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Sustainable work & occupational safety and health – Emma Brulin's research group

The research group investigates 1) organizational and individual risk and protective factors in the psychosocial work environment, 2) effects of shift and night work, and 3) symptom development and rehabilitation in stress-related ill health. We have a particular focus on employees within healthcare and how the work environment and health of the personnel affect the quality and safety of healthcare.

Part of the:

The healthcare system faces significant challenges as the population increases and ages, while healthcare resources gradually decrease. To cope with these challenges, healthcare services must establish a sustainable work environment where employees maintain good health, remain in their profession, and provide quality-assured care. To create a sustainable and healthy healthcare system, factors causing and perpetuating ill health among different occupational groups within healthcare need to be identified and addressed.

Projects

Organizational and Individual Risk and Protective Factors in the Psychosocial Work Environment

Healthcare employees work within a complex organization where individual, interpersonal, organizational, political, and societal factors directly or indirectly affect employees. Much of the research conducted so far has almost exclusively focused on the relationship at the individual level, i.e., between psychosocial working conditions and work-related well-being. Organizational-level demands have been systematically excluded despite studies indicating that organizational factors affect the relationships between demands/resources and health at the individual level. In this project, we research the links between organizational factors and employee health and working conditions.

 

Effects of Shift and Night Work

Shift and night work are prerequisites for providing 24/7 care. They pose challenges for workers and entail risks of accidents, ill health, and sick leave. In this area, we deepen our understanding of how shift and night work lead to ill health and how schedules should be designed to reduce the risk of ill health.

 

Symptom Development and Rehabilitation in Stress-Related Ill Health

The prevalence of sick leave due to stress-related ill health is high among healthcare employees. To develop effective preventive measures, we are building better knowledge of symptom development in stress-related ill health and develop methods for early detection. We have also developed and are clinically testing a treatment method for returning to work after sick leave due to stress-related ill health.

 

Relationship between Staff Work Environment and Health and Quality and Safety in Healthcare

Poor working conditions, mental ill health, sick leave, and high turnover have many consequences, including loss of production and increased societal costs. These problems also lead to significant personal suffering for those affected and can directly impact patient care and healthcare provision. Therefore, in this project, we research the link between workplace issues, employee health, and Quality and Safety in Healthcare.

Mental illness and organisational and social work environment in the construction industry – what works in practice?

Mental illness is currently the leading cause of sick leave in Sweden and is becoming increasingly common in the construction industry as well, where high workload and time pressure are contributing factors. To address this growing problem, Emma Cedstrand, Ph.D. at ̽»¨¾«Ñ¡, is leading a research project that aims to develop guidelines to improve the organisational and social work environment for both white-collar and blue-collar workers in the construction sector. The project is a collaboration between four large Swedish construction companies and the research group at KI. The project will begin with an observational study to map industry mental illness trends. After the first study, the research will focus on how work environment issues are handled in different construction projects within the four companies and how this work affects the employees' mental health. The goal is to identify guidelines that can contribute to a sustainable work environment and reduce mental illness in the industry. The project runs until September 2027.

Publications

All publications from group members

  • Preprint: SPRINGER SCIENCE AND BUSINESS MEDIA LLC. 2025
    Blease C; Hagström J; Sanchez CG; Kharko A; McMillan B; Gaab J; Brulin E; Locher C; Hägglund M; Riggare S; Mandl KD
  • Article: ANNALS OF FAMILY MEDICINE. 2025;:240179-150
    Brulin E; Teoh K
  • Article: INTERNATIONAL JOURNAL OF NURSING STUDIES. 2025;164:105017
    Nilsson T; Lashari A; Gustavsson P; Harma M; Bigert C; Bodin T; Maclachlan L; Norberg AL; Brulin E
  • Book chapter: TOWARDS SUSTAINABLE GOOD HEALTH AND WELL-BEING. 2025;p. 149-165
    Landstad BJ; Kvangarsnes GH; Larsson S; Brulin E
  • Article: HUMAN RESOURCES FOR HEALTH. 2024;22(1):77
    Gynning BE; Karlsson E; Teoh K; Gustavsson P; Christiansen F; Brulin E
  • Review: JOURNAL OF NURSING SCHOLARSHIP. 2024;56(6):790-801
    Ahlstedt C; Moberg L; Brulin E; Nyberg A
  • Article: JOURNAL OF OCCUPATIONAL MEDICINE AND TOXICOLOGY. 2024;19(1):42
    Christiansen F; Gynning BE; Lashari A; Zuberbuhler JP; Johansson G; Brulin E
  • Article: HUMAN RESOURCES FOR HEALTH. 2024;22(1):70
    Fernemark H; Karlsson N; Skagerstrom J; Seing I; Karlsson E; Brulin E; Nilsen P
  • Article: WORK AND STRESS. 2024;38(4):352-372
    de Lange AH; Teoh K; Fleuren B; Christensen M; Medisauskaite A; Lovseth LT; Solms L; Reig-Botella A; Brulin E; Innstrand ST; Lundmark R; van Dorssen P; Baathe F; Heijkants C; Furunes T; Correia I
  • Article: SCANDINAVIAN JOURNAL OF WORK ENVIRONMENT & HEALTH. 2024;50(7):519-526
    Gynning BE; Christiansen F; Lidwall U; Brulin E
  • Article: ALCOHOL AND ALCOHOLISM. 2024;59(6):agae077
    Thern E; Blindow KJ; Jonsson E; Brulin E; Landberg J; Bodin T; Elling DL
  • Article: JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE. 2024;12(9):2364-2371.e5
    Ekstrom S; Hernando-Rodriguez JC; Andersson N; Murley C; Arfuch VM; Merritt A-S; Janson C; Bodin T; Johansson G; Kull I
  • Article: OCCUPATIONAL MEDICINE-OXFORD. 2024;74(5):355-363
    Christiansen F; Gynning BE; Lashari A; Johansson G; Brulin E
  • Conference publication: OCCUPATIONAL MEDICINE-OXFORD. 2024;74(Supplement_1):0
    Elling D; Bodin T; Honkaniemi H; Kreshpaj B; Davis L; Nevriana A; Matilla-Santander N; Wegman DH; Wadensjö E; Kjellberg K; Luleå NL-B; Thern E
  • Journal article: OCCUPATIONAL MEDICINE-OXFORD. 2024;74(Supplement_1):0
    Thern EIO; Blindow K; Jonsson E; Brulin E; Landberg J; Bodin T; Elling DL
  • Review: BMC PUBLIC HEALTH. 2024;24(1):1788
    Blindow KJ; Cedstrand E; Elling DL; Hagland M; Bodin T
  • Preprint: RESEARCH SQUARE. 2024
    Gynning BE; Sidoli EF; Blindow K; Cedstrand E; Sabbath EL; Brulin E
  • Article: OCCUPATIONAL AND ENVIRONMENTAL MEDICINE. 2024;81(4):201-208
    Thern E; Elling DL; Badarin K; Rodriguez JCH; Bodin T
  • Article: SCANDINAVIAN JOURNAL OF PRIMARY HEALTH CARE. 2024;42(2):276-286
    Sandberg HM; Tjulin A; Brulin E; Landstad BJ
  • Preprint: RESEARCH SQUARE. 2024
    Gynning BE; Karlsson E; Teoh K; Gustavsson P; Christansen F; Brulin E
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Staff and contact

Group leader

All members of the group

Databases

The group is responsible for and manages two databases:

Swedish Longitudinal Study of Work Environment and Health in Healthcare (LOHHCS)

The LOHHCS cohort consists of a representative sample of physicians, nurses (including midwives and radiology nurses), and assistant nurses working in healthcare in Sweden. It is an open cohort replenished with newly graduated physicians, nurses, and assistant nurses before each data collection. The study is conducted annually starting in 2022 (for physicians, the study began in 2021). Register data from various registers, including sick leave registers, are linked to the survey responses.

The questionnaire contains four parts:

  1. Occupational Background: education and occupational background, working hours, and schedule.
  2. Work Environment: validated questions about psychosocial and physical work environment and working hours.
  3. Health: health and healthy habits.
  4. Demographics: marital status and family situation.

 

Working Hours and Health in Healthcare in Sweden (ATOHS)

ATHOS is a cohort of 60,000 healthcare employees in the Stockholm region between 2008 and 2022. An update is planned to include other regions in Sweden.

ATHOS contains detailed information on working hours obtained from register-based wage data for each workday during the study period. Health outcome variables, including cancer, cardiovascular diseases, childbirth outcomes, mental disorders, and sick leave, are obtained from regional and national registers.

We use longitudinal multivariate analysis to examine working hours and shift types in relation to health outcomes and sick leave.

SustaInHealth network

Aim

The core aim of the SustaInHealth network is to foster interdisciplinary collaboration, bringing together researchers from various fields to gain a more holistic understanding of and contribute to resilient and sustainable healthcare systems through cutting-edge research. The network's goal is to develop an interdisciplinary strategic research agenda with two main objectives: I) identifying research gaps and strategies to jointly address these gaps and II) ensuring the transfer of knowledge into successful and sustainable interventions and practices.

The network shares experiences and works toward finding research-based solutions to problems and challenges in healthcare, aligning the three pillars of Healthy Healthcare. The network seeks to ensure knowledge transfer into successful and sustainable interventions and practices and demands stakeholder involvement and the exchange of ideas between researchers.

The SustaInHealth network harnesses the power of interdisciplinary collaboration between researchers with different disciplinary backgrounds to identify and develop strategies to address research gaps. This network meets regularly, both online and in person.

If you are interested in participating, please get in touch with us.

Background

A holistic understanding of and contribution to resilient and sustainable healthcare systems stems from the idea that it is necessary to acknowledge that patients are situated in a dynamic environment consisting of healthcare workers, colleagues, organisational and professional cultures, structures, politics and financial systems. A resilient and sustainable healthcare system acknowledges the importance of a healthy staff as a key factor for safe and quality of care.

The SustaInHealth network is therefore guided by the healthy healthcare framework, acknowledging the link between the complex and interdependent relationships between three healthcare service dimensions known to impact healthcare, referred to as the three pillars: i) Healthcare professionals' health and well-being, ii) Organisational practice, and iii) Quality of care.

Healthcare professionals' health and well-being emphasise the importance of supporting their physical, mental, and emotional well-being. Ensuring that professionals are healthy and resilient is key to maintaining an effective healthcare system. Organisational practice focuses on healthcare organisations' structures, policies, and processes. Effective organisational practices promote efficiency, coordination and collaboration, and a healthy working environment that supports both staff and patient outcomes. The final pillar, Quality of care, refers to the standards of care provided to patients. High-quality care is achieved when healthcare systems ensure safety, patient-centeredness, effectiveness, and equity in service delivery.

These pillars are interconnected, each influencing and supporting the others to enhance healthcare performance. Additionally, these pillars need to be seen from the perspective of a digital transition and global movement that further the need for a holistic understanding of the healthcare system. Numerous initiatives and research projects are currently examining different aspects of healthcare organisations. Still, these efforts often focus on one or, at most, two of the pillars, resulting in a fragmented body of research. Thus, while there is a breadth of research investigating the healthcare context, it is quite fragmented and scattered.

The SustaInHealth network, therefore, aims to be a platform where researchers, stakeholders and practitioners can meet and learn from each other. The idea with SustaInHealth is to synthesise efforts across all three pillars, creating healthcare that is resilient and sustainable in the long term.

SustaInHealth is funded by FORTE (2024-02230)

Contact

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Emma Brulin

Senior Lecturer
Institute of Environmental Medicine
Keywords:
Data Mining Epidemiology Health Care Service and Management, Health Policy and Services and Health Economy Health Services Occupational Exposure Show all
Kevin Skogh
23-01-2025