What Makes a Difference? Exploring Organizational Initiatives and Conditions for a Favorable Psychosocial Work Environment in Swedish Primary Healthcare.

Background: The psychosocial work environment in healthcare is widely recognized as challenging. High workload, stress, and poor work-life balance contribute to negative health outcomes for healthcare workers. Swedish primary healthcare faces similar issues, yet efforts to address them have focused primarily on individual-based interventions, such as stress management. Research on organizational initiatives remains limited, despite their greater potential for achieving long-term, sustainable improvements. Aim: This study aims to explore characteristics of primary healthcare units where organizational initiatives to improve the psychosocial work environment have been successfully carried out. Methods: A multiple case approach was used, allowing various cases to be investigated and enabling identification of similarities and common patterns across the units. Results: Four main categories and 16 subcategories were identified, capturing key factors that contribute to a favorable psychosocial work environment in primary healthcare through organizational initiatives. The main categories are engaged leadership, an open workplace climate, conditions for improvement, and a structured work organization. Conclusion: This study identifies key characteristics of primary healthcare units that contribute to creating a favorable psychosocial work environment in Swedish primary healthcare. These elements promote inclusivity, balanced change processes, and staff involvement in decision-making. The findings underscore the need for further research on managerial challenges and effective strategies for staff recruitment and retention.