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Background Care and support for children and youth with mental ill health have become more specialized and are provided by an increasing number of stakeholders. As a result, services are often fragmented, inefficient and unco-ordinated, with negative consequences for the service user and their family. Enhanced collaboration could lead to improved care and support but requires a shared understanding and a joint problem formulation between involved stakeholders to commence. The aim of this study was to explore different stakeholders’ perceived problems associated with delivering care and support to children and youth with mental ill health and to discuss how the perceived problems relate to collaboration. Methods A qualitative descriptive study was conducted, using short statements of perceived problems written by stakeholders involved in the care and support of children and youth with mental ill health during an inter-organizational workshop. The 26 stakeholders represented school and student health, primary health care, specialist care, social services, and different service user organizations. Data were collected during February 2020. Inductive content analysis with a summative approach was used when analysing the data. Results The perceived problems were summarized in a model consisting of four main categories: Resources and governance; Collaboration and co-ordination; Knowledge and competence; and Stigma and confidence , containing 24 subcategories. These categories and subcategories were distributed over three levels: Societal level, Organizational level and Individual level. The perceived problems were shared on the category level but to some extent varied between stakeholder groups on the subcategory level. The perceived problems were either directly or indirectly related to collaboration. Conclusions The perceived problems often acted as barriers to achieving successful collaboration. The problems were distributed on all three levels in the developed model, indicating a complex problem. Even though the perceived problems were shared by stakeholders on an overall level, the findings indicate that the stakeholders did not have a completely shared understanding of the perceived problems, as they tended to focus on aspects most relevant to their own organization or perceptions. The challenge is to find which perceived problems are appropriate for inter-organization problem-solving and which can be solved within individual organizations.

Background Integrated occupational safety and health and patient safety management are essential for addressing the challenges faced by healthcare services today. Developing and evaluating tools that support this work is crucial. This project aims to assess the effectiveness of a structured method for systematic and integrated occupational safety and health and patient safety management systems (SIOHPS). Additionally, the project includes embedded economic and process evaluation. This article presents the overall design of the SIOHPS-project, with a specific focus on the design and evaluation of the (cost-)effectiveness study. Methods The project is guided by the Medical Research Council (MRC) framework for complex interventions and is coproduced with key stakeholders. The intervention is designed to support systematic occupational health and patient safety management systems, incorporating both Safety I and Safety II perspectives. It is grounded in safety culture theory and knowledge about team debriefing for learning. The intervention consists of several core components, including targeted education, end-of-shift team debriefings, and support for systematic management. The intervention is supported by a digital tool. A program theory guides the evaluation. A pragmatic stepped-wedge cluster-controlled design (p-SWD) is used, with hospital healthcare units as clusters. The p-SWD includes three steps, with at least four clusters transitioning from the control to the intervention group at each step. A minimum of twelve healthcare units from two different regions in Sweden will participate. The intervention effect will be evaluated using sick leave and quality of care as primary outcomes. Secondary outcomes include safety climate, work environment factors, healthcare worker health, performance, patient safety and quality of nursing care. Primary and secondary analyses are conducted based on intention-to-treat approach. Cost-effectiveness will be assessed using cost-benefit and cost-consequence analyses. Discussion The need of methods that integrate systematic occupational safety and health and patient safety management has been emphasized by different stakeholders worldwide. The SIOHPS study has strong potential for nationwide implementation in Sweden to help healthcare organizations address current challenges. Additionally, the project will contribute to existing safety culture theory by exploring the integration of these domains. Trial registration ClinicalTrials.gov Identifier: NCT06398860. Registration date: 2024-04-30.

To understand how telework is perceived among occupational groups with different work tasks within the same company, this qualitative study aimed to explore how managers and employees experience telework in relation to well-being, individual performance, and the work environment. This qualitative study used a phenomenographic approach. Fourteen online interviews, comprising seven managers and seven employees from the same industrial company, were conducted between February 2022 and September 2023. The data were analyzed inductively to capture variations in telework perceptions. The findings showed that telework is not universally beneficial or challenging; its effectiveness depends on contextual factors such as team setting, job role, type of work, and organizational culture. Telework benefits both employees and managers engaged in individual tasks (e.g., reading, drafting contracts, and preparing reports) or global collaborations, including improved well-being, work-life balance, and overall performance. However, starting with an office-based period that facilitated team cohesion, faster learning, and a deeper understanding of the organizational culture. Face-to-face onsite work could be time-consuming and, therefore, stressful for some, but it is time-saving for others. Onsite employees and managers faced increased workloads when colleagues teleworked, as employees tended to rely more on colleagues physically present in the office. This research highlights the need for tailored strategies to enhance the advantages of telework while reducing its challenges. It contributes to existing research by providing nuanced insights into the relationship between telework and occupational groups within an industrial setting and offering practical guidance for telework in this field.

Background The aim of this study is to evaluate the construct validity and responsiveness of a Swedish measure of health-related production loss as well as to investigate if there is a difference in the level of production loss within a population suffering from persistent back/neck pain and CMDs. Methods The sample was drawn from a study that assessed employees’ health and working capacity in 74 health care units before and after intervention. The study included 692 patients who reported working the previous six months at baseline measurement, and who were also asked to answer questions related to health-related production loss. Health-related measures were general health derived from Short Form-12, health-related quality of life derived from EQ-5D, and work ability derived from the Work Ability Index (WAI). Convergent validity and external responsiveness were assessed using Spearman’s Rank Correlation Coefficient and a linear regression model, respectively. Results The different measures of health showed a moderate-to-strong correlation with the measure of health-related production loss and fulfilled the criteria for construct validity. Changes in health and work ability led to significant changes in health-related production loss, which demonstrates external responsiveness. This result is valid for both the total population and for the two different subgroups that were evaluated. Conclusions The present study shows that this measure of health-related production loss is a valid measure for capturing production loss due to illness, and that work ability is more strongly correlated with health-related production loss than people’s general health is. The result shows an average of about 50 % reduced production due to illness, with back pain being the most costly.

Work motivation and job attitudes are important for productivity levels among academic employees. In situations where employees perceive problems, for example, health-related and work environment-related problems, the ability to perform at work could be affected, which may result in fewer publications, reduced quality and less research funding. Few studies, however, have paid attention to productivity loss among academic employees in order to understand how, or if, the perceived loss is affected by the reported problems, either alone or in combination with work motivation and job attitudes. To evaluate whether attitudes towards work—measured as job satisfaction, organisational commitment and work motivation—are associated with productivity loss in the workplace, a cross-sectional study was conducted. This type of design is required as performance is highly variable and is affected by changes in health and work status. This study includes employees who reported either health-related problems, work environment problems or a combination of both (n = 1475). Linear regression analyses were used to answer the hypotheses. Higher levels of motivation, job satisfaction and organisational commitment were associated with lower levels of productivity loss among employees who experienced either health-related or work environment problems. High work motivation and high commitment were significantly associated with lower levels of productivity loss among employees who experienced a combination of problems. In summary, productivity loss among academic employees is not only affected by health-related problems or problems in the work environment but also by work motivation, job satisfaction and organisational commitment; i.e., these factors seem to buffer, or moderate, the reduction in performance levels for this group of employees.

For individuals with recurrent or persistent non-specific low back pain (LBP), exercise and exercise combined with education have been shown to be effective in preventing new episodes or in reducing the impact of the condition. Chiropractors have traditionally used Maintenance Care (MC), as secondary and tertiary prevention strategies. The aim of this trial was to investigate the effectiveness of MC on pain trajectories for patients with recurrent or persistent LBP. This pragmatic, investigator-blinded, two arm randomized controlled trial included consecutive patients (18-65 years old) with non-specific LBP, who had an early favorable response to chiropractic care. After an initial course of treatment, eligible subjects were randomized to either MC or control (symptom-guided treatment). The primary outcome was total number of days with bothersome LBP during 52 weeks collected weekly with text-messages (SMS) and estimated by a GEE model. Three hundred and twenty-eight subjects were randomly allocated to one of the two treatment groups. MC resulted in a reduction in the total number of days per week with bothersome LBP compared with symptom-guided treatment. During the 12 month study period, the MC group (n = 163, 3 dropouts) reported 12.8 (95% CI = 10.1, 15.5; p = <0.001) fewer days in total with bothersome LBP compared to the control group (n = 158, 4 dropouts) and received 1.7 (95% CI = 1.8, 2.1; p = <0.001) more treatments. Numbers presented are means. No serious adverse events were recorded. MC was more effective than symptom-guided treatment in reducing the total number of days over 52 weeks with bothersome non-specific LBP but it resulted in a higher number of treatments. For selected patients with recurrent or persistent non-specific LBP who respond well to an initial course of chiropractic care, MC should be considered an option for tertiary prevention.

The study aimed to investigate managers’ perceptions of telework in relation to the work environment and the performance of their organizations. It was grounded on interviews with 17 managers from public and private organizations in Sweden using a phenomenographic research approach. The managers had experience in leading employees who teleworked, and their contact information was provided by the organizations. The results showed that managers perceived that telework led to more focus on delivery at work. When telework enabled working undisturbed and getting more work done, employees started to question the need to come to the workplace. Further, some employees changed their behaviors at the workplace; they tended to close their office doors to avoid distractions. Others valued social activities when working at the workplace. Managers also reported that telework could make small close-working teams even closer, but they could lose contact with others outside the teams. In addition, telework led to quicker but less informed decisions, which may benefit productivity in the short term but not in the long term. The findings of the study highlight managers’ perspectives on the consequences of telework in an organization, which is important for maintaining organizational sustainability.

ObjectivesCommon mental disorders (CMDs) are among the main causes of sickness absence and can lead to suffering and high costs for individuals, employers and the society. The occupational health service (OHS) can offer work-directed interventions to support employers and employees. The aim of this study was to evaluate the effect on sickness absence and health of a work-directed intervention given by the OHS to employees with CMDs or stress-related symptoms.MethodsRandomisation was conducted at the OHS consultant level and each consultant was allocated into either giving a brief problem-solving intervention (PSI) or care as usual (CAU). The study group consisted of 100 employees with stress symptoms or CMDs. PSI was highly structured and used a participatory approach, involving both the employee and the employee’s manager. CAU was also work-directed but not based on the same theoretical concepts as PSI. Outcomes were assessed at baseline, at 6 and at 12 months. Primary outcome was registered sickness absence during the 1-year follow-up period. Among the secondary outcomes were self-registered sickness absence, return to work (RTW) and mental health.ResultsA statistical interaction for group × time was found on the primary outcome (p=0.033) and PSI had almost 15 days less sickness absence during follow-up compared with CAU. Concerning the secondary outcomes, PSI showed an earlier partial RTW and the mental health improved in both groups without significant group differences.ConclusionPSI was effective in reducing sickness absence which was the primary outcome in this study.

To ensure high-quality care, operationalize resilience and fill the knowledge gap regarding how to improve the prerequisites for resilient performance, it is necessary to understand how adaptive capacity unfolds in practice. The main aim of this research was to explain the escalation process of intensive care during the first wave of the pandemic from a microlevel perspective, including expressions of resilient performance, intervening conditions at the micro-meso-macrolevels and short- and long-term consequences. A secondary aim was to provide recommendations regarding how to optimize the prerequisites for resilient performance in intensive care. A grounded theory methodology was used. First-person stories from different healthcare professionals (n70) in two Swedish regions were analyzed using the constant comparative method. This resulted in a novel conceptual model (including 6 main categories and 24 subcategories), and 41 recommendations. The conclusion of these findings is that the escalation of intensive care can be conceptualized as a transition from threatening chaos to temporary order through a complex process of adaptation. To prepare for the future, the components of space, stuff, staff, system and science, with associated continuity plans, must be implemented, anchored and communicated to actors at all levels of the system.

Background The aim was to investigate the prevalence of health problems and work environment problems and how these are associated with subjective production loss among women and men at an academic workplace. An additional aim was to investigate whether there were differences between women and men according to age group, years at current workplace, academic rank or managerial position. Methods A questionnaire was sent in 2011 to all employees at a Swedish university ( n  = 5144). Only researchers and teachers were included in the study ( n  = 3207). Spearman correlations were performed to investigate differences in health and work environment problems. Employees who reported having experienced work environment or health problems in the previous seven days ( n  = 1475) were included in the analyses in order to investigate differences in subjective production loss. This was done using Student’s t -test, One-way Anova and generalized linear models. Results The response rate was 63% ( n  = 2022). A total of 819 academic staff (40% of the population) reported experiencing either health problems, work environment problems or both during the previous seven days. The prevalence of health problems only or a combination of work environment and health problems was higher among women than men ( p -value ˂0.05). This was especially the case for younger women, those in lower academic positions and those who had worked for fewer years at their current workplace. No difference was found for work environment problems. The majority of the employees who reported problems said that these problems affected their ability to perform at work (84–99%). The average production loss varied between 31 and 42% depending on the type of problem. Production loss due to health-related and work-environment related problems was highest among junior researchers and managers. No significant difference between men and women was found in the level of production loss. Conclusion Subjective production loss in academia can be associated with health and work- environment problems. These losses appear similar for women and men even though younger female academics, women in lower academic ranks and those with fewer years of employment in their current workplace report a higher prevalence of health problems and combined work-environment and health problems than men.