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Office design's impact on sick leave rates

Authors:
  • School of Architecture, KTH Royal Institute of Technology
  • Stress Research Institute, Stockholm University

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Unlabelled: The effect of office type on sickness absence among office employees was studied prospectively in 1852 employees working in (1) cell-offices; (2) shared-room offices; (3) small, (4) medium-sized and (5) large open-plan offices; (6) flex-offices and (7) combi-offices. Sick leaves were self-reported two years later as number of (a) short and (b) long (medically certified) sick leave spells as well as (c) total number of sick leave days. Multivariate logistic regression analysis was used, with adjustment for background factors. A significant excess risk for sickness absence was found only in terms of short sick leave spells in the three open-plan offices. In the gender separate analysis, this remained for women, whereas men had a significantly increased risk in flex-offices. For long sick leave spells, a significantly higher risk was found among women in large open-plan offices and for total number of sick days among men in flex-offices. Practitioner summary: A prospective study of the office environment's effect on employees is motivated by the high rates of sick leaves in the workforce. The results indicate differences between office types, depending on the number of people sharing workspace and the opportunity to exert personal control as influenced by the features that define the office types.
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Ergonomics
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Office design's impact on sick leave rates
Christina Bodin Danielssona, Holendro Singh Chungkhama, Cornelia Wulffb & Hugo
Westerlunda
a The Stress Research Institute, Stockholm University, SE-106 91 Stockholm, Sweden
b The Psychology Department, Stockholm University, Stockholm, Sweden
Published online: 27 Jan 2014.
To cite this article: Christina Bodin Danielsson, Holendro Singh Chungkham, Cornelia Wulff & Hugo Westerlund (2014) Office
design's impact on sick leave rates, Ergonomics, 57:2, 139-147, DOI: 10.1080/00140139.2013.871064
To link to this article: http://dx.doi.org/10.1080/00140139.2013.871064
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Office design’s impact on sick leave rates
Christina Bodin Danielsson
a
*, Holendro Singh Chungkham
a1
, Cornelia Wulff
b2
and Hugo Westerlund
a3
a
The Stress Research Institute, Stockholm University, SE-106 91 Stockholm, Sweden;
b
The Psychology Department, Stockholm
University, Stockholm, Sweden
(Received 10 June 2013; accepted 22 November 2013)
The effect of office type on sickness absence among office employees was studied prospectively in 1852 employees working
in (1) cell-offices; (2) shared-room offices; (3) small, (4) medium-sized and (5) large open-plan offices; (6) flex-offices and
(7) combi-offices. Sick leaves were self-reported two years later as number of (a) short and (b) long (medically certified) sick
leave spells as well as (c) total number of sick leave days. Multivariate logistic regression analysis was used, with adjustment
for background factors. A significant excess risk for sickness absence was found only in terms of short sick leave spells in the
three open-plan offices. In the gender separate analysis, this remained for women, whereas men had a significantly increased
risk in flex-offices. For long sick leave spells, a significantly higher risk was found among women in large open-plan offices
and for total number of sick days among men in flex-offices.
Practitioner Summary: A prospective study of the office environment’s effect on employees is motivated by the high rates of
sick leaves in the workforce. The results indicate differences between office types, depending on the number of people sharing
workspace and the opportunity to exert personal control as influenced by the features that define the office types.
Keywords: office design/office type; sick leaves; employees; prospective study; gender
1. Introduction
Although the different negative effects of sickness absence is fairly well researched (see, e.g. European Commission 2002;
Milczarek, Schneider, and Rial Gonza
´lez 2009; Mustard, Lavis, and Ostry 2006), there is a lack of studies concerning
the determinants of sickness absence among white-collar workers, despite the fact that they make up the majority of
the workforce in the Western world today (Brill et al. 2001; Duffy 1999). In particular, the possible relationship between the
physical office environment and sick leave rates is under-studied. We know from empirical studies that absenteeism is
related to job characteristics such as high work demands, poor job control, monotonous work and so on. (e.g. Allebeck and
Mastekaasa 2004; Karasek and Theorell 1990; Vahtera, Pentti, and Uutela 1996). There are gender differences in sickness
absence both in terms of risk factors (e.g. Kivima
¨ki et al. 2007; Krantz 2003) and rates, with higher rates among women
(Blank and Diderichsen 1995; Niedhammer et al. 1998).
When investigating the office environment’s impact on employee health and well-being, the concept of personal control
is of special interest since the need for personal control over the surrounding environment is considered fundamental for
human well-being (see, e.g. Rothbaum, Weisz, and Snyder 1982; Ward 2012). Personal control is strongly related to office
employees’ environmental satisfaction (Bodin Danielsson and Bodin 2009), as well as perception of privacy (Haans,
Kaiser, and de Kort 2007; Kupritz 1998) and distraction (Lee and Brand 2010). In the increasingly ubiquitous open-plan
offices, the latter two factors are combined with noise and often hard to satisfy. The latter is considered the major stressor in
open-plan offices when perceived as ‘irrelevant sound’ (Banbury and Berry 2005), with negative effects on both health
outcomes and cognitive performance (Evans and Johnson 2000; Jahncke et al. 2011; Liebl et al. 2012). Since privacy
besides acoustic also includes visual privacy, the architectural design of the office, including workstation design and office
layout, is important (Charles and Veitch 2002; Lee 2010; Marquardt, Veitch, and Charles 2002). Office layout is highly
related to office types; hence their defining features are important when investigating the office environment’s possible
impact on employees’ health and well-being.
There are to our knowledge only a few studies that have investigated the office environment’s relation to health among
office employees, and sick leaves specifically. Differences in health status between employees in various office types have
been found, with the best health among those in flex-offices and cell-offices, and the worst in medium-sized open-plan office
(Bodin Danielsson and Bodin 2008). The explanation for the equally good health in the former two, very different, office
types could be that they both enable personal control, albeit through different means. In a Dutch study, in which the
researchers followed a company’s move from cell-offices to flex-offices (called ‘innovative office’ in the article) over a
q2014 Taylor & Francis
*Corresponding author. Email: christina.bodin.danielsson@stressforskning.su.se;info@stressforskning.su.se
Ergonomics, 2014
Vol. 57, No. 2, 139–147, http://dx.doi.org/10.1080/00140139.2013.871064
Downloaded by [Kungliga Tekniska Hogskola] at 07:25 11 March 2014
period of 15 months, it was found that employees reported better general health and less complaints concerning upper
extremities after the move (Meijer, Frings-Dresen, and Sluiter 2009). Here, the authors explained the result by the extra
efforts put into the ergonomics of the workstations in the new flex-offices. Concerning gender differences, a cross-sectional
study found differences regarding in which office types men and women reported the highest stress levels (Bodin
Danielsson 2007). With regard to sick leave, a large longitudinal study found that employees in cell-offices reported lower
rates than those working in open offices with more than six people (Pejtersen et al. 2011).
Beside the scarcity of health-related office research, there are substantial shortcomings in the existing office research,
e.g. in most cases the definitions are too vague regarding the office environments studied. Many studies compare cell-offices
with open-plan offices without any recognition of the fact that different types of open-plan offices exist which vary
substantially in their spatial and functional arrangements (Hedge 1982; Pejtersen et al. 2011). In addition, most studies are
post occupancy evaluations after relocation (Kaarlela-Tuomaala et al. 2009; Meijer, Frings-Dresen, and Sluiter 2009)or
cross-sectional (e.g. Bodin Danielsson and Bodin 2008; Bodin Danielsson and Bodin 2009; Bodin Danielsson, Wulff, and
Westerlund in press). A limitation in the former is that the actual shift of environment in itself may have a different impact
on the outcomes than the office environment per se. In cross-sectional studies, no causal relations can be established.
Despite this, the majority of office research is cross-sectional since office environments are difficult to study for a long
period of time because offices, for symbolic reasons, are often relocated or redesigned in connection with the shift of
management and leadership.
To the best of our knowledge, there are only two studies in which office employees’ health has been studied over a
longer period of time in relation to the office environment: Meijer, Frings-Dresen, and Sluiter’s study (2009), which
examined employee health status after a move from cell-office to flex-office, and Pejtersen et al.’s study (2011) of sickness
absenteeism in relation to individuals sharing workspace. However, in the former study, the sample is small (138 subjects)
and only two office types are studied. The second study has the benefit of being a large, longitudinal study; however, the
offices are defined only by the number of people sharing workspace.
The purpose of this article was to investigate whether office type has a prospective effect on employees’ sickness
absence. The environmental factors in an office can be classified as physical, psychosocial and organisational, which may
interact in their impact on employees. Recognising this, this study applies a more comprehensive definition of office type
that in addition to the number of employees sharing workspace also studies the opportunity to exert personal control in the
different office type. Our hypothesis was that sick leave rates differ between office types due to difference in terms of the
two former conditions.
2. Methods
2.1. Sample
Our sample comes from the 2010 and 2012 waves of the Swedish Longitudinal Occupational Survey of Health (SLOSH).
These respondents originally participated in the Swedish Work Environment Survey (SWES) in the years 2003 or 2005,
when they were gainfully employed and 16 –64 years of age. SLOSH is a nationally representative longitudinal cohort study
of work environment and health covering different aspects of the general life situation and working life, including
organisational aspects as well as the physical work environment with questions about office types. The fact that SLOSH
covers office types makes it useful for the purpose of this article. To our knowledge no other large survey does this. The
survey is conducted every second year. Data are collected by paper-and-pencil questionnaires (Hanson et al. 2011;
Magnusson Hanson et al. 2009), but with an internet questionnaire option offered in 2012. Participation is voluntary. In the
2010 wave, 20,291 persons were asked to participate, with a total response rate of 56.8%.
We restricted our sample to those employees who worked at both waves, i.e. in SLOSH 2010 and 2012, and did not
change their job in-between since the objective of the article was to understand the prospective association between office
type and sickness absence. We thus followed the individuals from 2010 and studied the association between the exposure to
office type in this year and the outcome, i.e. sickness absence measured in 2012 and referring to the last 12 months before
the measurement. With these exclusion criteria a total of 1852 participants remained in the analytic sample (Figure 1).
Employees who stated that they worked in a cell-office, but also worked 20% or more in team work elsewhere in the office
were excluded since it was unclear whether they worked in combi-offices or not.
2.2. Office definitions
The study is based on the seven office types that have been identified in contemporary office design. These are: (1) cell-
office, (2) shared-room office, (3) small open-plan office, (4) medium-sized open-plan office, (5) large open-plan office, (6)
flex-office and (7) combi-office (Bodin Danielsson 2007; Bodin Danielsson and Bodin 2008). These seven office types are
C. Bodin Danielsson et al.140
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defined by their unique combinations of architectural and functional features (Table 1). The architectural features are the
physical features of an office type, such as access to windows, spatial arrangements of rooms (e.g. corridors or open-plan
layout) and furniture arrangements which are partly given by the spatial organisation. Of the architectural features, the plan
layout is the most prominent. The functional features of an office type are determined by the work taking place and how it is
organised, i.e. the use of the office and functions related to this. These features are in turn determined by factors such as
functional needs, technical feasibility (information communication technology [ICT]) and so on. But it also works vice
versa, as technical and functional possibilities can lead to new organisation of work that affects the architectural design. The
seven office types should be viewed as both prototypes and ‘ideal’ office types, since there exists of the office that differs to
the described definitions.
SLOSH does not enable a detailed analysis of one particular functional feature, the individual employee’s decision
making power, which is an important functional feature that defines the different office types (see Bodin Danielsson &
Bodin 2008,2009). Thus a descriptive analysis based on mean values of employees’ degree of decision-making power in
work was done in the various office types (see Table A1 in Appendix). The degree of decision-making power in work was
measured by the three items of decision latitude dimension developed for the demand-control-support questionnaire
(Theorell et al. 1988) included in SLOSH.
2.3. Socio-demographics
Background data on sex, age, job rank, income and labour market sector, i.e. if the individual works in private or public
sector are given in Table 2 split by office type. Age is shown for the year 2010, job rank, income and labour market sector in
both 2010 and 2012.
The demographic data show some overall distinguishing characteristics in the sample. It shows that there are no
significant differences with respect to office type in the gender distribution or income in 2010. However, in 2012 there are
significant differences with respect to office type in terms of income. There are more women than men in the sample, and
the most equal gender distribution is found in medium-sized and large open-plan office together with flex-office. The
highest incomes are in both 2010 and 2012 found in medium-sized open-plan office followed by large open-plan office and
the lowest incomes in flex-office. The age distribution differs significantly between the office types with the highest
proportion of young people in small open-plan office and of old people in cell-office. Overall, there are fewer people in the
youngest age group than in the older age groups. The traditional open-plan offices (small, medium-sized and large open-
plan) are more common in the private than the public sector. The most common office type in the public sector is the combi-
office. Flex-office has also a larger representation in this sector. There are significant differences with respect to office type
in distribution of job rank in both 2010 and 2012. Lowest job ranks (unskilled and skilled manual workers combined with
non-manual workers) are in both years found in shared-room office and flex-office. The highest job rank (professional and
higher managers) has 2010 as its largest representation in combi-office followed by cell-office. It is the largest
representation found in medium-sized open-plan office followed by cell-office again.
2,555 respondents who worked 30% or less than full time at the time of SLOSH 2012 and were excluded.
1,478 respondents who had not responded to SLOSH 2010 were excluded.
278 respondents who worked 30% or less than full time at the time of SLOSH 2010 were excluded.
1,864 did not work in an office in 2006 and were excluded;
475 did not respond to the question on office type in 2010 and were excluded
465 worked <20% in an office in 2010 and were excluded.
587 had changed jobs between 2010 and 2012 and were excluded
29 with missing information on job change status were excluded
297 cell-office employees with 20% of teamwork elsewhere in office than in own office were excluded*
Final analytic sample available for analysis.
7,325
5,569
9,880
3,230
2,765
2,149
1,852
Figure 1. Exclusion of subjects from study base for the analysis. A total of 9880 people (44.2% men, 55.8% women) responded to
SLOSH 2012.
Ergonomics 141
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2.4. Descriptions of outcome variables
The following three dimensions were used as outcomes:
(a) Number of short sick leave spells was assessed by the question: ‘How many times have you taken sick leave for a
week or less during the past 12 months? Do not count care of a sick child.’ The responses were dichotomised into
one or no short absences (‘not at all or 1 spell’) vs. more than 2 spells (‘2 or more spells’).
(b) Number of long (medically certified) sick leave spells was assessed by the question: ‘How many times have you
taken sick leave for longer than a week during the past 12 months? Do not count care of a sick child.’ The response
was dichotomised into no long absences (‘On no occasion’) vs.all other categories. Sick leaves of longer than a
week require a certificate from a physician.
(c) Total number of sick leave days was measured by the response to the question: ‘Approximately how many days
have you in total been on sick leave during the last 12 months?’ The response was dichotomised into 7 days or less
(‘not at all’ or ‘1 7 days’) vs. more than 7 days (‘8 30 days’, ‘31 90 days’ and ‘91 days or more’).
2.5. Confounders
In the multivariate analysis, sex, age, labour market sector and job rank were treated as confounders (Table 2). All
confounders were treated as categorical variables. Age was divided into ,34 years, 35 –49 years and .49 years (consistent
Table 1. Office types prototypes defined by architectural and functional features.
Office type:
architectural features Functional features
1. Cell-office: single room office
The plan layout is characterised by corridors, either a single
or double corridor system
Individual room has access to a window
Most equipment is in the own room
Work is concentrated and independent
2. Shared-room office: 2 3 people/room
An office type sometimes a consequence of lack of workspace.
Workstations freely arranged in the room
For privacy reasons sometimes screens or other divisional
elements between workstations
No individual window, shares with roommate(s)
Team-based work or people with similar work assignment
share room
Most equipment outside of room, team-based shared room
tends to have own
Traditional open-plan offices:
Groups of employees sharing a common workspace in different
configurations.
Found in following three sub-categories:
3. Small open-plan office: 49 people per room
4. Medium-sized open-plan office: 10 24 people per room
5. Large open-plan office: .24 people per room
Shared workspaces within the office
Plan layout is open, based on an open flow of workspaces
instead of corridor systems
Workstations freely arranged in the room or in rows in a
larger workspace
Flexible for organisational changes
Routine-based work
Low level of interaction between employees
Often no amenities at workstation
More flexible and activity based office types:
6. Flex-office: no individual workstation
Plan layout is open, based on an open flow of workspaces
instead of corridor systems
Back up spaces for work activities not suitable to carry out
at the personal workstation, e.g. rooms for concentrated
work, telephone calls, different type of meeting rooms
Flexible for organisational changes
Dimensioned for ,70% of the workforce
The choice of workstation is free, has the option to work outside
of office as well
Good ICT is a necessity as the common computer system is
accessible from all workstations within the office
Mainly independent work, sometimes project based
7. Combi-office: .20% of the work in the office not at the
personal workstation, team-based work
No strict spatial definition, personal workstations can be
either individual rooms or open-plan office
Back up spaces for work activities not suitable to carry
out at the personal workstation. Extra focus on rooms for
group activities such as meeting and project rooms (booked
for longer periods)
Sharing of common amenities in common spaces
Work is both independent and interactive team work with
colleagues
The team move around in the office on an ‘as-needed basis’
using the wide range of common facilities
C. Bodin Danielsson et al.142
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with Bodin Danielsson and Bodin 2008) in order to account for possible nonlinear effects. Sector of business was
categorised into private and public. Job rank was categorised into (1) unskilled manual work, (2) skilled manual workers,
(3) non-manual workers, (4) intermediate/lower managers and (5) professionals and higher managers. These were formed
by combining the Swedish Socio-economic (SEI) code and the job rank classification used by Magnusson Hanson et al.
(2009).
2.6. Data analyses
To understand the prospective association between office types in 2010 and sickness absences in 2012, we applied logistic
regression models controlling for several background characteristics in 2010. In accordance with the aim of the study, the
main explanatory variable of office type was used. For this, the seven office type categories defined previously were used.
Cell-office was chosen to represent the reference category with which the other office types were compared.
The results are presented as odds ratios (ORs) with 95% confidence intervals. An OR greater than one indicates a higher
risk for sickness absence for the particular office type compared with the reference category. The statistical significance
level was fixed at p,0.05. For each of the outcomes analysed in this article, three models were shown total sample, male
and female separately.
Table 2. Socio-demographic characteristics participants by office types.
Cell-
office
Shared-room
office
Small open-
plan office
Medium-sized
open-plan office
Large open-
plan office
Flex-
office
Combi-
office
Sign. difference
between office
types
Office types n
1
¼851 n
2
¼243 n
3
¼124 n
4
¼84 n
5
¼144 n
6
¼91 n
7
¼315 n¼1852
Gender 0.220
Female 485 (57) 157 (65) 75 (60.5) 44 (52) 77 (53.5) 48 (53) 182 (58)
Male 366 (43) 86 (35) 49 (39.5) 40 (48) 67 (46.5) 43 (47) 289 (45)
Age group (years) #0.001
$34 34 (4) 15 (6) 21 (17) 8 (9.5) 14 (10) 5 (5.5) 22 (7)
3548 283 (33) 86 (35) 42 (34) 25 (30) 68 (47) 40 (44) 129 (41)
#49 534 (63) 142 (58) 61 (49) 51 (61) 62 (43) 46 (50.5) 164 (52)
Income (USD)
Income 2010 56.4 52.1 49.2 59.5 57.7 48.0 56.1 0.047
Income 2012 63.5
(2)**
54.8
(1)**,(4)**
56.1
(4)*
69.2
(2)**,(3)*,(6)*
64.4 54.5
(4)*
62.2 #0.001
Labour market sector #0.001
Private 384 (50) 118 (54) 82 (71) 63 (79) 111 (79) 36 (44) 132 (45)
Public 375 (49) 100 (46) 34 (29) 18 (22) 29 (21) 46 (56) 162 (55)
Job rank 2010 #0.001
Unskilled manual
workers
11 (1) 6 (3) 3 (2) 0 (0) 0 (0) 6 (7.0) 16 (5)
Skilled manual
workers
5 (1) 4 (2) 2 (2) 1 (1) 3 (2) 8 (9) 16 (5)
Non-manual
workers
204 (25) 84 (37) 36 (30) 24 (29) 25 (18) 19 (22) 38 (13)
Intermediate/lower
managers
298 (36) 83 (36) 51 (42) 32 (39) 74 (52) 33 (38) 140 (47)
Professionals and
higher managers
299 (37) 53 (23) 29 (24) 25 (30.5) 40 (28) 20 (23) 255 (42.1)
Job rank 2012 #0.001
Unskilled manual
workers
10 (1) 6 (2.5) 0 (0) 0 (0) 0 (0) 7 (8) 16 (5)
Skilled manual
workers
6 (1) 2 (1) 3 (2.5) 1 (1) 2 (1) 8 (9) 18 (6)
Non-manual
workers
216 (26) 84 (36) 37 (31) 18 (22) 25 (18) 20 (23) 33 (11)
Intermediate/lower
managers
298 (36) 95 (40) 48 (20) 33 (27) 30 (37) 36 (41) 137 (44)
Professionals and
higher managers
303 (36) 48 (20) 33 (27) 30 (37) 45 (32) 17 (19) 103 (34)
Note: Post-hoc (Sidak) tests for mean differences are indicated X
(1)– (4), (6)
,
*
p,0.05,
**
p,0.01,
***
p,0.001. Figures in parentheses are percentages.
Values in bold indicate significances reported in SPSS as 0.000.
Ergonomics 143
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3. Results
The results from the multivariate logistic analyses in Table 3 showed a clear difference in prospective risks for sickness
absence between the three outcomes used. With regard to short sick leave spells ($2 spells), a significant association with
office type was found in the analysis of the total sample as well as in the separate analyses for men and women. In the total
sample, elevated risks were found among employees in all three traditional open-plan offices in comparison with cell-
offices. The highest significant risk for short sick leave spells was found among employees in small (OR ¼1.9, p#0.001)
and large open-plan office (OR ¼1.82, p#0.001) followed by medium-sized open-plan offices (OR ¼1.22, p#0.05).
The same office types had the highest risk also in the women-only analysis, although less significantly than in the total
sample, with ORs of 1.97, 2.28 and 1.86, respectively, p#0.05. For men-only analysis, flex-offices were associated with a
significantly higher risk for short sick leave spells (OR ¼2.56, p#0.05). In terms of less negative outcomes, there was a
non-significant tendency towards lower rates of short sick leave spells in cell- and combi-offices.
With regard to long (medically certified) sick leave spells and total number of sick days ($8 days), the only significant
associations were found in the separate analyses for men and women. Here a significantly higher risk of long sick leave
spells was found among women in large open-plan offices (OR ¼2.14, p#0.05) than in cell-office. In men the risk of a
high total number of sick days was significantly higher in flex-offices (OR ¼2.63, p#0.05).
4. Discussion
This study of the prospective effect of office environment on sickness absence showed very different results for our three
outcomes, with a significant association found mainly in terms of short sick leave spells. In this regard, the three traditional
open-plan offices stood out negatively for both the total sample and women separately. For men, short sick leave spells were
significantly more common in flex-offices. In addition, women had higher risk of long sick leave spells in large open-plan
offices, and in men the total number of sick days was higher in flex-offices.
We found an excess risk of short sick leave spells in the same office types, which in other studies were found lessconducive to
employee health. That employees in traditional open-plan offices have a significantly highest risk for ill-health was for instance
found in a cross-sectional study (Bodin Danielsson and Bodin 2008), but also in a large longitudinal study (Pejtersen et al. 2011).
Table 3. Prospective associations between office types in 2010 and sickness absence outcomes in 2012 expressed as ORs from logistic
models adjusted for background factors.
a
Office
types
Cell-
office
R
Shared-room
office
Small open-plan
office
Medium-sized open-plan
office
Large open-plan
office Flex-office Combi-office
n¼1852 n
1
¼851 n
2
¼243 n
3
¼124 n
4
¼84 n
5
¼144 n
6
¼91 n
7
¼315
Outcome
Short sick
leave spells
($2 spells)
Total
sample
1.00 1.23 (0.81 1.86) 1.9
**
(1.16– 3.1)1.92
*
(1.08– 3.4)1.82
**
(1.14– 2.88) 1.69 (0.95 3.01) 0.95 (0.63– 1.42)
Women 1.00 1.48 (0.91– 2.42) 1.97
*
(1.08– 3.6)2.28
*
(1.11– 4.67)1.86
*
(1.04– 3.35) 1.56 (0.73 3.34) 1.0 (0.621.61)
Men 1.00 0.77 (0.32– 1.84) 1.92 (0.834.47) 1.48 (0.56 –3.95) 1.8 (0.84– 3.85) 2.56
*
(1.04– 6.34) 0.78 (0.37– 1.68)
Long sick
leave spells
(medically
certified)
Total
sample
1.00 0.79 (0.46 1.36) 0.7 (0.321.5) 0.51 (0.18– 1.44) 1.1 (0.592.05) 0.89 (0.56 1.42) 0.73 (0.50– 1.07)
Women 1.00 1.02 (0.55– 1.93) 0.53 (0.18– 1.54) 0.42 (0.98– 1.83) 2.14
*
(1.08– 4.26) 1.97 (0.87 4.44) 1.08 (0.61– 1.90)
Men 1.00 0.37 (0.11– 1.26) 0.97 (0.322.98) 0.56 (0.12 –2.5)
b
1.5 (0.514.28) 0.68 (0.30– 1.53)
Total
number
of days
($8 days)
Total
sample
1.00 1.37 (0.92 2.04) 1.02 (0.591.79) 0.88 (0.44 –1.78) 1.29 (0.782.14) 1.58 (0.89 2.81) 1.05 (0.71– 1.54)
Women 1.00 1.54 (0.96– 2.47) 0.94 (0.47– 1.87) 0.52 (0.18– 1.51) 1.71 (0.94 3.11) 1.16 (0.54 –2.5) 1.07 (0.671.7)
Men 1.00 1.0 (0.46 2.22) 1.21 (0.47– 3.11) 1.59 (0.61– 4.17) 0.69 (0.25 1.87) 2.63
*
(1.11– 6.26) 1.0 (0.5– 1.98)
Note:
R
Reference category. Figures in brackets are confidence intervals;
*
p#0.05,
**
p#0.01,
***
p#0.001.
a
Adjusted for age, sex, job rank and labour market sector in 2010.
b
ORs are not reported due to empty cells.
C. Bodin Danielsson et al.144
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The cumulative evidence thus indicates that traditional open-plan offices are less good for employee health. There could be
several explanations for this. The risk of infection could be higher among people sharing workspace, the exposure to
environmental stressors, such as noise and less ability for personal control in traditional office open-plan offices. Group
dynamics could also explain the negative outcomes in traditional open-plan offices, particularly large open-plan offices. Strong
group identity is after all more likely to develop in a smaller group of people (Svedberg 1992) as well as the peer control among
employees working in close collaboration with each other (Barker 1993). The non-significant tendency for better outcomes on
sickness absence in cell-offices and combi-offices could indicate that high personal control and low risks for infection in the
former and strong social coherence and peer control in the latter may decrease the risk of absenteeism. Positive aspect of social
control could be that people are more missed when absent in a small group due to a better visualoverlook and a greater concern
for team members. It could also be that the individual’s work effort is more noticeable or that the individual is less easily
replaceable in a smaller workgroup or team, due to a greater dependence of each other. The latter hypothesis is supported by
research on sickness presenteeism, i.e. being present at work despite being sick, which has found that people who work
collectively have more sickness presenteeism (Aronsson and Gustafsson 2005). According to this hypothesis, the social control
and group dynamics of the teams would then have a preventive effect on sick leaves prospectively.
Some gender differences were found. The association between short sick leave spells and office type was stronger
among women than among men working in the three traditional open-plan offices, and for long sick leave spells among
women in large open-plan offices. This may be due to a higher sensitivity to physical stimuli or a greater importance of
social support at work among women. Support for the latter hypothesis may be found in that women appear to receive more
social support than men at work (Plaisier et al. 2007; Winter et al. 2006). Additional explanations may be that the well-
established excess risk for sick leaves among women overall, which was found also in this study, may indicate a greater
vulnerability to the negative environmental stimuli that may be found in traditional open-plan offices. For men, there is
instead a stronger association between flex-office and risk of short sick leave spells and total sick days. This difference
between men and women indicates a possible larger importance of a personal workstation for the welfare of men than of
women, which in turn could depend on factors such as social status and so on. Flex-offices stood out as a less good office
type from a sick leave perspective than other office types independently of gender.
4.1. Concluding remarks and limitations
The fact that the study is based solely on self-reported data is a limitation that comes with most surveys and could lead to
spurious findings, especially if dissatisfaction with the office environment influences ratings of health. However, self-reported
sickness absence should be less affected than direct ratings of health, since the questions are about factual phenomena, although
these can be misremembered or consciously inflated to express dissatisfaction. Additional observations of the employees’
office environments would have been beneficial, although difficult to perform in a large national survey such as SLOSH.
Another weakness is that we have not adjusted for baseline health, which means that we cannot rule out reverse causality.
However, adjusting for baseline health could also lead to over adjustment, as long-term exposure to a certain office environment
could already have affected health at baseline. We therefore chose not to adjust for baseline health on the assumption that
selection into particular office types based on health would be rare and less of a problem than over adjustment. The major
limitation in our opinion is that the definition of office type based on the SLOSH 2010 is not precise enough to accurately define
office type, since the questionnaire contained only a couple of items on the office environment such as employee’s office type
and degree of collaboration and work at workstation but lack many environmental factors. The respondents may thus have
misunderstood the purpose of the questions on the office environment, which in turn may explain why (a) critical items
concerning the office type often were not filled in and (b) the responses were not always consistent. This, in turn, may lead to an
imprecision in the exposure measure and possibly lead to an underestimation of the effect of office design on health.
Whether or not sickness absence is a good measure of employee health and well-being can also be discussed, since it
measures health-related behaviour rather than health per se. Sickness absence could thus also be influenced by factors such as
attitudes towards health and work, as well as, e.g. job control and adjustment latitude (Kivima
¨ki et al. 2003). The different
association between office type and the risk of short versus long sick leave spells could, therefore, be due to differences in
attitudes towards the different types of absence and not on employee health, meaning that short spells of sick leaves are more
accepted or easier ‘to get away with’ in certain offices types than others. When discussing how good an indicator absenteeism is
of employee health and well-being, it should be noted that medically certified sickness absence is considered a good predictor of
poor health (Kivima
¨ki et al. 2003). However, regardless of these considerations, sickness absence is a relevant factor since it
negatively impacts on productivity and increases costs for businesses and put a pressure on the social insurance system.
In conclusion, the results of this prospective study indicate a higher 12-month prevalence of short sick leave spells
among employees in traditional open-plan offices, especially among women. The study also indicates a higher prevalence
of both short sick leave spells and more than eight days of total number of sick days among men in flex-offices. All together,
Ergonomics 145
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the results indicate lower odds of sick leave in office types with high personal control and a lower degree of environmental
stressors or more collaboration in teams with colleagues. There could be several explanations for these results. For example,
the lower potential to exert personal control in traditional open-plan offices associated with architectural features that lead
to a lack of visual and acoustic privacy in combination with the functional features that are related to job characteristics such
as lack of autonomy, freedom and so on. (e.g. Bodin Danielsson 2007,2008; Evans and Johnson 2000). This, combined with
the fact that social cohesion is more likely to develop in office types with a lot of team work, is thus in our opinion possible
explanations for the difference in short sick leave spells between the different office types.
To summarise, the results of this explorative study should only be viewed a first step in the investigation of the long-
term effect of the office environment’s impact on employee sickness absence. These results can thus only be viewed as
indications of the possible effect of office type on sickness absence. Future studies need a more precise study design focused
on the office environment in order to establish if these preliminary results on a prospective association between office type
and sickness absence hold true or not. Also studying the possible effect of office environment on health over a longer period
of time than 2 years would be beneficial since it is our firm belief that with such knowledge of the office environment’s
influence on different dimensions of employee health, important gains can be achieved in the long run.
Acknowledgements
This research was supported by FORTE, the Swedish Research Council for Health, Working Life and Welfare (formerly FAS)
[Postdoctoral grant number 2011-0402], with additional support from Magnus Bergwalls Stiftelse (MBS).
Notes
1. Email: holendro.chungkham@stressforskning.su.se
2. Email: cwf@psychology.su.se
3. Email: hugo.westerlund@stressforskning.su.se
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Appendix
Table A1. Mean values of routine-based work, freedom to plan and freedom to decide by office types in 2010.
Office types Cell-office Shared room
Small open-plan
office
Medium-sized
open-plan office
Large open-
plan office Flex-office Combi-office
N
1
¼1852 n
1
¼851 n
2
¼243 n
3
¼124 n
4
¼84 N
5
¼144 n
6
¼91 N
7
¼315
Routine-based work
[1: often; 4: rarely]
2.2 2.1 2.01 2.12 2.31 2.22 2.37
Freedom to plan
(How to do your work)
[1: rarely; 4: often]
3.52 3.41 3.3 3.23 3.21 3.12 3.47
Freedom to decide
(What to do)
[1: rarely; 4: often]
3.01 2.87 2.77 2.69 2.76 2.55 2.92
Note:Highest mean value is reported in bold and lowest mean value in italics.
Ergonomics 147
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Att spridning av sjukdomsframkallande luftvägsvirus kostar samhället enorma resurser har blivit uppenbart för alla under covid-19, men ovälkomna virus har varit människans följeslagare genom hela historien och ständigt uppkommer nya varianter med särskilt hög smittsamhet eller dödlighet. Riskerna har ökat med befolkningstillväxt och globalisering. Samtidigt har våra förutsättningar att skydda oss också blivit bättre genom ökad kunskap och framsteg inom medicin och teknik. Syftet med denna kunskapssammanställning är att beskriva smittvägar, riskfaktorer och skyddsåtgärder för infektiös luftvägssjukdom och därmed bidra till en minskad smittrisk vid arbetsplatser. Mycket av innehållet bygger på forskning om influensa och covid-19, men även en rad andra luftvägsinfektioner är inkluderade. Spridning av virus har här delats upp i tre smittvägar: inandning, direkt deponering och kontakt. Risken för smitta via inandning av virus är särskilt stor när avstånden mellan människor är korta och uppehållstiden lång i lokaler med dålig ventilation. Risken ökar om det också pågår aktiviteter som innebär spridning av virusinnehållande aerosolpartiklar till luften, såsom högt tal eller sång eller vissa medicinska procedurer, eller om den inandade luftmängden är förhöjd, som vid tungt arbete. Virusöverföring via direkt deponering sker när stora smittbärande droppar stänker direkt på en mottagare vid exempelvis hosta. Virusspridning via både inandning och direkt deponering sker på olika sätt genom luften, men benämns här inte ”luftsmitta” eftersom detta begrepp åtminstone enligt klassisk medicinsk indelning syftat på (effektiv) smitta via inandning över avstånd mer än enstaka meter och eftersom det främst använts för sjukdomar som är mycket allvarliga och därför kräver extrema skyddsåtgärder. Smitta via kontakt kan ske antingen via direkt beröring eller genom mellanled, som handtag eller andra ytor. Samtliga tre smittvägar är välbelagda för luftvägsvirus i den vetenskapliga litteraturen, men deras relativa betydelse varierar beroende situation, virustyp och interventioner för att minska smitta. För covid-19 pekar mycket forskning mot att inandning är en dominerande smittväg i många miljöer. Vissa yrkesgrupper, särskilt inom vårdsektorn, löper en förhöjd risk att smittas av luftvägsvirus. En lång rad skyddsåtgärder finns tillgängliga för att på olika sätt minska smittrisker: distans, hygien, fysiska barriärer, ventilation, administrativa åtgärder (exempelvis information, regleringar, kontroller, checklistor) och personlig skyddsutrustning. De flesta av dessa åtgärder har starkt stöd av vetenskapliga studier.
... They frame the research within knowledge on medical conditions such as cardiovascular Interior design strategies diseases and musculoskeletal issues or take the psychological stress perspective: support of employee functioning (Vischer, 2008), the balance between environmental resources and demands (Demerouti et al., 2001) and privacy theory (Altman, 1975). Ten papers investigated the health risks of different office types, comparing physical health conditions, environmental stress, mood or sickness absence between occupants of workspaces varying in architectural openness and number of workstations (Bodin Danielsson et al., 2014Jaakkola and Heinonen, 1995;Lindberg et al., 2018;Pejtersen et al., 2006Pejtersen et al., , 2011 or before and after implementation of a different office concept (Brennan et al., 2002;Foley et al., 2016;Haapakangas et al., 2018;Meijer et al., 2009). These studies showed that workspaces for a larger number of people were related to increased health complaints and distractions, especially in open-plan offices without the backup spaces provided by an activity-based working concept. ...
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