Omvandlingen av sjukvården mot marknadisering och nya driftsformer har huvudsakligen genomförts utifrån ekonomiska och politiska föresatser om ökad effektivitet och vårdkvalitet. Goda arbetsvillkor för personalen är en viktig förutsättning för förverkligandet av dessa mål. Givet det oklara kunskapsläget kring psykologiska implikationer av omställningen i välfärdssektorns styrning var syftet med avhandlingen att studera olika aspekter av arbetsvillkor samt arbetsrelaterade attityder och hälsa i privat, bolagiserad och förvaltningsdriven sjukvård. Det gjordes genom att undersöka hur krav och resurser i arbetet förhåller sig till uppkomsten och utbredningen av utbrändhet hos sjuksköterskor, betydelsen av kontroll i och över arbetet för de anställdas arbetstrivsel samt hur motivationsbaserade kognitioner av bemyndigande hos vårdpersonal förändras vid privatisering och relaterar till attityder och hälsa. De empiriska studierna inkluderade såväl tvärsnittliga som longitudinella enkätdata från tre svenska akutsjukhus med olika driftsform. Resultaten visade högre nivåer av utbrändhet hos sjuksköterskor i privat jämfört med förvaltningsdrivet sjukhus. För arbetstrivsel fanns ingen nivåskillnad mellan de tre driftsformerna. Krav i arbetet hängde samman med högre utbrändhetsnivåer och lägre arbetstrivsel. Flera resurser var förenade med lägre grad av utbrändhet medan kontroll hängde samman med högre trivsel. Vid en förändring från bolagiserad till privat driftsform var vårdpersonalens bemyndigande relativt stabilt. Dock fanns efter privatiseringen en tendens till standardisering då graden av bemyndigande blev mer lika. Likaså skedde en statusmässig differentiering i bemyndigande mellan yrkesgrupperna genom att flera med låg status fick mindre bemyndigande. Sammantaget pekar avhandlingen på fler likheter än skillnader mellan driftsformerna vilket antyder att driftsform tycks ha mindre betydelse för såväl nivå som betydelse av arbetsvillkor för personalens attityder och hälsa. / The shift in health care towards marketization and new types of ownership has mainly been carried out for financial and political reasons aimed at increasing care efficiency and quality. Good working conditions for the personnel are essential for these goals. However, knowledge of the implications at the individual level is still limited. Considering this, the aim of this thesis was to study working conditions, work-related attitudes and health in private for-profit (PFP), private non-profit (PNP), and publicly administered (PA) hospitals in three empirical studies. This was done by investigating how demands and resources at work predict the development of burnout, how control within and over work relate to employee job satisfaction, and how perceptions of empowerment change in connection with privatization and relate to attitudes and health. The empirical studies include cross-sectional and longitudinal questionnaire data from three Swedish acute care hospitals with different ownership types. The results showed higher levels of burnout among nurses at the PFP hospital than those at the PA hospital. There was no difference in levels of job satisfaction among the ownership types. Demands were associated with higher burnout levels and lower job satisfaction. Several job resources were associated with lower burnout, while control was related to higher job satisfaction. In a change from PNP to PFP, employees’ empowerment levels remained relatively stable. However, there was a tendency towards standardization as their degrees of empowerment became more similar after privatization. Also, a status-related differentiation in empowerment occurred among the occupational groups as some with low status experienced less empowerment. Altogether, the findings show more similarities than differences among the ownership types, suggesting that ownership is of less importance for both the levels and the impact of working conditions on attitudes and health. / <p>At the time of the doctoral defence, the following paper was unpublishd and had a status as follows: Paper 2: Manuscript.</p>

ABSTRACT The purpose of the present study was to explore the effects inclusion-exclusion on the job-related attitudes of the organizational workforce. These attitudes included job satisfaction, organizational commitment, burnout, and turnover intention. A quantitative survey was conducted using a sample of employees of a social service organization in San Bernardino County. Participants include employees from all levels and program areas of the social service organization. Study data was collected through the use of a self-report questionnaire. Measures were used to explore commitment to the organization, diversity perception, job satisfaction, turnover intention and burnout, the dependent variables. Using SPSS software to analyze data, descriptive statistics, correlation, and Mann-Whitney U analysis were conducted. More than half of the survey participants, as presented in Table 1 (see Appendix D), identified as women (n=35, 85.4%) and five (12.2%) accounted for the participants that identified as men. Results showed that Inclusion was significantly related to all job related attitudes except burnout, gender and race. Results were consistent with the literature in that inclusion is related to positive work-related attitudes, but inconsistent in regards to its relation with gender and race.

<p>The increasing use of temporary and part-time employment in recent decades was initially expected to lead to negative effects for the individual. The empirical evidence, however, has been equivocal and the consequences are therefore still unclear. This thesis adopts a psychological approach to alternative employment by investigating how heterogeneity in employment contracts together with individual differences associate with work attitudes and subjective well-being. It comprises four studies in which questionnaire data is used to study differences among temporary workers (Study I & II) and differences in the alternative workforce (fixed-term, on-call, and part-time workers) compared to permanent full-time workers (Study III & IV), in order to analyze the impact of different types of contracts together with individual differences. Study I found that attitudes, role stress, and health varied across different patterns in individuals’ backgrounds and contract forms. Study II demonstrated that distinct patterns of voluntary and involuntary contract motives and of work involvement associated with differences in reported work-related and general well-being. Study III showed that well-being and organizational attitudes were related to individuals’ job and contract preferences and, to some degree, heterogeneity in contract types. Study IV revealed that individuals’ perceptions of job conditions (control, demands, and job insecurity) predicted well-being, whereas type of employment contract was found to be less important. Employment contract forms, however, interacted with individual diversity in Study III and IV. The thesis concludes that differences among individuals are important for understanding the implications of different types of alternative employment contracts. Future research should focus on these interactive mechanisms to better understand the consequences of alternative employment forms.</p>

The increasing use of temporary and part-time employment in recent decades was initially expected to lead to negative effects for the individual. The empirical evidence, however, has been equivocal and the consequences are therefore still unclear. This thesis adopts a psychological approach to alternative employment by investigating how heterogeneity in employment contracts together with individual differences associate with work attitudes and subjective well-being. It comprises four studies in which questionnaire data is used to study differences among temporary workers (Study I &amp; II) and differences in the alternative workforce (fixed-term, on-call, and part-time workers) compared to permanent full-time workers (Study III &amp; IV), in order to analyze the impact of different types of contracts together with individual differences. Study I found that attitudes, role stress, and health varied across different patterns in individuals’ backgrounds and contract forms. Study II demonstrated that distinct patterns of voluntary and involuntary contract motives and of work involvement associated with differences in reported work-related and general well-being. Study III showed that well-being and organizational attitudes were related to individuals’ job and contract preferences and, to some degree, heterogeneity in contract types. Study IV revealed that individuals’ perceptions of job conditions (control, demands, and job insecurity) predicted well-being, whereas type of employment contract was found to be less important. Employment contract forms, however, interacted with individual diversity in Study III and IV. The thesis concludes that differences among individuals are important for understanding the implications of different types of alternative employment contracts. Future research should focus on these interactive mechanisms to better understand the consequences of alternative employment forms.

Extensive changes are taking place in working life and creating new and important areas for research. New knowledge is needed in order for individuals and organizations to be able to maintain long-term development. The aim of this thesis is to increase our understanding of how change and (im)mobility in the labor market are related to employees’ health, wellbeing, and work-related attitudes. The thesis comprises three studies, based on questionnaire data from different samples. Study I examined the potential consequences of downsizing in two organizations that had implemented change in two different ways (proactively and reactively). A proactive approach seems to lessen change-related demands and provide an opportunity for increased participation, which helps lessen the negative effects on employee work attitudes and wellbeing. The descriptive data from a representative sample in Study II revealed that 28 percent of the permanent and 50 percent of the temporary employees did not work in their preferred occupations. The results indicate that those individuals who were involuntarily embedded (locked-in position), especially among the permanent employees, had more health problems and less development at work. Study III utilizes a newly developed construct (work-related health attributions) that focuses on the individual’s perception of the relation between work and health. The results indicate that it seems to be a promising construct for predicting job satisfaction, organizational commitment, and turnover intention. For employees to have the opportunity to participate in organizational change, as well as the opportunity to exercise mobility and alter their circumstances when the organization, occupation, or job is not contributing to their better health appear to be factors that help improve health and sustainability for both employees and organizations.

Individers upplevelse av den psykosociala arbetsmiljön har visat sig hänga samman med trivsel, hälsa och välbefinnande. I ett långsiktigt perspektiv kan en god psykosocial arbetsmiljö främja kvalitet och produktivitet i organisationer, medan en sämre arbetsmiljö kan resultera i det motsatta. Arbetsgivare, som i Sverige har ett yttersta arbetsmiljöansvar, strävar efter att arbeta förebyggande och systematiskt med fokus på psykosociala arbetsmiljöinsatser. Samtidigt utgör individerna en del av den psykosociala arbetsmiljön och i samband med att de utför sitt arbete bidrar de även till formandet av arbetsmiljön. Med detta som utgångspunkt syftar avhandlingen till att studera psykosociala och personliga faktorer i form av krav och resurser, hälsa och välbefinnande samt ett organisatoriskt förebyggande program för anställda i välfärdssektorn. Detta har gjorts genom att undersöka hur olika krav och resurser i arbetet samt personliga resurser relaterar till olika hälsorelaterade utfall. Vidare har två varianter av ett nyutvecklat interventionsprogram med fokus på psykosociala faktorer och personliga resurser undersökts och utvärderats. En variant av programmet var riktad till både chefer och medarbetare, medan den andra varianten riktades enbart till chefer. Interventionsprogrammen undersöktes utifrån genomförbarhet och utifrån effektutvärdering. Resultaten visar att resurser i arbetet verkar ha mer hälsofrämjande potential än personliga resurser. Vidare visar resultaten att det program som inkluderade medarbetare och chefer accepterades av deltagarna och gick att genomföra praktiskt. Resultaten visar också att effekterna av båda programmen var oklara. Sammantaget visar avhandlingen på vikten av att såväl reducera krav i arbetet som att främja olika resurser, men även på de utmaningar som finns i att utforma, genomföra och utvärdera förebyggande organisatoriska interventioner. / Individuals’ experiences of the psychosocial work environment have been linked to their satisfaction, health, and well-being. In the long run, a favorable psychosocial work environment seems related to organizational quality and productivity, while a poorer psychosocial work environment may relate to the opposite. Employers, who in Sweden have the ultimate responsibility for the work environment, aim for systematic preventive efforts focusing particularly on factors of the psychosocial work environment. Additionally, individuals also form part of the psychosocial work environment, and may, through their own daily work practices contribute to creating the work environment. Based on this, the aim of this thesis is to study how psychosocial factors, in terms of demands and resources, and personal resources at work relate to health and well-being but also to investigate the effects of an organizational preventive intervention program. Specifically, job demands, job resources, and personal resources and their relations with health-related outcomes among employees of the Swedish welfare sector were investigated. Also, two versions of a newly developed intervention program focusing on psychosocial factors and personal resources were examined. This included a feasibility study of one program version offered to both employees and managers and an effect evaluation of another version offered to managers only. The results show that job resources seem to have a stronger health-promoting potential than personal resources. Moreover, the results show that while the program offered to both employees and managers was accepted by participants and found possible to implement practically, its effect were small. Similarly, effects of the program including managers only were also small. Overall, the thesis shows the importance of reducing job demands along with promoting different resources, but emphasizes the challenges in developing, implementing, and evaluating preventive organizational interventions. / <p>At the time of the doctoral defense, the following papers were unpublished and had a status as follows: Paper 1: Manuscript. Paper 3: Manuscript.</p>

Organisationer behöver kvalificerad personal för att fungera effektivt och därmed blir rekrytering en viktig aktivitet. Det är också angeläget att ny personal anpassar sig väl till arbetsförhållandena. Syftet med denna avhandling var att tydliggöra möjligheterna att genom urval bidra till en långsiktigt hållbar rekrytering för organisation, individ och samhälle. Avhandlingen omfattar tre delstudier och baseras på data från rekrytering av nya poliser i Sverige. En kohort har följts från urvalet av de sökande till polisutbildningen våren 2008 (N = 1 344) över tre uppföljningstillfällen (N = 717–729), nämligen vid slutet av två års polisutbildning, vid slutet av sex månaders aspirantutbildning och vid slutet av det första anställningsåret. Studie I syftade till att undersöka möjligheterna att välja ut de sökande som är mest lämpade att bli poliser genom att kombinera information från flera urvalsmetoder. Vanligtvis används intervjuer för att i slutet av urvalsprocessen välja ut de mest lämpade kandidaterna. Analyser med flera kriterier på framgångsrik rekrytering (prestation, tillfredsställelse med utbildning respektive arbete, vilja att stanna i yrket och hälsa) vid de tre uppföljningstillfällen, visade att ett alternativt förfarande – att kombinera information från urvalsmetoder som i tidigare steg använts för att sålla bort olämpliga sökande – hade högre prognosförmåga. Det handlade om information från begåvningstest, personlighetstest och konditionstest. Ett sådant förfarande kan också vara mer tillförlitligt och resurseffektivt. Vid urval av poliser bör intervjuer däremot främst ses som ett verktyg för att sålla bort olämpliga kandidater. Studie II syftade till att öka förståelsen för hur resultat från begåvningstest ska tolkas och användas vid urval. För de flesta yrken, inklusive polisyrket, har begåvningstest visats vara en av de urvalsmetoder som bäst predicerar prestation. Det har förklarats med effekter av generell begåvning. Resultaten från Studie II visade dock att utöver generell begåvning kan också en verbal och kunskapsladdad komponent antas viktig för att predicera prestation. Samtidigt gav studien stöd för att vid urval använda en samlad totalpoäng från begåvningstest. Studie III syftade till att undersöka den relativa betydelsen av urvalsfaktorer som personlighet och begåvning respektive den psykosociala arbetsmiljön för nya polisers arbetsrelaterade attityder och hälsa efter det första anställningsåret. Studien visade att arbetsmiljöfaktorer, såsom möjligheter till utveckling och återkoppling i arbetet samt rimlig arbets­belastning, var betydligt viktigare än urvalsfaktorer för nya polisers anpassning till arbetsförhållandena i yrket. Sammanfattningsvis visar föreliggande avhandling att det är meningsfullt att över tid beakta flera kriterier på framgångsrik rekrytering. Den visar också att information från flera urvalsmetoder bör kombineras för att välja ut de mest lämpade kandidaterna. Vidare visar avhandlingen på värdet av att använda verbalt laddade begåvningstest vid urval. Förmågan att predicera framgång i polisyrket med olika urvalsmetoder är dock måttlig. Avhandlingen visar däremot att arbetsförhållandena för ny personal kan ha avgörande betydelse. Det betyder att organisationer som strävar efter hållbar rekrytering bör prioritera både urval och sunda arbetsförhållanden för ny personal. Det gäller inte minst polisorganisationer där kostnaderna för rekrytering är höga. / Organizations need qualified personnel to work effectively. Accordingly recruitment is an important organizational activity. Moreover, to attain sustainability for organizations, individuals, and the society, it is assumed important that new personnel adjust well to their working conditions. The aim of this thesis was to investigate the role of selection for long-term sustainable recruitment. The thesis includes three studies based on data from the recruitment of new police officers in Sweden. A cohort of new police officers was followed from the end of the admittance process to the basic police training program in spring 2008 (N = 1,344) and then at three consecutive follow-ups (N = 717-729), 1) at the end of two years of academy training, 2) at the end of six months of field training, and 3) at the end of the first working year. Study I aimed to further the understanding of how to select suitable police applicants by using combinations of common selection methods. Analyses of several criteria (performance, satisfaction, occupational retention, and health) at the three follow-ups suggest that combining information from cognitive, personality, and physical fitness tests, that in earlier hurdles have been used to screen out unsuitable applicants, would be useful in identifying the most suitable candidates, while interviews may primarily be considered as a tool for screening out any unsuitable ones. Study II focused on how to interpret and make use of results from cognitive tests in applied settings such as selection. In most occupations, including the police, cognitive tests are among the most valid predictors of performance. This has been explained by the influence of general intelligence. However, the results from Study II showed that beyond general intelligence, a verbal and knowledge loaded component can be important in predicting performance. Also, the study supported the use of total scores in selection. Study III aimed to examine the relative importance of selection factors (e.g., personality and general intelligence) and psychosocial working conditions for new police officers’ work-related attitudes and health. The study showed that psychosocial working conditions, such as opportunities for development and feedback as well as a balanced workload, were far more important than selection factors for the new police officers’ adjustment to their occupation. Taken together, the thesis shows the value of considering several time points and several criteria of successful recruitment. Also, it demonstrates the usefulness of combining information from several selection methods to select the most suitable candidates, along with the value of using verbally loaded cognitive tests in selection. Still, the ability to predict success among police officers by using selection methods remains modest. Additionally, the thesis shows that the working conditions for new personnel can be considered crucial if recruitment is seen as a long-term process that also includes the introduction phase. Accordingly, organizations striving for sustainable recruitment need to focus on developing sound selection processes and providing sound working conditions for their new personnel. This is of particular importance for organizations such as the police, where the costs of recruitment are high. / <p>At the time of the doctoral defense, the following papers was unpublished and had a status as follows: Paper 3: Manuscript.</p>