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ULS - Unidade Local de Saúde em Portugal
Building an Organisational Health Strategy in One of Portugal’s Largest Public Healthcare Organisations
Context
The organisation analysed is the largest Local Health Unit in Portugal, integrating hospital care and primary healthcare across thirteen geographically dispersed locations. This diversity of clinical settings, professional groups, and operational contexts makes it challenging to build an integrated view of employee experience and organisational health.
At the time of the assessment, it was undergoing a demanding transformation. The integration of previously independent structures created the need to progressively align processes, management practices, leadership approaches and work organisation systems that had evolved differently over time, adding adaptation challenges for teams already facing high service demand, and frequent exposure to emotionally demanding situations.
The Challenge
The absence of comprehensive, organisation-wide psychosocial risk data limited the organisation's ability to develop a consistent evidence base for decision-making in this area. Without reliable indicators, it was difficult to know which factors were most strongly associated with employees' working conditions and wellbeing, identify priority areas, or assess how organisational changes were affecting the workforce, particularly where diverse professional realities coexisted across thirteen locations, two levels of care, and eleven distinct professional groups.
The challenge was not to identify isolated problems, but to build an integrated perspective capable of distinguishing factors inherent to healthcare delivery from those that could be influenced through management, work organisation, or organisational policies.
Approach
A mixed-method assessment combined quantitative and qualitative data. The quantitative component used the COPSOQ II – Copenhagen Psychosocial Questionnaire to assess psychosocial risks, with 3,341 professionals participating, representing 32.8% of the workforce. The qualitative component included 74 interviews and 14 focus groups, providing a deeper understanding of organisational dynamics, operational challenges, and the factors shaping employees' daily experiences. Triangulating both sources helped contextualise the findings and uncover the mechanisms behind the observed patterns.
To ensure representativeness, a mobilisation strategy combined institutional communications, digital campaigns, awareness materials, and engagement from local leadership. The outcome was the organisation's first structured set of psychosocial risk and organisational health indicators, and a baseline for future monitoring.
Key Findings
The assessment covered professionals across all 13 sites and 11 professional groups, capturing clinical, technical, operational, and support perspectives. The 32.8% participation rate provided a robust base to identify meaningful patterns in an organisation of this scale.
Three psychosocial demands emerged as particularly relevant: high emotional demands, high cognitive demands, and intense work pace, reflecting a context in which professionals are regularly exposed to human suffering, uncertainty, and rapid decision-making. Combined with organisational change and new operating models, these demands characterise a particularly challenging work environment.
Health and well-being indicators also varied across groups. Early-career professionals showed greater vulnerability to burnout indicators. These differences were observed across organisational contexts characterised by variations in professional experience, roles and working conditions. Operational support staff with frequent patient and family contact reported higher exposure to offensive behaviour and workplace violence, highlighting occupational violence as a relevant area for health and safety strategy.
At the same time, several psychosocial resources and positive dimensions of work were identified. Opportunities for development, meaningful work, and role clarity produced positive results, suggesting that many professionals retain a strong sense of purpose and clarity about their contribution to the organisation's mission, resources that may support adaptation and commitment in demanding environments.
Psychosocial Demands
Health and
well-being indicators
Psychosocial Resources
Cognitive
Demands
Emotional
Demands
Work Pace
Burnout
Meaninful Work
Impact
The project's most significant outcome was a structured evidence base on the organisation's psychosocial reality, providing for the first time objective indicators of how risk and protective factors are distributed across professional groups, care settings, and locations.
This supported action plans differentiated by context, professional group, and level of exposure, and gave an integrated view of the organisation's challenges across occupational health, wellbeing, leadership development, and risk management.
The indicators provide a baseline against which future assessments can track changes, support the evaluation of interventions and inform the adjustment of priorities as needs evolve, while segmented information enabled more efficient resource allocation. The organisation moved from a reactive approach towards a data-informed model of organisational health management.
Future Implications
This baseline provides the foundation for integrating psychosocial risk management into the organisation's ongoing monitoring and decision-making processes, letting the organisation track trends, assess interventions, and follow different groups and settings over time. A key lesson was that many challenges stemmed not only from the demanding nature of healthcare work, but also from ongoing transformation and the integration of previously separate structures, separating inherent care factors from those modifiable through management and work organisation.
Crucially, the assessment was conceived not as an endpoint, but as the foundation for targeted preventive action. The evidence generated supports the prioritisation of organisational interventions addressing work design, management practices, leadership, team functioning and other modifiable working conditions.
More than identifying risks, the project built the capability to monitor and manage them systematically, laying the foundations for an integrated health strategy, a key resource at a time when healthcare organisations struggle to retain staff, keep teams sustainable, and maintain quality of care.
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