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  • 1.
    Hollertz, Katarina
    et al.
    Institutionen för socialt arbete, Göteborgs universitet, Gothenburg, Sweden.
    Jacobsson, Kerstin
    Institutionen för sociologi och arbetsvetenskap, Göteborgs universitet, Gothenburg, Sweden.
    Seing, Ida
    Linköping University, Department of Behavioural Sciences and Learning, Education and Sociology. Linköping University, Faculty of Arts and Sciences.
    Den transparenta organisationen. Handläggaren och visibilitetskulturen i Försäkringskassan2017In: Socialvetenskaplig tidskrift, ISSN 1104-1420, Vol. 3-4, p. 239-260Article in journal (Refereed)
    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.

  • 2.
    Hollertz, Katarina
    et al.
    University of Gothenburg, Gothenburg, Sweden.
    Jacobsson, Kerstin
    University of Gothenburg, Gothenburg, Sweden.
    Seing, Ida
    Linköping University, Department of Behavioural Sciences and Learning, Education and Sociology. Linköping University, Faculty of Arts and Sciences.
    Organizational Governance of Activation Policy: Transparency as Organizational Ideal in the Everyday Life of a Welfare Agency2017In: New Horizons of European Social Policy: Risks, Opportunities and Challenges, 2017Conference paper (Other academic)
    Abstract [en]

    A critical task of sickness insurance policy in most Western welfare states during recent decades has been to reduce the economic burden on society due to sick leave, by stimulating and enforcing labour market participation. In Sweden, strong activation requirements have been implemented in the health insurance in the past decades. Currently, this orientation is reflected in the politically set objective to reduce the sickness absence rate in Sweden; the center-left government in 2016 stated that “the sickness benefit rate may not exceed 9.0 days per individual and per year in 2020”. Furthermore, it was stressed that “newly granted disability pension shall not exceed 18 000 per year during the period 2016-2020”. In achieving these targets, the Swedish Social Insurance Agency (SSIA) and their frontline staff have a key role. This paper explores the organizational mediation of ’welfare to work’ policy by investigating the organizational governance and modes of operating set in place in local SSIA offices in order to fulfill the political objectives and reach these targets. More specifically, the paper focuses on one dimension of the local governance of ’welfare to work’ policy, namely the role that transparency plays in the alignment of frontline staff with the normative regime of the agency as well as its effects on caseworker subjectivity.  

    The paper is based on an ethnographic study consisting of participant observations (mainly at work meetings with caseworkers, managers and insurance physicians/specialists) and qualitative interviews in the SSIA head office as well as five local offices. In total 57 interviews have been conducted and 37 meetings observed during 2015-17. Inspired by institutional ethnography (D. Smith) as well as ethnomethodology, the paper conceives of institutional settings as creating specific environments for the management of responsibility and accountability. Transparency is here key.

    The paper shows how the transparency ideal is an integral part of the organizational governance in the agency, and implemented through tools, technologies, infrastructures, teamwork, and socio-spatial governance. 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 (following Power 1997), colouring not only case management but also the relations between colleagues and between management and staff. As an internalized ideal, transparency affects caseworker subjectivity, lending the welcoming of audit as a way to self-improvement along with the improvement of organizational performance. However, transparency is much less salient in relation to clients and the outside world. Thus this everyday regime of visibility, as established in social interaction as well as in organizational routines, is at the same time part of an organizational politics of visibility designed to facilitate the organizational performances and the smooth implementation of welfare-to-work policies in the health insurance.

  • 3.
    Hollertz, Katarina
    et al.
    Department of Social Work, University of Gothenburg, Sweden.
    Kerstin, Jacobsson
    Department of Sociology and Work Science, University of Gothenburg, Sweden.
    Seing, Ida
    Linköping University, Department of Behavioural Sciences and Learning, Education and Sociology. Linköping University, Faculty of Arts and Sciences.
    Organizational governance of activation policy: Transparency as an organizational ideal in a Swedish welfare agency2018In: International Social Security Review, ISSN 0020-871X, E-ISSN 1468-246X, Vol. 71, no 4, p. 71-89Article in journal (Refereed)
    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.

  • 4.
    Jacobsson, Kerstin
    et al.
    Södertörns högskola, Institutionen för samhällsvetenskaper, Sociologi.
    Seing, Ida
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    En möjliggörande arbetsmarknadspolitik?: Arbetsförmedlingens utredning och klassificering av klienters arbetsförmåga, anställbarhet och funktionshinder2013In: Arbetsmarknad & Arbetsliv, ISSN 1400-9692, Vol. 19, no 1, p. 9-24Article in journal (Refereed)
    Abstract [sv]

    De höga kraven i dagens arbetsliv har lett till att många personer ses som icke anställbara och allt fler arbetssökande kodas som funktionshindrade av Arbetsförmedlingen. Artikeln analyserar det bedömningsarbete som ligger till grund för funktionshinderkodningen, och där de sökandes arbetsförmåga, anställbarhet och funktionshinder upptäcks, skapas och objektifieras. Funktionshinderkodningen ska dock främst förstås i en vidare kontext kopplat till krav och förväntningar i Arbetsförmedlingens omgivning.

  • 5.
    Karlsson, Elin
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Sandqvist, Jan
    Linköping University, Department of Social and Welfare Studies, Division of Occupational Therapy. Linköping University, Faculty of Medicine and Health Sciences.
    Seing, Ida
    Linköping University, Department of Behavioural Sciences and Learning, Education and Sociology. Linköping University, Faculty of Arts and Sciences.
    Ståhl, Christian
    Linköping University, Department of Behavioural Sciences and Learning, Education and Sociology. Linköping University, HELIX Competence Centre. Linköping University, Faculty of Medicine and Health Sciences.
    Social validitet för försäkringsmedicinska utredningar och påföljande myndighetsbeslut inom sjukförsäkringen2019Report (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.

  • 6.
    Karlsson, Elin
    et al.
    Linköping University, Faculty of Medicine and Health Sciences.
    Seing, Ida
    Linköping University, Department of Behavioural Sciences and Learning, Education and Sociology. Linköping University, Faculty of Arts and Sciences.
    Sandqvist, Jan
    Linköping University, Faculty of Medicine and Health Sciences.
    Ståhl, Christian
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Behavioural Sciences and Learning, Education and Sociology. Linköping University, HELIX Competence Centre.
    Communication Characteristics Between Clients And Stakeholders Within The Swedish Sickness Insurance System – A Document Analysis Of Granted And Withdrawn Sickness Benefit Claims2019Conference paper (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.

  • 7.
    Karlsson, Elin
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Seing, Ida
    Linköping University, Department of Behavioural Sciences and Learning, Education and Sociology. Linköping University, Faculty of Arts and Sciences.
    Sandqvist, Jan
    Linköping University, Department of Social and Welfare Studies, Division of Occupational Therapy. Linköping University, Faculty of Medicine and Health Sciences.
    Ståhl, Christian
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Communication characteristics between clients and stakeholders within the Swedish sickness insurance system: a document analysis of granted and withdrawn sickness benefit claims2019In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165Article in journal (Refereed)
    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.

  • 8.
    Nilsen, Per
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Schildmeijer, Kristina
    Department of Health and Care Sciences, Linnaeus University, Kalmar, Sweden.
    Ericsson, Carin
    Region Östergötland, Heart and Medicine Center.
    Seing, Ida
    Linköping University, Department of Behavioural Sciences and Learning, Education and Sociology. Linköping University, Faculty of Arts and Sciences.
    Birken, Sarah
    Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, USA.
    Implementation of change in health care in Sweden: a qualitative study of professionals’ change responses2019In: Implementation Science, ISSN 1748-5908, E-ISSN 1748-5908, Vol. 14, article id 51Article in journal (Refereed)
    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.

  • 9.
    Seing, Ida
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Activating the Sick-Listed: Policy and Practice of Return to Work in Swedish Sickness Insurance and Working Life2014Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    A critical task of social policy in most Western welfare states during recent decades has consisted of reducing the economic burden on society due to sick leave, by stimulating participation in the labour market. Many jurisdictions have introduced activation policies, based on the premise that work “per se” has a therapeutic effect on sick-listed workers. People are expected to be “active”, rather than “passive”, recipients of financial benefits. However, there is limited knowledge of how activation policies focusing on return to work (RTW) are carried out in local practice. Against this background, the overall aim of this thesis is to study the local practice of activation policies by analysing how they are received, implemented and experienced by welfare state organizations, employers and sick-listed workers. The analysis has been influenced by theories concerning organization fields, individualization, street-level bureaucracy and organizational governance.

    In this thesis, the overall aim is investigated in four interrelated papers. In Paper I, the aim is to analyse the perspectives of stakeholders (i.e. welfare state actors and employers) on work ability by studying multistakeholder meetings. Paper II sheds light on activation policy, focusing on early RTW in the context of modern working conditions; the aim is to analyse RTW practice in local workplace contexts, in relation to Swedish early-RTW policy. The third paper focuses on employers, with the aim of analysing their role and activities regarding RTW, in local workplace practice. In Paper IV, the aim is to analyse sick-listed workers’ experiences of the sickness insurance system in their contact with the Swedish Social Insurance Agency (SSIA) and their front-line staff.

    The empirical material comprises two empirical studies: 1) audio-recorded multi-stakeholder meetings from regular practice (n=9) and 2) semi-structured interviews with sick-listed workers and their supervisors in 18 workplaces (n=36). The analyses of the material have been performed in accordance with the principles of qualitative content analysis.

    Main findings of the papers reflect strong organizational boundaries in the implementation process of activation policies. Welfare state actors and employers appear to be governed by their own organizational logics and interests, so the actors involved fail to take a holistic view of sick-listed workers and do not share a common social responsibility for individuals’ RTW. This thesis illustrates how current activation policies focusing on RTW are based on a rather idealized image of the standard workplace. There is an explicit or implicit assumption that employers and work organizations are able to welcome sick-listed workers back to work in a healthy way. However, the intensity of modern working life leaves limited room for accommodating people with reduced work ability, who are not considered to have a business value to the workplace. In several cases, findings indicate that the SSIA’s focus on activation and early RTW clashes with the financially oriented perspective of employers. Economic considerations regarding their business take precedence over legal and ethical considerations, and employers have difficulty taking social responsibility for RTW. Sick-listed workers are encouraged to adjust to new workplace settings and environments to meet the demands of the workplace, and, if RTW is not possible, to the demands of the labour market. The findings also show that sick-listed workers experience that contacts with the SSIA are ‘standardized’; i.e., they perceive that the officials are loyal  to demands in their organizations rather than being involved actors who support workers’ individual needs. Sick-listed workers clearly experience that measures in Swedish activation policies have a strong focus on demanding aspects (financial work incentives) and less on enabling aspects (investments in skills).

    Overall, this thesis illustrates an emerging social climate where sick-listed workers are positioned as active agents who must take responsibility for their sick leave and their RTW process. In a Swedish context, RTW is a matter of activating the sick-listed rather than activating the workplace.

    List of papers
    1. Policy and Practice of Work Ability: A Negotiation of Responsibility in Organizing Return to Work
    Open this publication in new window or tab >>Policy and Practice of Work Ability: A Negotiation of Responsibility in Organizing Return to Work
    Show others...
    2012 (English)In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 22, no 4, p. 553-564Article in journal (Refereed) Published
    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.

    Place, publisher, year, edition, pages
    Springer, 2012
    National Category
    Occupational Therapy Work Sciences Public Health, Global Health, Social Medicine and Epidemiology Political Science Sociology
    Identifiers
    urn:nbn:se:liu:diva-73888 (URN)10.1007/s10926-012-9371-3 (DOI)000310472400012 ()
    Available from: 2012-01-16 Created: 2012-01-16 Last updated: 2017-12-08
    2. Early-Return-to-Work in the Context of an Intensification of Working Life and Changing Employment Relationships
    Open this publication in new window or tab >>Early-Return-to-Work in the Context of an Intensification of Working Life and Changing Employment Relationships
    2015 (English)In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 25, no 1, p. 74-85Article in journal (Refereed) Published
    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.

    Place, publisher, year, edition, pages
    Springer, 2015
    Keywords
    Social policy; Return-to-work; Sick leave; Work place; Career mobility
    National Category
    Occupational Therapy Public Health, Global Health, Social Medicine and Epidemiology Sociology Political Science Work Sciences
    Identifiers
    urn:nbn:se:liu:diva-112396 (URN)10.1007/s10926-014-9526-5 (DOI)000349971100008 ()24920449 (PubMedID)
    Available from: 2014-11-25 Created: 2014-11-25 Last updated: 2017-12-05Bibliographically approved
    3. Return to work or job transition?: Employer dilemmas in taking social responsibility for return to work in local workplace practice
    Open this publication in new window or tab >>Return to work or job transition?: Employer dilemmas in taking social responsibility for return to work in local workplace practice
    2015 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 37, no 18-19, p. 1760-1769Article in journal (Refereed) Published
    Abstract [en]

    Purpose: The aim was to analyze the role and activities of employers with regard to return to work (RTW), in local workplace practice.

    Method: Semi-structured interviews were conducted with sick-listed workers and their supervisors in 18 workplaces (n  = 36). The analytical approach to study the role of employers in RTW was based on the three-domain model of social corporate responsibility. The model illustrates the linkage between corporations and their social environment, and consists of three areas of corporate responsibility: economic, legal and ethical.

    Results: Employers had difficulties in taking social responsibility for RTW, in that economic considerations regarding their business took precedence over legal and ethical considerations. Employers engaged in either “RTW activities” or “transition activities” that were applied differently depending on how valued sick-listed workers were considered to be to their business, and on the nature of the job (e.g. availability of suitable work adjustments).

    Conclusions: This study suggests that Swedish legislation and policies does not always adequately prompt employers to engage in RTW. There is a need for further attention to the organizational conditions for employers to take social responsibility for RTW in the context of business pressure and work intensification.

    Implications for Rehabilitation

    • Employers may have difficulties in taking social responsibility for RTW when economic considerations regarding their business take precedence over legal and ethical considerations.
    • Rehabilitation professionals should be aware of that outcomes of an RTW process can be influenced by the worker’s value to the employer and the nature of the job (e.g. availability of suitable work adjustments). “Low-value” workers at workplaces with limited possibilities to offer workplace adjustments may run a high risk of dismissal.
    • Swedish legislation and policies may need reforms to put more pressure on employers to promote RTW.
    Place, publisher, year, edition, pages
    Informa Healthcare, 2015
    Keywords
    Activation policy, employers, sick leave, work accommodation, workplace
    National Category
    Occupational Therapy Public Health, Global Health, Social Medicine and Epidemiology Political Science Sociology Work Sciences
    Identifiers
    urn:nbn:se:liu:diva-112397 (URN)10.3109/09638288.2014.978509 (DOI)000359878700020 ()25355548 (PubMedID)
    Available from: 2014-11-25 Created: 2014-11-25 Last updated: 2017-12-05Bibliographically approved
    4. Activation Policies and Sick-Listed Workers’ Experiences and Trust in the Sickness Insurance System in Local Practice
    Open this publication in new window or tab >>Activation Policies and Sick-Listed Workers’ Experiences and Trust in the Sickness Insurance System in Local Practice
    2014 (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    In recent welfare and labour market reforms in Europe and North America, there is a general trend towards activation, in that people (e.g. those who are sick-listed, unemployed and recipients of social welfare) are expected to be “active”, rather than “passive”, recipients of financial benefits. Meanwhile, street-level bureaucracy in many welfare state organizations has been fundamentally reformed in recent years with the implementation of New Public Management Principles which have come to influence the day-to-day work of front-line staff. The aim of this paper is to analyse sick-listed workers’ experiences of the sickness insurance system in their contact with the SSIA and their front-line staff. The data consists of semistructured interviews with 18 sick-listed workers in Sweden. The material was analysed using qualitative content analysis. The findings illustrate that sick-listed workers experienced contacts with the Social Insurance Agency (SSIA) as “standardized”; that is, they perceived that the officials were loyal to demands in their organizations rather than involved actors that supported workers’ individual needs. The SSIA was described as having a mainly administrative and controlling function during their sick leave, resulting in a distant relationship. It was also clear that sick-listed individuals experienced the activation policy as demanding, and their sick leave was characterized by insecurity and uncertainty. Overall, this paper suggests that activation policies with regulations emphasizing time limits, and enforcement of standardized work processes at the SSIA, challenge sick-listed workers’ trust in the sickness insurance system.

    National Category
    Occupational Therapy Public Health, Global Health, Social Medicine and Epidemiology Work Sciences Political Science Sociology
    Identifiers
    urn:nbn:se:liu:diva-112398 (URN)
    Available from: 2014-11-25 Created: 2014-11-25 Last updated: 2014-11-26
  • 10.
    Seing, Ida
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Arbetsförmåga, anställningsbarhet och omställning i sjukförsäkringen2016In: Anställningsbarhet: perspektiv från utbildning och arbetsliv / [ed] Gun Sparrhoff, Andreas Fejes, Lund: Studentlitteratur AB, 2016, 2, p. 173-189Chapter in book (Other academic)
  • 11.
    Seing, Ida
    Score, Stockholms universitet .
    Arbetsförmåga och funktionshinder i arbetsmarknadspolitikens lokalapraktik.2009Report (Other academic)
    Abstract [sv]

    I ljuset av en förändrad arbetsmarknad där antalet människor klassificerade som funktionshindrade i arbetslivet har ökat handlar denna rapport om Arbetsförmedlingens verksamhet riktat mot sökande med funktionshinder.

    Studien bygger på intervjuer med tjänstemän på central och lokal nivå inom Arbetsförmedlingen och avdelningen Rehabilitering till arbete.

    Huvudsyftet är att beskriva och ge förklaringar till bedömningsprocessens utformning som leder fram till att en sökande klassificeras som funktionshindrad och därigenom berättigas särskilda arbetsmarknadspolitiska stödinsatser.

    Föreliggande studie lyfter fram en tämligen etablerad och expertorienterad verksamhet inom Arbetsförmedlingen där människors förmågor, kapaciteter och resurser utgör föremål för utredning, förändring och anpassning. I arbetsmarknadspolitikens lokala praktik framkommer således en grupp närbyråkrater som agerar i rollen som experter med en central roll i definitioner av sökandes funktionshinder. Samtidigt visar sig funktionshinderbedömningen bygga på en komplex och situationsbunden process starkt kopplad till konjunkturläge och normer på arbetsmarknaden. I rapporten konstateras att expertis, medikalisering och förändringar på arbetsmarknaden förklarar bedömningsprocessens utformning. Klassificeringen av sökande som funktionshindrade ska framförallt ses som ett resultat av Arbetsförmedlingens behov av att hantera en förändrad arbetsmarknad som har kommit att lämna mindre utrymme för personer som av olika anledningar uppfattas som avvikande. När Arbetsförmedlingens huvuduppdrag har kommit att bli matchning och där stora delar av arbetsmarknadspolitiska insatser har minskat blir funktionshinderbedömningen ett sätt för närbyråkraterna och de sökande att få tillgång till "exklusivare" former av stödinsatser som lönebidrag, Samhallanställning och offentligt skyddat arbete. Dessa insatser ses som en möjlig alternativ väg för att idag få sökande i aktivitet och arbete.

  • 12.
    Seing, Ida
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, Faculty of Health Sciences.
    Avstämningsmötet: en arena för förhandling omarbetsförmåga och rehabiliteringsansvar2011Report (Other academic)
    Abstract [sv]

    I juli 2003 infördes ett krav i lagstiftningen att Försäkringskassan vid behov ska använda sig av ett så kallat avstämningsmöte vid bedömningen av individers rätt till ersättning och rehabiliterande insatser från sjukförsäkringen. På policynivå har avstämningsmötet presenterats som ett effektivt verktyg i lösningen på problemen med långa sjukskrivningar och hög sjukfrånvaro. Genom att samla involverade aktörer ”runt ett bord” (Försäkringskassan, den sjukskrivne, sjukvården, arbetsgivare och Arbetsförmedlingen) förväntas parterna hitta gemensamma lösningar som ska underlätta den sjukskrivnes väg tillbaka i arbetslivet.

    Huvudsyftet med föreliggande studie har varit att analysera på vilka grunder involverade parter bedömer individers arbetsförmåga och möjligheter för återgång i arbete. En central frågeställning var att studera vilka aspekter av arbetsförmåga som under mötet belystes. Fokus riktades mot involverade aktörers resonemang om arbetsförmåga och hur parterna såg på sin egen och övriga aktörers roll i verksamhetsprocessen. Rapporten baseras på nio inspelade avstämningsmöten under år 2007 och 2008 i Östergötland. Det empiriska materialet har kompletterats med metodstöd från Försäkringskassan och offentliga rapporter. En innehållsanalytisk metod har använts i analysen av det empiriska materialet.

    Studiens resultat visar hur välfärdspolitikens fokus på arbetslinjen och aktiva insatser ställer krav på de organisationer som har till uppgift att återföra sjukskrivna i arbetslivet. Avstämningsmötet äger rum i skärningspunkten mellan organisationer med skilda regler och rutiner. Mötena utmärktes av en förhandling om arbetsförmåga och vilka aktörer som hade rehabiliteringsansvaret för individerna i fråga. Tre perspektiv på arbetsförmåga blev framträdande: det medicinska, regelverkets och arbetslivets perspektiv. Försäkringskassan argumenterade ofta utifrån sjukförsäkringens regelverk, och sjukvården betonade främst medicinska hinder för individens arbetsoförmåga, medan arbetsgivare framhöll individens fysiska nedsättningar i relation till arbetes krav. Samtidigt som perspektiven kunde knytas till specifik aktör kunde parterna växla mellan olika perspektiv på arbetsförmåga beroende på situation. I förhandlingen om den sjukskrivnes arbetsförmåga utgjorde den medicinska expertisen en ”neutral expertfunktion” som skapade legitimitet för parternas ståndpunkter. I rapporten visas hur Försäkringskassans regelverk med fokus på tidig återgång i arbete och aktiva insatser kom på kollisionskurs med arbetsgivarnas svårigheter att anpassa arbetsplatsen. Sjukskrivnas arbetsförmåga och möjligheter att återgå i arbete berodde därför inte enbart beror på den strikt medicinska bedömningen av funktionsnedsättning. I praktiken grundades bedömningen av arbetsförmåga istället på relationen mellan individens förmåga och arbetets förutsättningar. Studien aktualiserar avslutningsvis frågor om vilka förutsättningar den arbetslivsinriktade rehabiliteringen har när arbetsmarknaden idag tenderar att lämna begränsat utrymme för människor som inte anses leva upp till arbetslivets krav.

  • 13.
    Seing, Ida
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Labour Market of Opportunities?: Specialists Assess Ability to Work2015In: Makeshift Work in a Changing Labour Market: The Swedish Model in the Post-Financial Crisis Era / [ed] Christina Garsten, J. Lindvert and Renita Thedvall, Edward Elgar Publishing, 2015Chapter in book (Other academic)
    Abstract [en]

    In the aftermath of the global financial crisis, people who had never before had cause to worry about losing their jobs entered the ranks of the unemployed for the first time. In Sweden, the welfare state has been radically challenged and mass unemployment has become a reality in what used to be viewed as a model case for a full employment society. With an emphasis on Sweden in the context of transnational regulatory change, Makeshift Work in a Changing Labour Market discusses how the market mediates employment and moves on to explore the ways in which employees adjust to a new labour market. Focusing on the legibility, measurability and responsibility of jobseekers, the expert contributors of this book bring together an analysis of activation policy and new ways of organizing the mediation of work, with implications for the individual jobseeker. Students and researchers of labour market policy, the organization of markets and work and society both in Sweden and abroad will find this book to be of interest. Policy makers will find the empirical examples of policy processes among employees an extremely useful and insightful tool.

  • 14.
    Seing, Ida
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, Faculty of Health Sciences.
    Möjligheternas arbetsmarknad? Specialister bedömer ”arbetsförmåga”.2011In: Arbetets marknad: Arbetsmarknadens nya organisering. / [ed] C. Garsten, J. Lindvert & R. Thedvall, Malmö: Liber , 2011, 1:1, p. 80-104Chapter in book (Other academic)
    Abstract [sv]

    Såväl arbetsmarknadspolitiken som arbetsmarknaden präglas idag av krav och förväntningar på att människor ska kunna marknadsföra sig själva, ha rätt attityd och personlighet för att få en anställning. Mänskliga förmågor, kunskaper och färdigheter lyfts fram som centrala verktyg för att konkurrera på den moderna arbetsmarknaden och vara motståndskraftiga mot arbetslöshet och utanförskap. Detta är en utveckling som speglar en ny syn på individen som själv förväntas ta ansvar för arbetslöshet och anställning. Utvecklingen har formulerats i termer av ett ideologiskt skifte där det sociala ansvaret har kommit att förskjutas från samhälle till individ – från rätten till anställning till skyldigheten att vara anställningsbar. Samtidigt kan vi se att antalet grupper som befinner sig utanför den reguljära arbetsmarknaden blivit flera.

    Detta kapitel handlar om Arbetsförmedlingens verksamhet riktad mot sökande med nedsatt arbetsförmåga. Kapitlet belyser hur byråkratiska processer leder fram till hur arbetssökande klassificeras i termer av ett funktionshinder. Hur går arbetet med att bedöma och kategorisera egentligen till? Vilka antaganden vilar arbetet på? Kapitlet belyser hur verksamheten är utformad, hur utredningsprocessen ser ut, vilka aktörer som är involverade och hur begrepp som arbetsförmåga och funktionshinder operationaliseras. Ambitionen är att ge en rikare förståelse för hur Arbetsförmedlingen på lokal nivå arbetar, organiserar och utformar verksamheten för sökande med begränsad arbetsförmåga. 

  • 15.
    Seing, Ida
    Linköping University, Department of Behavioural Sciences and Learning, Education and Sociology. Linköping University, Faculty of Arts and Sciences.
    The activation paradigm and emotions in welfare bureaucratic work: The role of numerical targets in shaping the ideal caseworker at the Swedish Social Insurance Agency2017Conference paper (Refereed)
    Abstract [en]

    A critical task of sickness insurance policy in most Western welfare states during recent decades has been to reduce the economic burden on society due to sick leave, by stimulating labour market participation. Activation policies have gained strong support, and activities that prevent the “disability benefit trap” are favored by international organizations such as the OECD and EU as well as national governments. A common statement in policy documents is that “the longer people are off work due to illness, the less likely it is that they will return to work”. Work per se assumed to have a therapeutic effect, leading to good health and well-being. In line with this development, the Swedish center-left government in 2016 introduced a numerical target –and a very exact one – regarding the sickness absence rate in Sweden; it is stated that “the sickness benefit rate may not exceed 9.0 days per individual and per year in 2020”. Further, it is stressed that “newly granted disability pension shall not exceed 18 000 per year during the period 2016-2020”. The targets are part of a governmental “action plan for improved health and reduced sickness absence”. In achieving these targets, the Swedish Social Insurance Agency (SSIA) and their frontline staff have a key role. The state agency is responsible for administrating the sickness insurance and decisions regarding individuals’ right to sickness benefits.

    The aim of this paper is to analyze the role of numerical targets (understood as object and mobilizing symbols) in shaping caseworker subjectivity, including their emotions and relationships to clients. The study identifies central governance technologies used in the organizational shaping of the “ideal caseworker”. The paper is based on an ethnographic study with participant observations (meetings with caseworkers, managers and insurance physicians/specialists) and interviews in the head office and five local offices of the SSIA. In total 57 interviews were conducted and 37 meetings observed.

    The study shows how numerical targets are loaded with positive emotions within the organization, associated with emotions such as work joy, sense of achievement, pride and belonging – but also frustration and embarrassment in relation to colleagues and other local offices with “better numbers” and results. Furthermore, the analysis shows how teamwork (in so-called self-managed teams between caseworkers) and meetings with different street-level bureaucrat experts (e.g. insurance specialists and insurance physicians) constitute central governance technologies in the shaping of caseworker subjectivity and emotions. Teamwork and the meetings have an influence on caseworkers to achieve mobilization around the target 9.0. Governing by numerical targets illustrates the SSIA’s effort to create a feeling of togetherness at the workplace and influence caseworkers to move in the same direction – as well as maintain the “work strategy” in the sickness insurance and reduce the number of people on sickness benefits.

  • 16.
    Seing, Ida
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Education and Sociology. Linköping University, Faculty of Arts and Sciences.
    Johansson, Håkan
    Governing frontline-workers beyond NPM-models?: Ideals and practices of self-leadership in the Swedish Public Employment Service2018In: Conference of the Swedish Sociological Association: Sociology in a Polarized world, Lund, March 7-9, 2018, 2018Conference paper (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.

     

     

  • 17.
    Seing, Ida
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Education and Sociology. Linköping University, Faculty of Arts and Sciences.
    Johansson, Håkan
    Governing the post-bureaucratic organization: A comparative study of the Public Employment Service and the Swedish Social Insurance Agency2016Conference paper (Other academic)
    Abstract [en]

     

  • 18.
    Seing, Ida
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    MacEachen, Ellen
    Department of Public Health and Health Systems, Faculty of Applied Public Health, University of Waterloo, Ontario, Canada.
    Ekberg, Kerstin
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, HELIX Vinn Excellence Centre. Linköping University, Faculty of Health Sciences.
    Ståhl, Christian
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Activation Policies and Sick-Listed Workers’ Experiences and Trust in the Sickness Insurance System in Local Practice2014Manuscript (preprint) (Other academic)
    Abstract [en]

    In recent welfare and labour market reforms in Europe and North America, there is a general trend towards activation, in that people (e.g. those who are sick-listed, unemployed and recipients of social welfare) are expected to be “active”, rather than “passive”, recipients of financial benefits. Meanwhile, street-level bureaucracy in many welfare state organizations has been fundamentally reformed in recent years with the implementation of New Public Management Principles which have come to influence the day-to-day work of front-line staff. The aim of this paper is to analyse sick-listed workers’ experiences of the sickness insurance system in their contact with the SSIA and their front-line staff. The data consists of semistructured interviews with 18 sick-listed workers in Sweden. The material was analysed using qualitative content analysis. The findings illustrate that sick-listed workers experienced contacts with the Social Insurance Agency (SSIA) as “standardized”; that is, they perceived that the officials were loyal to demands in their organizations rather than involved actors that supported workers’ individual needs. The SSIA was described as having a mainly administrative and controlling function during their sick leave, resulting in a distant relationship. It was also clear that sick-listed individuals experienced the activation policy as demanding, and their sick leave was characterized by insecurity and uncertainty. Overall, this paper suggests that activation policies with regulations emphasizing time limits, and enforcement of standardized work processes at the SSIA, challenge sick-listed workers’ trust in the sickness insurance system.

  • 19.
    Seing, Ida
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    MacEachen, Ellen
    Department of Public Health and Health Systems, Faculty of Applied Public Health, University of Waterloo, Ontario, Canada.
    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.
    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.
    Return to work or job transition?: Employer dilemmas in taking social responsibility for return to work in local workplace practice2015In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 37, no 18-19, p. 1760-1769Article in journal (Refereed)
    Abstract [en]

    Purpose: The aim was to analyze the role and activities of employers with regard to return to work (RTW), in local workplace practice.

    Method: Semi-structured interviews were conducted with sick-listed workers and their supervisors in 18 workplaces (n  = 36). The analytical approach to study the role of employers in RTW was based on the three-domain model of social corporate responsibility. The model illustrates the linkage between corporations and their social environment, and consists of three areas of corporate responsibility: economic, legal and ethical.

    Results: Employers had difficulties in taking social responsibility for RTW, in that economic considerations regarding their business took precedence over legal and ethical considerations. Employers engaged in either “RTW activities” or “transition activities” that were applied differently depending on how valued sick-listed workers were considered to be to their business, and on the nature of the job (e.g. availability of suitable work adjustments).

    Conclusions: This study suggests that Swedish legislation and policies does not always adequately prompt employers to engage in RTW. There is a need for further attention to the organizational conditions for employers to take social responsibility for RTW in the context of business pressure and work intensification.

    Implications for Rehabilitation

    • Employers may have difficulties in taking social responsibility for RTW when economic considerations regarding their business take precedence over legal and ethical considerations.
    • Rehabilitation professionals should be aware of that outcomes of an RTW process can be influenced by the worker’s value to the employer and the nature of the job (e.g. availability of suitable work adjustments). “Low-value” workers at workplaces with limited possibilities to offer workplace adjustments may run a high risk of dismissal.
    • Swedish legislation and policies may need reforms to put more pressure on employers to promote RTW.
  • 20.
    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.

  • 21.
    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 Health 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.
    Avstämningsmötet som arena för förhandling om arbetsförmåga.2011In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 88, no 5, p. 408-417Article in journal (Refereed)
  • 22.
    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.

  • 23.
    Ståhl, Christian
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Sandqvist, Jan
    Linköping University, Department of Social and Welfare Studies, Division of Occupational Therapy. Linköping University, Faculty of Medicine and Health Sciences.
    Seing, Ida
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Aktivitetsförmågeutredning (AFU): Tillämpning, upplevelser och utfall2017Report (Other academic)
    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.

  • 24.
    Ståhl, Christian
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Seing, Ida
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Arbetslinjer och arbetsförmåga i det svenska socialförsäkringssystemet2014In: Den relativa arbetsförmågan: teoretiska och praktiska perspektiv / [ed] Kerstin Ekberg, Lund: Studentlitteratur AB, 2014, p. 75-93Chapter in book (Other academic)
    Abstract [sv]

    Vad är arbetsförmåga? Det är en komplex fråga vars svar beror på vem som svarar. Att fastställa en persons arbetsförmåga utifrån objektiva kriterier är mycket svårt eftersom den påverkas av många olika faktorer. Ändå görs detta av många olika aktörer i sjukskrivnings- och rehabiliteringsprocessen; för att bedöma om en person har rätt att få sjukpenning, som ett underlag för rehabiliteringsåtgärder och av Arbetsförmedlingen som en bedömning av anställningsbarheten.

    Hur ska då arbetsförmåga förstås? I denna bok belyses begreppet arbetsförmåga ur flera olika perspektiv. Sammantaget bildar de olika kapitlen en illustration av den komplexa helheten, av en arbetsförmåga som är relativ och som används av olika aktörer, på olika sätt, i olika syften.

    Boken vänder sig till personer som arbetar med bedömning av arbetsförmåga och med åtgärder för att främja återgång i arbete, till exempel läkare och annan sjukvårdspersonal, rehabiliteringsprofessioner, berörda inom arbetslivet och företagshälsovården.

  • 25.
    Ståhl, Christian
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Seing, Ida
    Linköping University, Department of Behavioural Sciences and Learning, Education and Sociology. Linköping University, Faculty of Arts and Sciences.
    Reforming Activation in Swedish Work Disability Policy2018In: 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.

  • 26.
    Ståhl, Christian
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. HELIX Competence Centre, Linköping University, Linköping, Sweden.
    Seing, Ida
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Sandqvist, Jan
    Linköping University, Department of Social and Welfare Studies, Division of Occupational Therapy. Linköping University, Faculty of Medicine and Health Sciences.
    Fair or square? Experiences of introducing a new method for assessing general work ability in a sickness insurance context2019In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 6, p. 656-665Article in journal (Refereed)
    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.

  • 27.
    Wreder, Malin
    et al.
    Stockholms centrum för forskning om offentlig sektor, SCORE.
    Seing, Ida
    Stockholms centrum för forskning om offentlig sektor, SCORE.
    Hushållstjänster: en studie av reformen och marknaden för skattesubventionerade hushållstjänster i Sverige2009Report (Other academic)
    Abstract [en]

    To make domestic services like maids and nannies less expensive, thereby increasing the legal market for companies offering such services, tax deduction has been on the right-wing feminist/political agenda in Sweden for almost fifteen years. On the 1st of July 2007, after a successful lobby campaign, such a reform was implemented. This paper, based on interviews with actors involved in promoting the reform, describes how the law permitting tax deduction finally passed and how the market for domestic services developed the years before and after the reform. The protagonists’ arguments for the importance of tax deduction for the survival and expansion of the market are also described. Their main arguments were: a) that the tax deduction would encourage people to buy these services from legal companies instead of using illegal workers, b) that many unemployed could be offered a legal job in the sector, and c) that the equality between men and women in work life would increase when women got rid of some of their family responsibilities. Our analysis shows that by framing the question differently in different situations, the reform protagonists managed to avoid some of the conflicts regarding gender equality, working conditions, competence, immigration/ethnicity and social class inherent in their arguments. These value conflicts are outlined in the papers final section. By integrating sociological theories on intersectionality with theories on the organization of markets, we analyze the value conflicts and also discuss why the reform antagonists (left-wing politicians, feminists and parts of the trade unions) failed to organize their resistance.

1 - 27 of 27
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