Health-Promoting Managerial Work: A Theoretical Framework for a Leadership Program that Supports Knowledge and Capability to Craft Sustainable Work Practices in Daily Practice and During Organizational Change
The aim of this article is to describe a theoretical framework, i.e., theoretical underpinnings and pedagogical principles, for leadership programs that support managers' evidence-based knowledge of health-promoting psychosocial work conditions, as well as their capability to apply, adapt, and craft sustainable managerial work practices. First, the theoretical framing is introduced, i.e., a system theory that integrates key work conditions with a practical perspective on managerial work and
... gerial work and organization. Second, pedagogical principles and measures for leaders' training in integrated handling across system levels are described. Last, we present summarized results from an intervention study applying the theoretical framework and pedagogical principles. The complexity of interactions among different factors in a work system, and the variety in possible implementation approaches, presents challenges for the capability of managers to craft sustainable and health-promoting conditions, as well as the evaluation of the program components. Nevertheless, the evaluation reveals the strength of the program, in providing holistic and context-sensitive approaches for how to train and apply an integrative approach for improving the work environment. Societies 2017, 7, 12 2 of 18 Studies of sustainable organizational developments point to the importance of a management approach that integrates the perspectives of effectiveness and quality of performance with the development of beneficial working conditions    . Sustainable work systems have been defined as the interaction between dimensions of intentions and the handling of actors, and social and cultural conditions. Each dimension and the interaction between the dimensions, are important for function, well-being, and capability within all levels (individual, group, and organizational)  . The concept of sustainable work systems aligns with the Ottawa Charter's principles of health promotion (1986), which emphasize that health is interrelated with our living conditions, including our working conditions, as well as that health is a critical resource for social, economic, and personal development. Thus, health-promotive perspectives at the workplace focus mainly on work resources that support employees and their managers in maintaining and improving their health, achieving their work goals, and developing personally, as well as handling significant risk factors and conditions  . High-quality leadership is considered to be a key condition for organizing better health-promoting working conditions     . The most important factors and conditions for improving workers' health, well-being, and engagement have been identified through literature reviews [4, 11, 12, 14, 15] , and the evidence-based knowledge is rather robust. However, the interactions between individuals, groups, and organizational factors have often of stronger magnitude than single factors [13, 16] . Therefore, managerial work based on the knowledge of how to handle the interactions of multi-component factors and conditions across organizational levels, is crucial for sustainable development. Managers also need organizational preconditions, competence, and strategies for meeting challenges in complex social and organizational working conditions, as well as for taking leadership in building the capacity for more sustainable working conditions    . This was also recently acknowledged by regulations in the Swedish Work Environment Authority (2015: 16). The interrelated factors associated with sustainable health imply that leadership programs which focus on building job resources and health-promoting conditions should be based on more holistic theories of sustainable working conditions. System theory requires the holistic consideration of factors, conditions, and relationships between individual challenges in the context of conditions at home and in the workplace (micro-level), within the rules, systems, norms, and values of the organization (meso-level), and with regard to impacts from society (macro-level)  . System theories have been developed in many nearby fields, e.g., ergonomics and human factors  , and occupational health  , to establish, support, and maintain healthy environments, acknowledging the interconnectedness between individuals, the workplace, and organizational and societal conditions. Recently, Bone (2015) applied the socio-bio-ecologic model of Bronfenbrenner (1999) to occupational health, to support a broadened view of workplace well-being. Her model  was complemented with the chronosystem level, i.e., focusing on time aspects including developments over time that may start at one level, but have implications for all levels. However, managers operate in a day-to-day world that is often far from theoretical ideas and models, and they face many difficulties in translating, interpreting, integrating, and actually implementing regulations and health objectives. This may explain why managers struggle with developing managerial practices that support sustainable work conditions [17, 18, 24] , despite years of occupational and public health research, which has identified the most important factors constituting risk for negative health outcomes across occupations and countries [4, 15] . Therefore, we applied more practical perspectives of managerial and institutional work in the development of a program that supports managers' knowledge and capability to craft sustainable work practices while also taking their own work situation into account. Inspired by Bone's (2015) application , we further developed the chrono-socio-bio-ecological model with a practice and handling perspective on managerial work and organizing    , and applied the model to focus on health-promoting and sustainable leadership. The model forms the theoretical framework for the leadership program.