How general practitioners used job crafting strategies during the COVID-19 pandemic in Sweden.

OBJECTIVE: General practitioners (GPs) played a crucial role in limiting the impact of the COVID-19 pandemic, and many GPs experienced they did not have the prerequisites to provide adequate care. However, GPs developed approaches that helped them to provide care to patients through various job crafting strategies. The aim of this study is to identify how job crafting strategies were deployed by GPs at the beginning of the COVID-19 pandemic in Sweden and the significance of the strategies on their work situation. DESIGN: A qualitative design with semi-structured interviews. The data was analysed using qualitative content analysis with job crafting as the conceptual framework for the analysis process. SETTING: Primary healthcare in five healthcare regions in Sweden. SUBJECTS: Fourteen GPs participated in individual interviews. RESULTS: In their endeavours to organise and provide care, GPs shaped the task, relational and cognitive boundaries of their work. GPs felt proud about finding new ways of working when given room to manoeuvre. Intensified collaboration between healthcare professionals made GPs more confident in their clinical work. GPs expressed that they consequently felt stronger in their professional role through what they accomplished in the organisation of care. CONCLUSIONS/IMPLICATIONS: The results suggest that the job crafting strategies GPs used were meaningful to them in clinical practice. Knowledge about how GPs' job crafting strategies were deployed might be useful for healthcare organisations in preparing for future health crises. Taking advantage of GPs' experiences and strategies is considered important for promoting sustainable working conditions for GPs in the future.

During the onset of the COVID-19 pandemic in Sweden, general practitioners took immediate action to re-organise their day-to-day work tasks.To manage professional uncertainty about how to provide the best possible care, general practitioners sought support from other healthcare peers.The professional self-confidence of general practitioners increased through what they accomplished when facing a major health crisis.

Study protocol: Local labour market programs-institutional structures, organizational forms and lived experiences.

In this programme, we map and examine local labour market programmes (LLMPs) at the municipal level in Sweden. This includes their institutional structure and organisation, as well as the experiences of participants in the programmes, using a longitudinal approach with the aim to improve LLMPs. The long-term goal is to increasing the inclusion of LLMP participants in working life. To answer the programme's questions, data will be collected and analysed within the four work packages. In each work package, a mixed-method approach is applied with a combination of quantitative and qualitative methods. The programme is informed by three overarching general theoretical approached, tying together institutional ethnography, intersectional studies of structural inequalities on different levels, and the role of emotions in everyday work. At the organisational level (WP 1), we will investigate the circumstances under which LLMPs are performed and negotiated by those involved. Here, the internal organisation, activities and methods are the focus. This approach will result in knowledge about the characteristics of these organisations and the factors promoting the inclusion of underrepresented groups in working life. By examining the activities in LLMPs (WP 2), we will be able to determine how their institutional structure differs between regions in Sweden, how the different municipalities work with labour market policy, how they translate national policy into the local context, how they organise their work and which initiatives they choose to adopt. By examining the individual experiences of those who are directly affected by such incentives (WP 3), knowledge and understanding will be obtained of the connections between experiences and labour market policies. This will give important insights into the functioning of local programmes and of the opportunities to create entry into the labour market. Furthermore, in WP4 we will develop and test an effect evaluation of work methods used in LLMPs and their effect on clients' progress over time.

A comparative study of governmental financial support and resilience of self-employed people in Sweden and Canada during the COVID-19 pandemic.

Globally, self-employed people were among the hardest hit by the repercussions of the COVID-19 pandemic and faced hardships such as financial decline, restrictions, and business closures. A plethora of financial support measures were rolled out worldwide to support them, but there is a lack of research looking at the effect of the policy measures on self-employed people. To understand how different governmental financial support measures enhanced the resilience of the self-employed and improved their ability to manage the pandemic, we conducted a mixed-method study using policy analysis and semi-structured interviews. The documents described policies addressing governmental financial support in Sweden and Canada during the pandemic, and the interviews were conducted with Swedish and Canadian self-employed people to explore how they experienced the support measures in relation to their resilience. The key results were that self-employed people in both countries who were unable to telework were less resilient during the pandemic due to financial problems, restrictions, and lockdowns. The interviews revealed that many self-employed people in hard-hit industries were dissatisfied with the support measures and found them to be unfairly distributed. In addition, the self-employed people experiencing difficulties running their businesses reported reduced well-being, negatively affecting their business survival.

COVID-19- related work, managerial factors and exhaustion among general practitioners in Sweden: a cross-sectional study.

INTRODUCTION: A significant number of international studies show that general practitioners (GPs) suffered from burnout when working during the COVID-19 pandemic. A Swedish study found that more than 16% of GPs had exhaustion in spring 2021. Exhaustion can be regarded as an initial stage of burnout. A knowledge gap remains on GPs´ working conditions, the impact of management during the pandemic and how it was associated with exhaustion. This study aims to explore the association between severe symptoms of exhaustion and COVID-19 pandemic-related work and managerial factors among Swedish GPs and whether managerial factors have an impact on the association between exhaustion and COVID-19-related work factors. METHODS: Cross-sectional data was drawn from the Longitudinal Occupational Health survey in Health Care Sweden (LOHHCS), which included a representative sample of practicing doctors in Sweden. The sample consisted of 6699 doctors with a response rate of 41.2%. This study constitutes a sample of doctors who reported working in primary care facilities at the time of data collection, i.e. 1013 GPs. The Burnout Assessment Tool (BAT) was used to assess severe symptoms of exhaustion. Questions were also asked about pandemic-related work and managerial factors. The data was analysed using descriptive statistics and multivariate logistic regression to identify the association between exhaustion, work and managerial factors. RESULTS: The multivariate analysis showed that GPs who managed COVID-19 patients were about twice as likely to report severe symptoms of exhaustion. Further, GPs who reported that management was unsupportive, provided unsatisfactory working conditions and unsatisfactory policies for patient prioritisation were between two and four times more likely to report severe symptoms of exhaustion. CONCLUSIONS: COVID-19-related work and managerial factors had a significant impact on the mental health of GPs. Furthermore, the potentially protective effect that satisfactory management actions had on mental health was limited. In the aftermath of the COVID-19 pandemic and in preparation for future major crises that have a high impact on healthcare, there is a need to investigate the measures that can be taken to enable GPs to carry out their work, while maintaining their wellbeing.

Making things work-In spite of a pandemic small scale enterprise managers' approach to business changes and health issues.

BACKGROUND: Covid-19 is one of the worst crises in modern working life with a direct negative impact on many enterprises and organizations. The aim of this study is to explore what managers in Small Scale Enterprises (SSEs) changed in their business during the Covid-19 pandemic, particularly addressing health issues. METHODS: A longitudinal qualitative research methodology was used, interviewing 16 managers of SSEs in the Norwegian and Swedish manufacturing and service sector both before (round 1) and during the pandemic (round 2). In this approach, time is designed into the research process, making change a key focus for analysis. RESULTS: The analysis resulted in two main themes, resilience and demanding occupational health and safety conditions, and five sub-themes. Results show how managers in SSEs changed their business during the Covid-19 pandemic and the impact of these changes. Although, the enterprises were heavily affected in the beginning of the pandemic, several managers found new solutions for their businesses to maintain and reach new customers. They applied a socially responsible management which addressed different health issues. CONCLUSION: Crises like the Covid-19 pandemic will have future impact on SSEs making it important to understand how managers in such enterprises address business and health issues. This knowledge may have practical implications for supporting managers in SSEs in how to perform a socially responsible management and maintain occupational health and safety measures. The managerial implications from this research are that they need to be flexible, reorientable and, at the same time, be loyal to the core business. This study shows the importance of doing longitudinal studies about business and health issues among mangers in SSEs.

Life Satisfaction among Self-Employed People in Different Welfare Regimes during the COVID-19 Pandemic: Significance of Household Finances and Concerns about Work.

Most studies have shown that self-employed people have higher levels of life satisfaction than employed people due to high levels of job satisfaction, work flexibility, and job control. However, during the COVID-19 pandemic, many self-employed people experienced economic strain and worried about the situation of their employees and survival of the company. The aim of this study was to examine the level of life satisfaction among self-employed people during the COVID-19 pandemic in different welfare regimes. Analyses were mainly based on Eurofound's "Living, Working and COVID-19" online survey. Fieldwork took place between April and June 2020 in 27 EU countries. The results showed that there was a significantly lower level of life satisfaction among self-employed people than employed people during the pandemic. This was in contrast to analyses from approximately one year before the pandemic, which showed that life satisfaction was higher among self-employed people. The main reasons for this lower level of life satisfaction among the self-employed during the pandemic were worse household financial situation and more worries about their job. Analyses of life satisfaction among the self-employed in different welfare regimes indicated that self-employed people in the Nordic welfare state regime largely kept their relatively high level of life satisfaction during the pandemic, but this was not the case for self-employed people in other welfare regimes.

Correction: The disappointment of financial support measures during the COVID-19 pandemic among small business managers' in Sweden.

[This corrects the article DOI: 10.1007/s43546-022-00347-7.].

Socio-Ecological Factors and Well-Being among Self-Employed in Europe during the COVID-19 Pandemic.

BACKGROUND: The self-employed are at increased risk of negative well-being outcomes when facing adversity such as the COVID-19 pandemic. Studies that examine socio-ecological factors that may protect their well-being are warranted. METHODS: Data were drawn from a cross-sectional survey of European self-employed people (n = 1665). The WHO-5 Well-being Index was used to examine the impact on well-being of factors at four socio-ecological levels. Independent sample t-tests, Pearson correlations and linear regression were applied to analyse differences between groups of self-employed and interactions between variables using SPSS. RESULTS: Well-being and the socio-ecological factors of resilience, social support, useful work and finding the rules clear were positively correlated with well-being. For self-employed who reported that it was challenging to run their business during the pandemic, social support and finding rules clear were of significantly greater importance to their well-being. CONCLUSIONS: The findings highlight that the socio-ecological factors of resilience, social support, doing useful work and finding the rules clear affect well-being. The results also indicate that it is vital to consider factors at multiple socio-ecological levels to improve the well-being of the self-employed during adversity.

Small business managers and Covid-19-The role of a sense of coherence and general resistance resources in coping with stressors.

BACKGROUND: The response of small business managers to an external event such as the pandemic can have a profound effect on the work environment, health and well-being for themselves and their employees. Previous research on small business managers during the pandemic has mainly focused on traditional pathogenic effects, and there is a lack of studies looking at the issue from a salutogenic health promotion perspective. The aim of this study is to explore whether a sense of coherence and general resistance resources were experienced by small business managers in Sweden and Norway during the Covid-19 pandemic. METHODS: A qualitative design was applied through exploratory interviews with 16 managers of small businesses in Sweden and Norway. A content analysis of the interviews was conducted using the sense of coherence concept by Aaron Antonovsky, with the three main components of comprehensibility, meaningfulness and manageability acting as a conceptual framework for the analysis process. RESULTS: Within the three main sense-of-coherence categories, six general resistance resources were identified as being important for the managers to handle uncertainty during the pandemic. These were understanding rules and regulations, social support, optimism, proactivity, problem-solving and flexibility and cooperation. CONCLUSIONS: The small business managers handled the pandemic in a way that worked well in their contexts, and the pandemic generally did not have a negative effect on their businesses or themselves. A salutogenic approach, through which the managers focused on identifying and using resources, was an important factor for managing stressors and adversity during the pandemic. Hence, the concept of salutogenesis may be used as an intervention to foster better health in small businesses, both at a personal and organisational level in order to handle future challenges effectively.

Sickness Presenteeism Among the Swedish Self-Employed During the Covid-19 Pandemic.

The present study analyzed the impact of business operations, work and family circumstances, and well-being on the risk of sickness presenteeism for Swedish self-employed workers during the Covid-19 pandemic. It is of great importance to investigate the impact of the pandemic on the self-employed and their enterprises because they are seen as key drivers of economic growth and constitute an expanding group in many countries. Data were obtained from 845 self-employed workers by a web-based survey including questions about background information, work and family circumstances, well-being, sickness presenteeism, and questions about the pandemic. Results were that around 40% of the self-employed introduced new products, processes, and marketing methods, and just over 50% attempted to get new customers during the pandemic. Nearly half of the self-employed people reported that they lost contracts, and 22% judged the risk of bankruptcy to be quite or highly likely. Regression analyses showed that the more the self-employed reported impact on business indicators, increased work hours, a higher level of work-family conflict, and a lower level of mental well-being, the higher the risk of sickness presenteeism. The most common reasons given by the participants for sickness presenteeism during the pandemic were "nobody else can carry out my responsibilities," "I can't afford to take sick leave" and "I enjoy my work." Conclusions are that a critical event such as the pandemic probably adds to an already high workload for the self-employed. Impact on business operations such as developing new products/services and marketing, risk of bankruptcy and increased work hours seems to be important factors for explaining sickness presenteeism among the self-employed. Theoretical contributions from the study suggest that critical events such as the Covid-19 pandemic should be considered as an important environmental factor when studying sickness presenteeism among self-employed.

The social interaction of return to work explored from co-workers experiences.

PURPOSE: The objective was to explore the role and contribution of co-workers in the return-to-work process. The social interaction of co-workers in the return-to-work process are analysed within the framework of the Swedish national and local employer organisational return-to-work policies. METHODS: An exploratory qualitative method was used, consisting of open-ended interviews with 33 workplace actors across seven work units. Organisational return-to-work policies were collected from the three public sector employers. RESULTS: The key findings that emerged during analysis showed that some co-workers have a more work-task oriented approach towards the return-to-work process, whilst others had a more social relational approach. In both situations, the social relations worked hand in hand with job tasks (how task were allocated, and how returning workers were supported by others) and could make or break the return-to-work process. CONCLUSION: A suggestion for improvement of return-to-work models and policies is the need to take into account the social relations amongst workplace actors, especially involving co-workers when planning for return-to-work interventions. Otherwise the proper attention to work arrangements, social communication and the role of co-workers in the return-to-work process might not be seen.

Exploring the meaning of early contact in return-to-work from workplace actors' perspective.

PURPOSE: The objective of this article was to explore the meaning of early contact in return-to-work, and how social relational actions and conditions can facilitate or impede early contact among actors in the workplace. METHOD: An exploratory qualitative method was used, consisting of individual open-ended interviews with 33 workplace actors at seven worksites across three public employers in Sweden. The workplace actors represented in these interviews included re-entering workers, supervisors, co-workers and human resources managers. Organisational policies on return-to-work were collected from the three employers. RESULTS: The analysis indicated that early contact is a complex return-to-work measure with shifting incentives among workplace actors for making contact. For instance, the findings indicated obligation and responsibilities as incentives, incentives through social relations, and the need to acknowledge and balance the individual needs in relation to early contact. CONCLUSION: The findings strengthen the importance of early contact as a concept with a social relational context that comprises more than just an activity carried out (or not) by the employer, and suggest that early contact with a sick-listed worker is not always the best approach for a return-to-work situation. This study provides a starting point for a more articulated conceptualisation of early contact.

Exploring workplace actors experiences of the social organization of return-to-work.

INTRODUCTION: There is a limited body of research on how the actual social exchange among workplace actors influences the practice of return-to-work. The objective of this study was to explore how workplace actors experience social relations at the workplace and how organizational dynamics in workplace-based return-to-work extends before and beyond the initial return of the sick listed worker to the workplace. METHOD: An exploratory qualitative method approach was used, consisting of individual open-ended interviews with 33 workplace actors at seven worksites that had re-entering workers. The workplace actors represented in these interviews include: re-entering workers, supervisors, co-workers, and human resource managers. RESULTS: The analysis identified three distinct phases in the return to work process: while the worker is off work, when the worker returns back to work, and once back at work during the phase of sustainability of work ability. The two prominent themes that emerged across these phases include the theme of invisibility in relation to return-to-work effort and uncertainty, particularly, about how and when to enact return-to-work. CONCLUSION: The findings strengthen the notion that workplace-based return-to-work interventions need to take social relations amongst workplace actors into account. They also highlight the importance and relevance of the varied roles of different workplace actors during two relatively unseen or grey areas, of return-to-work: the pre-return and the post-return sustainability phase. Attention to the invisibility of return-to-work efforts of some actors and uncertainty about how and when to enact return-to-work between workplace actors can promote successful and sustainable work ability for the re-entering worker.

Experience of the implementation of a multi-stakeholder return-to-work programme.

INTRODUCTION: Employers can use several strategies to facilitate return-to-work for workers on sick leave, but there seems to be limited knowledge of how workplace-based interventions are actually implemented in organisations. One public Swedish employer initiated a return-to-work programme which incorporated interventions suggested by earlier research, e.g. multi-professional health assessment, case management, educational peer-support groups and adapted workplace training. The overall purpose of the study is to analyse how the programme was implemented and experienced in the organisation, from the perspective of involved stakeholders, i.e. supervisors, occupational health consultants and a project coordinator. The objective of this paper is to identify and analyse how these stakeholders perceived that the programme had been implemented in relation to its intentions. METHODS: A qualitative method was used, consisting of individual interviews with eight supervisors and the project leader. Two group interviews with five occupational health service consultants were also conducted. RESULTS: The study revealed barriers to the implementation of return-to-work interventions. Not all of the intended interventions had been implemented as expected in policy. One explanation is that the key stakeholders expressed a more biomedical, individual view of work ability, while the programme was based on a more holistic, biopsychosocial view. CONCLUSION: Implementation of a return-to-work programme is an ongoing, long-term multi-level strategy, requiring time for reflection, stakeholder participation, openness to change of intervention activities, and continuous communication.