Managers in Health and Social Care Lack the Literacy to Keep Workforces Working

Health and social care systems across the world are running on empty. In Finland, where twenty-one government-funded wellbeing services counties deliver primary and specialized services and employ more than 220,000 professionals, the strain is measurable: 35 percent of health and social care workers report decreased work ability, and only 39 percent feel they recover well from work. Large-scale retirements and declining entry into the professions compound the shortage. A new qualitative study published in the International Journal of Public Health argues that a crucial, overlooked piece of the workforce puzzle sits with the people in the middle of the hierarchy: managers, and specifically how well they understand work ability itself.

Researchers from the Finnish Institute of Occupational Health and Aalto University interviewed 49 managers working in Finnish health and social care organizations between June and October 2024, as part of the EU-funded JACARDI research project. The interviews, conducted via Teams and lasting between 40 and 105 minutes, produced 740 pages of transcripts. Participants ranged from supervisors of fewer than ten employees to leaders of more than fifty, and their backgrounds varied widely: only 20 of the 49 had formal management education, and managerial experience spanned from under five years to more than twenty. The researchers analyzed the transcripts using deductive content analysis built around four dimensions of a concept they call work ability literacy: knowledge, understanding, motivation, and practical choices.

Work ability literacy is a young concept. It was originally defined as understanding the demands and effects of work on one’s health and work ability, and acting on that understanding to promote it. The researchers extended the idea by borrowing from health literacy, the ability to access, understand, appraise, and use information and services to maintain good health. In the workplace version, this means not only knowing what supports work ability but having the motivation and competence to act on that knowledge, whether the work ability in question is one’s own or that of employees. Managers, as representatives of the employer with legal responsibilities for employee safety, sit at a pivotal point in this system.

The findings reveal a strikingly fragmented picture. Managers drew their knowledge from three main sources: organizational information channels, personal experience and education, and interactions within the work community. Yet the organizational channels varied enormously, both between organizations and even between units of the same organization. All participating organizations had established work ability guidelines, and managers could call on occupational health services, human resources specialists, and in some cases dedicated workplace wellbeing planners. But many managers lacked the ability, skills, or opportunities to apply these policies in practice. Although organizations provided quantitative and qualitative indicators such as wellbeing surveys and workplace assessments, managers mostly relied on sickness absence alerts, the bluntest instrument available.

Experience, it turns out, was the most trusted teacher. Managers repeatedly emphasized know-how accumulated through years of work, describing it as learning the hard way. Practical experience sharpened their skill in engaging with employees and interpreting signs of strain, and it boosted their self-efficacy in handling sick leave processes. Educational backgrounds were diverse, but a consistent pattern emerged: managers whose views aligned with a broad understanding of work ability were also the ones who described further training as important for themselves. Interaction within the work community served as a third knowledge channel, with trusting relationships, daily conversations, personal observation, and attentive listening helping managers anticipate changes in an employee’s capacity. Team size, however, limited this channel; some managers reported so many subordinates that personal contact with each was nearly impossible.

Why did managers bother at all? Motivation clustered around three justifications: ensuring effective organizational operations, fulfilling managerial responsibilities, and supporting employee wellbeing. Many framed work ability support as the most important part of their job and pointed to their legal duty as employer representatives. Yet uncertainty shadowed this duty. Managers were unsure where their responsibilities began and ended, noted that they are not entitled to information about an employee’s health unless the employee discloses it, and some felt a conflict between the obligation to support work ability and the means actually available to them. A minority argued that work ability is primarily the individual’s own responsibility. Notably, the importance of work ability for care quality and patient safety went unmentioned in the interviews.

How managers understood work ability itself varied in ways that mattered. Some saw it primarily as an individual attribute, a matter of physical and mental health, motivation, and private-life habits such as exercise, sleep, and nutrition. In the data, this narrow view was clearly associated with weaknesses in other dimensions: managers who saw work ability as a personal trait often did not recognize supporting it as part of their own role. Most managers, by contrast, emphasized balancing personal resources against job demands and adapting work when needed. A third group articulated a holistic view, recognizing that work ability can be maintained, enhanced, and even created through how work is organized, oriented, and led. But even these managers drew a sharp line when the subject turned to themselves: leadership and the work environment became irrelevant to their own work ability, which they treated as a purely personal matter of lifestyle and limiting workload.

Practical choices followed the same pattern. Managers described modifying work content through shift planning, reduced hours, lighter duties, and ergonomic support; referring employees to occupational health services; offering social support through trust, presence, and listening; enhancing professional skills through training and career discussions; and promoting healthy lifestyles and recovery. What stands out is the timing. Corrective measures for diminished work ability dominated, and managers frequently described actions as proactive even when work ability had already declined, suggesting that proactivity was understood mainly as preventing prolonged sickness absence or permanent work disability rather than preventing decline in the first place. Experiences with occupational health services ranged from smooth collaboration to months-long waits for appointments, including with work psychologists, which managers identified as a light solution often delayed by half a year.

The study’s discussion zeroes in on the most concerning finding: even managers who were competent and committed, and who viewed employee work ability holistically, addressed their own work ability only through personal actions. The authors note that no previous studies directly support this observation, though earlier work among occupational health nurses showed a similar tendency to equate work ability literacy with health, personal attributes, and life situation. The different dimensions of literacy proved tightly intertwined, so gaps in knowledge rippled into narrow understanding, weakened motivation, and reactive decision-making. The researchers also raise questions about whether employers’ administrations and higher leadership possess adequate understanding of work ability and its strategic management, given how dependent support measures are on organizational structures.

The conclusion is a call for a systemic shift. To move from individual-focused, corrective measures toward preventive support at the work community and organizational level, organizations must recognize the importance of work demands and their effects, support managers at the strategic level, and provide adequate resources, clearly defined goals and responsibilities, and more education on the contents of work ability literacy. The authors emphasize skills and possibilities to prevent work disability as especially urgent. With workforce shortages in health and social care an urgent global challenge, the study suggests that extending working lives and sustaining an adequate labor force may depend less on heroic individual resilience and more on whether the managers who hold the system together are equipped, educated, and resourced to understand work ability before it fails.

Subject of Research: Work ability literacy among managers in the health and social care sector – a qualitative study

Article Title: Work ability literacy among managers in the health and social care sector – a qualitative study

Article References: Korkiakangas, E., Paavolainen, M., Selander, K., Nikunlaakso, R., Kaartinen, M., Koivisto, T., Nevanperä, N., & Laitinen, J. (2026). Work ability literacy among managers in the health and social care sector – a qualitative study. International Journal of Public Health, 71, Article 1610014. https://doi.org/10.3389/ijph.2026.1610014

Image Credits: AI Generated

DOI: 10.3389/ijph.2026.1610014

Keywords: work ability literacy, health and social care managers, occupational health, qualitative study, Finland, workforce shortage, work disability prevention, managerial competence, employee wellbeing, health literacy, public health, JACARDI project