Ulrica von Thiele Schwarz

Self-rated Health and Allostatic Load in Women Working in Two Occupational Sectors

This study set out to investigate how biological dysregulation, in terms of allostatic load (AL), relates to self-rated health (SRH) in women. Data on SRH and 12 biomarkers used to assess AL were available for 241 employees from the health care sector and 98 employees from the IT/media sector. In line with the hypothesis, results showed that a poor SRH, along with occupational sector, age and education, were significantly associated with a high AL, particularly for those working within the health care sector. This association between a poor SRH and AL, suggests a link between SRH and biological dysregulation.

Novel Programs, International Adoptions, or Contextual Adaptations? Meta-Analytical Results From German and Swedish Intervention Research

One of the major dilemmas in intervention and implementation research is adaptation versus adherence. High fidelity to an intervention protocol is essential for internal validity. At the same time, it has been argued that adaptation is necessary for improving the adoption and use of interventions by, for example, improving the match between an intervention and its cultural context, thus improving external validity. This study explores the origins of intervention programs (i.e., novel programs, programs adopted from other contexts with or without adaptation) in two meta-analytic intervention data sets from two European countries and compares the effect sizes of the outcomes of the interventions evaluated. Results are based on two samples of studies evaluating German child and youth preventative interventions (k = 158), and Swedish evaluations of a variety of psychological and social interventions (k = 139). The studies were categorized as novel programs, international adoption and contextual adaptation, with a total of six subcategories. In the German sample, after statistically controlling for some crucial methodological aspects, novel programs were significantly more effective than adopted programs. In the Swedish sample, a trend was found suggesting that adopted programs were less effective than adapted and novel programs. If these results are generalizable and unbiased, they favor novel and adapted programs over adopted programs with no adaptation and indicate that adoption of transported programs should not be done without considering adaptation.

Team behaviors in emergency care: a qualitative study using behavior analysis of what makes team work.

ObjectiveTeamwork 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.MethodsThe 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.ResultsWe 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.ConclusionsThis 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.

Functions of behavior change interventions when implementing multi-professional teamwork at an emergency department: a comparative case study.

BackgroundWhile there is strong support for the benefits of working in multi-professional teams in health care, the implementation of multi-professional teamwork is reported to be complex and challenging. Implementation strategies combining multiple behavior change interventions are recommended, but the understanding of how and why the behavior change interventions influence staff behavior is limited. There is a lack of studies focusing on the functions of different behavior change interventions and the mechanisms driving behavior change. In this study, applied behavior analysis is used to analyze the function and impact of different behavior change interventions when implementing multi-professional teamwork.MethodsA comparative case study design was applied. Two sections of an emergency department implemented multi-professional teamwork involving changes in work processes, aimed at increasing inter-professional collaboration. Behavior change interventions and staff behavior change were studied using observations, interviews and document analysis. Using a hybrid thematic analysis, the behavior change interventions were categorized according to the DCOM® model. The functions of the behavior change interventions were then analyzed using applied behavior analysis.ResultsThe two sections used different behavior change interventions, resulting in a large difference in the degree of staff behavior change. The successful section enabled staff performance of teamwork behaviors with a strategy based on ongoing problem-solving and frequent clarification of directions. Managerial feedback initially played an important role in motivating teamwork behaviors. Gradually, as staff started to experience positive outcomes of the intervention, motivation for teamwork behaviors was replaced by positive task-generated feedback.ConclusionsThe functional perspective of applied behavior analysis offers insight into the behavioral mechanisms that describe how and why behavior change interventions influence staff behavior. The analysis demonstrates how enabling behavior change interventions, managerial feedback and task-related feedback interact in their influence on behavior and have complementary functions during different stages of implementation.

Investigating variations in implementation fidelity of an organizational-level occupational health intervention.

BackgroundThe 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.PurposeThe 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.MethodThe 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.ResultsImplementation 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.ConclusionImplementation 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.

Promoting employee health by integrating health protection, health promotion, and continuous improvement: a longitudinal quasi-experimental intervention study.

Objective:To test the effects of integrating health protection and health promotion with a continuous improvement system (Kaizen) on proximal employee outcomes (health promotion, integration, and Kaizen) and distal outcomes (workability, productivity, self-rated health and self-rated sickness absence). Methods:Twelve units in a county hospital in Sweden were randomized to control or intervention groups using a quasiexperimental study design. All staff (approximately 500) provided self-ratings in questionnaires at baseline, and a 12- and 24-month follow-up (response rate, 79% to 87.5%). Result:There was a significant increase in the proximal outcomes over time in the intervention group compared with the control group, and a trend toward improvement in the distal outcomes workability and productivity. Conclusions:Integration seems to promote staff engagement in health protection and promotion, as well as to improve their understanding of the link between work and health.

Alignment for Achieving a Healthy Organization

Modern working life is characterized by change and competiveness. It is also characterized by a drift away from low-skilled work to more complex jobs and increased social interaction. This means that the human resources employees and their skills, competencies, engagement and motivation are the greatest asset of many organizations. This has implications for how an organization can be healthy, i.e. create an environment that will contribute to employee health, wellbeing and motivation as well as achieve business outcomes. In this chapter, we will draw on theories from work and organizational psychology and behavioral psychology, and our own research, to describe what we believe to be the fundament of a healthy organization. We will do this by introducing the concept of alignment, which will be used to illuminate the healthy organization. Alignment can be described as the lining up of different aspects of what is going on in an organization so that they create a common thread. This cuts across different layers and processes in the organization; thus vertical, horizontal and diagonal alignments will be described. In the second part, we will use the framework of alignment to illuminate why occupational health interventions need to be integrated with the organizations strategy and systems in order to create sustainable change. Implications of alignment for participatory approaches, intervention fit, program theories, the role of management and more will be discussed. In the third part, we will describe the implications of our view of an aligned, healthy organization for designing and evaluating interventions in organizations. This includes arguing for changing the roles and responsibilities of researchers and practitioners, and how this change can be beneficial to the organization as well as the quality of the research. (Less)

Comparing Employees and Managers’ Perceptions of Organizational Learning, Health, and Work Performance

The Problem Disagreement between subordinates and their managers’ perceptions of organizational climate and support has been related to less efficient work performance and worse organizational outcomes. Possible consequences of disagreement between managers’ and subordinates’ ratings of organizational learning are currently not known. Little is also known about how the level of agreement between the two ratings relates to employees’ performance and well-being at work. The Solution The study was conducted in an industrial company in Sweden. First-line managers’ and their subordinates’ responses to the Dimensions of the Learning Organization Questionnaire (DLOQ) were evaluated along with employees’ ratings of their work performance and health. The Stakeholders Key stakeholders include leaders responsible for group- and organization-level learning activitities and employees’ well-being and work performance. In addition, representatives from human development departments will find this study to be of interest.

The Dynamic Integrated Evaluation Model (DIEM) : Achieving Sustainability in Organizational Intervention through a Participatory Evaluation Approach

Abstract 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.

Interactions between lean management and the psychosocial work environment in a hospital setting – a multi-method study

BackgroundAs 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.MethodsThe 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.ResultsBetween 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.ConclusionsThe 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.