Process facilitators shifting between the support and expert roles in a complex work environment intervention in the Swedish healthcare sector

Ewa Wikström,Ingibjorg H Jonsdottir,Jonathan Severin,Magnus Akerstrom

doi:10.1108/jhom-10-2021-0382

Ewa Wikström, Ingibjorg H Jonsdottir + Show 2 more

Open Access

https://doi.org/10.1108/jhom-10-2021-0382

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Abstract

Process facilitation as part of a complex intervention for changing or improving practices within workplaces is becoming a common work method. The aim of this study was to investigate what characterizes the process-facilitating role in a complex intervention. The present study focuses on a complex work environment intervention targeting eight organizational units (workplaces) in the Swedish healthcare sector. The study applies a mixed-method approach and has been carried out in two steps. First, a qualitative process evaluation was performed. Secondly, an evaluation was conducted to see to what extent these identified conditions and mechanisms affected the quantitative intervention effect in term of sickness absence. The analysis shows that the facilitating role consisted of three overlapping and partially iterative phases. These phases involved different activities for the facilitating role. Depending on how the facilitating role and the intervention were designed, various supporting conditions were found to significantly affect the outcome of the intervention measured as the total sickness absence. It is concluded that the facilitation is not static or fixed during the change process. Instead, the facilitation role develops and emerges through the process of support during the different implementation phases. The facilitative role of performing support is based on a combination of support role activities and expert role activities. The support role focuses on support activities, while the expert role includes capacity building through knowledge- and legitimacy-oriented activities. This study contributes to earlier research by developing a methodological approach for carrying out process facilitation in complex interventions.

Highlights

Organizational factors are of critical importance for work-related mental health (Vingard, 2015)
What characterizes the facilitator role and process in a complex intervention? Our analysis shows that the facilitator role and process consisted of three overlapping and partially iterative phases (“The pre-intervention phase,” “The intervention phase” and “The post-intervention phase”)
The overall conclusion of this study is that the facilitator role in a complex work environment intervention is not static or fixed during the change process

Summary

Introduction

Organizational factors are of critical importance for work-related mental health (Vingard, 2015). A key factor for successful improvement of the work environment is involving the overall strategic management in the organization Another key factor is the involvement of human resources (HR) and the occupational health service (OHS) as supportive resources at a strategic level, and the collaboration between these two resources (Schmidt et al, 2017). In the traditional way of managing work environment initiatives, few models and processes for prevention and promotion at the organizational level are available. This has hindered work environment initiatives from an organizational perspective, highlighting the importance of collaboration between different managers and staff involved in managing the work environment (Schmidt et al, 2017; Liff et al, 2017). Developing a more integrated way of working has the potential to provide support to the line managers and to facilitate the process of managing the work environment

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