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Open Access Research article

Understanding significant processes during work environment interventions to alleviate time pressure and associated sick leave of home care workers – a case study

Gunn Robstad Andersen* and Rolf H Westgaard

Author Affiliations

Department of Industrial Economics and Technology Management, Norwegian University of Science and Technology, Alfred Getz veg 3, SB1, 12.etg, N-7491 Trondheim, Norway

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BMC Health Services Research 2013, 13:477  doi:10.1186/1472-6963-13-477

Published: 15 November 2013



Ergonomic and work stress interventions rarely show long-term positive effect. The municipality participating in this study received orders from the Norwegian Labour Inspectorate due to an identified unhealthy level of time pressure, and responded by effectuating several work environment interventions. The study aim is to identify critical factors in the interaction between work environment interventions and independent rationalization measures in order to understand a potential negative interfering effect from concurrent rationalizations on a comprehensive work environment intervention.


The study, using a historic prospective mixed-method design, comprised 6 home care units in a municipality in Norway (138 respondents, response rate 76.2%; 17 informants). The study included quantitative estimations, register data of sick leave, a time line of significant events and changes, and qualitative descriptions of employee appraisals of their work situation gathered through semi-structured interviews and open survey responses.


The work environment interventions were in general regarded as positive by the home care workers. However, all units were simultaneously subjected to substantial contextual instability, involving new work programs, new technology, restructurings, unit mergers, and management replacements, perceived by the home care workers to be major sources of stress. Findings suggest that concurrent changes induced through rationalization resulted in negative exposure effects that negated positive work environment intervention effects, causing an overall deteriorated work situation for the home care workers.


Establishment and active utilization of communication channels from workers to managers are recommended in order to increase awareness of putative harmful and interruptive effects of rationalization measures.

Intervention studies; Health care services; Home care services; Rationalization; Organizational change; Work environment; Ergonomics