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  • 1. Athlin, A. Muntlin
    et al.
    Farrokhnia, N.
    von Thiele Schwarz, Ulrica
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Karolinska Institutet, Sweden.
    Introduction of multi-professional teamwork: a promising approach towards a more patient-centred care in the emergency department2014In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 22, no 4, p. 274-275Article in journal (Other academic)
  • 2. Augustsson, Hanna
    et al.
    Richter, Anne
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Work and organizational psychology. Karolinska Institutet, Sweden..
    Hasson, Henna
    von Thiele Schwarz, Ulrica
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Work and organizational psychology. Karolinska Institutet, Sweden..
    The Need for Dual Openness to Change: A Longitudinal Study Evaluating the Impact of Employees' Openness to Organizational Change Content and Process on Intervention Outcomes2017In: Journal of Applied Behavioral Science, ISSN 0021-8863, E-ISSN 1552-6879, Vol. 53, no 3, p. 349-368Article in journal (Refereed)
    Abstract [en]

    This study investigates how individual- and group-level openness to organizational change, concerning change content and process, affects intervention outcomes. The intervention aimed to improve primary health care employees' competence in and use of information and communication technologies (ICT). Employees' (n = 1,042) ratings of their openness to the change content and process as well as of their workgroup's openness to the change content before the intervention were used to predict ICT competence and its use 18 months later. Openness to the change process predicted both ICT competence and use of competence, while openness to the change content and group openness predicted use of competence only. These results show that individual- and group-level openness to organizational change are important predictors of successful outcomes. Furthermore, employees should be open both to the content of the change and to the process by which the intervention is implemented in order to maximize outcomes.

  • 3. Augustsson, Hanna
    et al.
    von Thiele Schwarz, Ulrica
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Karolinska Institutet, Sweden.
    Stenfors-Hayes, Terese
    Hasson, Henna
    Investigating Variations in Implementation Fidelity of an Organizational-Level Occupational Health Intervention2015In: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 22, no 3, p. 345-355Article in journal (Refereed)
    Abstract [en]

    The workplace has been suggested as an important arena for health promotion, but little is known about how the organizational setting influences the implementation of interventions. The aims of this study are to evaluate implementation fidelity in an organizational-level occupational health intervention and to investigate possible explanations for variations in fidelity between intervention units. The intervention consisted of an integration of health promotion, occupational health and safety, and a system for continuous improvements (Kaizen) and was conducted in a quasi-experimental design at a Swedish hospital. Implementation fidelity was evaluated with the Conceptual Framework for Implementation Fidelity and implementation factors used to investigate variations in fidelity with the Framework for Evaluating Organizational-level Interventions. A multi-method approach including interviews, Kaizen notes, and questionnaires was applied. Implementation fidelity differed between units even though the intervention was introduced and supported in the same way. Important differences in all elements proposed in the model for evaluating organizational-level interventions, i.e., context, intervention, and mental models, were found to explain the differences in fidelity. Implementation strategies may need to be adapted depending on the local context. Implementation fidelity, as well as pre-intervention implementation elements, is likely to affect the implementation success and needs to be assessed in intervention research. The high variation in fidelity across the units indicates the need for adjustments to the type of designs used to assess the effects of interventions. Thus, rather than using designs that aim to control variation, it may be necessary to use those that aim at exploring and explaining variation, such as adapted study designs.

  • 4.
    Eib, Constanze
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    von Thiele Schwarz, Ulrica
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Karolinska Institutet, Sweden.
    Blom, Victoria
    Don’t Let it Get to You!: a Moderated Mediated Approach to the (In)justice–Health Relationship2015In: Journal of Occupational Health Psychology, ISSN 1076-8998, E-ISSN 1939-1307, Vol. 20, no 4, p. 434-445Article in journal (Refereed)
    Abstract [en]

    The present study investigates the consequences of overall justice perceptions on employees’ mental health and work-family conflict. While many studies have found that perceiving injustice at work is harmful, little is known about the underlying processes. Based on the allostatic load model, it is hypothesized that mental preoccupation with work, defined as a cognitive state, is a mediator linking overall justice perceptions to employee health. Moreover, we argue that locus of control is a moderator for the mediated relationship. We tested our hypotheses with panel data consisting of 412 Swedish office workers. Results support that mental preoccupation with work mediates the relationship between overall justice and mental health, and overall justice and work-family conflict. Results also reveal that mental preoccupation with work plays a greater mediating role for individuals with an external locus of control. Implications and suggestions for future studies on the emerging relationship between organizational justice and health are discussed.

  • 5. Hasson, Henna
    et al.
    Villaume, Karin
    Schwarz, Ulrica von Thiele
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Karolinska Institutet, Sweden.
    Palm, Kristina
    Managing Implementation Roles of Line Managers, Senior Managers, and Human Resource Professionals in an Occupational Health Intervention2014In: Journal of Occupational and Environmental Medicine, ISSN 1076-2752, E-ISSN 1536-5948, Vol. 56, no 1, p. 58-65Article in journal (Refereed)
    Abstract [en]

    Objective: To contrast line managers', senior managers', and (human resource) HR professionals' descriptions of their roles, tasks, and possibilities to perform them during the implementation of an occupational health intervention. Methods: Interviews with line managers (n = 13), senior managers (n = 7), and HR professionals (n = 9) 6 months after initiation of an occupational health intervention at nine organizations. Results: The groups' roles were described coherently, except for the HR professionals. These roles were seldom performed in practice, and two main reasons appeared: use of individuals' engagement rather than an implementation strategy, and lack of integration of the intervention with other stakeholders and organizational processes. Conclusions: Evaluation of stakeholders' perceptions of each other's and their own roles is important, especially concerning HR professionals. Clear role descriptions and implementation strategies, and aligning an intervention to organizational processes, are crucial for efficient intervention management.

  • 6. Hasson, Henna
    et al.
    von Thiele Schwarz, Ulrica
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Work and organizational psychology. Karolinska Institutet, Sweden.
    Nielsen, Karina
    Tafvelin, Susanne
    Are We All in the Same Boat?: The Role of Perceptual Distance in Organizational Health Interventions2016In: Stress and Health, ISSN 1532-3005, E-ISSN 1532-2998, Vol. 32, no 4, p. 294-303Article in journal (Refereed)
    Abstract [en]

    The study investigates how agreement between leaders' and their team's perceptions influence intervention outcomes in a leadership-training intervention aimed at improving organizational learning. Agreement, i.e. perceptual distance was calculated for the organizational learning dimensions at baseline. Changes in the dimensions from pre-intervention to post-intervention were evaluated using polynomial regression analysis with response surface analysis. The general pattern of the results indicated that the organizational learning improved when leaders and their teams agreed on the level of organizational learning prior to the intervention. The improvement was greatest when the leader's and the team's perceptions at baseline were aligned and high rather than aligned and low. The least beneficial scenario was when the leader's perceptions were higher than the team's perceptions. These results give insights into the importance of comparing leaders' and their team's perceptions in intervention research. Polynomial regression analyses with response surface methodology allow three-dimensional examination of relationship between two predictor variables and an outcome. This contributes with knowledge on how combination of predictor variables may affect outcome and allows studies of potential non-linearity relating to the outcome. Future studies could use these methods in process evaluation of interventions.

  • 7. Hvitfeldt Forsberg, Helena
    et al.
    Muntlin Athlin, Åsa
    von Thiele Schwarz, Ulrica
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Karolinska Institutet, Sweden.
    Nurses' perceptions of multitasking in the emergency department: Effective, fun and unproblematic (at least for me) - a qualitative study2015In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 23, no 2, p. 59-64Article in journal (Refereed)
    Abstract [en]

    Introduction: The aim was to understand how multitasking is experienced by registered nurses and how it relates to their everyday practice in the emergency department. Method: Interviews with open-ended questions were conducted with registered nurses (n = 9) working in one of two included emergency departments in Sweden. Data were analyzed using Schilling's structured model for qualitative content analysis. Results: Three core concepts related to multitasking emerged from the interviews: 'multitasking - an attractive prerequisite for ED care'; 'multitasking implies efficiency' and 'multitasking is not stressful'. From these core concepts an additional theme emerged: ' ... and does not cause errors - at least for me', related to patient safety. Discussion: This study shows how the patient load and the unreflected multitasking that follows relate to nurses' perceived efficiency and job satisfaction. It also shows that the relationship between multitasking and errors is perceived to be mediated by whom the actor is, and his or her level of experience. Findings from this study add value to the discourse on multitasking and the emergency department context, as few studies go beyond examining the quantitative aspect of interruptions and multitasking and how it is experienced by the staff in their everyday practice.

  • 8. Lornudd, Caroline
    et al.
    Tafvelin, Susanne
    von Thiele Schwarz, Ulrica
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Karolinska Institute, Sweden.
    Bergman, David
    The mediating role of demand and control in the relationship between leadership behaviour and employee distress: a cross-sectional study2015In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 52, no 2, p. 543-554Article in journal (Refereed)
    Abstract [en]

    Background: The relationship between leadership and employee distress is well established, however, the processes involved in this relationship remain largely unclear. For a stretched nursing workforce, understanding in what ways leadership may influence employee distress is particularly important.

    Objectives: To examine possible mediating effects of the work environment factors demand and control in the relationship between leadership behaviour in change, production, and employee orientation and employee distress.

    Design: Cross-sectional study design.

    Settings: The study was conducted at a large county council in Sweden providing both institutional and non-institutional care.

    Participants: A random sample of 1249 employees (primarily nurses, but also a wide range of other healthcare professionals and administrative staff), who had a healthcare manager that was about to enter a leadership development programme (n = 171), responded to a web-based questionnaire. The response rate was 62%.

    Methods: The employees rated their healthcare managers’ behaviour in change, production, and employee orientation, as well as their own perceptions of level of demand, control (subdivided into decision authority and skill discretion), and five distress outcomes. Multilevel analysis was performed.

    Results: The mediators demand, decision authority, and skill discretion were significant predictors of all five distress outcomes for all three leadership orientations. In eight of 15 regressions, the mediators fully explained the relationships between leadership orientations and outcomes. Four of five relationships with distress outcomes were fully mediated for change-oriented leadership, whereas two of five outcomes were fully mediated for production- and employee-oriented leadership. In all three leadership orientations, the relationship between the mediator skill discretion and the distress measure disengagement were particularly strong, with B-coefficients (−.44, p < .001) twice as high as for any of the other relationships.

    Conclusions: It seems that the way that employees perceive healthcare managers’ change-oriented behaviour, and how that aspect is related to employee distress, is primarily explained by perception of demand and control. Furthermore, regardless of leadership behaviour orientation, how employees perceive their opportunity to use specific job skills plays an important role in the interplay between perception of healthcare managers’ behaviour and disengagement.

  • 9. Mazzocato, Pamela
    et al.
    Hvitfeldt Forsberg, Helena
    von Thiele Schwarz, Ulrica
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Team behaviors in emergency care: a qualitative study using behavior analysis of what makes team work2011In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 19, no 70, p. 1-8Article in journal (Refereed)
    Abstract [en]

    Objective: Teamwork has been suggested as a promising approach to improving care processes in emergency departments (ED). However, for teamwork to yield expected results, implementation must involve behavior changes. The aim of this study is to use behavior analysis to qualitatively examine how teamwork plays out in practice and to understand eventual discrepancies between planned and actual behaviors. Methods: The study was set in a Swedish university hospital ED during the initial phase of implementation of teamwork. The intervention focused on changing the environment and redesigning the work process to enable teamwork. Each team was responsible for entire care episodes, i.e. from patient arrival to discharge from the ED. Data was collected through 3 days of observations structured around an observation scheme. Behavior analysis was used to pinpoint key teamwork behaviors for consistent implementation of teamwork and to analyze the contingencies that decreased or increased the likelihood of these behaviors. Results: We found a great discrepancy between the planned and the observed teamwork processes. 60% of the 44 team patients observed were handled solely by the appointed team members. Only 36% of the observed patient care processes started according to the description in the planned teamwork process, that is, with taking patient history together. Beside this behavior, meeting in a defined team room and communicating with team members were shown to be essential for the consistent implementation of teamwork. Factors that decreased the likelihood of these key behaviors included waiting for other team members or having trouble locating each other. Getting work done without delay and having an overview of the patient care process increased team behaviors. Moreover, explicit instructions on when team members should interact and communicate increased adherence to the planned process. Conclusions: This study illustrates how behavior analysis can be used to understand discrepancies between planned and observed behaviors. By examining the contextual conditions that may influence behaviors, improvements in implementation strategies can be suggested. Thereby, the adherence to a planned intervention can be improved, and/or revisions of the intervention be suggested.

  • 10. Muntlin Athlin, Åsa
    et al.
    von Thiele Schwarz, Ulrica
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Karolinska Institute, Sweden.
    Farrohknia, Nasim
    Effects of multidisciplinary teamwork on lead times and patient flow in the emergency department: a longitudinal interventional cohort study2013In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 21, p. 76-Article in journal (Refereed)
    Abstract [en]

    Background: Long waiting times for emergency care are claimed to be caused by overcrowded emergency departments and non-effective working routines. Teamwork has been suggested as a promising solution to these issues. The aim of the present study was to investigate the effects of teamwork in a Swedish emergency department on lead times and patient flow. Methods: The study was set in an emergency department of a university hospital where teamwork, a multi-professional team responsible for the whole care process for a group of patients, was introduced. The study has a longitudinal non-randomized intervention study design. Data were collected for five two-week periods during a period of 1.5 years. The first part of the data collection used an ABAB design whereby standard procedure (A) was altered weekly with teamwork (B). Then, three follow-ups were conducted. At last follow-up, teamwork was permanently implemented. The outcome measures were: number of patients handled within teamwork time, time to physician, total visit time and number of patients handled within the 4-hour target. Results: A total of 1,838 patient visits were studied. The effect on lead times was only evident at the last follow-up. Findings showed that the number of patients handled within teamwork time was almost equal between the different study periods. At the last follow-up, the median time to physician was significantly decreased by 11 minutes (p = 0.0005) compared to the control phase and the total visit time was significantly shorter at last follow-up compared to control phase (p = <0.0001; 39 minutes shorter on average). Finally, the 4-hour target was met in 71% in the last follow-up compared to 59% in the control phase (p = 0.0005). Conclusions: Teamwork seems to contribute to the quality improvement of emergency care in terms of small but significant decreases in lead times. However, although efficient work processes such as teamwork are necessary to ensure safe patient care, it is likely not sufficient for bringing about larger decreases in lead times or for meeting the 4-hour target in the emergency department.

  • 11. Ulhassan, Waqar
    et al.
    Sandahl, Christer
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Henriksson, Peter
    Bennermo, Marie
    von Thiele Schwarz, Ulrica
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Thor, Johan
    Antecedents and Characteristics of Lean Thinking Implementation in a Swedish Hospital: A Case Study.2013In: Quality Management in Health Care, ISSN 1063-8628, E-ISSN 1550-5154, Vol. 22, no 1, p. 48-61Article in journal (Refereed)
    Abstract [en]

    Despite the reported success of Lean in health care settings, it is unclear why and how organizations adopt Lean and how Lean transforms work design and, in turn, affects employees' work. This study investigated a cardiology department's journey to adopt and adapt Lean. The investigation was focused on the rationale and evolution of the Lean adoption to illuminate how a department with a long quality improvement history arrived at the decision to introduce Lean, and how Lean influenced employees' daily work. This is an explanatory single case study based on semistructured interviews, nonparticipant observations, and document studies. Guided by a Lean model, we undertook manifest content analysis of the data. We found that previous improvement efforts may facilitate the introduction of Lean but may be less important when forecasting whether Lean will be sustained over time. Contextual factors seemed to influence both what Lean tools were implemented and how well the changes were sustained. For example, adoption of Lean varied with the degree to which staff saw a need for change. Work redesign and teamwork were found helpful to improve patient care whereas problem solving was found helpful in keeping the staff engaged and sustaining the results over time.

  • 12. Ulhassan, Waqar
    et al.
    von Thiele Schwarz, Ulrica
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Karolinska Institutet, Sweden.
    Thor, Johan
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Interactions between lean management and the psychosocial work environment in a hospital setting - a multi-method study2014In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 14, p. 480-Article in journal (Refereed)
    Abstract [en]

    Background: As health care struggles to meet increasing demands with limited resources, Lean has become a popular management approach. It has mainly been studied in relation to health care performance. The empirical evidence as to how Lean affects the psychosocial work environment has been contradictory. This study aims to study the interaction between Lean and the psychosocial work environment using a comprehensive model that takes Lean implementation information, as well as Lean theory and the particular context into consideration. Methods: The psychosocial work environment was measured twice with the Copenhagen Psychosocial Questionnaire (COPSOQ) employee survey during Lean implementations on May-June 2010 (T1) (n = 129) and November-December 2011 (T2) (n = 131) at three units (an Emergency Department (ED), Ward-I and Ward-II). Information based on qualitative data analysis of the Lean implementations and context from a previous paper was used to predict expected change patterns in the psychosocial work environment from T1 to T2 and subsequently compared with COPSOQ-data through linear regression analysis. Results: Between T1 and T2, qualitative information showed a well-organized and steady Lean implementation on Ward-I with active employee participation, a partial Lean implementation on Ward-II with employees not seeing a clear need for such an intervention, and deterioration in already implemented Lean activities at ED, due to the declining interest of top management. Quantitative data analysis showed a significant relation between the expected and actual results regarding changes in the psychosocial work environment. Ward-I showed major improvements especially related to job control and social support, ED showed a major decline with some exceptions while Ward-II also showed improvements similar to Ward-I. Conclusions: The results suggest that Lean may have a positive impact on the psychosocial work environment given that it is properly implemented. Also, the psychosocial work environment may even deteriorate if Lean work deteriorates after implementation. Employee managers and researchers should note the importance of employee involvement in the change process. Employee involvement may minimize the intervention's harmful effects on psychosocial work factors. We also found that a multi-method may be suitable for investigating relations between Lean and the psychosocial work environment.

  • 13. Ulhassan, Waqar
    et al.
    von Thiele Schwarz, Ulrica
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Karolinska Institutet, Sweden.
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Sandahl, Christer
    Thor, Johan
    How Visual Management for Continuous Improvement Might Guide and Affect Hospital Staff: A Case Study2015In: Quality Management in Health Care, ISSN 1063-8628, E-ISSN 1550-5154, Vol. 24, no 4, p. 222-228Article in journal (Refereed)
    Abstract [en]

    Visual management (VM) tools such as whiteboards, often employed in Lean thinking applications, are intended to be helpful in improving work processes in different industries including health care. It remains unclear, however, how VM is actually applied in health care Lean interventions and how it might influence the clinical staff. We therefore examined how Lean-inspired VM using whiteboards for continuous improvement efforts related to the hospital staff's work and collaboration. Within a case study design, we combined semistructured interviews, nonparticipant observations, and photography on 2 cardiology wards. The fate of VM differed between the 2 wards; in one, it was well received by the staff and enhanced continuous improvement efforts, whereas in the other ward, it was not perceived to fit in the work flow or to make enough sense in order to be sustained. Visual management may enable the staff and managers to allow communication across time and facilitate teamwork by enabling the inclusion of team members who are not present simultaneously; however, its adoption and value seem contingent on finding a good fit with the local context. A combination of continuous improvement and VM may be helpful in keeping the staff engaged in the change process in the long run.

  • 14. Ulhassan, Waqar
    et al.
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Thor, Johan
    Sandahl, Christer
    von Thiele Schwarz, Ulrica
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Does lean implementation interact with group functioning?2014In: Journal of Health Organisation & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 28, no 2, p. 196-213Article in journal (Refereed)
    Abstract [en]

    PURPOSE: As healthcare often is studied in relation to operational rather than socio-technical aspects of Lean such as teamwork, the purpose of this paper is to explore how a Swedish hospital Lean intervention was related to changes in teamwork over time.

    DESIGN/METHODOLOGY/APPROACH: Teamwork was measured with the Group Development Questionnaire (GDQ) employee survey during Lean implementation at three units, in 2010 (n = 133) and 2011 (n = 130). Qualitative data including interviews, observations and document analysis were used to characterize the Lean implementation and context. The expected teamwork change patterns were compared with GDQ data through linear regression analysis.

    FINDINGS: At Ward-I, Lean implementation was successful and teamwork improved. At Ward-II, Lean was partially implemented and teamwork improved slightly, while both Lean and teamwork deteriorated at the emergency department (ED). The regression analysis was significant at ED (p = 0.02) and the Ward-II (p = 0.04), but not at Ward-I (p = 0.11).

    RESEARCH LIMITATIONS/IMPLICATIONS: Expected changes in teamwork informed by theory and qualitative data may make it possible to detect the results of a complex change.

    PRACTICAL IMPLICATIONS: Overall, Lean may have some impact on teamwork, if properly implemented. However, this impact may be more prominent in relation to structural and productivity issues of teamwork than group members' relational issues. Practitioners should note that, with groups struggling with initial stages of group functioning, Lean may be very challenging.

    ORIGINALITY/VALUE: This study focussed specifically on implications of Lean for nurse teamwork in a hospital setting using both qualitative and quantitative data. Importantly, the group functioning at the time when Lean is initiated may affect the implementation of Lean.

  • 15.
    von Thiele Schwarz, Ulrica
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Inability to Withdraw from Work as Related to Poor Next-Day Recovery and Fatigue among Women2011In: Applied Psychology, ISSN 1464-0597, Vol. 60, no 3, p. 377-396Article in journal (Refereed)
    Abstract [en]

    Recovery from work stress is crucial in avoiding stress-related ill-health. The aim of this longitudinal study was to investigate whether processes that prolong the mental exposure to work stressors, such as inability to withdraw from work (IW), the core construct in overcommitment, predicts fatigue and poor next-day recovery 6 months later over what is predicted by job control and job demands. Self-ratings in questionnaires were completed by 160 women working in dental care at two time points, 6 months apart. Job demands, job control, and IW were used to predict fatigue and poor next-day recovery, respectively. Multiple regression analyses show that having children living at home, high job demands, and high IW were associated with fatigue 6 months later. Job demands and IW, but not having children at home, predicted poor next-day recovery. Mediation analyses using a bootstrapping procedure indicated that IW partly mediated the relationship between job demands and fatigue and between job demands and next-day recovery. These findings highlight the importance of considering IW in relation to fatigue and recovery from work and that such factors should be included in interventions targeting work-related stress.

  • 16.
    von Thiele Schwarz, Ulrica
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Hasson, Henna
    Effects of worksite health interventions involving reduced work hours and physical exercise on sickness absence costs2012In: Journal of Occupational and Environmental Medicine, ISSN 1076-2752, E-ISSN 1536-5948, Vol. 54, no 5, p. 538-544Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate the effects of physical exercise during work hours (PE) and reduced work hours (RWH) on direct and indirect costs associated with sickness absence (SA). Methods: Sickness absence and related costs at six workplaces, matched and randomized to three conditions (PE, RWH, and referents), were retrieved from company records and/or estimated using salary conversion methods or value-added equations on the basis of interview data. Results: Although SA days decreased in all conditions (PE, 11.4%; RWH, 4.9%; referents, 15.9%), costs were reduced in the PE (22.2%) and RWH (4.9%) conditions but not among referents (10.2% increase). Conclusions: Worksite health interventions may generate savings in SA costs. Costs may not be linear to changes in SA days. Combing the friction method with indirect cost estimates on the basis of value-added productivity may help illuminate both direct and indirect SA costs.

  • 17.
    von Thiele Schwarz, Ulrica
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Hasson, Henna
    Employee Self-rated Productivity and Objective Organizational Production Levels: Effects of Worksite Health Interventions Involving Reduced Work Hours and Physical Exercise2011In: Journal of Occupational and Environmental Medicine, ISSN 1076-2752, E-ISSN 1536-5948, Vol. 53, no 8, p. 838-844Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate how worksite health interventions involving a 2.5-hour reduction of weekly working hours with (PE) or without (RWH) mandatory physical exercise affects productivity.Methods: Six workplaces in dental health care were matched and randomized to three conditions (PE, RWH and referents). Employees' (N = 177) self-rated productivity and the workplaces' production levels (number of patients) were examined longitudinally.Results: Number of treated patients increased in all conditions during the intervention year. While RWH showed the largest increase in this measure, PE showed significant increases in self-rated productivity, that is, increased quantity of work and work-ability and decreased sickness absence.Conclusions: A reduction in work hours may be used for health promotion activities with sustained or improved production levels, suggesting an increased productivity since the same, or higher, production level can be achieved with lesser resources.

  • 18.
    von Thiele Schwarz, Ulrica
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Karolinska Institutet, Sweden.
    Hasson, Henna
    Lindfors, Petra
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Applying a fidelity framework to understand adaptations in an occupational health intervention2015In: Work: A journal of Prevention, Assesment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 51, no 2, p. 195-203Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Two objectives are central when implementing occupational health interventions: high intervention fidelity, i.e. alignment with existing theory/evidence, and the need for fit, i.e., matching organizational and employee needs. These objectives can be contradictory and there is little advice on how to successfully combine them. OBJECTIVE: This study examines if an implementation fidelity framework can be used to categorize and describe how to adapt an occupational health intervention. METHODS: Using an adapted version of the Conceptual Framework for Implementation Fidelity, we analyzed the implementation of a workplace-based physical exercise intervention and its contextualized adaptations. Adaptations are described in terms of content, dose, coverage and timeliness, each on three levels: individual, unit and organizational. Data sources include systematic project documentation and reflexive discussions. RESULTS: The intervention was adapted across all aspects and levels of fidelity. Adaptations involved aligning the intervention with level characteristics: organizational level adaptations aligned health policies with cost/benefits, whereas unit level adaptations minimized interference with production and coordinated the intervention with employee preferences. On the individual level, the exercise type varied, which aligned individual needs with the intervention. CONCLUSIONS: The Conceptual Framework for Implementation Fidelity can help describe the balance between adaptation and adherence at different organizational levels.

  • 19.
    von Thiele Schwarz, Ulrica
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Hasson, Henna
    Lindfors, Petra
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Derailed or failed? A closer look at reduced working hours as an occupational health intervention.2015In: Derailed Organizational Interventions for Stress and Well-Being: confessions of Failure and Solutions for Success / [ed] Maria Karanika-Murray, Caroline Biron, Heidelberg: Springer Netherlands, 2015, 1, p. 21-26Chapter in book (Refereed)
    Abstract [en]

    In the Nordic countries, working hour reductions have been introduced as a possible occupational health intervention. We evaluated the effects of a working hour reduction from 37 to 30 hours a week among 100 employees within older people’s care. The outcome evaluation was broad, including health check-ups and extensive questionnaires covering work climate, work-home balance, health-related measures,  well-being and health behaviors. The results showed no improvements during the one-year project period, which raises the question whether the results are due to failure in implementation or theory. This chapter asks what is needed for considering a failure as a theory failure, that is, a default program theory in that the activities fail to bring the desired effects. It is suggested that the case described here may be one such example. In order to facilitate the separation of theory failure from implementation failure, we underscore the importance of program theory, also called theory of change or logic models. By scrutinizing the program theory before implementing an intervention, a critical evaluation of the mechanisms linking the intervention to various outcomes can be made. Also, the program theory is helpful for forming testable hypothesis that allows variation in process factors to be tested.

  • 20.
    von Thiele Schwarz, Ulrica
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Hasson, Henna
    Lindfors, Petra
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Effects of workplace-based physical exercise interventions on cost associated with sickness absence and on productivity2014In: Creating healthy workplaces: stress reduction, improved well-being, and organizational effectiveness / [ed] Caroline Biron, Ronald J. Burke and Cary L. Cooper Gower, Burlington: Gower Publishing Ltd., 2014, p. 109-128Chapter in book (Refereed)
    Abstract [en]

    This chapter aims to provide a research based framework for physical exercise interventions at work, present a case study of physical exercise in dentistry and outline a conceptual model specifying mechanisms linking the more well-known effect of physical exercise on individual outcomes to organisational outcomes. Specifically, the case is used to illustrate how physical exercise can influence productivity and organisational costs related to sickness absence.

  • 21.
    von Thiele Schwarz, Ulrica
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Work and organizational psychology. Karolinska Institutet, Sweden.
    Hasson, Henna
    Tafvelin, Susanne
    Leadership training as an occupational health intervention: Improved safety and sustained productivity2016In: Safety Science, ISSN 0925-7535, E-ISSN 1879-1042, Vol. 81, p. 35-45Article in journal (Refereed)
    Abstract [en]

    The safety climate in an organization is determined by how managers balance the relative importance of safety and productivity. This gives leaders a central role in safety in an organization, and from this follows that leadership training may improve safety. Transformational leadership may be one important component but may need to be combined with positive control leadership behaviors. Leadership training that combines transformational leadership and applied behavior analysis may be a way to achieve this. Purpose: The study evaluates changes in safety climate and productivity among employees whose leaders (n = 76) took part in a leadership training program combining transformational leadership and applied behavior analysis. Changes in managers' ratings of transformational leadership, contingent rewards, Management-by-Exceptions Active (MBEA) and safety self-efficacy were evaluated. Moreover, we compare whether the training has differentiated effects on safety depending on managers' specific focus on improvements in: (1) safety, (2) productivity or (3) general leadership. Result: Safety climate improved over time, while self-rated productivity remained unchanged. As hypothesized, transformational leadership, contingent rewards and safety self-efficacy as proxies for positive control behaviors increased while MBEA, a negative control behavior, decreased. Managers focusing on general leadership skills showed greater improvement in safety climate expectations. Conclusions: Training leaders in both transformational leadership and applied behavior analysis is related to improvements in leadership and safety. There is no added benefit of focusing specifically on safety or productivity.

  • 22.
    von Thiele Schwarz, Ulrica
    et al.
    Karolinska Institutet, Sweden.
    Lindfors, Petra
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Improved fitness after a workbased physical exercise program2015In: International Journal of Workplace Health Management, ISSN 1753-8351, E-ISSN 1753-836X, Vol. 8, no 1, p. 61-74Article in journal (Refereed)
    Abstract [en]

    Purpose: The purpose of this paper is to investigate the effects on fitness outcomes of a work-based physical exercise (PE) intervention among women working in older people’s care. In addition, effects on productivity-related outcomes including work ability and sickness absence were studied. Design/methodology/approach: Employees participated in a one-year intervention involving two one-hour weekly mandatory PE sessions. The intervention (n=13) was compared to referents (n=12). Fitness tests and self-reports on work ability and sickness absence were obtained before the intervention (T1), six months into the intervention and after 12 months. Findings: Fitness test scores (corrected for age and weight) increased significantly over time in the intervention group but not among referents. Perceived exertion decreased significantly in the intervention group and increased significantly among referents. For self-rated work ability and sickness absence, no significant time or group differences emerged. Research limitations/implications: Further research on larger groups of women is needed to delineate the effects of PE on self-rated productivity and performance. Practical implications: Work-based PE programs can improve fitness among women in older people’s care. Social implications: With previous research having primarily focussed on men, this study shows that women in blue-collar jobs also may benefit from taking part in work-based PE programs. Originality/value: This paper makes an important contribution through its focus on the effects of a work-based PE program on fitness and possible relations to productivity, among employed women.

  • 23.
    von Thiele Schwarz, Ulrica
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Lindfors, Petra
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Centre for Health Equity Studies (CHESS).
    Lundberg, Ulf
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Centre for Health Equity Studies (CHESS).
    Health-related effects of worksite interventions involving physical exercise and reduced workhours2008In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, Vol. 34, no 3, p. 179-188Article in journal (Refereed)
    Abstract [en]

    Objectives: This study examined the health-related effects of two worksite interventions, physical exercise and reduced workhours, on women employed in dentistry.

    Methods: Six workplaces were randomized to one of the following three conditions: (i) 2.5 hours of weekly, mandatory physical exercise of middle-to-high intensity to be performed during workhours (N=62), (ii) a reduction of full-time weekly workhours from 40 to 37.5 hours (N=50), and (iii) reference. In all, 177 women participated. Biomarkers and self-ratings in questionnaires were obtained before the intervention (T1), and six (T2) and 12 months (T3) after the intervention.

    Results: The results showed increased levels of physical activity and exercise in all of the groups, the level of physical exercise being significantly greater in the physical exercise group. Repeated-measures analyses of variance using data from T1 and T3 for biological measures and all three time points for self-ratings produced significant interaction effects for glucose, waist-to-hip ratio, and work ability and clear trends for general symptoms and upper-extremity disorders. Posthoc analyses showed that the results of the health-related measures differed between the interventions, decreased glucose and upper-extremity disorders in the exercise group, and increased high-density lipoprotein and waist-to-hip ratio among those working reduced hours.

    Conclusions: These results show that the two interventions had small and varied effects on biomarkers and self-reports of different aspects of health among women. It is suggested that interventions involving a modest reduction in workhours seem to be more effective if these hours are used for physical exercise.

  • 24.
    von Thiele Schwarz, Ulrica
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Work and organizational psychology. Karolinska Institutet, Sweden.
    Lundmark, Robert
    Hasson, Henna
    The Dynamic Integrated Evaluation Model (DIEM): Achieving Sustainability in Organizational Intervention through a Participatory Evaluation Approach2016In: Stress and Health, ISSN 1532-3005, E-ISSN 1532-2998, Vol. 32, no 4, p. 285-293Article in journal (Refereed)
    Abstract [en]

    Recently, there have been calls to develop ways of using a participatory approach when conducting interventions, including evaluating the process and context to improve and adapt the intervention as it evolves over time. The need to integrate interventions into daily organizational practices, thereby increasing the likelihood of successful implementation and sustainable changes, has also been highlighted. We propose an evaluation model—the Dynamic Integrated Evaluation Model (DIEM)—that takes this into consideration. In the model, evaluation is fitted into a co-created iterative intervention process, in which the intervention activities can be continuously adapted based on collected data. By explicitly integrating process and context factors, DIEM also considers the dynamic sustainability of the intervention over time. It emphasizes the practical value of these evaluations for organizations, as well as the importance of their rigorousness for research purposes.

  • 25.
    von Thiele Schwarz, Ulrica
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Karolinska Institutet, Sweden.
    Sjöberg, Anders
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Hasson, Henna
    Tafvelin, Susanne
    Measuring Self-Rated Productivity Factor Structure and Variance Component Analysis of the Health and Work Questionnaire2014In: Journal of Occupational and Environmental Medicine, ISSN 1076-2752, E-ISSN 1536-5948, Vol. 56, no 12, p. 1302-1307Article in journal (Refereed)
    Abstract [en]

    Objective: To test the factor structure and variance components of the productivity subscales of the Health and Work Questionnaire (HWQ). Methods: A total of 272 individuals from one company answered the HWQ scale, including three dimensions (efficiency, quality, and quantity) that the respondent rated from three perspectives: their own, their supervisor's, and their coworkers'. A confirmatory factor analysis was performed, and common and unique variance components evaluated. Results: A common factor explained 81% of the variance (reliability 0.95). All dimensions and rater perspectives contributed with unique variance. The final model provided a perfect fit to the data. Conclusions: Efficiency, quality, and quantity and three rater perspectives are valid parts of the self-rated productivity measurement model, but with a large common factor. Thus, the HWQ can be analyzed either as one factor or by extracting the unique variance for each subdimension.

  • 26.
    von Thiele, Ulrica
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Lindfors, Petra
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Centre for Health Equity Studies (CHESS).
    Lundberg, Ulf
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Centre for Health Equity Studies (CHESS).
    Self-rated recovery from work stress and allostatic load in women.2006In: Journal of Psychosomatic Research, ISSN 0022-3999, Vol. 61, no 2, p. 237-42Article in journal (Refereed)
    Abstract [en]

    Objective: The objective of this study was to investigate the relationships between self-rated recovery from work stress and biologic dysregulation in terms of allostatic load (AL) and individual biomarkers, respectively, in healthy women within the public health care sector. Methods: Two hundred forty-one women completed self-ratings of recovery and took part in a standardized medical examination, which provided individual biomarkers that were used to compute AL. Results: Cluster analysis of self-rated recovery resulted in three cluster profiles, including (1) recovered women (n=108), (2) nonrecovered women (n=51), and (3) fatigued women (n=82). Sequential logistic regression analysis showed that the fatigued profile had an increased risk for high AL. In contrast, there was no significant difference in individual biomarkers between recovery profiles. Conclusions: The findings establish an association between biologic processes and self-rated recovery from work stress, thus supporting the hypothesis that insufficient recovery may result in high AL.

  • 27.
    von Thiele, Ulrica
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Lindfors, Petra
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Centre for Health Equity Studies (CHESS).
    Lundberg, Ulf
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Centre for Health Equity Studies (CHESS).
    Self-rated recovery from work stress and allostatic load in women.2006In: International Journal of Behavioral Medicine, ISSN 1070-5503, Vol. 13, no S1, p. 352-Article in journal (Refereed)
    Abstract [en]

    This cross-sectional study was set to investigate the relationships between self-rated recovery from work stress and biological dysregulation in terms of allostatic load and individual biomarkers, respectively. 241 healthy women within the public health care sector completed self-ratings of recovery and took part in a standardized medical examination which provided individual biomarkers. These biomarkers were used to compute allostatic load, a summary indicator of biological challenges of multiple bodily systems. Cluster analysis of self-rated recovery resulted in three distinct cluster profiles: 1) recovered women (n = 108), with sufficient recovery and low levels of fatigue 2) non-recovered women (n = 51), with poor recovery in general and poor long term recovery in particular and 3) fatigued women (n = 82), characterized by poor short term recovery and high levels of mental and physical fatigue. A sequential logistic regression analysis was performed and the risk of high allostatic load was predicted from cluster group membership while controlling for age, education and whether or not participants had children living at home. Odds ratios showed that higher age and belonging to the fatigued profile were associated with high allostatic load. In contrast, there were no significant differences in individual biomarkers between recovery profiles. This study provides support for a focus on cumulative load when investigating the biological pathways of self-rated recovery from work stress. Furthermore, it adds to the research field by clarifying how self-rated recovery from work stress is related to allostatic load in healthy women employed in the public health care sector, which suggests that assessment of self-rated recovery from work could be used to prevent future ill health.

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