Reduced working hours and stress in the Swedish social services

Detta är en avhandling från Stockholm : Karolinska Institutet, Dept of Clinical Neuroscience

Sammanfattning: Background: Since a financial crisis in the 1990’s employees in the Swedish public sector have suffered from work stress and related consequences such as long-term sick leave. Reduced working hours has long been debated in Sweden as a possible way of improving psychosocial health, and was therefore empirically evaluated in a large, quasi-experimental trial in four public sectors; care and welfare, call centers, technology, and the social services. Working hours were reduced by 25 percent and workload reduced in proportion to this, and employers received financial compensation in order to be able to hire temporary extra staff. Social work in Sweden has been identified as a particularly exposed and vulnerable part of the public sector, subject to problems with employee retention and stress-related disorders. Therefore a specific study was made of social workers during the trial, in order to contribute to the scant body of research on interventions that may reduce work-related stress in social work. Aims: Study I explored the effect of reduced working hours on stress, symptoms of exhaustion syndrome, and related work-characteristics, in the participating social workers. Study II studied the impact of reduced working hours on stress, stressful situations, work and free-time stress, coping behaviour, situational reactivity, and burnout symtoms, at one of the participating social work agencies. Study III explored the experience of the social workers at the same agency, in relation to work-life balance, social work and everyday recovery choices. Study IV evaluated the impact of reduced working hours on stress and sleep in all four participating public sectors, with a particular focus on sleep. Study V examined employee time use, and the effect on total workload and time for recovery, in all four sectors. Methods: Studies I-V all used data collected during the reduced working hours trial, which had three measuring points: one at baseline, and two whilst participants in the intervention group were in the reduced working hours condition. Two extensive surveys were administered at each data point, covering a vast array of measures examining psychosocial health, both in terms of individual dimensions and the work environment itself. One of the surveys was constructed in in a diary format, where respondents filled out the same measures for seven consecutive days. Study I used multiple regression to analyse the social workers that remained per protocol at the end of the trial (n = 127), using both the questionnaire data and the diary survey data. Study II used concurrent mixed-method, collecting data both in the form of structured interviews based on principles from cognitive behavior therapy (n = 15), and two surveys only administered at the particular social work agency studied (n = 29), the MBI-HSS and ELSS. Study III used structured interviews (n = 12), performed at the same agency, and analysed with qualitative content analysis. Study IV used multilevel mixed models (n = 580) and the survey diary data from the trial to analyse stress and sleep in all four participating public sectors. Study V also used multilevel mixed models (n = 636) and diary data to analyse time-use in all four sectors, reported by respondents in a half-hour format that covered time awake and asleep. Results: Study I found positive effects of reduced working hours in social workers on demands, instrumental manager support. Work intrusion on private life, restorative sleep, stress, memory difficulties, negative emotion, sleepiness, fatigue and exhaustion improved on both workdays and weekends, and sleep quality on weekends. Study II found positive effects of reduced working hours in social workers in burnout, specifically reduced emotional exhaustion, and reduced reactivity in stressful situations. The interviewed described stressful work situations centered on lack of time due to high caseload; emergencies, practical setbacks, deadlines, client aggression, managerial interactions and managerial stress. The stressful home situations described also centered on lack of time; meeting friends, household chores, childcare, practical setbacks, experiencing burnout symptoms. In study III the interviewed social workers to varying degrees described a variety of positive experiences, such as feeling more positive anticipatory emotions when going to work, and going home, improved relationships with colleagues, clients, children, romantic partners, siblings and parents, reduced worry over work and private life, perceived lower risk for burnout, and more time for recovery activities. Study IV found improved sleep quality, reduced sleepiness, stress, worry and stress at bedtime on workdays and days off, in all four public participating sectors, and increased sleep duration in the intervention group during workdays. Study V found that all participants in the four participating public sectors that reduced work hours increased the time they used for relaxing hobby activities and domestic work during workdays, and for free-time activities on days off. Their total workload also decreased and more time was spent recovery activities on workdays, regardless of gender or family status. Conclusions: Stress was reduced, and sleep and work-life balance improved, in all studies that examined these aspects. A daily recovery pattern common to all four public sectors was found, fully compatible with the recovery strategies the social workers described in their interviews. Regardless of public sector, reduced working hours seemed to alleviate stress. This is theoretically supported by well-established theories, which suggests that the intervention reduced stress through reduced demands, reduced workload, reduced exposure to stress, decreased allostatic load, increased control over private demands, improved recovery, more informal social support and positive changes in work-life balance, recovery, mood and sleep. As for social workers, symptoms of exhaustion syndrome improved, as well as work-life balance, but few organizational dimensions. Professional coping behavior in social work was described as effective and problem-focused at both full-time and during reduced working hours. Stressful social work situations were described as improved due to reduced exposure to work stressors and improved recovery, rather than changes in work content or context, and all time conflicts off-work as resolved. The social workers’ experience of work-life balance focused on improved mood and recovery. Reduced working hours seemed to function as a preventive intervention for social workers, which seemed to affect quality of care, facilitate emotion work, and support professional longevity. For on-work recovery to improve, the high caseload described by the interviewed social workers would likely need to be reduced, which future studies of reduced working hours in social work should explore.

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