Understanding decision-making in large organisations around implementing workplace initiatives to mitigate the impact of musculoskeletal diseases: A qualitative study

BackgroundRheumatic and musculoskeletal diseases (RMDs) are a leading cause of absenteeism and presenteeism. Workplace initiatives to mitigate impacts of RMDs can have benefits for organisations and beyond. Decision makers within organisations require evidence to inform decisions around planning and investing in workplace initiatives for RMD. These decisions, taking place in disparate organisations within complex systems, are context-specific and nuanced.ObjectiveThis qualitative study aimed to understand how decisions are made within large organisations to mitigate the impact of RMDs on worse work outcomes and what evidential requirements facilitate decision-making.MethodsSemi-structured online interviews were conducted with participants representing key individuals in large organisations who make decisions within the workplace: directors (n = 6); line managers (n = 4); and managers with a health remit (n = 8) from both for-profit (n = 9) and not-for-profit (n = 9) organisations in the UK. Interview data were subject to thematic analysis using a Framework approach informed by systems thinking.ResultsEvidential requirements were discerned in light of interconnected system elements. Routinely collected sickness absence data was used irrespective of for-profit or not-for-profit status. Other sources of evidence included informal discussions. Line managers-a first point of contact-liaised with internal/external colleagues to facilitate interventions. They were responsible for collating evidence to inform decisions. Implications for workers at risk of or living with RMD were highlighted.ConclusionsThe importance of line managers in decision making around RMD has been highlighted. Bespoke line manager training which took account for organisation-specific factors could improve decision making to help mitigate impacts of RMD.