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Stress prevention programmes are predominantly reactive and aimed at individuals. Four factors that may contribute to this current status are discussed: the opinions and interests of company management, the nature of psychology, the difficulty of conducting methodologically 'sound' intervention studies and the denominational segregation of stress research. To increase the impact of organizational level interventions, the effects need to be demonstrated on matters that appeal to company management, such as quality of products and services, organizational flexibility, productivity and sickness absence rates. The demonstration of examples of good preventive practice is considered as a conditio sine qua non for developing effective stress prevention procedures and for the involvement of both social partners in this field. Therefore, 10 Dutch projects from several branches of industry, aimed at the reduction of work stress, physical workload and sickness absenteeism, were selected, analysed and compared. The results show that in most cases sickness absenteeism was reduced and that the benefits exceeded the costs of the interventions. Five factors seem to be at the heart of a successful approach: (1) its stepwise and systematic nature, (2) an adequate diagnosis or risk analysis, (3) a combination of measures (i.e. both work-directed and person-directed), (4) a participative approach (i.e. worker involvement) and (5) top management support. In conclusion, the projects suggest that stress prevention may be beneficial to both the employee and the organization. © 1998 John Wiley & Sons, Ltd.