Introducing Motivational Interviewing in a Sickness Insurance Context: Translation and Implementation Challenges.

Purpose Motivational interviewing (MI) is a conversational method to support clients in need of behavioral change. In an organizational reform, most Swedish sickness insurance officials were trained in MI to promote clients' return to work (RTW) after sick leave. The aim of this article is to investigate experiences of introducing MI as a tool to promote clients' RTW within a sickness insurance context, with special focus on the translation and implementation of the method. Methods A qualitative approach, comprising 69 interviews with officials, managers, and regional coordinators on two occasions. The material was analyzed through qualitative content analysis. Results Officials were positive about MI, but the application was limited to using certain tools with extensive individual variation. Officials struggled with translating MI into a sickness insurance context, where the implementation strategy largely failed to offer adequate support, due to low managerial priority, competing initiatives, and a high workload. Results of the educational intervention could therefore be seen on an individual but not an organizational level. Conclusions In order to translate MI into a sickness insurance context, training needs to be supported by organizational approaches that promote collective learning and sharing of experiences among officials. The results also illustrate how a method cannot be assumed to be implemented simply because training has been provided. Consequently, the application of the method needs to be carefully monitored in studies of interventions where MI is claimed to be used, in order to measure its effectiveness.

Lean production tools and decision latitude enable conditions for innovative learning in organizations: a multilevel analysis.

The effect of lean production on conditions for learning is debated. This study aimed to investigate how tools inspired by lean production (standardization, resource reduction, visual monitoring, housekeeping, value flow analysis) were associated with an innovative learning climate and with collective dispersion of ideas in organizations, and whether decision latitude contributed to these associations. A questionnaire was sent out to employees in public, private, production and service organizations (n = 4442). Multilevel linear regression analyses were used. Use of lean tools and decision latitude were positively associated with an innovative learning climate and collective dispersion of ideas. A low degree of decision latitude was a modifier in the association to collective dispersion of ideas. Lean tools can enable shared understanding and collective spreading of ideas, needed for the development of work processes, especially when decision latitude is low. Value flow analysis played a pivotal role in the associations.

Investigating work conditions and burnout at three hierarchical levels.

OBJECTIVE: To investigate the differences and the association between work conditions and symptoms of burnout at the three hierarchical levels: subordinates, first-line managers, and middle managers. METHODS: Analyses were based on questionnaire data from 4096 employees in nine organizations, containing three hierarchical levels: subordinates (n = 3659), first-line managers (n = 345), and middle managers (n = 92). RESULTS: Work conditions were found to differ between the three hierarchical levels, mostly between subordinates and managers. Managers experienced fewer symptoms of burnout than subordinates. Furthermore, the association between work conditions and burnout differed for subordinates, first-line managers, and middle managers. CONCLUSIONS: Occupational health research needs to focus more on differences between hierarchical levels regarding work conditions and burnout.

The importance of work conditions and health for voluntary job mobility: a two-year follow-up.

BACKGROUND: Changing jobs is part of modern working life. Within occupational health, job mobility has mainly been studied in terms of employees' intentions to leave their jobs. In contrast to actual turnover, turnover intentions are not definite and only reflect the probability that an individual will change job. The aim of this study was to determine what work conditions predict voluntary job mobility and to examine if good health or burnout predicts voluntary job mobility. METHODS: The study was based on questionnaire data from 792 civil servants. The data were analysed using logistic regressions. RESULTS: Low variety and high autonomy were associated with increased voluntary job mobility. However, the associations between health and voluntary job mobility did not reach significance. Possible explanations for the null results may be that the population was homogeneous, and that the instruments for measuring global health are too coarse for a healthy, working population. CONCLUSIONS: Voluntary job mobility may be predicted by high autonomy and low variety. The former may reflect that individuals with high autonomy have stronger career development motives; the latter may reflect the fact that low variety leads to job dissatisfaction. In contrast to our results on job content, global health measurements are not strong predictors of voluntary job mobility. This may be because good health affects job mobility through several offsetting channels, involving the resources and ability to seek a new job. Future work should use more detailed measurements of health or examine other work settings so that we may learn more about which of the offsetting effects of health dominate in different contexts.

New ways of organizing product introductions.

The aim of this paper is to describe and reflect on an interactive research approach used to address the challenges on how to improve product introductions, the part of the product realization process associated with the transfer of a product from product development to serial production. In the interactive research approach, research results as well as improvement of practice are given equal importance. The collaboration between researchers and practitioners therefore addresses both the focus and the process of the change. The approach includes four main iterative steps: 1) mapping/diagnosis, 2) feedback of results, 3) participation in development activities, and 4) follow-up/evaluation. The paper reports findings from interactive research in one company within office product industry and one company group, consisting of three company units within the engine industry. Preliminary findings indicate that the participating companies afterwards work in a more structured way with product introductions and that the employees have gained deeper knowledge about product introductions as well as experienced the advantages of working across functional boundaries. Furthermore, the interactive research approach is suitable to run projects from an ergonomics perspective as it focuses on developing both practice and theory, it is human-centered, and it emphasizes broad participation from practitioners.

Evaluation of job stress models for predicting health at work.

OBJECTIVES: Few workplace health promotion (WHP) interventions are designed to improve work conditions. Methods for measurement of work conditions are often developed from a risk factor perspective rather than a WHP perspective. More knowledge is needed on the work conditions that promote health in order to develop a good work environment. The purpose of the present study was to investigate if the Demand Control Support model, the Effort Reward Imbalance model and the Job Characteristic Inventory are correlated, if the subscales predict health and to analyze which combination of subscales is the most useful predictor of health longitudinally. PARTICIPANTS: The study used questionnaire data from 662 civil servants at baseline and at follow-up 2 years later. METHOD: The data were analysed by multiple regressions. RESULTS: A new model; effort, reward, and variety, was found having a higher predictive power to predict health than the original models. CONCLUSIONS: To promote health at work, social relations and health-mediating work conditions are important because these conditions may buffer health. Health can be assumed to be a resource that is created in everyday activities and interactions in workplaces, and there is a need to develop health measure instruments based on holistic health theories.

Swedish students' and preceptors' perceptions of what students learn in a six-month advanced pharmacy practice experience.

OBJECTIVE: To identify what pharmacy students learn during the 6-month advanced pharmacy practice experience (APPE) in Sweden. METHODS: Semi-structured interviews were conducted with 18 pharmacy APPE students and 17 pharmacist preceptors and analyzed in a qualitative directed content analysis using a defined workplace learning typology for categories. RESULTS: The Swedish APPE provides students with task performance skills for work at pharmacies and social and professional knowledge, such as teamwork, how to learn while in a work setting, self-evaluation, understanding of the pharmacist role, and decision making and problem solving skills. Many of these skills and knowledge are not accounted for in the curricula in Sweden. Using a workplace learning typology to identify learning outcomes, as in this study, could be useful for curricula development. CONCLUSIONS: Exploring the learning that takes place during the APPE in a pharmacy revealed a broad range of skills and knowledge that students acquire.

Circling around in tiredness: perspectives of patients on peritoneal dialysis.

The experience of tiredness linked to poor sleep in patients on peritoneal dialysis was explored using the qualitative method phenomenology. Eight women and six men in southeast Sweden were interviewed. The patients' descriptions were characterized by a circular structure "circling around in tiredness." This study illustrates the problems of tiredness and illuminates the need for healthcare professionals to assess the impact of tiredness and highlight the need for strategies to improve the patient's situation.

Factors associated with reflection among students after an advanced pharmacy practice experience (APPE) in Sweden.

OBJECTIVE: To identify individual and social factors associated with pharmacy students' level of reflection in an advanced pharmacy practice experience (APPE). METHODS: A postal questionnaire, including a reflective assignment, was sent to all pharmacy interns (n=262) at Uppsala University, Sweden, for 4 semesters in 2005-2007. RESULTS: In a univariate analysis, 7 factors were found to be associated with students' level of reflection. After controlling for covariates, 3 social factors were found to be independently associated with reflection: having a formal preceptor (OR=5.3), being at a small pharmacy (OR=19.8), and students' perception of the importance of discussing critical thinking with the preceptor (OR=1.2). No correlation could be observed between level of reflection and critical thinking, nor learning style. CONCLUSION: Social components seem to be of higher importance than individual components in students' reflective levels after pharmacy internship experience. Trained preceptors are important to foster reflection skills.

Storage lipid synthesis is non-essential in yeast.

Steryl esters and triacylglycerol (TAG) are the main storage lipids in eukaryotic cells. In the yeast Saccharomyces cerevisiae, these storage lipids accumulate during stationary growth phase within organelles known as lipid bodies. We have used single and multiple gene disruptions to study storage lipid synthesis in yeast. Four genes, ARE1, ARE2, DGA1, and LRO1, were found to contribute to TAG synthesis. The most significant contribution is made by DGA1, which encodes a novel acyl-CoA:diacylglycerol acyltransferase. Two of the genes, ARE1 and ARE2, are also involved in steryl ester synthesis. A yeast strain that lacks all four genes is viable and has no apparent growth defects under standard conditions. The strain is devoid of both TAG and steryl esters, and fluorescence microscopy revealed that it also lacks lipid bodies. We conclude that neither storage lipids nor lipid bodies are essential for growth in yeast.