J Health Behav Med Hist 2025-3
Optimizing Work Healthiness with the Work Healthiness ABCDE Method©
Robert C. van de Graaf, MD, director
MEDTCC Institute for Health, Behaviour, Medicine and its History, The Netherlands.
Introduction
Work healthiness©, a concept coined by doctor Robert C. van de Graaf in 2020,refers to ‘the ability of individuals and organizations to positively adapt to internal and external changes while maintaining control over their own functioning’. It is a continuous process requiring assessment of the situation and proactive adjustments to sustain performance, engagement, and well-being. This concept aligns with modern concepts such as sustainable employability, work ability, and vitality, emphasizing resilience, adaptability, and self-management.
Given the persistently high levels of stress-related dysfunction, burnout and sickness absence, enhancing work healthiness at both the organizational and individual levels has never been more critical. In the Netherlands, the sickness absence rate reached 5.4% in Q4 2024, meaning that out of every 1,000 working days, 54 were officially recorded as lost due to illness [CBS, 2025-1]. However, these absences are often not solely the result of medical conditions. In many cases, they arise from broader work-related issues, including an imbalance in job demands, insufficient organizational support, workplace culture surrounding sickness absence, or a lack of individual coping resources.
“A significant portion of absenteeism is likely rooted in misalignment within the TOP-fit triangle© at work [Van de Graaf, 2025-1], where task, organization, and person fail to align in a way that supports sustainable functioning and well-being. This mismatch is not a medical condition but rather a sign of a dysfunctional relationship between the three key elements of the TOP-fit triangle© in the workplace.” When the TOP-fit triangle© is out of balance, it can lead to unnecessary absenteeism, where employees stay home when they might have been able to work under different conditions, or presenteeism, where they continue working despite being unwell, often at reduced productivity. Addressing these misalignments is essential for creating healthier, more resilient and productive workplaces.
Mental health issues, stress, and burnout have become major contributors to sickness absence In 2023, 7,9% of the sickness absences in the Netherlands were linked to these factors [RIVM, 2025], while 19% of employees reported experiencing burnout symptoms in 2023 [CBS, 2025-2]. These concerning figures underscore that work-related stress is not merely an individual issue but a systemic challenge that demands an organizational response.
A misalignment within the TOP-fit triangle© – where job demands exceed personal capacities, organizational structures fail to provide adequate support, or employees struggle to maintain control over their work – creates a cycle of chronic stress. Left unaddressed, this imbalance increases the likelihood of frequent or prolonged absences and contributes to declining productivity. To foster a healthier and more sustainable work environment, organizations must take a proactive approach in identifying and correcting these structural misalignments.
To break this cycle, organizations must actively enhance work healthiness, which is defined as ‘the ability of individuals and organizations to positively adapt to internal and external changes while maintaining control over their own functioning’. By improving the alignment between task, organization, and person, and ensuring a better fit between job demands and available support structures, sickness absence and stress-related functional impairments can be significantly reduced. The Work Healthiness ABCDE Method© provides a structured, proactive approach to recognizing and addressing these mismatches. By shifting from a reactive approach that merely responds to sickness absence toward an active strategy that fosters work healthiness, organizations can create more sustainable, resilient, and productive workplaces, ultimately benefiting both employees and employers.
The Work Healthiness ABCDE Method©
The Work Healthiness ABCDE Method© provides a structured approach to systematically addressing these challenges and enhancing work healthiness. Central to the method is the TOP-fit model© with the TOP-fit triangle© [Van de Graaf, 2025-1]. The Work Healthiness ABCDE Method© provides a structured approach to assessing and optimizing work healthiness by analysing the three core components of the TOP-fit triangle©: task, organization, and person [Van de Graaf, 2025-1]. The task refers to the nature and demands of the job, including workload, complexity, and required skills. The organization encompasses the structures, culture, leadership, and resources that support or hinder effective functioning. The person represents the individual’s capabilities, health, motivation, and adaptability. With an optimal work healthiness these three elements can be maintained in balance within the TOP-fit triangle.
Assessment
The first step in the Work Healthiness ABCDE Method© is assessment, which involves analysing the three core elements of the TOP-fit triangle©: task, organization, and person. This step requires evaluating job responsibilities and demands, the support and resources provided by the organization, and the employee’s skills, health status, and coping mechanisms. A thorough assessment helps identify potential risks for both health problems and functional impairments, providing a foundation for targeted interventions to improve the situation.
Table. Work Healthiness ABCDE Method©
| Step | Description |
| Assess (A) | Analyze the task, organization, and person within the TOP-fit triangle©. Identify risks for health issues and functional impairments to enable targeted interventions. |
| Balance (B) | Determine if task, organization, and person are well-aligned (‘fit’). Identify mismatches that may cause stress, inefficiency, or health issues, and address them proactively. |
| Communicate (C) | Discuss assessment findings with stakeholders to foster awareness and shared responsibility. Encourage open dialogue and self-reflection to clarify priorities. |
| Develop (D) | Implement changes to improve the ‘fit’ in the TOP-fit triangle© by adjusting tasks, support, skills, etc. Aim to restore balance and enhance sustainability. |
| Evaluate (E) | Evaluate the impact of changes by monitoring satisfaction, performance, and well-being. Maintain successes, reassess needs, and restart the cycle for continuous improvement. |
Balance
After the assessment, it is essential to determine whether the relationships between the task, organization, and person are well-aligned (‘fit’). Key questions in this step include whether the tasks are suited to the individual’s capabilities, whether the organization provides adequate support for the tasks being performed, and whether the individual can meet the demands of the job without experiencing excessive stress. Identifying mismatches early on can reveal potential risks such as stress, burnout, reduced performance or sickness absence. Addressing these imbalances proactively allows for targeted interventions to improve the situation and prevent future issues.
Communicate
Effective communication is essential for translating insights from the assessment and balance evaluation into actionable steps. This phase involves discussing the findings with relevant stakeholders, including supervisors and colleagues, to foster awareness and shared responsibility. Engaging in self-reflection to clarify personal perspectives and priorities is also important. By aligning expectations and collaborating on solutions to address imbalances and risks, open communication reduces stigma around work-related challenges and encourages a culture of continuous improvement.
Develop
After raising awareness and engaging in communication, the next step is to actively develop and implement changes that improve the ‘fit’ within the TOP-fit triangle©. This may involve adjusting job tasks to better align with individual capabilities, enhancing organizational support to provide more effective resources, and improving personal skills and coping mechanisms through training, stress management, and well-being initiatives. The goal is to create an actionable plan that reduces risks, restores balance, and promotes a more sustainable and resilient work situation.
Evaluate
The final step in the Work Healthiness ABCDE Method© is evaluation, where the effectiveness of implemented changes is measured and further adjustments are made if necessary. This phase involves monitoring improvements in the ‘fit’ of the TOP-fit triangle©, such as job satisfaction, performance, and well-being indicators. Successful changes should be maintained, while areas still needing attention are reassessed. The ABCDE cycle then restarts by revisiting the assessment phase, ensuring ongoing monitoring and adaptation. By continuously measuring, refining, and restarting the cycle, individuals and organizations cultivate a sustainable process that enhances both work productivity and employability.
Practical Applications and Organizational Perspectives
The Work Healthiness ABCDE Method© is applicable at both the individual and organizational levels. For individuals, it serves as a self-management tool for monitoring their work, identifying risks and other stressors, and implementing personal strategies for improvement, thereby improving their work healthiness. For organizations, it provides a structured framework for leaders and HR professionals to assess workplace dynamics, enhance employee well-being, and develop targeted interventions to reduce absenteeism and presenteeism, and improve operational success.
Case Study: Applying the Work Healthiness ABCDE Method©
A real-world example highlights the effectiveness of this approach. An employee struggled with increasing stress due to a high workload and limited organizational support. Overwhelmed by multiple factors, he lost control of his work situation. To cope, he resumed smoking, consumed excessive coffee during the day, and relied on alcohol in the evenings to relax. The use of substances to cope with stress is common [Van de Graaf, 2025-2]. Eventually, he reported sick and received coaching to support his reintegration and long-term employability.
Using the Work Healthiness ABCDE Method©, an assessment identified key risks and misalignments within his TOP-fit triangle©. Through discussions with his manager, targeted interventions—such as task redistribution and flexible scheduling—were introduced. Over time, he regained control of his work situation, successfully quit smoking again, significantly reduced coffee intake, and stopped drinking alcohol during the workweek, limiting consumption to moderate levels on weekends.
A follow-up evaluation confirmed the improvements, making these changes a lasting part of his routine. His overall performance and well-being improved significantly, and he continued applying the Work Healthiness ABCDE Method© to sustain his work healthiness.
Conclusion
Work is a dynamic and evolving process that demands ongoing attention and proactive management to minimize the risks of work-related underperformance and health issues. The TOP-fit model© provides a structured way to analyse key factors influencing work healthiness, while the ABCDE method© offers a practical framework for continuous assessment, balance, communicate, develop, and evaluate. Given the persistently high levels of sickness absence and stress-related complaints, improving work healthiness is not optional but necessary. Employees frequently remain fully absent for extended periods, despite the possibility of partial participation. By systematically applying the ABCDE method© within the TOP-fit framework©, individuals and organizations can enhance resilience, adaptability, and sustainable performance, ultimately fostering a healthier, more engaged, and more productive workforce.
References
Van de Graaf RC (2025-1). The evolution of a behavioural model: how the triangle shaped my thinking. J Health Behav Med Hist 2025-1.
CBS (2025) https://www.cbs.nl/nl-nl/visualisaties/dashboard-arbeidsmarkt/werkenden/ziekteverzuim (2025, March 27th).
RIVM (2025-1). https://www.rivm.nl/mentale-gezondheid/monitor/gevolgen-mentale-ongezondheid/ziekteverzuimpercentage (2025, March 27th)
RIVM (2025-2) https://www.rivm.nl/mentale-gezondheid/monitor/werkenden/burn-out-klachten (2025, March 27th).
Van de Graaf RC (2025-2). The mutual relationship between work and substance use: the need for ADM policy in organizations. J Health Behav Med Hist 2025-2.