Work ability literacy in action: how Finnish leaders are strengthening workplace resilience

In Finland, the concept of work ability literacy, the knowledge and skills needed to understand, support, and strengthen employees’ capacity to work well, is moving from research into real-world practice. Through JACARDI pilot interventions led by the Finnish Institute of Occupational Health, healthcare and social services leaders are being equipped with tools and strategies that help them support work ability, promote recovery, and lead healthier, more resilient work communities.

The Finnish healthcare system has been undergoing changes for several years. In the reform implemented in 2023, healthcare and social services (HSS) were transferred from municipalities to the responsibility of regional authorities known as wellbeing services counties. This brought significant changes to organizational structures and their operations, as well as to the roles and positions of personnel. The healthcare and social services sector has certain profession-specific work strain factors, such as ethical strain, work pressure and shift work. With the reform, employees had some new stress factors to face: new working methods, in some cases new colleagues and a new organization. 

Based on research, work-related stress factors, such as work pressure, job stress, ethical strain, and uncertainty in work, have a significant impact on employees’ well-being. Work stress, shift work and sleep problems related to these increase the risk of cardiovascular diseases (CVD) and type 2 diabetes (T2D). Before the start of JACARDI, in autumn 2023, 38% of Finnish HSS personnel reported lowered work ability and only 35% reported good work recovery. The results are based on the “Mitä kuuluu?” (“How are you?”) study and surveys on well-being at work, conducted for Finnish wellbeing services counties.

Thus, the Finnish Institute of Occupational Health is conducting JACARDI pilots for the Finnish social and healthcare sector aiming to train HSS leaders to better support work ability in their work units. The aim is to increase the work ability literacy of the HSS leaders so that they can support employees who have or are at risk of CVD or T2D, and to support prevention of these diseases. Additionally, the pilots aimed to promote work recovery, health, and work ability through training for so-called work ability partners – employees of the participating work units. These work ability partners are expected to implement tasks that improve work ability in their units alongside their leaders.

What is work ability literacy?
Work ability literacy is defined as the understanding of the demands and the effects of work on one’s health and ability to work, and actions to promote one’s own work ability during work and leisure. 

The concept of work ability literacy was developed by the Finnish Institute of Occupational Health. It builds on health literacy principles and the Work Ability House model. It expands health literacy principles to include the context of work, profession, demands and effects of work on work ability, working conditions, and actions to promote and maintain work ability. By promoting work ability literacy, workplaces can better support employees in maintaining health and work capacity, ultimately contributing to improved labor participation for those living with cardiovascular disease and diabetes.

Put on your own oxygen mask first before assisting others

Starting the work at the end of 2023 and at the beginning of 2024, representatives of wellbeing services counties pointed out that the leaders are stressed and overworked, and the first priority should be to enhance their work ability and work recovery. Thus, the training program is initially aimed at helping leaders strengthen their work ability and recovery skills. 

The leaders began the training online with four group discussions designed to help them reflect on their situation, identify what is going well and where there is room for improvement, and try out methods to enhance one’s work recovery and work ability. The aim was also to provide opportunities for peer support. Subjects of the training included work recovery, work ability and work ability literacy, lifestyle factors, stress management techniques and psychological flexibility.

Results from the “Mitä kuuluu?” (“How are you?) study and well-being at work surveys conducted for Finnish wellbeing services counties: 
Research of the HSS personnel in Finland shows that around 50% of unit supervisors, managers and executive management experience high job demands. However, the management also has high decision latitude, which is why supervisors and managers tend to experience less work stress. 49% to 50% of social and health care unit supervisors, managers and executive management have felt insecurity due to workload exceeding their capacity during the years 2024 and 2025. In autumn 2025, the experiences of uncertainty due to the threat of job termination were most common among managers and executives (32%) as well as unit supervisors (31%).

After the training to improve leaders’ work recovery and work ability, the focus shifts to training aimed at motivating them and teaching them skills to lead work recovery and work ability in their work units, as well as facilitating and supporting the development efforts of their work communities. An important aim is to integrate actions improving work ability into the work processes and structures, such as regular meetings and other recurring events.

The aim is also to support discussions about work ability at the workplace, focusing on work rather than individual work ability. Leaders receive training on how to conduct one-on-one discussions and group discussions. They are also trained on psychological safety within the work community. One of the main tasks in the training is to build an annual cycle for improving work ability. 

Simultaneously, with leaders training, there is ongoing partner training for work ability. Work ability partners are employees of the work units, who received training to improve work ability and work recovery in the work units together with the leaders. These partners delivered tasks and challenges for individuals and the community to improve work recovery, health behaviors and mental wellbeing.

The work ability annual cycle as a solution for implementation

The work ability annual cycle compiles key actions that promote work ability and recovery within the workplace community. It helps leaders to systematically lead the development of work ability and recovery. The work ability annual cycle makes the promotion of work ability a shared responsibility, not just for supervisors or management. This applies to both the planning and implementation. The work ability annual cycle integrates the promotion of work ability and recovery into the daily life of the workplace, highlighting small daily actions. Annual planning facilitates operations amidst everyday busyness. It encourages supervisors to reflect on and discuss work ability, and to seek common solutions and development methods with their teams.

Permanent structures for work ability support

During the JACARDI project, the Finnish HSS sector has faced new challenges due to economic difficulties. HSS organizations have been undergoing downsizing. Challenges in HSS in Finland seem to continue, and the need for work ability support is extremely important now and in the future. Permanent structures for work ability support are needed.

Leaders in HSS play a significant role in promoting work ability and work recovery of the work unit. To lead work ability in their units in an ever-changing work environment, they must first take care of themselves. The work ability annual cycle, developed together with the workplace community, can be utilized by embedding the theme of work ability into workplace meetings and thus keeping the theme alive systematically throughout the year.

Learn more at the Finnish Institute of Occupational Health’s dedicated project page.

References 

Duchaine, C. S., Aubé, K., Gilbert-Ouimet, M., Vézina, M., Ndjaboué, R., Massamba, V., Talbot, D., Lavigne-Robichaud, M., Trudel, X., Pena-Gralle, A.-P. B., Lesage, A., Moore, L., Milot, A., Laurin, D., & Brisson, C. (2020). Psychosocial Stressors at Work and the Risk of Sickness Absence Due to a Diagnosed Mental Disorder. JAMA Psychiatry, 77(8), Article 8. https://doi.org/10.1001/jamapsychiatry.2020.0322 

Gan Y, Yang C, Tong X, Sun H, Cong Y, Yin X, Li L, Cao S, Dong X, Gong Y, Shi O, Deng J, Bi H, Lu Z. Shift work and diabetes mellitus: a meta-analysis of observational studies. Occup Environ Med. 2015 Jan;72(1):72-8. doi: 10.1136/oemed-2014-102150. Epub 2014 Jul 16. PMID: 25030030.  

 Gao, Y., Gan, T., Jiang, L., Yu, L., Tang, D., Wang, Y., … Ding, G. (2019). Association between shift work and risk of type 2 diabetes mellitus: a systematic review and dose-response meta-analysis of observational studies. Chronobiology International, 37(1), 29–46. https://doi.org/10.1080/07420528.2019.1683570  

Hackett RA, Steptoe A. (2017) Type 2 diabetes mellitus and psychological stress – A modifiable risk factor. Nature Reviews Endocrinology, 13(9), Article 9. https://doi.org/10.1038/nrendo.2017.64 

Kivimäki M, Kawachi I. (2015) Work Stress as a Risk Factor for Cardiovascular Disease. Current Cardiology Reports, 17(9), 74. https://doi.org/10.1007/s11886-015-0630-8  

Laitinen J, Selander K, Ervasti J, ja Kivimäki M. 2024. ”Mitä kuuluu hyvinvointialueiden työhyvinvoinnille 2023”. https://urn.fi/URN:ISBN:978-952-391-148-2. (in Finnish)

Laitinen J, Selander K, Nikunlaakso R, Ervasti J. 2025. ”Mitä kuuluu sosiaali- ja terveydenhuollon työhyvinvoinnille 2024”. https://urn.fi/URN:ISBN:978-952-391-199-4 (in Finnish)

Laitinen J, Nikunlaakso R, Ervasti J, ja Kivimäki M. 2026. ”Mitä kuuluu hyvinvointialueiden työhyvinvoinnille 2025”. https://urn.fi/URN:ISBN:978-952-391-231-1 (in Finnish

Lamiani, G., Borghi, L., & Argentero, P. (2017). When healthcare professionals cannot do the right thing: A systematic review of moral distress and its correlates. Journal of Health Psychology, 22(1), 51–67. https://doi.org/10.1177/1359105315595120 

Li W, Chen Z, Ruan W, Yi G, Wang D, Lu Z. (2019) A meta-analysis of cohort studies including dose-response relationship between shift work and the risk of diabetes mellitus. European Journal of Epidemiology, 34(11), 1013–1024. https://doi.org/10.1007/s10654-019-00561-y 

Nyberg ST, Fransson EI, Heikkilä K, Ahola K ym. (2014) Job Strain as a Risk Factor for Type 2 Diabetes: A Pooled Analysis of 124,808 Men and Women. Diabetes Care, 37(8), 2268–2275. https://doi.org/10.2337/dc13-2936 

Rosa D, Terzoni S, Dellafiore F, Destrebecq A. (2019) Systematic review of shift work and nurses’ health. Occupational Medicine, 69(4), 237–243. https://doi.org/10.1093/occmed/kqz063 

Rudkjoebing, L. A., Bungum, A. B., Flachs, E. M., Eller, N. H., Borritz, M., Aust, B., Rugulies, R., Rod, N. H., Biering, K., & Bonde, J. P. (2020). Work-related exposure to violence or threats and risk of mental disorders and symptoms: A systematic review and meta-analysis. Scandinavian Journal of Work, Environment & Health, 46(4), Article 4. https://doi.org/10.5271/sjweh.3877 

Salvagioni DAJ, Melanda FN, Mesas AE, González AD, Gabani FL, Andrade SM. de. (2017) Physical, psychological and occupational consequences of job burnout: A systematic review of prospective studies. PLOS ONE, 12(10), e0185781. https://doi.org/10.1371/journal.pone.0185781 

Sun M, Feng W, Wang F, Li P, Li Z, Li M, Tse G, Vlaanderen J, Vermeulen R, Tse LA. (2018) Meta-analysis on shift work and risks of specific obesity types. Obesity Reviews: An Official Journal of the International Association for the Study of Obesity, 19(1), 28–40. https://doi.org/10.1111/obr.12621 

Xi J, Ma W, Tao Y, Zhang X, Liu L, Wang H. (2025). Association between night shift work and cardiovascular disease: a systematic review and dose-response meta-analysis. Frontiers in Public Health, 2025:13, 1668848. doi: 10.3389/fpubh.2025.1668848 

 Xie F, Hu K, Fu R, Zhang Y, Xiao K, Tu J. Association between night shift work and the risk of type 2 diabetes mellitus: a cohort-based meta-analysis. BMC Endocr Disord. 2024 Dec 18;24(1):268. doi: 10.1186/s12902-024-01808-w. PMID: 39696306; PMCID: PMC11653577.