liu.seSearch for publications in DiVA
Change search
Link to record
Permanent link

Direct link
BETA
Seing, Ida
Publications (10 of 27) Show all publications
Karlsson, E., Seing, I., Sandqvist, J. & Ståhl, C. (2019). Communication Characteristics Between Clients And Stakeholders Within The Swedish Sickness Insurance System – A Document Analysis Of Granted And Withdrawn Sickness Benefit Claims. In: : . Paper presented at Work Disability Prevention and Integration Conference (WDPI).
Open this publication in new window or tab >>Communication Characteristics Between Clients And Stakeholders Within The Swedish Sickness Insurance System – A Document Analysis Of Granted And Withdrawn Sickness Benefit Claims
2019 (English)Conference paper, Poster (with or without abstract) (Refereed)
Abstract [en]

INTRODUCTION: Previous studies show differences regarding which clients receive sickness benefits as well as which clients are questioned or not within the sickness insurance system. There are indications that the characteristics of communication can have an impact on the sick leave process, which motivates this study with the following purpose.

PURPOSE: The purpose of this study was to investigate how communication within the Swedish sickness insurance system differs between cases of sick leave and how this may affect the clients’ case.

MATERIALS AND METHODS: This was a document study using thirty client files including the correspondence between clients, their case-manager at the Swedish Social Insurance Agency (SIA) as well as other stakeholders. The clients included had been on a work capacity evaluation during their sick leave spell and were aged 32-64 years. There were twenty women and ten men in this study, with a variety of the degree of sickness absence, disability pension and part time work. The material was analyzed using qualitative document analysis.

RESULTS: The results show different approaches in communication, characterized by emotional communication, matter-of-fact driven communication and information exchange, which have diverse success in affecting authority decisions. Arguments characterized by emotions such as frustration or desperation are to a larger extent neglected compared to those characterized by a matter-of-fact driven approach and referring to regulations and medical certificates. There are also differences in how information about the client is interpreted by different professionals.

CONCLUSION: There are differences regarding how clients and stakeholders communicate the clients’ needs and prerequisites, and how this affect the SIA. Further research must be carried out in order to establish social insurance literacy, initially for individuals on sick leave within the sickness insurance, and whether there are differences between diverse groups that could lead to injustice in the system.

Keywords
Work Capacity Evaluation, Social Insurance Agency, Insurance Medicine, Sickness Insurance System
National Category
Health Sciences
Identifiers
urn:nbn:se:liu:diva-163162 (URN)
Conference
Work Disability Prevention and Integration Conference (WDPI)
Available from: 2020-01-20 Created: 2020-01-20 Last updated: 2020-02-04Bibliographically approved
Karlsson, E., Seing, I., Sandqvist, J. & Ståhl, C. (2019). Communication characteristics between clients and stakeholders within the Swedish sickness insurance system: a document analysis of granted and withdrawn sickness benefit claims. Disability and Rehabilitation
Open this publication in new window or tab >>Communication characteristics between clients and stakeholders within the Swedish sickness insurance system: a document analysis of granted and withdrawn sickness benefit claims
2019 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165Article in journal (Refereed) Epub ahead of print
Abstract [en]

Purpose: The purpose of this study was to investigate how communication within the Swedish sickness insurance system differs between cases of sick leave and how this may affect clients’ cases.

Materials and methods: This was a document study using 30 client files from the Swedish Social Insurance Agency (SIA). The clients included had been on a work ability evaluation during their sick leave spell and were aged 32–64 years. The material was analyzed using qualitative document analysis.

Results: The results show different approaches to communication, characterized by emotional argumentation, matter-of-fact driven argumentation and information exchange, which have diverse success in affecting official decisions. Arguments characterized by emotions such as frustration or desperation are to a larger extent neglected by the authorities compared to those characterized by a matter-of-fact driven approach and referring to regulations and medical certificates.

Conclusion: There are differences regarding how clients and stakeholders communicate the clients’ needs and pre-requisites, and how this affects official decisions. Further research must be carried out in order to establish social insurance literacy, initially for individuals on sick leave within the sickness insurance system, and whether there are differences between diverse groups that could lead to injustices.

  • Implications for rehabilitation
  • Within a social insurance context, professionals need to provide clients with adequate and individually adapted information in order for procedures to be perceived as comprehensible and manageable by the clients.

  • The support from stakeholders such as the treating physician and/or employer can affect clients’ sick-leave process.

  • Clients’ treating medical professionals can contribute to ensuring that clients rights are met by communicating the clients’ needs to other stakeholders in a formal way.

Place, publisher, year, edition, pages
Taylor & Francis, 2019
Keywords
Sick leave; work ability; social insurance agency; vocational rehabilitation; social insurance system
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-156179 (URN)10.1080/09638288.2019.1592247 (DOI)30957576 (PubMedID)
Available from: 2019-04-08 Created: 2019-04-08 Last updated: 2019-10-18Bibliographically approved
Ståhl, C., Seing, I., Gerdle, B. & Sandqvist, J. (2019). Fair or square? Experiences of introducing a new method for assessing general work ability in a sickness insurance context. Disability and Rehabilitation, 6, 656-665
Open this publication in new window or tab >>Fair or square? Experiences of introducing a new method for assessing general work ability in a sickness insurance context
2019 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 6, p. 656-665Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To study social validity and perceived fairness of a new method for assessing general work ability in a sickness insurance context. Assessments are based on self-reports, combined with examinations by physicians, and, if needed, occupational therapists, physiotherapists and/or psychologists.

MATERIALS AND METHODS: Interviews with 36 insurance officials, 10 physicians, and 36 sick-listed persons, which were analysed through a qualitative content analysis.

RESULTS: Insurance officials and physicians considered the method useful and that it facilitated benefit decisions. The experiences of persons who had undergone the assessment differed, where the dialog with insurance officials seemed to have had an influence on experiences of the assessment and the decisions it led to.

CONCLUSIONS: The perceived fairness and social validity of the assessment depended on how it was carried out; organisational conditions and priorities; communication skills; and decision outcomes. Professionals have an important pedagogical task in explaining the purpose and procedure of the assessment in order for the sick-listed to perceive it as fair rather than square, i.e., too standardised and not considering individual conditions. If the assessment could be used also for rehabilitative purposes, it could possibly be perceived as more acceptable also in cases where it leads to denied benefits. Implications for rehabilitation The perceived fairness of work ability assessments is dependent on procedures for the assessment, communication with the person, and the outcome. What is considered fair differs between assessing professionals and persons being assessed. Professionals may influence the perceptions of fairness through their way of communication. Assessments need to be coupled with rehabilitation measures in order to perceived as relevant and acceptable.

Place, publisher, year, edition, pages
Taylor & Francis, 2019
Keywords
Sweden, Work ability, return to work; assessment, sickness insurance, work disability
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:liu:diva-146118 (URN)10.1080/09638288.2017.1401675 (DOI)000461521100005 ()29145740 (PubMedID)2-s2.0-85034264041 (Scopus ID)
Note

Funding agencies: SSIA

Available from: 2018-03-28 Created: 2018-03-28 Last updated: 2019-04-01Bibliographically approved
Nilsen, P., Schildmeijer, K., Ericsson, C., Seing, I. & Birken, S. (2019). Implementation of change in health care in Sweden: a qualitative study of professionals’ change responses. Implementation Science, 14, Article ID 51.
Open this publication in new window or tab >>Implementation of change in health care in Sweden: a qualitative study of professionals’ change responses
Show others...
2019 (English)In: Implementation Science, ISSN 1748-5908, E-ISSN 1748-5908, Vol. 14, article id 51Article in journal (Refereed) Published
Abstract [en]

Background

Implementation of evidence-based practices in health care implies change. Understanding health care professionals’ change responses may be critical for facilitating implementation to achieve an evidence-based practice in the rapidly changing health care environment. The aim of this study was to investigate health care professionals’ responses to organizational and workplace changes that have affected their work.

Methods

We conducted interviews with 30 health care professionals (physicians, registered nurses and assistant nurses) employed in the Swedish health care system. An inductive approach was applied, using a semi-structured interview guide developed by the authors. We used an analytical framework first published in 1999 to analyze the informants’ change responses in which change responses are perceived as a continuum ranging from a strong acceptance of change to strong resistance to change, describing seven forms of change responses along this continuum. Change response is conceptualized as a tridimensional attitude composed of three components: cognitive, affective and intentional/behavioral.

Results

Analysis of the data yielded 10 types of change responses, which could be mapped onto 5 of the 7 change response categories in the framework. Participants did not report change responses that corresponded with the two most extreme forms of responses in the framework, i.e., commitment and aggressive resistance. Most of the change responses were classified as either indifference or passive resistance to changes. Involvement in or support for changes occurred when the health care professionals initiated the changes themselves or when the changes featured their active input and when changes were seen as well founded and well communicated. We did not identify any change responses that could not be fitted into the framework.

Conclusions

We found the framework to be useful for a nuanced understanding of how people respond to changes. This knowledge of change responses is useful for the management of changes and for efforts to achieve more successful implementation of evidence-based practices in health care.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
Change response, Attitude, Health care, Implementation, Evidence-based practice
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-157006 (URN)10.1186/s13012-019-0902-6 (DOI)000468112400001 ()31088483 (PubMedID)2-s2.0-85065737495 (Scopus ID)
Note

Funding agencies: Linkoping University

Available from: 2019-05-22 Created: 2019-05-22 Last updated: 2019-07-01Bibliographically approved
Karlsson, E., Sandqvist, J., Seing, I. & Ståhl, C. (2019). Social validitet för försäkringsmedicinska utredningar och påföljande myndighetsbeslut inom sjukförsäkringen. Linköping: Linköping University Electronic Press
Open this publication in new window or tab >>Social validitet för försäkringsmedicinska utredningar och påföljande myndighetsbeslut inom sjukförsäkringen
2019 (Swedish)Report (Other academic)
Abstract [sv]

Bakgrund: I det svenska sjukförsäkringssystemet utförs försäkringsmedicinska utredningar av särskilda enheter inom hälso- och sjukvården på uppdrag av Försäkringskassan. Dessa utredningar ligger sedan till grund för handläggares beslut om sjukskrivnas rätt till sjukpenning. Studier av social validitet är ännu ovanliga inom försäkringsmedicin och folkhälsa men kan bidra med kunskap om vad som främjar eller hindrar att metoder uppfattas som godtagbara, begripliga och betydelsefulla.

Syfte: Att utforska sjukskrivna personers upplevelse av social validitet för försäkringsmedicinska utredningar och påföljande myndighetsbeslut avseende sjukpenning inom sjukförsäkringen.

Metod: Detta var en kvalitativ longitudinell studie baserad på telefonintervjuer med 30 sjukskrivna som varit på en försäkringsmedicinsk utredning, samt delvis deras akter från Försäkringskassan. En deduktiv innehållsanalys användes.

Resultat: Sjukskrivnas förståelse för utredningen var beroende av huruvida de specifika testerna var tydligt relaterade till personernas svårigheter eller ej och vilken information de hade fått. De anser att den standardiserade strukturen inte är relevant för alla och att bristen på individanpassning förvårar möjligheten att få en rättvis bild av deras arbetsförmåga. 

Diskussion: Social validitet utforskades för försäkringsmedicinska utredningar och myndighetsbeslut i termer av godtagbarhet, begriplighet och betydelse. Utredningarna indikerar en låg social validitet i termer av godtagbarhet på grund av bristen på individanpassning, även om vissa delar är mer socialt valida än andra. Vidare varierade utredningarnas begriplighet beroende på deras applicerbarhet och den erhållna informationen, medan dimensionen betydelse indikerar en högre grad av social validitet. Handläggarens påföljande myndighetsbeslut ansågs däremot orelaterat till utredningens resultat, sakna konkreta argument och ibland motsägande andra aktörers rekommendationer, vilket indikerar en låg social validitet i termer av både godtagbarhet, begriplighet och betydelse. 

Slutsats: Social validitet finns för delar av utredningarna men är låg för det påföljande myndighetsbeslutet.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2019. p. 39
Series
HELIX working papers, ISSN 1654-8213 ; 5
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-160717 (URN)
Available from: 2019-10-04 Created: 2019-10-04 Last updated: 2019-10-11Bibliographically approved
Seing, I. & Johansson, H. (2018). Governing frontline-workers beyond NPM-models?: Ideals and practices of self-leadership in the Swedish Public Employment Service. In: Conference of the Swedish Sociological Association: Sociology in a Polarized world, Lund, March 7-9, 2018. Paper presented at Conference of the Swedish Sociological Association: Sociology in a Polarized world, Lund, Sweden, 7-9 March 2018.
Open this publication in new window or tab >>Governing frontline-workers beyond NPM-models?: Ideals and practices of self-leadership in the Swedish Public Employment Service
2018 (English)In: Conference of the Swedish Sociological Association: Sociology in a Polarized world, Lund, March 7-9, 2018, 2018Conference paper, Oral presentation only (Other academic)
Abstract [en]

The academic debate on NPM has been running high for several decades, but more recently addressing governance and administrative steering ‘beyond NPM’. The Swedish government recently announced tillitsstyrning as a way to develop a different form of welfare governance that should allow ‘the professionals to be professional’.

The paper analyses the Swedish PES, which from being an agency highly governed by NPM ideals, has initiated comprehensive reforms to reduce management by numbers, detailed steering and result oriented control. Models of self-leadership are put forward as ways to promote new professional ideals and practices.

Inspired by discussions on governmentality, we analyse governance techniques of self-leadership at central level and what type of personal behavior and characteristics that are required from front-line workers. The paper explore how front-line workers act and react upon models of self-leadership how they support and resist organizational pressure to think and act as a self-leader.

The paper draws upon an ethnographic study with observations and interviews with officials at the head office, caseworkers and managers in local offices of PES.

 

 

National Category
Sociology
Identifiers
urn:nbn:se:liu:diva-157008 (URN)
Conference
Conference of the Swedish Sociological Association: Sociology in a Polarized world, Lund, Sweden, 7-9 March 2018
Available from: 2019-05-22 Created: 2019-05-22 Last updated: 2019-06-19Bibliographically approved
Hollertz, K., Kerstin, J. & Seing, I. (2018). Organizational governance of activation policy: Transparency as an organizational ideal in a Swedish welfare agency. International Social Security Review, 71(4), 71-89
Open this publication in new window or tab >>Organizational governance of activation policy: Transparency as an organizational ideal in a Swedish welfare agency
2018 (English)In: International Social Security Review, ISSN 0020-871X, E-ISSN 1468-246X, Vol. 71, no 4, p. 71-89Article in journal (Refereed) Published
Abstract [en]

The Swedish Social Insurance Agency (Försäkringskassan – SSIA) and its frontline staff have a key role in the implementation of activation policy. Drawing on ethnographic research conducted at local offices, this article investigates how the transparency ideal, as an integral part of the organizational governance of the activation policy, is negotiated and enacted in the everyday life of a welfare bureaucracy. The analysis shows the central role that the transparency ideal plays in the alignment of frontline staff with the normative regime of the agency. While the transparency ideal is central to the internal organizational life of the SSIA, the analysis shows how transparency is much less salient in relation to clients and other relations with the outside world.

Keywords
return to work, cash sickness benefit, rehabilitation, social security administration, Sweden
National Category
Social Sciences Sociology
Identifiers
urn:nbn:se:liu:diva-157004 (URN)10.1111/issr.12190 (DOI)
Available from: 2019-05-22 Created: 2019-05-22 Last updated: 2019-05-27
Ståhl, C. & Seing, I. (2018). Reforming Activation in Swedish Work Disability Policy. In: Ellen MacEachen (Ed.), The Science and Politics of Work Disability Prevention: (pp. 125-140). New York: Routledge
Open this publication in new window or tab >>Reforming Activation in Swedish Work Disability Policy
2018 (English)In: The Science and Politics of Work Disability Prevention / [ed] Ellen MacEachen, New York: Routledge, 2018, p. 125-140Chapter in book (Other academic)
Abstract [en]

In this chapter, we review the development of the activation concept in Swedish sickness insurance during the 2000s, by analyzing how it is conceptualized in government reports and translated into policy and practice. At different times, policy has been informed by different types of knowledge, where the conceptualization of activation has developed from focusing on individual responsibility for rehabilitation and promoting return to work through restricting access to benefits, towards a systems perspective, where return to work is considered a multistakeholder endeavor. We offer a critical analysis of the use of evidence in policy development and its practical consequences.

Place, publisher, year, edition, pages
New York: Routledge, 2018
National Category
Sociology Political Science
Identifiers
urn:nbn:se:liu:diva-157007 (URN)9780429443398 (ISBN)
Available from: 2019-05-22 Created: 2019-05-22 Last updated: 2019-05-23Bibliographically approved
Ståhl, C., Sandqvist, J. & Seing, I. (2017). Aktivitetsförmågeutredning (AFU): Tillämpning, upplevelser och utfall. Stockholm
Open this publication in new window or tab >>Aktivitetsförmågeutredning (AFU): Tillämpning, upplevelser och utfall
2017 (Swedish)Report (Other academic)
Abstract [sv]

Försäkringskassan har sedan 2010 utvecklat en metod, aktivitetsförmågeutredning (AFU), för bedömning av arbetsförmåga i relation till normalt förekommande arbete på arbetsmarknaden. Utredningen tar sin utgångspunkt i individens självrapporterade förmåga och involverar en bedömning av särskilt utbildade läkare, och vid behov även arbetsterapeuter, fysioterapeuter, och psykologer. AFU har testats i begränsad skala sedan 2011, vilket sedan stegvis har utökats.

I denna studie har 300 utredningar analyserats kvantitativt i relation till registerdata från Försäkringskassan, och 30 ärenden har analyserats kvalitativt genom aktanalyser. Därtill har intervjuer genomförts med handläggare, läkare och sjukskrivna. Studien har granskat utredningar genomförda under perioden 2013–2014.

Sammantaget tyder resultaten från de olika delstudierna i denna rapport på att AFU som bedömningsmetod oftast är i linje med den sjukskrivnes egen bedömning, och att inga skillnader i fortsatt sjukskrivning efter AFU finns beroende på kön eller ålder. Läkarens bedömning i AFU tycks inte predicera framtida sjukskrivning, vilket däremot individens självskattning gör.  Handläggare och bedömningsläkare (dvs. den läkare som utför AFU) anser generellt att AFU är en bra metod som ger relevant och användbar information. Dock används metoden sparsamt, vilket huvudsakligen tycks bero på ofullständig implementering. Utvidgade undersökningar uppskattas av handläggare och läkare då de ger ett bättre underlag. Dock finns det inga skillnader i fortsatt sjukskrivning mellan dem som fått utvidgad undersökning och övriga ärenden.

AFU leder till olika typer av utfall beroende på ärendets karaktär, där vissa får fortsatt sjukpenning eller sjukersättning, medan andra nekas fortsatt sjukskrivning. Utredningen spelar en mera central roll i ärenden där Försäkringskassan beslutar att neka sjukpenning, då den bidrar till att legitimera beslutet. I ärenden där sjukpenning beviljas bekräftar AFU huvudsakligen innehållet i tidigare underlag och får därmed en mera underordnad roll i kommunikationen med den sjukskrivne. Sjukskrivnas upplevelser av AFU skiljer sig åt, och inte enbart beroende på om utredningen lett till beviljad eller nekad sjukpenning. Försäkringskassans bemötande och handläggarnas dialog med de sjukskrivna tycks ha stor betydelse för hur sjukskrivna uppfattar utredningen och de beslut den leder till. Såväl handläggare som bedömningsläkare och andra inblandade vårdprofessioner har ett pedagogiskt ansvar i att förklara syftet med utredningen och de ingående momenten för att inte den sjukskrivne ska uppleva bedömningen som alltför standardiserad där individuella faktorer inte tas hänsyn till.

Abstract [en]

Since 2010, the Swedish Social Insurance Agency (SSIA) has developed a new method for activity ability assessments (aktivitetsförmågeutredning, AFU). This method is to be used when assessing work ability in relation to normally available jobs on the labor market, which is done after 180 days of sick leave. The assessment is based on a self-report from the person on sick leave, combined with an examination by specially trained physicians. If needed, an extended assessment may be carried out by occupational therapists, physiotherapists and/or psychologists. AFU has been tested on a limited scale since 2011, which has been gradually extended.

In this study, 300 assessments have been analyzed through regression analyses in relation to register data from the SSIA, and 30 case files have been analyzed through qualitative text analysis. Interviews has been carried out with insurance officials, physicians and sick-listed individuals who have undergone the assessment. The study have analyzed assessments carried out between 2013 and 2014. The overall results show that AFU as an assessment tool generally is in line with the self-reported ability, and there are no differences in continued sick leave based on gender or age. Physicians’ assessments in AFU does not predict future sick leave, which the self-reported assessment does. Insurance officials and physicians generally consider the method to be useful and that it provides relevant and useful information. It is however used sparsely, which is related to its limited implementation. Extended assessments are appreciated by officials and physicians as they provide more information; there are however no differences in future sick-leave between those who underwent extended assessments and those who did not.

AFU leads to different outcomes depending on the character of the case, where some are granted continued benefits while some gets denied. The assessment has a more significant role in cases where the SSIA denies benefits, where it serves to legitimize the decision. The experiences of people who has undergone the assessment differs, and not only between those who got benefits granted or denied. The contact with the SSIA and the dialogue with the insurance officials seems to have a large influence on how the sick-listed experience the assessment and the decisions it leads to. Officials and health care professionals involved in the assessment hence have an important pedagogical task in explaining the purpose with the assessment and its different parts, in order for the sick-listed not to feel that the assessment is standardized and not considering individual conditions.

Place, publisher, year, edition, pages
Stockholm: , 2017. p. 73
Series
Socialförsäkringsrapport, ISSN 1654-8574 ; 2017:15
National Category
Public Administration Studies
Identifiers
urn:nbn:se:liu:diva-146113 (URN)
Available from: 2018-03-28 Created: 2018-03-28 Last updated: 2018-03-28Bibliographically approved
Hollertz, K., Jacobsson, K. & Seing, I. (2017). Den transparenta organisationen. Handläggaren och visibilitetskulturen i Försäkringskassan. Socialvetenskaplig tidskrift, 3-4, 239-260
Open this publication in new window or tab >>Den transparenta organisationen. Handläggaren och visibilitetskulturen i Försäkringskassan
2017 (Swedish)In: Socialvetenskaplig tidskrift, ISSN 1104-1420, Vol. 3-4, p. 239-260Article in journal (Refereed) Published
Abstract [en]

The expansion of ”audit culture” in public sector governance is well documented, including its implications for caseworkers whose performance is constantly monitored. Transparency is an inherent part of the audit culture, yet there are fewer studies researching how the ideal of the transparent organization plays out in everyday life in welfare bureaucracies. Drawing on ethno-graphic research in five local offices of the Swedish Social Insurance Agency, this article investigates how the transparency ideal is enacted on an everyday basis in this agency. The analysis reveals how the transparency ideal penetrates the organizational life in a much more pervasive way than is usually acknowledged in the audit society literature. Special attention is given to the relevance of a horizontal dimension of transparency. It is argued that the horizontal dimension of transparency is a central aspect in relation to goal achievement and the normative governance of the caseworkers. However, even if the transparency ideal is central to the internal organizational life of the Swedish Social Insurance Agency, transparency is much less salient in relation to clients and the outside world. The article explores this organizational regime of visibility, as established in every-day social interaction as well as in organizational routines.

Place, publisher, year, edition, pages
Växjö, Sweden: Förbundet för Forskning i Socialt Arbete, 2017
Keywords
Försäkringskassan, granskning, handläggare, transparens, normativ styrning
National Category
Sociology
Identifiers
urn:nbn:se:liu:diva-157005 (URN)
Available from: 2019-05-22 Created: 2019-05-22 Last updated: 2019-05-29Bibliographically approved
Organisations

Search in DiVA

Show all publications