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Health promotion in virtual teamwork through health-oriented leadership
Virtual teamwork as a new flexible form of work is characterized by specific challenges and the associated health stress factors. The influence of executives on the health of employees has already been demonstrated in direct and personal team contact.
The aim of the work
The article is intended to provide an overview of the concepts of healthy leadership and to shed light on them in a virtual work context.
material and methods
In an exploratory literature search, previously available findings on concepts of healthy leadership are researched and summarized. A suitable approach to healthy leadership is identified from these research findings and the empirical state of research in relation to virtual teamwork is presented.
This review identified health-oriented leadership as a dominant approach among all theoretical concepts of healthy leadership. The main results of previous studies show that health-oriented leadership can have a significantly positive influence on the health of employees. Overall, leadership is a relevant health factor for workplace health promotion.
The empirical state of research makes it clear that there is still a need for research into health-oriented leadership. The relevance of further empirical studies for the virtual work context is discussed for science and practice.
Virtual teamwork as a new way of working is characterized by specific challenges and associated job demands. Leadership influence on the health of employees has already been proven in direct and personal team constellations.
The goal of this article is to provide an overview of healthy leadership concepts and illustrate them in a virtual working environment.
Materials and methods
In an explorative literature review, currently available findings on healthy leadership concepts are evaluated and summarized. Based on this, a suitable approach to healthy leadership is identified and the empirical state of research in virtual teamwork is presented.
Our review identified health-oriented leadership as the dominant approach among all theoretical concepts of healthy leadership. The central results of previous studies show that health-oriented leadership can have a significantly positive influence on the health of employees. Overall, leadership represents a relevant health factor for workplace health promotion.
The empirical state of research shows that there is still much need for research on health-oriented leadership in virtual teamwork. The relevance of further empirical studies for virtual work environments is discussed for science and practice.
(Inter) national statistics make it clear that psychosocial risk factors in the workplace are increasing. The European Company Survey in 2014 on new and emerging risks (ESENER-2) shows that psychosocial risk factors are the most frequently named health risk in the workplace: 77% of employees from the 28 EU member states stated that at least one psychosocial risk factor is currently There is a risk factor in the workplace . The most frequently mentioned risk factors include dealing with difficult customers, patients or students (58%) and time pressure (43%; ). The 2019 absenteeism report for employees in Germany also shows that mental illnesses make up the third largest type of illness with a share of 11.3%. Compared to other types of illness, it is one of the most rapidly increasing illnesses: from 2008 to 2018, sick days due to mental illness increased by 64.2%. In 2018, more cases were registered due to mental illness (5.1%) than due to cardiovascular diseases (3.7%). The average duration of cases for mental illness is 26.3 days per case. This is twice as long as the general average of 11.8 days . Collectively, these statistics illustrate the importance of mental health in the workplace for individuals as well as organizations.
Survey results with over 8019 employees illustrate the effects that progressive digitalization of the workplace has on the health of employees: a total of 23% of those surveyed stated that they were emotionally exhausted .
In this changing world of work, new flexible forms of work such as virtual teamwork are emerging. This is understood to mean spatially distributed teams that mainly communicate via digital information and communication technologies (ICT) and work on common goals and tasks over a certain period of time [2, 22, 28].
The flexible working conditions in virtual teams consequently change the requirements and resources of the employees. On the one hand, flexibility can lead to an improved work-life balance and thus job satisfaction . In addition to flexible working hours, also social support, e.g. B. in the form of target developments, the promotion of team culture or the social exchange with the direct manager and colleagues, represent an important resource. The room for maneuver and decision-making resulting from virtual teamwork can also have a positive effect on the motivation of virtual team members and managers as resources . On the other hand, irregular working hours, sources of error in communication, an increased susceptibility to conflict and a more difficult integration of new team members can be experienced as psychological stress factors . The limited or lack of personal contact with the virtual team members can lead to delimitation, lack of clarity in roles and a loss of trust and motivation . In addition, according to current studies, the use of digital ICT can lead to psychological stress factors that can have health consequences for employees. These include acceleration, complexity, lack of user-friendliness, interruptions, an omni- and permanent presence, communication noise due to ICT and unreliability due to technical problems . The changes in the more flexible working world also influence the influence of leadership  and place increased demands on virtual managers [1, 5, 16, 34, 42].
This review article focuses on health-oriented leadership in virtual teamwork, as this flexible form of work is increasingly used in organizations around the world  and is characterized by increased health stress factors . Management-specific possibilities of influence are to be shown and the approach of health-oriented management is to be examined in a differentiated manner.
Leadership as a health factor
The review article on the empirical relationship between leadership behavior and employee health by Gregersen et al.  shows that leadership can act both as a stressor and as a resource for employees. Numerous studies have also been able to demonstrate the influence of leadership on the health and well-being of dependent employees without managerial responsibility [15, 27, 31, 32, 41, 45]. The current meta-analysis by Kaluza et al.  was able to show that the well-being of managers can also have a decisive influence on the relationship between managerial behavior and employee health.
According to Franke et al.  there are four mechanisms by which leadership can have an impact on the health of employees. On the one hand, the manager can directly influence the health of the employees through their behavior and the type of communication. On the other hand, there can also be an indirect influence through the design of working conditions. Due to the specific work requirements of a manager, managers themselves can also be exposed to psychological stress factors. The experience of stress can mean a health risk for the managers themselves as well as for their subordinate employees. Finally, managers act as role models for employees and serve as multipliers for company health management . The attitude of employees can be influenced by the attitude of their manager , and the likelihood of using work safety practices with a positive role model can also be increased .
Established management concepts have often been empirically examined in relation to the health of employees. Health-related leadership concepts in the virtual work context include transformational leadership and relationship and task-oriented leadership . Meta-analyzes showed that a transformational and employee-oriented management style have positive health effects such as low health complaints, a reduction in stress and burnout and an increase in well-being and job satisfaction on employees [15, 31]. However, these leadership concepts were not developed to primarily predict health-related leadership behavior, but rather performance . Since few concrete recommendations for action and practical measures can be derived from these classic leadership concepts, more specific concepts of healthy leadership have been developed .
Overview of healthy leadership concepts
A current systematic literature search makes it clear that in the last two decades some theoretical concepts and empirical studies on healthy leadership have been developed in parallel, which overlap in many ways, but can also be distinguished from one another . Even if no absolute comparisons are possible due to the differences in the choice of method and research purposes, similarities in content between the theoretical concepts were found. There is agreement that there are observable differences in the health-promoting behavior, values and attitudes of managers. Furthermore, the relevance of healthy leadership for company health promotion was highlighted and recognized as the link between individual health and company health promotion. The review identified two dominant concepts of healthy leadership among all theoretical concepts: health-promoting leadership and health-oriented leadership . According to Eriksson et al.  can be defined on the basis of three components: a supportive management style, the organization of health-promoting activities and the provision of a health-promoting workplace.
In comparison to health-promoting leadership, it can be seen that the HoL approach of health-oriented leadership was developed in a broad deductive process and that the factor structure could also be confirmed . All empirical quantitative studies on health-oriented leadership also use the diagnostic tool developed for this leadership approach , which was developed in German and English [12, 14]. The structure and validity of the instrument could be confirmed by further practice-relevant studies [14, 17, 39]. The studies on health-promoting leadership, on the other hand, do not use a standardized diagnostic tool . Furthermore, in contrast to health-promoting leadership, the self-management of the manager could be taken into account in the approach of health-oriented leadership .
The criticism of the systematic literature search by Rudolph et al. , however, points out to researchers that, according to the current state of research, the existing constructs must be examined in a more differentiated manner, also the incremental validity. Only then can specific approaches to healthy leadership be distinguished from classic leadership concepts.
Definition of the HoL approach
The integrative HoL approach according to Franke and Felfe  combines all four effective mechanisms of leadership and, in addition to classic leadership, also includes health-oriented self-management of both the manager and the employees [12, 14]. Health-oriented leadership is not understood as a clearly delimited leadership concept, but as a leadership approach that only focuses on a specific sub-area of leadership behavior .
The HoL model consists of three components (SelfCare manager, StaffCare and SelfCare employee), whereby the health-oriented self-management of the manager (SelfCare) forms the basis. All three components are made up of three dimensions each: importance, mindfulness and behavior. In order to be able to lead oneself in a health-oriented manner, one's own health must be classified as important, the personal stress factors in the workplace must be perceived in the appropriate situations and, finally, there must also be the ability to act in order to translate one's own health awareness into appropriate health-promoting and preventive behavior .
With regard to StaffCare, too, the model assumes that in the first step the health of the employees must be classified as important by the respective manager. In the second step, attention must be paid to the health of the employees, so that in the last step, appropriate health-oriented management behavior can be shown. The self-care of the manager is fundamental for the model, because on the one hand it enables a health-oriented employee management (StaffCare) and on the other hand a pronounced self-care can serve as a role model for employees and positively influence the own health-oriented self-management (self-care) of the employees. The heuristic model of the management's influence on the health of employees assumes that the self-care of the manager has a positive influence on the self-care of the employees via the StaffCare. Health-oriented employee management and self-management by both the manager and the employees increase the likelihood of positive health parameters in the workforce such as increased well-being or reduced stress experience .
Current state of research
According to the current state of research, there are so far only 8 quantitative studies [13, 14, 17, 20, 21, 25, 26, 39] that have empirically investigated the approach and the instrument of health-oriented management according to Franke and Felfe  . First empirical results confirmed the basic assumptions made in this management approach [13, 14]. Employees showed higher scores in terms of mindfulness and the behavior of their own SelfCare and reported a better state of health as well as less irritation, health complaints and conflicts between the family and the workplace, if they could perceive that their manager has shown health-oriented behavior . It could be shown that the health of the workforce does not only depend on the health-oriented leadership, but also on the health-oriented self-management of the employees. This result makes it clear that employees also play an active role in the context of leadership and health in the workplace .
Managers can also have an indirect influence on the health of their employees through their health-oriented self-management. In 2 studies by Kranabetter and Niessen , employees were less exhausted and cynical when transformational managers developed an awareness of their own state of health. Their study also showed that employees were also less exhausted when executives with a transformational leadership style showed health-oriented behavior. Managers can thus act as role models for their employees with regard to their mindfulness and health behavior . In addition to health-oriented self-management, Köppe et al.  that the state of health of the manager itself can have an indirect crossover effect on the state of health of the employees. In their study, the executive's state of exhaustion had an indirect influence on the somatic complaints of the employees through their health-oriented leadership .
What decisive influence the combination of all three components of the HoL approach (StaffCare, SelfCare of executives and employees) can have on the health of employees, Klug et al.  prove. For the first time, they were able to identify four profiles of health-oriented leadership using the HoL approach and also examine them in connection with health parameters.The consistent profiles are characterized by exclusively positive (“high care”) or negative (“low care”) characteristics of the three components staff care, self care manager and self care employee. Two inconsistent profiles are described by discrepancies in the characteristics of self-management or leadership (“leader sacrifice” and “follower sacrifice”). The study results show that the “high-care profile” in particular correlates with less stress and better health of employees. This profile is characterized by high scores in staff care, self-care for managers and self-care for employees, as well as low scores in behavior that is hazardous to health .
Furthermore, health-oriented management can have a positive influence on the health-promoting behavior of employees . In the study by Krick et al.  it became apparent that, in addition to organizational and individual factors, the health-oriented self-management and employee management of the executives increase the probability that employees not only have the intention, but actually take part in company health promotion courses.
So far, two quantitative studies on the HoL approach have been carried out in two specific industries in Germany, both of which document particularly stressful situations for the workforce [17, 39]. The first industry-specific study was carried out in inpatient care for the elderly, an industry that is characterized by increasing stress on employees and high staff turnover . The results of the study make it clear that there is a positive direct connection between health-oriented management and health as well as the organizational commitment of employees, which is partially mediated by social resources and stress. It is assumed that the emotional attitude of employees towards the company is influenced by the health orientation of their manager, as it can be perceived as a general support. Mediation on the social context factors shows that health-oriented managers can also influence social relationships and the social climate in the team . The second industry-specific study was carried out at the police station. The workplace is characterized by different operational and organizational stress factors . The results of the study show that health-oriented management has a positive influence on the well-being of employees, both directly and indirectly through employee self-care. Furthermore, a negative correlation between health-oriented leadership and high levels of burnout, depression and physical complaints was found .
Studies on health-oriented leadership that have not used the HoL instrument also provide further insights into the effectiveness of the leadership approach. A qualitative interview study with executives identified behaviors on how to deal with exhausted employees. The most effective behaviors in this context include the (re) design of tasks, emotional support, communication of expectations and offers of help by the manager .
Furthermore, the results of an international longitudinal study with over 2316 employees and their 245 executives from Germany, Finland and Sweden show that health-oriented leadership, along with four other management approaches examined, has the greatest predictive power in explaining a sustainable improvement in several health characteristics . The perception of health-oriented leadership is associated with an increased commitment of employees and a reduction in depression across all three measurement points. In the long term, it has also been shown that health-oriented leadership leads to a reduction in emotional exhaustion and somatic complaints, an improvement in the team atmosphere and an increase in the work commitment of employees. In addition, interactions between health-oriented leadership and the assessment of stress (reduced job insecurity) and resources (increased autonomy and meaningful life) at the workplace were determined. Managers therefore also have an indirect influence on employee health by being able to influence the design of working conditions. The results make it clear that this management approach can enable room for maneuver and participation in the workplace .
Health-oriented leadership in virtual teams
An overview article on health-oriented leadership in the context of flexible working environments makes it clear that work that is independent of time and place is a particular challenge for both employees and managers, and in particular increases the demands on communication skills . Virtual teamwork is a specific form of flexible work. Kordsmeyer et al.  pointed out in their review article that health-oriented leadership in virtual teams is subject to specific requirements. In addition to the general management tasks in virtual teams, managers should therefore pay attention to potential health risks such as extended work-related accessibility, conflicts in the work-life balance and the reduced social exchange in the team in the sense of health-oriented leadership . Based on the concept of health-oriented leadership according to Franke et al. , intervention options to promote employee and self-management by executives and team members were also developed. According to this, executives should initiate kick-off events at the beginning of the cooperation, agree rules on extended accessibility and implement measures to promote trust and instruments for (online) risk assessment in the sense of health-oriented employee management. Chat forums or virtual coffee breaks can also promote social exchange . Managers should promote this form of informal exchange or initiate it themselves. In this way, for example, social context factors such as different holidays in multicultural teams can be discussed and mutual understanding promoted .
According to the current state of research, only the results of two qualitative studies on healthy leadership in virtual teamwork exist so far . In the first interview study, virtual managers were asked about their influence on the health-promoting or harmful working conditions of employees. Although the managers recognized the influence of psychological causes on their physical health, very few made a connection between management behavior and employee health. Instead, they recognized that their leadership behavior had an impact on the working atmosphere and corporate culture. In addition, the survey results make it clear that the virtual managers are aware of the specific psychological stresses in the workplace and counter these with specially developed compensatory activities . The second interview study, using the health-oriented leadership approach according to Franke and Felfe , asked virtual managers about their health-oriented self-management and leadership . The results showed that virtual executives attach great importance to health both in health-oriented self-management and in health-oriented employee management and are mindful of the state of health. In order to lead themselves in a health-oriented manner, the executives indicate in particular physical activity and their behavioral demarcation with work. For a health-oriented employee management, communication, the building of trust, the support in drawing the boundaries to work and the implementation of personal meetings are mostly described. In addition to social, technical and personal factors, mainly organizational influencing factors are listed in the implementation of health-oriented leadership .
Summary and Outlook
In summary, it can be seen that managers can play an important role in workplace health promotion [19, 20, 43]. They influence the state of health of employees directly through their health-oriented leadership [13, 14, 17, 39] or indirectly through their own state of health  as well as the health-oriented self-management of managers and employees [14, 20, 25, 26, 39]. Even if the current empirical study situation makes it clear that health-oriented leadership is not yet a scientifically well-researched construct, it is nevertheless of considerable relevance for science and practice [35, 37]. Previous empirical study results provide information on the opportunities for workplace health promotion when health-oriented leadership is integrated and promoted in the leadership model, personnel development and corporate health management. Since empirical studies on the transferability of the approach of health-oriented leadership in the virtual work context are not yet available , future research should investigate how health-oriented leadership is applied in virtual teams. In particular, the HoL approach  is recommended as a suitable model and instrument for further research.
conclusion for practice
Managers can be of decisive relevance in workplace health promotion, because with their self-management and leadership as well as their role model function, they can demonstrably influence the health of employees at various levels.
Due to increasing health stress factors in digitized and flexible working environments such as virtual teamwork, the implementation of health-oriented leadership in company health management is recommended.
The possible uses of health-oriented leadership in virtual teamwork must be empirically investigated in practice.
For further research on health-oriented leadership, the HoL instrument ("health-oriented leadership") is recommended.
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