<p>The psychosocial work environment in human service organizations is in many respects rewarding from the aspect of human interaction. However, it has also been described in several research reports as demanding and stressful both physically and mentally, resulting in a negative impact on employee health and a high degree of sickness absence. From a public health perspective it is important to focus on determinants of health in occupational groups that are characterized by caring and human relations. This thesis aims at identifying determinants of individual and organizational health in human service professions from a multifactorial perspective.</p><p>Based on both cross-sectional and longitudinal data, four studies of various aspects of psychosocial work exposures are carried out. Study I, an explorative and qualitative study, examines determinants of the psychosocial work environment in the Church of Sweden. Study II consists of a retrospective, randomized study assessing effects of goal clarity work on organizational well-being in the Church. Study III examines exposures resulting in stress-related sick leave among elderly care employees. Study IV is a longitudinal study that assesses effects of organizational change on health and sickness absence among elderly care employees. </p><p>The results show some positive experiences, despite overall demanding work conditions within both of the studied professions. In the Church (Paper I), experiences of freedom and influence at work and the Christian values tend be factors with modifying effect on health. Four patterns are identified for negative health impact; these include unclear organization, a sense of being different, stressful work and destructive communication style. Effects of goal clarity work (Paper II) indicate an overall positive impact on organizational well-being. In elderly care (Paper III), the results suggest, in general, a positive work climate and high effectiveness. Work related exhaustion was significantly higher among employees with stress related sickness absence. Factors of risk for being absent due to stress are approximately three times higher among employees dissatisfied with both their work and their social situations. Finally, measuring effects of organizational change (Paper IV), the results reveal evidence of unchanged self-rated health (SRH), work satisfaction and work exhaustion after reorganization. However, sickness absence increased across time and there is an indication of impaired levels of the anabolic hormone DHEA-S among those individuals affected by the reorganization. </p><p>The results point to a challenge for further research on the interplay between perceived stressors, resources available, biological stress markers and health in order to find adequate measures for improvements in psychosocial work environment in human service professions.</p>

The psychosocial work environment in human service organizations is in many respects rewarding from the aspect of human interaction. However, it has also been described in several research reports as demanding and stressful both physically and mentally, resulting in a negative impact on employee health and a high degree of sickness absence. From a public health perspective it is important to focus on determinants of health in occupational groups that are characterized by caring and human relations. This thesis aims at identifying determinants of individual and organizational health in human service professions from a multifactorial perspective. Based on both cross-sectional and longitudinal data, four studies of various aspects of psychosocial work exposures are carried out. Study I, an explorative and qualitative study, examines determinants of the psychosocial work environment in the Church of Sweden. Study II consists of a retrospective, randomized study assessing effects of goal clarity work on organizational well-being in the Church. Study III examines exposures resulting in stress-related sick leave among elderly care employees. Study IV is a longitudinal study that assesses effects of organizational change on health and sickness absence among elderly care employees. The results show some positive experiences, despite overall demanding work conditions within both of the studied professions. In the Church (Paper I), experiences of freedom and influence at work and the Christian values tend be factors with modifying effect on health. Four patterns are identified for negative health impact; these include unclear organization, a sense of being different, stressful work and destructive communication style. Effects of goal clarity work (Paper II) indicate an overall positive impact on organizational well-being. In elderly care (Paper III), the results suggest, in general, a positive work climate and high effectiveness. Work related exhaustion was significantly higher among employees with stress related sickness absence. Factors of risk for being absent due to stress are approximately three times higher among employees dissatisfied with both their work and their social situations. Finally, measuring effects of organizational change (Paper IV), the results reveal evidence of unchanged self-rated health (SRH), work satisfaction and work exhaustion after reorganization. However, sickness absence increased across time and there is an indication of impaired levels of the anabolic hormone DHEA-S among those individuals affected by the reorganization. The results point to a challenge for further research on the interplay between perceived stressors, resources available, biological stress markers and health in order to find adequate measures for improvements in psychosocial work environment in human service professions.

Sjukfrånvaron inom de svenska kommunala vård- och omsorgsorganisationerna ökar. Samtidigt har en organiserings- och styrningsförändring skett inom dessa organisationer de senaste decennierna i form av införandet av New Public Management (NPM) och dess reformer. Studien syftade till att genom en kvalitativ fallstudie få en ökad förståelse för hur psykosociala och organisatoriska faktorer tillsammans kunde ha inverkan på en kommunal vård- och omsorgsorganisations sjukfrånvaro för organisationens medarbetare inom kontaktyrken och dess chefer. Detta utifrån att identifiera vad organisationens sjukfrånvaro orsakades av samt för att föreslå åtgärder för att förebygga framtida sjukfrånvaro. För att uppfylla syftet och studiens frågeställningar genomfördes semistrukturerade intervjuer med totalt 19 intervjupersoner som representerade de arbetsgrupper med organisationens högsta och lägsta sjuktal under 2019 samt de chefsgrupper med organisationens högsta och lägsta sjuktal under 2019. Empirin analyserades utifrån den teoretiska referensramen. Denna innefattade tidigare forskning samt teorier gällande NPM, struktureringsteori, psykosociala sjukfrånvarofaktorer, organisatoriska sjukfrånvarofaktorer, psykosociala friskfaktorer, organisatoriska friskfaktorer samt organisationshälsa. Studiens resultat visade på tre framträdande psykosociala sjukfrånvarofaktorer för medarbetare respektive chefer, fyra organisatoriska sjukfrånvarofaktorer för medarbetare respektive chefer, fyra psykosociala friskfaktorer för medarbetare respektive chefer samt fyra organisatoriska friskfaktorer för medarbetare och fem organisatoriska friskfaktorer för chefer. Resultaten visade att de psykosociala och organisatoriska sjukfrånvaro- och friskfaktorerna påverkade varandra, att det fanns ett samband mellan chefers och medarbetares upplevda arbetsmiljö samt att sjukfrånvaron framförallt kunde härledas till strukturer medan frisknärvaron istället kunde härledas till individers handlingar. Tio åtgärder för att minska sjukfrånvaron inom kommunala vård- och omsorgsorganisationer presenterades utifrån studiens resultat och potentiell vidare forskning har föreslagits. / Sickness absence within the Swedish municipal healthcare organizations is increasing. At the same time, there has been a change in organization and governance within these organizations in recent decades in the form of the introduction of New Public Management (NPM) and its reforms. The study aimed to gain a better understanding of how psychosocial and organizational factors together could have an impact on a municipal healthcare organization's sickness absence, regarding employees in the human service profession and its managers, through a qualitative case study. This to identify what was causing the organization's sickness absence and on proposing measures to prevent future sickness absence. To fulfill the purpose and study questions, semi-structured interviews were conducted with a total of 19 informants representing the working groups with the organization's highest and lowest sickness numbers in 2019 and the management groups with the highest and lowest sickness numbers in 2019. The empirical data was analyzed based on the theoretical frame of reference. This included previous research as well as theories of NPM, structuring theory, psychosocial sickness absence factors, organizational sickness absence factors, psychosocial health factors, organizational health factors and organizational health. The study's results showed three prominent psychosocial sickness absence factors for employees and managers, four organizational sickness absence factors for employees and managers, four psychosocial health factors for employees and managers, four organizational health factors for employees and five organizational health factors for managers. The results showed that the psychosocial and organizational sickness absence and health factors affected each other, that there was a connection between managers and employees perceived work environment and that the sickness absence could primarily be attributed to structures, while work attendance instead could be attributed to individuals' actions. Ten measures to reduce sickness absence within municipal healthcare organizations has been presented based on the results of the study, as well as suggestions for further research.