title: Reorganization increases long-term sickness absence at all levels of hospital staff: panel data analysis of employees of Norwegian public hospitals.
abstract: BACKGROUND
  The Norwegian specialist health service has undergone many processes of reorganization during the last three decades. Changes are mainly initiated to increase the efficiency and quality of health care serving an ageing population under the condition of a diminishing labour supply. The aim of this study is to investigate the effects of reorganization on long-term sickness absence among different levels of hospital staff.
  
  
  METHODS
  The study draws on panel data on employees of Norwegian public hospitals in 2005 and 2007 (N = 106,715). National register data on individual employees' days of medically certified long-term (>16 days) sickness absence were linked with survey measures of actual reorganization executed at each hospital in each year. The surveys, answered by hospital administration staff, measured five types of reorganization: merging units, splitting up units, creating new units, shutting down units and reallocation of employees. The variation in sickness absence days was analysed using random and fixed effects Poisson regression with level of reorganization as the main explanatory variable.
  
  
  RESULTS
  The fixed effects analysis shows that increasing the degree of organizational change at a hospital from a low to a moderate or high degree leads to an increase in the number of days of long-term sickness absence of respectively 9% (95% CI: 1.03-1.15) and 8% (95% CI: 1.02-1.15). There are few significant differences between employees in different education categories. Only physicians have a significantly higher relative increase in days of long-term sickness absence than the control group with lower tertiary education.
  
  
  CONCLUSIONS
  Increased long-term sickness absence is a risk following reorganization. This risk affects all levels of hospital staff.
authors.affiliation: Department of Social Work, Child Welfare and Social Policy, Oslo and Akershus University College of Applied Sciences, Post box 4, St, Olavs plass, N-0130 Oslo, Norway. Mari-Holm.Ingelsrud@hioa.no.
authors.forename: Mari H
authors.initials: MH
authors.lastname: Ingelsrud
mesh_terms: D000041:Absenteeism; D000328:Adult; D005260:Female; D006754:Hospital Restructuring; D006779:Hospitals, Public / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008505:Medical Staff, Hospital; D008875:Middle Aged; D009664:Norway; D016012:Poisson Distribution; D018582:Sick Leave / Q000706:statistics & numerical data*; D013223:Statistics as Topic; D013997:Time Factors