This is the second part of a three-part glossary of terms from the social epidemiology of work organization. The first part presented terms related to the social psychology of work.¹ The third part will describe terms from the sociology of labour markets.² The concepts in this glossary have been drawn mainly from the sociology of organisations, business and management literatures. Most of the concepts deal with how work organisations are structured and the consequences such structures pose to the health of workers.

Alienation

The term “alienation” is derived from the Marxian concept that work is central to the well-being of all people. When Marx perceived that, under the conditions of nascent capitalism, workers were being de-skilled and psychologically disinvested in their work, he described them as being alienated.³

In the narrowest sense, the term describes the relationship between the worker and her work. However, the concept may more broadly be applied to the self and others.

Two elements are pertinent to the definition of alienation from work. Firstly, there is a structural condition where the identity of workers is submerged in the overall division of labour and the individual is deprived of autonomy and opportunity. The second element involves workers’ individual and collective responses to such conditions. Workers can internalise their alienation and develop various forms of mental and physical suffering. In investigating this response, Seeman⁴ developed scales to measure individual feelings of alienation along the dimensions of powerlessness, meaninglessness, normlessness, isolation and self-estrangement. But workers can also express their disaffection through various forms of resistance, protest or withdrawal, and work alienation can be moderated or ameliorated through several strategies both at work and in outside activities.⁵

Autonomy

Autonomy refers to personal liberty that allows people to determine their own courses of action. The degree of autonomy experienced by workers varies according to the technologies and management systems that exist in the workplace. High-level managers or business owners generally have a great deal of autonomy in deciding what they will do, when they will do it and how they will do it. Lower-level workers generally have less autonomy.

In a classic study, Blauner⁶ showed that workers in assembly line manufacturing systems had less autonomy than workers in continuous process plants. More recent authors have focused on the implications of alternative and high-performance innovations in the organisation of work.^7–9 At the simplest level, autonomy can be indexed by measuring workers’ ability to control certain aspects of their workday—for example, setting the time for starting and leaving work and being able to take a break at their own discretion. At higher levels, autonomy can be indexed by closeness of supervision and performance standards versus process standards of evaluation.

Dignity

Dignity refers to the ability to establish a sense of self-worth and self-respect and to possess a social presence that is worthy of respect from others. Positively, dignity is attained through noble action, steadfast loyalty to one’s group, or enduring great suffering.^10,11 Dignity is often connected to issues of class and ethnic identity. It is also rooted in pride in one’s daily work or in one’s ability to support a family and participate in the community.

The idea of dignity has two different meanings—the first is that people have a certain inherent dignity as a consequence of being human; the second is that people earn dignity through their actions.^12,13 In the workplace, dignity can be violated by mismanagement or by managerial abuse; it can be protected by acts of resistance.

Employee turnover

Employee turnover occurs when workers leave their positions in organisations.¹⁴ Their reasons for leaving jobs are a measure of employee morale.¹⁵ The rate of employee turnover is one measure of the commitment of employees to organisational goals. Turnover is determined partly by organisational policy and management through factors such as salary, benefits, promotions, training and work schedules, and partly by personal factors that are largely beyond employers’ control—for example, an employee’s desire to relocate. Temporal trends in the importance workers place on various reasons for leaving are useful, as they provide indirect evidence of organisational changes in the workplace.¹⁶

Exploitation

Although there are several definitions of exploitation (eg, Saint-Simonian, liberal), exploitation is a key concept in the Marxian tradition.

In the Marxian view, exploitation refers to the social mechanism underlying social class inequality. Exploitation is a characteristic of employment systems where unpaid labour is systematically forced out of one class and put at the disposal of another.

According to a traditional view of exploitation, workers are exploited if they work longer hours than the number of labour hours employed in the goods they consume.¹⁷ Recent definitions incorporate authority in the workplace into the process of exploitation. Capitalist production always entails an apparatus of domination including surveillance, positive and negative sanctions, and varying forms of hierarchy. Managers and supervisors exercise delegated capitalist class powers as they practise domination in production. The higher an employee rises in the authority hierarchy, the greater the weight of capitalist interests in this class location. The strategic position of managers in the organisation of production enables them to make considerable claims on a portion of the social surplus—the part of production left over after all inputs have been paid for—in the form of relatively high earnings.¹⁸

Several studies in the past decade have shown associations between exploitation, in particular its domination aspects, and health outcomes in general population samples.^19,20

Occupational class

Many commonly used measures labelled as “occupational class” are in fact measures of occupational stratification; they serve to roughly rank workers on a hierarchical dimension. Such measures of occupational class are frequently grouped with other measures of stratification as alternative measure of social class. However, the concept of occupational class has developed within a theoretical tradition generally characterised as “Marxian”.

In this tradition, occupational class is defined by relationships of ownership or control over productive resources (ie, physical, financial or organisational resources). Occupational class has important systematic consequences for the lives of people: the extent of a person’s legal right and power to control productive assets determines the strategies and practices devoted to acquire income and, as a result, determines a person’s standard of living.²¹

The composition and importance of occupational class systems vary internationally, but in developed economies, the most important classes are capitalists, self-employed and small business owners, workers and those with contradictory positions (eg, managers and supervisors who are workers, but who represent the interests of owners in their work).²²

Organisational culture

Organisational culture is a pattern of basic assumptions that develops as the members of an organisation learn to cope with problems of external adaptation and internal integration. These basic assumptions are expressed as values and behavioural norms in organisations.²³

Importantly for public health, these values and norms determine how members of organisations behave with respect to workplace safety, workplace justice, discrimination in promotions, hiring and work assignment, sexual discrimination or harassment, and other workplace issues such as managing demands, burnout and stress.

In organisations, the culture is usually implicit in daily routines. But when an organisation has to change, understanding the old culture, interpreting lessons learnt from new experience, and making employees throughout the organisation aware of new practices and encouraging them to follow these practices become a responsibility of leadership. Culture change becomes a part of organisational change that can be led and managed.^23–25 (Other terms with meanings overlapping organisational culture are organisational climate and workplace environment.)

Organisational justice and fairness

Organisational justice refers to whether or not decision-making procedures are consistently applied, correctable, ethical, and include input from affected parties (procedural justice). It also refers to respectful, considerate and fair treatment of people by supervisors (relational justice).²⁶

Organisational justice research has been developed from equity theory,²⁷ which considers the ratio of input and output, and compares that proportion with those of referent others. If this comparison leads a worker to believe that his or her situation is inequitable, the worker is motivated to reduce that inequity by reducing input, increasing output or changing the referent others.

These personal assessments are reinforced by strong social norms about fairness. Research has shown that perceived justice is associated with people’s feelings and behaviours in social interactions, and that low organisational justice is an important psychosocial predictor of employees’ health in modern workplaces.²⁸ For example, evaluations of low justice have been related to negative emotional reactions,²⁹ which in turn have been associated with unhealthy patterns of cardiovascular and immunological responses and certain health problems.³⁰

Outsourcing

Outsourcing is a strategic switch to using external suppliers to carry out activities previously handled by internal staff and resources. Outsourcing may include the creation of durable partnerships and the organisation of supply chains. This process can be especially sensitive for workers and their communities when it entails moving production from developed to developing countries. Outsourced work may also go to independent contractors, self-employed or home workers. Displaced and outsourced workers may be faced with reduced wages, longer working hours, problems in work-site management, inability to organise or protect themselves, failure of established regulatory procedures and the shifting of work to unregulated firms or sites.³¹

Power and authority

Power is the ability to make what one wants happen, even over the resistance or opposition of others. There are numerous sources of power, but they are often associated with having control over generalised resources such as money, organisations, political parties and communications media. Some of the sources of power are situation specific—for example, having access to information networks, having a particular position in an organisation or possessing control over particular natural resources. Other sources of power, such as charisma, are personal.

Power is manifest through the political processes in government policy, in the actions of organisations, and in the definition of agendas and issues whenever present or future possibilities are contested.³² Questions of on-the-job autonomy, skill discretion and decision latitude are largely questions of the decentralisation of power in organisations. Position and the capacities that come with a position to make decisions or take action mean having control over resources and decision-making power regarding the allocation of resources. Power also means having the ability to define the scope and limits of action, to set standards of performance, to evaluate performance and to distribute rewards.

The authority associated with different positions in organisations varies according to several factors—for example, authority varies in scope due to the function of the position in the organisation. In most positions, workers have only limited authority over themselves; those in other positions have the authority to define the division of labour for others, to decide the overall objectives of the organisation and to delineate the content of the organisational culture.³¹

Restructuring work organisations

There have been numerous attempts among managers in recent decades to reorganise work in search of a formula for “high-performance work organisation”.³³ The main forces behind these movements have been advances in information processing technology and expanded global competition. Some approaches to restructuring work have held possibilities for both improved productivity and reduced alienation; others have focused on cost-cutting and work intensification.¹⁰

Although there are many names for work restructuring—total quality management, process re-engineering, lean production and flexible specialisation are some of the more common—these management initiatives share several common characteristics. They organise workers in teams, use tactics such as job rotation and emphasise the development of skills in the workforce. They also have many common consequences. Downsizing or redundancy programmes reduce costs by reducing the number of people employed in an organisation.

After restructuring, organisations are left with fewer employees who are expected to give their best in a manner that enhances organisational efficiency and productivity, while at the same time the human capital is reduced and organisational memory is disrupted.^34,35 Work restructuring carried out in healthcare institutions has consequences both for healthcare workers and for people receiving care.^36,37 Restructuring brings changes in staff mix, work flows, job responsibilities and production design.^38,39