INTRODUCTION: This study explores organizational factors that contributes to low sickness absence in Swedish municipalities. METHODS: A qualitative, explorative design was used, including semi-structured individual interviews with 63 managers across 12 municipalities with either high or low sickness absence. Interviews were conducted with Human resources managers, Administration managers and Unit managers in senior care and schools. RESULTS: The results revealed that municipalities with low sickness absence demonstrate leadership practices that emphasize proximity and accessibility, promote employee development, integrate systematic work environment management, including employee participation into daily routines. Additionally, an open and effective communication was identified as a crucial factor in fostering sustainable organizations. The results show that municipalities with lower sickness absence rates tend to have more sophisticated organizational strategies, especially in clear and manageable areas, it requires strategic planning and well-defined structures. DISCUSSION: A recurring theme in the analysis is the proximity and interconnectedness observed in leadership, communication, and employee participation, with leaders that show a high degree of involvement in day-to-day activities. This "proximity principle," emerges as a potential significant factor influencing health outcomes in working life.