Department of Design Sciences, Lund University, Lund, Sweden.
Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden.
BMC Health Serv Res. 2022 Mar 15;22(1):345. doi: 10.1186/s12913-022-07710-2.
Home care is beset with work environment issues and high staff turnover, while research concerned with interventions to improve the work environment is sparse. Few of the existing interventions apply a participative approach, despite this being associated with more positive outcomes and sustainable change. This paper presents a framework, rooted in action research and action learning, for participatory work environment interventions in home care, and demonstrates how this framework has been implemented in four Swedish home care organizations.
The framework has three phases (pre-intervention, intervention planning and intervention implementation) and consists of cycles of action and reflection in three constellations: a group of researchers, a reference group with labour market organization representatives and home care managers, and intervention work groups in the home care organizations. The work was documented and analysed with focus on the realization of the framework and challenges that were met on the way. The interventions were evaluated using a pre-/post-test questionnaire design.
Parts of the framework were successfully implemented. The pre-intervention phase and the intervention planning phase, with intervention work groups, worked well. All four groups identified one intervention relevant to their own context. However, only two of the proposed interventions were fully implemented and evaluated. The high staff and management turnover, and the high rate of organizational changes made it impossible to evaluate the interventions statistically. Yet, data from open-ended questions in the post questionnaire showed that the two implemented interventions were perceived as successful.
The participatory framework, presented in this paper, seems promising for work environment interventions in home care. The framework was designed to reduce the risk of known disturbances affecting the process in unstable organizations. Despite this, it proved challenging to execute the framework, and especially the interventions, due to changes happening at high speed. In the two cases where organizational changes were not dominating, the interventions were implemented successfully. While the prerequisites for participation and successful implementation could be improved somewhat, the main issue, the instability of the organizational context, is hard for researchers or the individual home care units to tackle alone.
家庭护理面临工作环境问题和员工高流动率的困扰，而有关改善工作环境的干预措施的研究却很少。尽管参与式方法与更积极的结果和可持续变革相关，但现有的干预措施很少采用这种方法。本文提出了一个框架，该框架根植于行动研究和行动学习，用于家庭护理中的参与式工作环境干预，并展示了该框架如何在四个瑞典家庭护理组织中实施。
该框架有三个阶段（干预前、干预规划和干预实施），由三个群体中的行动和反思循环组成：一组研究人员、一个由劳动力市场组织代表和家庭护理经理组成的参考小组，以及家庭护理组织中的干预工作组。这项工作的记录和分析重点是框架的实现以及在实施过程中遇到的挑战。干预措施采用前后测试问卷设计进行评估。
框架的部分内容得到了成功实施。干预前阶段和干预规划阶段（有干预工作组参与）运作良好。所有四个小组都确定了一个与自身背景相关的干预措施。然而，只有两个拟议的干预措施得到了全面实施和评估。由于员工和管理层的高流动率以及组织变革的高频率，使得无法对干预措施进行统计评估。然而，后调查问卷中的开放性问题的数据表明，这两个实施的干预措施被认为是成功的。
本文提出的参与式框架似乎很有希望用于家庭护理的工作环境干预。该框架旨在降低已知干扰因素对不稳定组织中过程的影响。尽管如此，由于高速发生的变化，执行框架，特别是干预措施，仍然具有挑战性。在组织变革不占主导地位的两种情况下，干预措施得到了成功实施。虽然参与和成功实施的先决条件可以有所改善，但主要问题，即组织环境的不稳定性，对于研究人员或个别家庭护理单位来说，单独解决是困难的。
