From absence management to prevention that works

The Netherlands has a structural problem: occupational healthcare is often set up to react after someone drops out, while the biggest gains lie in the phase before. Much absence does not arise “suddenly”, but after weeks or months of rising pressure, poorer recovery, conflicts, lack of control or an accumulation of private and work factors. By the time someone calls in sick, prevention has usually already been overtaken by damage control.

Recent research by James van der Spek in collaboration with Nyenrode shows that this is not only a question of execution, but above all a question of the system. The core: prevention only really gets off the ground when market incentives, legal frameworks and ethical preconditions are right at the same time.

The market problem: prevention is hard to “prove”

Prevention often does pay off, but the return is hard to demonstrate. You don’t see what you have prevented, effects come later, and costs and benefits end up in different “budgets” within the organisation. As a result, attention naturally shifts to what is directly visible: case files, interventions after a sick report, process steps and lead times. Prevention thus becomes a programme alongside the work, instead of a normal part of how work is organised.

In practice, prevention works better when it is not sold as broad wellness, but as a manageable process: detect early, act quickly and scale up in a targeted way. Not doing more, but choosing more wisely where you intervene first.

The legal problem: standards exist, but enforce little

The Netherlands has plenty of instruments that are meant to support prevention, but in many organisations they are only filled in minimally. The reason is rarely unwillingness. More often, the rules push towards ticking “mandatory boxes”. As a result, the conversation gets stuck in policy and checklists, while it is really about day-to-day functioning: how managers act, how teams recover, and how early signals are picked up.

If you take prevention seriously, you translate obligations into concrete routines: fixed moments for reflection, clear roles and demonstrable follow-up. Not as extra administration, but as normal governance.

The ethical problem: prevention touches autonomy and trust

Prevention is always about people. That immediately brings you to boundaries: what may an employer ask, what does an employee want to share, and how do you prevent help from feeling like control? If those boundaries are not explicit, distrust arises and participation stays low. If the boundaries are too strict, help does not come in time.

Real prevention therefore calls for clear principles: voluntary participation where appropriate, strict separation between medical information and employer information, and transparency about what happens to data. Prevention only works when it is experienced as support, not as monitoring.

So what is an effective prevention strategy?

An effective approach combines three things. First: early detection at team and organisational level, so you are not dependent on a sick report as the “starting signal”. Second: quick, appropriate support that starts with a low threshold and only goes deeper where needed. Third: embedding it in the rhythm of the organisation, with simple management information that helps you choose and adjust.

What Healthguard does

Healthguard organises prevention as a working system around employability: recognising in time what is building up, quickly offering the right support, and setting it up so that privacy and trust stay intact. Not by adding yet another programme, but by making prevention part of how work and support actually run.

The guiding question then changes from “How do we manage absence neatly?” to “Which risks are building up now, and what are we doing this month to prevent absence later?”