15 Effect Chains A Method for Analysing Qualitative Effects in Occupational Health and Safety at Work

Martin Schmauder, Hanka Hoffmann

Introduction

The starting situation for activities related to health and safety at work in companies is characterised by a great deal of latitude for interpretation as regards the statutory outline conditions, with which companies respond individually to changes in the world of work and thus are able to open up potential in different ways. The flexibilisation of the world of work brings with it for example fresh demands on the skills and resources of employees. The intensification of work and expansion of responsibility leads to increased psychological stresses on employees. And not least, KRUEGER (2008) also highlights the significance of demographic change, particularly for SMEs: in the next two decades, we may anticipate an ageing (working) population across Europe. It is true that each worker ages differently, but the generally increasing mental and sensory deficits, above all the decrease in the capacity to adapt to changing circumstances, have to be compensated if even complex work tasks are to be performed through to pensionable age. Maintaining the health of employers is thus gaining increasing importance. This is achieved not only by avoiding or reducing absences, but by improving the state of health through improved conditions in the organisation, the work itself, and the development of personal qualities (Fig. 15.1).

C.M. Schlick (ed.), Industrial Engineering and Ergonomics, DOI 10.1007/978-3-642-01293-8_15, Springer-Verlag Berlin Heidelberg 2009

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Organisational conditions, incl.: Corporate culture Transparency of decisions Degree of division of labour Working conditions, incl.: Time pressure Leeway for action and creativity Work interruptions Person-related conditions, incl.: Social competence Identification with work Personal effectiveness Work behaviour State of health Physical well-being Mental well-being Self-confidence Irritability Anxiety ... Readiness to perform Quality of work Readiness for innovation Attendance record Fluctuation Willingness to cooperate ...

Fig. 15.1: Possible connections between organisation, work conditions, state of health and work behaviour. Source: based on B. Badura, in: BERTELSMANN STIFTUNG (2000, p. 25)

In the meantime, in accordance with the law on health and safety at work, in many companies workplace health and safety measures and health promotion measures are being implemented in order to safeguard human resources in a lasting way. These measures also contribute to a positive internal and external corporate image, as well as to service quality. The following illustration provides an overview of the problem areas and objectives that are most frequently addressed within the framework of company health promotion (Fig. 15.2).
Main themes
Physical stresses Company atmosphere Reducing sickness levels Communication Workplace design Health & Safety topics Autonomy Management style Organisation development Stress management 0 10 20 30 40 50 60 70 80 90 100

N=212 com panies

Fig. 15.2: Measures in contemporary health and safety at work and health promotion (AOK-BUNDESVERBAND 2007)

The spectrum of measures shows the breadth of contemporary health and safety at work, which includes health protection and health promotion. In addition to the question How can illness be prevented?, increasingly the question that is also

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asked is: What needs to be done in order to preserve and improve the health of the workforce? If one wishes to record and represent the productivity of workplace health and safety, it is not enough to limit oneself to looking at just the pursuit of safety and health objectives and local optimisation of work systems. With the perspective of results-oriented health and safety at work, the intention is to see the effects of workplace health and safety and health promotion services on the business results. The intention is that the overall benefit to the company can be illustrated, and that the contribution towards achieving diverse corporate goals is clear. We have results-oriented performance in health and safety at work and health promotion when these are shown to have contributed towards lowering overall costs or towards increasing the revenue of a company, and towards the long-term existence of the company by securing competitive product sales and by securing the necessary resources for adding value. The need for concrete argumentation aids to illustrate the business economic benefits of preventive workplace health and safety is growing. The central question for companies whether health and safety at work is worthwhile for them can still only be answered unsatisfactorily (FROBSE et al. 2008, LANGHOFF 2002, BRAUN et al. 1999). In this respect, the method of effect chains attempts to close a gap in a practical way: health and safety at work and health promotion make a contribution towards improving profitability. This contribution cannot always be measured in monetary terms. However, with the aid of the effect chains method, the indirect effects can now be described plausibly, and the benefits of health and safety at work and health protection can thus be made clear.

The Principle of Effect Chains

On the one hand, the effects of measures in preventive workplace health and safety cannot always be determined precisely beforehand. On the other hand however, even in retrospect it is not possible to establish a clear relation between measures and effects. There is thus no proven causality between a measure and an effect. So for example in the case of mechanical factors, causality is clear. If a protective grille is fitted at a feed point, injuries are avoided here. It is also undisputed that for example back problems are reduced by ergonomic measures, but one cannot say with certainty to what extent this is so, nor is it clear whether the ergonomic measures were the cause of this, or whether other effects played a role, too. The only thing that is undisputed is that the ergonomic measures have made a contribution towards reducing back problems. It is precisely here where the method of effect chains comes into play. It is not a matter of identifying causal relations; rather, the diverse and interlinked effects of the workplace health and safety and health promotion measures are illustrated. Effect chains are consequently complex constructions of causes and effects, as described for example by GOMEZ and PROBST (1995). In this sense, what is meant

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is webs of causes and effects, which take account of mutual influences and (interfering and encouraging) external influences. In such complex webs, effects themselves become causes, one cause can have many effects, just as one effect can have many causes. We describe these characteristics of the cause/effects web as multifinal and multicausal. Workplace health and safety measures, too, have various effects. These effects in turn have other effects, which ultimately in a positive case are noticeable as effects that increase revenue or reduce costs (Fig. 15.3). Both have a positive influence on company profits (PIEPER & VORATH 2005). Effect chains are accordingly intended to describe the contribution made by workplace health and safety and health promotion to the business result, and this can be differentiated via several sub-levels into partial indicators on both the revenue and costs sides.

Measure/ Cause
Effect/Cause
Effect

Effect/Cause Effect/ Cause Effect / Cause Effect/ Cause

Effect/ Cause Effect/ Cause Effect/ Cause

Effect/ Cause Effect/ Cause Effect

Reduction of costs

Increased revenue

Fig. 15.3: Connections between causes and effects

Possible Uses of and Limits to the Effect Chains Method

As we have already explained, the effect chains method can be used to illustrate the effects of measures. It is therefore suitable for the following applications: Prospective application to work out goals and indicators prior to implementing a measure: Here, possible consequences can be estimated in the planning phase. Objectives can be established (That is what we want to achieve in concrete terms!). It is also possible to identify potential unwanted effects through prospective application of the method. Through the representation of the effect structure, aspects can be identified to which particular attention must be paid.

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In general, it is possible at the start of the project to exchange views within the group about the objectives, to plan the measures, and to set priorities. Retrospective application to represent the observed effects: After workplace health and safety and health promotion measures have been implemented, a network of effects can be developed by means of the effect chains method. It is possible to show which positive (and also negative) effects a measure had, and how they are related. A contribution towards illustrating the benefits of the measure can be made here. However, no effects that are measurable directly in monetary terms are calculated here; rather, they are shown qualitatively. Since in general it is hardly possible to evaluate the success of workplace health and safety measures in monetary terms, it is precisely here that the strength of the method lies: It can be shown which benefits could be observed in the case of a concrete measure. When working out the effect chains, care must be taken to ensure that the effects that are actually observed are recorded. There is a risk that speculative effects, i.e. ones that are desired but did not actually occur, may be listed. The method provides stimuli for a structured exchange of opinions, and as an argumentation aid it can also form the basis for discussions about the effects of measures. Well-illustrated effect mechanisms enable the company to select the most suitable measures for achieving objectives, to optimise company procedures thereby, and to reduce the corporate risks in this connection. The limits of the method lie in the fact that effect chains can also go nowhere or end up in dead ends. Furthermore, it is not possible to demonstrate the achievement of concrete goals in an evaluation process.

Participative Effect Chain Processing

Having explained the principle of effect chains, in the course of a brief look at the principles of facilitation we shall explain how effect chains in health and safety at work can be identified. It is advantageous to work out effect chains in a facilitated team workshop. In practice, one finds typical discussion types which can be distinguished according to their objectives: In information discussions, the participants are to be instructed about something, given an overview, or receive instructions. In problem and decision discussions, solutions are worked out together, and measures are also coordinated. More interactions take place here, and also more emotion is shown. By contrast, the method of effect chains is more a form of brainstorming, in which ideas are found and above all experience can be gathered. It is precisely in this quite open form of discussion that the role of the facilitator is of decisive importance. The facilitator leads a discussion and should simultaneously be a specialist in the methods of communication. The facilitators task lies in leading the group to a result by using appropriate methods, during the course of which he directs the process methodically but remains neutral as regards content.

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Besides the actual content of the individual contributions, he must also take account of the relationships between participants, which can have an enormous influence on the result of a discussion (WATZLAWICK et al. 1974). It is therefore advantageous if the facilitator assumes an independent position in relation to the participants in the case of analysis of the effect chain, he acts as an external party in the company. He should know about the 4 aspects of a message (factual information, appeal, reference and self-disclosure) (SCHULZ VON THUN 1981) and also must not underestimate group dynamic processes. In its discussion, a group brings to light more than the sum of its individual members. DAMMER and SZYMKOWIAK (2008) go so far as to say that the whole is more than and different from the sum of its parts (p. 30). This more than and different from results from the group dynamic, from that which the group conveys non-verbally or scenically in terms of content, and ultimately from the greater breadth and unity of the work on the topic, simply through mutual stimulation and reflection in the group. The starting point for the effect chains workshop is a workplace health and safety or health promotion measure that has actually been implemented or planned. It is important to include representatives of all the protagonists involved in the measure in the group discussion, in order to depict the cause/effects web from different perspectives and thus as completely as possible. The various perspectives of the participants give rise to various expectations and aims. All have an entitlement and are part of the system to be dealt with. Gomez and Probst therefore suggest, in the spirit of a holistic procedure, putting together an interdisciplinary group of people with expertise, in order jointly to describe connections and/or to derive suitable possibilities for action. They also refer to the ethical aspect of such a procedure including all legitimate interests in so-called claim group teams right at the start of a holistic problem-solving process (GOMEZ & PROBST 1995). The formulation of the problem is important for the success of an effect chains workshop. What we mean by this is the initial question with which the participants are confronted. This should be considered carefully as a preliminary step a good question is decisive for a good result. The question serves to prompt the participants to express everything that they would like to express in other words, to set the process of finding the effect chains in motion. Each contribution is important here, and can stimulate the other participants to discussions or other contributions. In order for a complete network of effects to be depicted, all contributions need to be visualised. Three steps follow on from the initial question: 1. Requesting anonymous cards, with pin-board technique

In the most favourable case, the participants in an effect chains workshops are very heterogeneous, including as regards the position of individual people within the hierarchy (see above). Although this is important for producing a complete representation of all effects, it is precisely because of this that difficulties can arise at the start of a brainstorming session. For this reason, the written form of brain-

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storming so-called brainwriting, or requesting cards is more appropriate in this phase. The advantage here is that a great deal of information can be assembled within a short space of time, and possible inhibitions on the level of relationships or losses through production blocks (DIEHL & STROEBE 1991) are excluded. For example, the contributions made by a shy colleague are collected in the same way as those of an eloquent superior, something which cannot necessarily be achieved when such a procedure is carried out verbally. All the participants write down in parallel their experiences and opinions concerning the problem defined at the outset on cards (one aspect per card). It must be specified beforehand whether the number of cards is to be limited, which on the one hand restricts creativity, but on the other hand ensures a manageable quantity of cards. The cards are collected in by the facilitator and pinned to the display board. Cards whose contents are similar are grouped together (thematic clusters) with the aid of the participants. Writers of cards can remain anonymous. Cards can be supplemented during the discussion, too. In the discussion, generic terms are sought for thematic groups, which can be used for further work. 2. Guiding questions

In the second step, with the aid of the generic terms the web of effects is worked out. For this, we use a system of co-ordinates (Fig. 15.4). The use of this procedure is intended to achieve comparability of different group discussions. In the system of co-ordinates, those factors are shown which according to our understanding, based on DAMMER and SZYMKOWIAK (2008) ensure functional representativeness of the results of the survey. Based on the system of co-ordinates, and starting from the generic terms found in the first step, by means of guiding questions additional observed or suspected effects are determined and placed in relation to one another. Here, visualisation in the form of a mind map can be helpful (main branches with offshoots and secondary offshoots). Particular importance is accorded to the questions about the effects on the participant. In the sense of the theory of planned behaviour (AJZEN & FISHBEIN 1980), behaviour can change only if as a preliminary step, the intention and its predictors attitude to a particular behaviour (the sum of expectation and evaluation), subjective norms (corresponding to the social pressure that people close to the person exert in relation to the performance or non-performance of the particular behaviour), and perceived behaviour control (a persons conviction about how easy or difficult a behaviour is for him to carry out). For workplace health and safety measures, this means that they have to act on precisely those predictors, in order ultimately to achieve a change in peoples behaviour. According to Ajzen, action that takes account of workplace health and safety must be assessed positively by the person himself and must be assessed as easy to implement. Furthermore, the person has to believe that other people who are important to him likewise assess the performance of this behaviour positively. Depending on how far-reaching the

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effects of workplace health and safety measures are, they will also result in longterm changes in behaviour.
What effects did the measure have...? internally externally on the private sphere To what extent did the measure have an effect on colleagues in respect of...? skills behavior performance

Participants and those affected : Who triggered it? Whom did the effect affect?

Measure / Event
Time horizon: When did the effects occur? How long did the effects last?

Economy : desired effects increased turnover/reduction of costs unwanted effects increased costs/decline in turnover

What significance do the individual effects have?

Fig. 15.4: System of co-ordinates for producing functional representativeness

The following example guiding questions originate from a workshop carried out by the trade association for health provision and welfare (BGW). With representatives from hospitals and clinics that took part in the competition BGW health prize 2005, effect chains to represent the benefit of workplace health and safety and health promotion measures in hospitals and clinics were worked out. The facilitator names the measure under consideration, and asks for example: What was different afterwards? What happened then? What effect did that have o externally (society, customers)? o internally (colleagues, other departments, administration)? o on the private sphere/family? Do outsiders notice any of this? Have there been any effects on other areas? Have there been any effects on the company as a whole? What has changed in: o work tasks, workplaces/premises, work tools, work procedures, working environment (physical, social) o ecology

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o safety o behaviour? The respective answers are visualised in turn. The following illustration shows an example of this (Fig. 15.5).

Fig. 15.5: Example of visualisation when working out effect chains

When an effect has been identified, then additional effects are requested, so that a network of effects is produced. When identifying additional effects, the same questions can be used, but one can also ask for example: What can be deduced from that? What else resulted (additional effects)? The individual effects are placed in relation to one another and linked with arrows, which at the end will ideally lead to the field Reduction of costs and/or Increased revenue. 3. Weighting by means of points

For the purpose of structuring, finally the main effects of a workplace health and safety measure are identified, in that the workshop participants apply adhesive spots (e.g. 3, a maximum of 2 on one effect) to the effect which in their opinion is the strongest. This last work step, which creates transparency, makes sense, since it is only in this way that a measure can be evaluated in terms of its content, and

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the results that have been achieved can be compared with the actual goals of workplace health and safety at the company.

Application of the Method Experience so Far

In our experience, effect chains workshops are successful where the event that is to be discussed lies no more than 2 years in the past. The discussion takes place within the framework of a 90-minute facilitated workshop. Allowing for complete representation of the protagonists, group size should be between 8 and 12 people. Smaller groups do not provide sufficient anonymous protective space, and larger ones are no longer suitable for getting the group members to talk to one another and discuss a common topic. The event is facilitated by two facilitators, ideally male and female. Cofacilitation is necessary in order to be able to fulfill all the requirements with regard to visualising the discussion during the workshop, and to provide adequate documentation of the contextual facts of the discussion in the facilitator logs, whilst simultaneously guiding the discussion in a satisfactory manner. The cofacilitators switch between the roles of guiding the discussion and taking minutes at least once in the course of the discussion.

Examples of Effect Chains

Two examples of effect chains are shown below. These effect chains were worked out, amongst many others, in the BGW workshop mentioned above, and in the framework of the PAGSmonitor project. The first effect chain shows the diverse effects in connection with back training (Fig. 15.6).

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Bonus stamp received from health insurance scheme

Back training
Fun, motivation through the group Bonus stamp from companytraining record Financial bonus at year end

Getting to know colleagues from different departments Information, providing knowledge Asking other colleagues Demonstration of some exercises Health awareness has increased

Image boost for the company Loosening and firming of musculature Pleasant balance in relation to seated workplace CORRECT performance of exercises / movements

BUT: no new participants

More movement / sport in private life too Ideas to use at home

Faster communication

Fewer days off work for back problems

Reduction of costs

Increased revenue

Fig. 15.6: Back training effect chain

The second effect chain documents the interlinked effects that can be established as the result of carrying out a health day (Fig. 15.7).

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Health day
Image Information about possibilities Contribution for employees (reward) Rise in demand Business sectors are created Public attention Transfer to behaviour at the work place Change in behavior Movement Qualification of health promotion

Revaluation of the theme of health and safety at work Dialogue between the individual work groups

Fixed component of training plan Understanding for one another / communication

Increased work satisfaction Staff development

Creation of new jobs Health benefits in the holistic sense

Reduction of costs

Increased revenue

Fig. 15.7: Health day effect chain

Conclusion

With the effect chains method, a method is presented for representing the benefits of corresponding measures that is new in health and safety at work and health promotion. What is new is that the previous approach of assessing the workplace health and safety and health promotion measures in purely monetary terms is replaced by a qualitative illustration of the effects. This is associated with goaloriented company management. Using the method, it can be shown that health and safety at work and health promotion make an active contribution to the achievement of corporate goals. The method is also suitable for the planning and optimisation of workplace health and safety and health promotion measures. It can be used in small groups, and creates transparency in discussions about the effects of measures within the company. The method is currently being used and developed in the project PAGSmonitor: Economic health and safety at work through benchmarking. Thus for example the relations between the individual effects, based on GOMEZ and PROBST (1995), should be described in greater detail in three respects: According to their time horizon: do they act over the short term, medium term or long term (lines of different thicknesses or colour of arrows)? According to their intensity: is the influence weak (1), moderate (2), or strong (3)? According to their effect: reinforcing (+) or damping or stabilising (). It is possible to indicate the strength of influence by means of arrows of different thicknesses.

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The research project PAGSmonitor: Economic health and safety at work through benchmarking runs until September 2009 and is supported by the Federal Ministry of Education and Research.

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