Health Promotion International Advance Access published online on March 15, 2008
Health Promotion International, doi:10.1093/heapro/dan015
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Article |
Leadership, organization and health at work: a case study of a Swedish industrial company
1Nordic School of Public Health, P.O. Box 12133, SE-402 42 Göteborg, Sweden 2Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, SE-171 76 Stockholm, Sweden
* Corresponding author. E-mail: andrea{at}nhv.se
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SUMMARY |
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The application of knowledge on organization and leadership is important for the promotion of health at workplace. The purpose of this article is to analyse the leadership and organization, including the organizational culture, of a Swedish industrial company in relation to the health of the employees. The leadership in this company has been oriented towards developing and actively promoting a culture and a structure of organization where the employees have a high degree of control over their work situation. According to the employees, this means extensive possibilities for personal development and responsibility, as well as good companionship, which makes them feel well at work. This is also supported by the low sickness rate of the company.
The results indicate that the leadership and organization of this company may have been conducive to the health of the employees interviewed. However, the culture of personal responsibility and the structure of self-managed teams seemed to suit only those who were able to manage the demands of the company and adapt to that kind of organization. Therefore, the findings indicate that the specific context of the technology, the environment and the professional level of the employees need to be taken into consideration when analysing the relation between leadership, organization and health at work.
Key words: health at work; leadership; organization
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INTRODUCTION |
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Workplace is an important setting for health promotion. Studies have shown that the organization of work affects the health of the employees (Van der Hek and Plomp, 1997
; Chu et al., 2000). In this connection health has been defined not merely as an absence of disease but as a resource for everyday life, embracing physical, mental and social well-being (WHO, 1986). Studies have also shown that the leadership of the organization plays a critical role for creating and sustaining a health promoting workplace (Shain and Kramer, 2004). Therefore, the application of knowledge about leadership and organization is important for the promotion of health at work (Paton et al., 2005).
Parsons (Parsons, 1999) has presented a concept of health promoting organizations based on an ecological systems framework, including efforts targeting the organizational level, the interpersonal level and the individual level. Leadership plays an important role for organizations adopting such a holistic approach to health. However, the application of knowledge about organization and leadership is limited in the field of health promotion at workplaces. Instead, most health-promoting interventions have been focusing on individual employees and dealing with behavioural rather than organizational change (Shain and Kramer, 2004).
Research in this field has indicated that an increased personal control over the work situation is conducive to the health and well-being of an individual employee (Sparks et al., 2001), and affecting his or her possibilities to develop competence in work (Mikkelsen et al., 1999). The major risk factors for ill health related to stress in working life seem to be situations with high demands and low decision latitude, i.e. situations where the employees have a low degree of control over their work (Theorell et al., 1998).
Different forms of organization and leadership have been described in the management literature, but a key question is how applicable they are from a health promotion perspective. Management studies have mostly been targeting job satisfaction to increase productivity, and they have not been addressing other health issues such as the quality of working life and how to create supportive environments for health. One question is what form of leadership is required to create an organization that gives the employees control over their work situation. Another question is whether such leadership can lead to positive outcomes concerning both the health of the employees and the productivity of the organization.
Boumans and Landeweerd (Boumans and Landeweerd, 1993) have found that a task-oriented leadership, focusing mainly on the performance of work tasks in an organization, may lead to a high productivity but also to health complaints. Their research indicate, on the other hand, that a leadership that is more oriented towards human relations, or has a combination of task and relationship orientation, may have a positive impact on both job satisfaction and the productivity of the organization (Boumans and Landeweerd, 1993).
Studies have also shown that a ‘transformational’ leadership may be particularly important for job satisfaction (Pollock, 1998). This is a form of leadership that is oriented towards inspiring and motivating the employees through a shared vision of the future. Transformational leadership may give the employees an enhanced feeling of meaning in their jobs (Brossoit, 2001), which has also been shown to correlate with positive health outcomes (Hochwälder and Bergsten Brucefors, 2005).
The necessity to adapt the form of leadership to situational factors has often been stressed. In a classic model, Hersey and Blanchard (Hersey and Blanchard, 1982) have suggested that it is necessary to vary the leadership style depending on the maturity of the employees, i.e. their motivation to reach results, their willingness and ability to take responsibility and their knowledge and experience. When the maturity of the employees is low, the leadership has to be task-oriented, but it can be more relationship-oriented with a higher maturity. When the maturity is very high, neither a task- nor a relationship-oriented leadership is needed. Instead, in such a situation, leadership responsibilities can be delegated to the employees.
Self-managed work teams are examples of organizational units created to give a high degree of control to the employees. In such a team, the members are planning, organizing and controlling their own work tasks. Studies have shown that self-managed teams may contribute to a feeling of responsibility, which is linked both to increased job satisfaction (Batt, 2004) and increased work efforts (Manz, 1992).
There is, however, no clear evidence on the effectiveness of self-managed teams. Some studies have reported a high productivity in such teams (DeDreu and West, 2001), whereas others have reported a low productivity (Verespej, 1990). It has been suggested that these differences may be explained by the organizational context. Research has shown that it is easier to introduce teams with a high degree of self-management in an organization with a low level of centralization and formalization (Tata and Prasad, 2004).
Leadership may play an important role in creating such a decentralized structure, and also in creating an organizational culture that supports a high degree of control among the employees (Jones, 2005). Culture has been defined as the basic assumptions that are held and shared by the individuals within an organization (Schein, 2004). Such assumptions are found in beliefs and values about the organization, and they are expressed in symbols, processes and behaviours. The organizational culture may be created to support the structure of the organization, but it may also be used as a tool to exercise social control (Bate, 1994).
Against this background, further studies are needed to explore the role of organization and leadership in relation to health at work. The purpose of this article is to analyse the leadership and organization, including the organizational culture, in relation to the health of the employees in a Swedish industrial company.
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METHODS |
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Despite the previous research in the field, there is still a lack of knowledge of what form of organization and leadership is required for creating and sustaining health at work. Case studies have often been recommended in situations with such a lack of knowledge. However, the critical part is to select a case that may contribute to a deeper understanding of the health-promoting mechanisms of organization and leadership.
A Swedish industrial company with a low sickness rate was selected as a case for this study. The company is a family firm in the Stockholm area, constructing and producing cable machines for industrial applications. It is a leading performer in the market and constantly has to find innovative technical solutions to stay in that position. When the study was undertaken, the company had about 60 employees in three countries, including Sweden. The founder of the company was, at the time of the study, still active as a leader of the company, although his son was formally the chief executive officer (CEO).
The organization has a structure of self-managed teams and an organizational culture with the expressed aim to promote the possibilities of the employees to develop their skills and influence their work situation. According to market surveys, the company has had a better economic performance than other comparable companies (Market Manager, 2004). At the same time, the employees of the company have also had a comparatively low sickness rate (SCB, 2004), on the average 2 days a year.
To study this company, a qualitative case study methodology was chosen, and the data were collected through documentary studies, interviews and observations. The documentary studies included organizational documents dating up to 15 years prior to the commencement of the study, produced by the company itself and by national media. The documents were collected with help from administrative employees at the company and through internet searches. External marketing surveys, newspaper articles and television programmes about the company were analysed as well as annual reports, company journals and other documents produced by the company itself.
The interviews were undertaken with the CEO and five employees at three different occasions. These employees were chosen for having worked between 2 and 5 years at the company, being familiar with the company, but not having worked so long to take things in the company for granted. They were also chosen for representing the different work areas within the company: administration, fitting and construction. An additional interview was also conducted with one employee who had worked for 30 years in the company, to get his perspective on how the work organization had developed over years.
The interviews were semi-structured following an interview guide based on the following themes: the work tasks, the organization and the organizational culture, the leadership, the communication and relationships with colleagues and the feelings of well-being related to work. The employees were asked to describe an ordinary day at work, and how their experiences of the organization and leadership of the company were related to perceived work pressure and well-being. The CEO was asked to describe the ideas behind the work organization, how new employees were recruited and introduced to work, how decisions were taken and his relationship with the staff.
The observations were made during six different staff meetings, both meetings with all the employees and smaller team meetings. On these occasions, an observational guide, inspired by Schein (Schein, 2004), was used to capture key issues such as the environment, the participants, their interaction (overt as well as non-verbal) and activities. There were also observations made at coffee breaks and when work was performed, and there were opportunities to have informal discussions with employees and with the founder of the company, in addition to the interviews. Field notes were taken during the observations and reflections were written directly after each visit at the company.
All data collection was performed by the first author. All interviews were tape-recorded and transcribed. The data from the transcribed interviews, the summaries of the corporate documents and the notes from the observations were analysed according to hermeneutic principles (Gadamer, 2003), searching for a holistic context-based meaning of the content alternating between preliminary interpretations of the whole text and interpretations of the different parts of the text. All the text was read several times and the whole material was sorted under different themes, validated through consistency between the different data sources. The analysis process was continued until all essential aspects of the empirical data were included in the final interpretation.
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RESULTS |
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Values and culture
The founder of the company has consciously developed and refined the culture and the structure of the organization since it was established in the 1970s. He claims that ‘my business idea is basically honesty’ and that power and control is associated with fear and suspicion, and a sign of lacking confidence. He assumes that all individuals want to do something meaningful, take responsibility and develop in their work. He thinks that this is best promoted by freedom, appreciation and participation.
The philosophy of the founder permeates both the structure and the culture of the organization. It is also reflected in the buildings of the company. A new factory building was constructed in 2003. The major parts of this building are made of glass, meant to symbolize a pure flow of communication. The idea is that the shaping of the building should promote the participation of all employees and promote an open and honest communication. On the walls are hanging pictures from the company’s history, such as the first machines constructed.
The founder of the company is actively communicating the values of the organizational culture to the employees. He is taking a central role in the meetings with all the employees. In his communication he is often using metaphors, such as ‘geese flying in a delta formation’, related to the organization of the company. He spends a lot of time talking about the importance of the employees being alert and taking responsibility, emphasizing that it is the responsibility of the employees to make the company profitable and to find sustainable solutions.
An observation was made when the founder of the company together with all the employees formulated the quarterly goals of the company. The employees made their contributions when they were asked to, and the founder decided if he thought that a contribution was worth writing down. During the meeting, a picture of the company’s economic turnover was shown, and the founder talked about where money needed to be saved. He encouraged the employees to work with the quality of the products to change a negative trend. The final version of the goals was typed out and handed to all employees during the next coffee break.
A respect but also a certain distance to the founder of the company was expressed by the employees interviewed. They believed that a prerequisite for the company’s organization of work was a leader who raised the awareness of the employees’ own responsibilities for work performance.
Organizational structure
The company has a flat and decentralized structure. It has no formal hierarchy, no foremen and no time clocks. Instead, it is organized in self-managed teams. In these teams, the employees are expected to take initiative, try new things, take responsibility, adapt and co-operate. According to one of the employees, ‘it is a mental development, you are developing mentally, it is not only ... machines, you are also developing as an individual. You always learn something new all the time ... no limits are set, you can decide yourself in what pace and all that...’.
There is also an ambition to avoid professional divisions in the company. For example, the employees take turns in managing the reception and cleaning the workplaces. According to the CEO, the practical work experiences of the employees are more important than their formal education. Therefore, it is important for the company to have a work environment where the employees can learn, develop and take responsibility. Employees who are unwilling to step outside their professional limits and want to have a clear working division are not suitable for this company.
All the employees meet at 7.45–8.00 every morning in smaller teams. The aim of the meetings is that the employees should share their visions for the day, but also report what they have achieved the previous day and what they plan to achieve during the day. The teams are formed according to functions, needs or common work tasks. The members of the teams shift regularly to promote contacts between different employees. According to the interviews, the morning meetings are a great help for performing work tasks and finding ways to collaborate with colleagues. Without these meetings, more managers would be needed.
The work of the self-managed teams is goal-oriented. A structured schedule is used for setting annual and quarterly goals of the company, and the employees are involved in this process. The employees are also setting their own goals every week according to the schedule. The quarterly and annual goals were described in the interviews as reminder of what is expected by the individual, an eye-opener, rather than financial goals or goals for production.
In addition to the morning meetings, there are also common coffee breaks every day at 9 AM and 2 PM, where all the employees are expected to participate. These breaks are used as information meetings. A bell rings in the building to call attention that the meetings are taking place. A flipchart and an overhead projector are always present to be used at these occasions.
The individuals and the organization
Work is divided according to the ability and the motivation of the different employees. It was expressed, however, both in the interviews and in connection with the observations that it could be hard for some employees to balance the extensive responsibility given to each individual with the need to co-operate in teams. Therefore, it could be difficult for the employees to find their roles. As one of them explained it, ‘you get nothing served on a silver spoon; no one tells you that this is what you should do...’.
The employees interviewed described that they manage to perform their tasks by experience and by asking other employees. They said that they can feel burdened by new and extensive tasks, but they are always able to manage these tasks somehow, which leads to an enhanced skill and task development. Two of them described that they occasionally felt burdened and worried in their spare time about their work tasks, whereas others said that they don’t have a problem separating work from their private life. All the employees interviewed emphasized, however, that the extensive possibilities for personal development and responsibility make them feel very well at work.
Several persons interviewed pointed out that there is no competition between the employees. Instead, co-operation was described as a condition for the organization of work, and the team work was regarded as both positive and sensible. One explanation for the good co-operation was that there are no divisions where employees only mind their own work tasks, ‘everything is woven together, everyone is dependent on each other, no matter what area they work in’. In all the interviews it was expressed that the good companionship and support from colleagues strongly contribute to a feeling of well-being at work.
All the persons interviewed described the frequent communication in the company as something positive and an important condition for their work. The employees felt motivated by what they perceived as a good atmosphere in the organization. They felt that their contributions were appreciated. According to the CEO, they try to have a straight and honest communication in the organization, where everyone should be aware of the situation of the company.
The employees explained in the interviews how they over time had adapted to the organizational culture. They described how they had learnt to express themselves according to the prevailing norms for communication at meetings and how to perform their work tasks within the self-managed teams. Those who have not been able to accomplish their tasks or conform to the organization of the company had, over the years, resigned. Today the structure and culture of the organization is clearly expressed already during recruitment of new employees. The recruitment is selective, favouring those who are able to adapt to the organization.
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DISCUSSION |
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TOPSUMMARYINTRODUCTIONMETHODSRESULTSDISCUSSIONFUNDINGREFERENCES |
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This case study has described the leadership and organization, including the organizational culture, of a Swedish company in relation to the health of the employees. The founder of this company has developed and actively promoted an organizational culture, which is based on assumptions that all individuals want to do something meaningful and take responsibility for their work. With this culture, the organization has developed a decentralized structure consisting of self-managed teams where the employees have a high degree of control over their work situation. According to the employees, there are extensive possibilities for personal development and responsibility, as well as good companionship, which make them feel well at work. This is also supported by the low sickness rate of the company.
These results support the studies indicating that an increased personal control over the work situation is conducive to the well-being of individuals (Sparks et al., 2001). Creating self-managed teams is one way of increasing the degree of control for the employees. However, as Tata and Prasad (Tata and Prasad, 2004) have pointed out, the success of self-managed teams is context-dependent. A decentralization of responsibility may be facilitated by a leadership that actively promotes the organizational culture and the goals of the company. It also requires a structure for the employees to plan their work, including overall guidelines and channels for communication. Without the daily meetings it would be hard for the employees in the company studied to develop their co-operation. Furthermore, the employees need constant information to enable them to work independently. Good relations between the employees are also critical for their co-operation in the performance of the work tasks.
The organization of work in the company studied has many parallels to current management theories. Employees are encouraged to work independently and it is seen as an important task of leadership to create understanding and support for work performance (Mintzberg, 1999). The founder of this company has many of the characteristics of a transformational leadership, which is also very similar to the form of leadership found in ‘excellent’ corporate cultures (Peters and Waterman, 1982). The question is, however, if these characteristics of the company really are meant to be health promoting or just a way to socially control employees to work harder to fulfil the goals of the company.
Important ethical aspects of the organization, leadership and culture of the company studied can be raised in this connection (Bate, 1994). The founder has a central role in the studied company, strongly promoting his own ideas on organizational culture and structure. This may, however, lead to difficulties for employees with different perspectives. Employees in the company can decide how to perform their work tasks, but they do not express opinions against the dominating culture of the company during the observations and interviews. Making the employees feel responsibility for the goals of the company is a way to create a strong loyalty to the company. The way the employees are organizing themselves through regular group meetings can also be interpreted as a way of creating a social peer pressure to make them work harder.
A literature review by Shain and Kramer (Shain and Kramer, 2004) has shown that the organization and design of work needs to be targeted to promote health. Additionally, it would be important also to consider contextual factors such as the technology and the environment of the organization and the professional level of the employees (Mintzberg, 1993; Mintzberg, 1999). This study indicates that the form of leadership and organization of the company studied may be both effective and health promoting, but it may not suit all employees and organizations. Employees who did not fit the culture and structure of this company have resigned and those who are still there have adapted to the existing organization.
The conclusions of this study should be drawn with caution because of the specific context of the company studied. Most of the employees in the company are skilled workers selected by the company for their will and ability to cope with the particular organization of work. Parallels to a healthy workers effect can be drawn, i.e. that employees in general are healthier compared with individuals without employment (Choi, 1991). The company studied seems to suit those who are able to manage the demands of the company and adapt to the organizational culture. When extensive responsibilities are delegated to the employees in an organization, they can be handled only if necessary skills exist and if the employees experience success in accomplishing their tasks (Yukl, 2006).
There is clearly a need for more research about the impact of organization and leadership on the health of employees. Comparative studies would give a more general picture of the health-promoting mechanisms associated with different forms of organization and leadership. Aspects of organizational culture are not always as explicit as in this study, and should be explored further in continued research on health-promoting work organizations. Future research should also explore what different employees consider as health promoting for them, and how this fits with management ideas and performance.
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FUNDING |
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Funding to pay the Open Access publication charges for this article was provided by the Nordic School of Public Health.
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REFERENCES |
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TOPSUMMARYINTRODUCTIONMETHODSRESULTSDISCUSSIONFUNDINGREFERENCES |
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Bate P. Strategies for Cultural Change. (1994) Oxford: Butterworth-Heinemann Ltd.
Batt R. Who benefits from teams? Comparing workers, supervisors and managers. Industrial relations (2004) 43:183–212.[CrossRef][ISI]
Boumans N. P., Landeweerd J. A. Leadership in the nursing unit: relationships with nurses well-being. Journal of Advanced Nursing (1993) 18:767–75.[CrossRef][ISI][Medline]
Brossoit K. B. Understanding employee empowerment in the workplace: Exploring the relationships between transformational leadership, employee perceptions of empowerment, and key work outcomes. In: Dissertation Abstracts International (2001) US: Univ Microfilms International. 9-B. Section B61.
Choi B. C. K. Definition, sources, magnitude, effect modifiers, and strategies of reduction of the healthy worker effect. Journal of Occupational Medicine (1991) 34:979–989.[ISI]
Chu C., Breucker G., Harris N., Stitzel A., Gan X., Gu X., et al. Health-promoting workplaces—international settings development. Health Promotion International (2000) 15:155–167.
DeDreu C. K. W., West M. A. Minority dissent and team innovation: The importance of participation in decision making. Journal of applied Psychology (2001) 86:1191–1201.[CrossRef][ISI][Medline]
Gadamer H. -G. Truth and Method (2003) 2nd edition. New York: The Continuum Publishing Company.
Hersey P., Blanchard K. H. Management of Organizational Behavior. (1982) 4th edition. Englewood Cliffs, NJ: Prentice-Hall.
Hochwälder J., Bergsten Brucefors A. Psychological empowerment at the workplace as a predictor of ill health. Personality and Individual Differences (2005) 39:1237–1248.[CrossRef][ISI]
Jones K. Leading an empowered organization (LEO): does the course work? British Journal of Community Nursing (2005) 10:92–97.[Medline]
Manz C. Self-leading work teams: moving beyond self-management myths. Human Relations (1992) 45:1119–1139.[Abstract]
Market Manager. MM-Class – A valuation of a company’s growth, profitability, and capital structure. (2004) http://www.mmp.se (last accessed 1 February 2004).
Mikkelsen A., Saksvik P. O., Eriksen H. R., Ursin H. The impact of learning opportunities and decision authority on occupational health. Work and Stress (1999) 13:20–31.[CrossRef][ISI]
Mintzberg H. Structure in Fives: Designing Effective Organizations. (1993) Englewood Cliffs, NJ: Prentice Hall.
Mintzberg H. Mintzberg on managing professionals. Human Resource Management International Digest (1999) 15–15.
Parsons M. Health promoting organizations: A systems model for advanced practice. Holistic Nursing Practice (1999) 13:80–89.[Medline]
Paton K., Sengupta S., Hassan L. Settings, systems and organization development: the Healthy Living and Working Model. Health Promotion International (2005) 20:81–89.
Peters T., Waterman R. Search of Excellence: Lessons from America’s Best-Run Companies. (1982) New York: Harper & Row.
Pollock K. S. The relationship between leadership style and subordinate satisfaction and performance in public accounting firms. In: Dissertation Abstracts International (1998) US: University Microfilms International. 1244. 594–A.
Schein E. Organizational Culture and Leadership. (2004) 3rd edition. San Francisco: Jossey-Bass.
SCB. Sickness absence and ill-health in Sweden – in a statistical perspective [In Swedish: Sjukfrånvaro och ohälsa i Sverige – en belysning utifrån SCB:s statistik]. (2004) Stockholm: Official statistics from Sweden.
Shain M., Kramer D. M. Health promotion in the workplace: Framing the concept; Reviewing the evidence. Occupational and Environmental Medicine (2004) 61:643–648.
Sparks K., Faragher B., Cooper L. C. Well-being and occupational health in the 21st century workplace. Journal of Occupational and Organisational Psychology (2001) 74:489–509.[CrossRef]
Tata J., Prasad S. Team self-management, organizational structure, and judgements of team effectiveness. Journal of Management Issues (2004) 16:248–265.
Theorell T., Tsutsumi A., Hallquist J., Reuterwall C., Hogstedt C., Fredlund P., et al, and the SHEEP Study Group. Decision latitude, job strain and myorcardial infarction: A study of working men in Stockholm. American Journal of Public Health (1998) 88:382–388.
Van der Hek H., Plomp H. N. Occupational stress management programme: a practical overview of published effect studies. Occupational Medicine (1997) 47:133–141.
Verespej M. A. When you put the team in charge. Industry Week (1990) 229:30–32.
WHO. The Ottawa Charter for Health Promotion. (1986) Copenhagen: WHO.
Yukl G. Leadership in Organizations (2006) 6th edition. Upper Saddle River, NJ: Prentice-Hall.
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