
7.3
Overview of the recommendations for specific bodies
The main recommendations of this study are directed at the national

governments and the social partners.
National governments should:
start a dialogue with employers and unions to set up a national action
programme to promote and to support workplace activities directed at
reduction in absenteeism related to ill health, extension of active work
participation for older workers and reintegration of long-term absentees
support this programme with information, dissemination of examples of
good practice, development of training programmes, research, monitoring of
outcomes and provision of anti-discrimination legislation on health and age
stimulate the collection of national data on absenteeism and disability so
that these data can be compared with data from other European countries
Employer organisations should:
encourage companies to start preventive activities at the workplace and
stop the selection of workers on grounds of age and/or health
150
organise demonstration projects in specific industrial sectors and

disseminate the experience of these projects in handbooks and videos
promote cooperation in prevention between larger companies and SMEs on
a regional or sectorial level, and the exchange of practical experiences
Individual companies should:
use the results of health needs assessments to set up preventive activities,
to focus on the health of the workers and to develop an age-specific personnel
policy
ask their suppliers for proof of their good health and safety practice
Trade unions should:

also play a role in the promotion of workplace health activities and the
dissemination of information as a contribution to the national programme
train their members for active participation in workplace activities and for
participation in a project group or steering committee
make agreements on investments in workplace safety and health in
collective bargaining with employers
Workers councils and individual workers should:
press their employers to pay more attention to health at work
The occupational health services (OHS) should:

play an initiating or supporting role in the organization of preventive and
reintegrative activities at the workplace
support management to integrate health promotion activities into
organisational policy and practice
increase cooperation with general practitioners and other relevant health
specialists to support the rehabilitation of long-term absentees
Insurance/sickness funds have a direct financial interest in the national programme on reduction of absenteeism related to ill health and in workplace health
promotion. These funds should:
support the national programme financially and reward employers who
initiate workplace health activities
play a role in exchange of information for and between SMEs
151
fund research into the costs and benefits of interventions directed at the
reduction of absenteeism related to ill health
support the development of standardized registration systems for
absenteeism
The academic community should:
play a role in the development of new models and methodologies
(especially for SMEs), in evaluation of existing prevention programmes, in the
development of monitoring systems, and in research on aspects such as costs
and benefits of specific interventions at the workplace.
The national initiatives should be supported at the European level by the EU.
This contribution could include the following aspects:
promotion of exchange of experiences between countries
dissemination of information on models of good practice

funding of methodology development (especially for SMEs) and supranational research activities
stimulation of the development of training modules to manage prevention
and absenteeism projects
promotion of comparable statistical data on absenteeism and disability
152
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156
Appendix
Overview of the Case Studies
157
Case 1: Waterland Hospital (NL: 1991 - 1995)

Characteristics:
- type of organization: non-profit: independent
- company size: 800 employees
- proportion of production staff: 430 nursing staff
- proportion of women: 829c women
Short description of case:
The 'Healthy working tor health' project is one of a set of four model projects carried out at the
initiative of the government. The projects aim at improving the health, safety and welfare of
workers, thus reducing sickness absence and unfitness for work. Among the key problems
revealed by the analyses were: the pressure of work: the internal environment; the physical effort
demanded by the job; the service rosters and the lype of leadership provided. The intervention
programme aimed both at improving the working conditions and the physical and mental health
of workers, and at intensifying the monitoring of the absent worker. At the end at' the project the
absenteeism has gone down from 8.99c to 4.69c: the benefits are twice as high as the costs; and
the evaluation of the project is positive. The hospital will continue to adopt the same procedures
and during the coming years will continue to pay attention to the health of the workers and to
reducing sickness absence.
Phase 1: Getting started
- ill health absenteeism policy
absenteeism can be affected by action: department head plays important role
- prompting factors
absenteeism above average (8.99c cf. 6.59c) and aims to be better than average
- project plan
steering committee: external supervisors; participatory approach; step by step; comparison with
control hospital;
- participants
higher and middle management; management of care sector; personnel department:
organizational expert: staff; works council: external supervisors (financed by government)
Phase 2: Identifying needs and problems
- method
interviews with key figures; checklists: questionnaire; measurement of stress risks (Wl-.):
- main risk factors physical workload; working hours and rosters; pressure ol' work;
organization of work; inside temperature; management style; training and career opportunities
- target groups
whole organization; risk groups
Phases 3 and 4: Organising solutions and implementation
- procedural activities
better procedures and information on absenteeism; introduction of lay reporter; training for
managers in absenteeism counselling
- preventive activities: work-oriented
reduction in physical workload: better technical aids; better work: rosters; better work
organization; modification of working climate, etc.
158
Overview and case studies

- preventive activities: person-oriented
lifestyle activities; various courses (eg dealing with aggression)
- reintegrative activities
better absenteeism counselling
Phase 5: Evaluation and consolidation
- effects on absenteeism
sharp fall to below sector average and control hospital (5.8% cf. 5.3% and 4.9% respectively)
- other results
improvements in work situation; more attention to sick staff and working conditions
- costs and benefits
positive: benefits (NLG 3250 pp) exceed costs (NLG 1500 pp)
- enabling factors
motivation of management; step-by-step approach; extensive analysis: course on absenteeism

supervision: participatory approach in individual projects; theme day for staff
- barriers
involvement of middle management; role of steering committee (takes too much out of the
hands of rest of management and management subsequently shirks responsibility); slow
progress because of limited brief of steering committee; involvement of staff in steering
committee; prioritizing of problems difficult
- follow-up
priority given to continued increase in responsibility of management; steering committee
dissolved; measures integrated in existing organization
Case 2: Nelissen van Egteren Bouw BV, construction company

(NL: 1991 - 1995)
Characteristics:
- type of organization: profit; local plant
- proportion of production staff: 100 staff
- proportion of women: 5% women
The project 'Building for healthy work' is also a model project for the sector and aims at
improving lhe health, safety and welfare of workers, thus reducing sickness absence and
unfitness for work. A first priority has been given for improving social relations and stress
management. At a later stage it was decided that attention should also be given to the physical
conditions at work. The absence figures recorded during the course of the project indicate that
since 1991 the percentage has dropped by almost 30% and the frequency by a good 20%. The
cost benefit analysis shows that each invested dutch florin produces 2,5 florins in two years.
The company has decided to continue the absenteeism activities.
policy on both short and long-term absence due to ill-health, though reporting procedure.
159

contacts with environmental health service, socio-medicai team and training for managers
formulated in annual mental health plan
- prompting factors
high level of absenteeism and large take-up of invalidity benefit
- project plan
steering committee; external supervisors: participatory approach; step by step: comparison with
control companies
- participants
branch manager: middle management: personnel : company doctor; works council', external
supervisors (financed by government)
- method
questionnaire
- main risk factors
monotonous work; pressure of work; physical working conditions; insufficient support:
attachment to company and colleagues; career opportunities: renumeration
- target groups
whole company
better procedures and monitoring of absenteeism: training managers in absenteeism
interviewing
changing consultative structure: ergonomie modifications: training for managers: absenteeism
interviews; stress management
communication and work consultation; training for building elite staff; work consultation;
ergonomie lifting
more opportunities for reintegration; setting up socio-medicai team
percentage fall of almost 30%: 20% fall in frequency
- other results
growth in problem-solving capacity: motivation and commitment staff increased: staff see
health as their own responsibility
positive: benefits (NLG 1667 pp) exceed costs (NLG 1333 pp)
- enabling factors
role of external project group; length of project
- barriers
lack of support from senior management, so that middle management less committed: quality
certification activities required too much time and attention: large size of steering committee
- follow-up
continued attention
160

Case 3: Thomassen en Drijver VERBLIFA, metalworking industry (NL: 1989 - 1991)
Characteristics:
- type of organization profit: local plant
- company size: between 250 and 1000 employees
- proportion of production staff: 100%: 373 staff in 3 production departments
- proportion of women: mainly men
The project 'Influencing individual absenteeism' was carried out among various organizations,
including Thomassen en Drijver VERBLIFA in Hoogeveen. Three production departments
participated in the project. Within the project the absence monitoring procedure has been
improved and priority is also given to improving the style of leadership. The project also
involved adopting preventive (situational) measures, included improving the airconditioning. In
the three years that the project has been running the percentage absence at TDV Hoogeveen has
fallen by 30% and the frequency of reporting has been halved. The benefits are more than twice
as high as the costs. The project died a natural death but what took place as part of the project
has been continued, duly adapted to the existing structure.
Phase 1 : Getting started
absenteeism policy formulated, but insufficiently implemented
- prompting factors
high level of absenteeism, dissertation led to author being asked to tackle absenteeism in the
company
- project plan
coordination by personnel in consultation with branch manager: external supervisors; step by
step; alternate experimental and monitoring control
- participants
branch management; personnel: insurance doctor; works council; external supervisors (financed
by government)
- method
analysis of absenteeism: questionnaire
- main risk factors
quality of work; physical working condition (eg noise); climate; job security
- target groups
better procedures on absenteeism; training managers in absenteeism interviewing; setting up
steering committee to draw up annual plan on working conditions; quarterly inspections on
safety, health and welfare
integration of monitoring responsibilities into executive functions; improvement in climate;
better ventilation; sound dampening measures; training for managers: quality of management
and interview skills
161

better absenteeism councelling
percentage fall of 30%; 50% fall in frequency
- other results
reduction in job satisfaction and health-related complaints; increase in organizational
commitment and satisfaction with management
Positive: benefits (NLG 6434 pp) exceed costs (NLG 2681 pp)
- enabling factors
great deal of attention paid to actual implementation and maintenance: link between staff
reaction survey and absenteeism survey gives good base; single liaison person between project
team and company: high degree of motivation to tackle absenteeism
- barriers
non-committal attitude of management, personnel officer and works council because project
imposed on them; alternating experimental and control function
- follow-up
continued attention: further fall in ill-health/absenteeism; action integrated into existing
structure
Case 4: Du Pont Nemours Belgium NV, chemical industry

(B: 1987 -1994)
Characteristics:
- type of organization: profit; subsidiary
- proportion of production staff: 247 staff
- proportion of women: 247 women
For years this chemical plant has been developing a culture which respects accident prevention
and health promotion. A great deal of attention goes to specific targets in general health
promotion. In 1980 a test project was carried out in one of the American plants. On the basis of
research, most attention was paid to the monitoring of weight, lipids and blood pressure and to
discouraging smoking, stress management and fitness training. The rate of absenteeism dropped
in this experiment from 6 to 4% within two years. The same programme was carried out in the
Belgian plant in 1988. At the moment the rate of absenteeism at this plant is a mere 2% as it
had been for some years. The rate has continued to remain more or less the same, at this
extremely low level of around 2%.
prevention the best method of keeping down absenteeism
162

- prompting factors
initiative of US mother company
- project plan
operation of occupational health service; participation of staff in work-related problems
- participants
management: occupational health service; trade union; staff
- method
listing of risks for safety and health aspects for each service
- main risk factors
none
- target groups
whole company

risk oriented approach; health education; responsibility for safety matters given to line
managers
safety training for managers; systematic analysis of new accidents
ergonomie training fork-lift truck drivers: cpr training for all; workers periodical check-ups (risk
profile assessment); computer-assisted health and safety information; fitness and sports
opportunities; courses for prevention of back complaints for VDU workers; support for alcohol
and drug problems, mental health, high blood pressure, stress management, giving up smoking
alternative work is offered; first aid station available

absenteeism already low: 2%; fall in middle management, slight rise in lower and higher
positions; total remains at around 2%
- other results
changed attitudes regarding accident prevention and health promotion
costs: 56 US$ per worker per year in 1987
- enabling factors
acceptance of alternative work is employee's choice
- barriers
fear of invasion of privacy in trade unions; cuts
- follow-up
health programme continued; shift in emphasis to primary prevention
163
Case 5: Volkswagen Brussel NV, metalworking industry (B: 1991 1994)

Characteristics:
- type of organization
profit: subsidiary
- company size
5755 employees
- proportion of production staff
5153
- proportion of women
285 women
The rate of absenteeism at this car factory was sharply on the increase and in 1991 reached
more than 9%. An attendance premium of BFr 4000 was introduced for employees who were
continuously and uninterruptedly present for eight week periods. The system of absence
monitoring was adapted in such a way that every absentee would be monitored at least once.
But the reduction was particularly achieved through the offering of alternative work in the event
of accident and later also in the event of sickness. In addition the available work positions were
analysed and catalogued in accordance with the physical demands which they made of the
employee. The rate of absenteeism dropped with these measures even more sharply than it had
previously risen, reaching 2.5% in 1993. It has stabilized at around 3%.
human beings central: new policy, under which frequent absence no longer leads automatically
to dismissal
- prompting factors
high level of absenteeism; improper use of sandwich courses; arbitrary checks and poor
economic state of company
- project plan
institution of industrial relations service: reactive involvement of representatives of employees'
organizations
- participants
industrial relations service: industrial medical service; trade union representatives
- method
7000 individual absenteeism files analyzed; inventory of all possible alternative jobs
- main risk factors
none
- target groups
whole company
164

establishment of attendance bonus; sick employee is checked by doctor; establishment of
random absenteeism checks
none

none
offering alternative work in case of sickness; return-to-work interview with line manager,
personnel (industrial relations) and trade union representative
sharp fall from 9% to 2.3%
- other results
social conflict
annual benefits, etc. estimated att almost 1591 ECU pp fall in wage bill costs: strikes which
may result from absenteeism policy
- enabling factors
fear of loss of job (rotating unemployment)
- barriers
lack of clarity on monitoring and arbitration procedures; alternative work imposed
- follow-up
slight increase in absenteeism; social tensions remain high
Case 6: Ministry of Labour and Employment, cleaning service

(B: 1993 - 1994)
Characteristics:
non-profit; part of ministry
- company size
66 employees
100% production staff
65 women
This case involved a group of only 65 employees (all women) in a government service. The rate
of'absenteeism had reached the excessive height of 18% in 1992. On the occasion of an external
investigation of the Ministerial services through a consultancy, it was proposed to close down
the service and contract the cleaning out to a private company. The administration decided, as
an experiment, to make an effort to improve the operation of the service. After investigation,
165

two means were opted for. First, a risk analysis was carried out to achieve as high a level as
possible of primary prevention and as close as possible to the source of the risks. Secondly, a
"Goal oriented Intervention strategy" was followed. On this basis, a programme of action was
drawn up in which the employees themselves were involved. In 1993 the rate of absenteeism
dropped to 11%.
no ill-health/absenteeism policy; specific industrial medical service no longer exists
- prompting factors
high level of absenteeism and poor quality of work; threatening abolition of service; external
advisors and 'company'-screening
- project plan
project group; internal supervisors; participatory approach
- participants
management domestic services; management training service; internal occupational
psychologist; management of security service; occupational medical inspector
- method
analysis of industrial accidents and absenteeism; listing of risks for products and workplaces;
ergonomie analysis; analysis of quality of the service analysis of work situation and discussion
groups
- main risk factors
dissatisfaction; high level of absenteeism; quality of work; heavy loads; isolated work; lack of
safety (eg no fire drills); relations with policy staff (white collar!
- target groups
whole cleaning service
none
less heavy working materials; functional office design; better archives; clear job descriptions:
safer cleaning products
training and education; protective clothes: first aid training; back school
none
in the years preceding project absenteeism ran at 10%, 10.5% and 18%: since the project at
11%, and 12%, and, in 1995 11%
- other results
annual benifits estimated 883 ECU pp
166

- enabling factors
fear of unemployment; agreement that measures proposed would actually be
implemented;support from board and trade unions; information to all involved; quality of
external supervisors; participation of those involved
- barriers
cumbersome, inert organizational structure
- follow-up
many measures introduced subsequently; setting up of occupational health service
Case 7: East Midlands Electricity, utility company (UK)

Characteristics:
profit; independent
- company size
4200 employees
East Midlands Electricity takes an integrated approach combining management control with
support for sick employees and preventative actions. Their principal health initiatives have
included:
- private health care and rehabilitation courses for employees with musculoskeletal problems
- a stress audit resulting in an employee assistance programme and greater awareness of the
causes, symptoms and effects of stress
- screening and education campaigns in areas of health concern
- phased return to work for employees who have had serious illnesses.
The occupational health service is well-supported by senior management, liaises with line
managers and consults with the unions before the introduction of new initiatives. The company
is cautious about evaluation, but are certain that absence has decreased as a result of their
efforts. An employee survey produced very positive results.
Integrated approach to absenteeism through checks by management and supervision of sick
staff and prevention through training and education; managers responsible for attendance;
keeping in touch and conducting return-to work interviews
- prompting factors
long waiting times in the National Health Service; large number of organizational changes
combined with domestic worries have led to high degree of stress; occupational health service
convinced that prevention helps
- project plan
coordination by occupational health service
167

- participants
management; occupational health service: staff volunteers (health liaison offers); trade union
representatives
- method
analysis of absenteeism (according to diagnosis):questionnaire on stress
- main risk factors
- target groups
production workers
managers primarily responsible for attendance of staff
better communication
hearing protection; information and training; eg video in physical workload; individual
counselling for stress problems (employee assistance programme); information for management
on stress; training for management in managing change; health information (smoking, diet,
etc.); information on women's and men's specific health problems
keeping contact with sick staff; conducting return-to-work interviews; treatment by specialisis
(avoiding waiting list); physiotherapy; reintegration course; phased reintegration (gradually
increasing workload) or offering alternative work
apparent sharp fall in ill-health/absenteeism; reduction in duration of sickness periods
(organization reticent in interpreting sickness figures); exact figures not available
- other results
staff appear more prepared to admit that they have problems and how they deal with them;
managers more aware that they can cause stress and try to avoid unnecessary pressure; positive
attitude to measures taken
benefit is lower absence and a dramatic reduction in injury recovery time
- enabling factors
involvement of top management; information on new developments
- barriers
alow progress because all levels keen to be involved in decisionmaking (average
implementation time 18 months)
- follow-up
planned information on diet and movement: planned 'cold-care' initiative
168
Case 8: Post Office, postal service (UK: 1984 - present)

Characteristics:
profit; government-owned
- company size
200 000 (in 2 pilots: c. 7000 per pilot)
The Post Office has an excellent reputation for its health initiatives. It first began to tackle
workplace stress in 1984 by setting up a pilot programme of specialist counselling. Absence in
the pilot group was reduced by 66% and, following this success, additional occupational health
staff were trained in counselling. Workplace seminars on stress are now run regularly. The
success of the Post Office's initiatives is increased by 'embedding' the occupational health staff
in the organisation so that they are close enough to spot problems as they arise. The
occupational health service is now beginning a three-year programme of auditing employee
health and suggesting pro-active measures.
health of workforce directly relevant to profitability of company; company pays great attention
to prevention through lifting courses, ergonomie workplace design, information campaigns,
stress courses, etc.; managers keep records of absenteeism which are monitored for each
division
- prompting factors
desire to reduce take-up of Invalidity Benefit due to psychological problems: more attention to
tackling stress required
- project plan
project group introduced in 2 pilot regions; comparison with control companies
- participants
occupational health service; management; personnel officers; trade union representatives
- method
analysis of medical retirement; feedback from senior occupational health staff
- main risk factors
aggression and violence; overload through organizational change; combination of work and
caring responsibilities
- target groups
whole company
managers primarily responsible for attendance of staff
169

introduction of policy and procedure to reduce problems in the workplace
individual counselling for stress problems; training of occupational health staff and personnel
officers in counselling on stress problems: stress information: time management, assertiveness
and management style in order to reduce stress
individual counselling for stress problems
two-thirds reduction in average duration of absence through illness of 117 cases counselled in
the pilot scheme
- other results
reduction in extra leave; reduction in disciplinary measures; improvement in performance of
those participating in counselling; improved psychological health; reduction in consumption of
alcohol, tobacco and coffee; rise in use of relaxation exercises among cases
benefits: approx. 102.000 saved in 6 months in the pilot scheme in 1987
- enabling factors
willingness to act; counsellors familiar with organization; guarantee of confidentiality
- barriers
insufficient resources; employees not interested in prevention as long as they have experienced
no problem
- follow-up
large-scale individual health examination on voluntary basis now begun; based on risk
assessment employees are given health information or advised to visit the doctor
Case 9: Unipart, motor vehicle parts industry (UK: 1992 - present)

Characteristics:
profit; independent
- company size
1800 employees
> 50% production staff
Unipart's health strategy is one of 'wholesale prevention' rather than 'retail cure'. It feels that
the very act of measuring the results of health initiatives in terms of absence reduction would
contradict Unipart's core belief that 'concern for the well-being of our employees is part of our
responsibility'. Health and safety is constantly emphasised as the responsibility of every
employee: 'Remember: all accidents can be prevented by human action.' The goal is zero
accidents and zero illnesses. Unipart's Lean Machine well-being centre was proposed after
awareness of stress increased. Employees were thoroughly consulted and lhe success of the
Lean Machine is evident by its popularity - over 1300 out of 1800 employees are regular users.
170

Phase I : Getting started
prevention better than cure; staffare principal resource; involvement of staff essential; aim for
high degree of involvement, good morale and good health
- prompting factors
desire to reduce risk of back complaints, cardiovascular diseases and stress; continually
changing organization leads to physical and mental problems
- project plan
project group; external experts; participatory approach
- participants
top management: 15 staff volunteers from all levels of the organization; external experts
- method
drawing up inventory of workers' opinions on desirability of health centre
- main risk factors
back complaints, cardiovascular diseases and stress; physical and mental problems
- target groups
whole organization
not part of this project
good ergonomie furniture; clean production; alert safety policy; risk inventories in order to
prevent motor system complaints
opening of fitness centre: fitness, sport and treatment and therapy (eg physiotherapy), nutritional
advice and beauty parlour; distribution of working conditions handbook; course in defensive
driving; information on safety through newsletters and training; periodic check-ups
physiotherapy; offer of alternative work
litter and healthier workforce, longterm effects on absenteeism not measurable
- other results
of the 1800 staff 1300 make regular use of facilities
costs: overl million
- enabling factors
financial success of company; organizational culture of care for and investment in staff:
establishment of staff needs proximity of health specialists
- barriers
none, given the commitment of the chief executive
- follow-up
centre still exists, no new activities planned
171
Case 10: Beiersdorf AG Hamburg, chemical industry

(D: 1992 - 1997)
Characteristics:
profit; subsidiary
- company size
5500 employees
2000 production staff
40% women
The "Health is a winner" project is a joint project run by the international chemical concern
Beiersdorf AG Hamburg and a statutory health insurance company AOK in the sphere of
company health promotion. With the active support of AOK Hamburg, Beiersdorf AG was able
to carry out a comprehensive analysis of its absenteeism situation and to implement a large
number of admirable health care initiatives.
In addition to some one-off analyses, the establishment of health circles was designed lo ensure
that staff remain involved in all plans for change. A wide range of courses was offered to
encourage staff to adopt more health-conscious behaviour. Participation in these courses was
encouraged by the fact that AOK members received an annual bonus payment of up to ECU
250 if they attended regularly. On the basis of extensive analyses, carried out with the help o
external experts, a large number of measures to improve preventive behaviour were developed
and implemented. Even in the middle of the project, the trends seem to be positive. Because of
the insufficient inclusion of the influential division managers, the implementation of measures
of a situational nature proved difficult for the project team.Between 1992 and 1993, sick leave
for all Beiersdorf employees fell by 0.5 percentage points. The 0.5% reduction corresponds lo a
reduction in lost productivity - calculated on a value creation basis - of ECU 290 pp. This
method of calculation used by Beiersdorf certainly gives results at the upper end of lhe
spectrum. A more cautious estimate based on continued payment of remuneration gives a
reduction in continued remuneration paid of around ECU 170 pp.
economic, image and social and legal reasons for promoting health through individual ami
work-related activities
- prompting factors
new legislation enables medical insurance institutions to undertake activities to reduce ill health
absenteeism in companies
- project plan
steering committee; 2 project groups: external experts; participation through health circles
- participants
management; personnel: staff: works council: external experts; medical insurance institution
- method
interviews with experts; questionnaire on staff needs; group discussions on the work situation:
analysis of absenteeism (according to diagnosis)
172

- main risk factors
mobility, airways; work situation (eg management); overload through reorganizations; menta
overload; irregular shifts
- target groups
production workers; women
none

health circles (kind of quality circles on improvement of working conditions) are leading to
improvements in the working situation
courses eg on movement and relaxation, back classes, stress, lifting and carrying, stopping
smoking, cancer screening
0.5% drop in absenteeism from 1992 to 1993; (34% lower than control group)
- other results
in 1994 one in three employees had taken part in course on health promotion; 10 health circles
have been set up
benefits: between ECU 170 and ECU 290 pp
- enabling factors
participation of health insurance and external consultants
- barriers
management insufficiently involved (only in project group, not on steering committee); mutual
cooperation sometimes awkward
- follow-up
project is still running
Case 11: Verkehrs-Aktiengesellschaft Nrnberg, regional transport

(D: 1987 - 1988)
Characteristics:
non-profit; municipal service
- company size
2266 employees
< 5% women
173

In 1987, the Nrnberger Verkehrsbetriebe AG started a project to reduce the incidence of
unfitness for driving duties amongst bus drivers, which has now become a model in itself. It
demonstrates the success of reintegration measures based on shorter working hours for shift
workers. It was not absenteeism caused by ill health as such that was the focus for the project at
VAG Nrnberg, but rather the time lost by older employees and employees suffering from longterm ill health. Taking the high number of staff unfit for driving duties at its starting point, a
change in the structure of the work schedule was introduced, with the objective of humanizing
the working environment. Taking various interest groups within the company into consideration,
two models for shortening the working hours of groups at risk were worked out and tested. The
models, which were a consensus reached after considerable problems, have now. with a few
minor amendments, become models for other companies. Taking into account the savings
achieved by the reduction in absenteeism, the surplus of the project was DM 13.000.
company pays great attention to working conditions and decreasing health of ageing workers:
both the economic costs of absenteeism for the company and the social costs of ill health for the
individual workers are recognized
- prompting factors
only 5% of drivers reach retirement age in this job
- project plan
working party: external supervisors
- participants
management; company doctor; middle management; works council
- method
analysis of absenteeism; questionnaire; interviews with experts; group interviews
- main risk factors
mental stress; physical stress (sitting position); environmental nuisance (noise, harmful
substances); irregular shifts (nights, weekends, etc)
- target groups
drivers; staff unfit for driving; the long-term sick
none
better roster and statutory reduction in working hours for older staff; course for managers of
those unsuited to administrative work
course on stress prevention health promotion for 60 administrators based on age
- rcintegrative activities
support for supervised move to alternative employment; better roster and reduction in working
hours as work adaptation for returning long-term sick staff
174

lower level of absenteeism where new roster had been introduced than in control group for
older employees and long-term sick staff resuming their duties
- other results
no other differences with control group
benefits: DM 293 000 (including DM 57 000 subsidy); costs: DM 280 000
- enabling factors
large measure of agreement between interested parties on aim
- barriers
the many conditions which had to be met to be able to change the rosters
- follow-up
course for executives discontinued; counselling activities for those unsuitable for administrative
service discontinued: four-day working week for older staff generally introduced: very popular
Case 12: Sinterit GmbH, earthenware industry (sanitary)

(D: 1991 - 1992)
Characteristics:
profit; subsidiary
- company size
125 employees
< 10% women
The case of Laufen Sinterit GmbH, a small company in the ceramics industry, shows, on the
other hand, how a small company is carrying out, at comparatively low cost, a successful
project to improve the work situation of its employees. A project was conceived with the
support of external consultants to reduce absenteeism by at least 15% overall within a year. The
primary objective was to change the working situation so that the satisfaction of the staff would
rise. The project was to be supplemented by measures which would raise the absenteeism
barrier in order to achieve a rapid reduction in absences from work. Overall, the project
objective of reducing absenteeism by 15% within a year was almost achieved. One year after
the start of the project, a reduction in absenteeism of 13% was achieved, from 9.4% to 8.3%. A
reduction in the cost of continued remuneration payments of around ECU 42,000 was offset by
direct costs resulting from consultancy and training, also amounting to ECU 42,000. This meant
that the project covered its costs in the first year. Participation groups set up to involve
employees in changes in the work situation were developed over the long term into instruments
for quality management.
175

No definite ill health/absenteeism policy: medical service geared mainly towards promoting
safety and individual cases
- prompting factors
sharp rise in demand for sanitary fittings was reason why absenteeism led to an immediate fall
in production and failure to meet delivery deadlines
- project plan
project group; external supervisor: participatory approach
- participants
management; middle management: external supervisor; staff; works council
- method
analysis of absenteeism; analysis of work situation through group discussions
- main risk factors
organization; work; information flow; management; isolated workplace; piece wage system
- target groups
whole company; moulding shop
new sickness/absenteeism procedure (who is responsible for what, managements conduct
absenteeism interviews with frequent absentees); training of managers in absenteeism
interviews
discussion groups on quality of work; introduction of measures of improving working
conditions
none
none
total absenteeism fell by 13% from 9.4% in 1991 lo 8.3% in 1992 (target was 15% reduction);
however, in the moulding shop absenteeism rose (large number of older Turkish staff)
- other results
in all departments discussion groups led to increase in motivation
costs equal benefits (ECU 335 per employee)
- enabling factors
management easily approachable
- barriers
strong involvement of senior management obstacle to staff participation and to contribution
from middle management (especially because the works council was so weak); passive attitude
of older Turkish staff
- follow-up
discussion groups have become quality circles for T.Q.M.
176
Case 13: Copper Mine (P: 1989 - present)

Characteristics:
profit; 51% government-owned, 49% British multinational
- company size
1000 employees
12% women
Case A (As minas de cinco estrelas" - Five-star mining company) concerns a publicly controlled
enterprise that operates Europe's largest copper mines. Its head offices and industrial
establishments are situated in the centre of Baixo Alentejo, which is, ironically, perhaps the
poorest and most depopulated region of the EU. Enterprise A has adopted an exemplary, and
even pioneering, approach in areas such as environmental protection, health and safety at work
and human-resource management, in a sector in which, despite the potential of Portugal's
natural resources, a gold-digging culture has traditionally prevailed. The measures taken by the
mining company to adress workplace absenteeism varied between discouraging workers from
taking sick leave as a result of illness or accident, by penalizing them by reducing or cancelling
their production or management bonus to the daily provision of general health practioner and
nursing care and to starting team-based underground work organisation and weekly 'safety
talks'. The project was mainly a top-downwards approach. Absenteeism (including maternity
leave and other reasons) remained at the same level. It was the half (3,5% in the last four years)
what was expected initially (7%) for a high-tech underground copper mine like this.
continuous improvement of working environment;encouraging all staff to feel responsible for
prevention and reduction of accidents; promotion of health and welfare and protection of the
environment
- prompting factors
desire to excel in the field of health and safety as in other fields of working life
- project plan
no project; measures are current policy implemented; top-down
- participants
management, middle and lower management; personnel; occupational health and safety
(OH&S) service; OH&S committee; OH&S employee representatives
- method
analysis of absenteeism, frequency and seriousness of accidents; questionnaire on
organizational climate; social audit report; evaluation and monitoring of working conditions
- main risk factors
back complaints; accidents (including traffic accidents); stress; shift and night work;
underground work: lifestyles (including drug use)
177
- target groups
whole company
conditions of employment incentives like performance bonuses, no absenteeism and complying
with safety regulations (up to 20% of basic salary); devolution of personnel affairs to immediate
line managers
management training for young managers; socio-technical design of industrial facilities
continuous monitoring: improvement of working conditions
personal protective equipment (helmet, goggles, hearing protection); periodical examinations:
flu and hepatitis vaccinations: HIV test at commencement of employment; information on
improving lifestyle (smoking, alcohol and drugs); drug and alcohol test; company magazine:
training on occupational health and safety: cultural, sporting and recreational activities; social
facilities in the communities close to the mine
surgery; medical care for urgent cases: treatment of alcohol and drug addiction: return-to-work
check
absenteeism had been running at 3.6% (compared with an average of 9% in all business sectors
and an average of 4.5% in banking and insurance); absence due to illness and/or accidents
totalled 2.7%
- other results
number of accidents per million man-hours worked has been decreasing from 48 in 1989 io 7 in
1995: proportion of hours lost due lo accidents is now lower (13%) than in 1989 (27'7r)
benefits: compared with 7% absence through illness the savings in wages total ECU 450 pp
against costs: ECU 250 pp paid oui in bonuses: positive balance ECU 200 pp
- enabling factors
young average age of staff, many protective measures laken; staff motivated; delegation of
personnel responsibilities lo immediate line managers: corporale culture: written health policy
and yearly action plan
- barriers
too much pressure from team not lo take time off work so as not to miss bonus
- follow-up
continued
Case 14: Municipality and Municipal Waterworks

(P: 1989 - present)
Characteristics:
178
- company size
1266 (municipality) plus 499 (municipal waterworks)
63% (municipality)
34% (municipality)
The local authority has an health and safety scheme, which is run in association with an
insurance company. This was launched in 1989 and is still a pioneering project in Portugal. The
local authority prides itself on being "the only local authority with an occupational-health
service for workers", in anticipation of legislation in the area of health and safety at work. The
unique and specific nature of this scheme lay essentially in the principles of: (i) the integration
of health care, (ii) the organization and operation of multidisciplinary teams, (iii) the
involvement of key actors, (iv) management through action schemes or programmes, (v) the
definition of a written health and safety policy, and (vi) the co-funding of activities by
insurance companies (23). Absenteeism caused by incapacity for work as a result of illness and
occupational accidents has averaged at 6.3%. The incidence of accidents at work in the structure
of absenteeism has. by contrast, been falling (2% in 1990 and 1 % in 1994). The Occupational
Health Service has not undertaken a cost/benefit study.

aim is to improve health and quality of working life as part of the municipality mission ('to
build a city for its citizens); company health policy has been implemented since 1989 by the
occupational health service, which was set up jointly with an insurance company
- prompting factors
unacceptably high economic and social cost of absenteeism (including low staff morale, poor
quality and public image); one third of absenteeism is part of "black economy": staff take sick
leave to work elsewhere; high level of blue collar worker' turnover
- project plan
no project: measures are current policy implemented; top-down: information given to works
council
- participants
insurance company: management; oh&s service; works council

- method
analysis of absenteeism; interviews with long-term absentees; annual report on occupational
health and safety: health status questionnaire survey
- main risk factors
weather constraints; heat/cold; painful working positions; heavy loads: dyslipidaemias; back
pain: alcohol abuse; poor pay; ageing; low status (blue collar workers); vdu work;
organizational stress (white collar workers)
- target groups
whole company, with special attention for long term absentees and disabled workers
179

possible reductions of up to 1/6 of salary in cases of short-term absenteeism ( 30 days):
medical certificate issue by the occupational physician has been encouraged
ergonomie modifications (lifting. VDU work): noise reduction, ventilation, light, climate
control; setting up network of health and safety coordinators; placing of first-aid boxes in
various locations
personal protective equipment', safety instructions; preventive examinations: cardiovascular
diseases, prostate cancer, intestinal, uterine and lung cancer; stress treatment; vaccinations; oral
hygiene; prevention of back complaints; psychosocial counselling; vdu ergonomy; health
promotion; additional social protection
surgery, including family members; support for treatment of drug addiction; treatment of
alcohol problems; reintegration of long-term sick staff
total absenteeism remained high in the period 1990-1995; absence due to illness and accidents
in municipality remained almost constant at around 6.3%; the offering of alternative work to
103 long-term sick cases led to a reduction in absenteeism from 25% to 15% for this group
- other results
absence due to accidents decreased from 2% in 1990 to 1% in 1995; alternative work for 71
former long-term sick-cases
costs are part of OH&S budget, including assurance premiums (equal to 300 ECU pp)
- enabling factors
willingness to act: large health team; human resource management feels responsible; written
health policy and yearly action plan
- barriers
ageing; low status; poor pay; blue collars's poor living and working conditions: lack of
participation; top-down management; non-profit organisation; public administration culture
- follow-up
continued
Case 15: Electrical Engineering Industry (P: 1991 - present)

Characteristics:
profit; subsidiary. German multinational
- company size
347 employees
180

23% women

The factory producing distribution and power transformers is one of the six establishments of a
German multinational in Portugal. It is going through a process of organizational change, with
the introduction of Total Quality Management (TQM), in the certification stage of its qualityguarantee system. The rate of absenteeism among blue-collar workers is high (more than 10%
in 1994). The aim is to cut this to 4%. In the certification phase of the quality-guarantee system,
the factory's management is now paying greater attention to the area of health and safety at
work, which coincides with central guidelines issued by the parent company and with the
introduction of an "environmental officer" in each of the Group's enterprises. Between October
1994 and June 1996, overall absenteeism dropped drastically to 6%, especially among bluecollar workers.
there is an integrated action plan for 1994-1995 which aims at promoting the health of the
whole workforce, mainly by means of preventive action leading to both a reduction in
occupational diseases and work-related illnesses, and a reduction in industrial accidents and
work-related disability, as part of the quality assessment and assurance system
- prompting factors
as a component of quality certification, the introduction of Total Quality Management, a
reduction in absenteeism is also implicitly necessary; six years ago company doctor pointed out
need to expand and integrate the safety function guidelines of the German mother company;
introduction of environmental expert into company
- project plan
no project; measures are part of current policy implemented; top-down; participation in TQM
discussion groups
- participants
management; middle and lower management, oh&s service; employees in TQM discussion
groups
- method
questionnaire survey of staff opinions on organization; description of characteristics of staff and
general determining of state of health of workforce; annual report on illhealth/absenteeism;
determining and monitoring of working conditions
- main risk factors
noise; painful working positions; work accidents; dangerous substances: stress; lack of
autonomy and participation
- target groups
whole company
absenteeism reported to immediate line managers; career opportunities based on attendance and
performance
181

personal protective equipment: risk inventories and discussion forums as part of quality
guarantee; protection of works and plant; participation in TQM
periodic medical examination of staff; health promotion; training in safety & health at work
surgery; supervision of long-term sick: staff; return-to-work check
absenteeism due to illness and injury among blue collar workers was around 10% at the last
quarter of 1994 (introduction of TQM); in mid 1996 it was 6%
- other results
employee commitment to TQM: improved participation; improvement of working conditions
and work organization; reduced non-quality costs
costs: 225 ECU pp (salary of company doctor and nurse, personal protective equipment,
periodic examination, medicines, etc)
- enabling factors
market requirements and pressure to perform: quality certification; participatory methods
through TQM; written policy: budget and information systems for health and safety:
involvement of personnel + safety, health and welfare committee: no industrial conflict: written
health policy and yearly action plan
- barriers
resistance to change; lack of motivation to take pari in discussion groups: lack of satisfaction
with pay; waiting lists in public hospitals
- follow-up
continued; plan to train personnel in safety and health at work to enhance quality and
productivity; health and work circles to be implemented within TQM
Case 16: Bormioli Rocco CaSa, glass industry (I: 1992 - 1998)
Characteristics:
profit: local plant
- company size
300 employees
5/6 production staff
1/3 women

The company Bormioli Rocco Casa SpA is since 1992 part of the Bormioli Group which is one
of the largest undertakings in the glassmanufacturing sector in Italy. The change in management
was accompanied by a series of actions to reorganize the company. The initiatives concerning
182

the working environment were part of a general scheme to redesign the structure of production
and organization of work that was launched virtually immediately after ownership of the
company, which had been in a situation of economic and financial crisis and suffering from
obsolete industrial relations, was transferred to a group that was already a leader in the sector
and whose first objective was to harmonize production, market and environmental conditions in
its various companies. The innovations introduced have had an indirect impact on levels of
absenteeism - which have been falling over the past three years - and have indirectly reduced
the number of accidents at work. Not all of the planned phases have already begun, still others
will be launched over the next three years.
Phase 1 : (etting started
no explicit absenteeism policy, but conviction that for an effective preventive policy it is
necessary to develop effective strategies in the field of accident prevention, hygiene and
company medicine and to take environmental measures
- prompting factors
(he company was taken over in 1992; measures to reduce absenteeism by improving health and
safety are a component of reorganization by new management; reasons for the reorganization:
economic situation, high level of absenteeism, environmental pollution and compliance with
legislation
- project plan
component of top-down reorganization; no direct staff participation
- participants
management; safety specialist; trade union representatives
- method
- main risk factors
noise; temperature; accidents: back complaints; position (repetitive movements)
- target groups
none

replacement of product lines; introduction of automated lifting; sound insulation; temperature
insulation; introduction of mechanical monitoring, reduction in work pressure ; dust extraction
system; new furnace using clean fuel: new floors and better cleaning of them
personal protective equipment: information on use of personal protective equipment
external doctor (surgery twice a week)
total absenteeism in the 1980s sometimes 28% (great deal of nonattendance without good
183

reason); 1991 absenteeism (before new management) was 5.3% due to illness and 1.5% due to
accidents; by 1994 absenteeism had fallen to 4.0% due to illness and 1.07c due to accidents
- other results
quality and quantity of products improved: motivation increased through reduction in pressure
and improved job content for sorters
costs include LIT 118 million (ECU 5.900) for personal protective equipment
- enabling factors
new property of the company; market requirements and pressure to perform
- barriers
- follow-up
continued; intention to fit soundproof booths: intention to train personnel in prevention and
safety at work, a (statutory) trade union officer for safety will be appointed
Case 17: Inalca, meat processing industry (I: 1990 - present)

Characteristics:
profit; local plant
- company size
580 employees
23% women
Inalca (meat processing) is a leader in its sector. The complicated innovations it has introduced
have no precedent in Italy. Despite the fact that levels of absenteeism in the company were low
even before specific initiatives were launched, the main aim of the initiatives was to reduce lhe
number of accidents. The implementation of technological innovations and the introduction of
additional means of personal protection indeed have had an impact on the number of accidents
and even the level of absenteeism.
- prompting factors
component of total reorganization which was begun in 1990 and will continue for an indefinite
period; the reason for tackling absenteeism is its high level and the large number of accidents
- project plan
component of general reorganization introduced top-down; participation of staff in making risk
inventories; working party on safety set up (personnel officer, production manager and safety
officer)
184

- participants
management; personnel; staff; employee representation (from works council)
- method
analysis of absenteeism and accidents risk inventory
- main risk factors
accidents; draughts; temperature; tuberculosis (also transmitted by animals); brucellosis
- target groups
none

safer equipment and machines; more maintenance; placing of warning notices
personal protective equipment (eg elbow-length steel gloves); training of staff in use of personal
external doctor (comes twice a week) for periodic examinations; staff with health problems can
be referred to specialists at company's expense; first-aid station; tele-alarm service with nearest
hospital for help in emergencies
absenteeism among production staff fell by more than half from 1991 to 1994 from 3.2% (3210
days' sick leave divided by 455 employees 220 working days) to 1.5% (1632 days' sick leave
divided by 486 employees 220 working days)
- other results
fall in number of accidents between 1991 and 1994 from 211 to 114
costs include LIT 100 million (ECU 5.000) on personal protective equipment
- enabling factors
- barriers
company is the only slaughterhouse in Italy: no other examples available for technical
innovations: resistance among employees to using personal protective equipment
- follow-up
new premises being built in which a great deal of attention will be paid to working conditions;
risk inventory will be concluded, in which all employees should be consulted on possible work
problems
~
:,'
Case 18: Ragno SpA, ceramics industry (I: 1990 - present)

Characteristics:
profit; local plant
185

- company size
719 employees
41% women
In the case of Ragno SpA - ceramics industry, the company's decision to make improvements
was positively influenced by its leading position, so that it could invest in optimizing its future
performance. The rates of absenteeism in the company were much lower than national averages
for the sector even before it launched specific accident-prevention initiatives. Since 1990. the
company has boosted investment in preventing the occupational accidents and illnesses that are
the main causes of absences. The company has launched a series of actions to improve the
environment both in and outside the company and to protect workers' health. Result have been
observed as regards a reduction a drop in absenteeism figurs and also as regards the absolute
disappearance of occupational illnesses and a drop in the number of accidents.
- prompting factors
desire to monitor and protect employees' health and to reduce absenteeism
- project plan
no project; Integral part of company policy implemented top-down; indirect participation of
staff
- participants
management; middle management; "environment" committee, works council representatives sit
on this committee; trade union representatives
- method
analysis of accidents
- main risk factors
dust; lead; noise: temperature; eye fatigue; accidents; occupational diseases such as silicosis and
hypacusis: short-term absenteeism
- target groups
none
safer, less noisy and cleaner equipment; systematic cleaning of machines with eg vacuum
cleaning equipment; reduction of lead level in products; more ventilation; sound insulation
measures; placing warning notices/warning stickers; reduction of working hours to 33 hours and
36 minutes
186

personal protective equipment; training of safety experts and heads of departments (everyone is
involved: suppliers, managers, staff, trade unions, medical service); information for staff on use
of personal protective equipment; company's own medical service carries out periodical
examination
reintegration of staff returning after an industrial accident
absence due to illness and accidents among production staff has run at around 4.4% since 1992;
previous data for absence through illness are known only for the 1970s, when absence stood at
around 20%; nationally the absenteeism due to illness and accidents in the ceramics industry
stands at 16.5%
- other results
decrease in number of accidents between 1991 and 1994
not calculated
- enabling factors
- barriers
resistance to using personal protective equipment
- follow-up
closely following development of new technologies for improvement of internal and external
environment; staff training on safety planned
Case 19: As Rora Fabrikker, food industry (N: 1991 - 1994)

Characteristics:
profit; subsidiary
- company size
74 employees
63.5% women
AS Rra Fabrikker is a private food-production company in a small rural community. It offers a
good example of a company-initiated project aimed at reducing ill-health absenteeism and
improving the work environment. A description of this scheme could be "Improving the social
environment means that more people come to work". This was achieved by improving firstly
the physical and then the psychosocial work environment, and thus reducing the level of illhealth absenteeism. The improvements needed in the underlying situation in order to achieve
this were, primarily, better communication between staff and management and greater openness
187

in the whole company to put an end to gossip and job insecurity, for instance. During the first
four years of the ill-health absenteeism project (198892) ill-health absenteeism reduced, later on
it rose to 9.6% in 1993 and 13.2% in 1994. This high level was caused by a few people on longterm sick-leave.
working condition and illhealth/absenteeism policy part of striving for constant improvement in
quality and productivity (ISO 9001); an understanding attitude to those who are ill is essential
- prompting factors
negative operating results in 1988 and 1989. high absenteeism in 1988 (10%) and 1991 (16%):
uncertainty and poor communication between management and workforce; tragic events
(illness, death, etc.) among staff and their children
- project plan
part of national project: health and safety committee acts as a project group; participatory
approach
- participants
management, esp. operations manager; health & safely committee; senior safety representative;
senior trade union representative (shop steward); occupational health service; external expert
(related to trade union); staff
- method
questionnaire on functioning of organization sent out in 1988. reported back at department level
- main risk factors
interpersonal aspects: gossip, "bullying", dissatisfaction with work, little say in decisions, little
feeling of attachment
- target groups
whole company
introduction of occupational health service
- preventive activities: work oriented
increasing safety in canteen; introduction of system of reporting accidents; information bulletin
for staff suggestions for improvements in working conditions: ergonomie improvements;
protection against cold and draught; job rotation; training of a few staff as working conditions
experts; information and training of the "supervisors" on dealing with subordinates and working
conditions matters; training of management in interpersonal skills: job rotation; improved
production planning procedures
- preventive activities:person oriented
periodical examinations; information on "bullying"; greater openness: talking wilh rallier than
about each other; publication of status report on developments in tragic evcnls involving staff in
order to avoid gossip
reintegration of long-term sick staff combined with information and openness towards
colleagues: a rehabilitating female alcoholic even appeared on radio and in lhe local newspaper,
etc.
188

absence through illness: 1991-1992-1993-1994: 12%-7%-10%-13% respectively, previously fall
in absenteeism and rise in production from 1988 onwards
- other results
improvement of physical environment; improvement of information supply; improvement of the
atmosphere in and image of the company; more openness and satisfaction; improvement in
safely
not calculated
- enabling factors
food and beverage industry in Norway could point to many successful projects that had
prevented workplace absenteeism; an active project group involving many employees; support
from consultants of the central union and expertise in the occupational health service
- barriers
no particular difficulties in progress of project

- follow-up
planned participation in national project on reintegration of long-term sick staff
Case 20: Trondheim, municipality (N: 1993 - 1994)

Characteristics:
- company size
7700 employeeslincluding 500 staff involved in project. 300 in I district)
74% women

The municipality of Trondheim has a formalized illhealth absenteeism project called "A better
work environment - reduced ill-health absenteeism" and has developed an action strategy for
improving the work environment and health of employees. The departments and socalled
"units" within the municipality have adopted a systematic strategy in three phases to prevent
and reduce ill-health absenteeism including a form of extended self-certification. The units
within the municipality are therefore good examples of how to reduce ill-health absenteeism by
improving the work environment by transferring more responsibility and authority to the
individual unit, managers and members of staff. The aim of the project in the municipality of
Trondheim was to reduce ill-health absenteeism by 10%. The units taking part in the project
showed an average reduction in ill-health absenteeism of 17.7% in the course of one year.
Phase I : Getting started
I of the 5 principal aims of the municipality is to make the working environment better and
safer through regular evaluation of the physical and social working environment and the setting
189

up of environmental groups in order to improve the working environment where necessary; the
district's policy is that more openness and communication should give more sense of security at
work and cause absenteeism to disappear: trade union representatives consider absenteeism too
low and aim for short-term absenteeism to increase in proportion to long-term absenteeism
- prompting factors
desire to reduce budget by bringing down absenteeism on health grounds; high level of
absenteeism (7.7%); improvement of working conditions
- project plan
managers themselves responsible for project: participatory approach; steering committee:
working parties for each unit: phased approach: interviews with long-term invalids (tertiary
prevention), survey of staff on factors which endanger health (secondary prevention) and
working conferences for each unit (primary prevention); information on project: conference
starting days
- participants
senior management; unit management: project officer; occupational health service; employee
representatives; external researcher; political representative
- method
interviews with long-term sick staff; questionnaire on work responsibilities, health and stress to
all members of staff concerned; annual work conference in each unit on improvement in
working conditions
- main risk factors
physical conditions; organization of work; communication; openness; social climate;
reintegration of long-term sick staff
- target groups
relaies to 500 staff in 26 units (300 and 11 units within I district department)
opportunity to increase number of days of 'self-certification' from 3 to 5 days of illness without
doctor's certificate being necessary (up to 4 times a year)
eg ergonomie improvements (working position, equipment, workplace design); ventilation; aids;
maintenance of buildings; new division of responsibilities; clarification of role, job rotation,
better replacement arrangements, safer round of checks by nightwatchman, etc.; outings, contact
between different services, better relations with management: introduction of flexible working
hours
fitness; relaxation techniques; conflict management
sending flowers and visiting; keeping informed: inviting to (social) gatherings: return-to-work
reception: work modified
fall in absenteeism from 8.5% in Sept. 1993 to 7.2% in Sept.1994 in units involved compared
with fall in municipality as a whole from 7.2% to 6.4% in the same period (monthly figures?)
190
Overview' and case studies

- other results
number of "self-certifications" 68% higher in trial period than in control periods; greater
understanding for long-term sick staff; more aware that prevention of problems is important;
shift in emphasis from monitoring to trust; individuals themselves responsible for health and
working environment and management also responsible
costs: 12 million NOK (1,4 million ECU)
- enabling factors
agreement that workplace absenteeism was too high; employee's representatives were
encouraged to participate; had an opportunity to utilize a stepwise approach that: ( 1 ) focused on
long-term absenteeism, (2) eliminating potential harmful stressors, (3) continuous improvement
of working conditions
- barriers
management did not feel responsible for absenteeism; language used too academic; staff saw no
connection between sickness and working conditions; work conference phase delayed too long,
only in this phase was general awareness created; staff frightened that interviews and
questionnaires were being used as a means of monitoring
- follow-up
three-phase strategy extended to all units; trial self-certification extended to all units; project
must now be implemented in everyday practice, district department is doing this by establishing
action plans for each unit for internal control
Case 21: Central Administration Vienna, bank Austria

(AU: present)
Characteristics:
profit; subsidiary
- company size
1700 employees
< 10% production staff
55% women
The health and sickness related absenteeism programme of the Bank Austria AG is the visible
expression of a comprehensive corporate health and personnel policy. The programme has been
built up over the past ten years and includes a collection of health protection strategies and
measures; prevention in relation to behaviour and relationship; medical prevention, treatment
and rehabilitation; work organisation and workplace design, including training of managerial
staff: and regulatory measures to influence sickness related absenteeism. The sickness-related
absenteeism ratio is low, but has risen by some 10% since Bank Austria was founded in 1992.
Investments in the company health policy are regarded as effective both in general and in terms
of costs. To date there has been no systematic analysis of sickness-related absenteeism, nor have
there been any studies evaluating it.
191

comprehensive policy: integrated health promotion, prevention and occupational health care
- prompting factors
rising absenteeism rate: further development of comprehensive health policy: new health centre
- project plan
no project; continuous programme coordinated by personnel department: regular meetings of
"work place committee"
- participants
higher management; steering committee: personnel department: health centre; occupational
health service: internal and external experts: works council representatives
- method
analysis of absenteeism: medical examinations: group discussions: interviews of employees and
experts
- main risk factors
psychosocial stress due to work load, organisation of work and lime: pressure: psychosocial
problems; lifestyle
- target groups
whole organisation; risk groups; units with high absenteeism rate
monitoring of absenteeism; group discussion and individual interviews in high absenteeism
units
better organisation of work: ergonomie workplace design; discussion groups about
improvements in the working situation
health examinations; personal prevention and counselling; stress management: physical activity
and sport
return-to-work meetings: physiotherapy and psychological treatment
following the foundation of Bank Austria a slight increase at an very low level (2.5%-2.8%)
- other results
reported high level of work satisfaction
health promotion and prevention activities are judged to be cost-effective
- enabling factors
comprehensive health policy: high motivation of management and works council: new health
centre; comprehensive workplace health promotion: medical care: highly experienced and professional staff; sufficient resources
- barriers
192
Overview' and case studies

- follow-up
new effort to monitor and analyze absenteeism rates: continued effort to maintain low level of
absenteeism
Case 22: Alfred Wall AG Graz, printing and packaging materials

(AU: present)
Characteristics:
profit; independent
- company size
570 employees
689c production staff
28% women

In lhe course of a restructuring programme implemented over several years, Alfred Wall AG
launches a pilot project to reduce sickness-related absenteeism. It forms part of the company's
new policy on health protection and sickness-related absenteeism, in the past few years, the
most important initiatives have been comprehensive health and environmental protection
measures in connection with renovation of the plant and machinery; these involved affecting a
significant reduction in chemical pollution of the environment, noise pollution and the risk of
accidents. Additional measures were the introduction of the employee welfare service, as a
contact point for employees and a link between the workforce, the works council and the
company's management, and a new canteen providing health meals. While the overall level of
sickness related absenleeism has remained unchanged, the differences between the two branches
of production have become smaller. No further results have been observed to date.

company uses social services for employees mediating between company physician,
management and workers; to show workers that the company respect them, but that they have
their own responsibility, also for their health; a worker-oriented ill-health absenteeism project is
to be developed
- prompting factors
high level of absenleeism in packaging materials division (7-8%) as compared with printing
division (5-6%); new management following reorganisation of company; high level of work
stress due to growing production
- project plan
until December 1996 no project, but continuous programme
- participants
higher management; personnel department; company nurse; company physician; works council
193

- method
analysis of absenteeism: monitoring of chemical pollution and noise: medical examinations:
- main risk factors
work load; time pressure; working hours; chemical pollution; noise: shift work: organisation of
work
- target groups
whole organisation; risk groups: division with high absenteeism rate
monitoring of absenteeism: planning of and pilot activities for absenteeism project
better work safety and pollution control
health food in canteen; counselling support
medical examinations and advice
no change in absenteeism rate
- other results
good organisational climate
not calculated
- enabling factors
motivation of managers; motivation and experience of company physician and nurse responsible
for counselling support
- barriers
- follow-up
new project to reduce absenteeism; continued effort to strengthen company health policy
Case 23: Entsorgungsbetriebe Simmering Wien, sewage and waste

treatment (Au: present)
Characteristics:
profit; independent
- company size
300 employees
194

13% women

Simmering waste disposal plants are implementing various general activities and specific
measures in the context of a long-established policy on health and sickness-related absenteeism.
They are aimed at improving the social climate, the prevention and alleviation of illnesses and
disorders, and reducing sickness-related absenteeism. Initiatives have focused on environmental
protection within the company, regular medical examinations of members of the workforce,
behaviour-oriented prevention, the introduction of healthy meals in the canteen and a
comprehensive programme of further training for all employees. In the past few years, a change
in the sick-leave regulations (doctor's certificate after one day instead of three days) has
resulted in a reduction in sickness-related absenteeism, amounting to more than 20%.
company is prepared to invest in their workers; investments are made in the occupational health
service and in the activities of the personnel department to develop the workers; monitoring and
control of absenteeism takes place; a new staff promotion system is planned
- prompting factors
rising absenteeism rate; change in personnel department; moderate success of training middle
managers
- project plan
no project: continuous efforts
- participants
personnel department; occupational physicians; works council; external expert
- method
analysis of absenteeism; monitoring of chemical pollution; medical examinations; discussions
with experts and employees
- main risk factors
chemical pollution; heal: difference in temperature inside-outside; work load; organisation of
work
- target groups
whole organization; risk groups
monitoring of absenteeism; medical certificate after one day of sick leave instead of 3 days
better work safety; better pollution control
health information campaigns: education and training courses; personnel protective equipment
(cloths); medical examinations; preventive medical advise
selective medical treatment
195

decline of absenteeism rate following new regulation about certificale
- other results
assumed benefit of regulatory measures
- enabling factors
change in personnel department support from management, works council and company
physician
- barriers
- follow-up
continued effort to control absenteeism: new staff promotion project.
196
European Foundation for the Improvement of Living and Working Conditions

Preventing Absenteeism at the Workplace
Luxembourg: Office for Official Publications of the European Communities
1997- 196 p p . - 16.0 23.5 cm
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EF/97/14/EN
PREVENTING ABSENTEEISM AT
THE WORKPLACE
EUROPEAN RESEARCH REPORT
This is the first study of workplace absenteeism and illhealth to cover all Member States of the European Union.
The report describes and assesses national regulations
and statistics, documents the perspectives of government
and social partners, and reviews strategies to reduce
workplace absenteeism. The main focus of the study is
upon analysis of the experiences in leading companies
with measures to address the causes of absenteeism
related to ill-health- the key lessons for successful practice
are identified. The recommendations emphasise the need
for greater awareness, action, and analysis to respond to
the major economic and human significance of workplace
absenteeism due to ill-health.
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PREVENTING

Robert Grndemann (sociologist) is working as a senior researcher/consultant at

for the Improvement of Living and Working Conditions

Wyattville Road, Loughlinstown, Co. Dublin, Ireland

Cataloguing dala can be found at the end of this publication

THE COSTS OF ABSENTEEISM RELATED TO ILL HEALTH

THE EUROPEAN STUDY ON ABSENTEEISM

REGULATIONS AND STATISTICS ON

4.1.2 Characteristics of the regulations on extended or

STRATEGIES TO REDUCE WORKPLACE ABSENTEEISM

MODELS OF GOOD PRACTICE

Within the Foundation's programme of work on 'health and safety', increasing

Preventing absenteeism at the workplace

action to improve worker's health and attendance, outlining implications for

The costs of absenteeism

The socio-economic situation in Europe

The socio-economic situation in Europe continues to change at a rapid pace. In

Preventing absenteeism at the workplace

The reduction of absenteeism and disability as a result of current measures at

The costs of absenteeism related to ill health

1.3 The scale of the issue

Preventing absenteeism at the workplace

force, the costs of medical treatment, and administration costs incurred by

What stake do the different parties have?

statutory sick pay

occupational sick pay

low morale of colleagues

extra staff kept on payroll

The costs of absenteeism related to ill health

Preventing absenteeism at the workplace

The next chapters give an overview of how measures to reduce absenteeism

The European study on

This chapter offers information on the context of the European study on

2.1 Aim and content of the study

Preventing absenteeism at the workplace

a network of experts coordinated by TNO. The results showed major differences

2.2 The definition of absenteeism

The European study on absenteeism and ill health

Richard Horst Noaek

Jacques van Damme

Universitt Graz. Institut fr

Extended or permanent disability relates to arrangements after the first period

Preventing absenteeism at the workplace

2.3 Workplace absenteeism and ill-health

2.4 The structure of the report

The European study on absenteeism and ill health

This chapter describes the extent to which workplace absenteeism and

Preventing absenteeism at the workplace

Most information was available about the perspectives of the governments. It

3.2 The perspective of national governments

Preventing absenteeism at the workplace

million) on information and research in order to support the reduction of

Preventing absenteeism at the workplace

work, in which no account is taken of someone's education and previous

Preventing absenteeism at the workplace

Preventing absenteeism at the workplace

economic recession plays a part, as a result of which it is believed that

Preventing absenteeism at the workplace

3.3 The perspective of the employers' organisations

workplace absenteeism in companies. In Portugal an agreement was signed

Preventing absenteeism at the workplace

In Finland employers' organizations report that they are particularly concerned

The perspective of the trade unions