The Importance of Work Place Stressors and Employee Experiences for Sickness Absence in Norwegian Hospitals

Do organizational changes, shift-work and long working hours make employees sick? It is often assumed that this is the case, but our research shows that it is not necessarily so. The picture is more mixed and less straightforward. We have used data from a Norwegian health trust to analyze the effects of organizational changes and work stressors on sickness absence. The health care sector is characterized by both long working hours, frequent organizational changes, and shiftwork. Health care personnel work around the clock. We find that while external stressors such as organizational changes can lead to increased sickness absence, not all changes lead to an increase. Downsizing increases sickness absence, but other organizational changes can reduce sickness absence. The idea that organizational changes are something negative for the employees? health needs to be revisited. Whether an organizational change causes a negative health effect probably depends on the type of change, which again probably affects the employees' experience of the change. The picture is mixed for working hours and sickness absence. Bernstrøm and Houkes (2020) find a clear effect of shift work on short-term sickness absence. This effect is robust and withstands controls for age, gender, and whether or not the employee has small children. The effect on long-term sickness absence is less clear. One possible explanation for this is that it is the result of selection; perhaps people who become sick of working nights actively change their work schedule into one that does not include night shifts. For working hours the results are a bit complicated. Several studies show that long working weeks lead to negative health outcomes, but at the same time lower sickness absence. Several of these studies have not controlled for unobservable individual variables, they have compared individuals who work normal hours to individuals who work long hours. This can be problematic. In her analysis Bernstrøm (2018) carries out an analysis with fixed effects at the individual level, this means that each person is compared to him/herself over time. Importantly, it also means that unobservable individual-level differences are controlled for. The results of the analysis support that those who work long hours have lower sickness absence. This does not change with the use of fixed effects. This project has led to several international publications, a Ph.D., and new knowledge. The research carried out in the project has also inspired new projects and new research.

- Prosjektets resultater har gitt case sykehuset mer detaljert kunnskap om sykefraværet i sin organisasjon. Dette er kunnskap sykehuset kan benytte i sitt arbeid med å redusere sykefraværet. Kunnskapen om effekten av organisatoriske endringer og objektive stressfaktorer på sykefravær er også relevant for ledere og beslutningstakere i andre helseorganisasjoner og organisasjoner. - prosjektet har gitt kunnskap om hvilken betydning a) objektive stressfaktorer som skiftarbeid og b) interne organisasjonsendringer har for sykefravær. Disse funnene er publisert i internasjonale vitenskapelige tidsskrift og har bidratt til å øke kunnskapen på dette feltet. - Prosjektet har ledet til en PhD - Forskningen fra dette prosjektet har vært viktig i utviklingen av to nye NFR-finaniserte prosjekter ("Flex-it" og "Compress"), og har derfor bidratt til å styrke den norske forskningskompetansen på feltet.

The aim of the current project is to investigate the interaction between exposure to objective stressors at work (i.e. organizational change, work hours and shift work), employees' subjective experience of the work environment (e.g. demands, control, oppo rtunity for growth) , and sickness absence, in a large Norwegian health trust. The health and social sector suffers from Norway's highest registered sickness absence. At the same time, several aspects of the working conditions in the sector are expected to be particularly straining, including stressors such as shift work outside of normal hours and a high frequency of organizational changes. Investigating how the employees experiences at work mediates and/or moderates the relationship between objective stressors and sickness absence will likely provide valuable information about why the stressors influence sickness absence, and why some employees are affected more than others. We will collect data on the stressors, sickness absence, and employee exper iences from different Sources in one hospital. Data will be analyzed at group level, including approximately 1000 hospital units identifiable over time from 2011 to 2015. The use of group-level data will be of importance to be able to focus on organizati onal characteristics (e.g. amount of work pressure in a unit), rather than individual characteristics (e.g. how much overtime do one employee choose to work). The longitudinal design, and data from independent data sources, will be vital in the pursuit o f causal interaction. Nonetheless, central R&D challenges will include assessing the appropriateness of aggregating different data sources and discussing alternative explanations to the causal inferences proposed. The project will provide valuable infor mation to managers and policy makers aiming to organize work in a health-promoting manner. The project will provide information to enhance our understanding of why stressors influences sickness absence.