Workplace health promotion: :
Getting to grips with the structures

Many companies still believe that optimising your behaviour prevents unhealthy stress in the workstation. But it has long been clear that managers play a key role in this. However, the pressure to which they are exposed makes them themselves the addressees of workplace health promotion. Indra Dannheim's doctoral degree has now taken a course that shows for the first time that specific measures for managers pay off.

Indra Dannheim laughs. There is nothing to suggest that stress plays such a major role in her everyday working life. For many years now, the 32-year-old has been working on the question of how employees can stay healthy despite work intensification, deadline pressure and other pressures in the workstation. The Fulda native is convinced: "In order to maintain health, well-being and performance at the workstation in the long term, there is no way around workplace health promotion."

However, it is a challenge for small and medium-sized enterprises and organisations (SMEs) to establish workplace health promotion (WHP), as they are usually missing the resources. As an employee at the Fulda Regional Innovation Centre for Health and Quality of Life (RIGL), Indra Dannheim therefore tried to support SMEs. In particular, she focussed on how employees deal with workload. What exactly manages stress and what ways do those affected see to reduce it?

Gap between offer and need

She found confirmation of what she had suspected for some time: "In our workshops, none of the participants mentioned yoga or sports courses as a solution. I noticed a huge discrepancy between the solutions developed by the employees themselves and the actual measures in the companies, which are often limited to courses and training courses."

Countless BGF service providers have now jumped on the bandwagon and offer measures for individual behavioural optimisation. "In practice, an offer has developed that hardly fulfils the employees' requirements," she sums up.

Stress experience shapes leadership behaviour

She read in the academic literature that managers play a central role, that their experience of stress influences leadership behaviour and that there is a clear connection between the well-being of the manager and their behaviour towards employees. This made it clear: "If workplace health promotion is not structurally anchored in SMEs and no division is driving the topic forward, then the appointment of managers is all the more crucial." 
Consequently, the statutory health insurance's guideline on prevention names healthy management as a prioritised field of action for SMEs, but does not admit whether measures for managers are actually effective. "There is a lack of evidence," says Indra Dannheim. "Above all, I think it is important to question what decision-makers really mean by WHP and what effect measures have on managers," she says, describing her approach, which she ultimately pursued in a doctoral degree.

Status survey in the region

She interviewed ten managers from small and medium-sized IT and technical service enterprises in the region about their personal stress management behaviour. Her exemplary status survey shows: In KMUO, managers are confronted with high work-related stressors such as a high volume of work, time pressure, the removal of boundaries, a shortage of skilled labour or financial pressure. The respondents reported exhaustion, negative effects on work quality and leadership performance, anxiety and conflicts at workstation and in the family. "Managers often deliberately jeopardise their health in favour of their own work goals," she notes.

An even more important finding was that organisational development was mentioned most frequently as a strategy for reducing work stress. However, none of the respondents mentioned WHP as a possible coping strategy. In other words, employees are trying to reorganise structures, but do not associate this structural approach with WHP. "This is a problem," she says, "because WHF as a corporate strategy has great potential to strengthen health and well-being in the workstation." She therefore advises: "Companies should increasingly see health promotion as an organisational development process."

Healthy structures instead of training courses

She is not alone in this. Other researchers now also recommend focusing on health-promoting organisational development. "We're not just supposed to do yoga and relaxation exercises in the workstation, we're supposed to perform. That's why it makes sense to see health promotion as an integrative, strategic approach aimed at designing healthy work structures and processes," she says, explaining her position.

In two further studies, she found evidence that special measures for managers can actually be effective. To this end, she analysed the results of previously published university studies with regard to two questions. Firstly, she wanted to know to what extent the effectiveness of stress management interventions for managers had already been vouched for; secondly, she was interested in whether the effects of such interventions on the health and well-being of employees could also be admitted.

Measures are effective

"Overall, the results are only meaningful to a limited extent," cautions Indra Dannheim, for example because the samples were too small and the interventions and settings too different. And because all the university studies analysed were conducted in the workplace, which makes randomisation more difficult than in laboratory studies, which would be considered a high quality standard for intervention studies.

Nevertheless, based on the available studies, it is safe to say that stress management interventions for managers can be an effective tool for improving mental health as well as workstation and leadership-related endpoints, such as job satisfaction and leadership skills. Positive effects were also found with regard to the impact of health-oriented interventions for managers on the health and well-being of employees: Where investments were made in the health of managers, there was less tendency towards exhaustion, fewer sickness-related absences and greater job satisfaction.

"These results are definitely robust enough to recommend that SMEs focus on health-promoting organisational development and pay more attention to managers," says Indra Dannheim, categorising her findings, but adds: "Nevertheless, BGF measures for managers should never be seen as the sole approach to reducing work-related illnesses. Rather, they are a building block of a holistic approach that combines behavioural and situational prevention and sees health promotion in the workstation as a joint task." Valuable insights for a region predominantly characterised by SMEs.

Personal details:
Indra Dannheim studied the Bachelor's programme in Health Promotion at the Fulda University of Applied Sciences and the Metropolitan University of Copenhagen (2012-2015) and completed her Master's degree in Prevention and Health Promotion at the European University of Flensburg (2015-2018). She gained her first practical experience in workplace health promotion as a working student at SAP in Walldorf. She then wanted to return to Fulda, where she got her first permanent job at RIGL-Fulda. She worked closely with the Fulda Chamber of Industry and Commerce and has been a jury member with distinction for "Healthy working in FD" ever since. In 2024, she became self-employed. In June of this year, she completed her doctoral degree at the University of Paderborn on the topic: workplace health promotion for managers against the background of the prevention principle "Healthy management". Exemplary status survey in small and medium-sized enterprises and effectiveness evaluations of health-orientated interventions for managers. She obtained her doctorate cumulatively, i.e. she published three articles in renowned academic journals that had previously been reviewed by colleagues (peer review).

Note: The text appeared in slightly abridged form in print on 12 July 2025 on the regional science website and is available here available here. (in German)