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Akerstrom M, Severin J, Miech EJ, Wikström E, Roczniewska M. Reducing sickness absence among public-sector healthcare employees: the difference-making roles of managerial and employee participation. Int Arch Occup Environ Health 2024; 97:341-351. [PMID: 38409534 PMCID: PMC10944807 DOI: 10.1007/s00420-024-02048-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 01/16/2024] [Indexed: 02/28/2024]
Abstract
PURPOSE Evaluations of organizational-level interventions to prevent work-related illness have identified enabling factors, but knowledge of necessary and sufficient conditions for intervention success is needed. The aim was to identify difference-making factors that distinguish intervention groups with and without a positive intervention effect on sickness absence. METHODS An organizational-level intervention designed to decrease sickness absence by providing support from process facilitators was implemented at eight healthcare workplaces in Sweden between 2017 and 2018. We applied coincidence analysis (CNA) to analyze 34 factors and determine which factors were necessary and sufficient for a successful implementation of tailored interventional measures on an organizational level (dichotomous) and reduced sickness absence (trichotomous). RESULTS Two factors perfectly explained both the presence and absence of a successful implementation: "a high sense of urgency" and "good anchoring and participation from the strategic management". The presence of either of these factors alone was sufficient for successful implementation, whereas the joint absence of both conditions was necessary and sufficient for the absence of successful implementation and an intervention effect. In addition, high employee participation was both necessary and sufficient for a high intervention effect. For organizations without high employee participation, successful implementation led to a medium-effect size. CONCLUSIONS This study identified participation as a difference-maker in the implementation process. Participation from different stakeholders turned out to be important in different phases. When implementing organizational-level interventions, high participation from both strategic management and employees appears to be crucial in terms of the intervention's effect on sickness absence.
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Affiliation(s)
- M Akerstrom
- Region Västra Götaland, Institute of Stress Medicine, Carl Skottbergs Gata 22B, 413 19, Gothenburg, Sweden.
- School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
| | - J Severin
- Region Västra Götaland, Institute of Stress Medicine, Carl Skottbergs Gata 22B, 413 19, Gothenburg, Sweden
- School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - E J Miech
- Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, USA
| | - E Wikström
- Department of Business Administration, School of Business, Economics and Law, University of Gothenburg, Gothenburg, Sweden
| | - M Roczniewska
- Procome Research Group, Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
- Institute of Psychology, SWPS University, Sopot, Poland
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Dahlqvist I, Ståhl C, Severin J, Akerstrom M. Shifting from an individual to an organizational perspective in work environment management - a process evaluation of a six-year intervention program within the Swedish public sector. BMC Public Health 2023; 23:1108. [PMID: 37291519 PMCID: PMC10248951 DOI: 10.1186/s12889-023-16059-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/06/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Working systematically with the work environment, particularly the organizational and psychosocial work environment entails several challenges for employers. There is a lack of knowledge on how to best undertake this work. Thus, the aim of this study is to evaluate the process of a six-year organizational-level intervention program where workplaces could apply for additional funds to implement preventive intervention measures, with the intention of improving working conditions and reducing sickness absence within the Swedish public sector. METHODS The program management process was studied using a mixed-method approach combining qualitative document and content analyses based on process documentation produced between 2017 and 2022 (n = 135), interviews with internal occupational health services professionals in 2021 (n = 9) and quantitative descriptive analyses of submitted applications with decisions from 2017 to 2022 (n = 621). RESULTS Qualitative analyses of the process documentation revealed concerns from the project group regarding access to sufficient competence and resources among stakeholders and participating workplaces, and role conflicts and ambiguities between the program and everyday operations. To address these challenges, the application process was developed over time using the knowledge gained from previous years. A change in the mental models in work environment management, from an individual to an organizational perspective, was seen among the project group and the internal occupational health services responsible for implementing most of the granted intervention measures. In addition, the proportion of granted intervention measures on an organizational level increased throughout the years from 39% in 2017 to 89% in 2022. The changes in the application process were believed to be the main contributor to the change among the applying workplaces. CONCLUSIONS Results indicate that a long-term organizational-level workplace intervention program may be used, by the employer, as a tool for shifting from an individual- to an organizational perspective in the work environment management. However, additional measures on multiple levels need to be implemented to secure a sustainable shift in perspective within the organization.
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Affiliation(s)
- I Dahlqvist
- Region Västra Götaland, Institute of Stress Medicine, Gothenburg, Sweden
| | - C Ståhl
- Department of Behavioural Sciences and Learning, Division of Education and Sociology, Linköping University, Linköping, Sweden
| | - J Severin
- Region Västra Götaland, Institute of Stress Medicine, Gothenburg, Sweden
- School of Public Health and Community Medicine, Institute of Medicine, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Magnus Akerstrom
- Region Västra Götaland, Institute of Stress Medicine, Gothenburg, Sweden.
- School of Public Health and Community Medicine, Institute of Medicine, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
- Institute of Stress Medicine, Region Västra Götaland, Carl Skottbergs gata 22B, Gothenburg, 413 19, Sweden.
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Akhtar MW, Huo C, Syed F, Safdar MA, Rasool A, Husnain M, Awais M, Sajjad MS. Carrot and Stick Approach: The Exploitative Leadership and Absenteeism in Education Sector. Front Psychol 2022; 13:890064. [PMID: 35936337 PMCID: PMC9350597 DOI: 10.3389/fpsyg.2022.890064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 03/22/2022] [Indexed: 11/29/2022] Open
Abstract
Utilizing the conservation of resources theory, this study investigates serial mediation of facades of conformity and depression between exploitative leadership and absenteeism. A total of 211 education sector employees using the convenient sampling technique took part in the survey with data collected in a time-lagged research design. Findings of the study reveal that facades of conformity and depression mediate the independent paths and play a serial mediating role between EL and absenteeism path. This study suggests that EL works as a workplace stressor, under which employees try to protect their valuable resources from further loss in the form of facades of conformity, in doing so, it leads to depression; thus, employees ultimately use absenteeism as an active coping strategy to cope with workplace stressors.
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Affiliation(s)
- Muhammad Waheed Akhtar
- Asia-Australia Business College, Liaoning University, Shenyang, China
- Department of Management Sciences, COMSATS University Islamabad, Sahiwal, Pakistan
| | - Chunhui Huo
- Asia-Australia Business College, Liaoning University, Shenyang, China
| | - Fauzia Syed
- Faculty of Management Sciences, International Islamic University, Islamabad, Pakistan
| | | | - Arsalan Rasool
- Department of Public Administration, The Islamia University Bahawalpur, Bahawalpur, Pakistan
| | | | - Muhammad Awais
- Faculty of Management Sciences, The University of Lahore, Sargodha, Pakistan
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Ståhl C, Gustavsson IN, Jonsdottir IH, Akerstrom M. Multilevel, risk group-oriented strategies to decrease sickness absence in the public sector: evaluation of interventions in two regions in Sweden. Int Arch Occup Environ Health 2022; 95:1415-1427. [PMID: 35451629 PMCID: PMC9273540 DOI: 10.1007/s00420-022-01864-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 04/01/2022] [Indexed: 11/05/2022]
Abstract
Purpose Sickness absence has been identified as needing to be addressed through multilevel interventions, but knowledge regarding optimal design and implementation of such interventions is scarce. The aim of this study was to evaluate the implementation and effects of a large-scale multilevel intervention in the public sector in Sweden. Methods The overall effect of the intervention was assessed using mixed-effect models. Sickness absence data (before, and 6 or 12 months after the intervention) for 90 intervention groups and 378 reference groups was retrieved from administrative personnel systems from the two participating regional councils. The implementation processes were evaluated using qualitative content analysis of qualitative interviews conducted at two timepoints. Results The results show that the vast majority of implemented measures were on an individual level and the integration of the intervention differed between the two regions. The reception and perception of the intervention activities seem to have been influenced by the implementation process, and how well the interventions were communicated and integrated, both regarding the integration of the different interventions and their integration into the discrete context and existing routines. No short-term overall effects on sickness absence were found. Conclusions The results point to the many challenges in implementing complex interventions, especially where organizational measures are involved—including adequate participation by, and communication between, the involved actors, as well as sufficient resources. The results indicate potential learning effects regarding the awareness of organizational factors in sick leave, after implementing and integrating multilevel strategies.
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Affiliation(s)
- Christian Ståhl
- Department of Behavioral Sciences and Learning, Linköping University, 581 83, Linköping, Sweden. .,HELIX Competence Center, Linköping University, 581 83, Linköping, Sweden.
| | - Isa Norvell Gustavsson
- Department of Health, Medicine and Caring Sciences, Linköping University, 581 83, Linköping, Sweden
| | - Ingibjörg H Jonsdottir
- The Institute of Stress Medicine, Region Västra Götaland, 413 19, Gothenburg, Sweden.,School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy at the University of Gothenburg, 405 30, Gothenburg, Sweden
| | - Magnus Akerstrom
- The Institute of Stress Medicine, Region Västra Götaland, 413 19, Gothenburg, Sweden.,School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy at the University of Gothenburg, 405 30, Gothenburg, Sweden
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Cost-Benefit Evaluation of an Organizational-Level Intervention Program for Decreasing Sickness Absence among Public Sector Employees in Sweden. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052998. [PMID: 35270691 PMCID: PMC8910127 DOI: 10.3390/ijerph19052998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/25/2022] [Accepted: 03/02/2022] [Indexed: 02/01/2023]
Abstract
Work-related illnesses create a vast economic burden for employers and society. Organizational-level workplace interventions are recommended to prevent these illnesses, but the knowledge about the economic benefits of such interventions is scarce. The study aimed to evaluate the economic benefit of an organizational-level workplace program for decreasing sickness absence. The program contained a monetary support approach (MSA) and an approach combining monetary and facilitator support (FSA). Cost–benefit analyses were used, where the results were compared to those of business as usual. Economic benefits of reduced sickness absence were based on the value of reduced production loss and direct sick pay costs, respectively. Sensitivity analyses were used to assess the robustness of the results. The program had a positive net benefit when measuring productivity loss, where the FSA had a net benefit and the MSA had a net loss. A negative net benefit was derived when measuring direct sick pay costs. The intervention effect on sickness absence affected the net benefit the most. This program was economically beneficial in terms of reducing the productivity loss, but not of reducing direct sick pay costs connected to short-term sickness absence. Using evidence-based methods is essential for increasing the long-term net benefit of organizational-level workplace interventions.
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Wikström E, Severin J, Jonsdottir IH, Akerstrom M. Process facilitators shifting between the support and expert roles in a complex work environment intervention in the Swedish healthcare sector. J Health Organ Manag 2021; 36:25-47. [PMID: 34985224 PMCID: PMC9616018 DOI: 10.1108/jhom-10-2021-0382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 11/10/2021] [Accepted: 11/10/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE Process facilitation as part of a complex intervention for changing or improving practices within workplaces is becoming a common work method. The aim of this study was to investigate what characterizes the process-facilitating role in a complex intervention. DESIGN/METHODOLOGY/APPROACH The present study focuses on a complex work environment intervention targeting eight organizational units (workplaces) in the Swedish healthcare sector. The study applies a mixed-method approach and has been carried out in two steps. First, a qualitative process evaluation was performed. Secondly, an evaluation was conducted to see to what extent these identified conditions and mechanisms affected the quantitative intervention effect in term of sickness absence. FINDINGS The analysis shows that the facilitating role consisted of three overlapping and partially iterative phases. These phases involved different activities for the facilitating role. Depending on how the facilitating role and the intervention were designed, various supporting conditions were found to significantly affect the outcome of the intervention measured as the total sickness absence. RESEARCH LIMITATIONS/IMPLICATIONS It is concluded that the facilitation is not static or fixed during the change process. Instead, the facilitation role develops and emerges through the process of support during the different implementation phases. PRACTICAL IMPLICATIONS The facilitative role of performing support is based on a combination of support role activities and expert role activities. The support role focuses on support activities, while the expert role includes capacity building through knowledge- and legitimacy-oriented activities. ORIGINALITY/VALUE This study contributes to earlier research by developing a methodological approach for carrying out process facilitation in complex interventions.
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Affiliation(s)
- Ewa Wikström
- Department of Business Administration,
School of Business, Economics and Law
,
University of Gothenburg
, Gothenburg,
Sweden
| | - Jonathan Severin
- Region Västra Götaland
,
Institute of Stress Medicine
, Gothenburg,
Sweden
| | - Ingibjorg H. Jonsdottir
- Institution of Neuroscience and Physiology
,
University of Gothenburg
, Gothenburg,
Sweden
- Institute of Stress Medicine
, Gothenburg,
Sweden
| | - Magnus Akerstrom
- Occupational and Environmental Medicine,
Institute of Medicine
,
School of Public Health and Community Medicine
,
The Sahlgrenska Academy
,
University of Gothenburg
, Gothenburg,
Sweden
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