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BACKGROUND: Occupational Health Service (OHS) is a service that should support employers and employees with theirwork environment. Previous research indicates the need for deeper knowledge about the effect of workplace interventionswith a focus on planning, organizing and designing the workplace to improve work conditions in hospital settings. OBJECTIVE: The aim was to evaluate the outcomes, workplace interventions and intervention strategies in hospital settings. METHODS: A systematic literature review was conducted. CINAHL, MEDLINE, PsycInfo, Scopus, and Web of ScienceCore Collection were searched in September 2021. The Mixed Methods Appraisal Tool was used to evaluate the quality ofthe included studies. Study results are presented through a narrative synthesis. A protocol for this study was registered onthe Open Science Framework. RESULTS: Twenty-six studies, published between 2010 and 2021, were included. These included randomized controlledtrials (RCTs), non-RCTs, and mixed methods reports with moderate to good quality. The results support the use of workplaceinterventions to improve work conditions, health, and well-being in hospital settings. Combinations of different interventions,tailored to the specific organization, were used. Important intervention strategies commonly used in the start-up, evaluation,and intervention of successful workplace interventions, were identified. Using a pragmatist complexity approach in workplaceinterventions can improve outcomes by providing clear intervention strategies and combinations of tailored interventions,related to context specific problems. CONCLUSION: OHS support in workplace interventions with clear intervention strategies will contribute to improve workconditions, health and well-being in hospital settings., Corrected Proof

BACKGROUND:Scientific research has identified a lack of psychometrically well-tested methods for evaluation of the work environment in healthcare settings. The Structured Multidisciplinary Work Evaluation Tool (SMET) questionnaire has been evaluated and has shown good content validity, as well as intra-rater and test-retest reliability. There are, however, still unknowns regarding the psychometric properties. If the SMET questionnaire is to be used in practical occupational health service (OHS) work and scientific research in healthcare settings, further psychometric evaluation is needed. OBJECTIVE:The aim of this study was to gain further understanding of the psychometric properties of the SMET questionnaire when used in research and clinical OHS practice in healthcare settings. METHODS:The psychometric evaluation was conducted using classical test theory (Cronbach’s alpha, explorative factor analysis) and Rasch analysis (measurement targeting, category threshold order, person separation index) on data previously collected in development projects within the healthcare sector. RESULTS:The results support the use of the SMET questionnaire as a psychometrically well-tested method for evaluation of the work environment in healthcare settings. They support the use of the initial 1–10 scale since all 10 steps are used. The results also support the trichotomization procedure since the trichotomized scale captures the construct of the work environment with good measurement targeting and good category threshold order. CONCLUSION:The results of this study support the use of the SMET questionnaire as a psychometrically well-tested method for a broad multifactorial evaluation of the work environment in healthcare settings.

BACKGROUND: The work environment is a complex phenomenon in which many factors interact. Scientific research indicates a relation between the work environment and employee health, staff turnover, patient satisfaction and patient safety. There is a great need for knowledge on how to conduct work environment interventions and practical work environment management to maximize benefits to the employees. OBJECTIVE: The aim of this study is to explore how Occupational Health Service (OHS) support will affect the work environment, sick leave, staff turnover, patient satisfaction and patient safety during and following the Covid-19 pandemic in a medical ward setting. METHODS: Mixed methods evaluation of a concurrent work environment quality improvement project at the Department of Internal Medicine and Geriatrics in a local hospital in the south of Sweden. RESULTS: The mixed methods evaluation of the quality improvement project received funding from FUTURUM - Academy for Health and Care Jönköping County Council and Region Jönköping County and the study protocol was approved by the Swedish Ethical Review Authority. The work environment quality improvement project will continue between May 2020 and December 2021. CONCLUSIONS: The study might contribute to increased knowledge of how work environment interventions and practical work environment management can impact the work environment and employee health, staff turnover, patient satisfaction and patient safety. There is a need for knowledge in this area for OHS management to provide increased benefits to employees, employers and society as a whole. CLINICALTRIAL: INTERNATIONAL REGISTERED REPORT: DERR1-10.2196/34152.

Kartläggning 2015 visade stora problem i arbetsmiljön på kliniken. Förbättringsarbete med Arbetsmiljöenheten som stöd i det systematiska arbetsmiljöarbete påbörjades omgående och har genomsyrat klinikens arbete under åren fram till idag. Strukturerad Multidisciplinär Arbetsmiljökartläggning (SMAK) metoden användes i det praktiska arbetet. Arbetsinsatserna visar stora effekter på sjuktal och möjligheten att rekrytera ny personal.

INTRODUCTION Occupational health service (OHS) is considered an expert function when it comes to supporting workplaces in their systematic work environment management (SWEM). Scientific research shows that OHS is not used as support in preventive SWEM, but instead to support individuals when work related problems are already acquired. Since OHS is not used in preventive SWEM, the knowledge about how to conduct successful SWEM is limited. More knowledge about important implementation factors in this field is needed. OBJECTIVE The aim of this study is to increase the knowledge of how work environment interventions in healthcare settings are implemented and how this implementation affects the outcome. METHODS A systematic literature review with a narrative synthesis. DISCUSSION The results can be used as a guide for how to implement future work environment intervention studies. It can also be used as a guide to practical OHS work, how to support employers and employees inSWEM, or preventive work interventions with a systems approach. Increased knowledge and increased support within the work environment management might be of great value, benefiting employers, employees, the healthcare system and society.

The Certified Nursing Assistant (CNA) is an important part of the workforce in hospitals and nursing homes, whose work includes heavy and repetitive work tasks including patient manual handling. The Structured Multidisciplinary work Evaluation Tool (SMET) questionnaire is an Occupational Health Service method for evaluation of the work environment. The aim of this study is to compare the SMET questionnaire with technical measurements of physical workload in CNAs in a medical ward setting. 16 CNA's participated voluntarily to 8 h of measurements during one workday. Physical workload was measured with surface electromyography and inclinometers, and the work environment was evaluated with the SMET questionnaire during the same working day. Spearman's rho was used in the statistical correlation analysis between measurements. This study shows strong, statistically significant correlations between the items in the SMET questionnaire and measured physical workload, n CNAs.

BACKGROUND: Occupational health services (OHS) are rarely involved in preventive issues and systematic work environment management. The Structured Multidisciplinary Work Evaluation Tool (SMET) questionnaire was created to address the lack of multidisciplinary/multifactorial OHS tools with the aim to be used in preventive issues and systematic work environment management. OBJECTIVES: The aim of this study was to evaluate trustworthiness of the inter-rater reliability in the qualitative analysis of the open-ended items and intra-rater reliability of the self-estimated items in the SMET questionnaire. METHODS: A qualitative comparison of the inter-rater reliability in the qualitative analysis of the open-ended items was performed to evaluate trustworthiness. The intra-rater reliability of the self-estimated items in the SMET questionnaire were analysed with Elisabet Svensson method. RESULTS: Qualitative analysis of the open-ended items showed good trustworthiness. The self-estimated items showed a high percent agreement (PA), 0.98-0.99 in the physically, 0.99 in the environmentally and 0.98-1.0 in the psychosocially demanding items. A low degree of systematic errors and individual variability were found. CONCLUSIONS: The SMET questionnaire shows good trustworthiness and intra-rater reliability and can be used to follow up and evaluate work environmental interventions.

BACKGROUND: Important success factors for the Occupational Health Service (OHS) include services being based on active participation and risk identification from a multidisciplinary/multifactorial perspective. Despite an extensive search, no questionnaire with this approach was found so a new questionnaire was developed at the OHS. The aim of this study was to develop and validate the new questionnaire named Structured Multidisciplinary work Evaluation Tool (SMET) through action research. METHOD: Communicative and pragmatic validity were tested through the development of the questionnaire using action theory and presented in a descriptive portrayal. The Content Validity Index (CVI) was used to test content validity for each item as well as for the questionnaire as a whole. RESULT: Communicative and pragmatic validity were developed and tested over time in four different periods between 2008 and 2014, in 24 clinics (with a total of approximately 1000 employees) in Region Jönköping County. The content validity of the SMET questionnaire as a whole was close to excellent and the validity of the questions regarding physically and psychosocially demanding work factors were found to be excellent. The questions regarding environmentally demanding work factors were found to have a lower, but still good, validity. CONCLUSION: The SMET questionnaire has very good content validity. The pervasive work with the SMET questionnaire also shows good pragmatic and communicative validity.