Dentistry in Sweden - Healthy work or ruthless efficiency?

Sammanfattning: The general objective of this thesis is to provide an understanding of the organization of Sweden's Public Dental Health Service (PDHS) and the problems it has faced, e.g. dentists’ job dissatisfaction. This is done against the background of the historical development of the Service. The thesis comprises five papers, based on two empirical studies. Questionnaires were used for both studies: respondents for Study 1 were 769 dentists and 493 dental nurses in the PDHS; and for Study 2, 472 dentists and 3,595 other Swedish professionals (response rates 66%-88%). The materials were analyzed using multiple regression models and other statistical methods. Properties of "healthy work" among professionals were investigated. Graduate workers in general emphasized the intellectuality and value of work. Dentists in the PDHS, showed the greatest discrepancy between ideal and reality of all professional groups. Staff opinions on the managerial control system employed in the PDHS were analyzed. Dentists reported that their pace of work was adapted to surveillance, competition and demands of the employer. On analysis of perceived changes in managerial control systems, it was found that such changes tend to be distributed along two dimensions, interpreted here as mirroring "hard" and "soft" Human Resource Management (HRM). The combined effects of "hard" and "soft" HRM on work conditions were more negative for dentists than for other professionals. It became apparent that a duality in managerial changes contributed to a polarization between human-service and other professional work. While opportunities for healthy work increased among graduates who worked with things and data, the same changes led to a deteriorated effort-reward balance for human-service workers. Negative effects were found to be more pronounced for dentists in the PDHS than for human-service workers as a whole. The results are discussed in terms of dentists enclosure within the profession and their scope of action, to leave or protest.