Labour Administration Research Articles

General practitioners’ attitudes and practices regarding sick leave certification for patients with depression in Norway – a cross-sectional study

BackgroundDepression is among the most frequent reasons for sick leave, whereas health authorities recommend a rather strict practice, arguing that work is health-promoting. We aimed to explore GPs’ attitudes and practices regarding sick leave certification for depressed patients.MethodsA cross-sectional study using the Norwegian Physician Survey (N = 1617, 70% response rate) in 2021. The GPs in the panel (N = 221) responded to questions about sick leave certification and cooperation with employers and the Norwegian Labour and Welfare Administration (Norwegian acronym: Nav) regarding patients with depression. We used crosstabulation with chi square statistics and logistic regression models to assess differences among GPs.ResultsAmong 221 GPs, 62% often/very often perceived patients’ questions for sick leave certification as the main reason for encountering. A total of 46% often/very often considered patients’ expectations inappropriate, with female GPs more frequently than male GPs (36% vs 56%, p = 0.005) and younger GPs more frequently than their older counterparts (p < 0.001). Although 68% considered sick leave as part of treatment, only 16% often/very often initiated sick leave unless patients raised the question. Sixty-seven percent of GPs reported to often/very often avoid sick listing, if possible, more females than males. GPs who often/very often considered questions for sick leave inappropriate less often considered sick leave as part of treatment (odds ratio (OR): 0.25; 95% CI: 0.13–0.49), and less often report a well-functioning cooperation with Nav (OR:0.37; 95% CI:0.14–0.96). GPs who often/very often considered sick leave as part of treatment more often proposed sick leave for their patients (OR:4.70; 96% CI 1.57–14.01) and reported a less strict approach to sick listing (OR: 40; 95% CI: 0.20–0.79). Ninety-five percent of the GPs rarely/never had direct contact with patients’ employers, whereas 92% often/very often asked patients about their dialogue with the workplace. Eighty-eight percent of the GPs often/very often experienced cooperation with NAV as good, and 87% often/very often felt trusted by them.ConclusionsMost GPs reported a strict attitude towards sick leave for depression, whereas one-third had a less strict approach. Different perceptions of the appropriateness of sick listing indicate variations in treatment and access to social security benefits.

Changes in sick leave one year before and after starting treatment: a naturalistic study of employed outpatients with common mental health disorders

Background This study explores sick leave changes 1-year pre- and post-treatment start for common mental health issues and their associations with self-reported symptoms, functioning, and health changes. Methods Ninety-five employed patients, without previous disability benefits, underwent treatment at a public mental health outpatient clinic. Sick leave data was obtained from the Norwegian Labour and Welfare Administration. Symptoms, work/social functioning, and health quality were self-reported at treatment onset and completion. Results Twelve months before starting treatment, only 6.3% were on sick leave, contrasting with 69.5% at treatment start. At post-treatment, 25% received work assessment allowance (WAA), 63% were off sick leave, and 12% were on sick leave. Sick leave days exhibited an inverted U-shape for non-WAA recipients. Those on sick leave post-treatment reported less improvement in symptoms and health, while the WAA group showed diminished work functioning enhancement. Discussion Evaluating the effect mental health treatment has on sick leave is clearly affected by the timing of assessments. Treatment seems associated with improved sick leave outcomes compared with status at treatment start, but less so when compared with status one year before starting treatment. Also, a large group of patients went on to receive WAA, constituting a group in need of further longitudinal evaluations and interventions.

Universal Design of Public Services: A Case Study of the Norwegian Labour and Welfare Administration.

This paper presents how employees in a governmental organization strive towards incorporating universal design into their work practices when developing digital solutions - and what workplace aspects helps and hinders them in their efforts to ensure the digital services they build are accessible for all users. A case study of the Norwegian Labour and Welfare Administration (NAV) indicate that ensuring universal design in organizations entails activities far beyond WCAG testing. For NAV, cross-disciplinary stream-aligned teams appears a driving factor for universal design, as is widespread collegial support and easy-to-use resources. We further hypothesize that SWOT analyses could help identify threats and opportunities for promoting universal design in organizations.

Street-level bureaucrats’ attitudes towards clients in discretionary decision-making: Evidence from the Norwegian labour and welfare administration

It is commonly assumed that the attitudes of street level bureaucrats (SLBs) towards benefit recipients influence the discretionary decisions they make. Although discretion in the policy process has been a contentious issue, the impact of bureaucrats’ attitudes has received limited scholarly attention. This study investigates the impact of attitudes on discretionary decision-making and whether the impact of attitudes is conditioned by the SLBs’ perception of recipients’ conduct, when sanctioning non-compliance of requirements among social assistance recipients. The study employs survey data from 925 bureaucrats within the Norwegian Labour and Welfare Administration, measuring four attitude components: cognitive, positive affective, negative affective, and behavioral attitudes. A vignette experiment allows assessing how sensitive discretionary decision-making is to SLBs’ perceptions of recipient conduct. The findings indicate that cognitive attitudes significantly impact discretionary decision-making and are sensitive to SLBs’ perceptions of the recipients’ personal responsibility. Prejudiced cognitive attitudes (viewing recipients as dishonest, manipulative, unpredictable, or stubborn) are associated with a greater tendency to attribute non-compliance to a lack of willingness, irrespective of external circumstances. The study contributes to a deeper understanding of discretionary decision-making and sheds light on the complex dynamics between SLBs’ attitudes and their perceptions of client attributes, offering new insight for public policy and administration.

Frontline workers’ role in digital self-service co-production: Channel promoters, digital helpers, or intermediators

When public services move online, citizens are expected to serve themselves on digital platforms and enrol in public services through self-service procedures. In this digital encounter, many citizens struggle to live up to the “self” in self-services and seek in-person assistance from public professionals. These professional actors play an essential role in enabling the co-production of self-services for citizens who struggle to be truly self-serving. This article explores the frontline workers’ roles in self-service co-production when interacting with citizens seeking help in the service procedures. Service interactions have been studied in two meeting centres of the Norwegian Labor and Welfare Administration. We have conducted observations of office interactions in general and at digital self-service stations in particular. Interviews with public officials have complemented these observations. We use intermediation and co-production theory as analytical lenses in our data analysis. The findings show that the role of frontline workers can be both flexible and narrow in nature and that they take on the role of intermediaries when acting as a bridge between the analogue world and the digital domain. We also see that the intermediating role frontline workers take will vary and is influenced by organisational, personal, and external circumstances that can enable or restrain the co-production of self-services.

The social gradient in institutional trust from 2011–2019 in the general population in Norway

Abstract Background Trust is described as the glue of healthy societies. Although Norway is among the countries with the highest levels of trust in public institutions, the increasing socioeconomic differences observed may threaten levels of institutional trust. Therefore, we aimed to investigate such differences in the general population between 2011 and 2019. Methods A repeated cross-sectional study was conducted using data on the general population in Østfold county from 2011 (N = 16673) and 2019 (N = 15935). Differences in trust toward five public institutions (healthcare system, school system, labour and welfare administration (NAV), police, and municipal council) by educational level were investigated with Chi-square tests. Logbinomial regression analyses were used to examine potential changes in high trust over time. Gender and age were included in the analyses as control variables. Results A relatively high proportion of the general population reported high levels of trust to the health care system (2011: 71%; 2019:80%), police (2011: 73%; 2019:77%), and the school system (2011: 64%; 2019:66%), whereas a lower proportion reported high levels of trust to NAV (2011: 37%; 2019:41%) and the municipal council (2011: 45%; 2019:36%). Both in 2011 and 2019 a clear social gradient in institutional trust was found for all institutions (p &amp;lt; 0.05). There was a significant increase in the level of trust in the health care system (low education:RR=1,10; middle:RR=1,12; high:RR=1.06) and a significant decrease in trust in the community council (low:RR=0,77; middle:RR=0,80; high:RR=0,83) in all educational groups from 2011 to 2019. The level of trust in NAV increased significantly in the highest education groups, while a non-significant decrease was shown in the low educational group. Conclusions The persisting social gradient in institutional trust is worrying as trust is an important factor in ensuring inclusion, social capital, democracy, and health and wellbeing. Key messages • Institutional trust is an important factor in ensuring inclusion, social capital, democracy, and health and wellbeing. • The lower levels of institutional trust found in low educational groups could be of particular concern as these groups might be more dependent on the different parts of the welfare system.

Aberrations in medically certified sick leave and primary healthcare consultations in Norway in 2023 compared to pre-COVID-19-pandemic trends

BackgroundSince 2022, Norway has employed a vaccine-only COVID-19 strategy. Primary healthcare in Norway uses International Classification of Primary Care version 2 (ICPC-2) codes. This study aims to systematically compare medically certified sick leave and primary healthcare consultations in 2023 with the pre-pandemic 2010–2019 trends, and subsequently estimate the magnitude of these changes.MethodsFor the respective outcomes of (A) working person-years lost to medically certified sick leave (WYLSL) and (B) number of primary healthcare consultations, 556 and 85 ICPC-2 code combinations were extracted from the Norwegian Labour and Welfare Administration’s sick leave registry and the Norwegian Syndromic Surveillance System. For each ICPC-2 code combination, a Bayesian linear regression was performed using data between 2010 and 2019 to estimate an expected baseline for 2023, which was then used to calculate the deviation from the pre-pandemic trend. A false discovery rate of 5% was used to account for multiple testing.ResultsAll years from 2020 to 2023 had excess WYLSL, corresponding to 14,491 (90% PI: 8,935 to 20,016) in 2020, 12,911 (90% PI: 5,916 to 19,996) in 2021, 21,263 (90% PI: 12,627 to 29,864) in 2022, and 24,466 (90% PI: 14,023 to 34,705) in 2023. This corresponded to an economic loss of approximately 1.5 billion USD in 2023. Excess WYLSL due to A* (General and unspecified) increased from 2020 to 2023, with an estimated excess of 4,136 WYLSL in 2023 (69% higher than expected). More than half of this increase was explained by A04 (Weakness/tiredness general), whose excess WYLSL in 2023 were estimated at 2,640 (80% higher than expected). The excess in A04 (Weakness/tiredness general) corresponded to an economic loss of 161 million USD and accounted for 11% of the total excess WYLSL in 2023. The excess WYLSL in R* (Respiratory) in 2023 was 3,408, which correspond to an economic loss of 207 million USD and accounted for 14% of the total excess in 2023.ConclusionsSignificant excesses in working person-years lost to medically certified sick leave and primary healthcare consultations in 2023. A sizable proportion of the excesses were due to diseases/symptoms associated with acute and post-acute sequelae of COVID-19.

RETURNING TO THE PUBLICATION OF DOCTOR OF JURIDICAL SCIENCES, PROFESSOR M.A. SARSEMBAYEV «THE NEED TO IMPROVE STANDARDS OF ILO CONVENTIONS AND THE KAZAKHSTAN LABOR LAW»

This article analyzes the article by Professor M.A. Sarsembayev on the topic «The need to improve standards of ILO conventions and the Kazakhstan labor law», which was published in the Bulletin of the Institute of Legislation and Legal Information of the Republic of Kazakhstan No. 2 (47) in 2017. In the article Professor M.A. Sarsembayev focuses on the International Labor Organization (ILO) conventions, including the e Convention on Equal treatment and equal opportunities for men and women workers: workers with family responsibilities, adopted in Geneva on the 67-th session of the ILO General Conference on 23 June 1981, the Convention on the Protection of Wages, adopted in Geneva on 32-th session of the General conference of the ILO 1 July 1949, and the ILO Convention on the Minimum Wage Fixing Machinery by 16 June 1928, which are ratified by the Republic of Kazakhstan, with the aim of improving the norms of national labor legislation. The author also identifies shortcomings in these conventions and provides recommendations (translations, new formulations, additional articles, and terms) for their improvement, emphasizing that Kazakhstan, as a party to these conventions, can make proposals for their enhancement through the ILO’s Bureau of Labor Administration. The article also addresses the issue of accession to conventions such as the Convention on Minimum Standards of Social Security (No. 102), the Convention on the Right to Organize and Collective Bargaining in Agriculture (No. 11), the Convention on Compensation for Workmen in Agriculture (No. 12), and the Convention on Medical Care and Sickness Benefits for Workmen in Agriculture (No. 25), considering their significance for the national legal system of Kazakhstan.

Working Status in Patients With Untreated Unruptured Intracranial Aneurysms: A Descriptive Longitudinal Study

BACKGROUND AND OBJECTIVES: Many patients with unruptured intracranial aneurysms (UIAs) remain untreated if the risk of treatment exceeds the estimated risk of aneurysm rupture, potentially leading to diagnosis-related stress and anxiety. Working status may serve as a marker for the total level of function including mental health and psychological burden of the condition. The aim of the study was to assess the working status before and after a diagnosis of an untreated UIA. METHODS: This was a retrospective nationwide registry-based descriptive longitudinal study. It included all working-age patients diagnosed with an UIA in Norway between 2008 and 2018 and 1:1 age-matched and sex-matched controls without a diagnosis of an intracranial aneurysm that were randomly selected from the Norwegian population. The history of sickness absence in the period of 1 year before and after diagnosis was retrieved from The Norwegian Labour and Welfare Administration records and compared between the groups. RESULTS: In total, 2141 patients and 2141 controls were included in the study. Proportion of working patients decreased from 62.1% (95% CI 60.0%-64.1%) 1 year before the diagnosis to 51.3% (95% CI 49.1%-53.4%) 1 year after the diagnosis (P &lt; .001). In comparison, the proportion of working controls decreased from 77.9% (95% CI 76.1%-79.6%) 1 year before day 0 to 73.4% (95% CI 71.5%-75.2%) 1 year after day 0 (P = .001). The odds of working were 86.7% lower among the patients than among the controls (odds ratio 0.133, 95% CI 0.091-0.194; P &lt; .001) when controlled for the baseline working status. The older the individuals, the less likely they were to work (odds ratio 0.908, 95% CI 0.889-0.926; P &lt; .001). CONCLUSION: The work participation of patients diagnosed with UIA is low prediagnosis compared with the general population and decreases significantly postdiagnosis.

Bureaucracies’ Extended Arm in Co-creation: A Study of Institutional Complexity in the Context of Public Services

Co-creation, as a central strategy of the New Public Governance (NPG) paradigm, is deemed essential to address complex societal challenges. A qualitative, in-depth study was conducted to explore collaborative processes between the Norwegian Labour and Welfare Administration (NAV) and three external organizations. The aim of co-creation among these actors was to limit/prevent outsiderness by providing more individualized work inclusion services to young adults facing vulnerabilities. Our study examines collaborative processes between NAV and external actors in work inclusion efforts and explores how institutional complexity within NAV influences the potential for co-creation among these actors. We found that the bureaucratic logic of the Traditional Public Administration (TPA) within NAV forces external actors to engage in challenging, time-consuming procedures, turning them into bureaucracies’ extended arms rather than independent contributors of resources. Additionally, core principles of New Public Management (NPM), such as resource control and optimization, overshadow the importance of shared responsibility, equality, and knowledge sharing (NPG). With NAV as an example, the article demonstrates the importance of effectively managing institutional complexity in public organizations to succeed in co-creation. It contributes empirical and contextual examples of co-creation processes in the public sector, as the co-creation literature is still very theoretical, descriptive, and conceptual.

Cultivating Pacific Cocoa: Chinese Plantation Labor in Colonial Era Samoa and Vanuatu

Abstract From the 1890s to the 1930s the cocoa plantations of the southwest Pacific relied on Pacific Islander and Asian indentured labor from China and Vietnam. In Samoa and the New Hebrides (now Vanuatu) white planters lobbied colonial administrations for permission to introduce Chinese under contract as indentured labor, a coercive and controversial labor system. This article points to the role of transimperial economic competition in encouraging the use of indentured labor, traversing German, French, and British colonial administrations in the Pacific. Cocoa cultivation, white planters argued, required more regular attention compared with sugar or copra, and Chinese indentured workers were deemed the most suitable to meet these requirements. Australian, New Zealand and British administrators in the Pacific, who were keenly aware of ongoing French indenture practices, lobbied to introduce and retain indentured labor. Without the perceived competitive edge of indentured labor, cocoa cultivation was considered unlikely to prosper. It was not until the mid-1930s that recruitment of Chinese indentured labor ended. It came at a time of international and Chinese calls for abolition of coerced labor but was also driven by anti-immigration and pro-white nationalist sentiments. Even after recruitment ceased, the New Zealand administration in Samoa obliged Chinese workers to remain on the cocoa plantations. While the French did repatriate Chinese recruits, they retained Vietnamese workers. Only after 1945 were indentured workers freed from the obligation to cultivate cocoa, and finally permitted to abandon the plantations.

Return to Work After Surgery for Lumbar Disk Herniation

Study Design. An observational registry-based study. Objective. We investigated the long-term patterns of sick leave among patients undergoing surgery for lumbar disk herniation using two nationwide databases to study the achievement of post-surgery return to work (RTW). Summary of Background Data. The ability to RTW is increasingly recognized as an essential outcome measure for spine surgery. Methods. The study included 13,698 patients aged 18 to 60 on sick leave undergoing surgery for lumbar disk herniation from January 2007 through January 2019. Data from the Norwegian Registry for Spine Surgery (NORspine) and the Norwegian Labour and Welfare Administration (NAV) were linked. Certified sick leave around the time of surgery was assessed. The patients were further categorized according to the length of pre-surgery sick leave, and the rate of sustainable RTW for the different groups was compared using survival analysis. The association between successful surgical outcomes, defined by a 30% improvement in Oswestry Disability Index score, and achievement of sustainable RTW was analyzed using a logistic regression model. Results. Two years after surgery, 76% of the patients had returned to work. Shorter pre-surgery sick leave was associated with a higher proportion and rate of achieved sustainable RTW: Among patients with sick leave of less than 30 days, a total of 99% achieved sustainable RTW (median 46 d); only 40% of patients with longer-lasting work assessment allowance achieved the same goal within two years. Successful surgical outcomes were associated with sustainable RTW for all patient groups, but the impact of surgical success on RTW declined as sick leave extended beyond 180 days. Conclusion. Most patients had returned to work two years after lumbar disk herniation surgery. Shorter pre-surgery sick leave was associated with achieving faster and more sustainable RTW. Successful surgical outcomes had less impact on patients with extended sick leave. Level of Evidence III

Getting an outsider’s perspective - sick-listed workers’ experiences with early follow-up sessions in the return to work process: a qualitative interview study

PurposeThe aim of this study was to explore how early follow-up sessions (after 14 and 16 weeks of sick leave) with social insurance caseworkers was experienced by sick-listed workers, and how these sessions influenced their return-to-work process.MethodsA qualitative interview study with sick-listed workers who completed two early follow-up sessions with caseworkers from the Norwegian Labor and Welfare Administration (NAV). Twenty-six individuals aged 30 to 60 years with a sick leave status of 50–100% participated in semi-structured interviews. The data was analyzed with thematic analysis.ResultsParticipants’ experiences of the early follow-up sessions could be categorized into three themes: (1) Getting an outsider’s perspective, (2) enhanced understanding of the framework for long term sick-leave, and (3) the empathic and personal face of the social insurance system. Meeting a caseworker enabled an outsider perspective that promoted critical reflection and calibration of their thoughts. This was experienced as a useful addition to the support many received from their informal network, such as friends, family, and co-workers. The meetings also enabled a greater understanding of their rights and duties, possibilities, and limitations regarding welfare benefits, while also displaying an unexpected empathic and understanding perspective from those working in the social insurance system.ConclusionFor sick-listed individuals, receiving an early follow-up session from social insurance caseworkers was a positive experience that enhanced their understanding of their situation, and promoted reflection towards RTW. Thus, from the perspective of the sick-listed workers, early sessions with social insurance caseworkers could be a useful addition to the overall sickness absence follow-up.

Treatment Effect Modifiers for Return-to-Work in Patients With Musculoskeletal Disorders

Investigating how individual characteristics modify treatment effects can improve understanding, interpretation, and translation of trial findings. The purpose of this secondary analysis was to identify treatment effect modifiers of the MI-NAV trial, a 3 arm, parallel randomized controlled trial which compared motivational interviewing and stratified vocational advice intervention in addition to usual case management (UC), to UC alone. This study included (n = 514) participants with musculoskeletal disorders on sick leave for at least 50% of their contracted work hours for at least 7 consecutive weeks with the Norwegian Labour and Welfare Administration. Sickness absence days was the primary outcome, measured from baseline assessment date until the 6-month follow-up. Potential treatment effect modifiers, identified a priori and informed by expert consultation and literature, were evaluated using linear regression models and statistical interaction tests. For motivational interviewing versus UC, age (mean difference [MD] −.7, 95% confidence interval [CI] −1.5 to .2; P = .13) and self-perceived health status (MD −.3, 95% CI −.7 to .1; P = .19) were identified as potential effect modifiers (P ≤ .2). For stratified vocational advice intervention versus UC, analgesic medication use (MD −26.2, 95% CI −45.7 to −6.7; P = .009) was identified as a treatment effect modifier (P ≤ .05). These findings may assist in more targeted treatment adaptation and translation as well as the planning of future clinical trials. PerspectiveThis secondary analysis of the MI-NAV trial found that analgesic medication use, age, and self-perceived health may modify the effect of 2 vocational interventions on reducing sickness absence in people with musculoskeletal disorders.

Professional responses to exogenous change: the social work profession and the jurisdictional domain opened up by the Norwegian welfare-to-work reform

ABSTRACT This paper examines the social work profession’s responses to the organizational reform of the Norwegian Labour and Welfare Administration, which opened a new jurisdictional domain of employment services to groups marginalized in the labour market. This domain was not colonized by any established professions, and social workers were the only occupation in the reformed organization with the character and identity of a profession. With existing research as the main source, the paper shows that despite having influenced the reform policy, during reform implementation, agents of the profession refrained from expanding the jurisdiction of social workers and instead protected and maintained its established jurisdiction based on municipal social services. Potential explanations behind the response are discussed: the pressure from the organizational context, combined with the profession’s ingrained distrust of ‘the system’; the ‘dirtiness’ of welfare-to-work tasks, around which some scepticism existed; and the profession’s strong value base and lack of capacity to articulate its knowledge base and, subsequently, theorize its knowledge and skills as resources that were key to meeting the reform’s welfare-to-work goals. All three explanations have some explanatory power but must still be considered tentative and in need of more research.

Is infrastructure a critical aspect of self-organized entrepreneurial activity?

The limitation of capitalist principles and ethics has long been an issue for self-organized enterprises. Even though capitalist modes of labor organization, administration, and management are expelled from the workplace, issues of growth, investment, production, and circulation remain exposed to dominant forms of production. Nevertheless, communities of solidarity, along with spatial and techno-material settings, constitute the infrastructure of commoning practices in those endeavors. We compare the cases of the factory occupation movement in Argentina and the occupation of the Vio.Me. factory in Greece (2010), where a shift to self-organization emerged in the context of the Argentinian and Greek economic crises. We focus on struggles revolving around the use and ownership of spatial-material infrastructure and the production of use-values, highlighting the emancipatory potential of self-organization. Space and objects appear as a contested terrain, while at the same time, material settings are transformed, through the collectives’ participation in networks of distribution and solidarity.

Analysis of Survival Strategies for Illegal Indonesian Workers in Malaysia

The increase in illegal Indonesian workers (TKI) every year is a polemic in itself; the opportunity to become an illegal TKI can be detrimental to the state and individual TKI because they will not get their rights and are vulnerable to problems with inappropriate labor administration. The Indonesian government must immediately resolve this problem to ensure that there are no more illegal Indonesian migrant workers coming to Malaysia. This research uses a qualitative method by collecting data through interviews, observation, and documentation from three sources on the survival of illegal migrant workers working in Malaysia. The analysis uses spatial and narrative analysis. This is a novelty in this research and direct observations in the field by the author. The research results show that the main factors for illegal migrant workers going to Malaysia are the availability of jobs, high wages, and the lure of families working there. The workers chose to be illegal because they did not have a valid visa, did not want to renew their advanced visa or a tourist visa, and switched to becoming workers in Malaysia. As for surviving as an illegal worker, the survival strategy for surviving as an illegal worker is to carry out economic, social, legal, and political survival strategies. This research is important to follow up on because many Indonesian citizens are still interested in working abroad illegally and not complying with established regulations, which can harm various parties.

Migrant healthcare assistants’ decision to work in long-term care

In high-income countries, population ageing has a significant impact on the labour force and care demands. As a result, the tendency is to rely on migrant workers to meet workforce and care demands. Drawing on insights from Bronfenbrenner’s ecological systems theory, this study focused on unskilled migrant healthcare assistants in Norway’s long-term care. The objectives were to explore factors influencing the decision of unskilled migrant healthcare assistants to work in elderly care, sources of knowledge about work in elderly care, and challenges encountered in elderly care work. The key research questions were as follows: a) What factors influence the decision of migrant healthcare assistants to work in elderly care? b) What are the sources of knowledge/information about work in elderly care for migrant healthcare assistants? c) What are some of the challenges of working in elderly care for migrant healthcare assistants? Qualitative research and purposive sampling were used to recruit 20 participants: 13 unskilled migrant healthcare assistants and seven managers of long-term care facilities in South-Eastern and Northern Norway. Data were collected using in-depth individual interviews, focus group discussions and participant observation, and thematically analysed. Findings indicated that factors influencing unskilled migrant healthcare assistants' decision to work in the elderly care sector included cultural norms and values of caring for older people, nonrecognition of overseas qualifications and economic considerations. State-organized language learning programmes, Norwegian Labour and Welfare Administration (NAV) offices, as well as migrant family and community networks, provided crucial information about work in elderly care. Challenges regarding lack of career progression, temporary working contracts, low status and poor wages emerged. In conclusion, meaningful employment outcome through better opportunities for career progression are essential for unskilled migrant healthcare assistants’ well-being and care for older people. It would be useful for long-term care policymakers and stakeholders to address the challenges faced by its aged care workforce.

Enabling Teams to Implement Innovative Personalized Activation in a Public Sector Context: Why and How Frontline Leadership Matters

This article investigates the strategies used by frontline supervisors to lead teams in the implementation of innovative activation services and the ways in which these strategies are perceived by the frontline workers they lead. Empirical data are collected from team observations and in-depth interviews with frontline supervisors and workers known as employment specialists in a public sector context, i.e., in the Norwegian Labour and Welfare Administration (NAV). In this context,a large-scale programme known as Extended Follow-Up was implemented beginning in 2017 with the aim of improving activation services for persons with complex support needs. We identified two leadership strategies: a) a team-focused strategy based on interdependence, in which frontline workers were encouraged to shape and adapt the activation services to each jobseeker, and b) a rule-focused strategy based on constant monitoring of frontline workers to secure their adherence to predefined tools and aims. The former strategy promoted team cohesion and provided the necessary psychological safety to implement the personalized activation service,while the latter strategy limited the frontline workers’ creativity and room to manoeuvre. Our findings reveal that integrative leadership approaches that combine autonomy with support present greater prospects for successful innovation implementation in a public sector context.

Comparing digital to traditional follow-up in the Norwegian Labour and Welfare Administration: A youth perspective on trust and satisfaction

Comparing digital to traditional follow-up in the Norwegian Labour and Welfare Administration: A youth perspective on trust and satisfaction