8287803 Evaluating quick return restrictions on sickness absence in healthcare employees: a difference-in-differences study

<h3>Background</h3> Quick returns in shift work have been linked to adverse health effects. The 2020 reform of Working Time Act in Finland limited rest periods under 11h in irregular shift work. <h3>Material and Methods</h3> This observational longitudinal study, analysed as a quasi-experiment, used a difference-in-differences regression analysis with unit and time fixed effects and robust standard errors to evaluate the changes in quick returns and sickness absence following the 2020 reform. We assessed changes in sickness absence from 2019 to 2021 across hospital work units. The study compared units mandated to limit quick returns (Treatment group; 416 units, over 20,500 employees, 72% in nursing) with units that had low levels of quick returns prior to the reform and did not need to limit quick returns (Control group; 37 units, over 1700 employees, 70% in nursing). <h3>Results</h3> Simple regression analysis with fixed effects for unit and time over 2019–2020 showed a less pronounced increase in sickness absence by −0.7 percentage points (95% confidence interval [CI]: −1.3 to −0.1) for the treatment group compared to the control group, indicating a 13% lower rate of sickness absence. For the period 2019–2021, the estimate was −0.5 percentage points (95% CI: −1.0 to 0.0). When incorporating covariates and inverse probability weighting, the estimates were more substantial with narrower confidence intervals: −0.9 percentage points (95% CI: −1.4 to −0.3) for 2019–2020, and −0.6 percentage points (95% CI: −1.2 to −0.1) for 2019–2021. <h3>Conclusion</h3> The problematic characteristics and consequences of shift work can be controlled, through legislation also. Policymakers and managers should evaluate and adjust the frequency of quick returns to achieve the potential effects on employee well-being, health, and operational efficiency, which in this study was indicated by the reduction in sickness absence.