1. Leadership and sickness absence Hugo Westerlund, Ph.D. Stress Research Institue, Stockholm University 2009-07-08/ Hugo Westerlund, Ph.D., Stress Research Institute1

2. Unemployment and sickness absence in Sweden 1990-2008 2009-07-08/ Hugo Westerlund, Ph.D., Stress Research Institute2

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

4. Evidence in the literature A systematic international review concluded that there was moderate evidence that good leadership was associated with decreased risk of sickness absence (RR=0.73; 0.70-0.89). –Kuoppala et al., JOEM 2008;50:904-915. –and scanty evidence on disability pension –‘sickness absence’ not precisely defined –mostly support from supervisor © 2006-9 SU & Hugo Westerlund

5. Organisational justice Growing literature showing prospective association with health (Elovainio et al., Soc Sci Med 2004;58:1659-1669). –also shown in Whitehall II data (Head et al., J Psychosom Res 2007;63:433-440). –relational justice specifically about supervisor © 2006-9 SU & Hugo Westerlund

6. Relational Justice Your supervisor considers your viewpoint. Your supervisor was able to suppress personal biases. Your supervisor provided you with timely feedback about the decisions and their implications. Your supervisor treated you with kindness and consideration. Your supervisor showed concern for your rights as an employee Your supervisor took steps to deal with you in a truthful manner. © 2006-9 SU & Hugo Westerlund

7. A forest company in Sweden and Finland Authoritarian and laissez-faire conflict resolution associated with more sickness absence than democratic (Hyde et al., Soc Sci Med 2006;63:2218-2227). Lack of attentive managerial leadership associated with more sickness absence (Westerlund et al., Work, accepted for publication). © 2006-9 SU & Hugo Westerlund

8. The SLOSH study adjusted prospective associations (ORs) < 1 week> 1 week31+ days Presentee- ism MWMWMWMW Inspirational leadership11 sometimes1.72.0** seldom3.2*3.0*** Team integration1111 sometimes0.80.4**1.00.6* seldom0.60.881.40.8 Integrity1111 sometimes2.5*1.71.31.2 seldom1.71.9*1.8*** Autocratic leadership2.2*1.41.8**1.4 sometimes1.71.11.31.0 seldom1111 Nyberg et al., Scand J Public Health 2008;36:803-811.

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

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

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

12. What characterises workplaces with low sickness absence Swedish study of 2,063 companies with >74 employees each –classified into low, medium, and high absenteeism companies with low absenteeism existed also in industries with overall high absenteeism, e.g. cleaning firms –qualitative interviews with managers & unions Companies with low vs. moderate absenteeism: –focussed on early rehabilitation –had an active HR department communicating with line managers –use occupational health care services more –have a preventive perspective 15-05-08/ Fil.dr. Hugo Westerlund, Stressforskningsinstitutet12

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

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

15. 2009-07-08/ Hugo Westerlund, Ph.D., Stress Research Institute15 THANKS FOR LISTENING! hugo.westerlund@stress.su.se