Enhancing individual task performance and productivity: an ethnographic observational study of supported employment among social services clients in Finland

Abstract

Background

The purpose of the study was to investigate the various aspects of employees’ work environment, including their job characteristics; the level of support provided by supervisors, job coaches and coworkers; and their perceptions of job performance and productivity from the perspectives of both employees and supervisors in the context of sustainable employability in supported employment interventions. This study was part of the Finnish Work Ability Programme Evaluation Study (2020–2024).

Methods

This study is theoretically informed by the concepts of specific work ability and sustainable employability, as well as how health affects productivity at the task level—approach. The research is based on qualitative data obtained through ethnographic fieldwork, nonparticipating observing with interaction at work, which includes observing employed individuals in their workplaces. Additionally, we recorded discussions, took photos at work, and conducted interviews with supervisors and job coaches.

Results

The main findings were that persons with disability or decreased work ability were employed in precarious low-productivity work, with limited opportunities for more sustainable employment. Several means from public employment services to decrease the employer’s personnel costs were used. The supervisors appeared to have a strong grasp of each employee’s task-specific productivity level. Supervisors had to adapt their usual tasks to provide extra support for employees, often focusing more on work performance. The role of coworkers and the work community as whole was also important. The personal support of job coaches during the employment phase was crucial, but their role in the workplace was unclear, especially to employers.

Conclusions

To strengthen sustainable careers, the matching of jobs and individuals should be promoted through closer and productivity-oriented cooperation with employers and work communities in vocational rehabilitation and re-employment. The chosen qualitative research strategy, ethnographic fieldwork at work and multi-perspective data collection provided new interpretations of the possibilities for sustainable employability using the Supported Employment method. From the perspectives of both enabling prolonged working careers for employees and providing a clear understanding of task-performance-based productivity to employers, there is a need for more microlevel data on what happens in work and workplaces, particularly the social mechanisms through which results are achieved.

Background

Challenges for the sustainability of national economies and companies’ competitiveness and, at the same time, a shortage of manpower have led to increased inclusion and an inclusive open labour market for policymakers and employer organizations within the EU [1]. Despite this, there is limited evidence of employers systematically adopting these inclusive policies and changing their behaviour in their use of labour [2, 3]. Newer strains of public and active labour market policy have begun to increase interest in the role of employers and employer practices and reflect the common interests of policy makers, employers, and jobseekers with disabilities [4, 5]. These issues need more attention in social and health care services, as they also have an impact on the social determinants of health for working aged people [6].

This study is theoretically informed by specific work ability and sustainable employability—concepts and how health affects productivity at the task level—approach in the implementation setting of the evidence based Supported Employment (SE) measure, and the recruited employees being individuals with disabilities or other decreases in their work ability.

We consider IPS as a specific, quality criteria and evidence-based model within the broader framework of SE. SE measures provide support to individuals with disabilities or other disadvantaged groups to help them secure and maintain paid employment in the open labour market. Individual Support and Placement (IPS) is a model for people with serious mental illness and refers to the evidence-based practice. This SE intervention, guided by IPS quality criteria, had a broader target group, as is often the case in SE interventions [7].

Our theoretical starting point was a broad understanding of work ability as a dynamic relationship between an individual, their work, and its structures such as employers’ facilities and practices. The main factor in the Tengland’s concept of specific work ability [8, 9] is the meaningfulness of average daily tasks at work. In addition to individual factors such as competences, personal means, and sufficient health, Tengland [9] described physical, psychosocial, and organizational environments as factors that meaningfully support the individual. The concept of sustainable employability [10] refers to the individual’s ability and opportunity to obtain a job, keep a job and advance in a career, and the conditions under which an employee can make a full contribution to the work and simultaneously secure their health and well-being. Additionally, the work of recruited people should create value for both the organization and the employee [10]. Both concepts clearly emphasize the emergence of work performance and workability, which are situationally linked to various factors in the work and work environment.

Also, when recruiting people with disabilities, employers do so by keeping productivity expectations in mind. Some employers utilise this cheaper workforce to address short-term labour shortage for tasks where it is otherwise difficult to find staff or tailor jobs or tasks to suit their needs and productivity expectations, with the help of employment instruments such as wage subsidies [11]. Policies and services for individuals with disabilities or disadvantages often have driven them towards any job regardless of quality, and often to low-yielding and low-paying precarious work [7]. MacEachen & Ekberg [12] have argued that instead, we should prioritize decently paid and sustainable employment. In this study, we examine microlevel productivity using the disposition of how health affects productivity by Bevan & Cooper [13]. In their model of three dimensions of health and productivity the dimensions are (1) the labour market participation definition, (2) the reduced workplace productive capacity definition and basically, our interest in this study was (3) the task performance definition, especially how employee ability to work (health) and measures to enable or improve it affects the output side of the productivity equation, whereas the first two dimensions represent the input side of the productivity equation. Along the individual’s task performance, Bevan& Cooper [13] emphasize here also the functions and interactions of management and supervisors. Our interest in this study was the task performance definition, especially how employees’ ability to work and measures to enable or improve it affects the output side of the productivity equation. Along with the individual’s task performance, the researchers emphasize the functions and interactions of management and supervisors [13].

SE and Individual Placement and Support (IPS) are considered vocational rehabilitation (f. ex. [14,15,16] or interventions between health care and public employment services [11, 17]. These approaches aim to personalize services and facilitate swift labour market insertion for people with various disabilities and health problems [18], supporting employment as a new goal for Finnish social services (see Study setting). The SE and IPS approaches should provide professional aid for matching jobs based on job seekers’ preferences and employers’ needs in the process of concurrently searching for competitive employment and health treatments [19]. These approaches have been studied from the perspectives of employment, well-being, and cost-effectiveness outcomes [19,20,21]. The evidence suggests that SE and IPS are effective in improving vocational outcomes such as obtaining a job, days in competitive employment and job tenure compared with other vocational rehabilitation approaches or usual treatment [19, 21]. SE methods have been successful in integrating vulnerable individuals into work: across the 28 RCT studies, 55% of IPS participants, (young) people with severe mental illness, achieved competitive employment [16, 22] when carried out according to the values, standards, and principles of SE or IPS and quality criteria of IPS [23].

The economic impacts of supported employment measures have been studied from the perspectives of earnings, taxpayers, and cost-effectiveness. Typically, through the supported employment method, one is employed temporarily and often part-time. The duration of employment is longer than that of other vocational rehabilitation services, although there is less research on long-term job retention after employment [19]. A meta‐analysis revealed that, compared to control participants, IPS participants gained employment faster, maintained employment four times longer during follow‐up, earned three times the amount from employment, and were three times as likely to work 20 h or more per week [16]. Long‐term studies show that half of all clients enrolled in IPS become steady workers, maintaining employment for 10 years or longer. They also found that significantly higher earnings for IPS clients than for controls persisted over a five‐year period after the two‐year intervention in the U.S. Cost‐effectiveness analyses of randomized controlled trials of IPS have generally revealed that the aggregated costs of vocational and mental health services are no greater and are sometimes significantly lower for IPS than for standard services. IPS is a cost-effective approach to employment [20]. Park et al. [24] noted that IPS as an economic case is conservative, as evidence on the long-term impacts of programs is limited. Additionally, we have been unable to find research specifically addressing the productivity of individuals employed through supported employment from the perspective of employers.

As mentioned earlier, given the comprehensive understanding of work ability as a dynamic relationship between an individual, their work and its structures, employment is affected not only by individual factors but also by factors related to their work and its structures, such as the labour market and employers’ practices. There are many studies on the impacts of SE and IPS. The supply of work and the employer’s role are essential for the outcome; however, according to the review article [7], from the point of view of work and the workplace, SE and IPS interventions have been little studied. There is less research on the quality and opportunities of jobs, the work itself for sustainable working careers and employers’ interests, such as the productivity of these work tasks designed for people with disabilities. In this multiple case study, we address the issue of work tasks at the microlevel within the accurate context of each specific provision of work and, after the individual task performance dimension by Bevan & Cooper [13], how in these cases a decrease in work ability affects work performance and productivity.

Methods

Aim

The aim of this study was to investigate the various aspects of employees’ work environment, including their job characteristics, the level of support provided by supervisors, coworkers, and job coaches, their perceptions of job performance and productivity from the perspectives of both employees and supervisors in the context of sustainable employability in SE interventions. The research questions were as follows:

• 1. What kind of job characteristics, employment contracts, income and tasks did the employees have?

• 2. How did the supervisors, job coaches and coworkers provide support to the employees?

• 3. How did employees, job coaches and supervisors describe the job performance and productivity of employees’ work?

Study setting

The Finnish Government’s employment-related initiative based on Prime Minister Sanna Marin’s Government Programme, The Work Capacity Programme (2019–2023) and its measures, aimed to address existing challenges related to employing individuals with partial work ability. The goal was to remove barriers to employment for individuals with reduced work ability and to enhance services that support their work ability. The program was implemented through initiatives by both the Ministry of Economic Affairs and Employment and the Ministry of Social Affairs and Health [25]. This study was a part of the “Finnish Work Ability Programme Evaluation Study (2020–2024)” [26, 27]. The evaluation study focused on initiatives led by the Ministry of Social Affairs and Health. The program’s measures targeted the unemployed with decreased work ability, focusing on broad solutions to enhance both work ability and employment. The goals included identifying support needs for those whose work ability was decreased, offering personalized and timely services, and encouraging job creation for them. New solutions were explored through experimental projects introducing effective services and operating models. The project included various initiatives that were carried out in 22 government-funded projects throughout Finland.

Our study focused on evidence-based supported employment (SE). The government’s program targeted two groups of Finnish adult social work clients for this intervention: individuals with learning disabilities and long-term unemployed participants in rehabilitative work activities, who had reduced work ability due to disabilities and illnesses. Both the SE intervention and support for employment in the open labour market were new initiatives for Finnish social services. The evidence-based supported employment (SE) was implemented by 20 projects [26]. At the outset of the development work, experts developed 25 quality criteria based on IPS quality criteria [22, 28]. These criteria were adapted to the context of Finnish adult social care and disability services. Also, an IPS criteria-based training was conducted for those engaged in client work.

In this developmental experiment, the target group included long-term unemployed individuals with decreased work ability and those with various disabilities, in addition to individuals with learning disabilities. Selection as a client for the SE measure therefore took place primarily through social and employment services instead of healthcare. In total, 571 participants took part in this measure [27]. The evidence-based SE measure is explained in more detail in Table 1.

Table 1 The evidence-based supported employment measure in The Finnish Work Capacity Programme

Data collection

The research material comprised qualitative data obtained through ethnographic fieldwork and interviews. The aim was to gather data from 6–8 cases, i.e. individuals who had achieved targeted employment outcomes in the competitive labour market through the local projects funded by the national Work Capacity Programme [25] and gained six cases (see The data). Participation in the study was voluntary, and informed consent was obtained from all participants in the study before starting the data collection.

We sought to understand the sociocultural issues of recruiting to and staying at work for people with disabilities in their work and workplace surroundings with ethnography, which seeks to comprehend the sociocultural dimensions of a phenomenon [29]. The objective is to obtain insights that may not be attainable through alternative methods, such as solely relying on interviews or surveys [30]. Following the practices of contemporary ethnographic work organization research, the researchers visited and immersed themselves in the work and workplace without engaging in prolonged fieldwork [31,32,33]. Short-term ethnography is distinguished by its intensity, which contributes to deep and valid forms of understanding. This intensity manifests in three ways: through research encounters, the dialogue between ethnography and theory, and post fieldwork engagements with materials [33]. To align with the underlying assumptions of the research and the intrinsic characteristics of the research material, an insider perspective was used to collect information.

In ethnographic studies conducted within work organizations, a methodological tool that has emerged is “shadowing,” where researchers follow and observe individuals and perform their work [34]. As researchers observe individuals, activities, and interactions in the workplace, patterns begin to emerge, leading to the development of questions and hypotheses based on these observations. It is crucial to maintain objectivity and mitigate observer bias, where researchers unconsciously influence their observations to align with their expectations [30]. Despite researchers’ aim to maintain a distant and passive observational role, the execution of the study unavoidably influenced the work shift and interactions within the workplace. During these periods, researchers engaged in interviews and discussions with both the employee and other individuals. The outcome of this approach can be described as a nonparticipating observer with interaction [35]. Also in our case, numerous spontaneous discussions took place at work without any prompting from the researchers. Additionally, we conducted interviews with supervisors and job coaches.

The study participants were recruited through project managers and job coaches. Project managers were informed about the study via email and given the choice to participate. One manager opted out. After obtaining consent from the project manager, job coaches identified and contacted employees, explaining the research’s objectives and context. When consent from employees was obtained, researchers reached out to their supervisors to ask for their consent and coordinate observations. One employer declined to participate. Coworkers and clients encountered during the observations were also informed about the research. The interviews were arranged via email.

The data were collected between January 2022 and July 2022 in five different cities across Finland. Observations were conducted at the employees’ workplaces or at the locations where the work was performed, for those engaged in mobile or multilocation work. Two researchers participated in each observation session, which occurred twice with intervals of 1–3 weeks. The second observation day followed the same approach as the first. Both researchers observed the entire employee’s work shift and recognized the importance of simultaneous participation to mitigate subjectivity and selectivity in observation.

The researchers documented their observations and took handwritten field notes [34] using a technique called the “two-mode approach” [31, 32, 36]. In the first mode, detailed descriptions of the actions and dialogue were written without interpretation. This included detailed descriptions of encounters and interactions, including information on what occurred, where and when it took place, how it unfolded, who was involved, and the topics discussed among individuals in the field. Additionally, field notes incorporate the employees’ own narratives and interpretations of the events, as well as the emotions, atmospheres, and moods that were perceptible. In the second mode the observing researcher wrote down their subjective and initial interpretations, first impressions, questions, immediate thoughts, reflections, and emotions evoked by the events. It was also noted what was interesting or surprising and what felt important, even if the reasons were not yet clear [36]. Researchers also utilised cameras on their mobile phones to capture various work processes and environments. Conversations were recorded when feasible. The field notes were transcribed immediately or the following day and the transcriptions of the audio recordings as well as the photographs were incorporated into the observation diary.

Supervisors’ interview data (Supplementary File 1) were collected between or during observation days, with web conferencing used in four cases and face-to-face interviews in two cases. The supervisor interviews focused on (1) the adaptation of work for the employee and its success; (2) the level of support needed from the workplace, methods of work ability management, and workplace support utilized; and (3) work performance and productivity. The data gathered from the supervisor interviews were compared to the observations from the first day and used to refine tasks for the second day.

On the first day of observing the first case, we discovered that, contrary to our initial plan, we were missing the perspectives of job coaches in our data. At this point, following the principles of grounded theory data collection [37], it was decided that the data needed to be supplemented with interviews with job coaches to gather more information on job searches, job modifications, and long-term support. The interviews covered the following themes (Supplementary File 2): the client’s vocational profile and employability, job searching, job guidance and orientation, job performance and workplace support, the role of supervisors and coworkers in supporting the employee, interaction with the work community, concluding or terminating job coaching, and opportunities and barriers to implementing quality-based job coaching. The interviews were conducted either via videoconferencing or face-to-face at the interviewees’ workplace.

The observation and interviews were conducted by three female researchers, two of whom are the authors of this article. As a multidisciplinary team, they have extensive experience as researchers and developers in the workplace, collaborating with various stakeholders (see [35, 36]. They possess specialized knowledge in qualitative research methods, including ethnographic studies and observations. Additionally, they received guidance from senior researchers in the field. The researchers had no prior relationship with the employees, or their supervisors involved in the observations or interviews.

The data

The researchers observed two different shifts of nine employed individuals in six different workplaces or work settings. Eight supervisors and seven job coaches were interviewed. A total of 24 participants were involved in the study. The initial group of participants comprised employed individuals who were part of the target demographic for the Work Ability Program and participated in the local initiatives of the projects. The second group of participants comprised supervisors who worked at the workplaces of employed individuals. They acted as immediate supervisors for these individuals, were responsible for their recruitment, and/or oversaw organizing their daily work. The third group consisted of job coaches who had worked or were currently working with these employed individuals.

The data for each case consisted of two observation diaries that included photographs and transcriptions of any recordings made during the workday, as well as supervisor and job coach interviews. All the recordings from the observation sessions and interviews were transcribed by a professional transcriber as a contracted service. For analysis, all the data was pseudonymised [38].

A total of 63 h of observation were conducted in the workplaces, 709 double-spaced pages of filed notes. The transcription of audio recordings made during work hours amounted to 304 pages. The interviews conducted with supervisors and job coaches contributed to 372 pages and 1238 photographs were also gathered (See Table 2).

Table 2 Description of the total material collected in the study case by case

Analysis

The data were analysed in a research question-driven and multi-perspective manner, comparing different materials and cases [39], using data and method triangulation. The study involved observing work in the workplace and work environments using an organizational ethnographic framework [29,30,31, 33].

The research data in this study are inherently context dependent, encompassing various factors such as participants’ own background, the Work Ability Program, the fieldwork setting, the nature of the work itself, and the personal circumstances of the employed individuals. Additionally, the context includes interactions with various actors encountered within the workplace, as well as their thoughts and opinions pertaining to the specific situation being investigated.

Following the observation, the researcher engaged in reflection and immediate documentation, typically completed within one to two workdays after each observation day. Once all the data for each case had been collected, the researchers conducted a data session via an online meeting. In this data session, both inductive and deductive reasoning [40] and within-a-case and across-the-case analysis [41] started. Researchers aimed to establish a common initial understanding, identify differing observations or interpretations. Additionally, three dimensions were utilized as a framework for well-being and productivity, to integrate and refine observations from the performance of individual job tasks, participation in the labor market, and workplace productivity capacity [13]. The researchers also discussed their observations regarding sustainable employment opportunities from the perspectives of meaningfulness of work [42, 43], competencies and strengths, and workplace productivity, drawing on Tengland’s [8, 9] concept of specific work ability. The multidisciplinary team of three researchers collaborated to establish the initial understanding and interpretations. During the discussion, researchers also addressed the data saturation.

The entire multi-perspective dataset was imported into the Atlas.ti software [44] for systematic analysis and categorization. The researchers collaboratively developed classification codes for each of the three research questions. The researchers divided the analysis work among themselves based on the research questions [40]. The quotation reports of classified codes were analysed: one researcher performed the factual analysis of work and job tasks, and the other two researchers structured themes through content and theme analysis. Individual-specific situations were interpreted, and comparisons between cases were made with the goal of producing both practical and theoretical material to classify the data.

After the classification, thematic analysis was conducted for each research question by comparing cases using content analysis. The aim was to identify important, interesting, or recurring themes and their relationships within the data [40, 45] and to understand and interpret the data [39]. Preliminary observations were highlighted through data sampling, which formed the main themes of the results. Continual discussions among the three researchers took place in joint data sessions. The aim of comparing cases was to compare or connect cases within their own contexts and identify the relationships between cases [39]. The theoretical frameworks were utilized to support the data-driven and case-based analysis.

The analytical process was based on case-by-case analysis and multi-perspective descriptions of the cases, and we looked at each case in its own context [40, 45,46,47,48]. The data analysis procedure was a stepwise process, integrating within-case and across-case analysis approaches [40] (see also Fig. 1). All qualitative data were integrated into each case during the within-case analysis process, and we analysed each case in its own context [40]. After that we entered to the across-case analysis based on our RQs [39], where we looked at each case in its context and synthesized within case features and themes across cases. The qualitative features and themes were compiled into main results [39, 40] so that the features of the phenomenon could be detected and identified at the exact level [40]. The qualitative features of the cases were structured [39] so that the features of the phenomenon could be detected and identified at the exact level (see [40]). The complete multi-perspective dataset provided in-depth qualitative knowledge of each case. The team continued analysing and reviewing the multiple datasets again (see [49]), based on both data and theory, that is, according to abductive and retroductive reasoning [50]. All researchers participated weekly in joint analysis sessions side by side for each research question. Typically, they lasted two hours. Two researchers finally concluded joint process writing.

Fig. 1

Flow chart of the analysis process

Results

Job characteristics and tasks

The employees were employed mostly in part-time entry-level jobs in various industries by both private and public employers (Table 3). The jobs were on a fixed-term basis relative to the employment relationships, and the duration of the term varied between 3 and 24 months. The working time varied between 11.5 and 38.15 working hours per week. Two employees worked full-time. The rationale for part-time work highlighted one’s actual ability to work and its alignment to labour demand, making it a targeted solution despite potential negative aspects related to sustainable employment.

Table 3 The employees’ industry and employer sector, job title, duties and working hours

The job was daytime work, and one employee had double shift work. All employees’ work also required on-site presence during the COVID-19 pandemic. Two individuals had found employment in the private sector. In addition, two individuals who had found employment in the public sector had opportunities to extend their fixed-term contracts.

[Researcher]: “Yeah. In addition, how long are you allowed to work here with this contract?”

[Employee]:” Two years...”

[Researcher]: “And is it counted from the beginning of [name of the month]?”

[Employee]: “Yes, that is right. The wage subsidy work started on [date], so it is been two years... In addition, then, [Supervisor] mentioned that usually they continue even after that.” [Case D, observation diary, recording].

The employees were paid in accordance with the salary scales defined by the respective Finnish industry-specific collective agreements. In addition to the salary, five out of nine employees had a permanent disability pension, and two had an adjusted unemployment benefit. The wage earned from work was important to all employed individuals, although it was difficult to predict the outcome of the coordination of earned income and benefits, especially housing allowances. The workplace contexts, job titles, main tasks and working hours are described in detail in Table 3.

The job tasks of the employed individuals were low-skilled tasks, although two individuals had received professional training in the relevant field, while one person had obtained a higher education degree in a different field. Only in one job was a valid driver’s licence required. In these jobs, the required skills can be taught and learned with the guidance of a job coach or through on-the-job training provided by a supervisor and/or coworker.

“By observing, you learn—and then by doing and trying. That is the best way.”

[Case B, observation diary, employee].

Support from supervisors, job coaches and coworkers in the workplace

The critical factor for fluency at work was sufficient support provided by a supervisor or a job coach or, in some cases, by coworkers. In three cases (and with six employees), the precondition for success in the job was daily, continuous, or frequently recurring support from a job coach or supervisor, emphasizing the importance of guidance in the workplace. One employee worked independently. The primary responsibility for guiding the employed individual’s on-the-job learning rested with the workplace, either as a supervisor or, in some cases, a close coworker. Additionally, a job coach participated in the orientation process of the employees in three cases. The amount of time dedicated to this guidance varied significantly. The process of starting a new job often included a work trial period or similar period that was also utilized to evaluate employees’ skills, and adjustments could be made to align tasks with employees’ capabilities and preferences.

[Employee]: “And when it was kind of like that at the beginning, or when I was doing a work trial here, it was kind of like the same thing. but then again, kind of different.”

[Researcher]: “In what way was it different?”

[Employee]: “Well, different in a way that I socialized with the residents and, like, we just went through that with [Job coach] last week, like, […]. yeah. In addition, it is not part of my job description.”

[Researcher]: “Did this clarify when you got the new job description?”

[Employee]: “Yeah, it did clarify. Yeah, it clarified at what time things need to be done.” [Case E, observation diary, recording].

The role of the supervisors varied. They mainly had the same tasks and responsibilities as with all other employees. However, the supervisors realized that they needed to develop new ways to carry out their usual tasks to provide enough support for the employed individual. This involved discussing matters related to the supervisor’s role and responsibilities with the employed individual in a manner that ensured understanding. These discussions covered various aspects, including strengthening workplace skills such as familiarizing the employed individual with workplace practices, adhering to agreed-upon work hours, addressing occupational safety and hygiene practices, explaining sick leave policies, and providing information about occupational health services.

“The same principles apply, so similar things that we go through with anyone else, […] then there are a lot of questions that need to be opened up and made as clear as possible. I have taught a lot, so if they have learned something from this, I have also learned from them along the way. […] And then the client’s voice […] so we listen to them and the issues they bring up, so we take them seriously.” [Case A, interview, supervisor].

Although supervisors were expected to intervene in work-related matters as necessary from the perspective of service or production processes, they often found themselves providing more support and feedback on work performance than usual, requiring additional resources The availability of supervisor support varied across different workplaces. Problems that emerged during job tasks were addressed together with the supervisor or, in one case, with the job coach. For example, one supervisor was committed to supporting the employed individual in their work-based learning for several months. Another supervisor assisted the employed individual with tax-related questions. However, there were cases where supervisors were unable to provide any support to the employed individual due to their inability to allocate any additional work hours.

“There are these big units and shift work, so maybe it is also about having to […] put up with not being able to spend as much time as you’d like with everyone, having conversations and contacts. However, maybe it is just something you have to accept, that you just cannot do it, and then try to, like, do it well enough.” [Case E, interview, supervisor].

While job coaches recognized that all clients benefited from their personalized support during the employment phase, the extent of coaching needed in the workplace differed among individuals. Some individuals did not require ongoing coaching support after successfully securing employment. However, according to the job coaches interviewed, clients receiving disability services typically require more intensive and long-term support, which could extend over several years, with even minor adjustments to job tasks or work organizations necessitating continuous assistance.

The job coach’s role went beyond task instruction and involved guiding the employee in adapting to the workplace culture. They provided insights into unwritten norms, established practices, and appropriate break times during the shift. One job coach also mediated between the employee and other members of the work community. After the employment and orientation phases, the job coach might develop support measures, such as organizing tasks into a structured schedule or providing comprehensive instructions. Some employees benefited from intensive support from the job coach throughout their entire shift. One supervisor proposed that a job coach could assist coworkers in learning how to train others in their job duties.

“Our customization is that […] the work time starts at nine. Because […] [the employee] needs a moment with the job coach every morning. So that is why it does not start at eight. [---] Therefore, like, how to make this work and happen both from our perspective and from [the employee]’s perspective.” [Case A, interview, supervisor].

The division of tasks between supervisors and job coaches was sometimes unclear and were influenced by communication challenges. Supervisors might state that a job coach was not needed during the onboarding phase, leading the job coach to assume that the employed individual would smoothly handle their tasks with the support available in the workplace. Some employers were unaware of the available support options and did not know to seek assistance from the job coach, despite their need for guidance and help in supervising the employed individual. For example, one employee required significant support from the supervisor, and the job tasks were continuously tailored to their needs, with adjustments made over months as the employee gained experience. On the other hand, some supervisors utilised the job coach not only to provide comprehensive support to the employed individual but also as a workplace counsellor for issues related to the work community.

“We have interpreted this, well, this issue in a way that [the immediate supervisor] has been somewhat burdened. Like, if we have called or visited there, it has come across as a bit of frustration, maybe then this issue has come to light. […] However, nevertheless, [the supervisor] did not truly want us there. Therefore, well, this is kind of a paradox in that the service is offered, but then, if it is not accepted, and then, it still burdens the other person, so it is a bit of a challenging situation.” [Case C, interview, job coach].

The jobs required various forms of interaction during a work shift: working alone at a workstation, in pairs or teams, or alone with the clients. When the job task was familiar to the team members, the work proceeded smoothly without verbal interaction. Working alongside or in pairs was one model that supported work-based learning and future job performance. Employees relied on the support of coworkers mostly in cases where there was a problem to be solved or when they needed some help. However, one employee mentioned that asking help was rare, as they did not want to be a burden.

“So, like, I have truly good relationships with everyone. There is no problem. However, but when, um, how to say it, they do their own tasks, I do my own tasks. Then, I get this feeling, you know, like, even though it is never like a big deal to ask. However, then I get this feeling, you know, that I do not want to bother them again. [...] Like, if I ask something like where to find this or that.” [Case D, observation diary, recording, the employee].

In one case, it was coworkers who relied on the assistance of the employee and asked for help during work. Nevertheless, the role of coworkers and the rest of the work community was considered important. One job coach emphasized the role of the work community and stated that despite employees appearing to work independently, the support and approval of the work community are also important for the smooth progress of work.

Job performance and productivity

In four cases, employed individuals were recruited to meet the employer’s defined workforce needs. In two cases, the work was sold to the person ordering the subcontracted work. One of the ideal “win‒win” situations for the employment of a person with disability was described as recruitment where the employer lessens the needed work, i.e., saves costs, and the disabled person receives little wage in addition to their other income.

“Therefore, like, this is basically, you know, an ideal situation where there was a need and, like, the customer wanted it too. In addition, like, it was the customer who actually brought up the need. Therefore, you know, it was clear that there was money to be saved and, you know, the customer would benefit from it by getting paid.” [Case A, Interview, job coach].

In addition to workforce needs, the recruitment of people with disabilities or other difficulties in obtaining employment was guided by a contractual client requirement in one case.

“In each [service unit], [the public buyer of the services] requires that we have people who are challenging to employ, so we need to recruit them. We actually have more of them than what is needed, with the aim of having one such [service unit] assistant in every [service unit].” [Case D, interview, supervisor].

In another case, the employer’s own societal perspective was described in the observation diary:

“[The entrepreneur] shared personal experiences about [people with disabilities] and how, as an entrepreneur, they wanted to help. They mentioned that [the enterprise] is not a charity organization and that making profits is important, but if they have the opportunity to help as an entrepreneur, they want to do so. They expressed how wonderful it is to see someone rise up and take control of their life.” [Case F, observation diary].

The matching of job tasks based on the goals and skills of the employed individual varied. First, the individual was employed based on the employer’s workforce needs, a previously defined task package, and working hours, which were not tailored. Alternatively, the tasks were tailored according to the pace of the employee’s learning on the job during the long training period preceding employment under the supervision of an immediate supervisor.

Subcontracted tasks were also tailored. The selection of subcontracted tasks was based on the employees’ skills, abilities, and ongoing guidance in the workplace. It was typical for tasks to be repeated in a similar manner multiple times during a work shift. In some tasks, attention to detail was necessary, as the specifics of the tasks varied even within repeated tasks. The employed individual had limited autonomy, and their discretion was limited to the specific timing determined by the employer for carrying out a particular task or the order in which they performed different tasks during a work shift.

When working independently, employees aimed to be efficient without compromising the quality of work or making mistakes. For some, keeping the timetable was a constant source of stress. Previous work experience in any field or some form of vocational training supported job performance. Success in some tasks required planning one’s own actions, intertwining different tasks, focused independent work, and responding to ad hoc situations or requests. The intensity of work varied during shifts and between different shifts. Some tasks allowed for autonomy, such as the ability to influence the timing of task completion, while in other cases, the job description needed to be clarified, and autonomy reduced to ensure job performance. In some roles, work was tied to the overall team or workplace’s shared work process and schedule (Table 4).

Table 4 Description of employees’ job titles, task customizations, job performances and productivity, and employers’ subsidies and services

In addition to the SE method, a variety of instruments via public employment services have also been actively used to lower the employment threshold for people with disabilities. All six employers utilized wage subsidies during the employment phase. The use of wage support was justified by the lower productivity of the person’s work.

“Do mates at work ever wonder why that person gets the same pay as me, even though they may not be able to give the same amount of input? And maybe they do not even know that part of their salary comes from wage subsidies, precisely because there are challenges in employing and performing the job, and they may not be able to give a hundred percent effort, and that is okay.” [Case C, interview, job coach].

Additionally, one employer had used a 3-month-long work trial period before recruitment. During the work trial period, the employer does not incur any salary costs.

“Well, one big factor here is that it includes the on-the-job learning section first, so it is kind of like an entrance to those tasks, which does not cost [the employer] anything.” [Case D, interview, supervisor].

Two employers utilized the arrangement subsidy for working conditions, which is specifically intended for accommodating working conditions and for personal guidance and support for performing the work. This subsidy was applied for by employers through public employment services (PESs). Furthermore, in two cases, the employer’s employment threshold was lowered through salary payment arrangements available through PES.

In SE, according to job coaches, demonstrating productivity concretely to an employer recruiting workforce during the job search phase is a critical factor for employment in the open labour market. Their observation was also that especially in disability services, it may be unclear what level of efficiency or productivity working in the open labour market requires from a person with disability or a decrease in their work ability.

“Therefore, like, how can you justify to an employer that, like, I have used the example of a car repair shop […] when you have highly paid car mechanics and engineers there […] Is it worth them to clean the workshop floor […] It costs like 40-50 [€] an hour when that guy cleans the floor. Or would it be more sensible for them to hire someone [with decreased work ability] who works for a lower wage, gets support and stuff […] and then, like, telling the entrepreneurs about it […] so that they understand the financial benefits.” [Case A, interview, job coach].

According to the interviewees, there was also a demand for part-time work.

“Many workplaces, many [entrepreneurs] […] would like an employee who works only 15 hours a week […] they might have […] enough work for just those 15 hours. They cannot offer 40 hours a week […] And the entrepreneur’s [got] positive experiences, their [the employees] motivation to work [has been] better than many who have been working all the time, their attitude is truly good.” [Case B, interview, job coach].

Additionally, public employers also had productivity targets, although they may not have been fully grounded in precise cost calculations.

Individual task-based productivity varied among employees. The employees themselves realistically assessed their own productivity as did their employers. The facilitator of productivity was the wage subsidy received by the employer, justified by the fact that the individual is unable to perform at the same level as others, nor is required to. Guidance also had a significant impact on productivity, and it was acquired through the employer’s support for arranging work conditions for personal guidance via PES.

Throughout shifts the intensity of work varied, or the shift was designed to be very efficient in terms of work hours and scheduling. The efficiency of the work was also affected by the fluctuation in the work ability of the employed individual during the shift; at times, they were unable to do anything.

“A first quiet moment [after 4 hours] between 10 past two to 20 past two p.m., [the employee] is waiting in the kitchen, doing nothing but following children’s eating. [image] […] From the point of view of productivity, the work shift is organized quite efficiently in terms of length and timing of working hours.” [Case C, observation diary].

The tasks were typically low-productivity work, but in some work processes, the employed worker, through their own contribution, freed up the qualified staff to perform tasks requiring expertise, indirectly increasing service productivity and reducing rush, which could indirectly improve the well-being of other staff. Despite employees’ good efficiency, recognized by both the supervisor and coworkers, there were structural barriers to sustainable employment, particularly for public employers. Some employees also had additional coaching support to enhance productivity, meaning that work productivity was often achieved through other strong economic and social support, independent of the SE method. In some cases, from the point of view of achieving the employer’s productivity goals, the work input that was in addition to providing personalized support was decisive.

[Researcher]: “...the arrangement subsidy for the working conditions, so [Employer] specifically receives it for your...”

[Job coach]: “...my contribution to the work, then.”

[Researcher]: “…the result of the work is achieved, so without that guiding input, it will not happen.” [...]

[Job coach]: “Exactly. This seems to be the case.” [Case B, interview, job coach].

Discussion

The main findings were that persons with disability or decreased work ability were employed in precarious low-productivity work and that there were few opportunities for more sustainable employment. The tasks were the so-called entry-level tasks or job descriptions of various industries. In addition, to decrease the employer’s personnel costs, several employment instruments provided by public employment services were used. The supervisors needed to develop ways to carry out their usual tasks to provide enough support for the employed individual and provide more support for work performance than usual. The role of coworkers and the work community as whole was also important. The personal support of job coaches during the employment phase was crucial, but their role in the workplace, especially that of employers, was unclear.

Most of the part-time job tasks of employed individuals were low-skilled, and the required skills could be learned through on-the-job training provided by a supervisor or coworker. According to the scoping review, similar results have been obtained in other studies [7]. In these jobs, part-time work wages were low and compensated by social security. Typically, subsidized employment methods are employed part-time and/or temporarily [19]. This may be explained by the fact that employers, who may be motivated mainly by short-term goals—productive or partly free labour—might be less motivated to sustain reciprocal engagement over a prolonged period [51]. In our results, one notable example was how a large public organization utilised this type of recruitment to address its immediate labour shortage. Furthermore, as noted by MacEachen & Ekberg [12] more measures are needed for fair wages and sustainable employment.

Our finding that the jobs gained through SE measures were competitive but supported by wage subsidies has been reported previously in Sweden [11]. The outcome of working career prospects and increase in earnings after employment by the IPS have been better in several RCT studies than what we found [16]. The target group was not only people with severe mental illness but Finnish social services customers in various vulnerable labour market positions, such as people with disabilities and unemployed individuals with decreased work ability. The employment outcome of evidence based IPS has been similarly mixed in other target groups than people with severe mental illness [16, 52]. This can also be attributed to the fact that the professionals involved in this development project were still aligning their activities with the quality criteria of the IPS. Moe et al. [53] reported that the successful implementation of IPS requires change in many organisations, which was also faced by professionals in these projects when implementing evidence-based SE in the context of social services.

In evidence-based SE, the core belief is that with the right work and support, everyone can be employed. The concept of sustainable employability builds on this principle and extends it by structuring the elements that underpin employees’ work ability and career sustainability. It encompasses the ability to obtain work, maintain employment, and progress in one’s career, while ensuring that employees can make a full contribution while safeguarding their health and well-being [9]. Tengland’s work ability concept emphasizes the importance of meaningful job tasks and comprehensive competence, highlighting the close relationship between health and the realization of skills and abilities [8]. Considering these concepts in the context of evidence-based SE principles raises questions about the potential for more sustainable employment by closely examining factors affecting occupational health, safety, and well-being. It also prompts consideration of how prepared employers are to describe job opportunities in such detail during the recruitment phase.

Our findings highlight the diverse nature of supervisor support in the workplace and its impact on the employment experiences of individuals. While primary support comes from the supervisor, coworkers also play a crucial role, particularly in addressing urgent issues that arise during work when immediate supervisor support is unavailable. According to our results, its crucial to ensure maintaining open communication with coworkers, being able to seek their assistance when needed. Our results are in line with those of Gustafsson et al. [54], where interviewed people with disabilities who were employed, with the help of SE methods, pointed out the importance of being a valued worker and the sense of social belonging. Mutual respect among employees, perceived social support from co-workers is essential for achieving effective workplace inclusion and enhancing organizational learning and strengthening the desire to stay in the organization [55]. Gustafsson et al. [54] concluded that the emphasis should not only be on the adjustment of the employed individuals, but also on the adaptation of the work community [54].

In the research literature of SE, the “natural support” at work is often mentioned as a promoting or a hindering factor of employment and work performance depending how they appear at workplace [7]. However, it should be noted that “natural support” requires attention, and it should not be assumed to occur automatically. Instead, it needs to be determined whether natural support is present, and if not, how to support the entire work community in supporting each other. Also, the concepts of special work ability [8, 9] and sustainable employability [10] raise psychosocial factors at work as one aspect of work ability.

Our findings are in line with Moe et al. [53] who have stated the implementation of IPS requires more than just creating and filling the role of the employment specialist. It also posed challenges in the delegation of roles and responsibilities between sectors and involved adjusting in multiple organizations. Our finding that the role of the job coach in the workplace was unclear, especially to employers, is twofold. First, there should be clearer communication about the job coach’s role and its possibilities, making this opportunity better known to both employers, work communities, employed individuals and their co-workers. Second, attention should be given to emphasizing the equality of employees by providing additional support, rather than stigmatizing them. Few development proposals were made regarding the role and tasks of job coaches, except for one suggestion by a supervisor who proposed that job coaches could train coworkers in guiding their own work to new employees, potentially reducing the stigma associated with job coach support.

The reduced working hours and timing of active hours to shift as effectively as possible and the duration of the employment relationship were commonly cited employer justifications, often attributed to productivity. All six employers utilized wage subsidies during the employment phase, like what was reported from, another Nordic welfare state model, Sweden by Gustafsson et al. [11]. Additionally, all other possibilities of PES’s employment instruments were well utilized, often with the help of job coaches’ knowledge and practical support. This means that several means to decrease the employer’s personnel costs were in use.

Our results show also, after job coaches, that the wage subsidy was necessary to use to compensate the loss in employees’ productivity. Also, supervisors had this kind of a grasp of the level of their productivity. Supervisors very realistically and patiently described their expectations of the perceived variation or development of their work pace. Overall, the observed work efficiency did not meet the pace of the open labour market in terms of productivity during the observation period. Therefore, from this point of view there were few direct employer-responsible sustainable employment and working career possibilities.

We understood that these subsidies facilitated the risk-taking associated with recruitment, but we did not obtain a clear idea of the significance of the subsidies for productivity over a longer period. In earlier studies, employers’ overall expectations for recruited employees with disabilities also affected their job performance [7]. Although this expectation was seldom discussed openly, all these employees’ kept productivity and efficiency issues in their minds and repeatedly reflected them with researchers during observation. There is a need for practical measures for this interaction, as Bevan & Cooper [13] emphasize; developing a more comprehensive understanding of the work ability and productivity links at the task level could significantly enhance our ability to identify how employees’ work ability and measures to improve it can affect the output side of the productivity equation.

Our practical implication follows that of Baxter et al. [56], that the IPS fidelity scale should in future include more detailed employer, workplace and working community factors. Along our results, this implication is based on the resent scoping review results [7]: research from the point of view of the employers and other workplace actors is scarce. Also, sustainable employment is still hard to achieve also through SE or IPS measure.

Limitations of the study

The study encountered some challenges during the data collection phase, including difficulties in obtaining cooperation from all projects and employers. Ensuring that individuals in vulnerable labour market positions were informed about their rights when discussing informed consent presented challenges, as we aimed to ensure that the research was ethically sound. We encountered the Hawthorne effect [29], where individuals change their behaviours when they know they are being observed. Efforts were made to emphasize good work performance for the researchers, and the impact was reduced when the same two researchers observed the same work during two different shifts.

Moreover, our time in the field was relatively short, especially in the context of traditional ethnography [35]. However, according to Pink and Morgan [33], a brief duration in the field is not necessarily a weakness; it can yield more intensive data. The intensity was also present in data collection phase that was laborious and time-consuming involving travel, field observation, and immediate, detailed documentation to ensure the integrity of the observations amidst other tasks or distractions.

Strengths of the study

The employer’s perspective, especially concerning productivity, has been underexplored, and this research introduces a new approach to the topic [7]. This research employs short-term organizational ethnographic [29,30,31,32]. The recent review article [7] suggested that ethnography has been underutilized as a research method in an otherwise extensively reported SE/IPS intervention. This research employed also multi-perspective data collection [39], providing a comprehensive and deep understanding of the phenomenon under study [29, 39]. Integrating field observations with other data, such as photographs, conversation recordings, and interviews, deepened our insights. In compiling the multi-perspective case descriptions and in the analysis process, a systematic combination of different methods was implemented [36, 39, 40].

We utilized reflexive thematic analysis (RTA), a versatile qualitative method well-suited for analysing diverse qualitative data, as applied in this study. RTA aided researchers in clarifying their theoretical assumptions and detailing the choices made during the research process [40]. We established our theoretical assumptions based on the literature: the framework formed by the values, standards principles of the evidence-based SE-intervention [16, 17] linked to the two concepts of work ability [8,9,10] and Bevan & Cooper’s [13] framework of individual work performance linked to wellbeing and productivity. Reflexivity was demonstrated in various ways during the analysis process, including self-reflection on researchers’ own observations, collaborative theory-informed reflection with another researcher who observed the same work, and systematic analysis of the entire dataset within the multidisciplinary research team.

Conclusions

As part of a holistic approach to public health, it is important to create inclusive work environments and support sustainable careers for individuals with disabilities or reduced work ability. This is crucial for vocational rehabilitation, active labour market policies, and overall impact on the social determinants of health. Research has shown that supported employment (SE), particularly Individual Placement and Support (IPS), has led to increased employment, income, and well-being for individuals. However, efforts are needed to ensure fair wages, sustained employment, and closer collaboration with employers to assess productivity and establish realistic goals. Additionally, there is a need for policy and organizational changes to challenge and reshape employer attitudes towards disabled workers, as well as provide more support to employers in their hiring practices.