Healthy approach to absenteeism

Sweden is not in as good shape as its clean and shiny image might suggest. DeeDee Doke finds out what employers and the government are doing to cut the high cost of staff on sick leave

At the Stockholm headquarters of Sweden’s Folksam insurance company, employees can help themselves to two free pieces of fruit from the canteen each day. Later in the day, they may want to take a dip in the company pool, work out with weights or on a treadmill in Folksam’s exercise rooms, or play hockey in its court-sized gyms.

Elsewhere in Stockholm, workers at oil company Svenska Statoil are planning to participate in a weekend midnight run, which will earn them points with their employer towards prizes or cash bonuses.

To non-Scandinavians, such activities and philosophies seem to mesh well with the image of strapping good health that Swedes have long embodied. Inside Sweden, however, the truth is at odds with the stereotype: too many workers are taking too many days off sick, reducing productivity and driving sick pay expenses through the roof for both the government and employers.

In 2002, the Swedish Government paid out SK48.5bn (£3.61bn) in sickness leave and in 2003, SK48.6bn (£3.62bn). Long-term illness or disability compensation cost the government SK9.9bn (£3.72bn) in 2002, and SK58.5bn (£4.36bn) in 2003.

For the government, improving workers’ health has become a national priority as well as a business imperative.

“It was so obvious we had to do something,” says Jan Gronlund, state secretary at the Ministry of Industry, Employment and Communications. Gronlund’s area of responsibility includes the labour market and the ‘Working Life’ policy.

Around 1997, Gronlund says, the cost of sickness absence started to increase dramatically. The government’s attention at that point, however, was focused on reforming the country’s pensions system, and several years passed before the looming health problem was addressed.

In 2001, the Social Democrat government introduced a framework for a ‘health at work’ strategy. Among the actions taken was the formation of the Swedish Work Environment Authority, intended to reduce risks of ill health and accidents in the workplace. The authority is also charged with improving the work environment in terms of physical, psychological, social and organisational issues, some of which represent previously unexplored territory for the Swedish Government, Gronlund says.

An extended plan of action to achieve healthier working lives for Sweden’s workforce was further agreed by the government in conjunction with two other political parties, the Left Party and the Green Party. This collaboration led, late last year, to a ‘declaration of intent’ to promote and achieve a healthier working life. Under the new measures, employers will take on added financial responsibility for long-term illnesses (see box, right).

For HR departments, the message has been clear – high absenteeism is a business issue that affects the bottom line. HR will have to develop the right policies for getting ailing workers back to work and then keeping them there.

“Two years ago, the top managers at our bank did not talk about these matters. It was not on the agenda at all,” says Gunnel Blomberg, who oversees staff health and workplace issues in the HR department at major Swedish bank Foreningssparbanken. Now, Blomberg says, HR is “clearly on the map”. The bank is placing greater responsibility on line managers and staff council health committees to monitor and act on employee health issues.

“It’s all down to how you manage health matters,” says Blomberg. Her company has introduced health-related measures into its existing ‘balanced scorecard’ approach to measurements, of which a key aspect has been making managers understand “that this is a problem that costs”.

At Foreningssparkbanken, the amount of sickness-related absence doubled between 1998 and 2002. In the past year, it has dropped from 4.8 per cent to 4.4 per cent.

“That may not seem like much, but it has taken a lot to get there,” Blomberg says. By this year’s end, it is hoped that figure will drop to below 4 per cent. The ultimate target is 2.5 per cent.

Blomberg acknowledges that her team does not have all the answers yet, but a number of important questions have surfaced that need to be addressed: Why, for instance, are women over-represented in sickness-absence figures? And why do some departments at the bank have higher rates of absenteeism than others? The latter issue may be down to employees in some areas having less control over their workload or environment than elsewhere, Blomberg says.

At Svenska Statoil, sickness-related absenteeism has dropped from 6.8 per cent in 2001 to 3.3 per cent in 2004. The biggest portion of the drop – from 5.9 to 3.3 per cent – occurred between 2003 and 2004, says HR director Eva Widen.

Svenska Statoil has a gym and offers activities such as aerobics and hockey at its Stockholm headquarters, and for employees based elsewhere, the company provides up to SK1,000 (£75) a year in gym membership subsidies – for which the company gets tax relief. Every employee is entitled to a half-hour massage each month from a visiting chiropractor. And a ‘hunting for points’ incentive programme rewards workers who exercise, with more awarded for participating with colleagues than for solo activity.

Although such incentives may be responsible for part of the rapid decline in sickness-related absence, Widen also attributes Svenska Statoil’s success to a greater emphasis on monitoring and managing employees who regularly call in sick. These employees are asked to meet with their manager and an HR representative to discuss the problem and possible solutions, which might even mean a new job. “It is good to just sit down and talk about it,” says Widen, with some understatement.

Folksam, which prides itself on providing a healthy, happy work environment, has also placed considerable importance on meeting with employees who are either on long-term sick leave or who regularly take a day or two off, claiming illness. Every employee who was on long-term sick leave and those who had racked up more than five sick-leave absences in a year were called in for discussions with a manager and HR.

“We have to understand what was behind their absence,” says Birgitta Rennerstam, head of HR. “We want them to whistle when they come to work, and if they like Folksam and their job, they are going to do a much better job.”

Folksam found that such discussions also encouraged many employees who had been on long-term sick leave to return to work at least part-time.

The company provides each employee with a health profile and guidance regarding diet and exercise – all on a voluntary basis. And line managers are being trained to watch for early warning signs of sickness absenteeism patterns or stress.

“By having an early interview, the manager can determine the real problem, and see what opportunities need to be sorted out, instead of the solution being a sick-note for the staff member,” says Rennerstam.

Even Swedish contact centres are launching their own good-health campaigns for body and spirit. When Excellent SNT pays for team outings as a reward for a job well done, alcohol is not part of the equation. Family events are sponsored by the company, and like many other companies, Excellent also subsidises membership of gyms or other health-related activities.

In the workplace, Excellent has introduced health promotion measures such as hydraulic desks that allow workers to stand up to work during their shifts.

“You are bound to your place during work,” says managing director Johan Johansson says. “That’s why we are so keen on getting them to exercise. You have to do more than just change positions.”

However, much of the sickness-related absence problem involves mental stress – a factor which has been rising in the past five to seven years, says Stefan Melander, of Sweden’s Salaried Employees Union (HTF), which represents workers in the private sector. Employers’ continual cost-cutting drives are a major contributor, he claims.

While Melander agrees that such benefits as subsidised gym memberships are worthy steps to improve workers’ health, he also says that some of that focus needs to be redirected. “The problem is, when they focus on individual behaviours, they forget about the work environment. You have to change how organisations work,” he says.

Ultimately, Gronlund believes that solutions to long-term illness and stress-related absences must be developed through a Swedish version of joined-up government – co-operation between labour market officials, authorities overseeing the sickness insurance programmes and the state employment offices.

“Today, we see too many barriers between these authorities,” he says.

A healthier working life

The goal: Halving sickness-related absence from work from 2002 to 2008.

  • From 1 January 2005, employers are being called on to help the state finance employees’ sickness allowance costs in the following ways:

  • Employers will pay, via a special sickness insurance contribution, 15 per cent of the sickness allowance paid to their employees

  • The period of sick pay (from the employer) will be reduced from 21 to 14 days

  • The employer will be encouraged to take active measures to reduce sickness absence. Therefore, the employer co-financing will not apply if the employee receives preventive sickness allowance, participates in rehabilitation that qualifies for rehabilitation compensation, or returns to work to a certain extent

Obliged to report sickness

As of July 2003, employers are required by Swedish accounting law to report sickness absence. That means that sickness absence data must be included in the annual report and that the reporting must be comparable for private companies, municipalities, county councils and government authorities.

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