Process facilitators shifting between the support and expert roles in a complex work environment intervention in the Swedish healthcare sector

Examining preventive occupational health and safety management in the Swedish welfare sector-questionnaire development, its validity and reliability, and initial findings on employers' knowledge

INTRODUCTION

A preventive approach to occupational health and safety management (OHSM) can improve working conditions, but more knowledge is needed on how this should be organised in practice. Here, we describe the development, validity and reliability of a questionnaire used to examine employers' preventive OHSM within the Swedish welfare sector. Furthermore, employers' knowledge of preventive OHSM was explored using the survey data.

MATERIAL AND METHODS

A questionnaire was developed based on interviews with key actors (n = 7), experts (n = 6) and intended respondents (n = 5). Using the final questionnaire, 197 responses were collected from employer (n = 126) and employee representatives (n = 71) and used to assess the validity and reliability of the questionnaire. Qualitative and quantitative analyses of open-ended and multi-choice items were used to assess the response distribution, content validity and interrater reliability (i.e. employer-employee correspondence from 32 matched pairs from the same workplace). Quantitative and qualitative analyses of survey responses from employer representatives were performed to assess their knowledge of preventive OHSM.

RESULTS

The final questionnaire included 91 items covering employers' working routines, resources and work environment economics. Qualitative analyses indicated a high content validity in the questionnaire, with a satisfactory response distribution and very small proportion of missing data on individual survey items. Overall, the interrater reliability was high (>60%), but the employer representatives generally gave more examples within different areas of the OHSM compared to the employee representatives. Most of the employer representatives (74%, n = 90) assessed that their organisation had sufficient knowledge regarding preventive OHSM but that the knowledge of work environment economics was lower.

CONCLUSIONS

By combining work environment research with questionnaire design research, high validity and reliability was achieved for this questionnaire. Furthermore, the employers generally perceived that they have high knowledge of preventive OHSM but that more knowledge is needed on work environment economics.

Reducing sickness absence among public-sector healthcare employees: the difference-making roles of managerial and employee participation

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.

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

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.

Multilevel, risk group-oriented strategies to decrease sickness absence in the public sector: evaluation of interventions in two regions in Sweden

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.

Cost-Benefit Evaluation of an Organizational-Level Intervention Program for Decreasing Sickness Absence among Public Sector Employees in Sweden

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.