148 Chapter 5 limited access of OPs (28, 32). Thus, collaboration between these two domains needs improvement. To improve the collaboration, the first step is to raise awareness among GPs on the relation between health complaints and work, to train GPs to be more able to discuss work-related problems, and to refer patients more easily to an OP (28, 31, 32, 34). The second step is to explore initiatives to improve the collaboration, by for example addressing misconceptions between GPs and OPs roles and independence of OPs and how to reach and communicate effectively with each other (31). In this study, several stakeholders described that employers of employees with a lower SEP give the health of their employees less priority and often put economic interests first. They focus more on the organizational processes and performances of employees than on the health and well-being of their employees (35,36,37). Although, it is understandable that employers primarily think about the needs and interests of their businesses, most employers are still willing to ensure a safe and healthy working environment for their employees. However, literature shows that some employers are more reluctant to invest in the working environment, particularly in case the employer considers employees with a lower SEP to be of lower value and more easily replaceable (38). Prevention is considered an important priority by all stakeholders in this study, but they also mentioned that investments in prevention are limited. Literature shows that there is insufficient attention by employers for prevention (29, 39), that a low number of organizations has policies on prevention, and if there are policies on prevention these are mainly present in larger organizations (39). The latter was also found in the present study; a smaller organization with fewer resources can be considered a barrier for investments in prevention. Another explanation for insufficient investments described in this study and in literature, is that the benefits of preventing health problems on the longer term are unclear (29). In the Netherlands, employers pay and therefore determine which preventive services and services for sick-listed employees are provided to employees in organizations. However, sick listed employees result in a financial burden for employers and the implementation of services for these employees are linked to short term economic benefits (38). As a result, employers are inclined to mainly focus on services for employees on sick leave (29) and will less likely invest in preventive services. Prevention in organizations is challenging, as this study showed that methods for the identification of employees mainly focus on indicated prevention, which makes it difficult to early identify employees at risk. Although, employees in the Netherlands are enabled by law to visit an OP for preventive advice, employees make little use of this opportunity. Moreover, OPs availability to preventively solve problems on multiple life domains was also considered limited in this study. Their tasks mainly consist of providing advice to employees on sick leave,
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