Safety Science 49 (2011) 565–574

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Safety Science
journal homepage: www.elsevier.com/locate/ssci

New tools and strategies for the inspection of the psychosocial working
environment: The experience of the Danish Working Environment Authority
Mette Bøgehus Rasmussen a,*, Tom Hansen a, Klaus T. Nielsen b
a
The Danish Working Environment Authority, Arbejdstilsynet, Tilsynscenter 1, Postboks 1288, 0900 København C, Denmark
b
Centre for Working Environment & Working Life, ENSPAC, Roskilde University, Hus. 08.2, PO Box 260, DK-4000 Roskilde, Denmark

a r t i c l e i n f o a b s t r a c t

Article history: In 2007 the Danish Working Environment Authority launched a new strategy to strengthen and qualify
Available online 13 August 2010 primary prevention of work related stress. Part of the strategy consists of increased inspections of the
psychosocial working environment as well as the development and implementation of a new inspection
Keywords: tool, namely the ‘‘guidance tool”.
Labour inspection tools Twenty-four sector specific guidance tools have been developed to help WEA inspectors assess psycho-
Psychosocial working environment social working environment problems in all Danish enterprises. Based on recent research, the guidance
Psychosocial hazards
tools consist, in each sector, of the three to five most important risk factors (for example quantitative
Working environment legislation and
regulation
demands, emotional demands, and work related violence), as well as the most important preventive fac-
Work related stress tors, e.g. quality of management, influence/control and training.
During the first years of the strategy, an increasing number of inspectors have issued improvement
notices regarding work related stress and violence, and there has been an increasing number of notices
issued on several risk factors. For some aspects, the tools have helped increase the clarity and compre-
hensibility of the improvement notices and reduce the WEA’s time consumption per enterprise.
The guidance tools seem to be a suitable and efficient way of assessing several health and safety risks
concerning work related stress and violence thereby allowing the WEA to detect more of the existing
problems. Future challenges projected for the strategy include continuously training all WEA inspectors
in the proper use of the tools and continuously refining the tools – or developing new tools – based on
further research and experiences from practice.
Ó 2010 Elsevier Ltd. All rights reserved.

1. Introduction
Work related stress is a known contributor to physical and psy-
chosocial health problems as well as an increasing economic bur-
den for enterprises and society (European Foundation for the
Improvement of Living and Working Conditions, 2007; Leka and
Kortum, 2008). Furthermore, many enterprises experience work
related stress and psychosocial working environment (PWE) issues
challenging (e.g. Gensby et al., 2008a,b) and they are considered
complex matters to handle in a regulatory framework (Black,
2001; Johnstone et al., 2008).
According to Hansen et al. (2009), problems related to PWE are
a source of concern in many Western countries. At the same time,
their literature review found that the actual inspection and regula-
tion of PWE was far from commonplace. In their policy oriented
discussion on psychosocial hazards, Leka and Kortum (2008) point
out that ‘‘. . .despite developments of policy in this area, there still ap-
* Corresponding author. Tel.: +45 70121288; fax: +45 70121289.
E-mail addresses: at@at.dk, mbra@at.dk (M.B. Rasmussen), ktn@ruc.dk
(K.T. Nielsen).
pear to be a broad science-policy gap and an even broader one be-
tween policy and practice” (p. 294), however Leka and Kortum do
not suggest authority inspections as a mean of regulation. In a sim-
ilar vein, Lippel and Quinlan point out that ‘‘A number of jurisdic-
tions have developed instruments for the prevention and
management of workplace violence (Chappell and Di Martino, 2006)
and bullying/harassment (Einarsen, 2000; Lippel, 2005) but few have
provided legislative tools specifically adapted to the management of
psycho-social risk factors associated with work organisation. . .”.
The current paper addresses the development and use of a leg-
islative tool specifically developed and adapted by the Danish
Working Environment Authority (WEA; the Danish labour inspec-
tion) for the assessment of psychosocial risk factors at work. The
aim of this paper is to examine experience, results and challenges
of the development and implementation of this ‘‘guidance tool” as
seen from the perspective of the WEA by which two of the present
authors are employed.
In 2004, the Danish government committed itself to a new
prioritisation of the working environment for the period of
2005–2010 with PWE being one of four targeted areas
(Arbejdstilsynet, 2005). To implement the priorities, the WEA

0925-7535/$ - see front matter Ó 2010 Elsevier Ltd. All rights reserved.
doi:10.1016/j.ssci.2010.06.002
566 M.B. Rasmussen et al. / Safety Science 49 (2011) 565–574
launched a new strategy in April 2007. Among others, an organisa-
tional change took place with a view to increasing the focus on
PWE (see Section 4). Part of the strategy was the development
and implementation of a guidance tool which aims to assess six
risk factors in the PWE in order to help inspectors assess the
PWE: Quantitative demands (workload, pace of work); emotional
demands (contact with clients/customers/citizens); risk of violence
and threats; traumatic experiences; night and shift work; and bul-
lying and sexual harassment.
As we shall see later, the underlying objective of the tool was
not to enable inspectors to identify all PWE-issues in an enterprise,
e.g. relational conflicts or employeeś (lack of) career development
opportunities (see explanation for this omission and discussion of
the implications of this strategy in Sections 2 and 6). Rather, the
strategy aimed at increasing inspectorś opportunities to find
the most common PWE problems during inspection, including
the more ‘‘simple” categories such as the risk of violence. The tool
also sought to make more complex PWE problems like quantitative
or emotional demands manageable for inspectors (as well as for
the enterprises) by focusing attention on the specific work taking
place, e.g. by addressing specific consequences of (high) quantita-
tive demands such as employees reporting problems in keeping
the required level of service when having a heavy workload or very
high pace of work.
Our paper traces the implementation of the guidance tool for
regulating PWE in the Danish context. The guidance tool has been
developed in, and is to be used in, a particular context. Therefore,
we begin (in Section 2) by describing the following aspects of the
Danish context: Actors in the health and safety field, legislation,
and political and cultural background. In Section 3 we present
the theoretical and empirical background for the tool, followed
by the strategy for implementing the tool in Section 4 (that is,
PWE related activities and new ways of inspection). Experience
and preliminary results are presented in Section 5 and are dis-
cussed in Section 6. Future challenges are examined in Section 7.
Links to relevant aspects of the Danish PWE-inspection, an Eng-
lish version of the guidance tool, the legal provisions concerning
PWE, inspection flow, etc. are available at (Danish Working Envi-
ronment Authority, 2010a) http://synkron.at.dk/sw74437.asp.
2. PWE in its Danish context
Denmark is a European country with a population of about
5.5 million people, of whom about 2.3 million people are employ-
ees. There are about 200,000 enterprises with employees. Of these,
there are about 150,000 enterprises with less than 10 employees.
There is more than a century long tradition for co-operation be-
tween public authorities and the social parties (employer’s associ-
ations and unions) on the public regulation of occupational health
and safety, or as what is known in Scandinavia as the working envi-
ronment (Koch and Nielsen, 1998). This context can be summa-
rised as:
2.1. Actors in the field of the working environment
The Minister for Employment has the supreme authority in work-
ing environment matters and has the authority to impose the
Working Environment Act (cf. Arbejdsmiljøloven). As an agency
under the auspices of the Ministry for Employment, the WEA
supervises enterprises by drawing up rules and providing informa-
tion on the working environment. The WEA has the authority to
penalise enterprises which do not comply with the working envi-
ronment legislation.
In the Working Environment Council, the Social Parties influence
the making of new rules and plans for the working environment.
Complaints against WEA rulings with reference to the working
environment legislation may be brought before a Working Environ-
ment Appeal Board which includes representatives of the social
parties.
A vital element in the regulation is the enterpriseś own efforts to
improve health and safety conditions. This effort is facilitated by a
permanent working environment organisation comprised of both
management and mandatory elected working environment repre-
sentatives in workplaces with more than 10 employees.
At an intermediary level eleven trade safety committees have
been established to strengthen the sector oriented activities of
the social parties, e.g. through information and guidance. Finally,
there is a liberal market for private occupational health and safety
consultants who provide professional assistance to enterprises on
various working environment matters. However, under certain cir-
cumstances the WEA can issue a consultancy notice that requires a
workplace to seek assistance from a certified occupational health
consultant (cf. Section 4.2).
2.2. The history, legislation and regulation on PWE
The Danish Working Environment Act is a framework Act,
which lays down the general objectives and requirements in rela-
tion to the working environment. Overall, the Act states that ‘‘the
work shall be planned, organised and performed in such a way as to
ensure safety and health” (Arbejdsmiljøloven, paragraph 38, Sec-
tion 1). The frame of the Act is ‘‘filled” out by a series of executive
orders on the major aspects of the Act. Relevant to PWE are exec-
utive orders on e.g. performance of work and the design of the
workplace (Danish Working Environment Authority, 2010b)
http://synkron.at.dk/sw12160.asp.
Regulating and inspecting PWE has a fairly long history in
Denmark:
In 1974 a major reform to an almost all-encompassing Working
Environment Act was passed. It has been amended several times
since, most thoroughly in 2004. Regulating PWE has been on the
agenda – more or less – since before the 1974 reform; well being
was discussed in a commission report that came out just before
the reform. And although the Act (or its legally binding ‘‘com-
ments”) specifically exempts well being from legal regulation, the
formulations of the Act concerning health mean that PWE is not
exempted. The fine (some would say elusive) line between well
being and PWE seems to have moved over the years to allow for
more legal regulation in the field.
In 1994, the Minister of Labour organised a committee – dubbed
the Methods Committee – to clarify the roles of the various actors
in the field of regulating PWE. The committee had representatives
from unions, employer’s organisations and the Ministry of Labour,
including officials from the WEA.
The committee submitted a report (Rapport fra et af arbejds-
ministeren nedsat udvalg, 1995) that covered various aspects of
the regulation of PWE, including a number of key conclusions:
 That PWE problems should primarily be solved by the enter-
prises themselves through co-operation between management
and employees.
 That the organisations in the labour market (unions and
employers associations) have an important role to play in pre-
venting and solving PWE problems (both points are just reiter-
ating the general rules, see Section 2.1 above).
 That labour inspection is involved in uncovering the causes of
PWE problems, but only intervenes in relation to problems related
to the individual’s work situation (our marking, see below).
The report also discussed difficulties in assessing and docu-
menting risk factors. When people experience PWE problems and
 M.B. Rasmussen et al. / Safety Science 49 (2011) 565–574 567

these are acknowledged by the WEA, further investigation is re-
quired; and it is recommended that any reaction from the WEA
should require an ‘‘objective ascertainable cause”.
In its recommendations, the committee divided the risk factors
into two main groups based on their root causes:
The first group comprised psychosocial factors which are linked
to the working situation of the employees and whose cause must
be sought in working processes or methods, the products used or
the psychosocial context in which work is performed. The most
important factors concerning the focus of this paper are the
following:
 Work related violence.
 Traumatic experiences.
 Emotional demands (work with people under certain
conditions).
 Quantitative demands (heavy workload/fast pace of work on a
more than temporary basis).
 Working alone.
 Night and shift work.
 Demand (Workload, pace of work). High or low demand is a
stressor.
Based on the NRCWE research and the recommendations by the
Methods Committee on regulating PWE the guidance tool primar-
ily focuses on demands, influence/control, and social support.
Obviously other factors are relevant for PWE too, but in developing
the guidance tool, the WEA focused on the elements relevant to la-
bour inspection in the Danish context, i.e. the psychosocial factors
which are linked to the working situation of the employees (the
first group above).
The conceptual framework underlying the guidance tool could
be described as an extended Karasek model (Model 1) (Karasek
and Theorell, 1990):

The second group encompassed the psychosocial problems

which are a direct result of managerial decisions or the relations
between either management–workforce or between members of
the workforce, as well as factors arising from situations outside
the enterprise. These factors do not arise directly or indirectly from
an employee’s working situation and include wages, salaries and
pensions, promotion, influence on managerial decisions, and job
uncertainty when a company is scaling down as a result of market
conditions.
If the WEA considers that a psychosocial risk factor in an enter-
prise belongs to the first group, it may investigate with a view to
requiring the enterprise to find a solution to the problem. On the
other hand, if the risk factors belong to the second group they
are no longer to be seen as the concern of the WEA. At the same
time, the WEA are empowered to handle bullying and sexual harass- The model highlights the importance of looking both at the spe-
ment at work, irrespective of its causes. cific demands in a given job and which means of control the em-
The report had no formal legal status but, as we shall see soon, ployee has of his/her work conditions – in the model below
still plays an important role in the regulation of PWE in Denmark. translated into the resources made available by the enterprise to as-
Relevant to this paper is its influence on the development and sist the employee in fulfilling the job demands (Model 2).
implementation of the guidance tool, which we turn to next.
The following presents how empirical and theoretical inspira-
tions have been combined to create the ‘‘balance model” underly-
ing the guidance tool.

3. Empirical and theoretical background for the guidance tool

Research from the National Research Centre for the Working

Environment in Denmark (NRCWE) has identified six key elements
of major importance for the PWE (based on COPSOQ, 2003; Kris-
tensen et al., 2005) – in Denmark often referred to as the golden
nuggets:
 Influence/control over one’s own work and working conditions.
Low influence/control is a stressor. High influence/control is a
growth factor.
 Meaning at work. Low meaning is a stressor. High meaning is a
growth factor.
 Reward (Wages, career, appreciation/recognition). Low reward
relative to the effort is a stressor. High reward relative to the
effort is a growth factor.
 Predictability, Relevant information about important plans and
changes. Low predictability is a stressor.
 Social support from managers and colleagues. Low social sup-
port is a stressor. High social support is a growth factor.
The concept of resources in the guidance tool is a broader con-
cept relating to influence/control. It also consists of e.g. support
from collegues and management, practical help, help with prioriti-
sations, clear tasks and expectations, training, and a balance be-
tween quantity and quality on the one hand and time available
on the other hand (see discussion of prevention in Section 6).
Furthermore, the tool is based on the risk management ap-
proach for managing the working environment (Gensby et al.,
2008a; Leka et al., 2008; Mackay et al., 2004). That is, a focus
on the organisational rather than individual level, a participatory
approach (which, here, means that the purpose of the tool is to ac-
cess the ‘‘local knowledge” of the employees and managers; i.e.
the guidance tool is designed as questions for employees and
management), and that the factors being assessed should cover
the most important and prevalent PWE risk factors in a given
568 M.B. Rasmussen et al. / Safety Science 49 (2011) 565–574
sector. These considerations lead to the following six risk factors
being in focus:
 Quantitative demands (workload, pace of work).
 Emotional demands.
 Work related violence.
 Traumatic experiences.
 Night and shift work.
 Bullying and sexual harassment.
These risk factors are characterised by being both prevalent in
many sectors and by being within the realms of what the WEA
are entitled to inspect. Using the risk factor approach, the aim of
the inspections become to assess if and how a given risk factor is
present in an enterprise and which means the enterprise uses to
assure that the risk factor is either eliminated, reduced or handled
to prevent health risks. This way, in the guidance tool, ‘‘demand” is
translated into ‘‘prevalence of risk factor” and ‘‘resources” are
translated into ‘‘prevention”.
The focus of the inspection is to assess whether there is a bal-
ance between the prevalence of the risk factor and the prevention
measures taken by the enterprise. In making this assessment, the
inspector can use knowledge about the consequences of problems
in the psychosocial working environment that can be measured on
an organisational level, e.g. low quality, high turnover and high
sickness absence (Dollard et al., 2007; Roozeboom et al., 2008).
When introducing the risk factor approach and organisational con-
sequences the balance model is as follows (Model 3):
Thus, the PWE risk factors combined with the extended Karasek
model and the risk management approach are translated into the
guidance tool consisting of three parts:
1. On the left side are questions aiming at assessing the prevalence
of the risk factor.
2. On the right side are questions aimed at assessing the measures
the enterprises take to prevent that the risk factor becomes a
health risk.
3. At the bottom are questions aimed at assessing organisational
consequences related to the specific risk factor.
On the next page (page xxxx) you find an example of the risk
factor violence and threats, from the ‘‘office” guidance tool. Please
note that in the Danish context, the risk factor of violence and
threats primarily encompasses aggression from external parties
(e.g. clients/customers/citizens) whereas the risk factor of bullying
and sexual harassment encompass aggression inside the workplace
(e.g. employee–employee aggression, which in some cases is de-
scribed as horizontal violence; McKenna et al., 2003). A full version
of the guidance tool is available at (Danish Working Environment
Authority, 2010b) http://synkron.at.dk/sw74437.asp.
The idea behind the tool is that the prevalence of risk factors
influences the necessity for prevention, and the level of prevention
has implications for the organizational consequences, which in
turn has implications for the prevalence of risk factors. Thus, more
risks require more prevention while alternatively, more demand-
ing work can be accepted with higher levels of prevention.
In order to make the tool suitable for the specific inspection, 24
separate guidance tools have been developed for different jobs or
sectors, e.g. industry, care, and office work. There are strong simi-
larities in the guidance tools across sectors, but each tool uses the
terms and phrases relevant to that specific job or sector. Moreover,
the specific tool only features the most relevant risk factors for that
job or sector. Workload/pace of work and bullying/sexual harassment
are considered relevant for all sectors which means that these risk
factors are included in all tools. And, for example, in addition to
these two risk factors, the office-tool also contains the risk factors
of emotional demands and risk of violence and threats whereas the
industrial production-tool contains the risk factors of traumatic
experiences and night and shift work.
An evaluation report on the Swedish development of new PWE
inspection methods (Frick et al., 2006) emphasizes the need for a
proper integration of new tools and methods in the existing orga-
nisation and activities in order for the development of PWE regula-
tion to have a long-term impact. The success of implementing the
guidance tools must be seen in, and can only be measured in, the
context of preceding and parallel strategies and activities. We shall
present this context briefly in the following section.
4. PWE related activities and new ways of inspection
4.1. PWE related activities
Since 1995, and more especially since 2007, there has been an
ongoing effort in the WEA to develop PWE related initiatives. The
most important initiatives in this general development could be
summed up in these external and internal activities:
4.1.1. External activities
 A national effort to disseminate information on PWE to raise
awareness and knowledge has been implemented.
 A number of information materials for enterprises have been
published, including a handbook on PWE.
 Inspection campaigns solely focused on PWE have been carried
out in several industries with severe problems in this area
including hospitals, schools and prisons. PWE has also been pri-
oritised in a number of sector focused efforts including home
care, residential institutions, and office work.
 Since April 2007, the WEA is obligated to inspect the PWE in all
enterprises in Denmark with employees. (see below).
 Since April 2007, the WEA has also assisted enterprises in mak-
ing action plans when receiving improvement notices concern-
ing problems in the PWE (this new offer to the enterprises is
referred to as ‘‘process guidance”).
4.1.2. Internal activities
 Skills development projects have been undertaken to improve
the inspectors’ qualifications in relation to inspecting PWE.
Most importantly:
s All inspectors have been trained in using the new tool.
s There have been several courses of training all inspectors in
assessing and evaluating PWE health and safety risks.
 M.B. Rasmussen et al. / Safety Science 49 (2011) 565–574
 The job of inspecting PWE has been organised and made sys-
tematic through:
s Method descriptions and instructions for the inspectors.
s Specific guidelines on methods to use when inspecting PWE.
s Templates are continuously being developed and improved
to assist inspectors in writing improvement notices.
s Best practice examples of improvement notices are made
available for all inspectors on the WEA intranet.
 Special PWE Task forces have been established in each of the
four regional organizational units that constitute the out-going
inspectional part of the WEA. The task forces consist of six to
nine inspectors with specific PWE competence. The task forces’
main assignments are:
s Assisting other inspectors in assessing PWE problems and in
formulating improvement notices.
569
s Inspecting complicated PWE problems.
s Providing process guidance to enterprises that have received
improvement notices.
In sum, the package of activities indicates that the guidance
tools do not stand alone. Rather, a targeted array of activities can
be seen as the WEA’s response to a growing concern for PWE with-
in the WEA itself, the wider professional working environment
community, the public in general – among others demonstrated
by an increased media focus on ‘‘stress victims”, and the parlia-
mentary political system. As mentioned in the introduction, PWE
was one of four targeted areas in the working environment prior-
itisation 2005–2010 of the Danish government. Parallel to this pri-
oritisation, the vast majority of the political parties reached a
welfare agreement in 2007. The overall purpose of this agreement
570 M.B. Rasmussen et al. / Safety Science 49 (2011) 565–574
was to sustain welfare in Denmark by ensuring (employees) later
withdrawal from the labour market, and parts of the agreement
consisted of initiatives concerning working environment. With an
extra appropriation of 70 million Danish kroner (about 13.6 $)
every year in the period of 2007–2010, the welfare agreement pro-
moted the initiatives on PWE. In addition to the initiatives pre-
sented above, the welfare agreement facilitated, among others,
an increase in the numbers of labour inspectors from about 400
to 500 during 2007–2008 and henceforth.
4.2. Inspection procedures
Since the 2004 amendment to the Working Environment Act, all
workplaces are to be inspected on a regularly basis every third year
(the system will be fully operational after 7 years; and workplaces
that have a formal working environment certificate are exempted).
The inspector begins with a ‘‘screening visit”, which can be fol-
lowed by an ‘‘adapted inspection” if the screening gives the inspec-
tor reason for it. Since 2007, the screening includes PWE as an
obligatory point on the agenda. This means that by now almost
all enterprises are inspected in relation to PWE.
If the first screening inspection gives reason for further investi-
gation of the PWE, the ‘‘adapted inspection” assessment can in-
clude several methods of data collection depending on the risk
factor and the information material available at the enterprise.
E.g. the assessment can include data that enterprises provide
through records of sickness absence and employee turnover, regis-
tration of incidents, etc. The WEA can also conduct meetings with
the working environment representatives at the enterprise (repre-
sentatives of both employees and management, cf. Section 2.1), fo-
cus group interviews or individual interviews with employees,
interviews with management, and observations of work. The guid-
ance tools are being used in different parts of the inspection, see
Section 5.1, but especially during interviews with employees and
management.
The model below presents a brief overview of the Danish
inspection flow regarding PWE (Model 4).
Inspection flow concerning
PWE
WEA inspection at the enterprise:
Detect health and safety risk on PWE
Improvement notice concerning PWE
Enterprise makes action plan to solve
PWE-problem (+offer from WEA: Process
guidance on how to make action plan)
WEA evaluates action plan
Acceptance: Rejection:
Enterprise can Enterprise is
continue on sanctioned to get
solving PWE- help from an
problem on its authorized working
own (+ follow up environment
by WEA) consultant to solve
the problem
Most important in the inspection flow is the fact that enter-
prises receiving an improvement notice concerning PWE from
the WEA must firstly make their own action plan for solving the
problem1. This procedure concerning PWE differs from correction
notices relating to other working environment problems in allowing
the enterprise to demonstrate its ‘‘will and ability” to deal with the
problem. If the action plan indicates appropriate and required ‘‘will
and ability” for the enterprise to solve the problem on its own, the
WEA accepts the action plan and the enterprise can continue imple-
menting it. Nonetheless, the WEA procedure is to follow up on the
process and effects of the plan after a period of time. If the action
plan is rejected, the enterprise will receive a consultancy notice with
a view to getting help from an authorized health and safety consul-
tant to solve the problem – based on the assumption that more help
is needed in order for the enterprise to solve the problem.
Evaluating the action plans often involves considerations with
inspection colleagues (e.g. members of the PWE task force) and in-
volves decisions on several factors and parameters. Among others,
the specific elements of the plan are included in the evaluation, as
well as the implementation process and internal aspects of the
enterprise, e.g. the size of the enterprise and its potential for
requesting internal or external consultants. The European Frame-
work for psychosocial risk management PRIMA-EF (Leka et al.,
2008) suggests that successful interventions in organisations
should include versatility of the intervention strategy, involvement
of the employees as well as management, clear structure for duties,
responsibilities, and time-frame, and a systematic and realistic
intervention process that is continuously adapted to the specific
enterprise (see also Holten and Nielsen, 2009). Thus, the WEA eval-
uation of the action plan aims to be in line with some of the key
recommendations made by the PRIMA-EF.
By adding the ‘‘will and ability” step, regulating PWE can be
seen as leaning more to the compliance side than the rest of the
Danish working environment regulation – with reference to the
deterrence–compliance axis discussed in much of the literature
on occupational health and safety regulation (e.g. Ayres and
Braithwaite, 1995; Hutter, 1989, 1997). In regulating PWE, it is
found necessary to give the workplaces more leeway because it
is considered a more complex matter than other regulated working
environment problems.
5. Experience and results
It is still too early to evaluate the full impact of the new tools
and strategies. Nonetheless, based on the first years of the imple-
mentation, the following observations can be made:
5.1. Experience
The guidance tool has been evaluated via a questionnaire which
has been completed by about 100 inspectors and via four focus
group interviews with altogether 32 inspectors from all four regio-
nal Inspection Centres. The evaluation found that inspectors use
the guidance tool for preparing before starting out on visiting a
new sector, before visiting an enterprise, for checking during the
inspection (e.g. to make semi-structured group interviews with
employees) and for evaluation after the inspection whether the
enterprise has violated the Working Environment Act. Further-
more, inspectors use the tool as a template when writing the
improvement notices.
Most inspectors use the tool to support and structure their dia-
logue with the enterprise. They might choose relevant questions or
themes from the tool during the interview, thereby adapting the
1
Most improvement notices are issued on departmental or organisational level
(covering more employees), depending on the risk, size of enterprise etc., though
notices on bullying or sexual harassment can in some cases be issued on an individual
level.
 M.B. Rasmussen et al. / Safety Science 49 (2011) 565–574
tool to the specific enterprise. Sometimes inspectors use the guid-
ance tool openly during the interview though most inspectors do
not – in order to facilitate an ‘‘open” dialogue. A practical observa-
tion is that inspectors often perform group interviews on
PWE-matters in pairs – which facilitate a more fluent shift
between dialogue, ‘‘checking” the guidance tool, and making notes.
Most inspectors emphasize that they find the guidance tool
helpful for investigating and assessing PWE problems. Many
inspectors also reported an increased awareness of, and interest
in, PWE-matters along with increased skills relating to regulating
PWE. At the same time, many inspectors still find PWE more com-
plex to handle than other working environment issues; this is due
to the subject matter as such and because methods and inspection
procedures differ from methods and procedures related to other
working environment problems.
Regarding the enterpriseś response to the new strategies –
according to the inspectors – many enterprises find PWE-matters
a delicate subject for inspection although most acknowledge that
psychosocial issues are important aspects of the working environ-
ment and that WEA inspects this area as well as the physical work-
ing environment.
5.2. Results
This section presents some preliminary quantitative data, gath-
ered by the WEA, relevant to regulation of PWE.
It is always difficult to measure effects (e.g. Cox et al., 2008;
Hansen et al., 2009), and there are several limitations associated
with the following presentation of the preliminary results of the
WEA strategy. Introducing the new ‘‘all workplaces are inspected”
procedures have been made sector by sector. This means data can-
not be compared over time because, for example, hospitals were
predominantly inspected in one period and auto repair shops in
another. Moreover, different kinds of additional sector focused ef-
forts PWE have taken place during certain periods of time which
also affects the types and amounts of notices issued.
With these limitations in mind, there has been a significant in-
crease in the quantity of improvement notices issued since the new
strategy was launched in April 2007: In 2006 the total number of
notices, sanctions, etc. issued on PWE was 245, in 2007 it was
673, in 2008 it was 1053, and in 2009 the number was 767. The
drop in 2009 was related to fewer of the additional efforts men-
tioned above being made, and to the effect of the international
financial crisis (e.g. in some sectors fewer reports of problems with
high work load and in some cases employees being less inclined to
report PWE problems to WEA inspectors during inspections).
Though, overall there has been an increased tendency for PWE no-
tices to be issued and the first statistics for spring 2010 are in line
with this tendency. Also, improvement notices issued on PWE have
gradually been spread to a greater variety of sectors during the last
years.
The increase in PWE-related notices issued is not just a result of
WEA issuing more notices or sanctions overall. In 2005 improve-
ment notices issued regarding PWE amounted to about 2.5% of
the total number of sanctions, notices, etc. issued on all types of
working environment problems whereas the same figure has in-
creased to about 5% since 2007.
The aim of the tool to help WEA inspectors detect both more
‘‘simple” risk factors like the risk of violence and more complex
problems like emotional demands seems to have been par-
tially accomplished. The increased notices issued cover both the
risk factors of violence, traumatic experiences and emotional de-
mands and, to a slightly smaller degree, quantitative demands
and bullying and sexual harassment. The differences in the in-
crease rates indicate that some PWE problems are less accessible
and harder for inspectors to detect than others, and they reflect
571
that the process is still in progress. It has gone some way towards
handling different risk factors but there is still a long way to go.
Considerable human and economic resources have been in-
vested in the new strategy since 2007. But due to the tool, the
training, the risk factor approach and the initiatives of the overall
strategy (PWE task forces, templates, etc.), the WEA’s time con-
sumption of inspecting the PWE regarding the specific workplace
has been reduced. The time reduction concerns both the visits
and data collection at the enterprises and the administrative pro-
cess of writing the improvement notice, which in many ways could
be described as a profit for both the WEA and the enterprise.
And, though preliminary, the tendency seems to be that the
WEA improvement notices are now better at substantiating how
and why a certain PWE-problem involves a health and safety risk
to the employees.
Thus, so far the guidance tool and the new strategy (at least for
some PWE problems) seem to be a suitable and efficient way of
assessing the health and safety risks concerning work related
stress and violence, thereby allowing the WEA to detect more of
the existing problems. Furthermore, since PWE-matters are now
an integrated part of the general inspection in all enterprises the
WEA expects that the continued focus on stress prevention and
PWE contributes to and strengthens the enterprise’s own aware-
ness and capacity for stress prevention.
About 60% of enterprises which receive an improvement notice
have asked for and received WEA’s process guidance regarding ac-
tion plans. When inspectors evaluate the process guidance after
the sessions many of these enterprises describe the WEA guidance
as helpful in planning and implementing their action plan. Among
others, enterprises seem to find guidance on the parameters men-
tioned by the PRIMA-EF for successful interventions in organisa-
tions helpful: E.g. sparring on how to involve employees or
management in the implementation process, and sparring on
how to set up a clear structure for duties, responsibilities, and
time-frame (cf. http://prima-ef.org/default.aspx; Holten and
Nielsen, 2009). Though, it is still too early to evaluate whether
the improvement of the action plans will result in better manage-
ment of the PWE problems on a long term basis.
For the WEA, the process guidance offers a good opportunity for
dialogue with the enterprises on their experiences with regard to
problems in the working environment and their feedback on WEA’s
inspection. Also, the process guidance has turned out to be an
important source of knowledge, in general, on the enterprises re-
sources and difficulties with planning and implementing actions
on PWE problems; which in turn can help the WEA to improve
the guidance on PWE to other enterprises.
6. Discussion
In the prevention hierarchy of primary prevention (directed at
the sources of stress, secondary prevention; directed at making
people able to cope with stress, and tertiary prevention; directed
at helping those suffering from stress related symptoms or dis-
eases), (e.g. Cooper and Cartwright, 1997; LaMontagne et al.,
2007; Leka et al., 2008) there seems to be a tendency for workplace
initiated interventions to belong to the secondary or tertiary level
of prevention (Cooper and Cartwright, 1997). Cooper and Cart-
wright (1997) suggest the reason for this is, among others, that
individual changes are easier to detect and seem less disturbing
than large organisational changes. Public initiatives, however,
seem to be more focused at the primary level; that is at least the
case when we look at national surveillance systems of psycho-so-
cial risk factors in the workplace as reviewed by Dollard et al.
(2007). These systems and the factors they monitor do not in
themselves constitute prevention, but nevertheless their focus
572 M.B. Rasmussen et al. / Safety Science 49 (2011) 565–574
suggests primary intervention rather than secondary and tertiary
intervention.
The same preference for primary prevention can be seen in the
Danish guidance tool. This should not come as a surprise given the
objective of the Danish Working Environment Act that ‘‘the work
shall be planned, organised and performed in such a way to ensure
safety and health” (paragraph 38).
However, elements of secondary and tertiary prevention also
underpin the guidance tool. The prevention part of the tool (focus
on employees’ training, instruction, planning of the work, etc.) indi-
rectly draws on secondary prevention strategies. The assumption is
that through instruction, training, and involving employees in the
planning and prioritisation of the work, workplaces can provide
the employees with some suitable coping strategies. Furthermore,
the risk factors of violence and threats, traumatic experiences,
and emotional demands link up with tertiary prevention, for exam-
ple by addressing the enterprisés preventive actions taken shortly
after an incident as well as follow up on a longer term basis with
a view to rehabilitate the employees with stress related symptoms.
One of the important 2007 innovations in the guidance tool is
that six risk factors are evaluated separately. The old more holistic
approach was that the PWE should be considered in its totality,
and that all improvement notices should cover all aspects of the
PWE (at least those belonging to ‘the first group’ of problems,
namely those linked to the working situation and as such inside
the realm of WEA regulation; cf. Section 2.2). In some cases the
‘‘old” procedure could lead to notices that were 20–30 pages long
– and sometimes even longer. The advantage of these long and
comprehensive notices was that the workplaces in some instances
felt ‘‘more thoroughly understood”. On the other hand, many
workplaces found it difficult to identify which areas were most
important to address in order to comply. Further, the holistic ap-
proach was notably much more time-consuming for both the
workplace and the WEA.
With the new more targeted notices, the advantages and disad-
vantages are reversed: a more focused perspective points out
clearer the essence of the most significant health risk to the enter-
prise whereas some enterprises express that they could have
wished for a more holistic approach. In a wider perspective it is a
question as to whether the risk factor approach strengthen the
enterprises opportunity to handle elements of the PWE or rather
involves a risk of fragmenting the notion of PWE and leave ‘‘holes
between the factors”. For example, whether the WEA covers all rel-
evant PWE problems or risk overlooking hazards that fall between
the factors, for example when more factors have synergetic effects.
A part of this dilemma is addressed by the fact that an enter-
prise can receive more than one improvement notice on PWE or,
two risk factors can be addressed in one notice, if the WEA consid-
ers that the Act is violated on both factors and if there is an inex-
pedient interaction between the two aspects making it important
to address both factors at the same time, for example on both high
workload/fast pace of work and risk of violence and threats. An-
other practical remark relevant for this discussion is that, during
the process guidance, the WEA recommends enterprises to include
other aspects of the PWE in their action plans if the enterprise
should find other risks, initiatives or strategies important in order
to improve the PWE and/or address certain health risks. Though,
the question of risk factor approach vs. holistic approach and the
inherent dilemmas will be interesting to follow in the future.
In a yet wider perspective, the primary function of the guidance
tool is of course to guide the inspector in his or her inspection. But
inspecting is more than just checking whether the working condi-
tions comply with the law or not; it is also a sort of a ‘‘learning sit-
uation” where inspectors aim to develop the ability of the
workplace to prevent working environment problems in the future
(an enforcement style referred to as compliance as opposed to
deterrence in the literature; see Hutter, 1989). The kind of ‘‘learn-
ing” the new tools and strategies facilitate at the enterprise is still
an open question, though, the offer on process guidance aims to
improve the enterpriseś ability to prevent PWE problems in the fu-
ture. Also, the WEA inspections aim at including even more dia-
logue and guidance to enterprises in the new WEA strategy for
2010–2020 (Arbejdstilsynet, 2010).
Finally, the guidance tool has to be measured not only on the
functionality in their daily use, but also in terms of their political
and bureaucratic legitimacy. Regulating an area with a steadily
growing attention from the public, the media, the unions and
employers associations, and the politicians requires good tools.
And so do the expectations that the WEA performs its duties in
accordance with contemporary norms for modern organisations
and public agencies: legality, accountability and cost-effectiveness.
Many perspectives are included in the ongoing evaluation, devel-
opment of, and dialogue on the Danish labour inspection tools.
7. A short conclusion, perspectives and continuous challenges
This paper has told the story of how the guidance tool for PWE
has been developed and implemented so far. The active period of
the tool has been short but the preliminary results suggests that
the tool and the wider WEA strategies have helped inspectors to
detect more of the existing PWE problems in the enterprises;
resulting in an increased number of improvement notices issued
on PWE-matters. Of course, various human and economic re-
sources have been invested in the new strategy but regarding the
specific enterprise the new strategy has reduced the WEÁs time
consumption of inspecting the PWE. And, though preliminary,
the tendency seems to be that the improvement notices are now
better at substantiating how and why a certain PWE-problem in-
volves a health and safety risk to the employees.
So far it seems that the Danish development that makes PWE a
part of the authorities regulation through routine inspections is a
fairly isolated phenomenon. The study by Dollard et al. (2007) sug-
gests there is a certain commonality in the various surveillance
systems related to the PWE that many countries have imple-
mented recently. Similarly, there seems to be a fair amount of con-
sensus when many European countries develop regulation
strategies that try to stimulate companies to take PWE seriously
through establishing best-practice guidance on the management
of PWE. In particular the British ‘‘Management standards” (Mackay
et al., 2004) can be seen as an example, as at least United Kingdom,
Denmark (Gensby et al., 2008a) and Ireland (Gensby et al., 2008b)
have been inspired by these standards. The European Framework
for psycho-social risk management, PRIMA-EF (Leka and Cox,
2008) has, despite few references to the particular ‘‘Management
standards”, parallel visions of management systems that integrate
the PWE-issues into a continuous learning circle. Clearly, such
schemes are an instrument in the regulatory toolbox in Denmark
too (Holten and Nielsen, 2009) – indeed they are active within
the WEA’s inspection strategy; but still the Danish way of inspect-
ing the PWE regularly and proactively stands out.
In Denmark, it is still too early to evaluate the longer-term ef-
fects or consequences of the new tool and strategies. But in the
short run it will be interesting to see the effects and evaluations
of, among others, the risk factor approach and the process guidance
that aims at helping enterprises make better action plans. The eval-
uation of the long term effects is known to be inherently difficult,
anyway, as many studies testify (Cox et al., 2008; Hansen et al.,
2009; Kristensen, 2001), but the further development will be inter-
esting to observe.
The future, though, still holds various challenges for the WEA’s
inspections of PWE: even though most enterprises acknowledge
 M.B. Rasmussen et al. / Safety Science 49 (2011) 565–574
that psychosocial issues are a part of the working environment, it is
important that inspectors know how to introduce the subject to
the enterprises properly and how to explain improvement notices
in a comprehensible way. This can be a challenge to inspectors
with other educational or training backgrounds than psychology.
Thus, a continuous challenge for the strategy is to continue quali-
fying all WEA inspectors in the proper use of the tool, including
continuing to observe the dynamics between generalist and expert
inspectors, and continuously to refine the tool based on further re-
search and experience from practice.
Furthermore, the tool has been developed to help the inspectors
to detect some of the most common and generally acknowledged
PWE problems. In the future other PWE problems might call for
further development of the guidance tool or the development of
different tools and methods for dealing with complex and changing
work arrangements, including boundary-less work (Johnstone and
Quinlan, 2006; Quinlan, 2007; Quinlan and Bohle, 2008; see also
Walters in this issue).
Another important challenge for inspectors is to be able to make
the right evaluations as to whether the enterprise has violated the
law and to write accurate improvement notices. The guidance tool
helps the inspectors determine which data to collect and which
questions to ask, but gives less guidance on how to evaluate the
health risk. To face up to this challenge, all inspectors are continu-
ously being trained to evaluate and assess the specific health risks
in the PWE. For example, to make the inspectors able to recognize
in greater detail that the different elements of the assessment
(prevalence of risk, prevention, and consequences) weigh differ-
ently depending on the risk factor that is being assessed.
Finally, as we have pointed out in our discussion, other chal-
lenges relate to handling the dilemma between the risk factor ap-
proach and the complexity and interaction of the whole PWE in a
given enterprise. And, in the Danish case there is a specific chal-
lenge related to the distinction made between risk factors stem-
ming from different ‘‘root causes” (cf. Section 2.2) – either
directly related to the work or resulting from management deci-
sions or organizational relations.
Labour inspections are important facilitators of healthy working
environments, but at the end of the day, changes have to come
from inside the organisations themselves. New inspection tools
and strategies to improve PWE do, hopefully, play a role in making
many workplaces a better place to work, but they will not do the
job alone. Cf. the debate on the deterrence–compliance axis (Ayres
and Braithwaite, 1995; Hutter, 1997) the question relates to how
different means of ‘motivation’ or management systems interact
in substantiating improvements in the PWE at the enterprise. E.g.
whether governmental regulation is considered necessary for sup-
porting (and controlling) enterprises own effort on the PWE, or
whether governmental strategies should rather focus on empower-
ing enterprises by making government tools available for enter-
prises like e.g. the Management standards for Work Related
Stress in the United Kingdom. While some claim that the deter-
rence strategy risks lowering the level of ‘‘minimal requirements”
or demotivate some enterprises, it could also be argued that a
sheer compliance strategy would fail to reach the enterprises
who do not manage to handle the PWE properly on their own
(Gensby et al., 2008a). Nevertheless, the experience of the Danish
Work Environment Authority may well be of relevance to many
similar countries and the results of the Danish strategies will hope-
fully be an inspiration for other inspectorates.
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