Organizational change and the risk of sickness absence: a longitudinal multilevel analysis of organizational unit-level change in hospitals

Why downsizing may increase sickness absence: longitudinal fixed effects analyses of the importance of the work environment

BACKGROUND

Downsizing can often have a detrimental effect on employee health and increase sickness absence. Earlier research has theoretically argued that such negative consequences are due to taxing alterations in the work environment, but research efforts to empirically test this argument remain limited.

METHODS

In this study, we investigate whether the environment for control, role clarity, and commitment in different work units can explain the relationship between unit-level downsizing and sickness absence. We combined register- and self-reported data from 19,173 employees in a large Norwegian health trust in the period 2011-2015 and conducted a longitudinal fixed effects analysis.

RESULTS

Unit-level downsizing was found to be significantly related to increased short-term sickness absence, reduced organizational commitment, and reduced control. Reduced commitment explained a small part of the increase in short-term sickness absence after unit-level downsizing. There was no mediating effect of either control or role clarity.

CONCLUSION

The study contributes to a better understanding of the underlying mechanisms that help explain why downsizing leads to adverse health consequences and sickness absence by highlighting the complexity of this relationship and introducing organizational commitment as a relevant mediator.

Organisational-level risk and health-promoting factors within the healthcare sector-a systematic search and review

Introduction

The healthcare sector is globally experiencing increasing demands and workplace interventions on an organisational level is sought to create healthy workplaces. The aim of this study was to provide an overview of Nordic research on the work environment and health of healthcare professionals, with a focus on identifying organisational-level risk and health-promoting factors.

Methods

This systematic search and review was based on an analysis of studies published in peer-reviewed journals between 1 January 2016 and 3 January 2023. The selected studies investigate the relationships between organisational-level risk and health-promoting factors and measures of health and well-being among healthcare professionals during ordinary operations. To increase applicability, this systematic search and review was limited to the Nordic countries as they share the same context with a publicly-funded widely accessible healthcare system. A total of 2,677 articles were initially identified, with 95 original studies meeting the criteria for relevance and quality.

Results

Identified organisational risk and health-promoting factors were categorised into five categories: work schedule distribution, operations design and work methods, ergonomic conditions, working conditions and personnel policies, and the organisation's ethical environment. In addition, two themes across the categories emerged, providing further insight into the implications for practice. The first theme emphasises risk and health-promoting factors in the actions that employers take to fulfil the organisation's goals. The second theme emphasises risk and health-promoting factors in connection with the ability of employees to do their jobs at a level of quality they deem acceptable.

Conclusion

Several organisational-level risk and health-promoting factors were identified, and the results indicate that the actions that employers take to fulfil the health-care organisation's goals and promote the ability of employees to provide high-quality care are important for the health and wellbeing of healthcare employees.

Impact of decentralized management on sickness absence in hospitals: a two-wave cohort study of frontline managers in Danish hospital wards

BACKGROUND

This study explores the impact of decentralized management on the sickness absence among healthcare professionals. Sickness absence is a reliable indicator of employees' wellbeing and it is linked to management quality. However, the influence of decentralized management on sickness absence has not been adequately studied.

METHODS

The research design combined a two-wave, web-survey of frontline managers in two Danish university hospitals with administrative data on sickness absence at the ward-level. The first and second wave included data from 163165 and 137 frontline managers linked to 121 wards and 108 wards. Data was analysed using an ordinal logistic regression model.

RESULTS

Wards where frontline managers had the highest level of decentralised decision authority compared to none showed lower odds of ward-level sickness absence (ORcrude: 0.20, 95% CI: 0.05-0.87). A very high extent of cross-functional decision authority showed lower odds of sickness absence (ORcrude: 0.08, 95% CI: 0.01-0.49). Overall, the results showed a clear data trend, although not all results were statistically significant.

CONCLUSION

Higher levels of decentralized management in wards were positively associated with lower risks of sickness absence in hospital wards. The study supports future research on how to empower decision autonomy at the frontline level of management.

Absenteeism at Two Occupational Health Services in Belgium from 2014 to 2021

Medical certification is often needed for absences of longer than one workday. The literature remains unclear as to whether this changes absenteeism. Earlier research found that the merging of two firms can augment or diminish short-term absenteeism. This study was conducted to examine whether prolonging self-certification or merging increases short-term absenteeism. Data from January 2014 to December 2021 were retrospectively collected from HR absenteeism files at two occupational health services in Belgium. Sickness periods of longer than 4 weeks were excluded. Company 1 started a merger in 2014, and company 2 prolonged of the self-certification period in 2018. The total full-time equivalents (FTEs) of company 1 increased by 6%, while company 2 had an increase of 28%. At company 1, there was a decline in absenteeism, while company 2 had an increase. The ARIMA (1, 0, 1) model provided a statistically significant local moving average (company 1: 0.123; company 2: 0.086) but no statistically significant parameters for the intervention (company 1: 0.007, p = 0.672; company 2: 0.000, p = 0.970). Prolonging the self-certification period by up to 5 days without medical certification or merging was not found to increase short-term absenteeism.

Do Differences in Drinking Attitudes and Alcohol-Related Problems Explain Differences in Sick Leave? A Multilevel Analysis of 95 Work Units Within 14 Companies From the WIRUS Study

Background

Systematic reviews have shown a strong relationship between alcohol consumption and sick leave. The effect of alcohol consumption on sick leave may, however, vary according to the work environment. While attitudes toward drinking may impact sick leave, there is little research on the contribution of drinking attitudes to sick leave. Moreover, alcohol-related problems and drinking attitudes may be influenced by the broader sociocultural contexts of the organizational units where people work.

Objectives

This study aimed to explore the relationship of alcohol-related problems and drinking attitudes with sick leave while considering the nesting of employees within working units within companies.

Method

Data from the WIRUS (Workplace Interventions preventing Risky alcohol Use and Sick leave) study were linked to company-registered sick leave data for 2,560 employees from 95 different work units in public (n = 9) and private companies (n = 5) in Norway. Three-level (employee, work unit, and company) negative binomial regression models were estimated to explore the 12-month prospective association of alcohol-related problems and drinking attitudes with four measures of sick leave (one-day, short-term, long-term, and overall sick leave days). Models were adjusted for gender, age, cohabitation status, educational attainment, work position, and employment sector.

Results

We observed higher variation of one-day, short-term, and overall sick leave days between companies than between work units within companies (15, 12, and 30% vs. 0, 5, and 8%, respectively). However, neither alcohol-related problems nor drinking attitudes were associated with sick leave and, thus, those variations in sick leave were not explained by alcohol-related problems or drinking attitudes.

Conclusion

Our findings suggest company-level differences are more important than within company differences when explaining differences in sick leave. While alcohol-related problems or drinking attitudes were not associated with sick leave, future studies may need to explore the role of company policies, practices, or social norms in variations in sick leave rates.

Association of changes in work due to COVID-19 pandemic with psychosocial work environment and employee health: a cohort study of 24 299 Finnish public sector employees

OBJECTIVES

To examine the associations of COVID-19-related changes in work with perceptions of psychosocial work environment and employee health.

METHODS

In a cohort of 24 299 Finnish public sector employees, psychosocial work environment and employee well-being were assessed twice before (2016 and 2018=reference period) and once during (2020) the COVID-19 pandemic. Those who reported a change (='Exposed') in work due to the pandemic (working from home, new tasks or team reorganisation) were compared with those who did not report such change (='Non-exposed').

RESULTS

After adjusting for sex, age, socioeconomic status and lifestyle risk score, working from home (44%) was associated with greater increase in worktime control (standardised mean difference (SMD)Exposed=0.078, 95% CI 0.066 to 0.090; SMDNon-exposed=0.025, 95% CI 0.014 to 0.036), procedural justice (SMDExposed=0.101, 95% CI 0.084 to 0.118; SMDNon-exposed=0.053, 95% CI 0.038 to 0.068), workplace social capital (SMDExposed=0.094, 95% CI 0.077 to 0.110; SMDNon-exposed=0.034, 95% CI 0.019 to 0.048), less decline in self-rated health (SMDExposed=-0.038, 95% CI -0.054 to -0.022; SMDNon-exposed=-0.081, 95% CI -0.095 to -0.067), perceived work ability (SMDExposed=-0.091, 95% CI -0.108 to -0.074; SMDNon-exposed=-0.151, 95% CI -0.167 to -0.136) and less increase in psychological distress (risk ratio (RR)Exposed=1.06, 95% CI 1.02 to 1.09; RRNon-exposed=1.16, 95% CI 1.13 to 1.20). New tasks (6%) were associated with greater increase in psychological distress (RRExposed=1.28, 95% CI 1.19 to 1.39; RRNon-exposed=1.10, 95% CI 1.07 to 1.12) and team reorganisation (5%) with slightly steeper decline in perceived work ability (SMDExposed=-0.151 95% CI -0.203 to -0.098; SMDNon-exposed=-0.124, 95% CI -0.136 to -0.112).

CONCLUSION

Employees who worked from home during the pandemic had more favourable psychosocial work environment and health, whereas those who were exposed to work task changes and team reorganisations experienced more adverse changes.

Impacts of organizational restructuring on the health of ambulance drivers from a university hospital

The transport of patients by ambulance is part of the services offered by a Hospital and its importance lies in facilitating the connection between the institutes involved in patient care. However, a significant amount of complaints about irritability and aggressiveness of drivers was registered after a strategic change in the organizational structure that directly affected these professionals. This study aimed to survey the health issues of ambulance drivers at this hospital, from the reorganization of work, through an ergonomic analysis of work. The data were obtained through observation and interviews with managers, leaders, and drivers of the transport sector of the hospital. The main results found were: 1) the key performance measurement is time, which is a measure that does not consider all variabilities that occur during transport, 2) prescribed work of drivers only considers the task of driving an ambulance, while their real work includes taking care and paying attention to the needs of the patient and other professionals, 3) after the restructuring and centralization of the transport sector, drivers stopped feeling as part of the team of health professionals and started to feel like a "shared service".

Administration of Strategic Agreements in Public Hospitals: Considerations to Enhance the Quality and Sustainability of Mergers and Acquisitions

Merger processes between hospitals have high benefit potential for patients, staff and managers. This integration of health centres can improve the quality and safety in patient care. Additionally, cooperative processes enhance the sustainability of the health system, by increasing team spirit, giving innovative ideas and improving staff satisfaction. In this article, the critical factors for successful hospital mergers and acquisitions in the Public Health System were considered to develop a brief guide to help with the organisation of a merger process. Five sections were designed: Strategic administration and objectives, Staff management, New hospital complex structure, Processes and Results. This guide facilitates the communication between a variety of stakeholders, thus improving the engagement between all members of the new healthcare system. This could be particularly important for countries with large regional variance in the organisation of health care and resources.

Changing to improve? Organizational change and change-oriented leadership in hospitals

PURPOSE

This paper aims to fill gaps in one's knowledge of the impact of organizational change on two outcomes relevant to hospital service quality (performance obstacles and physician job satisfaction) and in one's knowledge of the role of middle manager change-oriented leadership in relation to the same outcomes. Further, the authors aim to identify how physician participation in decision-making is impacted by organizational change and change-oriented leadership, as well as how it mediates the relationships between these two variables, performance obstacles and job satisfaction.

DESIGN/METHODOLOGY/APPROACH

The study adopted a cross-sectional survey design including data from Norwegian hospital physicians (N = 556). A hypothetical model was developed based on existing theory, confirmatory factor analysis was carried out in order to ensure the validity of measurement concepts, and the structural model was estimated using structural equation modelling.

FINDINGS

The organizational changes in question were positively related to performance obstacles both directly and indirectly through participation in decision-making. Organizational change was also negatively related to job satisfaction, both directly and indirectly. Change-oriented leadership was negatively related to performance obstacles, but only indirectly through participation in decision-making, whereas it was positively related to job satisfaction both directly and indirectly.

ORIGINALITY/VALUE

The authors developed a theoretical model based on existing theory, but to their knowledge no other studies have tested these exact relationships within one model. These findings offer insights relevant to current and ongoing developments in the healthcare field and to the question of how hospitals may deal with continuous changes in ways that could contribute positively towards outcomes relevant to service quality.

Work-related moderators of the relationship between organizational change and sickness absence: a longitudinal multilevel study

Background

A sizeable body of research has demonstrated a relationship between organizational change and increased sickness absence. However, fewer studies have investigated what factors might mitigate this relationship. The aim of this study was to examine if and how the relationship between unit-level downsizing and sickness absence is moderated by three salient work factors: temporary contracts at the individual-level, and control and organizational commitment at the work-unit level.

Methods

We investigated the association between unit-level downsizing, each moderator and both short- and long-term sickness absence in a large Norwegian hospital (n = 21,085) from 2011 to 2016. Data pertaining to unit-level downsizing and employee sickness absence were retrieved from objective hospital registers, and moderator variables were drawn from hospital registers (temporary contracts) and the annual work environment survey (control and organizational commitment). We conducted a longitudinal multilevel random effects regression analysis to estimate the odds of entering short- (< = 8 days) and long-term (> = 9 days) sickness absence for each individual employee.

Results

The results showed a decreased risk of short-term sickness absence in the quarter before and an increased risk of short-term sickness absence in the quarter after unit-level downsizing. Temporary contracts and organizational commitment significantly moderated the relationship between unit-level downsizing in the next quarter and short-term sickness absence, demonstrating a steeper decline in short-term sickness absence for employees on temporary contracts and employees in high-commitment units. Additionally, control and organizational commitment moderated the relationship between unit-level downsizing and long-term sickness absence. Whereas employees in high-control work-units had a greater increase in long-term sickness absence in the change quarter, employees in low-commitment work-units had a higher risk of long-term sickness absence in the quarter after unit-level downsizing.

Conclusions

The results from this study suggest that the relationship between unit-level downsizing and sickness absence varies according to the stage of change, and that work-related factors moderate this relationship, albeit in different directions. The identification of specific work-factors that moderate the adverse effects of change represents a hands-on foundation for managers and policy-makers to pursue healthy organizational change.