{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T14:09:21Z","timestamp":1784038161738,"version":"3.55.0"},"reference-count":39,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T00:00:00Z","timestamp":1783987200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T00:00:00Z","timestamp":1783987200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100016378","name":"Technische Universit\u00e4t Dortmund","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100016378","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Health Serv Res"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The German healthcare system faces a persistent shortage of skilled professionals, particularly in nursing, driven by demographic change, high workloads, and challenging working conditions. In response, new working-time models such as the four-day workweek have emerged as potential solutions to improve job attractiveness, employee well-being, and staff retention. This study examines different models of the four-day workweek as social innovations within the healthcare system, focusing on their development, implementation, and implications across institutional levels.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A qualitative research design was employed, with 27 semi-structured interviews conducted between August 2024 and February 2025. Participants included nurses, physicians, hospital managers, political stakeholders, and representatives from unions and professional organizations. Data were analyzed using qualitative content analysis following Mayring, supported by MAXQDA software. The analysis was guided by a theoretical framework on the institutionalization of social innovations, examining processes across micro-, meso-, and macro-levels. An iterative approach was used to link empirical findings with theory.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Three main working-time models were identified: part-time work, the compressed four-day workweek (constant weekly hours distributed over fewer days), and the reduced four-day workweek (fewer hours with unchanged pay). Part-time work is widely used as an individual coping strategy but entails financial risks. The compressed model is more easily implemented within existing regulatory and financial structures and is perceived as attractive, yet it does not significantly reduce workload and may intensify daily strain. The reduced model shows greater potential for improving well-being and retention but faces substantial challenges related to staffing, financing, and regulatory constraints. Overall, findings reveal tensions between normative expectations of high-quality care and limited resources, leading to paradoxical outcomes across system levels.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The compressed four-day workweek represents an adaptive but limited innovation, while the reduced model holds transformative potential but requires systemic change. Effective implementation of new working-time models in healthcare depends on coordinated action across institutional levels, including supportive financial, regulatory, and organizational frameworks.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12913-026-15099-5","type":"journal-article","created":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T01:16:35Z","timestamp":1783991795000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Exploring the different models of the four-day workweek as social innovations in Germany\u2019s healthcare system"],"prefix":"10.1186","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-5412-2863","authenticated-orcid":false,"given":"Katharina","family":"Hast","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,14]]},"reference":[{"key":"15099_CR1","unstructured":"Destatis. 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In German sociology, obtaining formal approval from an ethics committee is not mandatory for all types of research. The ethics committee is intended to assist researchers, particularly in cases of uncertainty. Against this background and given the low risk associated with this study, no approval was sought from an external ethics committee (German Research Foundation (DFG). (2023). FAQ: Humanities and Social Sciences.\n                      \n                      . Accessed 25 April 2026.). The research involved semi-structured interviews with non-vulnerable healthcare professionals, not with patients or other vulnerable groups. All participants received written information about the project and signed a consent form prior to the interview. The consent form stated that no special categories of personal data would be collected, that the interviews would be audio-recorded and transcribed by the researcher, that the audio files would be deleted after transcription, and that all directly identifying information would be removed or pseudonymized prior to analysis and publication. Participation was voluntary and could be withdrawn at any time without negative consequences. Personal contact information was stored separately from the research data, protected from unauthorized access, and will be deleted upon completion of the dissertation, unless participants have expressly consented to longer-term storage for potential follow-up contact. In accordance with the DGS Code of Ethics (Deutsche Gesellschaft f\u00fcr Soziologie (DGS) & Berufsverband f\u00fcr Soziologie in Deutschland (BsiD). (2017). Ethik-Kodex der Deutschen Gesellschaft f\u00fcr Soziologie (DGS) und des Berufsverbandes f\u00fcr Soziologie in Deutschland (BsiD).\n                      \n                      . Accessed 25 April 2026.), participants were not exposed to any harm or risks beyond those of everyday life, and confidentiality and anonymity were strictly maintained throughout the entire research process.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"978"}}