The impact of real-world implementation of environmentally sustainable work practices on mental and physical health of healthcare workers: a longitudinal cohort study in Dutch healthcare organisations
| ISRCTN | ISRCTN25033513 |
|---|---|
| DOI | https://doi.org/10.1186/ISRCTN25033513 |
| ClinicalTrials.gov (NCT) | Nil known |
| Clinical Trials Information System (CTIS) | Nil known |
| Protocol serial number | EU Horizon Europe Research and Innovation Programme grant agreement No. 101137149 (INTERCAMBIO: https://intercambio-project.eu/). |
| Sponsor | Erasmus MC |
| Funder | HORIZON EUROPE Reforming and enhancing the European Research and Innovation system |
- Submission date
- 09/12/2024
- Registration date
- 10/12/2024
- Last edited
- 09/06/2025
- Recruitment status
- Recruiting
- Overall study status
- Ongoing
- Condition category
- Other
Plain English summary of protocol
Background and study aims
To reduce the environmental impact of the Dutch healthcare sector, the Dutch government developed the Green Deal for Sustainable Healthcare. To achieve the objectives of this initiative, several measures are implemented in the healthcare sector which requires that healthcare workers change their work practices, e.g. through waste separation, transitioning from disposable to reusable products (which often require cleaning or sterilization), and reducing unnecessary use of disposable items such as nonsterile gloves. However, healthcare workers already experience high work pressure and mental health problems, leading to high sickness absence rates and high turnover intention. The required transition to sustainable work practices may lead to an increased amount of work and decreased task clarity, thereby resulting in increased job demands. Additionally, these practices often come with stricter protocols and guidelines which are likely to reduce autonomy, an important job resource. This combination of rising job demands and diminishing job resources could add to the already high levels of job strain and work stress, potentially impacting workers’ mental and physical health. In the long term, these health effects may lead to reduced productivity and increased rates of sickness absence. On the other hand, studies in sectors outside of healthcare suggest that employee pro-environmental or “green” behaviour at work can have beneficial effects on workers, such as increased well-being and work engagement. The study aims to investigate the impact of sustainable work practices in healthcare on working conditions and, subsequently, healthcare workers’ health and well-being.
Who can participate?
The study is open to Dutch-speaking healthcare workers aged 18 years years and older who are exposed to a sustainability intervention that requires a change in their work practices. The department in which they work must commit to participating in the study.
What does the study involve?
This study has two parts: a quantitative study and a qualitative study.
- Quantitative study: healthcare workers will fill out questionnaires at multiple time points during the study. Before new sustainable work practices are introduced, participants will complete two initial questionnaires. After the work practices are implemented, they will fill out follow-up questionnaires at 1, 2, 3, and 6 months. These questionnaires will ask about working conditions, perception of their work, mental and physical health, stress, productivity, and sickness absence, among other variables. Participants will use a mobile app to fill out these questionnaires.
- Qualitative study: to better understand how sustainable work practices influence working conditions and health, and what facilitates or hinders their implementation, participants will be asked to take part in interviews or focus groups. These discussions will explore how the new sustainable work practices affect their jobs and well-being. Additionally, structured observations at workplaces will be conducted to see how the changes in work practices affect time management and daily tasks.
What are the possible benefits and risks of participating?
Participants who complete all questionnaires up to and including month 6 will receive a €25 gift card as compensation for their time. Those who complete the questionnaires up to and including month 3 will receive a €15 gift card. Participants who take part in an interview or focus group will also receive a €25 gift card.
There are no anticipated risks associated with participation in the study. The main burden is time: participants will need to spend about 1 hour in total completing questionnaires throughout the study. Interviews or focus groups will also take 1 hour.
Where is the study run from?
The study is being run from Erasmus University Medical Center (Erasmus MC) in Rotterdam, The Netherlands.
When is the study starting and how long is it expected to run for?
August 2024 to January 2028
Who is funding the study?
The European Union’s Horizon Europe Research and Innovation Program (INTERCAMBIO; https://intercambio-project.eu/)
Who is the main contact?
M. Koks, PhD candidate, m.koks@erasmusmc.nl
Contact information
Principal investigator
Dr. Molewaterplein 40
Rotterdam
3015 GD
Netherlands
 ORCID ID |
0000-0002-2019-4178 |
|---|---|
| Phone | +31 10 703 8460 |
| h.lammers-vanderholst@erasmusmc.nl |
Public, Scientific
Dr. Molewaterplein 40
Rotterdam
3015 GD
Netherlands
| ORCID ID |
0000-0002-0559-6881 |
|---|---|
| Phone | +31 10 703 8460 |
| m.koks@erasmusmc.nl |
Study information
| Primary study design | Observational |
|---|---|
| Study design | Single-centre observational longitudinal cohort study |
| Secondary study design | Cohort study |
| Study type | Participant information sheet |
| Scientific title | The impact of sustainable work practices on mental and physical health of healthcare workers |
| Study objectives | Negative hypothesis: The introduction of sustainable work practices may lead to an increased amount of work and decreased task clarity, thereby resulting in increased job demands. Additionally, these practices often come with stricter protocols and guidelines which are likely to reduce autonomy, an important job resource. This combination of rising job demands and diminishing job resources could add to the already high levels of job strain and work stress, potentially impacting workers’ mental and physical health. In the long term, these health effects may lead to reduced productivity and increased rates of sickness absence. Positive hypothesis: Sustainable work practices may contribute to healthcare workers feeling that they are making a positive impact on societal issues through their work, thereby improving their work engagement. Additionally, working more sustainably can provide healthcare workers with a sense of agency, particularly those who are concerned about climate change and environmental pollution. Both pathways can positively impact mental health. |
| Ethics approval(s) |
Approved 27/02/2025, Non-WMO Review Committee of Erasmus MC Rotterdam (Dr. Molewaterplein 40, Rotterdam, 3015 GD, Netherlands; +31 10-70 34428; metc@erasmusmc.nl), ref: MEC-2024-0800 |
| Health condition(s) or problem(s) studied | Working conditions, productivity, mental health, and physical health in healthcare workers. |
| Intervention | The study will assess the impact of changes in work practices introduced through real-world sustainability projects. Since the researchers have no control over the nature or timing of these interventions, the study qualifies as a "natural experiment". Various sustainability projects that will start shortly or are already underway have been identified. These projects focus on reducing the use of disposable products and unnecessary medication prescriptions in hospital wards, reducing the environmental impact of endoscopy units, and saving plastics, water, energy, and other resources in hospital laboratories. Other sustainable work practices implemented during the study can also be added to the evaluation. Repeated questionnaires will be administered to healthcare workers through a mobile app. The questionnaire will be administered twice before the implementation of sustainable work practices to establish a baseline, and subsequently at 1, 2, 3, and 6 months after implementation to measure the outcomes over time. Healthcare workers will provide data on working conditions, perception of their work, mental and physical health, stress, productivity, and sickness absence, among other variables. |
| Intervention type | Behavioural |
| Primary outcome measure(s) |
Mental and physical health are measured using the WHO-5 wellbeing index and the self-rated health question, respectively, at baseline and 3 and 6 months after implementation of the intervention. |
| Key secondary outcome measure(s) |
1. Working conditions, measured at baseline and 1, 2, 3, and 6 months after implementation of the intervention: |
| Completion date | 01/01/2028 |
Eligibility
| Participant type(s) | Health professional |
|---|---|
| Age group | Adult |
| Lower age limit | 18 Years |
| Sex | All |
| Target sample size at registration | 500 |
| Key inclusion criteria | 1. Employed in a hospital (e.g. physician, nurse, laboratory worker) or other healthcare organisation, such as a nursing home or general practice, in the Netherlands 2. 18 years or older 3. Mastering the Dutch language 4. Must have access to a smartphone |
| Key exclusion criteria | 1. Being on long-term sick leave (over three months) at time of the start of the study |
| Date of first enrolment | 01/03/2025 |
| Date of final enrolment | 01/03/2027 |
Locations
Countries of recruitment
- Netherlands
Study participating centre
Rotterdam
3015 GD
Netherlands
Results and Publications
| Individual participant data (IPD) Intention to share | Yes |
|---|---|
| IPD sharing plan summary | Stored in non-publicly available repository |
| IPD sharing plan | The datasets generated during and/or analysed during the current study will be stored in a non-publicly available repository (the specific repository and further information will be determined at a later date). |
Study outputs
| Output type | Details | Date created | Date added | Peer reviewed? | Patient-facing? |
|---|---|---|---|---|---|
| Participant information sheet | Participant information sheet | 11/11/2025 | 11/11/2025 | No | Yes |
| Study website | Study website | 11/11/2025 | 11/11/2025 | No | Yes |
Editorial Notes
09/06/2025: The following changes were made to the trial record:
1. The ethics approval was added.
2. The study website was added.
10/12/2024: Study's existence confirmed by the Horizon Europe.
