{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T06:04:53Z","timestamp":1789538693366,"version":"build-2803163510"},"reference-count":41,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>\u201cHigh-demand sectors\u201d are characterized by substantial physical, psychological, and emotional demands, alongside persistent recruitment and retention challenges. Despite growing interest in shaping healthy organizations, research has largely focused on workplace- or individual-level determinants. The aim of this study was to deepen the understanding of organizational-level health-promoting factors by exploring experienced managers\u2019 perspectives and visions regarding the promotion of a healthy work environment in high-demand sectors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using an exploratory qualitative design, semi-structured digital interviews were conducted with 16 managers from 15 organizations in the transport, health and social care, construction, and retail trade sectors. The data were analyzed using an inductive-to-abductive thematic analysis informed by relevant theory on organizational health-promoting factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The findings indicated that healthy organizations are understood not as products of isolated wellbeing initiatives, but as organizations characterized by an integrated culture of care embedded in structures, routines, and leadership practices. Four interrelated themes were identified: integrated occupational health and safety management system, strategic efforts to promote organizational attractiveness across the employee lifespan, present and supportive leadership focused on employee wellbeing, and effective communication structures. Managers emphasized systematic and participatory occupational health and safety practices, structured onboarding, competence development, flexible accommodation across the employment life course, visible and relationally close leadership, and open, psychologically safe communication as central organizational resources for balancing high demands and sustaining both employee wellbeing and organizational functioning.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This study extends prior research on healthy organizations by highlighting the importance of a lifespan-oriented workforce strategy and by framing an organization-wide culture of care as a unifying condition for resilience, retention, safety, and long-term work ability in high-demand sectors.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1888516","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T05:32:16Z","timestamp":1789536736000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Creating healthy organizations: an integrated culture of care in high-demand sectors\u2014a qualitative study of private-sector organizations in Sweden"],"prefix":"10.3389","volume":"14","author":[{"given":"\u00c5sa","family":"St\u00f6llman","sequence":"first","affiliation":[{"name":"Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University","place":["Uppsala, Sweden"]},{"name":"Department of Occupational and Environmental Medicine, Uppsala University Hospital","place":["Uppsala, Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fredrik","family":"Molin","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University","place":["Uppsala, Sweden"]},{"name":"IPF, The Institute for Organizational and Leadership Development, Uppsala University","place":["Uppsala, Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristina","family":"Eliasson","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University","place":["Uppsala, Sweden"]},{"name":"Department of Occupational and Environmental Medicine, Uppsala University Hospital","place":["Uppsala, Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,16]]},"reference":[{"key":"ref1","volume-title":"Occupational Safety and Health in Europe: State and Trends 2023","year":"2023"},{"key":"ref2","first-page":"16","volume-title":"The European Framework for Psychosocial Risk Management","author":"Leka","year":"2008"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1037\/1065-9293.58.3.129","article-title":"The path to a healthy workplace: a critical review linking healthy workplace practices, employee well-being, and organizational improvements","volume":"58","author":"Grawitch","year":"2006","journal-title":"Consult Psychol J Pract Res"},{"key":"ref4","volume-title":"Creating Healthy Workplaces: Stress Reduction, Improved Well-Being, and Organizational Effectiveness","author":"Biron","year":"2014"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1177\/0149206307300814","article-title":"Emerging positive organizational behavior","volume":"33","author":"Luthans","year":"2007","journal-title":"J Manag"},{"key":"ref6","first-page":"194","volume-title":"Positive Occupational Health Psychology. Occupational Health Psychology","author":"Bakker","year":"2010"},{"key":"ref7","volume-title":"Positive Factors at Work: The First Report of the Nordic Project","author":"Eriksson","year":"2008"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1186\/1471-2458-14-135","article-title":"Effects of organisational-level interventions at work on employees\u2019 health: a systematic review","volume":"14","author":"Montano","year":"2014","journal-title":"BMC Public Health"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"533","DOI":"10.2147\/clep.S314959","article-title":"Nordic health registry-based research: a review of health care systems and key registries","volume":"13","author":"Laugesen","year":"2021","journal-title":"Clin Epidemiol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1108\/JCRE-10-2015-0028","article-title":"Accommodating new ways of working: lessons from best practices and worst cases","volume":"18","author":"Brunia","year":"2016","journal-title":"J Corp Real Estate"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"565","DOI":"10.1186\/s12913-018-3364-7","article-title":"Workplace wellness: industry associations are well placed and some are ready to take a more active role in workplace health","volume":"18","author":"Marsh","year":"2018","journal-title":"BMC Health Serv Res"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"259","DOI":"10.5271\/sjweh.4238","article-title":"Improving health-promoting workplaces through interdisciplinary approaches. The example of Wisework-C, a cluster of five work and health projects within horizon-Europe","volume":"51","author":"De Moortel","year":"2025","journal-title":"Scand J Work Environ Health"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"309","DOI":"10.1108\/02683940710733115","article-title":"The job demands-resources model: state of the art","volume":"22","author":"Bakker","year":"2007","journal-title":"J Manag Psychol"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"499","DOI":"10.1037\/0021-9010.86.3.499","article-title":"The job demands-resources model of burnout","volume":"86","author":"Demerouti","year":"2001","journal-title":"J Appl Psychol"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"193","DOI":"10.3233\/WOR-2012-1472","article-title":"Organizational factors related to low levels of sickness absence in a representative set of Swedish companies","volume":"47","author":"Stoetzer","year":"2014","journal-title":"Work"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1519981","DOI":"10.3389\/fpubh.2025.1519981","article-title":"Organizational factors behind low sickness absence in Swedish municipalities\u2014an explorative qualitative study","volume":"13","author":"St\u00f6llman","year":"2025","journal-title":"Front Pub Health"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"11","DOI":"10.3389\/fmed.2024.1509023","article-title":"Organisational-level risk and health-promoting factors within the healthcare sector\u2014a systematic search and review","volume":"11","author":"Akerstrom","year":"2025","journal-title":"Front Med"},{"key":"ref18","volume-title":"Measuring Organizational-Level Factors that Promote Healthy Working Conditions and their Long-Term Development","year":"2021"},{"key":"ref19","volume-title":"Risk and Health-Promoting Factors in the Healthcare Sector \u2013 Organisational Factors of Importance to the Health of Employees","author":"\u00c5kerstr\u00f6m","year":"2023"},{"key":"ref20","volume-title":"S\u00e4kerhetskultur I Praktiken: Fr\u00e5n Hinder Till M\u00f6jligheter I Byggbranschen [Safety Culture in Practice: From Barriers to Opportunities in the Construction Industry]","year":"2025"},{"key":"ref21","first-page":"103","volume-title":"Safety Management and Safety Culture in the Construction Industry. National Occupational Injury Research Symposium 2018 (NOIRS 2018)","author":"Dong","year":"2018"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1177\/10519815251334329","article-title":"Assessing safety climate in construction workplaces: a three-step review of individual-level and organizational-level factors","volume":"82","author":"Hu","year":"2025","journal-title":"Work"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1177\/15598276221113509","article-title":"The evolution from occupational health to healthy workplaces","volume":"18","author":"Kirsten","year":"2024","journal-title":"Am J Lifestyle Med"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"442","DOI":"10.1016\/j.ssci.2019.05.052","article-title":"Organisational climate and employee health outcomes: a systematic review","volume":"118","author":"Loh","year":"2019","journal-title":"Saf Sci"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1093\/intqhc\/mzm042","article-title":"Consolidated criteria for reporting qualitative research (Coreq): a 32-item checklist for interviews and focus groups","volume":"19","author":"Tong","year":"2007","journal-title":"Int J Qual Health Care"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"Braun","year":"2006","journal-title":"Qual Res Psychol"},{"key":"ref27","volume-title":"NVivo (Computer Program)","year":"2018"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"1410","DOI":"10.46743\/2160-3715\/2022.5340","article-title":"A guide to abductive thematic analysis","volume":"27","author":"Thompson","year":"2022","journal-title":"Qual Rep"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1136\/oem.2007.033860","article-title":"Incorporating work organisation into occupational Health Research: an invitation for dialogue","volume":"65","author":"Macdonald","year":"2008","journal-title":"Occup Environ Med"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"616","DOI":"10.1037\/0021-9010.90.4.616","article-title":"A multilevel model of safety climate: cross-level relationships between organization and group-level climates","volume":"90","author":"Zohar","year":"2005","journal-title":"J Appl Psychol"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"579","DOI":"10.1348\/096317909X470690","article-title":"Psychosocial safety climate as a precursor to conducive work environments, psychological health problems, and employee engagement","volume":"83","author":"Dollard","year":"2010","journal-title":"J Occup Organ Psychol"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"45","DOI":"10.3390\/safety9030045","article-title":"Leadership and the promotion of health and productivity in a changing environment: a multiple focus groups study","volume":"9","author":"Mi\u00f1o-Terrancle","year":"2023","journal-title":"Safety"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"e0281823","DOI":"10.1371\/journal.pone.0281823","article-title":"Effectiveness of formal onboarding for facilitating organizational socialization: a systematic review","volume":"18","author":"Fr\u00f6g\u00e9li","year":"2023","journal-title":"PLoS One"},{"key":"ref34","volume-title":"Health-Promoting Leadership: A Study of the Concept and Critical Conditions for Implementation and Evaluation","author":"Eriksson","year":"2011"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1016\/j.jsr.2024.04.001","article-title":"What is safety leadership? A systematic review of definitions","volume":"90","author":"Adra","year":"2024","journal-title":"J Saf Res"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1186\/s12912-025-04263-7","article-title":"The effects of leadership on patient safety culture in health care: a systematic review","volume":"25","author":"Althobaiti","year":"2026","journal-title":"BMC Nurs"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1080\/09617353.2022.2035627","article-title":"Leadership styles and safety performance in high-risk industries: a systematic review","volume":"41","author":"Ta","year":"2022","journal-title":"Saf Reliab"},{"key":"ref38","doi-asserted-by":"crossref","first-page":"250","DOI":"10.2307\/2666999","article-title":"Psychological safety and learning behavior in teams","volume":"44","author":"Edmondson","year":"1999","journal-title":"Adm Sci Q"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"694","DOI":"10.1016\/j.aap.2011.09.042","article-title":"Psychosocial safety climate moderates the job demand-resource interaction in predicting workgroup distress","volume":"45","author":"Dollard","year":"2012","journal-title":"Accid Anal Prev"},{"key":"ref40","doi-asserted-by":"crossref","DOI":"10.3310\/hsdr03260","article-title":"Evaluating the Evidence on Employee Engagement and its Potential Benefits to NHS Staff: a Narrative Synthesis of the Literature","volume-title":"Health Services and Delivery Research","author":"Bailey","year":"2015"},{"key":"ref41","volume-title":"Positive Organizational Scholarship","author":"Cameron","year":"2003"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1888516\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T05:32:21Z","timestamp":1789536741000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1888516\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,16]]},"references-count":41,"alternative-id":["10.3389\/fpubh.2026.1888516"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1888516","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,16]]},"article-number":"1888516"}}