Article open access publication

Dual impact of organisational change on subsequent exit from work unit and sickness absence: a longitudinal study among public healthcare employees

Occupational and Environmental Medicine, BMJ, ISSN 1351-0711

Volume 75, 7, 2018

DOI:10.1136/oemed-2017-104865, Dimensions: pub.1103978049, PMC: PMC6035486, PMID: 29760173,



  1. (1) Department of Occupational and Environmental Medicine, Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen, Denmark.
  2. (2) University of Copenhagen, grid.5254.6, KU






OBJECTIVES: We investigated work-unit exit, total and long-term sickness absence following organisational change among public healthcare employees. METHODS: The study population comprised employees from the Capital Region of Denmark (n=14 388). Data on reorganisation at the work-unit level (merger, demerger, relocation, change of management, employee layoff or budget cut) between July and December 2013 were obtained via surveys distributed to the managers of each work unit. Individual-level data on work-unit exit, total and long-term sickness absence (≥29 days) in 2014 were obtained from company registries. For exposure to any, each type or number of reorganisations (1, 2 or ≥3), the HRs and 95% CIs for subsequent work-unit exit were estimated by Cox regression, and the risk for total and long-term sickness absence were estimated by zero-inflated Poisson regression. RESULTS: Reorganisation was associated with subsequent work-unit exit (HR 1.10, 95% CI 1.01 to 1.19) in the year after reorganisation. This association was specifically important for exposure to ≥3 types of changes (HR 1.52, 95% CI 1.30 to 1.79), merger (HR 1.29, 95% CI 1.12 to 1.49), demerger (HR 1.41, 95% CI 1.16 to 1.71) or change of management (HR 1.24, 95% CI 1.11 to 1.38). Among the employees remaining in the work unit, reorganisation was also associated with more events of long-term sickness absence (OR 1.15, 95% CI 1.00 to 1.33), which was particularly important for merger (OR 1.31, 95% CI 1.00 to 1.72) and employee layoff (OR 1.31, 95% CI 1.08 to 1.59). CONCLUSIONS: Specific types of reorganisation seem to have a dual impact on subsequent work-unit exit and sickness absence in the year after change.


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