”Health promoting teams, relational work and individual strategies of how to

survive in Danish psychiatric work-places”

Betina DybbroeCentre for Health Promotion ResearchRoskilde University, Denmark

Work-related stress as one of the big challenges for health promotion

A psycho- social A psycho- social approach to the approach to the phenomena:phenomena:a. Psychic wear-a. Psychic wear-out, violation of out, violation of the self, to the self, to experience being experience being externally externally managed managed (Semmers, (Semmers, Prætorius) Prætorius)

b.Lack of b.Lack of possibilities for possibilities for unfolding unfolding professionality professionality and subjective and subjective meaning in work meaning in work (Kristensen, (Kristensen, Olsén, Andersen Olsén, Andersen og Buch)og Buch)

The psycho-social environment of health

Traditional distinctions between sociology, psychology and cultural analysis should be overcome and health promotion should be investigated through studying individuals in relation to others and the socio-cultural context , as a psycho-social environment of health that is structural and interactive at the same time (Siegrist & Marmot 2004).

What is the significance of cooperation in the work place for promoting health?

In psychiatry- long traditions of team work- and strong effectivisation

In ingeneering work- long tradition of project work- and individual performance measurements

In vocational teaching- new team discourse, individual work tradition

”Well-being in teams”

Financed by the Danish Work-Environmental Research Fund

1. jan.2011- 1. june 2014 Three Universities in consortium Multisited- ethnographic field work,

focus-group and life history interviews, policy analyses

Work is organised through teams of two-three, and every professional works in several teams with other professions, and the whole unit works as a team ( 25 people)

75% or more, of work takes place in interrelational spaces, with relational work with clients, colleagues, other institutions and professionals-

Work is highly time-effective, and there is always work ”hanging over” the schedule

High engagement and meaning making in work

Management do not have access to most part of work, and quality is the responsibility of the professionals

There are many emotions displayed in work, between clients and professionals, and between professionals

Ethnographic findings in child- and youth psychiatry: patterns and significant observations

Health…

4 out of 5 have had longer periods of stress

There is very low sick- leave in general but few long term sick leaves – stress and back problems

Everybody likes the ”actual work” Even though sharing work happens al

the time, employees defend teams

Dilemmas and double-bind situations that may create stress:

Professional meaning making and identification with professional ethics-Holding on to interprofessional work processes and team cooperation-Creating quality in working conditions in teams

-And producing standardised solutions on time

-and dividing labour to save time, not sharing responsibility

- Performing individually, but with low quality

In team work - findings

Collaboration:-engagement and pride, and sharing legitimacy-ethical professional meaning making and creativity, playful practice- Containing and managing each others feelings, and those of clients

Sharing work- cooperation:

- standard solutions and individual doubts

Relational cut-off and working more ”on time”

Individual shame and guilt in relation to goals

Healthy collaboration?

Nurses have been especially vulnerable, they take many work loads alone, and doctors have a large turnover

Psychologists are not so vulnerable, they are the group workingmostly in close collaboration in teams

The treatment teams, where everything is done in close collaboration create joy and professional meaning

Hypotheses- (found also in Aronsson,Arneson Gustavsson)

Interacting and creating shared work , means more professionalism and resistance to standardised routinisation

Social support enhances creativity, recognition and visibility in work

In relational and emotional work, working in collaboration can help manage emotions and create meaning