Mental health at work is moving from the margins of wellbeing programmes into the centre of organisational risk management. For hospitals, the key European message is clear: psychosocial risks should be assessed and prevented as occupational safety and health risks, not treated only after staff become unwell.
European Union | 27 August 2026
Healthcare organisations are demanding workplaces. High workloads, shift work, emotional demands, workforce shortages, exposure to violence, rapid organisational change and responsibility for vulnerable patients can combine to create substantial psychosocial pressure.
The European policy environment is now giving this issue greater visibility. EU-OSHA’s Healthy Workplaces Campaign 2026–2028, Together for mental health at work, focuses on the prevention and management of psychosocial risks and identifies health and social care as a priority sector.
The legal foundation, however, is not new. EU-OSHA states explicitly that managing work-related psychosocial risks is a legal imperative under Framework Directive 89/391/EEC. The Directive requires employers to ensure workers’ safety and health, assess workplace risks and apply preventive principles through national occupational safety and health systems.
Wellbeing support is not a substitute for prevention
Counselling, resilience programmes and employee assistance can be valuable. But they do not remove an employer’s responsibility to examine whether workload, scheduling, role design, organisational change, leadership or workplace violence are themselves creating avoidable risk.
The management question should therefore move from “How do we help staff cope?” to “What in the way we organise work may be creating or amplifying psychosocial risk?”
What is the European legal basis?
Council Directive 89/391/EEC — the Framework Directive on safety and health at work — establishes the general obligation for employers to ensure workers’ safety and health in every aspect related to work.
Its prevention principles include:
- avoiding risks;
- evaluating risks that cannot be avoided;
- combating risks at source;
- adapting work to the individual;
- adapting to technical progress;
- developing a coherent prevention policy covering technology, organisation of work, working conditions, social relationships and the working environment;
- giving collective protective measures priority over individual protective measures.
The Directive does not use a modern list of specific psychosocial hazards. Its general duty and risk-assessment framework apply across occupational risks. EU-OSHA explicitly interprets this framework as covering work-related psychosocial risks and states that employers have a legal responsibility to ensure workplace risks are properly assessed and controlled.
Precise duties, enforcement mechanisms and required documentation depend on the national legislation that transposes and develops the EU framework. Hospitals should therefore connect European principles to their national occupational safety and health obligations.
What counts as a psychosocial risk?
Workload
Excessive workload, work intensity, insufficient recovery, unsocial schedules and sustained time pressure can become organisational risk factors.
Control and role clarity
Conflicting demands, lack of autonomy, unclear responsibilities and insufficient involvement in decisions can contribute to work-related stress.
Leadership and change
Poor communication, insufficient support and badly managed organisational change are recognised psychosocial risk factors.
Violence and harassment
Harassment, difficult interactions and violence from patients or others can affect workers’ psychological and physical health and require systematic prevention.
Why hospitals require a specific approach
Psychosocial risk in healthcare cannot be reduced to a generic staff survey. Hospital work combines several exposures that can reinforce each other: night work, emergency demand, moral and emotional pressure, unpredictable workload, staffing gaps, patient and family expectations, violence risk and rapid clinical decision-making.
EU-OSHA’s dedicated analysis of the health and social care sector describes high exposure to psychosocial risks and highlights regular risk assessment, worker participation and supportive working environments as important preventive measures.
The 2026–2028 Healthy Workplaces campaign also reports, using the 2025 OSH Pulse Survey, that 29% of EU workers experience stress, depression or anxiety caused or made worse by work. For hospital managers, such figures should not be used to diagnose individual staff. Their value is in reinforcing the need to identify organisational patterns and prevent avoidable harm.
Four levels of prevention
- Design work safely: address workload, staffing, scheduling, role clarity and the organisation of work.
- Equip managers: train leaders to recognise risk factors, communicate effectively, manage change and act early.
- Protect and support: provide clear pathways for violence, harassment, distress and occupational-health support.
- Monitor organisational signals: combine workforce, safety and experience data to identify emerging risk before it becomes crisis.
Risk assessment should examine the organisation of work
A psychosocial risk assessment should not ask only whether workers feel stressed. It should examine the factors that can create risk, which groups or services are most exposed, and what preventive actions are possible.
Hospitals may need to consider, among other issues:
- staffing and workload relative to demand;
- overtime, night work and recovery time;
- predictability and stability of rosters;
- role clarity and decision-making autonomy;
- exposure to violence, aggression and traumatic events;
- major organisational changes and restructuring;
- management support and communication;
- bullying, harassment and discrimination;
- career insecurity, recognition and development;
- digital work intensification and new forms of monitoring.
Worker participation is part of effective risk management
EU-OSHA emphasises the involvement of workers and their representatives in identifying and managing psychosocial risks. This is particularly important because the same organisational policy may affect services differently.
A hospital-wide workload policy, for example, can look reasonable at corporate level while creating unsafe pressure in one emergency service, intensive-care unit or community team. Risk assessment should therefore combine organisation-wide indicators with local participation and service-level analysis.
A practical 90-day agenda for hospital leaders
Assess and integrate
Review whether psychosocial risks are explicitly included in the organisation’s occupational risk-assessment framework and whether workforce, HR, occupational health, quality and safety data are connected.
Identify high-exposure services and involve workers and their representatives in understanding the risks.
Act on organisational causes
Prioritise preventable factors such as unsafe workload patterns, poor change management, role ambiguity, violence exposure or dysfunctional communication.
Train managers in prevention, early action, referral pathways and psychologically safe leadership.
Monitor and govern
Define Board-level indicators and escalation criteria. Evaluate whether interventions change the underlying risk rather than only increasing use of support services.
Create a regular review cycle linked to workforce planning, safety, organisational change and quality governance.
What should hospitals monitor?
No single indicator measures psychosocial risk. A useful management dashboard may combine:
- staff absence and long-term absence patterns;
- turnover and exit reasons;
- vacancy, overtime and temporary staffing pressure;
- roster instability and repeated missed rest;
- workplace violence and harassment incidents;
- staff experience and psychological-safety measures;
- occupational-health referrals at aggregated level;
- service-level workload and demand indicators.
These indicators should be used to identify organisational risk, not to monitor or profile individual mental-health status.
The 2026–2028 European campaign
The Healthy Workplaces campaign is not legislation. It is an EU-OSHA awareness and prevention programme aligned with the EU occupational safety and health framework. Its value for hospitals is practical: it concentrates European tools and attention on psychosocial risk management during the period 2026–2028.
Seven questions for every hospital board
- Are psychosocial risks formally included in our occupational risk assessment?
- Which services or professional groups face the highest organisational exposure?
- Are workload, scheduling and staffing treated as mental-health and safety issues?
- How do we assess the workforce impact of major organisational change?
- Are managers trained to prevent risk and respond appropriately when concerns emerge?
- Do staff have safe routes to report violence, harassment and unacceptable behaviour?
- Can we distinguish support for individuals from action on the organisational causes of risk?
From individual resilience to organisational responsibility
Hospitals should continue to support professionals who experience distress. But a mature mental-health strategy cannot stop at support services.
The stronger management approach is preventive: identify risks, redesign work where possible, equip managers, involve workers and monitor whether the organisation is becoming safer and more sustainable.
Assess. Prevent. Support. Learn. Lead.
A healthy workforce requires a healthy organisation of work.
Official resources
- EU-OSHA: Psychosocial risks and mental health at work
- Council Directive 89/391/EEC on safety and health at work
- Healthy Workplaces 2026–2028: Together for mental health at work
- Healthy Workplaces: prevention and management of psychosocial risks
- EU-OSHA: Psychosocial risks in the health and social care sector
This article provides general information, not legal or occupational-health advice. Framework Directive 89/391/EEC is implemented through national law, and hospitals should assess their precise duties under the applicable national occupational safety and health framework and collective arrangements. The Healthy Workplaces Campaign is an EU-OSHA prevention initiative, not a separate legal instrument.
Secretary-General perspective
Healthcare cannot depend indefinitely on professionals adapting themselves to avoidable organisational pressures. Leadership has a responsibility to create working environments in which people can deliver demanding care safely, sustainably and with the support they need.
Leandro Luís · Secretary-General, European Association of Hospital Managers