Case study

Involving employees in creating a healthy workplace

Medewerker bouw

Health at the workplace for and with everyone?

Programmes to improve employee health often fail to have the desired effect, particularly for workers in manual occupations. “This is because they are not or insufficiently tailored to what employees actually need and care about”, explains Agnes Meershoek. Inge Houkes adds, “A healthy workplace is about much more than just ‘fruit and fitness’, to put it bluntly. It’s also about workplace design, planning and scheduling, physical and psychological safety, and – above all – about taking employees seriously.”

Agnes and Inge, both associate professors at Maastricht University, conduct research on participatory approaches to promoting employee health (CAPHRI research line: Health Inequity and Societal Participation). Agnes: “Many companies invest in workplace health promotion interventions, but their effectiveness is limited.” “This is because they mainly focus on promoting a healthy lifestyle”, explains Inge. “Get more exercise, eat healthier, quit smoking… These interventions end up having little effect because they don’t address actual employee needs.” “Employees are often concerned about the impact of their work and working conditions on their health. If those aspects are neglected, lifestyle interventions just fall short of the mark for them”, adds Agnes. Inge’s Healthy HR research project (ZonMw) and Agnes’s Health in Action research project (ZonMw and SBCM) sought to determine whether a different kind of approach does have a positive impact on employee health. Agnes: “Both studies investigated an innovative approach that actively involves employees and pays attention to their needs, skills, and experiences.”


Work together

Inge is the project leader of the Healthy HR project, in which seven companies participated. It led to the development of “Healthy HR”, an online step-by-step toolkit that organisations can implement themselves. The toolkit was developed using focus groups in which employees shared their thoughts on health, sustainable employability, and what they need to enjoy their work. “The method takes as its starting point employee knowledge, skills, and experience; the employer’s appreciation for employee expertise; and the will to use that knowledge and experience to create a healthier work environment”, explains Inge. “Employees, HR managers, and supervisors work together to assess what employees need, decide on priorities, agree on short-term and longer-term actions, and implement and evaluate these.” She adds, “The Healthy HR process sometimes reveals surprisingly simple issues that can be resolved quickly and easily. For example, there was a maintenance worker who was dissatisfied with the inefficient organisation of his work van. He was given the freedom to reorganise the van as he saw fit. Eliminating this daily source of annoyance increased his job satisfaction and commitment. But even if an issue requires a major change that cannot be made immediately, it’s useful to discuss it openly. Employees will usually be understanding if a supervisor can give a proper explanation of why the issue can’t be resolved yet. Essentially, it’s all about listening to each other and feeling heard.”

Inge Houkes

Project: The MAISE-toolkit, a dialogue-based approach to improve the health of workers with a low socio-economic status

A sense of belonging

Agnes is the project leader of Health in Action, an ethnographic participatory research project in which four companies participated. “We likewise talked to employees, shadowing them at work and having one-on-one conversations with them. Their experiences gave us insight into their views on health and work. It turned out that for them, health was mainly about safety, unity, good communication, and a sense of belonging. People feel healthier at work if they feel taken seriously. They possess knowledge that can be used to not just identify, but also resolve processes with a negative impact on workplace health. For example, there was a sheltered employment facility where employees who had just completed a task weren’t allowed to leave the shop floor. They were just sitting there twiddling their thumbs, getting bored and frustrated. As a result of our conversations with them, they now have a toolbox with games, physical exercises, and practical activities on lifestyle and social skills.” Another company now involves maintenance workers in designing production lines, to take safe maintenance into account at an early stage. The Health in Action project has produced concrete tools, such as a website (, workshops for companies, and a guide with tips and examples.


Us-versus-them mentality

Both projects clearly show that there is a sharp divide between the shop floor and the office. Workers on the shop floor possess a wealth of knowledge and expertise, but things are constantly being imposed on them from above. “This leads to an us-versus-them mentality”, explains Agnes. “It makes employees feel underestimated and unheard. I have a good example of a forklift operator who got a new safety helmet. The helmet obstructed his view of the rear-view mirror, so he kept having to take it off for safety reasons. It would have saved him a lot of frustration if he had simply been included in the purchasing process. Or take companies where production workers don’t have key cards to access the office, but office workers can enter the shop floor. This creates a sense of inequality, which negatively affects job satisfaction – and ultimately work commitment, vitality, and sustainable employability.”

Agnes Meershoek

Project: Health in action, a participatory ethnographic research into work place health promotion for employees with low social economic position (SEP)

A bit of courage

Organisations can implement the Healthy HR toolkit and the Health in Action website themselves. “It may sound simple, but it isn’t”, cautions Inge. “Changing organisational culture can be difficult for both employees and supervisors. Employees aren’t used to being asked for their opinions. And we were quite surprised to discover how difficult supervisors find it to really talk to their employees. It can be confronting. It requires them to let go of the familiar and be receptive to employee feedback.” “It takes a bit of courage”, says Agnes. “The courage to experiment based on employee knowledge and experiences; the courage to change business processes and ingrained habits and routines. And it isn’t a one-time thing, but rather a cyclical process of dialogue – participation – implementation – integration – evaluation/dialogue. We hope that many more companies will begin to realise that their employees deserve a say in creating a healthy workplace, in the broadest sense of the word.”

Text: Margo van Vlierden
Translation: Emdash

Research Teams

Project ‘The MAISE toolkit’

  • Prof. dr. Angelique de Rijk (promotor), Professor in Work and Health, specialising in Re-integration into Work, department of Social Medicine, CAPHRI
  • Dr. Inge Houkes (project leader, co-promotor), associate professor in Work and Health, department of Social Medicine, CAPHRI
  • Prof. dr. Hans Bosma (promotor), Professor in Social Epidemiology, department of Social Medicine, CAPHRI
  • Emmelie Hazelzet, MSc (PhD candidate), department of Social Medicine, CAPHRI/MUMC+

Project 'Health in Action'

  • Dr. Agnes Meershoek (project leader), associate professor, department Health, Ethics and Society, CAPHRI
  • Prof. dr Klasien Horstman, Professor Philosophy and Public Health, department Health, Ethics and Society, CAPHRI
  • Dr. Dorit Biermann-Teuscher, post doc, department Health, Ethics and Society, CAPHRI
  • Dr. Lotte Thissen, post doc, department Health, Ethics and Society, CAPHRI

Collaborating partners

Researchers have many local, national, and international partners with whom they collaborate, sometimes already for decades. Some of the partners with whom shared output was created (e.g. articles, Phd theses, interventions) are reported below.

Partners project ‘The Maise toolkit’

  • Interduct
  • 5 companies from industrial, financial and hospitality sectors
  • Mulder Arbeid en Gezondheid

Partners project 'Health In Action'

Our employees are more aware of their own health  (project leader)

Our most important scientific output

Researchers in this group chose journals with high impact factors in the field of public health. Recent examples are shown below.

Our most important output for societal target groups

Social impact is created by looking for opportunities to improve the situation of employees at the workplace, employees in lower skilled jobs, through participatory approaches.

Gezond HR

Healthy HR
The project Healthy HR has a societal impact at different levels: the micro-level (i.e., the individual becoming more aware of health and SE, getting a voice and more job control, and feeling responsible), organizational level (i.e., organizations being enabled to start a dialogue with employees, improving working conditions and becoming more attractive on the labour market), and the societal level: The findings of this project can be relevant to the Dutch government, including policymakers. It advocates for a radical change towards a more progressive view on work and prevention. The project resulted in a practical online toolkit which can be applied by work organizations ( and an instrument (including a manual) for the measurement of sustainable employability from the perspective of the employee in a lower skills job, the MAISE-Easy (Maastricht Instrument for Sustainable Employability) (Mignon et al., 2022).

gezondheid met de werkvloer logo

Health in Action
The project Health in Action has a societal impact as it developed a participatory approach for workplace health promotion in which employees and management together can improve workplace health. It provide insight in conditions under which implementation of the approach can be successful. The project resulted in a website (, a practical guide and a workshop to introduce employers and employees in the ethnographic-participatory approach to workplace health and provide handles and tips to tailor and implement the approach in their own organization.