TEORIJA IN PRAKSA let. 54, 2/2017 209 Jožica ČEHOVIN ZAJC, Andrej KOHONT* IMPACTS OF WORK INTENSITY ON EMPLOYEES’ QUALITY OF WORK, LIFE AND HEALTH Abstract. In Slovenia, work intensity (i.e. temporal, emotional and work-related demands) is increasing and already exceeds the EU average. In this paper, a public opinion poll about work, family and health con- ducted on a representative sample of 1,082 citizens of Slovenia reveals the negative impacts of work intensity on the quality of work, life and health. The key finding is that employees who experience a higher level of work intensity suffer a deterioration of health and are simul- taneously less likely to be able to afford the time needed for health care due to their work obligations. Keywords: work intensity, health, quality of life, quality of work Introduction Work is an important economic, social and psychological ingredient of human life. It provides income for employees and their families; it can help them socially with group identification, and can provide satisfaction and a sense of accomplishment, achievement and success (Burke et al., 2010). Due to the current prevailing focus on its economic effects, further under- lined with the recent social and economic crisis, work is becoming ever more intensive. This can result in negative effects, like ill-health and dissatis- faction. Therefore, it is relevant to analyse the impacts of work intensity on workers’ health and the quality of their life and work. The aim of this research is to examine the impacts of work intensity on workers’ health and quality of life and work. First, we want to determine if there is any difference in the level of work intensity among workers with different types of employment contract (occasional, part-time and full-time employees). Second, we are interested in work intensity impacts on employ- ees’ health. Third, we also want to find out if the level of work intensity dif- fers among groups of workers that practise presenteeism and continue to work despite being sick. In the final part of our analysis, we are interested in whether and how work intensity is correlated with the quality of life, work- ing conditions and reasons for continued employment. ČLANKI * Jožica Čehovin Zajc, PhD, Assistant, Faculty of Social Sciences, University of Ljubljana; Andrej Kohont, PhD, Assistant Professor, Faculty of Social Sciences, University of Ljubljana. TEORIJA IN PRAKSA let. 54, 2/2017 210 Jožica ČEHOVIN ZAJC, Andrej KOHONT In order to understand the practical implications of this research, it needs to be said that managers may find the study useful in assessing the effects of work intensity in organisations and in leadership activities on one hand, and on the other health policy-makers may use the results to better under- stand the causes of broader aspects of occupational diseases. Literature review Previous research conducted in Slovenia has shown an increase in work intensity (Svetlik, 2006: 22; Stanojević, 2006: 157–182; Kanjuo-Mrčela and Ignjatović, 2013). Employees in Slovenia today work much more than they used to. Comparatively large groups of permanently employed Slovenian workers are overburdened with work, and the load is more heavily trans- ferred to fixed-term workers than in other countries, especially marginal groups of younger workers (Stanojević, 2006: 174–176). Compared to the EU-27 average, Slovenia has higher work intensity, higher presenteeism and a higher rate of work despite being sick (Kanjuo-Mrčela and Ignjatović, 2013). Moreover, the latest Eurofound (2015) research shows that in Slove- nia more workers work under tight deadlines and at very high speed, more of them work in excess of 40 hours per week in their main jobs, and often work more than 10 hours a day. It is evident that Slovenian management still relies on workers who ‘work hard rather than smart’ and, according to Svetlik (2006: 22), this cannot be the basis for success. According to Kalleberg (2013), work intensity, i.e. control over the pace and scheduling of work, is one of the dimensions of job quality. A lot of research has been done on work intensity in the context of work qual- ity (Boxall and Macky, 2014; Kalleberg, 2013; Svetlik, 1996: 163). Hence, work intensity is a construct which is not yet well developed, defined and researched from the perspective of its probable consequences (Fiksenbaum et al., 2010: 81, Fairris, 2004; Burke et al., 2010). Authors of various studies suggest that work intensity is made up of different dimensions: pace, effort and affect (Green, 2004), time demands (longer work hours), emotional demands (levels of job stress) and job demands (greater workloads) (Burke et al., 2010), high working speeds, tight deadlines or insufficient time to complete a job (Boisard et al., 2003: 18, Ozutku and Altindis, 2013), role overload, time demands, and hours worked (Boxal and Macky, 2014). Moreover, there are many similar concepts in the literature that describe work intensity. Some scholars use the term “working hard” to determine work intensity as comprising a time component (hours worked) and an intensity perspective (intensity of the effort at work) (Ozutku and Altindis, 2013; Burke et al., 2010; Stanojević, 2006). Work intensity is also often per- ceived as an effort-related activity, “the rate of physical and/or mental input TEORIJA IN PRAKSA let. 54, 2/2017 211 Jožica ČEHOVIN ZAJC, Andrej KOHONT to work tasks performed during the working day” (Green, 2001: 56) or the “speed of work” (Burchell and Fagan, 2004). Scholars from various backgrounds and disciplines have used different theories to capture aspects of this phenomenon (Burke et al., 2010). In the neoclassical tradition, the conflict is resolved through market forces – the worker is a seller of effort, and the employer is a buyer (Fairis, 2010). In a Marxian tradition, market forces play no role. Instead, the domination of labour by bosses resolves the conflict of interest between capital and labour over the level of work intensity (Fairis, 2010). When managing human resources and the quality of the work process, two perspectives stand out: One is the technical aspect, which focuses on productivity. The other is the individual, the human aspect that focuses on the person and ensures that they are positively affected. Historically, work intensity has been crucial in ensuring that production goals are met. How- ever, the 1950s saw the arrival of theories that emphasise the humanisation of work and the happiness of employees. Three theories should be empha- sised – theory Y, theory X and theory Z. McGregor’s theory Y (1960) refutes Taylor’s Scientific Management according to which what matters are primar- ily the work’s result, productivity and performance (theory X). Moreover, he emphasises the importance of the person as well as the result. Ouchi (1981) builds on these findings in Theory Z, adding the importance of employees’ quality of work life, interpersonal relations and employees who are capable of making decisions. Boxal and Macky (2014) compare the effects of work intensity on employee well-being, and emphasise the importance of including work intensification in the assessment of employee well-being. Work intensity has emerged as a considerably more powerful and consistent predictor of work and health outcomes than hours worked (Burke et al., 2009). Based on the literature reviewed, at the individual level, work intensity has mainly negative outcomes for employees – poorer well-being in terms of fatigue, job-induced stress and work-life balance (Boxal and Macky, 2014; Aleksić et al., in press), insomnia, irritability, burnout, turnover and sickness (Burke et al., 2010), physical exhaustion and mental stress (Green and Mcintosh, 2001), and in terms of lower job satisfaction (Burke et al., 2009), especially in a coercive, non-rewarding work environment (Burke et al., 2010). Positive outcomes for both the employee and the employer (e.g. increased satisfaction and work engagement) are possible with intrinsic employee factors, such as a strong psychological desire to work intensely, in a work environment that is conducive to personal effort and aligned with individual needs (Burke et al., 2010). Consequences of work intensity not only affect an individual’s well-being but also their families, organisa- tion, co-workers and society (Burke et al., 2009; Burke et al., 2010; Boxal TEORIJA IN PRAKSA let. 54, 2/2017 212 Jožica ČEHOVIN ZAJC, Andrej KOHONT and Macky, 2014). Work intensity factors are significant predictors of work- to-family conflict factors (Ozutku and Altindis, 2013) and the work-life bal- ance (Boxal and Macky, 2014; Aleksić et al., in press). A more recent study by Aleksić and co-authors (in press) revealed a three-way interaction: when perceived time pressure (one of the key dimensions of work intensity) and leader-member exchange on creativity are high, satisfaction with work-life balance is high, positive outcomes of high creativity may be the result. How- ever, work intensity is positively related to work outcomes (op. the ques- tion is, whether in the long run as well?) and negatively related to psycho- logical well-being (Burke et al., 2009). Beside lower levels of psychological well-being (job stress, exhaustion, work-family conflict, and psychosomatic symptoms), respondents reporting greater work intensity also indicated higher levels of potentially problematic job behaviour, such as perfection- ism and non-delegation (Burke et al., 2009). At the organisational level, two contrasting sets of outcomes are possi- ble. First, these negative psychological and physiological effects threaten the smooth and efficient functioning of the organisation and, eventually, its financial viability. Much of the research regarding long working hours has called for organisations to take note and deal with negative outcomes such as stress, burnout and turnover (Burke et al., 2010). Second, given the appro- priate context, hard work can be satisfying for employees who are moti- vated by such pressure, and there may be associated organisational rewards for the individual and productivity gains for the organisation (Burke et al., 2010). Overall, Burke et al. (2010) theorise that work intensity is influenced by two interrelated sets of determinants: those internal and those external to the employee. An employee can be intrinsically motivated to work ‘hard’ because of personal factors, such as being a workaholic. The external or environmental variables that determine the work context, such as organi- sational values, may affect work intensity. The most extreme consequence of work intensity is “karoshi”. This Japanese term is used to describe death resulting from work overload (Burke et al., 2010). In a European context, ‘burnout’ is used to describe long-term exhaustion and reduced interest in work as a psychological sickness of very productive individuals with higher goals, who are willing to work more due to intrinsic factors and not the influ- ences of others. Burnout is the final state where the adaptive processes have failed, and individuals change their attitudes and behaviour towards co- workers, work and the organisation. While every person deals with stress, burnouts are common among those who start their career with enthusiasm and have higher goals and expectations (Brill, 1984). TEORIJA IN PRAKSA let. 54, 2/2017 213 Jožica ČEHOVIN ZAJC, Andrej KOHONT Methods This study analyses data from the latest Slovenian research about the work environment and health, the Slovenian public opinion SJM 2011/1 (Hafner-Fink et al., 2011) which was carried out on a random representative sample (N = 1082) of adult Slovenian inhabitants between March and June 2011. For the analysis, only the subsample of employed respondents was used. Work intensity was measured with the following indicators about work on a 5-point Likert scale, with 1 meaning I completely disagree, and 5 mean- ing totally agree: a) Today I work far more than I did a decade ago; b) I do not have time for work outside my primary job to improve my living stand- ard; c) I am overburdened by the amount of work I have to do at my job – work overload; d) I am constantly under time pressure at work; e) I work in unsafe and/or unhealthy working conditions; f) I do physically demanding tasks at work; and g) My work is stressful. The indicators had an approxi- mately normal distribution (skewness and kurtosis coefficients between -1 and +1). A principal component analysis (PCA) was conducted on seven items with an oblique rotation (direct oblimin). The Kaiser-Meyer-Olkin measure confirmed the good (according to Field, 2009) sampling adequacy for the analysis (KMO = 0.74). All KMO values for individual items were above the acceptable limit of 0.5. Bartlett’s test of sphericity (χ² (28) = 833.24, p < 0.001) indicated that correlations between items were sufficiently large for PCA. An initial analysis was run to obtain the eigenvalues for each component in the data. Two components had eigenvalues exceeding Kaiser’s criterion of 1 and in combination explained 51.8% of the variance. The first component explains 35.8% of the variance. It consists of indicators that measure a bigger amount of work tasks than a decade ago, time shortage for additional work after the primary job, work overload, constant time pressure and stressful work. The common feature of these indicators is a psychical perception of work intensity. The second component explains 16.0% of the variance. It consists of two indicators that measure physical, unsafe and unhealthy work intensity – unsafe and/or unhealthy working conditions and physically chal- lenging tasks at work. The results showed moderately positive correlations among those two components (Pearson r = 0.205, p ≤ 0.001). Respondents with higher physical unsafe and unhealthy pressures feel more psychical intensity and vice versa. Those with lower work intensity on the physical level have lower physi- cal, unsafe and unhealthy work intensity. These results suggest that we can also speak of a one-dimensional structure of work intensity. Based on this and due to the relatively high reliability of all seven indicators (Cronbach TEORIJA IN PRAKSA let. 54, 2/2017 214 Jožica ČEHOVIN ZAJC, Andrej KOHONT x = 0.392α = 0.743, N = 7), principal axis factoring (PAF) was used to form one common factor that consists of all seven of the above-mentioned indicators. The main part of this study relies on the results of the Pearson corre- lation test between work intensity and individuals’ health, quality of life, working conditions and reasons for staying in their organisations. To reveal the differences in work intensity between occasional, part-time and full-time employees, we used a one-way ANOVA. To reveal the differences between levels of work intensity among groups of workers that practise presen- teeism and could or could not receive health care because they could not afford to be absent from work due to work obligations, we used a t-test for independent samples. Results Work intensity and type of employment contract First, we wanted to know which workers, depending on their type of employment contract, had the highest work intensity. We focused on the differences in work intensity among occasional, part-time and full-time employees. The results of the one-way ANOVA show that occasional work- ers work significantly more intensely than part-time workers (p = 0.003) and even more than full-time employees (p < 0.001). On the other hand, there is no significant difference in work intensity between part-time and full-time employees. On a scale from 0 (the lowest work intensity) to 1 (the highest work intensity), part-time and full-time employees work at an average level of intensity of 0.1, while occasional workers work at a much higher intensity level, at the level of 0.7. Work intensity and health The next part mainly focuses on the correlations between work inten- sity and health, quality of life, working conditions and reasons for con- tinued employment. If we look at the correlation between work intensity and health, Pearson’s test showed that lower work intensity results in bet- ter health, whereas higher levels of work intensity contribute to ill health. Respondents with a higher work intensity have, in the previous four weeks, more frequently experienced health-related issues at work or when doing household chores and felt physical pain. They statistically significantly con- sider their health as poorer and are unsatisfied with it. TEORIJA IN PRAKSA let. 54, 2/2017 215 Jožica ČEHOVIN ZAJC, Andrej KOHONT Impacts of work intensity on employee’s quality of work, life and health Table 1: CORRELATION BETWEEN WORK INTENSITY AND HEALTH Work intensity Pearson r p N Having trouble working at job or doing chores at home due to health problems in the last 4 weeks 0.275** 0.000 497 Experiencing physical pain in the last 4 weeks 0.213** 0.000 496 Self-evaluation of personal general health 0.138** 0.002 497 Satisfaction with personal health -0.121** 0.007 498 Source: Hafner-Fink et al. (2011). Presenteeism and absence of health care and level of work intensity Further, we examined the differences in work intensity among workers who have not sought medical care due to their work obligations. The results of the t-test for independent samples showed that respondents who have not received healthcare because they could not afford to be absent from work (t = 2.295; p = 0.026) had a statistically higher work intensity (x = 0.392) than those who did not have problems due to receiving healthcare because of work obligations (x = 0.001). Work intensity was measured on a scale from 0 – the lowest to 1 – the highest work intensity. Work intensity and quality of life An examination of the correlation between work intensity and quality of life showed that a higher work intensity also significantly influences the amount of free time, satisfaction with the material welfare of one’s family, and work satisfaction. Individuals with a higher work intensity have much less free time, and are less satisfied with their jobs and the material welfare of their families. Individuals with a higher level of work intensity are less happy in their lives in general, they feel more depressed, they are unsatis- fied with how they spend their free time and they are not going to work cheerfully. They also feel they cannot overcome their problems and they are losing their self-confidence. TEORIJA IN PRAKSA let. 54, 2/2017 216 Jožica ČEHOVIN ZAJC, Andrej KOHONT Table 2: CORRELATION BETWEEN WORK INTENSITY AND QUALITY OF LIFE Work intensity Pearson r p N Quantity of free time in the last year? -0.309** 0.000 494 Happiness with family’s material status -0.232** 0.000 498 Happiness with the job -0.227** 0.000 498 Feeling unhappy or depressed in the last 4 weeks 0.210** 0.000 497 Being happy to go to work at current job every day -0.208** 0.000 495 Being happy with the way of spending free time -0.197** 0.000 498 Rating of general level of happiness in life 0.180** 0.000 495 Feeling of not being able to overcome personal problems in the last 4 weeks 0.157** 0.000 497 Deterioration of self-confidence in the last 4 weeks 0.089* 0.047 496 Source: Hafner-Fink et al. (2011). Work intensity and working conditions The correlation between work intensity and working conditions shows that individuals with a higher level of work intensity are also significantly more often overburdened by their work obligations, they appraise that they give to their organisations more than they receive in return, and that their organisations expect more knowledge than they can possess. All of these correlations are strong. Individuals with a higher level of work inten- sity work more hours per week, and are willing to work even more only for higher payment. On the other hand, organisations that appreciate their employees’ needs, take measures and actions to balance their work and family lives, and consider employees’ suggestions for improvements have lower work intensity. Table 3: CORRELATION BETWEEN WORK INTENSITY AND WORKING CONDITIONS Work intensity Pearson r p N Having difficulties by coping with the many different assignments at a job. 0.510** 0.000 496 Giving more to the organisation than organisation gives to me. 0.404** 0.000 487 Higher expectations of employer than personal abilities. 0.368** 0.000 497 TEORIJA IN PRAKSA let. 54, 2/2017 217 Jožica ČEHOVIN ZAJC, Andrej KOHONT Work intensity Pearson r p N The organisation’s management appreciates the employees’ needs. -0.256** 0.000 484 The organisation has taken measures to balance work and family life. -0.253** 0.000 468 Average working hours per week? 0.216** 0.000 475 The organisation adequately responds to its employees’ improvement suggestions. -0.136** 0.003 473 Being only prepared to work more for higher pay. 0.134** 0.003 493 Source: Hafner-Fink et al. (2011). Work intensity and reasons for continued employment Regardless of the working conditions, all of the surveyed employees remain in their organisations. The survey does not include the ones who could not cope with their working conditions and left their organisations. This is because the survey’s questions only focus on the workers’ current place of employment. Table 4: CORRELATION BETWEEN WORK INTENSITY AND REASONS FOR CONTINUED EMPLOYMENT Work intensity Pearson r p N Primarily working at the organisation out of necessity. 0.259* 0.000 493 One of the main reasons for staying in the organisation is a feeling of moral obligation. 0.254** 0.000 490 Not having enough alternative options to leave the current organisation. 0.235** 0.000 490 Feeling that leaving the current organisation would be too stressful. 0.218** 0.000 487 Source: Hafner-Fink et al. (2011). Another aspect this study aims to discover is the correlation between work intensity and reasons for staying in the organisation. Employees with a higher level of work intensity are most likely to stay in their current organi- sation out of necessity, a sense of moral obligation, a lack of opportunities to leave, or because they find it too stressful to leave their current organi- sations. All of these correlations are statistically significant and moderately strong. TEORIJA IN PRAKSA let. 54, 2/2017 218 Jožica ČEHOVIN ZAJC, Andrej KOHONT Discussion On an individual level, work intensity has a strong negative impact on workers’ quality of work, life and especially health. In fact, it appears to be inversely proportional to workers’ health. This is of particular concern given the results showing that work intensity also affects one’s ability to access health services. This is especially true for the most intense workers who cannot afford to leave work to visit their doctor and can potentially face serious health problems as a result. Presenteeism, therefore, negatively affects one’s access to health services and can in turn lead to a deterioration in health. While many authors (Aronsson and Gustafsson, 2005; Drew et al., 2005; Schultz and Edington, 2007; Bergstrom, 2009; Schaufeli et al., 2009; Bocker- man et al., 2010; Škerjanc and Fikfak Dodič, 2015) highlight a negative cor- relation between presenteeism and poorer health, much fewer studies have addressed the lack of access to health services as a result of presenteeism (Hargrave et al., 2008; Mandiracioglu et al., 2015). We would emphasise that this is an aspect that tends to be overlooked, but it is certainly not insig- nificant as it contributes to workers’ poorer health. In the future, the subject should be further considered and possible ways to improve the situation should be explored. Further, our research shows that work intensity is also affected by the availability of free time. Workers who work longer hours tend to be less satisfied with their own material status. Therefore, more work does not contribute to an improvement in one’s material status. High work intensity and dissatisfaction with material status also increase general dissatisfaction with life and raise feelings of depression; they reduce self-confidence and individual ability to solve everyday problems. The results confirm previous findings (Bonde, 2008; Burke et al., 2009; Fiksenbaum et al., 2010, Ozutku and Altindis, 2013) and are consistent with the current results of the Europe- wide Eurobarometer survey on working conditions (Eurobarometer, 2014) showing that, among mental health problems associated with work, stress, depression and anxiety are the most important. In an organisational context, the results suggest that employees who work intensively are often lost in their work tasks, feel they contribute more than they receive, work more hours a week and are prepared to do even more hours for higher pay to improve their material status. This is a vicious circle in which people work more and more in order to earn a little more, while their health deteriorates due to the higher work intensity, as demon- strated in some previous research (Arlinghaus and Nacreiner, 2013). If we connect the above with the previously mentioned lack of access to health services, it may be concluded that workers who work more tend to place TEORIJA IN PRAKSA let. 54, 2/2017 219 Jožica ČEHOVIN ZAJC, Andrej KOHONT a low additional income above their health, forego visiting the doctor, and allow their health to deteriorate. By increasing the intensity of work, organisations negatively affect their workers’ health. Our research results are consistent with previous find- ings (Paediker et al., 2006; Arlinghaus and Nachreiner, 2013; Burke et al., 2009, 2010; Boxal and Macky, 2014). Although workers persist in working for these organisations, that is mainly because their options to find other work are limited or they remain in the organisation because of a sense of moral obligation. The exacerbated economic situation has reduced employ- ment opportunities in the labour market and paralysed workers. Occasional workers are specially burdened by work within these frameworks. On the other hand, there is also positive side. Organisations that have a lower intensity of work respect the needs of their employees, take meas- ures to reconcile work and family life, and take employee suggestions for improvements into account. Similar findings were highlighted by several studies (see Boxall and Macky, 2014; Dollard et al., 2014; Boisard, 2003; Ozutku and Altindis, 2013). This study also has some limitations. It is difficult to measure effort or work intensity objectively; it can only be determined through self-reports, or extraordinarily well-controlled laboratory experiments (Burke et al., 2010). The extent of the relationship between work intensity and health can only be established by using longitudinal data relating to the changing states of health and work (Boisard et al., 2003). The study was limited to the available secondary data of the cross-sectional study and the methodology is focused only on the direct influences of work intensity on the health, quality of life and work of employees. As we were using secondary research, we were limited by the scope of the data available. Further, health deterioration, qual- ity of life and work may all have several occupational and non-occupational causes (Boisard et al., 2003). Therefore, this study is only a superficial reflec- tion of the effects of work intensity and further studies in this field should include more in-depth and longitudinal analyses. Conclusion The present study holds important implications for health promotion in the workplace. It should encourage managers and human resource (HR) professionals to pay more attention to health promotion and workers’ health, and to place it above work intensity. If they were working smarter, by taking the health status and needs of workers into account and reducing the negative effects of intensive work, their organisations’ long-term results would definitely improve. Changes in the direction of greater humanisation of work are certainly not possible without changes to the organisational TEORIJA IN PRAKSA let. 54, 2/2017 220 Jožica ČEHOVIN ZAJC, Andrej KOHONT culture. This culture of well-being must be based on management bod- ies’ active involvement in programmes that contribute to reduced work intensity and enhance workers’ health on a daily basis, which requires the coordinated work of HR professionals and managers. Detecting stressors and eliminating them, monitoring presenteeism and its causes, improving labour relations, particularly the close monitoring of workloads and better reconciliation of work and family life are only a few of the measures that can help improve the situation. They must be substantiated by the adoption of action programmes that involve the participation of managers, HR man- agers, workers and workers’ representatives. For the field of public health and preventive reduction of occupational and other work-related disease states, our results showing that workers do not access health services due to labour intensity and presenteeism are the most alarming. In this way, workers are deteriorating their own health. To improve the situation, more prevention programmes focusing on employ- ees’ health are needed. It is vital that they are implemented by the workers’ representatives and employers/HR professionals who would motivate work- ers to attend regular check-ups. The measures to improve health in the work- place currently applied in Slovenia in collaboration between employers, trade unions and health professionals are recording good results. The situa- tion might be further improved by creating systematic preventive examina- tions of employees, which would be carried out at predetermined intervals. These measures would benefit all stakeholders – employers, workers’ repre- sentatives, employees, state representatives and health representatives. For further research, besides fluctuation and absenteeism, the evalua- tion and monitoring of presenteeism and its consequences for health are needed. Especially important are the links between presenteeism and acces- sibility to health services. 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