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Summary
Most organisations in this Swedish welfare-sector study had access to occupational health services, but many did not use them extensively when planning and implementing preventive action.
Of the 122 participating organisations, 112 had access to occupational health services. Around half used them to a high or very high degree when identifying the need for preventive measures, but only 29% to 35% involved them extensively when designing measures, making decisions or implementing interventions.
Successful collaboration was linked less to whether occupational health services were internal or external and more to how closely they were involved. Organisations reported better collaboration where contracts supported ongoing involvement, managers had established procedures for consultation and occupational health professionals contributed to the design of preventive measures.
The study suggests that occupational health expertise has greater preventive value when it is involved early and integrated into routine safety management, rather than being used mainly to provide isolated services after problems have emerged.
Aim and Context
Occupational health services can provide medical, ergonomic, organisational and psychological expertise, but access does not guarantee effective use.
The researchers examined how Swedish welfare organisations used occupational health services in preventive occupational health and safety management. They also looked at the organisational conditions associated with successful collaboration and whether stronger collaboration was linked with better preventive management.
The sectors included healthcare, social services, education, public administration and other welfare-related services.
Methodology
The researchers carried out a cross-sectional study using survey data from 122 organisations.
Of these, 112 had access to occupational health services. Nineteen used an internal provider and 93 used an external service.
Most survey respondents were human resources professionals, who accounted for 72% of responses. The sample represented organisations across 11 of Sweden's 21 regions and 70 of its 290 municipalities.
The researchers used descriptive statistics alongside coincidence analysis, a configurational method designed to identify combinations of conditions associated with successful or unsuccessful collaboration.
Successful collaboration was based on whether organisations agreed that their occupational health arrangements supported preventive and health-promoting safety management.
Access Was High but Preventive Use Was Limited
Ninety-two per cent of participating organisations had access to occupational health services.
However, only 54% reported using them to a high or very high degree when identifying the need for preventive measures.
Their involvement fell further during later stages. Only 29% to 35% used occupational health services extensively when designing measures, deciding how they would be implemented or carrying out interventions.
Between 27% and 38% reported low or very low involvement during these stages.
This indicates that occupational health providers were more likely to be involved in recognising a problem than in shaping the response.
Only About Half Reported Successful Collaboration
Among organisations with occupational health services, 52 reported successful collaboration, representing about 46% of the sample.
Forty-eight gave a neutral response and 11 expressed some level of disagreement.
The study therefore found a substantial gap between having access to occupational health services and considering the relationship effective for preventive work.
Close Interaction Was Associated With Better Collaboration
Organisations reported better collaboration where occupational health involvement extended beyond individual service requests.
Regular meetings, ongoing information sharing and involvement in preventive management were associated with greater satisfaction.
The configurational analysis identified three routes associated with successful collaboration.
One involved contracts that supported close involvement in both specific interventions and routine organisational development. Another combined established internal procedures with extensive dialogue when preventive measures were designed. A third involved external demands influencing an intervention while occupational health professionals were closely involved in deciding its content.
The common factor was active involvement in shaping preventive action.
Internal Providers Were Not Automatically More Successful
The study found no significant difference in satisfaction between organisations using internal occupational health services and those using external providers.
An internal provider could still be excluded from decision-making, while an external provider could become closely involved through suitable contracts, regular communication and established working relationships.
The type of provider therefore mattered less than how the relationship operated in practice.
Limited Dialogue Was Linked With Unsuccessful Collaboration
The analysis of unsuccessful collaboration identified one main pattern: limited dialogue with occupational health services combined with work-environment problems extending beyond simple physical strain.
These problems included workload and resource pressures, social work-environment issues, noise, air quality and chemical exposure.
Such issues may require input from several professional disciplines. Where occupational health specialists were not involved in defining and designing the response, organisations were more likely to report unsuccessful collaboration.
Contracts Need to Be Supported by Working Practices
The study found that contract type alone was not significantly associated with satisfaction.
A contract may allow regular consultation, but that opportunity has little effect if managers do not involve the provider or only purchase isolated services.
Organisations therefore need both contractual arrangements that permit preventive involvement and internal procedures explaining when occupational health advice should be sought.
Evidence of Better Safety Outcomes Was Limited
Successful collaboration was not significantly associated with a greater proportion of preventive or organisation-level measures.
It was also not significantly associated with perceptions that occupational health and safety management prevented accidents or ill health.
There was a small statistically significant association between successful collaboration and the perception that safety management promoted employee health.
The study therefore does not establish that closer occupational health collaboration leads directly to fewer injuries or cases of ill health.
Limits of Evidence
The study was cross-sectional, so it cannot establish whether successful collaboration improved safety management or whether organisations with stronger management systems were already more likely to collaborate effectively.
Most outcomes were based on employer perceptions rather than objective measures such as sickness absence, staff turnover or injury records.
The study also focused on Swedish welfare organisations, many of them large municipal or regional bodies. The findings may not transfer directly to smaller businesses, industrial workplaces or countries with different occupational health systems.
Takeaways for Practice
- Employers should examine whether occupational health services are involved early enough to influence preventive action, rather than being contacted only after a problem has emerged.
- Contracts should allow occupational health professionals to contribute to intervention design, organisational development and routine safety discussions.
- Managers also need clear procedures for consultation and regular contact with providers. Meetings should cover emerging risks and preventive planning, not simply the purchase of individual services.
- The study indicates that occupational health services are more likely to contribute effectively when they are part of the organisation's preventive management process rather than treated mainly as suppliers of separate clinical or technical services.
Read the full research study here:
Employers’ utilization of and collaboration with occupational health services in preventive occupational health and safety management by Akerstrom M, Wahlström J, Reineholm C, Jonsdottir IH https://www.sjweh.fi/article/4269