Age related work load—a work environment intervention with a life course perspective

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Abstract

A work environment intervention to test a model of age related workload was carried out at a local hospital. The staff received training about life course, work and work ability. Efforts at making changes in the work place were encouraged. Action plans were to be presented and the participating wards were given a grant in relation to the existing age structure, to carry out changes and to recruit younger persons. The results showed that the experience of workload, ergonomic troubles, psychosocial troubles and work stress had decreased at the same time as the experience of stimulation and of joy at work had increased. It was not possible to see any reduction in the HR costs or change in the working time and sick leaves. The action plans showed limited suggestions of changes. The organization's complexity and the traditional hierarchy of hospitals do not stimulate change, but the supervisors' involvement is also critical to the result of the staff's work. Work environment interventions are complicated and complex and influenced by many factors. One year is a very short time for an intervention. The importance of the experience of the staff of an improved work environment is however not to be diminished.

Introduction

Sweden has one of the oldest populations of all OECD member countries. The number of older people is rising rapidly. The demographic reality of an ageing population in combination with increasing possibilities for medical diagnostics and medical treatments increases the demands on the health care sector. At the same time, the work force of Swedish health care is growing older and long term sick leave and early retirements as well as old age retirements are increasing. 28% of all Swedish women work in the care sector, where heavy lifting and uncomfortable working positions are still part of the daily work. In the health care sector, far fewer improvements concerning the work environment have taken place than in the industry sector.

The Swedish health care system underwent major organizational changes in the beginning and the middle of the 1990s. The primary objectives of the changes were to increase the outpatient care and to reduce the level of hospitalization in order to increase the effectiveness and to reduce the costs for health care. This was carried out by transferring operations from the county council hospitals to the local authorities. One effect was that the number of hospital beds was reduced and, as a result of this, the number of hospital staff had to be reduced. According to the Swedish labor legislation, the most recently employed, and also the youngest staff, therefore were given notice. Another effect was that the patients cared for in hospitals now often are very old with multiple diagnosis. These effects combined with the demographic development and the fact that most of the remaining staff in the Swedish hospitals was recruited during the expansion of health care in the 1970s has led to the result that in Swedish hospitals today old staff cares for aged patients.

The definition of who is to be considered an older person in the work force is unclear. In a study of older people's work ability, the WHO defines the group as people over the age of 45, while the ILO defines older workers as all people who risk encountering difficulties at their job due to their age [1]. A study from the Swedish National Insurance Board about employers' attitude toward older workers [2] and a study of the Norwegian municipal sector [3] indicate that individuals start to be perceived as older workers when they are between 50 and 55 years old. This means that who is counted as older varies between different areas and in different work environments. Age is thus not the only significant factor, but also the structure of the work environment and how the work is organized.

The individual's work ability must be related not only to age and life course but also to how the work is organized, the responsibilities and the work place. It must be viewed from several aspects and the organization's demands on the individual must be adapted according to that individual's specific conditions. For many older health care workers, the job and its organization look the same today as they did when the employees completed their training 30–40 years ago. A person's work ability may be expressed as a whole where the individual, her responsibilities, health, knowledge and work place constitute the parts. This whole varies with life course and age, but also according to changes that occur in the job and in society. A person's work ability means that the individual's ability to function is compatible with the demands from the job. One way to measure the work ability, which is currently used in a number of countries, is a measurement using the Work Ability Index [4]. The work ability is measured by using the index partly through subjective self-evaluations of health and mental abilities and partly through information about illness and absence due to illness in relation to the demands of the job. The measurements are then compiled in a scale.

A work environment intervention that came to be called age related workload and which aimed at supporting the staff was conducted in the local hospital in Varberg between 1999 and 2001. The purpose of the work environment intervention was to test a model of age related workload by combining the Work Ability Index with a financial human resource estimate and thereby motivate the financing of a further development of the work environment. The idea was that the factors, which should be influenced by this intervention were workload, ergonomic problems, psychosomatic problems, stress, cooperation and social climate as well as job satisfaction.

Section snippets

Methods

The intervention was made on health care staff in three different wards: one rehabilitation ward with 39 employees; one gynecological ward with 28 employees and a medical outpatient ward with 14 employees. The intervention meant that the staff received training about life course, work and the work ability. During the training, efforts at making changes in the work place were encouraged with regard to developing routines as well as how the work is organized. Each work place was given a grant,

Results

From an individual perspective, the analysis has been made mainly using the work environment survey. Because the time period for the work environment intervention is relatively short and the population is small, we are unable to conclude reliably that the work environment intervention has had an impact on the staff's workload and job satisfaction. There are however differences in how the work environment is perceived that may indicate a positive development. At all the participating work

Discussion

The aim of this work environment intervention was to educate the participants about life course and work and thereby create an understanding for the problems in the work environment that the age structure in the work places within the health care sector may cause and that this understanding might produce a further development of routines as well as of how the work is organized. There was also a hope that it would be possible to measure the effect of the intervention by measuring a perceived

Conclusions

The costs for human resources, the salary expenses and sick leave are too rough an estimate for it to be possible to draw any conclusions of the effects of a work environment intervention on an organizational level. If costs for human resources and salary expenses are to be used when following up efforts to improve the work environment, these costs must also be related to the method of time management at the work places that are studied.

The conclusions that may be drawn concerning action plans

References (10)

  • WHO
    (1993)
  • Riksförsäkringsverket Analyserar
  • R.J. Mykletun

    Interventions for better health in health care workplaces: individual or organisational level

  • K. Tuomi

    Work ability index

    (1994)
  • W.F. Cascio

    Costing human resources

    The financial impact of behaviour in organizations

    (1987)
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