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  • 1.
    Ekberg, Kerstin
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Pransky, Glenn S.
    Liberty Mutual Research Institute for Safety, Hopkinton, MA, USA; University of Massachusetts Medical School, Worcester, MA, USA .
    Besen, Elyssa
    Liberty Mutual Research Institute for Safety, Hopkinton, MA, USA.
    Fassier, Jean-Baptise
    Claude Bernard University Lyon, France.
    Feuerstein, Michael
    Claude Bernard University Lyon 1, Lyon, France.
    Munir, Fehmidah
    School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.
    Blanck, Peter
    Burton Blatt Institute, Syracuse University, Syracuse, NY, USA.
    New Business Structures Creating Organizational Opportunities and Challenges for Work Disability Prevention.2016In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 26, no 4, p. 480-489Article in journal (Refereed)
    Abstract [en]

    Purpose Flexible work arrangements are growing in order to develop resource-efficient production and because of advanced technologies, new societal values, changing demographics, and globalization. The article aims to illustrate the emerging challenges and opportunities for work disability prevention efforts among workers in alternate work arrangements. Methods The authors participated in a year-long collaboration that ultimately led to an invited 3-day conference, "Improving Research of Employer Practices to Prevent Disability," held October 14-16, 2015, in Hopkinton, Massachusetts, USA. The collaboration included a topical review of the literature, group conference calls to identify key areas and challenges, drafting of initial documents, review of industry publications, and a conference presentation that included feedback from peer researchers and a roundtable discussion with experts having direct employer experience. Results Both worker and employer perspectives were considered, and four common alternate work arrangements were identified: (a) temporary and contingent employment; (b) small workplaces; (c) virtual work/telework; and (d) lone workers. There was sparse available research of return-to-work (RTW) and workplace disability management strategies with regard to alternate work patterns. Limited research findings and a review of the grey literature suggested that regulations and guidelines concerning disabled workers are often ambiguous, leading to unsatisfactory protection. At the workplace level, there was a lack of research evidence on how flexible work arrangements could be handled or leveraged to support RTW and prevent disability. Potential negative consequences of this lack of organizational guidance and information are higher costs for employers and insurers and feelings of job insecurity, lack of social support and integration, or work intensification for disabled workers. Conclusions Future studies of RTW and workplace disability prevention strategies should be designed to reflect the multiple work patterns that currently exist across many working populations, and in particular, flexible work arrangements should be explored in more detail as a possible mechanism for preventing disability. Labor laws and policies need to be developed to fit flexible work arrangements.

  • 2.
    Ekberg, Kerstin
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, HELIX Vinn Excellence Centre.
    Wåhlin, Charlotte
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Occupational and Environmental Medicine Center. Karolinska Institutet, Stockholm, Sweden.
    Persson, Jan
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Bernfort, Lars
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences. Region Östergötland, Heart and Medicine Center, Allergy Center.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Early and Late Return to Work After Sick Leave: Predictors in a Cohort of Sick-Listed Individuals with Common Mental Disorders2015In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 25, no 3, p. 627-637Article in journal (Refereed)
    Abstract [en]

    Objectives The study aims to identify individual and workplace factors associated with early return to work (RTW)-defined as within 3 months-and factors associated with later RTW-between 3 and 12 months after being sick-listed-in a cohort of newly sick-listed individuals with common mental disorders. Methods In a prospective cohort study, a cross-sectional analysis was performed on baseline measures of patients granted sick leave due to common mental disorders. A total of 533 newly sick-listed individuals fulfilled the inclusion criteria and agreed to participate. A baseline questionnaire was sent by post within 3 weeks of their first day of certified medical sickness; 354 (66 %) responded. Those who were unemployed were excluded, resulting in a study population of 319 individuals. Sick leave was recorded for each individual from the Social Insurance Office during 1 year. Analyses were made with multiple Cox regression analyses. Results Early RTW was associated with lower education, better work ability at baseline, positive expectations of treatment and low perceived interactional justice with the supervisor. RTW after 3 months was associated with a need to reduce demands at work, and turnover intentions. Conclusions Early RTW among sick-listed individuals with common mental disorders seems to be associated with the individuals need to secure her/his employment situation, whereas later RTW is associated with variables reflecting dissatisfaction with work conditions. No health measures were associated with RTW. The study highlights the importance of considering not only health and functioning, but also workplace conditions and relations at the workplace in implementing RTW interventions.

  • 3.
    Ekberg, Kerstin
    et al.
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, HELIX Vinn Excellence Centre. Linköping University, Faculty of Health Sciences.
    Wåhlin, Charlotte
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Persson, Jan
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Bernfort, Lars
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Is Mobility in the Labor Market a Solution to Sustainable Return to Work for Some Sick Listed Persons?2011In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 21, no 3, p. 355-365Article in journal (Refereed)
    Abstract [en]

    Aim: The study aims to identify characteristics associated with long-term expectations of professional stability or mobility among recently sick-listed workers, and to study whether expectations of professional mobility and turnover intentions were associated with duration of sick leave.

    Methods: A cross-sectional study was performed on baseline measures in a prospective cohort study of patients who were granted sick leave due to musculoskeletal (MSD) or mental (MD) disorders. A total of 1,375 individuals fulfilled the inclusion criteria. A baseline questionnaire was sent by mail within 3 weeks of their first day of certified medical sickness; 962 individuals responded (70%). The main diagnosis was MSD in 595 (62%) individuals and MD in 367 (38%).

    Results: Expectations of ability to remain in the present profession in 2 years was associated with better health and health-related resources, younger age, higher education, and better effort-reward balance. Effort-reward imbalance, MD, high burnout scores, and better educational and occupational position were associated with turnover intentions. Low expectations of ability to remain in the present profession defined two vulnerable groups with regard to RTW, those with no turnover intentions were older, had lower personal resources, more often had MSD, and slower RTW rate. Those with turnover intentions had a clear effort-reward imbalance and high burnout scores.

    Conclusions: The results of this explorative study underline the importance of differentiating RTW-interventions based on knowledge about the sick-listed person's resources in relation to the labor market and the work place, and their expectations of future employment and employability.

  • 4.
    Jansson, Inger
    et al.
    School Health Science, Sweden; Kalmar County Hospital, Sweden.
    Birgitta Gunnarsson, A.
    Kronoberg County Council, Sweden.
    Bjorklund, Anita
    School Health Science, Sweden.
    Brudin, Lars
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Kalmar County Hospital, Sweden.
    Perseius, Kent-Inge
    Kalmar County Hospital, Sweden; Karolinska Institute, Sweden.
    Problem-Based Self-care Groups Versus Cognitive Behavioural Therapy for Persons on Sick Leave Due to Common Mental Disorders: A Randomised Controlled Study2015In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 25, no 1, p. 127-140Article in journal (Refereed)
    Abstract [en]

    Purpose To evaluate the interventional capacity of problem based method groups (PBM) regarding mental health and work ability compared to cognitive behavioural therapy (CBT) for persons on sick leave due to common mental disorders. Methods In a randomised controlled design the experimental group received PBM and the control group received CBT. Outcomes were measured by the Hospital Anxiety and Depression Scale (HADS), the Stress and Crisis Inventory 93 (SCI-93) and the Dialogue about Working Ability instrument (DOA). Results Twenty-two participants in the PBM group and 28 in the CBT group completed intervention. Both groups showed significant lower scores on the two HADS subscales. Regarding stress the PBM group showed significant decrease in one (out of three) subscales of SCI-93. The CBT group showed significant decrease on all subscales of SCI-93. Regarding work ability the PBM group showed significant higher scores on one of five subscales of DOA. The CBT group showed significant higher scores on four of five subscales of DOA. Between groups there were significant differences to the favour of CBT on one of two subscales of HADS, all three subscales of SCI-93 and on two of the five subscales of DOA. Conclusion PBM seem to be able to reduce anxiety- and depression symptoms. CBT showed to be superior to PBM in reducing symptoms in all aspects of mental health, except for anxiety, in which they seem equally effective. Regarding work ability CBT showed to be superior, with significant effect on more aspects compared to PBM.

  • 5.
    Johansson, Gun
    Institutionen för folkhälsovetenskap, Avdelningen för arbets- och miljömedicin, Karolinska Institutet.
    Return to work and adjustment latitude among employees on long-term sickness absence2006In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 16, no 2, p. 181-191Article in journal (Refereed)
    Abstract [en]

    Introduction: The aim was to study whether return to work (RTW) after long-term sickness absence is affected by adjustment latitude i.e. opportunities to adjust one's work to one's state of health by e.g. choosing among work tasks and deciding about work pace and working hours. We also studied whether the effect of adjustment latitude differed between those returning full-time and those returning part-time.

    Methods: Differences between men and women were also studied. A questionnaire was sent to 5,590 salaried employees who had been on sick leave for at least 90 days in 2000. The year after, 2001, they received a questionnaire which included questions about work status, working conditions, adjustment latitude and health.

    Results: The questionnaire was returned from 3056 persons. Among women 32% were fully back to work, 34% were partly back and 34% were still on sick leave. Comparable figures for men were 33%, 32% and 36%.

    Conclusion: For both men and women the likelihood to RTW increased with increasing number of opportunities to adjust. Adjustment latitude increased returning to part-time as well as full-time work. The study indicates that work organisation is important for RTW.

  • 6. Lundblad, I.
    et al.
    Elert, Jessica
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Gerdle, Björn
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Randomized controlled trial of physiotherapy and Feldenkrais interventions in female workers with neck-shoulder complaints.1999In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 9, p. 179-193Article in journal (Refereed)
  • 7.
    Nilsing, Emma
    et al.
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Söderberg, Elsy
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Berterö, Carina
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Primary Healthcare Professionals' Experiences of the Sick Leave Process: A Focus Group Study in Sweden2013In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 23, no 3, p. 450-461Article in journal (Refereed)
    Abstract [en]

    Purpose The aim of this study was to explore primary healthcare (PHC) professionals' experiences of the sick leave process. Methods This is an explorative study using data from four semi-structured focus group discussions with a purposeful sample of PHC professionals in A-stergotland County, Sweden. Content analysis with an inductive approach was used in the analysis. Results Four key themes emerged from the analysis; priority to the sick leave process, handling sickness certifications, collaboration within PHC and with other stakeholders, and work ability assessments. Patients' need for sick leave was handled from each professional group's perspective. Collaboration was considered important, but difficult to achieve and all the competencies available at the PHC centre were not used for work ability assessments. There was insufficient knowledge of patients' work demands and contact with an employer was rare, and the strained relationship with the social insurance officers affected the collaboration. Conclusions This study highlights the challenges physicians and other PHC professionals face when handling the need for sick leave, especially when encountering patients with symptom-based diagnoses, and the influence of non-medical factors. Hindrances to good practice were increased demands, collaboration, and role responsibility. The challenges in the sick leave process concerned both content and consequences related to poor collaboration within PHC and with representatives from various organizations, primarily employers and social insurance officers. Further research on how to develop a professional approach for handling the sick leave process is needed.

  • 8.
    Nordqvist, Cecilia
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Holmqvist, Christina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Alexanderson, Kristina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Views of laypersons on the role employers play in return to work when sick-listed2003In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 13, no 1, p. 11-20Article in journal (Refereed)
    Abstract [en]

    Sickness absenteeism is an increasing public health problem, but few studies have examined the views of laypersons regarding factors that promote return to work. The present investigation concerns the opinions of such individuals on the role employers play in this context. Data from five focus-group interviews of laypersons with experience of long-term sickness absence were subjected to grounded theory analysis. When asked about factors that hinder or promote return to work, the laypersons spontaneously emphasized the importance of the employer. Specifically, they stressed the need for a structured back-to-work program at each workplace, which should include contacting absent employees and informing fellow workers of possible changes in task assignments upon return of the absent person. Reported hindering factors included lack of such information, leading to envy and harassment. Respondents also asserted the importance of work supervisors in creating a positive emotional atmosphere.

  • 9.
    Pransky, Glenn S.
    et al.
    Liberty Mutual Research Institute for Safety, 71 Frankland Road, Hopkinton, USA; University of Massachusetts Medical School, Worcester, USA.
    Fassier, Jean-Baptise
    Claude Bernard University Lyon 1, Lyon, France.
    Besen, Elyssa
    Liberty Mutual Research Institute for Safety, 71 Frankland Road, Hopkinton, USA.
    Blanck, Peter
    Burton Blatt Institute, Syracuse University, Syracuse, NY, USA.
    Ekberg, Kerstin
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Feuerstein, Michael
    Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
    Munir, Fehmidah
    University of Loughborough, Leicester, UK.
    Sustaining Work Participation Across the Life Course.2016In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 26, no 4, p. 465-479Article in journal (Refereed)
    Abstract [en]

    Introduction Many disability prevention strategies are focused on acute injuries and brief illness episodes, but there will be growing challenges for employers to manage circumstances of recurrent, chronic, or fluctuating symptoms in an aging workforce. The goal of this article is to summarize existing peer-review research in this area, compare this with employer discourse in the grey literature, and recommend future research priorities. Methods The authors participated in a year-long sponsored collaboration that ultimately led to an invited 3-day conference, "Improving Research of Employer Practices to Prevent Disability", held October 14-16, 2015, in Hopkinton, Massachusetts, USA. The collaboration included a topical review of the scientific and industry literature, group discussion to identify key areas and challenges, drafting of initial documents, and feedback from peer researchers and a special panel of experts with employer experience. Results Cancer and mental illness were chosen as examples of chronic or recurring conditions that might challenge conventional workplace return-to-work practices. Workplace problems identified in the literature included fatigue, emotional exhaustion, poor supervisor and co-worker support, stigma, discrimination, and difficulties finding appropriate accommodations. Workplace intervention research is generally lacking, but there is preliminary support for improving workplace self-management strategies, collaborative problem-solving, and providing checklists and other tools for job accommodation, ideas echoed in the literature directed toward employers. Research might be improved by following workers from an earlier stage of developing workplace concerns. Conclusions Future research of work disability should focus on earlier identification of at-risk workers with chronic conditions, the use of more innovative and flexible accommodation strategies matched to specific functional losses, stronger integration of the workplace into on-going rehabilitation efforts, and a better understanding of stigma and other social factors at work.

  • 10.
    Seing, Ida
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    MacEachen, Ellen
    School of Public Health and Health Systems, Faculty of Applied Health Sciences, University of Waterloo, Canada.
    Ståhl, Christian
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Linköping University, HELIX Vinn Excellence Centre.
    Ekberg, Kerstin
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Linköping University, HELIX Vinn Excellence Centre.
    Early-Return-to-Work in the Context of an Intensification of Working Life and Changing Employment Relationships2015In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 25, no 1, p. 74-85Article in journal (Refereed)
    Abstract [en]

    Purpose Many Western welfare states have introduced early-return-to-work policies, in which getting sick-listed people back to work before they have fully recovered is presented as a rather unproblematic approach. This reflects a belief in the ability of employers and the labour market to solve sickness absence. Against this background, the aim of this study was to analyse return-to-work practice in local workplace contexts, in relation to Swedish early-return-to-work policy.

    Methods Semi-structured interviews were conducted with 18 matched pairs of workers and managers. The material, comprising a total of 36 interviews, was analysed using qualitative content analysis.

    Results Three main themes were identified: (1) intensive workplaces and work conditions (2) employer support—a function of worker value and (3) work attachment and resistance to job transition. The results reflected the intensity of modern working life, which challenged return-to-work processes. Managers had different approaches to workers’ return-to-work, depending on how they valued the worker. While managers used the discourse of ‘new opportunities’ and ‘healthy change’ to describe the transition process (e.g. relocation, unemployment and retirement), workers regularly experienced transitions as difficult and unjust.

    Conclusions In the context of early-return-to-work policy and the intensity of modern working life, a great deal of responsibility was placed on workers to be adaptable to workplace demands in order to be able to return and stay at work. Overall, this study illustrates an emerging social climate where sick-listed workers are positioned as active agents who must take responsibility for sick leave and return-to-work process.

  • 11.
    Seing, Ida
    et al.
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, Faculty of Health Sciences.
    Ståhl, Christian
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, HELIX Vinn Excellence Centre. Linköping University, Faculty of Health Sciences.
    Nordenfelt, Lennart
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Bülow, Pia
    Avdelningen för beteendevetenskap och socialt arbete, Hälsohögskolan, Jönköping.
    Ekberg, Kerstin
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, HELIX Vinn Excellence Centre. Linköping University, Faculty of Health Sciences.
    Policy and Practice of Work Ability: A Negotiation of Responsibility in Organizing Return to Work2012In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 22, no 4, p. 553-564Article in journal (Refereed)
    Abstract [en]

    Purpose In welfare policy and practical work it is unclear what the concept of work ability involves and assessments may be different among involved actors, partly due to a lack of theoretical research in relation to regulations and practice. Based on theoretical and legal aspects of work ability the aim of the study is to analyze stakeholders’ perspectives on work ability in local practice by studying multi-stakeholder meetings.

    Methods The material comprises nine digitally recorded multi-stakeholder meetings. Apart from the sick-listed individual, representatives from the public Social Insurance Agency, health care, employers, public employment service and the union participated in the meeting. The material was analyzed using qualitative content analysis.

    Results Three perspectives on work ability were identified: a medical perspective, a workplace perspective and a regulatory perspective. The meetings developed into negotiations of responsibility concerning workplace adjustments, rehabilitation efforts and financial support. Medical assessments served as objective expert statements to legitimize stakeholders’ perspectives on work ability and return to work.

    Conclusions Although the formal goal of the status meeting was to facilitate stakeholder collaboration, the results demonstrates an unequal distribution of power among cooperating actors where the employers had the “trump card” due to their possibilities to offer workplace adjustments. The employer perspective often determined whether or not persons could return to work and if they had work ability.

  • 12.
    Ståhl, Christian
    Linköping University, HELIX Vinn Excellence Centre. Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, Faculty of Health Sciences.
    Implementing Interorganizational Cooperation in Labour Market Reintegration: A Case Study2012In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 22, no 2, p. 209-219Article in journal (Refereed)
    Abstract [en]

    Introduction To bring people with complex medical, social and vocational needs back to the labour market, interorganizational cooperation is often needed. Yet, studies of processes and strategies for achieving sustainable interorganizational cooperation are sparse. The aim of this study was to analyse the implementation processes of Swedish legislation on financial coordination, with specific focus on different strategies for and perspectives on implementing interorganizational cooperation.

    Methods A multiple-case study was used, where two local associations for financial coordination were studied in order to elucidate and compare the development of cooperative work in two settings. The material, collected during a 3-year period, consisted of documents, individual interviews with managers, and focus groups with officials.

    Results Two different implementation strategies were identified. In case 1, a linear strategy was used to implement cooperative projects, which led to difficulties in maintaining cooperative work forms due to a fragmented and time-limited implementation process. In case 2, an interactive strategy was used, where managers and politicians were continuously involved in developing a central cooperation team that became a central part of a developing structure for interorganizational cooperation. An interactive cooperation strategy with long-term joint financing was here shown to be successful in overcoming organizational barriers to cooperation. Conclusions It is suggested that a strategy based on adaptation to local conditions, flexibility and constant evaluation is preferred for developing sustainable interorganizational cooperation when implementing policies or legislation affecting interorganizational relationships.

  • 13.
    Ståhl, Christian
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Andersson, Frieda
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Shifting to Value-Based Principles in Sickness Insurance: Challenges in Changing Roles and Culture2018In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 28, no 4, p. 730-739Article in journal (Refereed)
    Abstract [en]

    Purpose Management principles in insurance agencies influence how benefits are administered, and how return to work processes for clients are managed and supported. This study analyses a change in managerial principles within the Swedish Sickness Insurance Agency, and how this has influenced the role of insurance officials in relation to discretion and accountability, and their relationship to clients. Methods The study is based on a qualitative approach comprising 57 interviews with officials and managers in four insurance offices. Results The reforms have led to a change in how public and professional accountability is defined, where the focus is shifted from routines and performance measurements toward professional discretion and the quality of encounters. However, the results show how these changes are interpreted differently across different layers of the organization, whereNew Public Management principles prevail in how line managers give feedback on and reward the work of officials. Conclusions The study illustrates how the introduction of new principles to promote officials discretion does not easily bypass longstanding management strategies, in this case managing accountability through top-down performance measures. The study points out the importance for public organizations to reconcile new organizational principles with the current organizational culture and how this is manifested through managerial styles, which may be resistant to change. Promoting client-oriented and value-driven approaches in client work hence needs to acknowledge the importance of organizational culture, and to securethat changes are reflected in organizational procedures and routines.

  • 14.
    Ståhl, Christian
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Edvardsson Stiwne, Elinor
    Linköping University, Department of Behavioural Sciences and Learning, Education and Adult Learning. Linköping University, Faculty of Arts and Sciences.
    Narratives of Sick Leave, Return to Work and Job Mobility for People with Common Mental Disorders in Sweden2014In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 24, no 3, p. 543-554Article in journal (Refereed)
    Abstract [en]

    Purpose The aim of this study was to analyze how different types of sick leave narratives were related to return to work (RTW), job mobility or continued sick leave for people sick-listed with common mental disorders. Special attention was paid to how the respondents described their contacts with employers and rehabilitation professionals.

    Methods Eight persons sick-listed with common mental disorders were interviewed at two occasions (2005–2006 and 2008–2009) about their self-perceptions, their sick leave, and their contacts with their employers and rehabilitation professionals, first during their first months as sick-listed, and a follow-up after approximately 4 years.

    Results Two types of narratives were identified: restitutive (with focus on recovery and RTW), and contingent (focusing on managing the present). A common theme was that mental problems were not recognized and talked about in the same way as physical problems. This had consequences for peoples’ acceptance of their diagnoses and for the RTW processes. In restitutive narratives, RTW was essential for returning to life as it was, where support from managers and colleagues facilitated a successful return. In contingent narratives, the experience of sick leave was part of a broader story of change where work relations were of less importance.

    Conclusions A narrative understanding of rehabilitation involves sensitivity toward the stories people are caught up in, and what role professionals may play in them. Promotion of job mobility may be difficult to accept for persons with restitutive narratives, while persons caught up in contingent narratives may be more open—and benefit more—from such solutions.

  • 15.
    Ståhl, Christian
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, HELIX Competence Centre.
    Gustavsson, Maria
    Linköping University, Department of Behavioural Sciences and Learning, Work and Working Life. Linköping University, Department of Behavioural Sciences and Learning, Education and Sociology. Linköping University, Faculty of Arts and Sciences. Linköping University, HELIX Competence Centre.
    Introducing motivational interviewing in a sickness insurance context: Translation and implementation challenges2018In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 28, no 2, p. 357-364Article in journal (Refereed)
    Abstract [en]

    Motivational interviewing (MI) is a conversational method to support clients in need of behavioral change. In an organizational reform, most Swedish sickness insurance officials were trained in MI to promote clients’ return to work (RTW) after sick leave. The aim of this article is to investigate experiences of introducing MI as a tool to promote clients’ RTW within a sickness insurance context, with a special focus on the translation and implementation of the method. Methods A qualitative approach, comprising 69 interviews with officials, managers, and regional coordinators on two occasions. The material was analyzed through qualitative content analysis. Results Officials were positive about MI, but the application was limited to using certain tools with extensive individual variation. Officials struggled with translating MI into a sickness insurance context, where the implementation strategy largely failed to o er adequate support, due to low managerial priority, competing initiatives, and a high workload. Results of the educational intervention could therefore be seen on an individual but not an organizational level. Conclusions In order to translate MI into a sickness insurance context, training needs to be supported by organizational approaches that promote collective learning and sharing of experiences among officials. The results also illustrate how a method cannot be assumed to be implemented simply because training has been provided. Consequently, the application of the method needs to be carefully monitored in studies of interventions where MI is claimed to be used, in order to measure its effectiveness. 

  • 16.
    Ståhl, Christian
    et al.
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, HELIX Vinn Excellence Centre. Linköping University, Faculty of Health Sciences.
    Svensson, Tommy
    Linköping University, Department of Behavioural Sciences and Learning, Sociology. Linköping University, Faculty of Arts and Sciences.
    Ekberg, Kerstin
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, HELIX Vinn Excellence Centre. Linköping University, Faculty of Health Sciences.
    From Cooperation to Conflict? Swedish Rehabilitation Professionals' Experiences of Interorganizational Cooperation.2011In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 21, no 3, p. 441-448Article in journal (Refereed)
    Abstract [en]

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

    Method Two groups (n = 15) from different organizations met on a regular basis to discuss their practice from a cooperation perspective. The participants had experience of cooperation in the organizational setting of Coordination Associations. 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 Interorganizational cooperation in rehabilitation is generally perceived as promoting coherence and communication. Nevertheless, there are several contradictory factors in the implementation of such work forms, primarily inflexible sickness insurance regulations and inability of managers to implement cooperation in regular practice.

    Conclusions While interorganizational cooperation promotes professional discretion and tailored solutions, the insurance system contradicts such ambitions through increased governance. Ultimately, the contradictory tendencies of cooperative initiatives and the stricter governance of sickness insurance regulations are political matters. If political attempts to promote interorganizational cooperation are to succeed, the increasing sectorization that results from strict governance of sickness insurance regulations needs to be targeted on a system level.

  • 17.
    Ståhl, Christian
    et al.
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, Faculty of Health Sciences. Linköping University, HELIX Vinn Excellence Centre.
    Svensson, Tommy
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Behavioural Sciences and Learning, Sociology.
    Petersson, Gunilla
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Ekberg, Kerstin
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, HELIX Vinn Excellence Centre. Linköping University, Faculty of Health Sciences.
    A Matter of Trust?: A Study of Coordination of Swedish Stakeholders in Return-to-Work2010In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 20, p. 299-310Article in journal (Refereed)
    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.

  • 18.
    Ståhl, Christian
    et al.
    Linköping University, Department of Medicine and Health Sciences, Work and Rehabilitation . Linköping University, Faculty of Health Sciences.
    Svensson, Tommy
    Linköping University, Department of Behavioural Sciences and Learning, Sociology . Linköping University, Faculty of Arts and Sciences.
    Petersson, Gunilla
    Linköping University, Department of Behavioural Sciences and Learning, Sociology . Linköping University, Faculty of Arts and Sciences.
    Ekberg, Kerstin
    Linköping University, Department of Medicine and Health Sciences, Work and Rehabilitation . Linköping University, Faculty of Health Sciences.
    The Work Ability Divide: Holistic and Reductionistic Approaches in Swedish Interdisciplinary Rehabilitation Teams2009In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 19, no 3, p. 264-273Article in journal (Refereed)
    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.

  • 19.
    Svensson, Tommy
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Karlsson, A
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Alexanderson, Kristina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Nordqvist, Cecilia
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Shame-inducing encounters. Negative emotional aspects of sickness-absentees' interactions with rehabilitation professionals2003In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 13, no 3, p. 183-195Article in journal (Refereed)
    Abstract [en]

    There is little knowledge on how sickness absentees experience encounters with rehabilitation professionals. This paper explores and describes negative emotions ("shame " in a broad sense) experienced by individuals on sick leave in their interactions with rehabilitation professionals. We performed a qualitative analysis of data from five focus-group interviews. The participants had experience of sickness absence with back diagnoses and discussed factors that facilitate or impede return to work. Reports of demeaning experiences in encounters with rehabilitation workers were frequent and could be divided into two major categories: 1) subjects perceived the behavior of rehabilitation professionals as distanced in a negative way, and felt that they were treated in an indifferent and nonchalant manner or fairly routinely, 2) subjects felt that they were disqualified, which included being discredited or belittled. This explorative study indicates the need for further, more directed investigations of emotional aspects of interactions between sickness absentees and rehabilitation professionals.

  • 20.
    Tjulin, Åsa
    et al.
    Linköping University, Department of Medicine and Health Sciences, Work and Rehabilitation . Linköping University, Faculty of Health Sciences.
    Edvardsson Stiwne, Elinor
    Linköping University, Department of Behavioural Sciences and Learning, Centre for Teaching and Learning. Linköping University, Faculty of Educational Sciences.
    Ekberg, Kerstin
    Linköping University, Department of Medicine and Health Sciences, Work and Rehabilitation . Linköping University, Faculty of Health Sciences.
    Experience of the Implementation of a Multi-Stakeholder Return-to-Work Programme2009In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 19, no 4, p. 409-418Article in journal (Refereed)
    Abstract [en]

    Introduction Employers can use several strategies to facilitate return-to-work for workers on sick leave, but there seems to be limited knowledge of how workplace-based interventions are actually implemented in organisations. One public Swedish employer initiated a return-to-work programme which incorporated interventions suggested by earlier research, e.g. multi-professional health assessment, case management, educational peer-support groups and adapted workplace training. The overall purpose of the study is to analyse how the programme was implemented and experienced in the organisation, from the perspective of involved stakeholders, i.e. supervisors, occupational health consultants and a project coordinator. The objective of this paper is to identify and analyse how these stakeholders perceived that the programme had been implemented in relation to its intentions. Methods A qualitative method was used, consisting of individual interviews with eight supervisors and the project leader. Two group interviews with five occupational health service consultants were also conducted. Results The study revealed barriers to the implementation of return-to-work interventions. Not all of the intended interventions had been implemented as expected in policy. One explanation is that the key stakeholders expressed a more biomedical, individual view of work ability, while the programme was based on a more holistic, biopsychosocial view. Conclusion Implementation of a return-to-work programme is an ongoing, long-term multi-level strategy, requiring time for reflection, stakeholder participation, openness to change of intervention activities, and continuous communication.

  • 21.
    Tjulin, Åsa
    et al.
    Linköping University, Department of Medicine and Health Sciences, Work and Rehabilitation . Linköping University, HELIX Vinn Excellence Centre. Linköping University, Faculty of Arts and Sciences.
    Maceachen, Ellen
    Institute for Work & Health, Toronto, ON, Canada.
    Ekberg, Kerstin
    Linköping University, Department of Medicine and Health Sciences, Work and Rehabilitation . Linköping University, HELIX Vinn Excellence Centre. Linköping University, Faculty of Arts and Sciences.
    Exploring Workplace Actors Experiences of the Social Organization of Return-to-Work.2010In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 20, no 3, p. 311-321Article in journal (Refereed)
    Abstract [en]

    Introduction: There is a limited body of research on how the actual social exchange among workplace actors influences the practice of return-to-work. The objective of this study was to explore how workplace actors experience social relations at the workplace and how organizational dynamics in workplace-based return-to-work extends before and beyond the initial return of the sick listed worker to the workplace. Method An exploratory qualitative method approach was used, consisting of individual open-ended interviews with 33 workplace actors at seven worksites that had re-entering workers. The workplace actors represented in these interviews include: re-entering workers, supervisors, co-workers, and human resource managers. Results The analysis identified three distinct phases in the return to work process: while the worker is off work, when the worker returns back to work, and once back at work during the phase of sustainability of work ability. The two prominent themes that emerged across these phases include the theme of invisibility in relation to return-to-work effort and uncertainty, particularly, about how and when to enact return-to-work. Conclusion The findings strengthen the notion that workplace-based return-to-work interventions need to take social relations amongst workplace actors into account. They also highlight the importance and relevance of the varied roles of different workplace actors during two relatively unseen or grey areas, of return-to-work: the pre-return and the post-return sustainability phase. Attention to the invisibility of return-to-work efforts of some actors and uncertainty about how and when to enact return-to-work between workplace actors can promote successful and sustainable work ability for the re-entering worker.

  • 22.
    Wåhlin, Charlotte
    et al.
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Ekberg, Kerstin
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, HELIX Vinn Excellence Centre. Linköping University, Faculty of Health Sciences.
    Persson, Jan
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Bernfort, Lars
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Evaluation of self-reported work ability and usefulness of interventions among sick-listed patients2013In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 23, no 1, p. 32-43Article in journal (Refereed)
    Abstract [en]

    Aim To describe the types of intervention offered, to investigate the relationship between the type of intervention given, patient-reported usefulness of interventions and the effect on self-reported work ability in a cohort of sick-listed patients with musculoskeletal disorders (MSD) or mental disorders (MD).

    Methods A prospective cohort study was performed including 810 newly sick-listed patients (MSD 62 % and MD 38 %). The baseline questionnaire included sociodemographic characteristics and measures of work ability. The 3-month follow-up questionnaire included measures of work ability, type of intervention received, and judgment of usefulness.

    Results Twenty-five percent received medical intervention modalities (MI) only, 45 % received a combination of medical and rehabilitative intervention modalities (CRI) and 31 % received work-related interventions combined with medical or rehabilitative intervention modalities (WI). Behavioural treatments were more common for patients with MD compared with MSD and exercise therapy were more common for patients with MSD. The most prevalent workplace interventions were adjustment of work tasks or the work environment. Among patients with MD, WI was found to be useful and improved work ability significantly more compared with only MI or CRI. For patients with MSD, no significant differences in improved work ability were found between interventions.

    Conclusions Patients with MD who received a combination of work-related and clinical interventions reported best usefulness and best improvement in work ability. There was no difference in improvements in work ability between rehabilitation methods in the MSD group. There seems to be a gap between scientific evidence and praxis behaviour in the rehabilitation process. Unimodal rehabilitation was widely applied in the early rehabilitation process, a multimodal treatment approach was rare and only one-third received work-related interventions. It remains a challenge to understand who needs what type of intervention.

1 - 22 of 22
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