Dual impact of organisational change on subsequent exit from work unit and sickness absence: a longitudinal study among public healthcare employees

Abstract

ObjectivesWe investigated work-unit exit, total and long-term sickness absence following organisational change among public healthcare employees.MethodsThe study population comprised employees from the Capital Region of Denmark (n=14 388). Data on reorganisation at the work-unit level (merger, demerger, relocation, change of management, employee layoff or budget cut) between July and December 2013 were obtained via surveys distributed to the managers of each work unit. Individual-level data on work-unit exit, total and long-term sickness absence (≥29 days) in 2014 were obtained from company registries. For exposure to any, each type or number of reorganisations (1, 2 or ≥3), the HRs and 95% CIs for subsequent work-unit exit were estimated by Cox regression, and the risk for total and long-term sickness absence were estimated by zero-inflated Poisson regression.ResultsReorganisation was associated with subsequent work-unit exit (HR 1.10, 95% CI 1.01 to 1.19) in the year after reorganisation. This association was specifically important for exposure to ≥3 types of changes (HR 1.52, 95% CI 1.30 to 1.79), merger (HR 1.29, 95% CI 1.12 to 1.49), demerger (HR 1.41, 95% CI 1.16 to 1.71) or change of management (HR 1.24, 95% CI 1.11 to 1.38). Among the employees remaining in the work unit, reorganisation was also associated with more events of long-term sickness absence (OR 1.15, 95% CI 1.00 to 1.33), which was particularly important for merger (OR 1.31, 95% CI 1.00 to 1.72) and employee layoff (OR 1.31, 95% CI 1.08 to 1.59).ConclusionsSpecific types of reorganisation seem to have a dual impact on subsequent work-unit exit and sickness absence in the year after change.

Work-related moderators of the relationship between organizational change and sickness absence: a longitudinal multilevel study

“…The results of this study show a significantly reduced risk of short-term sickness absence prior to unit-level downsizing and a significantly increased risk of short-term sickness absence after unit-level downsizing. Similar to our previous study [ 16 ], the results only partially corroborate prior research showing a relationship between organizational change and increased sickness absence and reduced health [ 2 , 57 ], also at the unit-level [ 8 – 10 ]. Indeed, in line with Østhus and Mastekaasa [ 12 ], our results did not show increased long-term sickness absence at any stage of the downsizing process.…”

“…Earlier research has often demonstrated increased sickness absence and reduced health related to both organization-level changes [ 2 , 7 ] and unit-level changes [ 8 – 10 ]. For example, studies have found a relationship between unit-level structural changes [ 9 ], and organizational-level merger [ 2 ], and increased probability of > 16 days sickness absence [ 2 , 9 ]; between unit-level merger and unit-level layoffs and increased risk of > 28 days absence spells [ 10 ], and between organizational-level downsizing and increased risk of > 3 days absence spells [ 7 ]. However, noteworthy studies have also found limited and even lower odds of long-term sickness absence (> = 15 and > =4 days) in relation to downsizing [ 11 , 12 ].…”

“…For example, short-term sickness has been defined as periods lasting up to 3 days [ 7 , 20 ], up to 7 days [ 21 ], and up to 42 days [ 22 ]. Similarly, long-term sickness absence has been defined as absence periods lasting more than 3 days [ 7 , 20 ], more than 16 days [ 2 , 9 ], more than 28 days [ 10 ], more than 55 days [ 23 ], and more than 90 days [ 24 ]. In Norway, public hospital employees have the authority to self-certify sickness absence periods lasting 8 days or less.…”

Longitudinal associations between organizational change, work-unit social capital, and employee exit from the work unit among public healthcare workers: a mediation analysis

“…Elevated rates of employee exit (ie, turnover) from the workplace following reorganization have been reported consistently in the literature (7)(8)(9)(10)(11)(12)(13), and studies suggest that organizational changes may have a dual impact on employee exit and health (11,14). Specifically, quarterly employee-exit rates increased from 3.1% to 3.4% after implementation of new healthcare workflows (9), andrelative to no changeexcess employee-exit rates of 15-50% have been demonstrated in the years following merger, splitup, relocation, change of management, and >3 changes performed simultaneously in the healthcare sector (11,12). Such higher employee-exit rates have been associated with adverse psychosocial outcomes among the remaining employees as well as high replacement costs and loss of productivity (15).…”

“…However, there seems to be a downside to organizational changes in terms of poor employee health and well-being (1)(2)(3)(4)(5)(6). Elevated rates of employee exit (ie, turnover) from the workplace following reorganization have been reported consistently in the literature (7)(8)(9)(10)(11)(12)(13), and studies suggest that organizational changes may have a dual impact on employee exit and health (11,14). Specifically, quarterly employee-exit rates increased from 3.1% to 3.4% after implementation of new healthcare workflows (9), andrelative to no changeexcess employee-exit rates of 15-50% have been demonstrated in the years following merger, splitup, relocation, change of management, and >3 changes performed simultaneously in the healthcare sector (11,12).…”