Health - Promoting Leadership : A Study of the Concept and Critical Conditions for Implementation and Evaluation

Aim: This thesis aims to describe and analyse the concept of health-promoting leadership, including critical conditions for implementation and evaluation of such leadership. Methods: Three case studies and one conceptual analysis were conducted using qualitative methods, including interviews, observations and document analysis. The qualitative data material in study III was supplemented with quantitative material from a leadership survey. Study I was a qualitative case study of a Swedish industrial company characterized by a low sickness rate, a structure of self-managed teams and an organisational culture that aimed to develop employee skills and influence. Study II was a phenomenograpic study of health-promoting leadership, as described by 20 individuals employed in Swedish municipalities. Study III was a case study of an intervention programme for the development of health-promoting leadership conducted in four city districts of Gothenburg, Sweden. Study IV was a case study on collaboration in workplace health promotion between municipalities in a Swedish region. Results: Study I illustrates how a company leader developed and influenced organisational culture, including the employees’ control over their work situation, participation and personal development. The results of this study emphasise the importance of considering contextual factors when evaluating the role of leadership in promoting health at work. Study II describes health-promoting leadership in three different ways: organising healthpromoting activities, supportive leadership style, and developing a health-promoting workplace. Interviewees frequently linked good leadership in general with good employee health. Study III shows the importance of regarding the development of health-promoting leadership as a contribution to building organisational capacity for a health-promoting workplace. The intervention programme was implemented in an existing management group already producing action plans for workplace health promotion. Such integration is an important part of building organisational capacity for creating and sustaining a health-promoting workplace. Study IV shows that collaborative health-promoting leadership is viewed as a strategy to reduce the sickness rate among municipalities in a region. The study implies that collaborative workplace health promotion should be organised initially on a small scale, giving participants the time and opportunities to develop mutual trust. Moreover, Study IV demonstrates the importance of including participants with differing levels of knowledge and experience about workplace health promotion. Conclusions: Health-promoting leadership can be defined as leadership that works to create a culture for healthpromoting workplaces and values, to inspire and motivate employee participation in such a development. Healthpromoting leadership can also be viewed as a critical part of organisational capacity for health promotion, including managerial knowledge and skills as well as organisational policies and structures that support a healthpromoting workplace. Therefore, leadership involvement in the systematic development of both the physical and psychosocial work environment is important.