ARTICLE
May work joy flourish – Eskilstuna municipality tackles ill health at the roots
In a new co-creative project, Mälardalen University and the Municipality of Eskilstuna are working together to reduce ill health in the municipality’s female-dominated occupations. Instead of directing interventions at the individual, the aim is to transform the organisation at its core.
It is a well-known problem that female-dominated municipal services suffer from poorer working conditions, higher levels of stress, ill health, and sickness absence than other sectors. Ulrica von Thiele Schwarz, professor of psychology at Mälardalen University, leads a Forte-funded research project that aims to investigate and highlight these differences, and to contribute knowledge about measures that could make the work environment more sustainable.
– It is important to focus specifically on female-dominated occupations because the problem of ill health is so extensive there. It is a sector where the basic conditions for people to be able to feel well at work are worse than in others; there is a poorer balance between demands and resources from the outset.
– It is important to focus specifically on female-dominated occupations because the problem of ill health is so extensive in these areas.
Ulrica von Thiele Schwarz
Professor of Psychology at Mälardalen University. Photo: David Helgersson
Work-related ill health is often approached with a focus on the individual or the group, despite the fact that organisational conditions are frequently a root cause of the problem. As a researcher, it is easy to adopt the same focus and thereby miss the underlying causes of ill health, Ulrica argues. For example, employers may offer individuals counselling support, mindfulness courses, or lectures on stress, or propose measures aimed at the work group.
– Then you come in thinking that you should organise dialogue groups or try to do what you can locally within a work group. That is also important. But it becomes very insufficient if the underlying problem is of an entirely different magnitude.
Many causes behind ill health
The root causes of ill health in childcare and eldercare have been established in previous research. Nor are they new. Malin Ragnegård, Chair of the Swedish Municipal Workers’ Union (Kommunal), argues that substantial organisational change is needed to address ill health in female-dominated occupations.
– We must put an end to underfunding, understaffing, and the systematic deprioritisation of welfare services and staff. This requires sufficient and long-term funding of welfare services. Economic investments are needed to achieve adequate staffing levels, gender-equal wages, and professionally trained staff. Secure employment, sustainable working hours, and competitive working conditions are required. The knowledge and shared understanding already exist – now it is time to put them into practice.
– Even though there appears to be a clear consensus on the surface among trade unions, politicians, employers, and authorities that the work environment in welfare services must improve in order to reduce ill health, it is evident that there is a lack of capacity for action, Malin Ragnegård argues.
We must put an end to underfunding, understaffing, and the systematic deprioritisation of welfare services and staff.
Malin Ragnegård
Chair of the Swedish Municipal Workers’ Union (Kommunal). Photo: Fredrik Sandin Carlsson
Co-creative research with the Municipality of Eskilstuna
The Municipality of Eskilstuna has rolled up its sleeves and is co-creating the project together with the researchers. Organisational change is what Ulrica’s research project aims to understand and support. However, to succeed, it is not enough to merely study an organisation from the outside. A crucial aspect of the project is that the researchers co-create with the Municipality of Eskilstuna, starting from its goal of reducing sickness absence in eldercare.
– We designed large parts of the project together. Research on this type of organisational intervention is difficult, because as a researcher you cannot decide to change the very foundations of an organisation. Decisions have to be made at high levels within the organisation – in this case, political decisions.
Traditionally, it is the researcher who defines the problem, determines the methods, and conducts analyses of the study object – for example, a workplace. In co-creative research, however, researchers and practitioners jointly develop, implement, and evaluate the project. Instead of studying the organisation from the outside, knowledge is built together with those who work within it – to create change that lasts.
– Sometimes we researchers are careless with the term and call it co-creation when we really mean that we have been given access and permission to conduct a study. But in this particular case, there is a mutual dependence between us and the municipality. The responsibility for change naturally lies with the municipality. The responsibility to support the process and follow it up lies with us. And in between, we constantly need each other, says Ulrica.
Organisationel changes are now being implemented
The new strategies are now being put into practice. The project examines which organisational conditions must change before sickness absence can even begin to decline – everything from staffing levels and staff turnover to how many employees each manager is responsible for. Employees, managers, senior leadership, and politicians have held meetings and jointly developed a shared programme logic that describes the steps towards a better work environment and, ultimately, reduced sickness absence.
The project is now entering a phase where the researchers analyse what characterises the units within the municipality that are moving in the right direction. Much remains to be done, but based on the programme theory and pilot studies, a few factors are expected to stand out, according to Ulrica.
– Psychological safety within the work group is one factor that makes a difference – for example, that employees feel able to raise issues that are not working well and that it is acceptable to make mistakes. Another important factor is reducing the number of tasks that are perceived as unnecessary or unreasonable from the employees’ perspective.
Swedish social insurance agency report: Women still have higher sickness absence than men
- Since the 1980s, when more women entered the labour market, women’s sickness absence has been higher than men’s. No improvement can be seen, despite political goals to reduce the gap.
- Women have sickness absence at twice the rate of men.
Stress-related conditions have increased by 25 per cent over five years. - Women face more than twice the risk of long-term sickness absence due to mental ill health compared with men.
- The risk of long-term sickness absence among women is linked to a combination of gender inequality in private life and shortcomings in the work environment.
- Occupational segregation also contributes to the difference. The highest risk of long-term sickness absence is found in health and social care, where many women are employed.
TEXT: Thomas Wedérus
