Sick Leave-A Signal of Unequal Work Organizations?: Gender Perspectives on Work Environment and Work Organizations in the Health Care Sector: A Knowledge Review

By Vänje, Annika | Nordic Journal of Working Life Studies, December 2015 | Go to article overview

Sick Leave-A Signal of Unequal Work Organizations?: Gender Perspectives on Work Environment and Work Organizations in the Health Care Sector: A Knowledge Review


Vänje, Annika, Nordic Journal of Working Life Studies


Introduction

The winds of change affect the structures of working life in the Swedish health care sector

The background to this article is governmental interest in finding reasons why a majority of the employees in Sweden who are on sick leave are women. A sector dominated by women that is interesting to look closer at in relation to this question is health care. From an overall perspective there has been a privatization trend in Swedish health care, with instability and changes to the ownership structures as a consequence, which has erased the borderlines between public and private sectors and affected the work conditions (Kamp et al. 2013). On top of this economic recession and the associated demand for efficient, streamlined organizations have led to a constantly increasing pace of working, and in its pursuit of efficiency, the sector has turned to the manufacturing industry's established management concepts such as Lean production (Brännmark and Holden 2012, McCann et al. 2015, Sederblad 2013). Health care is also a professional sector with clear hierarchies and a significant gender order (Lindgren 1999). Well known is that groups on the work market that have low-status positions, as many women in health care have, are more often than those who have high-status positions negatively affected by organizational changes (Härenstam et al. 2004). Consequently many women in the Swedish health care industry are exposed to negative changes in their working conditions due to privatization and/or new public management (NPM) strategies such as Lean thinking (Kamp et al. 2013). In the late 1990s Landsbergis et al. (1999) published an article on what impact Lean has on workers' health, and have also presented health issues such as stress and musculoskeletal diseases (MSDs). Health problems that we know come with demands on more effective work at the same time as the individual's control over the job is unchanged and the interactions with the management remain the same or even decreased (Ganster and Rosen 2013, Koukoulaki 2014).

The main employment sector for women in the EU is health care and social work (EU-OSHA 2013). When it comes to work health the most common diagnoses in Europe for sick leave are just MSDs and stress-related diseases (EU-OSHA 2013). Health care and social work are also the fourth most exposed work group when it comes to serious accidents at work in the EU member states (Eurostat 2013). At the same time health care and social work are the jobs that have the highest sickness absence in Europe (EUOSHA 2013). In Sweden women employed in the health care sector and who are on sick leave (for 14 days or more) have the same kind of diagnosis, that is, MSD and mental illnesses (Försäkringskassan 2011).

The overall question to answer with the help of this review article on work environment and/or work organization is consequently why a majority of the workers who are on sick leave in Sweden are women and to be found in health care and social work (Försäkringskassan 2011). The review was originally a commission from the Swedish Work Environment Agency and a special project initiated since the sick absence in Sweden is dominated by women, in all diagnoses except accidents at work and heart-related diseases (Försäkringskassan 2011). Three issues will be discussed in the following sections from a meso-level: (i) recent changes in the Swedish health care sector's working organizations and their effects on gender, (ii) what research says about work health and gender in the health care sector, and (iii) the meaning of gender at work in the health care sector. The aim is to first discuss these three issues to give a picture of what gender research says concerning work organization and work health, and second to examine the theories behind the issues. The main focus is on the Swedish health care sector.

Methods

The article is based on literature found using the Royal Institute of Technology's (KTH's) library search engine KTHB Primo, which provides access to the university's online subscriptions and includes scholarly journal articles, print journals and ejournals, print books and ebooks, conference proceedings, doctoral theses and dissertations, as well as bibliographic databases. …

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