Demanding change? Employee sickness absence, disability retirement and turnover in response to hospital reorganization
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AbstractAs in the rest of the industrialized world, organizational changes have been increasingly frequent in the Norwegian hospital sector in recent decades. Due to an ageing population, medical advances expanding treatment opportunities and a lack of labour supply, organizational changes are undertaken to meet the demand for both higher efficiency and better quality in the health services. This dissertation addresses concerns about how rapid organizational change affects employees. The aim is to analyse how organizational changes in the Norwegian hospital sector have affected individual employees’ sickness absence, disability retirement and turnover. Moreover, the dissertation investigates whether some categories of employees thought to have a marginalized position in the labour market due to low education or bad health were more affected by the organizational changes than others. Two types of organizational change are investigated: internal departmental changes and hospital mergers. The dissertation consists of three papers which use panel data methods to analyse official register data on Norwegian hospital employees between 2000 and 2008. The individual register data was matched to hospital level information on organizational changes gathered through surveys answered by hospital management or collected from the National Patient Register. Article 1 uses individual fixed effects Poisson regression to study the effect of increasing the number of internal departmental changes on the number of registered long-term sickness absence days. The results show a small, but significant increase in sickness absence following increases in the number of changes among all levels of hospital staff. Article 2 uses logistic regression with hospital fixed effects to study whether mergers increase the risk of disability retirement entry amongst hospital staff. The analyses suggest that there is a small increase in disability retirement entry in the second year following mergers, but only for employees with secondary or lower education. Article 3 uses discrete-time survival analysis to investigate whether turnover increases during mergers. Turnover to three destinations (other job within the hospital sector, job in other sector and out of work) is modelled. Moreover, the article investigates whether the effect of mergers on turnover varies according to employees’ previous sickness absence. The analyses found no effect of mergers on turnover out of the hospital sector for either healthy or unhealthy employees. Only turnover within the hospital sector increased following mergers, most likely as a direct and desired effect of the mergers. Taken together, the results suggest that the organizational changes at the Norwegian hospitals have caused some distress amongst employees in the short term. However, the effects are limited for most employees. The lack of downsizing in the sector in the time period studied might explain the moderate effects. Furthermore, Norwegian working life is characterized by a high level of unionization. Employee participation is institutionalized both at each individual workplace and at the policy level through the cooperation of the state, employer and employee unions. Given the context of a relatively generous welfare state, the Norwegian working life model offers both employees and companies the security they need in order to take the risk of making necessary adjustments in order to adapt to changing environments. However, I also find a higher risk of entering disability retirement following hospital mergers amongst the lowest educated employees. This calls for some concern as to whether the sum of increasingly frequent small changes may amount to a less inclusive working life in the long run.
List of papers
|Article 1 Ingelsrud, MH (2014) Reorganization increases long-term sickness absence at all levels of hospital staff: panel data analysis of employees of Norwegian public hospitals. BMC Health Services Research 14(1): 411. Published with an Attribution 2.0 Generic License. https://doi.org/10.1186/1472-6963-14-411|
|Article 2 Ingelsrud, MH (2016) Disability retirement and public sector reorganization: Hospital mergers in Norway. Acta Sociologica 59(1): 35-50. The paper is removed from the thesis in DUO due to publisher restrictions. The published version is available at: https://doi.org/10.1177/0001699315611191|
|Article 3 Ingelsrud, MH. Turnover during hospital mergers in Norway: Neither healthy nor unhealthy employees leave the hospital sector. Under review at Nordic Journal of Working Life Studies. To be published. The paper is not available in DUO awaiting publishing.|