Is It Time to Revisit Health Circles to Redesign Jobs for Better Work and Health?

It's not enough to advocate abstract notions of organizational solutions for employee wellbeing.

HR and business-management thought leaders are starting to catch up with 20^th-century research, advocating organizational solutions for employee wellbeing and performance.  These are contrasted with behavioral or individual solutions, which focus on modifying the habits and practices of employees rather than the work they do.

Many of these advocates have never studied or even worked with organizations. So, as examples of organizational solutions, they invoke ill-defined “culture” strategies and commodified adaptations of the values your parents were supposed to teach you, like empathy and respect.

Some propose solutions like greater availability of mental health services that, by the standards of most experts who study employee wellbeing, aren’t organizational solutions (because they’re predicated on the belief that the employee must change, independent of their job conditions and work environment).

Real organizational solutions require changes within the organization, not just organizational support to help workers fix the things some CEO thinks are wrong with them. Change the work, not the worker.

Meanwhile, real-life business leaders have shown little interest in organizational solutions, certainly not to an extent that justifies investing the resources evidence-based interventions require.

But perhaps the rate of employers’ uptake will soon change, as consciousness about worker wellbeing is raised and new research promotes organizational solutions over behavior change (often, unfortunately, presented as a binary choice rather than two components of a comprehensive strategy).

This movement may be accelerated by the release of “Over Work,” the new book by journalist Brigid Schulte, whose previous book, “Overwhelmed,” rigorously untangles the work and home demands of workers, especially women. (Disclosure: I’m a Brigid Schulte fanboy. If you’re in the US and prefer not to buy from companies like Amazon, you can purchase Over Work and Overwhelmed from the Heigh Ho bookstore).

In Over Work, Schulte indicts behavioral interventions:

The piecemeal approaches are certainly easier. They are aimed at both blaming and “fixing” individual workers, as if we just needed to breathe our way out of overwork or our poorly paid jobs and all would be well.

Health Circles

I’ve previously written about health circles, a process in which employees hold facilitated meetings to identify…

• work-related risks to their health

• solutions to reduce risk and improve their health

…with an emphasis on the impact of job demands, job autonomy, and social support.

Health circles culminated in German research in the 1990s. Studies showed that they lead to improve health and productivity through a participatory process of job and work redesign.

Unfortunately, health circles never really caught on – perhaps because, in the end, it’s business leaders (not workers) who are most resistant to change.

I’ve seen little health circle research in the past decade and, to be honest, I’ve yet to hear of an American company that tried health circles. (It’s distinctly possible that American every-man-for-himself culture, typically veiled as personal accountability, clashes with the democratic underpinnings of health circles. We won’t know until we try them.)

I don’t even have reason to believe that health circles ever really took hold in German businesses; the few German workers and managers I’ve chatted with never heard of them.

Now may be the time to revisit health circles.

Keep an eye out for a forthcoming Heigh Ho podcast conversation that outlines key steps to implement health circles. In the interim, the following summarizes a controlled study – one I’ve frequently cited in keynotes and webinars – that serves as a model of health circles’ potential.

Nurses and Aides Improve Work and Wellbeing with Health Circles

A study of nurses and aides in a Canadian hospital offers insight into the intersection of job redesign, psychosocial risk, and employee health.

The hospital used an intervention based on health circles.

A discussion of the entire study is beyond the scope of this article, but I want to at least give you a glimpse, in Figure 1 (below), of examples of job design issues and solutions the health circles identified, leading to changes like:

• New strategies to address overload demands when shorthanded

• Fairer processes for training

• Better communication systems to reduce ambiguity and improve effectiveness

• Improved scheduling

• More autonomy in decision making

• Addressing uncivil or unfair treatment.

(These improvements also give you a sense of the inevitable overlap between job design and best management practices.)

Three years after the changes were made at the hospital, the caregivers reported:

• More satisfactory levels of job demands, autonomy and social support

• Better work quality

• Improved health measures…

  • fewer sleep disorders

  • better overall mental health

  • less burnout.

A control group in the study got worse on almost all the health measures.

Health circles, which may also be considered a form of team-based job crafting, appear to be a scalable, participatory organizational solution that enhances employee wellbeing and performance.

Figure 1. Source: Bourbonnais, R., Brisson, C., & Vézina, M. (2011). Long-term effects of an intervention on psychosocial work factors among healthcare professionals in a hospital setting. Occupational and Environmental Medicine, 68(7), 479-486.

• Read the scientific review that found “health circles have a favorable effect on workers’ health, well-being, and sickness absence.”

• Read a brief summary of the health circles process from Europe’s Psychosocial Risk Management Excellence Framework (PRIMA-EF) Consortium, originally part of the World Health Organization’s Healthy Workplaces Framework.

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RIP Karina Nielsen, (1973 - 2024)

I was reminded of health circles when I heard the recent news about the untimely passing of Karina Nielsen. Prof Nielsen was at the forefront of research into participatory approaches to employee wellbeing and conducted many evaluations of organizational solutions, including health circles. I spotted Prof Nielsen at a Work, Stress, and Health conference a few years ago and was tempted to ask, “Hey, whatever happened to health circles?” but was too self-conscious to approach her. Pro tip: Don’t let your inner gremlins prevent you from seeking wisdom from brilliant, generous role models. You may not get another chance.