In 2011, the Swedish Government asked the Swedish Work Environment Authority to develop specific initiatives aimed at preventing women from being excluded from working life due to work-related problems. As part of this task, the Work Environment Authority inspected almost 60 municipal authorities and compared the work environment conditions and organisational prerequisites in female-and male-dominated enterprises. The results were an eye-opener for all those involved in a variety of ways.

The Swedish labour market is largely gender-divided, which means that men and women are to some extent exposed to different risks as regards ill health. Women become ill more often as a result of their work, while men are exposed to more accidents. Women account for a greater proportion of absence due to illness than men, and more women than men are forced to stop working prematurely for health reasons.

It was against that background that in 2011 the Swedish Government asked the Work Environment Authority (Arbetsmil­ jöverket) to develop and carry out specific activities aimed at preventing women from being excluded from working life. This task was carried out during the period 2011–2014 and the aim was to raise the level of knowledge concerning the work environment of women and identify better methods for raising awareness of strain-related work environment risks in the supervisory work.

The Work Environment Authority organised the government assignment as a programme consisting of two projects. These projects were called Sustainable work envi­ ronment with a focus on women (abbreviated in Swedish to "HAK") and Ergonomics in the work environment of women ("EKA").

Within the HAK project, the Work Environment Authority began conducting inspections in spring 2013. These inspections involved comparing the work environment conditions and organisational prerequisites in female-and male-dominated municipal enterprises. A focus was placed on the female-dominated home care service and the male-dominated enterprises within the technical administration.

Almost 60 municipalities were covered by the inspections and around 70 of the approximately 250 Work Environment Authority inspectors took part.

Moving beyond areas of specialism

"We went out in pairs, a man and a woman: one who was accustomed to dealing with care issues and one who was more accustomed to ‘hard issues’ such as machinery and so on. It was a completely new and different way of working. It was a learning experience across the boundaries of the inspectors’ normal areas of specialism", says work environment inspector Marianne Tiborn.

"In many cases, the inspectors encountered expectations that the inspections would result in actual changes, particularly within the home care service. Yet there was also a realisation that changing existing structures, values and attitudes takes time. My view is that the initiative, the group discussion, the follow-up meetings with the presentation of results and so on were all well received by both politicians and administration managements, managers and employees", says the work environment inspector.

One of the municipalities to be inspected was Örebro, which is situated in Central Sweden and has just under 140 000 inhabitants.

Monika Gustavsson and Jenny Nygårds, area manager and unit manager respectively within the home care service, were aware of differences with regard to work environment conditions and organisational prerequisites between their enterprise and the technical administration, but the results of the Work Environment Authority’s inspections were still somewhat surprising.

"It is easy to become blind to short-comings around you. We became aware of the differences that exist. We didn’t think the differences were that great", says Monika Gustavsson.

"The biggest eye-opener was probably the fact that the prerequisites were so different", adds Jenny Nygårds.

One area where the home care service and the technical administration differ greatly from each other is the number of workers for which the first line managers (unit managers) are responsible, and this applies in both Örebro and elsewhere.

"Whereas a manager on the technical side is responsible for 17-20 staff, in the home care service we have 35-45", explains Jenny Nygårds.

Work is now under way to put forward proposals to the municipal board as to how to proceed on the basis of the Work Environment Authority’s report on the conditions.

"The managers in the technical administration and ourselves would like to carry out a pilot project with the same density of managers as they have, in order to see whether it can have an impact on absence due to illness", adds Monika Gustavsson.

There are also major differences as regards financing. The technical administration is largely grant-financed, whereas the home care service is primarily income-financed and operates in a competitive market. "We are only paid for ‘user time’, i.e. the time during which our staff are actually with the people we are helping. Everything else, such as travel, administration and so on, must be covered by the reimbursement. The output is therefore measured week by week."

"We need more part-time staff in order to do the job, but this wouldn’t work from a staff policy perspective. There is a conflict of objectives as we have to fulfil both the budgetary requirements and the municipal authority’s core values", says Jenny Nygårds.

"It’s the same as regards legislation", she says. "The municipal authority is ultimately responsible for the provision of care (under the Swedish Social Services Act) and it is not possible to stop work simply because the time/support that a user has been granted has finished. It is needs that govern what we do. At the same time, we have to comply with the requirements of the Swedish Work Environment Act. Neither law takes precedence over the other; both laws have to be complied with".

Learning from one another

"The work carried out by the home care service is both meaningful and rewarding, but it is also physically demanding and mentally challenging. Part-time sick-leave is the biggest problem. Still, if we look at the results of the employee surveys that have been conducted, our employees and managers are more satisfied than those of the technical administration", says Jenny Nygårds.

"The Work Environment Authority’s inspection initiative has not only revealed differences between the home care service and the technical administration, it has also given rise to a good collaboration. We work with people and have better interpersonal skills; those on the technical side are better at approaching the work environment systematically. We discovered that we could help each other, learn from each other", says the unit manager.

The Work Environment Authority’s inspections were conducted in the form of a group discussion with unit managers from the home care service and the technical administration, and with staff from the home care service and the technical administration. One question which arose on a number of occasions, in different municipalities, was how we can recruit more men in the home care service.

"In the group in which I participated, we talked a lot about the fact that we wanted to recruit more men. This is proving difficult, as many older people do not want to have men help them", says Marie Stuberg. She has a split position within Örebro municipality’s home care service. She works 50% as a nurse and 50% as an operations manager (a fairly recently established support function for the unit managers).

"The question is whether users should be able to choose. Compare the situation with that within the county council, e.g. within emergency care. There, you cannot choose which staff help you. As things stand at the moment, a user can say that they do not want a man to help them with personal hygiene, for example. They are then assigned a woman to deal with showering, which is a more physically demanding job and more for them to do", says Marie Stuberg. "We want a message from above, from the politicians to the users, that we have the staff we have and people willjust have to accept that."

Marie Brorsson is a social democrat and chair of one of Örebro’s two care boards.

"I was at the last follow-up meeting where the Work Environment Authority presented the results of the inspections. It was pleasing to learn that people were relatively satisfied with the work and with the managers, even if the results did indicate that the job was very stressful", she explains.

"We have a gender initiative that has been ongoing for many years. This initiative is in place as regards budgeting and the like and is ‘live’. I think both civil servants and politicians bear it in mind in their work."

"There are plenty of preconceptions amongst both the care staff and amongst us here in the technical administration", says Ann-Marie Grönkvist, unit manager with responsibility for the municipality’s waste management.

"We have now got a dialogue going, and it is important to get away from the ‘them and us’ mindset. After all, we have a common employer and shared objectives. What we are now thinking about is how we can benefit from each other, share our experiences with each other and work across the boundaries."

The male worker is the norm

The comparison of work environment and working conditions in the home care service and technical administrations of the municipal authorities that were inspected showed, among other things, that the home care service is task-based and primarily income-financed, whereas the technical administration is assignment-based and primarily grant-financed.

As with workload, staffing and other resources are not adapted to what the home care service is expected to achieve. On the technical side, the resources correspond relatively well to what has to be done.

The staff in the home care service have little personal control over, or freedom of action in, their work. Coping with the pressure of the job is not easy and almost always stressful. Within the technical administration, the staff have quite a lot of control and freedom of action; they can cope with the pressure of the job even if they do sometimes get stressed.

Around 73% of the managers in the home care service have more than 30 staff. Lack of time, a great deal of administration and many relationship interfaces are characteristic of the situation that these managers face, and they find it difficult to be there when the work is actually carried out and to support the staff. Within the technical administration, only 10% of the managers have more than 30 staff. They have the necessary resources to support the staff; they can be present and manage problems at an everyday level. Common to both areas are deficiencies in the systematic initiatives relating to the work environment, a lack of knowledge concerning the work environment and tender reporting.

"Men and women have different professions and even if they have the same profession, they usually still perform different duties. And if they have the same duties, then the work, tools and equipment are all usually designed around men, as the man is the norm in society", claims Minke Wersäll, one of the project managers.

"The reason behind the differences in occupational ill health between men and women should not be sought in biology, but in everything else", she claims.

The prerequisites for systematic initiatives relating to the work environment are not as good for the female-dominated enterprises. The pattern is the same in virtually every municipality that was inspected, regardless of size. There are differences in traditions, attitudes and values linked to the traditional gender pattern which prevails in society. This has consequences for the work environment.

"Research has shown that a gender-neutral approach to the work environment is generally based around the average male worker and does not indicate how men and women who fall outside the norm are doing at work. In this regard, we have an important task ahead of us. We must continue to highlight how gender is accorded importance in our work processes", says Minke Wersäll.

"The assignment has taught us that it is the way in which the work is organised which determines the risks as regards strain injuries", she continues.

"The gender pattern that prevails in society must be broken in order to bring about sustainable work environments. It takes time to change values, attitudes and traditions; further initiatives are therefore still needed. We are now working in various ways to look at the results of the concluded projects, particularly within our own authority. We need to look at our experiences, learn from them and explore them in more detail in order to ensure that the programme has sustainable effects. Highlighting, comparing and reflecting upon the conditions for men and women will lead to measures that result in a better work environment for everyone. In order to succeed in this regard, it is essential that we have leadership that has a knowledge of gender issues, a manager who can see patterns; and in our director-general, we have such a manager", claims Minke Wersäll.

Since the start of the year, the Work Environment Authority has had a new assignment, for which Minke is project manager. This new assignment could be seen as a direct continuation of the previous government assignment, but the focus is now being placed on psychosocial and organisational factors•.

Special report - Women at work: in search of recognition

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Sweden: labour inspection crusade against exclusion of women from the labour market