The management of psychosocial risks at work: state of the art and future perspectives.

BACKGROUND: Psychosocial risk management represents a current challenge in Occupational Health and Safety (OSH) due to their impacts of such risks on work stress and the rapid changes of the world of work. An effective psychosocial risk management can be carried out on the basis of an integrated multidisciplinary model founded on the risk management paradigm. Over years, the occupational medicine has played an important role at national level in this area, contributing to the creation of an integrated and participatory approach.
OBJECTIVES: This study explores the developmental process of psychosocial risk management over time in Europe and Italy, to offer an update on the state of the art at a national level and insights on future perspectives.
METHODS: Through a reflection on research developments, in Europe and in Italy, we outline how the knowledge obtained has been translated into policies, which have encouraged the implementation at international and national level of consolidated practices for the management of psychosocial risks.
RESULTS: An overview of some key steps of the inclusion of psychosocial aspects in OSH is presented, highlighting the positive impact of the multidisciplinary approach. Moreover, the driving role played by policies for implementation in organizational practice is also highlighted, with particular reference to the Italian example. DISCUSSION: Starting from the existing knowledge, it is necessary to tackle emerging risks by continuing to translate the knowledge obtained from research into policies that have a driving role in the identification and implementation of actions and practical tools.

Introduction

Managing psychosocial risks is one of the main challenges in occupational health and safety (OSH) in consideration of their potential impacts on work-related stress (WRS) and workers’ well-being (33). Psychosocial risks are defined as those aspects related to the work design, organization and management, and their social contexts that may cause negative psychological, physical and social effects, when insufficiently managed (15, 33).

Recent data from European Working Condition Survey (17) show that 25% of workers report high pressure during the working hours, and a similar percentage reports that work has a negative influence on their health. Moreover, 22% of the respondents report working frequently during their free time as well, to satisfy work demands. By comparing the point of view of enterprises, recent findings from the European Survey of Enterprises on New and Emerging Risks (18) highlight some recurrent psychosocial risk factors among European enterprises where interviews were conducted (EU-28), among the others “Having to deal with difficult customers, patients, pupils etc.” (61%), and “time pressure” at work (44%). Moreover, 21% of enterprises reports more difficulties in managing such risks then other OSH risks.

Managing psychosocial risks is essential also in light of the rapid changes in working conditions. The higher flexibility of the world of work, technological development and changes in the workforce are modifying the way the work is designed and organized (41), leading to the emergence of new aspects of risk to be considered and included in the OSH protection. The growing digitalization in the work processes, the advent of collaborative robots, the gig-economy, the increasing number of migrant workers and women in the workplaces require to investigate and manage new psychosocial aspects (26). Moreover, during the current COVID-19 emergency, the adoption of adequate actions to prevent and contain the risk of infection brings about potential psychological impacts related to the return to work, the fear of being infected and contagious, and the adoption of new working methods and work settings compared to the past. In particular, the Covid-19 emergency has rapidly led to an openness to flexibility at work (remote work, flexible hours), producing permanent changes in the current work scenario and potential impacts on workers’ health and well-being that are still to be fully investigated and verified.

Effective psychosocial risk management can be carried out on the basis of an integrated and multidisciplinary model founded on the risk management paradigm, also considering the new and emerging aspects to be investigated, related to the change in the world of work. This should start from the identification of problems and the assessment of the associated risks, to identify the best solutions to reduce such risks at source (10). In this perspective, occupational medicine has played an important role at national level in the development of guidelines, approaches and models in this area, contributing to the creation of an integrated and participatory approach to psychosocial risk management.

In particular, we recall the contribution of the Italian Society of Occupational Medicine and Industrial Hygiene that produced a consensus document on evaluation, prevention and correction of the harmful effects of work-related stress (5). This provided guidance for occupational doctors working among the other figures in charge of prevention at the workplace. Moreover, the research activity leading to the development of the Inail methodology for the assessment and management of work-related stress (27, 30), started from the Department of Occupational Medicine of former Ispesl, favoring multidisciplinary collaboration over time.

The present work aims to explore the topic of psychosocial risk management, through a reflection on its research development, in Europe and in Italy, and on how the knowledge obtained has been translated into policies and practices over time. Moreover, we offer an update on the state of the art at a national level and insights on needs and opportunities for the future based on the consolidation of existing knowledge.

The development process at research, policy and practice level

Figure 1 presents an overview of some key steps of the inclusive and developmental process of psychosocial aspects related to stress and well-being in the context of OSH protection.

Figure 1

Main steps of the psychosocial risk management development at research, policy and practice level in Europe and Italy

With no claim of being exhaustive, we intend to offer a reflection on a process that, starting from the development of knowledge as result of research, has led to its implementation at a policy level, thus favoring consolidated practices at national level for psychosocial risks management into organizations.

At European level, in the late 70s, there was a development of theories and approaches including psychological and social aspects to the management and prevention of workers’ health and well-being (7, 33). The application of the risk management paradigm in this area represents a key step (8) which led to the identification of a taxonomy of psychosocial risks. This taxonomy, promoted by the European Agency for Safety and Health at Work (14), has favored the recognition of psychosocial risks as main sources of WRS and their inclusion in the assessment and management of OSH risks. This model was then integrated into a European framework for the management of psychosocial risks into organizations (32), involving most of the European countries. Then, research activity on psychosocial risks has been more and more focused on investigating those aspects connected to demographic changes (active aging, gender differences, migration and work), and to the new way of working, by accepting the challenge of offering updated knowledge, models and tools based on the changes in the world of work.

At policy level, in 1989 the European Framework Directive 89/391/EEC on OSH established the obligation of employers to assess and manage in a preventive manner all types of OSH risk, including psychosocial ones (20). This opened to the development of follow-up policies and procedures that have deepened the topic of managing psychosocial risks in the workplace over time. In particular, a turning point is represented by the signing of the two European framework agreements on WRS and on harassment and violence at work, respectively in 2004 and 2007. Such agreements have contributed to clarify definitions and methods linked to psychosocial risk management, and they have been implemented by the European states in different ways and levels (19, 21, 34).

In addition to the Framework Directive and the subsequent agreements mentioned above, several policies and guidelines relevant to the topic and applicable at European level have also been developed over time (some of the main ones are shown in Figure 1). These include both legally binding tools (including national regulations, directives, decisions and legislative acts) and other kinds of policies that are developed by recognized national, European and international organizations, including those with a non-binding or voluntary nature (e.g. agreements, recommendations, guidelines). Such tools have influenced the development and adoption of practical intervention actions over time, and they have raised awareness among institutions, stakeholders and organizations (34). The legal and policy development in this field has boosted the development of models, approaches and practical tools oriented to psychosocial risk management into the organizations, confirming itself as one of the main drivers for the management of psychosocial risks (16). Among these, we highlight guides, methods and practical tools, such as those developed in order to respond to the need of carrying out an assessment for the implementation of effective interventions, tailored to the specific critical issues.

Among others, a national example is the Management Standards model of the Health and Safety Executive (24), which was also adapted to the Italian context.

Moreover, among the European actions, we highlight reports and tools from institutions as Eurofound, Eu-OSHA, Senior Labour Inspectors Committee (SLIC), that provide open data, information and good practices useful to raise awareness and adoption of different level actions among the main stakeholders (social parties, organizations, managers, prevention figures, workers).

Among these, it is worth mentioning the prospectical survey on working conditions (EWCS), the European Survey of Enterprises on New and Emerging Risks (ESENER), the Online interactive risk assessment platform (OiRA), and the numerous awareness campaigns carried out.

The Italian case

As shown in Figure 1, the national developmental process approaches and mirrors the European one, from which it received impulse on the three levels under analysis. At research level, the first multidisciplinary approaches to OSH date back to the 70s, following the recognition of the existence of an interaction between environmental, physical and human factors in the workplace, through the diffusion of an ergonomic approach to work (23). Through ergonomics applied to work, centrality was given to the human being, with his abilities, perceptions and psycho-physical development, and this laid the foundations of the modern concept of prevention, that integrates contributions from different disciplines (medicine, psychology, engineering, biology, etc.).

During the same years, the National Body for Accidents Prevention (ENPI) pushed the first multidisciplinary interventions at practical level in the analysis and assessment of the work environments and related risks. This was done through the creation of interdisciplinary groups composed of engineers, doctors, chemists and psychologists (23). This multidisciplinary approach was then formalized into the National Health System through the 1978 health reform (Italian Law 833/1978), which introduced different business roles in the Prevention Departments and Local Prevention Services, including those from Occupational Medicine and Occupational Psychology. Several research initiatives have followed over time leading to increasingly integrated knowledge and models in the OSH field, and gradually including the concept of stress and well-being at work. Among these, as non-exhaustive examples, the project Stress at work in enlarging Europe, of which the former Ispesl was partner (25), and the program “Cantieri” from the Department of Public Administration (2) aiming to the development of the organizational well-being in public administration.

Despite the efforts made between the 70s and the 80s to create a multidisciplinary network for OSH management, and several research initiatives put in place, the turning point for the inclusion of psychosocial risk management in Italy came later in 2008, with the Legislative Decree 81/08. This has stimulated an integrated approach to the management of OSH risks, and opened to the integration of European models into the risk assessment. The Legislative Decree 81/08 has made explicit the obligation for the employer to assess and manage the risks associated with the WRS, as well as all other risks, in accordance with the contents of the 2004 European Framework Agreement (39). Then, in November 2010, the Permanent Advisory Committee for OSH developed some indications useful for the assessment of the WRS risk, by identifying a methodological path to support organizations, representing the minimum level requirement of implementation. Given the specific obligation and, even more, the rapid changes in the world of work, it was clear the relevant role of scientific research in providing rigorous contributions on this topic, to develop and update valid solutions and tools to support organizations, and to monitor the management of the WRS in Italy.

Under the normative and political boost, a response at practical level occurred with the development of a consensus document on the assessment, prevention and correction of the harmful effects of WRS from the Italian Society of Occupational Medicine and Industrial Hygiene (5). This aimed to create guidelines on stress at work targeted to occupational doctors working into organizations. Actions from this scientific society have contributed to the creation of an integrated and participatory approach to the management of psychosocial risks by promoting multidisciplinary collaboration. Also the following national initiatives and proposals were based on multidisciplinarity, especially the WRS risk assessment of the “Interregional Technical Coordination of Prevention in the Workplace” and the “National Network for Prevention of Psychosocial Distress in the Workplace”, both published in 2010. After that, the Department of Occupational Medicine of the former Ispesl has made an effort to integrate European models with national experiences, also adapting its proposal to the national regulatory requirements, in order to achieve a solid and integrated proposal for the assessment and management of WRS risk (27, 30). Thanks to an international and national network, specific research activities have been conducted through a multidisciplinary group. Through, firstly, the participation to the PRIMA-EF and PRIMA-ET projects and then a close benchmarking examination of European models on psychosocial risk management, the multidisciplinary group came to the definition of a methodological path based on the Management Standards Model (27, 30). The wide diffusion of this methodology has ensured over time the activation of national and international monitoring (28, 29, 15, 17, 18), which has also made it possible to push research activities towards current issues related to changes in the world of work, in order to integrate and update psychosocial risk management also at a national level.

The Inail methodology for the assessment and management of WRS risk: strengths and impacts

The INAIL methodological proposal offers a scientifically founded and dynamic process, consisting of four phases and supported by validated assessment tools (3, 40, 43). The process is based on the risk management paradigm to the WRS (8). This continuous process starts from the identification of problems and the estimation of risk and identifies resources, strategies and actions that are essential to correct and prevent it. The object of the assessment are psychosocial factors that may constitute a risk for the emergence of WRS and that are integrated, in this proposal, in the overall prevention system, allowing the organization to manage WRS risk as all other OSH risks (30, 38). In addition to the evidence based process and tools used, several aspects have proved decisive in practice for an effective WRS risk management. A first aspect relies on the active involvement of workers, management and the entire prevention professionals, as key referents in the OSH protection. Such participative approach, also recalled at European level (13) and confirmed by scientific evidence (11, 37), is essential for an effective risk identification, and for raising a process of awareness and effective change within the organization. A second aspect is related to the multi-method approach to the risk assessment. By its very nature, WRS risk requires a multi-method (checklists, questionnaires, focus groups) and multi-source (objective and verifiable data, qualitative data, perceptions) assessment. Beyond the minimum legal requirements, the Inail methodology provides for two assessment phases, with different related tools and sources of information (preliminary and in-depth) allowing for a better identification of risk and, consequently, a better definition of management interventions, as contextualized and adapted to the specific problems.

Finally, the presence of a free to use online platform for organizations allows for the systematic collection of data, which makes it possible to analyze the tools’ reliability in a self-improvement view, as well as to identify updated cut-offs based on the distribution, allowing organizations to define their risk levels based on the national criterion.

The Inail methodological proposal is currently the most used at national level (29). A recent data monitoring on the online platform shows about 8,000 organizations registered, and a significant number of checklists and questionnaires filled-in (16,443 checklists, 177,972 questionnaires and 27,500 homogeneous groups of workers). National monitoring from the ESENER survey highlighted a decrease from 2009 to 2014 in the concern reported by the interviewees regarding the presence of psychosocial risks in the organization, and a strong improvement in actions and procedures to manage psychosocial risk, in particular with respect to work-related stress (12). This trend registered a slowdown from 2014 to 2019 (18), emphasizing the reflection on the predominant role of legislation as a driver for psychosocial risk management in organizations (16).

Research activities related to the Inail methodology are currently pursuing on three main fields. The first concerns the need to contextualize the methodology to critical sectors, starting with healthcare (28). Studies currently in progress are focussing on the modular nature of the methodology that allows for the integration of additional tools and dimensions, which can be useful for contextualizing the assessment and management of psychosocial risks. The results will provide an integrated methodological proposal, in compliance with the proper time needed for solid and significant results. Another study asset is oriented towards the need to facilitate moving from an assessment perspective to an intervention perspective. It is worth noting that the aim of an effective WRS risk prevention process is the identification and, above all, the implementation of adequate interventions for managing and preventing organizational and work problems emerged. However, moving from the assessment to the risk management is not easy to do, and this requires investigation and development of practical tools to support organizations. Such tools should favor the identification of effective and targeted interventions and bridge the gap between assessment and intervention.

Role of the Occupational Physician: perspectives and opportunities

With the inclusion of the management of risks related to WRS in the risk assessment, it became necessary to integrate the traditional activity of occupational physicians with their active contribution to the prevention of psychosocial risk factors and their related impacts, with an integrated and participatory approach to workers’ health.

As required by art. 25 paragraph 1 letter a of the Legislative Decree 81/08, occupational physicians collaborate with the employers along with the entire steering group, in the assessment of the risks related to WRS, and in the planning of the measures to be activated for health management and protection. This participation can become more active through the support for training activities on WRS, the collection of information and data for the filling-in of the checklist, and the management of in-depth assessment tools, such as the semi-structured interview and the focus group, in consideration of the role and skills of the occupational physician. Over time, it has been clarified that the current regulatory provisions do not provide for an explicit obligation of health surveillance for workers exposed to WRS risk, since interventions on work design and work organization aiming at reducing or limiting the risk at source must be privileged. However, it should be considered that art. 41 paragraph 1 letter b of the Legislative Decree 81/08 provides for the possibility of conducting extraordinary medical examinations for WRS upon request by the worker. Moreover, in those organizations using the Inailcheck-list for the preliminary assessment, every request for extraordinary medical examination coming from the worker, even if not related to stress, is a sentinel event and must be registered and collected.

Finally, we should not forget the contribution of the occupational physician to the management of individual cases that may emerge from risk assessment, including the management of absenteeism events, since they could constitute possible WRS outcomes.

As part of their activities, occupational physicians can also offer a valid contribution to the evaluation of work ability in integration with the aspects of work design and work organization, also in relation to the increase of workers’ age and for the promotion of active aging at work.

Occupational physicians can also contribute, promote and participate in organizational initiatives for health promotion with regard to stress related diseases, and with particular attention to gender and age differences, disability management, and with a corporate social responsibility perspective.

In the current Covid-19 emergency, the role of occupational physicians in psychosocial risks management is fundamental for their capability in anticipating specific OSH needs linked to significant work changes and potential psychological and social impacts.

In this regard, it is worth noting that the Italian Society of Occupational Medicine (SIML) has recently delivered a distance learning course on the role of the occupational physician in the management of the risk of infection from SARS-CoV-2. This aimed to provide an update to occupational physicians on technical and scientific aspects associated to the pandemic and operational recommendations on the management of aspects related to the emergency, including psychosocial ones. In the context of psychosocial risk management, occupational physicians, as global consultants for OSH protection, have the tools and skills to understand and anticipate transversal risks. From the perspective of a multidisciplinary approach, they should therefore be involved, from the beginning of the preventive process of risk assessment and management in the organization (1).

Discussion

This work offers an in-depth analysis on the topic of psychosocial risk management in OSH, through a reflection on how actions at research, policy and practice level are integrated and mutually influenced over time, in European and Italian contexts.

The process of inclusion in OSH of the interaction among workers and the aspects of design, organization and work context was then outlined, starting from the origins in the research field, and exploring how the knowledge obtained was then translated into policies, up to the current state of management in organizations. On the basis of the same analysis level used (research, policies, practice; Figure 1), the needs and perspectives for future developments in this area remain to be identified.

Starting from the consolidation of existing knowledge, it is necessary and effective to address emerging risks by continuing to translate the knowledge obtained from research into policies having a leading role in the identification and implementation of practical actions and tools. Failure to achieve integration among such three levels has been shown to produce a slowdown in the development process over time.

An example comes from Italy, where the impetus on a multidisciplinary approach between the 70s and 80s, due to the introduction of ergonomics at work and the interdisciplinary groups in the national health system and institutions, did not result in an integrated approach to psychosocial risks management until 2008. That year, a driving action at political level led to the Legislative Decree 81/08. At a policy level, carrying out continuous monitoring is essential to identify new and emerging needs to be covered with new regulatory tools. It is also essential to adapt binding policies to the changes that have taken place over time, but also to integrate them with non-binding or voluntary policies that have proven effective in the transition to practice (34, 35). An example comes from the impetus given at European level by the framework agreement on the WRS, which has been implemented by most European countries in different level national actions (19, 21).

At a research level, one of the main current issues concerns demographic changes in the workforce. The aging workforce, the greater presence of women at work and the increase in immigration bring about specific needs for managing OSH and the need for integration and changes in practices and occupational policies.

The same applies for changes in the world of work due to the rapid technological development, and also to the increase in speed, flexibility and job insecurity, which occurred with the advent of the gig economy and zero-hour contracts.

The increase of sharing platforms able to provide immediate services in every part of the world, the increase of temporal and spatial flexibility at work, the introduction of innovative systems, even complex as robotics and artificial intelligence, require in-depth analysis in terms of impacts on OSH prevention, to develop models and solutions for a sustainable working life.

As regards work flexibility, the current Covid-19 emergency has given a strong impetus to the study of the implications in terms of OSH and productivity, because of the large number of workers working completely or partially from home. This experience will also provide useful elements for policy development in OSH prevention, by addressing issues such as work organization, working by objectives, and right to disconnect, in order to encourage the introduction of innovative organizational models.

As regards the models for psychosocial risks assessment and management into organizations, from a research point of view, it appears fundamental to explore aspects related to the identification and implementation of interventions, also through effectiveness studies aiming to verify the findings and to explore the strong points of the process. The aim is to propose solid and practical tools to support organizations, as was done for risk assessment, to facilitate the identification of effective and targeted interventions.

At a practical level, based on previous experience, it is necessary to focus on improving monitoring systems to share comparison data available, at international level as well, with all the parties involved in OSH research and development, also to raise the level of awareness through campaigns focussing on specific needs and topics.

Finally, it is worth noting the need for providing contextualized models and tools, and flexible solutions, targeted to critical aspects of some contexts (healthcare, public administration), and small enterprises complexities (4).

No potential conflict of interest relevant to this article was reported by the authors