28 Chapter 2 Environmental factors. As environmental factors, physicians mentioned work-related factors (e.g., workload, work content, work autonomy, commuting time) and workplace factors (e.g., facilities, noise, light, climate). Patient representatives added organizational policies and practices, social support, job control and job fit, conflicts at work, discrimination, and re-organization as factors associated with the ability to work fulltime. One physician said, “The moment you create more possibilities at work, people have the ability to make a positive contribution to work, even at higher ages” (Ph9). A patient representative said, “All circumstances at work, and whether or not you are satisfied with them, play a very important role in your work capacity” (Pa2). Regarding social factors, we found that workers’ social situations can impact the number of hours they are able to work. A person’s household, family obligations, family concerns, problems and worries, may negatively influence the ability to work a certain number of hours per day or per week. However, family support can also have a positive effect. A physician said, “When you have big problems in your private life, you can be physically able to work, but your true ability to work and your productivity will be lower as long as these issues are not resolved” (Ph9). A patient representative said, “When you have a good partner, good support and feel well, you are better able to cope with your limitations” (Pa6). Further, most participants stated that societal norms strongly influence what is generally considered to be normal. Both physicians and patient representatives considered fulltime working as normal, but the number of hours per day and per week may differ, depending on societal norms. These norms can be based on legal and collective arrangements between employers and employees regarding working conditions, on policies within companies, and on insights within social groups. A physician said, “What is expected of a worker is based on legal or social norms. Apparently, a Dutch fulltime employee is legally required to work 40 or 38 hours, depending on the labor agreement, or fewer hours, depending on the employment contract. But that doesn’t say anything about his physical ability” (Ph5). A patient representative said, “I think that most people are able to work between 30 to 40/50 hours (per week), but it strongly depends on where you come from and on your upbringing” (Pa3). Participants generally agreed that every person has his or her own maximum of hours that he/she can work, and stated that it is impossible to prescribe a universal maximum of working hours. A patient representative stated, “I think the maximum amount is very personal and very much dependent on the sort of work you do. I don’t think there is an upper limit that applies to everyone” (Pa8). Physicians stated that the maximal number of hours a person can work per day or per week may differ from person to person, ranging from 9 to 12 h per day and from 55 to 80 h per week. According to the physicians, the upper limit is influenced not only
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