Little room for maneuvering: hospital managers' perspectives on integration of physical exercise during working hours. A qualitative investigation in a grounded theory design

Aim: Health care is challenged by an increasing number of patients and a reduced work force. Workplace health promotion with physical exercise may attract personnel and reduce sick-leave; however, adherence is low. In hospitals, participation is challenged by patient care, and employees describe a lack of support from managers and colleagues. Little is known about managers’ perspectives. Aims were to explore motivation, barriers, and strategies in hospital managers when integrating exercise during working hours. Subject and methods: Middle managers from clinical and non-clinical departments participating in an exercise intervention were interviewed. Through grounded theory with inductive coding and constant comparison categories were constructed, and a theoretical model for implementation was proposed. Results: Thirteen managers described barriers with integration of excise during working hours. A core category, room for maneuvering, comprised categories in four levels: the societal, hospital, department, and personal. Perceived challenges in the health care sector limited the ambitions for workplace health promotion, and strategies for the economic prioritization of exercise were requested. Shift work and difficulty leaving patients affected the solutions made for clinical staff to participate. Managers with a strong physical literacy saw themselves as role models and encouraged participation; however, they hesitated in their engagement and social actions when the room for maneuvering was limited. Conclusions: Middle managers experienced little room for maneuvering when integrating exercise during working hours in clinical practice and hesitated in their engagement and support. A theoretical model proposes actions on all organizational levels when implementing exercise during working hours in hospitals.