Organisational change requires a proactive focus on the working environment to prevent stress and sickness absence before problems arise

ORGANISATIONAL CHANGE CAN BE both necessary and beneficial. But it can also alter working conditions so significantly that an implementation plan and good communication are not enough. A dedicated focus on the working environment is also needed to support the organisation's core tasks.

All too often, this aspect only receives attention when sickness absence increases, collaboration begins to break down, or key employees leave the organisation. By the time the working environment becomes a priority, the opportunity to prevent problems at their source has often been missed. Instead, efforts increasingly focus on limiting or repairing the damage.

THE OFTEN OVERLOOKED COST OF ORGANISATIONAL CHANGE

Organisational change can improve the way tasks are carried out, clarify responsibilities and create a more sustainable division of labour. At the same time, it changes the demands and resources associated with work. A new organisational structure changes reporting lines and where employees can turn for support. A digital solution may save time in one area while creating additional work in another. A merger can bring professional expertise together while disrupting established working relationships and communities.

And a cost-cutting measure may look straightforward on a spreadsheet: Two positions are eliminated, while the number of citizens requiring services, documentation requirements and deadlines remain unchanged. The work falls to those who remain. New tasks, or new ways of performing familiar tasks, can also create a gap between demands and employees' competencies. Responsibilities become unclear or take longer to fulfil, and emotional demands may increase.

Research has linked organisational change to poorer mental health and, depending on the nature of the change, subsequent prescriptions for psychotropic medication, sickness absence and employees leaving their work units. A Danish study of healthcare employees also found an increased incidence of cardiovascular disease in the following year, associated with changes including management changes and redundancies. These studies demonstrate associations, while causal relationships remain uncertain. Nevertheless, the findings are serious enough to warrant risk assessment before changes begin.

DENMARK'S LARGEST HEALTHCARE MERGER

On 1 January 2027, the Capital Region of Denmark and Region Zealand will merge to form the Region of Eastern Denmark. Approximately 65,000 employees will become part of a single organisation serving 2.8 million citizens. It will be the largest healthcare merger in Danish history.

The aim is to create a more integrated healthcare system and greater equality in health. Meanwhile, patient care and day-to-day operations must continue as new management structures, administrative functions, working procedures and collaborative relationships take shape.

This raises very practical questions: What additional demands will arise while the new organisation is being established? Where might professional traditions, IT systems and working procedures clash? Who will take on new tasks and responsibilities? And what happens to local support and professional belonging when organisational boundaries change?

Organisational changes also affect citizens and patients. When familiar services, contact persons or expectations change, this can trigger uncertainty, frustration and complaints. As a result, the changes may also increase the emotional demands placed on employees.

The Region of Eastern Denmark will also become a single employment area. The vast majority of employees will continue working at their current locations, while tasks, functions and employees may, in exceptional cases, be transferred to other parts of the region. This brings issues such as influence, predictability, commuting time and belonging to a workplace community into play. Proactive risk assessment can help inform organisational decisions, the sequencing of changes and the protective measures introduced along the way.

THE RISKS ARE ALREADY COVERED BY DANISH REGULATIONS

Denmark's Executive Order on the Psychosocial Working Environment identifies factors including excessive workloads and time pressure, high emotional demands, and unclear or conflicting demands. These factors may pose risks to employees' health and safety if they are not adequately prevented.

The risks are therefore covered by existing regulations, but they are addressed under different headings. As a result, organisational change is not explicitly identified as a workplace risk factor that should be assessed while there is still an opportunity to shape the changes.

WHAT CAN WE LEARN FROM SWEDEN AND NORWAY?

In Sweden, the obligation is very clear: When changes are being planned, employers must investigate and assess the risk of illness or accidents. The assessment must be documented in writing.

In Norway, employers must identify potential health risks and assess the consequences for the working environment before restructuring takes place. The assessment must lead to preventive measures before, during and after the restructuring process.

In Denmark, a workplace risk assessment (APV) must be carried out when changes to work, working methods or work processes may affect the working environment. The Danish wording thus links the requirement to the change itself. In our Nordic neighbouring countries, the expectation that risks should be assessed before changes begin is much more explicit. This provides a stronger incentive to act while the changes can still be influenced.

EFFECTIVE PREVENTION FOCUSES ON THE WORK ITSELF

When organisational change leads to uncertainty, sleep problems, conflicts or declining wellbeing, explanations can easily become focused on individuals. Some employees are said to struggle with change. Others are told they need to be more resilient or adaptable. The organisation may offer stress management or individual counselling. Such support can be valuable. But it cannot stand alone if the problems are linked to how the work itself has changed.

Conflicting priorities from two management levels require joint clarification. New tasks require genuine prioritisation. A fragmented workplace community needs new relationships and access to support. And if new demands no longer match employees' competencies, that gap must be addressed through the organisation of work.

The change process itself also requires attention, drawing time and resources away from other tasks. Anger and dissatisfaction may grow, particularly if employees experience a loss of meaning or a widening gap between demands and competencies. If a large proportion of a team experiences strain at the same time, this can weaken the very workplace community that might otherwise provide important support during the transition. In other words, the team must not only manage the change itself but may simultaneously lose some of its capacity to help its members cope with it.

Risk assessment also provides management with a better basis for decision-making. Employees understand working procedures, dependencies, bottlenecks and professional quality requirements that are rarely visible in an organisational chart. Their knowledge belongs in the assessment. A thorough assessment should also consider how the changes affect the preventive measures and protective factors already in place.

Before, during and after

Before the change: Which tasks, roles, relationships and resources will be affected? Where might new or conflicting demands arise? Who risks losing support, influence or opportunities for professional consultation? How can appropriate support be organised throughout the process? And can the pace, sequence or staffing be adjusted before the plan is finalised?

During the change: How are workloads, uncertainty and collaboration developing? Do managers have the time and support needed both to implement the changes and maintain day-to-day operations? How quickly are emerging problems addressed?

After the change: Is the new organisational structure functioning as intended? Have responsibilities and priorities become clear? Have the temporary additional demands disappeared? And what needs to be adjusted or rebuilt?

A MAJOR MERGER REQUIRES STRONG PREPAREDNESS FOR CHANGE

The Region of Eastern Denmark is already taking shape. The merger involves many changes happening in parallel. Some processes will run smoothly, while others will encounter difficulties. That is why attention to the working environment must remain closely integrated throughout the process: What is working? Where are strains increasing? And where is there a need to adjust course?

Most major organisational changes already have financial and legal workstreams, a communication strategy and an implementation plan. Preparedness for change adds a dedicated working environment workstream: Assess risks beforehand. Monitor developments closely throughout the process. And make adjustments as the reality of the changes becomes clear.

Otherwise, the workplace risk assessment risks becoming a post-mortem that merely reveals what went wrong after the damage has already been done.