Psykosocialt Arbejdsmiljø på Regionale Arbejdspladser (PARA): Viden der virker

The purpose of the project, Psychosocial Working Environment at Regional Workplaces (PARA), was to increase knowledge about efforts that have a positive effect on the psychosocial work environment at workplaces organized under the regional level of government in Denmark. At the same time, this research-based knowledge was meant to be used locally at regional workplaces as a starting point for concrete initiatives to improve the work environment.
The purpose was investigated through various methodological perspectives that have provided relevant knowledge within the following five focus areas, which were selected prior to the project by Danske Regioner and Forhandlingsfællesskabet:
 Recognition, respect, professionalism and time for the core task
 Changes
 Violence and threats of violence
 Retention
 Introduction of new hires and graduates.

The purpose is met through a mixed-methods research design, which combines
qualitative and quantitative research methods and contains the following elements:
 Mapping of the work environment and organizational context at workplaces at the regional level of government using different qualitative and quantitative
sources of data.
 Establishment of a quantitative research resource, a ‘regional work environment cohort’, which is used as a quantitative database to investigate associations between factors in the psychosocial work environment, mental health, sickness absence and retention.
 Identification of possible efforts in relation to the five focus areas. The efforts are described in a series of guidelines, which have been tested, evaluated and further developed in the project in collaboration with 64 participating work units spread over eight workplaces using both qualitative and quantitative methods.

Most efforts for improving the psychosocial work environment take place locally at the workplace. It has therefore been a main focus of the PARA project to investigate methods that managers and employees at regional workplaces can apply in order to strengthen the basis for local efforts to improve the work environment. Against this background, and based on the research-based knowledge in the field, the researchers have developed a set of guidelines that inform the workplaces on how to go about efforts to improve the work environment and the researchers introduced these guidelines to the
participating workplaces as part of the project collaborations. The guidelines and the collaboration with the participating workplaces are based on a systematic and learning approach to the efforts of improving the work environment. In addition, the work environment efforts in the PARA project are based on three general recommendations:
 Employee involvement
 Adaptation to the workplace
 Clear and persistent communication

The results from the PARA project suggest that the three general recommendations can contribute to increasing the possibilities for; 1) that local initiatives to improve the work environment lead to improvements in the work environment and employee well-being, 2) that the initiatives become anchored in the workplace and, 3) that the initiatives become an integral part of the local handling of the core task. However, the PARA project also shows that there are large differences in how well regional workplaces are able to carry out effective and solution-oriented work environment initiatives that suit the local context. Using quantitative and qualitative methods the researchers have
investigated how contextual factors can affect the local occupational health and safety initiatives in order to gain more knowledge on how the local conditions affect the local efforts to improve the work environment.

The research project's central findings appear within the following themes:
 Identification of potentials to reduce sickness absence, increase retention and support mental health through improvements in the work environment (chapter 2).
 Insights into concrete and local work environment processes at regional workplaces as well as positive experiences with a learning approach to working with complex work environment issues (chapters 3-5).
 Insights into how the psychosocial work environment has developed in the
participating work units and which factors have had an impact on this development.
Here, particular emphasis is placed on the description of local variations in the so-called work environment competency and on understanding work environment competency as a relevant concept for understanding the ability of local units to identify and act relevantly in relation to challenges in the work environment (chapters 6-7).
 Insight into a number of contextual factors that constitute opportunities and
limitations in relation to locally based initiatives to improve the work environment, as well as clarification of the resulting options for action (chapter 8).

In addition, the PARA project contributes with knowledge on the local efforts to improve the work environment at regional workplaces. In continuation of this, the PARA project identifies a large variation in the work units' ability to deal with their work environment problems locally, as well as a number of conditions that respectively inhibit and promote work environment work. These conditions relate, in particular, to the way in which the work environment initiatives are organized and to the local cooperation around the work environment initiatives. In addition, the PARA project also contributes with an analysis of various concrete dialogue-based work environment tools and techniques, as
well as a discussion of how knowledge and knowledge dissemination can be understood in the context of work environment work at regional workplaces.
Potentials to reduce sickness absence, increase retention and support mental health through improvements in the working environment.

The results from the part of the PARA project, which is based on epidemiological analyses of a large amount of data on psychosocial working environment and well-being from the Capital Region, show that there is considerable potential in terms of reducing sickness absence, increasing retention and supporting mental health among employees at regional workplaces through improvements in the psychosocial working
environment. This applies in particular if it is possible to promote cooperation and strengthen the relationships between managers and employees, as well as increase the opportunities for development and influence in the work. The results from this part of the project underline the relevance for both managers and employees of initiating and implementing efforts aimed at improving the psychosocial working environment at regional workplaces.

A learning approach to working environment work positively supports work with complex working environment issues Experience from PARA has shown that problems in the psychosocial work environment often are constituted by more complex and interwoven issues that they appear at first glance. Sustainable efforts in relation to such "wild" issues call for a thorough investigation of these issues. By using a learning approach, employees and managers are
invited to put the research-based knowledge into play through the methods that are included in the guidelines. The research-based knowledge is presented through a number of specific themes that are described in the guidelines. Moreover, these themes are made operational in dialogue questions and statement cards, which help the participants to examine their own work environment by using current research-based knowledge.

Through three exemplary case descriptions, it is shown how a learning approach supports workplace exploration of challenges as well as possible actions in the form of initiatives and trial actions. The "thick case descriptions" show how the work environment problems are woven into the context and the concrete work tasks. They also show how workplaces identify very different types of efforts to improve the work environment in different departments that work within the same focus area. This observation shows the value of a dialogue-based approach, which precisely opens the door for employees to
play an active role in identifying the efforts that need to be initiated in the workplace.

Further, the PARA project shows the value of local dialogues about complex work environment problems. At the participating workplaces, dialogues involving employees have been carried out to uncover and investigate these issues. In general, the researchers and the participating workplaces have had good experiences from using these dialogue-based approaches, which have been supported by the guidelines. For example, the dialogue methods: perspective interviews and dilemma thinking, open ways of examining
different perspectives across professional groups and units. The dialogues thus have an independent value and can be regarded as a work environment initiative in itself. At the same time, the dialogues support the uncovering of tacit knowledge and the complex nature of the issues, which further contributes to the formulation of relevant initiatives and trial actions that are more likely to address the underlying causes of the problem.

The experience from the PARA project shows that initiatives and experimental actions can both provide solutions to concrete problems and have a wider significance by preventing or reversing negative dynamics in the psychosocial work environment, so that they are instead made an occasion for professional development and for finding new ways of managing the core task. The local processes are of great importance – the ability of units to identify and act relevantly towards challenges in the work environment.

Looking across the participating workplaces, the results from the PARA project show that there have only been marginal changes in the work environment from the start of the individual workplace collaborations to their end. However, when you look more closely at the participating work units, the results show large shifts over time, which suggests that the processes that take place locally in the participating work units are of great importance for how the psychosocial work environment and employee well-being have developed. The quantitative data indicate that the psychosocial working environment and employee well-being develop more positively among employees who report that their work unit 'to some extent' or ' to a high extent' have implemented the agreed initiatives to improve the work environment than among employees who report that they have 'not at all' or 'to a low extent' implemented the agreed initiatives. These
results could indicate that the potential of the PARA effort has primarily been realized in the work units, where the local work environment work was based on a systematic and learning approach to the work environment efforts.

However, as mentioned above, there is a difference in the extent to which the
participating workplaces have been able to implement solution-oriented and systematic work environment initiatives, and there are a number of conditions at the workplace that are important for this. The PARA project shows that there are large differences in the individual work units' competency and prerequisites for solving concrete working environment problems (hereafter 'Work environment competency'). The results from the workplaces that have participated in the PARA project show that there is a large gap between how the employees from the participating work units assess the working environment competency in their work unit, which both has an impact on the way they
have worked with their efforts in connection with the PARA project and for how their work environment and well-being have developed over time.
What enables and limits local work environment initiatives?
The qualitative and the quantitative analyses also point to some concrete points of attention that workplaces can use to strengthen their local efforts to improve the work environment and their own work environment competency. We have identified a number of contextual factors that in different ways constitute opportunities and barriers for successful working environment initiatives. These fall under four headings:
 Employee involvement: The collaboration between managers and employees is important to ensure that efforts are perceived as meaningful and lead to
improvements in the work environment. The psychological safety in the department is decisive for whether it is possible to enter into a trusting dialogue about the psychosocial work environment. At the same time, work pressure can make it difficult for employees to have the opportunity to participate in work environment initiatives.
 A systematic and learning approach: Systematics work environment work is of great importance for the experienced work environment competency in the cases. At the same time, a learning approach has proven to be very effective in terms of unfolding complex issues in the psychosocial work environment and in terms of formulating and following up on concrete efforts and trial actions. The systematic and learning approach is supported by the guidelines developed in the PARA project.
 To build cooperation around the work environment initiatives: As mentioned,
the departments' work environment competency is important for their ability to
translate work environment knowledge, including PARA's guidelines. Here it is
important that workplaces are aware that they can get help and support from
'translators and bridge builders' of knowledge, such as work environment consultants or other resource persons. It can form the basis for learning and developing work environment competency.

Time- and learning space: It is crucial for the impact of work environment
initiatives that time- and learning space is created so that the local dialogues on work environment and handling of the core task can take place. The experiences from workplace collaborations show that these time- and learning spaces can, for example, be limited by changes in the workplace and high demands – fx emotional demands.

In Chapter 8 we identify a number of options for action with a view to strengthening the efforts to improve the work environment and thus also strengthening the workplaces' work environment competency, based on the collaborations with the workplaces.

Overall, the results from the PARA project indicate that there is a great potential in the local efforts to create a good psychosocial work environment and that such locally rooted initiatives will have a positive effect on employees' mental health, sick leave and employee retention. The developed guidelines, which specifically seek to support the implementation of a systematic and learning approach to work environment efforts, can help to support these locally rooted efforts and can thus contribute towards strengthening well-being and retention and to reducing sickness absence among workers in regional workplaces.
However, the results also indicate that not all work units in the regional labor market are equally 'prepared' to manage their local work environment problems and realize the potentials that the PARA project has identified. The results indicate that these differences will also have an impact on the extent to which the regional workplaces will be able to use the PARA project's guidelines to strengthen the working environment - and by working systematically and learning with their working environment efforts, there is also a good chance for workplaces to develop their working environment competency.

Final note
It should be noted that the PARA project began in 2019 and was completed in mid-2023. During that period, Denmark has gone through the Covid pandemic, a nursing strike and increasingly greater challenges with regard to the recruitment and retention of staff in a number of areas. This formed the framework for and was a condition for PARA. The framework and conditions have partly challenged the practical research work in all phases, especially in relation to the recruitment of workplaces for the project, but also in
relation to the possibilities of the workplaces to balance their participation in the project with the day-to-day handling of the core tasks.