Hanna Öfverström

Syftet med projektet är att generera kunskap om hur den organisatoriska och sociala arbetsmiljön (OSA) kan förbättras inom byggbranschen. Vi vill bl.a. undersöka varför vissa arbetsplatser lyckas med OSA-arbetet medan andra inte gör det och om det finns en koppling mellan å ena sidan ett gott OSA-arbete och å andra sidan, krav, resurser och stress. Detta är något som inte undersökts tidigare. Vidare trycker en nyligen publicerad utvärdering av föreskriften Organisatorisk och social arbetsmiljö (AFS 2015:4) påbehovet av branschspecifika verktyg för att lyckas skapa en god OSA. Resultatet av vårt projekt avser bidra med sådana branschspefika verktyg och riktlinjer. Projektet är ett samarbete mellan tre stora byggföretag i Sverige

Peab, Skanska och JM samt flera branschrelevanta organisationer och Arbetsmiljöverket. Syftet med att involvera dessa aktörer är att säkerställa relevans och användbarhet samt på ett effektivt sätt sprida lärdomar från projektet ut i verksamheterna. Vi tror att det finns goda möjligheter att resultaten kan komma till praktisk nytta. Avslutningsvis bidrar även projektet med kunskap om förekomst av och trender för psykisk ohälsa för olika grupper (tjänstemän/yrkesarbetare) inom byggbranschen i Sverige. Kunskap som i hög utsträckning saknas och som kan ligga till grund för riktade insatser. Projektet har en flermetodansats där kvalitativa och kvantitativa metoder såsom enkäter, intervjuer och registerdata kommer att användas för att besvara frågeställningarna.

Research problem and specific questions: This program sheds light on the implementation challenges involved in changing health determinants to achieve improvements in public health. The aim of the program is to explore implementation challenges related to decision-making and practical implementation of structural interventions as well as preventive programs and their implication for health equity. The program combines expertise in public health and implementation science with the goal of identifying ways to close the gaps in health among societal groups. Data and method: The program builds on complexity theory to reflect that implementation of public health initiative involves multiple, often interdependent, stakeholders, decisions and activities. The program has three phases. The first is an exploratory qualitative phase including interviews with local politicians and administrators (in municipalities and regions) to understand how they make decisions about public health, including how the needs of different societal groups and conflicting societal goals are prioritized. The second phase involves several naturalistic experiments of local implementation and de-implementation cases investigating barriers and facilitators to these processes, strategies to overcome barriers, management of fidelity and adaptations and implementation outcomes. This entails a participatory approach in which the local actors implement initiatives and participate in collecting data. Analysis includes qualitative and quantitative cross-case comparisons. In the third phase, implementation capacity-building interventions aimed at decision-makers and implementers of public health initiatives are designed and evaluated. Relevance and utilisation: Although Sweden has one of the most developed welfare systems and ambitious public health policy goals, health inequalities are growing and systematic inequalities in health remain in almost all health outcomes and determinants. Implementation of structural interventions and preventive programs are needed, yet implementation research shows that these too often fail to reach, retain and deliver value to those most in need. If implementation between groups diverge, implementation of public health initiatives may increase rather than decrease health inequalities. This program addresses this contradiction by developing new knowledge on how public health initiatives can be implemented for disadvantaged populations. Plan for program realisation: This multidisciplinary program takes a participatory approach involving three research environments at two universities. A total of 63% of the costs cover salaries for the 12 participating junior and senior researchers. Operating costs (15%) include reference group reimbursement, communication activities and data collection.

To ensure the provision of health and welfare services of high quality, safety and cost-effectiveness, managers and professionals are required to implement changes such as new methods and guidelines. Despite this, managers and staff have little training and support in implementation. Lack of implementation capacity is particularly problematic since the new national knowledge-based management structure has the utmost goal that all professionals should use the best knowledge within every encounter with clients and patients. The management structure will provide knowledge-based methods but lacks a plan for how the health and welfare workforces should implement these in practice.The proposed project aims to investigate how implementation capacity can be built within health and welfare organisations by evaluating team training in evidence-based implementation.The Building Implementation Capacity (BIC) intervention builds on the Behaviour Change Wheel and considers implementation as a matter of behaviour change. The intervention will be provided to a total of 90 teams of both managers and staff working in health and welfare organisations. The intervention provides the participating teams with knowledge and skills in applying a systematic implementation model. A longitudinal mixed-methods evaluation will be applied to investigate the extent to which the intervention results in success in practical implementation and the extent to which it develops implementation capacity in the teams and the wider organisation.The uniqueness of this project is that it focuses not only on the implementation of a particular method or guideline, but also evaluates the development and sustainability of implementation capacity in participating organisations. As such, this project aims to contribute to understanding how work teams can build sustainable implementation capacity, and in doing so, contributing to fulfilling the goal of the new national knowledge-based management structure.

A large number of interventions used in health care lack evidence of effectiveness and may be unnecessary or even cause harm and should therefore be de-implemented. Lists of these types of ineffective (i.e., low-value) practices have become common, but these lists have little chance of leading to improvements without sufficient knowledge regarding how de-implementation can be carried out. Professionals’ decisions regarding de-implementing these practices are not only a matter of scientific evidence

the puzzle is far more complex with relational, economic and personal interests playing a role.This project aims to investigate how health care professionals navigate the landscape of their individual preferences, conviction of scientific evidence, patient requests and health care system goals to make decisions regarding de-implementation of low-value care.This multidisciplinary project is carried out in four steps, starting with an explorative design to study tensions health care professionals encounter when dealing with low-value practices. Thereafter, a factorial survey experiment will be applied to empirically test how professionals carry out decision-making while considering the tensions. A framework for professionals’ decision-making concerning de-implementation and intervention suggestions will be developed to guide de-implementation of low-value care in health care practice. The project contributes by providing new knowledge on how and why professionals make decisions related to low-value practices. It offers a wider contribution to the research on implementation in terms of closing the gap between research and practice. This project’s novel contribution lies in approaching this gap from the perspective of the care practices used in health care that lack evidence of effectiveness rather than studying how new evidence can be implemented.