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In Cooperation We Trust: Interorganizational Cooperation in Return-to-Work and Labour Market Reintegration
Linköping University, Department of Medicine and Health Sciences, Work and Rehabilitation . Linköping University, Faculty of Health Sciences.ORCID iD: 0000-0003-3310-0895
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overarching aim of this thesis is to study Coordination Associations (CAs) as a structure for interor-ganizational cooperation in rehabilitation, return-to-work and labour market reintegration. This has been done through empirical studies of two CAs in eastern Sweden.

Central questions for the thesis are:

  • How have representatives on different hierarchical levels in the participating organizations experi-enced cooperation within the structure of CAs?
  • What influence do different organizational and/or professional preferences have on interorganiza-tional cooperation?

The four studies in this thesis have had different approaches to studying interorganizational cooperation.

Study I was concerned with a specific work form, namely interdisciplinary rehabilitation teams, where the analysis concerned how the different professionals in these teams perceived the common work, and how they interpreted the concept of work ability, which is a central concept for determining eligibility for sickness benefits.

Study II focused on managers and board members of the CAs in order to determine their motives for and commitment to interorganizational cooperation. The analysis was concerned with the organizational identification and the self-interest of each actor, where the issue of trust between representatives from dif-ferent organizations was specifically targeted in the analysis.

Study II focused on managers and board members of the CAs in order to determine their motives for and commitment to interorganizational cooperation. The analysis was concerned with the organizational identification and the self-interest of each actor, where the issue of trust between representatives from dif-ferent organizations was specifically targeted in the analysis.

Study III aimed to elucidate the perspectives of officials in different organizations connected to the CAs regarding both the development of cooperation in the CAs, and how the recent changes in sickness insurance regulations will influence future cooperation.

Study IV focused on different perspectives regarding the concept of work ability among representa-tives from all participating organizations, since changes in sickness insurance regulations have changed the assessment process and therefore also the demands for interorganizational cooperation.

The general methodological approach to the studies in this thesis has been explorative; qualitative methods have been used, involving interviews, focus groups and problem-based group discussions. Inter-views and focus groups have had an open-ended structure, and the material has been analysed through qualitative content analysis.

The aim of the Coordination Associations studied in this thesis has been to bridge the gaps between the participating organizations by promoting consensus through common work forms. However, the re-sults from the studies show that such ambitions are troublesome in highly specialized public organizations. Cooperation in the CAs has to a large extent been organized as collaborative work forms rather than as coordination of existing practices. The collaboration has been based on an idea of consensus, where all organizations were expected to participate on equal terms and find common work forms. Although it has been shown that officials from different organizations can work together, the managerial level’s priorities are more determined by their organizational goals and values, which makes them unwilling to finance collaborative work on a longer term.

Another theme of the thesis is the lack of cooperation between the public rehabilitation system and the employers. The public actors lack knowledge of working conditions, and since the work principle guides the rehabilitation process, it is necessary to incorporate employers into the cooperation to facilitate sustainable return-to-work and labour market reintegration.

A central conclusion of the thesis is that consensus is not a reasonable starting point when designing cooperation structures between public organizations. A sustainable cooperation structure needs to incorpo-rate and coordinate the different actors’ priorities into a long-term cooperation strategy, rather than base the cooperation on vulnerable collaboration projects.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press , 2010. , 117 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1171
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-54894ISBN: 978-91-7393-430-5 (print)OAI: oai:DiVA.org:liu-54894DiVA: diva2:311074
Public defence
2010-05-25, Aulan, Hälsans hus, Campus US, Linköpings universitet, Linköping, 13:00 (English)
Opponent
Supervisors
Available from: 2010-04-20 Created: 2010-04-20 Last updated: 2013-09-03Bibliographically approved
List of papers
1. The Work Ability Divide: Holistic and Reductionistic Approaches in Swedish Interdisciplinary Rehabilitation Teams
Open this publication in new window or tab >>The Work Ability Divide: Holistic and Reductionistic Approaches in Swedish Interdisciplinary Rehabilitation Teams
2009 (English)In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 19, no 3, 264-273 p.Article in journal (Refereed) Published
Abstract [en]

Stakeholder cooperation in return to work has been increasingly emphasised in research, while studies on how such cooperation works in practise are scarce. This article investigates the relationship between professionals in Swedish interdisciplinary rehabilitation teams, and the aim of the article is to determine the participants’ definitions and uses of the concept of work ability. Methods The methods chosen were individual interviews with primary health care centre managers and focus groups with twelve interdisciplinary teams including social insurance officers, physicians, physiotherapists, occupational therapists, medical social workers and coordinators. Results The results show that the teams have had problems with reaching a common understanding of their task, due to an inherent tension between the stakeholders. This tension is primarily a result of two factors: divergent perspectives on work ability between the health professionals and the Social Insurance Agency, and different approaches to cooperative work among physicians. Health professionals share a holistic view on work ability, relating it to a variety of factors. Social insurance officers, on the other hand, represent a reductionistic stance, where work ability is reduced to medical status. Assessments of work ability therefore tend to become a negotiation between insurance officers and physicians. Conclusions A suggestion from the study is that the teams, with proper education, could be used as an arena for planning and coordinating return-to-work, which would strengthen their potential in managing the prevention of work disability.

Place, publisher, year, edition, pages
Springer Netherlands, 2009
Keyword
Work ability, return to work, cooperation, team, interdisciplinary
National Category
Public Health, Global Health, Social Medicine and Epidemiology Sociology Social Sciences Interdisciplinary Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-19739 (URN)10.1007/s10926-009-9183-2 (DOI)
Note
The original publication is available at www.springerlink.com: Christian Ståhl, Tommy Svensson, Gunilla Petersson and Kerstin Ekberg, The Work Ability Divide: Holistic and Reductionistic Approaches in Swedish Interdisciplinary Rehabilitation Teams, 2009, Journal of occupational rehabilitation, (19), 3, 264-273. http://dx.doi.org/10.1007/s10926-009-9183-2 Copyright: Springer Science Business Media http://www.springerlink.com/ Available from: 2009-07-27 Created: 2009-07-27 Last updated: 2013-09-03
2. A Matter of Trust?: A Study of Coordination of Swedish Stakeholders in Return-to-Work
Open this publication in new window or tab >>A Matter of Trust?: A Study of Coordination of Swedish Stakeholders in Return-to-Work
2010 (English)In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 20, 299-310 p.Article in journal (Refereed) Published
Abstract [en]

Introduction Stakeholder cooperation in return-to-work has been increasingly emphasized over the last years. However, there is a lack of empirical studies on the subject. This study explores different public stakeholders' experiences of participating in Coordination Associations (CAs), a Swedish form of structured cooperation in return-to-work. The aim of the study is to determine the impact of stakeholder interests on the prerequisites for cooperation. Methods Thirty-five representatives from two CAs in eastern Sweden were interviewed regarding the aim, structure and strategies for their common work. Results Stakeholders' actions are to a high degree determined by their institutional preferences and self-interest. In the CAs, the motives for cooperation differ, and although these differences supposedly could be overcome, they are in fact not. One of the stakeholders, the Public Employment Service, limit its interest to coordinating resources, while the other three wishes to engage in elaborated cooperative work forms, implying the crossing of organizational borders. This discrepancy can largely be attributed to the difficulties for representatives from state authorities in changing their priorities in order to make cooperation work. Conclusions Stakeholders' interests have a high impact on the prerequisites for cooperation in return-to-work. By referring to organizational goals, stakeholders engage in non-cooperative behaviour, which threatens to spoil cooperative initiatives and to develop distrust in cooperative work forms. The results of this study expose the complexity of and threats to cooperation, and its conclusions may be used by return-to-work stakeholders in different jurisdictions to improve the possibilities for the development of cooperative structures.

Place, publisher, year, edition, pages
SpringerLink, 2010
Keyword
Work ability, Return to work, Cooperation Team, Interdisciplinary
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-21379 (URN)10.1007/s10926-009-9205-0 (DOI)19787442 (PubMedID)
Available from: 2009-10-01 Created: 2009-10-01 Last updated: 2017-12-05
3. Discretion, governance and cooperative learning: Swedish rehabilitation professionals’ experiences of financial cooperation
Open this publication in new window or tab >>Discretion, governance and cooperative learning: Swedish rehabilitation professionals’ experiences of financial cooperation
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Purpose: This article analyses the experiences of Swedish rehabilitation professionals in interorganizational cooperation in return-to-work and labour marker reintegration.

Method: Two groups (n=15) from different organizations met recurrently to discuss their practice from a cooperation perspective. The participants had experience of cooperation in the organizational setting of Coordination Associations (CAs). The groups worked with a tutor according to a problem-based methodology to discuss how their practice is influenced by new structures for cooperation. The material was analysed inductively using qualitative content analysis.

Results: The results show that CAs were successful in creating cooperative work forms at a local level by ensuring financial support for interorganizational work. This experience was considered positive by the participants. However, the different developments in the two CAs (one attained a sustainable cooperation, the other did not) show the importance of local strategies for maintaining the positive effects of cooperation.

Conclusions: Work forms initiated by Coordination Associations have been perceived and used as learning environments in which the participants use the learning opportunities provided by the formal cooperation structures. However, the level of trust between managers and officials is low, implying that officials have limited support to learn from their cooperation.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-54891 (URN)
Available from: 2010-04-20 Created: 2010-04-20 Last updated: 2013-09-03Bibliographically approved
4. Swedish Rehabilitation Professionals’ Perspectives on Work Ability Assessments in a Changing Sickness Insurance System
Open this publication in new window or tab >>Swedish Rehabilitation Professionals’ Perspectives on Work Ability Assessments in a Changing Sickness Insurance System
2011 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 33, no 15-16, 1373-1382 p.Article in journal (Refereed) Published
Abstract [en]

Purpose: This article analyses Swedish rehabilitation professionals’ perspectives on how changed sickness insurance regulations will affect their practice and cooperation, with a special focus on work ability assessments.

Method: Two groups of representatives (n=15) from different organizations involved in rehabilitation and return-towork met 7 times to discuss their practice from a cooperation perspective. The groups worked with a tutor according to a problem-based methodology to discuss how their practice is influenced by new structures for cooperation. The material was analysed inductively using qualitative content analysis.

Results: The results show that work ability assessments are often made without considering work characteristics. Officials at the Social Insurance Agency do not consider themselves competent in assessing work ability. The basis for decisions of eligibility for sickness benefits is thus weak, which is troublesome from a legal perspective. The officials do not cooperate with employers or occupational health services in work ability assessments.

Conclusions: Recent policy changes calls for comprehensive cooperation between the insurance system, health care, employment services and employers. This study shows that there are flaws in this cooperation. The design of the system is in conflict with the policy ambition of increasing return-to-work, because it disregards employers as cooperation partners.

Place, publisher, year, edition, pages
Informa Healthcare, 2011
National Category
Medical and Health Sciences Social Sciences
Identifiers
urn:nbn:se:liu:diva-54893 (URN)10.3109/09638288.2010.532282 (DOI)000291886000010 ()
Note
Original Publication: Christian Ståhl, Tommy Svensson, Gunilla Petersson and Kerstin Ekberg, Swedish Rehabilitation Professionals’ Perspectives on Work Ability Assessments in a Changing Sickness Insurance System, 2011, Disability and Rehabilitation, (33), 15-16, 1373-1382. http://dx.doi.org/10.3109/09638288.2010.532282 Copyright: Informa Healthcare http://informahealthcare.com/ Available from: 2010-04-20 Created: 2010-04-20 Last updated: 2013-09-03

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