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  • 1.
    Andersen, Åsa
    et al.
    Uppsala University, Sweden.
    Ståhl, Christian
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Anderzen, Ingrid
    Uppsala University, Sweden.
    Kristiansson, Per
    Uppsala University, Sweden.
    Larsson, Kjerstin
    Uppsala University, Sweden.
    Positive experiences of a vocational rehabilitation intervention for individuals on long-term sick leave, the Dirigo project: a qualitative study2017In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 17, article id 790Article in journal (Refereed)
    Abstract [en]

    Background: The process of returning to work after long-term sick leave can sometimes be complex. Many factors, (e.g. cooperation between different authorities and the individual as well as individual factors such as health, emotional well-being and self-efficacy) may have an impact on an individuals ability to work. The aim of this study was to investigate clients experiences with an individually tailored vocational rehabilitation, the Dirigo project, and encounters with professionals working on it. The Dirigo project was based on collaboration between rehabilitation authorities, individually tailored interventions and a motivational interviewing approach. Methods: A descriptive qualitative design was used with data collected through interviews. Fourteen individuals on long-term sick leave took part in individual semi-structured interviews. The interviews were analysed using content analysis. Results: The analysis showed overall positive experience of methods and encounters with professionals in a vocational rehabilitation project. The positive experiences were based on four key factors: 1. Opportunities for receiving various dimensions of support. 2. Good overall treatment by the professionals. 3. Satisfaction with the working methods of the project, and 4. Opportunities for personal development. Conclusions: The main result showed that the clients had an overall positive experience of a vocational rehabilitation project and encounters with professionals who used motivational interviewing as a communication method. The overall positive experience indicated that their interactions with the different professionals may have affected their self-efficacy in general and in relation to transition to work. The knowledge is essential for the professionals working in the area of vocational rehabilitation. However, vocational rehabilitation interventions also need a societal approach to be able to offer clients opportunities for job training and real jobs.

  • 2.
    Back, A.
    et al.
    Karolinska Institute, Sweden; Stockholm County Council, Sweden.
    Ståhl, Christian
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    von Thiele Schwarz, U.
    Karolinska Institute, Sweden.
    Richter, A.
    Karolinska Institute, Sweden; Stockholm County Council, Sweden.
    Hasson, H.
    Karolinska Institute, Sweden; Stockholm County Council, Sweden.
    Walking the tightrope-perspectives on local politicians role in implementing a national social care policy on evidence-based practice2016In: INTERNATIONAL JOURNAL OF MENTAL HEALTH SYSTEMS, ISSN 1752-4458, Vol. 10, article id 75Article in journal (Refereed)
    Abstract [en]

    Background: Despite national policy recommending evidence-based practice (EBP), its application in social care has been limited. While local politicians can affect the process, little is known about their knowledge, attitudes and roles regarding EBP. The aim here is twofold: to explore the role of local politicians in the implementation of EBP in social care from both their own and a management perspective; and to examine factors politicians perceive as affecting their decisions and actions concerning the implementation of EBP policy. Methods: Local politicians (N = 13) and managers (N = 22) in social care were interviewed. Qualitative thematic analysis with both inductive and deductive codes was used. Results: Politicians were rather uninformed regarding EBP and national policy. The factors limiting their actions were, beside the lack of awareness, lack of ability to question existing working methods, and a need for support in the steering of EBP. Thus, personal interest played a significant part in what role the politicians assumed. This resulted in some politicians taking a more active role in steering EBP while others were not involved. From the managers perspective, a more active steering by politicians was desired. Setting budget and objectives, as well as active follow-up of work processes and outcomes, were identified as means to affect the implementation of EBP. However, the politicians seemed unaware of the facilitating effects of these actions. Conclusions: Local politicians had a possibility to facilitate the implementation of EBP, but their role was unclear. Personal interest played a big part in determining what role was taken. The results imply that social care politicians might need support in the development of their steering of EBP. Moving the responsibility for EBP facilitation upwards in the political structure could be an important step in developing EBP in social care.

  • 3.
    Dannapfel, Petra
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Peolsson, Anneli
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. 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.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Applying self-determination theory for improved understanding of physiotherapists rationale for using research in clinical practice: a qualitative study in Sweden2014In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 30, no 1, p. 20-28Article in journal (Refereed)
    Abstract [en]

    Physiotherapists are generally positive to evidence-based practice (EBP) and the use of research in clinical practice, yet many still base clinical decisions on knowledge obtained during their initial education and/or personal experience. Our aim was to explore motivations behind physiotherapists use of research in clinical practice. Self-Determination Theory was applied to identify the different types of motivation for use of research. This theory posits that all behaviours lie along a continuum of relative autonomy, reflecting the extent to which a person endorses their actions. Eleven focus group interviews were conducted, involving 45 physiotherapists in various settings in Sweden. Data were analysed using qualitative content analysis and the findings compared with Self-Determination Theory using a deductive approach. Motivations underlying physiotherapists use of research in clinical practice were identified. Most physiotherapists expressed autonomous forms of motivation for research use, but some exhibited more controlled motivation. Several implications about how more evidence-based physiotherapy can be achieved are discussed, including the potential to tailor educational programs on EBP to better account for differences in motivation among participants, using autonomously motivated physiotherapists as change agents and creating favourable conditions to encourage autonomous motivation by way of feelings of competence, autonomy and a sense of relatedness.

  • 4.
    Ellen, MacEachen
    et al.
    University of Waterloo, Canada; University of Toronto, Canada; Institute Work and Heatlh, Canada.
    Kosny, A.
    University of Toronto, Canada; Institute Work and Heatlh, Canada; Monash University, Australia.
    Ståhl, Christian
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    OHagan, F.
    Trent University, Canada.
    Redgrift, L.
    Institute Work and Heatlh, Canada; Dalhousie University, Canada.
    Sanford, S.
    Institute Work and Heatlh, Canada.
    Carrasco, C.
    Institute Work and Heatlh, Canada.
    Emile, Tompa
    Institute Work and Heatlh, Canada; McMaster University, Canada.
    Mahood, Q.
    Institute Work and Heatlh, Canada.
    Systematic review of qualitative literature on occupational health and safety legislation and regulatory enforcement planning and implementation2016In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 42, no 1Article, review/survey (Refereed)
    Abstract [en]

    Objective The ability of occupational health and safety (OHS) legislation and regulatory enforcement to prevent workplace injuries and illnesses is contingent on political, economic, and organizational conditions. This systematic review of qualitative research articles considers how OHS legislation and regulatory enforcement are planned and implemented. Methods A comprehensive search of peer-reviewed, English-language articles published between 1990 and 2013 yielded 11 947 articles. We identified 34 qualitative articles as relevant, 18 of which passed our quality assessment and proceeded to meta-ethnographic synthesis. Results The synthesis yielded four main themes: OHS regulation formation, regulation challenges, inspector organization, and worker representation in OHS. It illuminates how OHS legislation can be based on normative suppositions about worker and employer behavior and shaped by economic and political resources of parties. It also shows how implementation of OHS legislation is affected by "general duty" law, agency coordination, resourcing of inspectorates, and ability of workers to participate in the system. Conclusions The review identifies methodological gaps and promising areas for further research in "grey" zones of legislation implementation.

  • 5.
    Fagerlind Ståhl, Anna-Carin
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. 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.
    Smith, Peter
    Inst Work and Hlth, Canada; Univ Toronto, Canada; Monash Univ, Australia.
    Longitudinal association between psychological demands and burnout for employees experiencing a high versus a low degree of job resources2018In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 18, article id 915Article in journal (Refereed)
    Abstract [en]

    Background: Exhaustion and burnout are common causes for sickness absence. This study examines the relationship between psychological demands and burnout over time, and if environmental support modifies the longitudinal relationship between psychological demands and burnout at baseline, with burnout measured 2 years subsequently. Methods: A questionnaire was sent to employees in seven Swedish organizations in 2010-2012 with follow-up after 2 years, n = 1722 responded (64%). Linear regressions were used to examine the associations between burnout and psychological demands at baseline and burnout at follow-up. Stratified regression models examined if relationships between burnout and psychological demands at baseline on burnout at follow-up differed for employees in supportive versus unsupportive work environments. Results: Burnout and psychological demands at baseline were associated with burnout at follow-up, after adjustment for study covariates. No significant differences were observed between estimates for psychological demands and burnout among respondents in supportive work environments versus those in unsupportive work environments. Conclusions: This study shows that high demands are associated with greater risk of burnout, regardless of level of other work supports. This has implications for prevention of sick leave due to burnout and for rehabilitation, where demands such as work pace, workload and conflicting demands at work may need to be reduced.

  • 6.
    Gensby, Ulrik
    et al.
    Team Arbejdsliv.
    Limborg, Hans Jørgen
    Team Arbejdsliv.
    Mahood, Quenby
    Institute for Work and Health.
    Ståhl, Christian
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Behavioural Sciences and Learning, Education and Sociology. Linköping University, HELIX Competence Centre.
    Albertsen, Karin
    Team Arbejdsliv.
    Employer Strategies for Preventing Mental HealthRelated Work Disability: A Scoping Review2019In: Nordic Journal of Working Life Studies, ISSN 2245-0157, E-ISSN 2245-0157, Vol. 9, no 1, p. 57-101Article in journal (Refereed)
    Abstract [en]

    This study examined Nordic research on psychosocial work environment and disability manage- ment, specifically employer strategies for preventing work disability in common mental disorders (CMDs).A scoping review was performed to identify strategies across several research databases, alongside contact with content experts, hand-searching of non-indexed journals, and internet searches. Identification and selection of relevant studies, charting of data, and collating and sum- marizing of results was done using a six-step framework for conducting scoping reviews. Several key elements and knowledge gaps were identified in current prevention approaches and work- place initiatives across the included studies.We propose a program theory for workplace preven- tion of CMD-related work disability.The program theory may help specify employer strategies, and bridge activities with stakeholders outside the workplace.

  • 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.
    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.

  • 8.
    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.

  • 9.
    Lundmark, Åse
    et al.
    Linköping University, Department of Medical and Health Sciences. 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.
    Företagshälsovård mot sjukskrivning?: Företagshälsovårdstjänster i förebyggande och rehabiliterande syften i Norrköpings kommun2019Report (Other academic)
    Abstract [sv]

    Denna rapport beskriver resultat från en studie där Norrköpings kommuns användning av företagshälsovårdens tjänster för sjuk- och friskanmälan undersökts. Syftet med rapporten är att beskriva sjukskrivnas erfarenheter av sjukskrivnings- och rehabiliteringsprocessen, med särskilt fokus på av användningen av företagshälsovård och hur detta hänger samman med kontakten med övriga aktörer. Studien bygger på intervjuer med femton deltagare som arbetar inom vård- och omsorgssektorn i Norrköpings kommun som har analyserats genom kvalitativ innehållsanalys.

    Kontakten med företagshälsovården upplevs generellt som positiv, både i relation till sjuk- och friskanmälan och till olika åtgärder som initierats. Deltagarna uppskattar särskilt att kunna prata med en tredje part. Utformningen av avtal med företagshälsovården tycks dock ha betydelse för vilken typ av insatser som kan sättas in. Några problem med tjänsten för sjuk- och friskanmälan lyftes, exempelvis missvisande rubriceringar av sjukfrånvaroorsak, och upplevelser av onödig kontroll.

    Betydelsen av chefens stöd lyfts av samtliga deltagare. En optimal kontakt med chefen karaktäriseras av en aktiv chef som sätter den sjukskrivne medarbetaren i fokus och i samråd med medarbetaren planerar och lägger upp återgången i arbete. Den ambivalenta chefen initierar anpassningar och åtgärder, men detta sker ibland utan involvering av medarbetaren. För sjukskrivna med en mera passiv chef är kontakt med

    företagshälsovården ibland det enda stöd som initierats för att främja återgång till arbete. Resultatet pekar på att chefens roll och stöd vid sjukskrivning och återgång i arbete inte är utbytbart mot insatser från andra aktörer, såsom företagshälsovården. Kontakten med arbetsplatsen är viktig, och sjukskrivna betonar framför allt betydelsen av chefens kontakt, närvaro, och att denne anpassar kontakten utifrån sjukskrivningsorsak. Dialog mellan chef och medarbetare behövs kring hur kontakten med arbetsplatsen på lämpligast sätt bör läggas upp och på så vis anpassas efter den individuella situationen.

    Företagshälsovården kan användas för att stödja arbetsgivaren i arbetet med att förebygga och hantera sjukfrånvaro, och de insatser som erbjuds upplevs ofta som uppskattade och effektiva. Insatserna från företagshälsovården och arbetsgivaren bör dock initieras i samråd med den sjukskrivne för att öka möjligheterna att insatserna upplevs som hjälpsamma och rättvisa.

  • 10.
    Müssener, Ulrika
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. 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.
    Söderberg, Elsy
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Does the quality of encounters affect return to work? Lay people describe their experiences of meeting various professionals during their rehabilitation process2015In: Work: A journal of Prevention, Assesment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 52, no 2, p. 447-455Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Among the many aspects of the rehabilitation process that may be relevant for its outcome, the impact of encounters with various professionals has received little attention. OBJECTIVE: The objective was to gain a deeper understanding of how individuals with experiences of being on sick leave perceive their encounters with professionals, and how such encounters affected their ability to return to work, as well as their attitudes towards the sickness insurance system. METHODS: An inductive qualitative approach was used to analyze data from 20 interviews with men and women, aged 33-59, in Sweden who had experience of being on sick leave for at least 28 days. RESULTS: The study shows how interviewees encounters with professionals affected their self-confidence and perception of their ability to return to work. Professionals treatment of people on sick leave seems to be affected by the structural prerequisites for offering support, where sickness insurance regulations are suggested to have a large impact. CONCLUSIONS: An encouraging and supportive attitude on the part of the professionals is essential for empowering people to handle obstacles during the rehabilitation process; whereas feeling rejected and belittled in the return to work process may lead to disempowerment, and/or delays in measures and longer periods on sick leave.

  • 11.
    Neher, Margit Saskia
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. 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.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Learning opportunities in rheumatology practice: a qualitative study2015In: Journal of Workplace Learning, ISSN 1366-5626, E-ISSN 1758-7859, Vol. 27, no 4, p. 282-297Article in journal (Refereed)
    Abstract [en]

    Purpose

    – This paper aims to explore what opportunities for learning practitioners in rheumatology perceive of in their daily practice, using a typology of workplace learning to categorize these opportunities.

    Design/methodology/approach

    – Thirty-six practitioners from different professions in rheumatology were interviewed. Data were analyzed using conventional qualitative content analysis with a directed approach, and were categorized according to a typology of formal and informal learning.

    Findings

    – The typology was adjusted to fit the categories resulting from the analysis. Further analysis showed that work processes with learning as a by-product in general, and relationships with other people in the workplace in particular, were perceived as important for learning in the workplace. The use of many recognized learning opportunities was lower. Barriers for learning were a perceived low leadership awareness of learning opportunities and factors relating to workload and the organization of work.

    Research limitations/implications

    – The generalizability of results from all qualitative inquiries is limited by nature, and the issue of transferability to other contexts is for the reader to decide. Further studies will need to confirm the results of the study, as well as the proposed enhancement of the typology with which the results were categorized.

    Practical implications

    – The study highlights the importance of relationships in the workplace for informal learning in rheumatology practice. In the clinical context, locally adapted strategies at organizational and individual levels are needed to maximize opportunities for both professional and interprofessional informal learning, taking the importance of personal relationships into account. The findings also suggest a need for increased continuing professional education in the specialty.

    Originality/value

    – The workplace learning typology that was used in the study showed good applicability to empirical health-care study data, but may need further development. The study confirmed that informal workplace learning is an important part of learning in rheumatology. Further studies are needed to clarify how informal and formal learning in the rheumatology clinic may be supported in workplaces with different characteristics.

  • 12.
    Neher, Margit
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. 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.
    Ellström, Per-Erik
    Linköping University, Department of Behavioural Sciences and Learning, Education and Sociology. Linköping University, Faculty of Arts and Sciences.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Knowledge Sources for Evidence-Based Practice in Rheumatology Nursing.2015In: Clinical Nursing Research, ISSN 1054-7738, E-ISSN 1552-3799, Vol. 24, no 6, p. 661-679Article in journal (Refereed)
    Abstract [en]

    As rheumatology nursing develops and extends, knowledge about current use of knowledge in rheumatology nursing practice may guide discussions about future knowledge needs. To explore what perceptions rheumatology nurses have about their knowledge sources and about what knowledge they use in their practice, 12 nurses working in specialist rheumatology were interviewed using a semi-structured interview guide. The data were analyzed using conventional qualitative content analysis. The analysis yielded four types of knowledge sources in clinical practice: interaction with others in the workplace, contacts outside the workplace, written materials, and previous knowledge and experience. Colleagues, and physicians in particular, were important for informal learning in daily rheumatology practice. Evidence from the medical arena was accessed through medical specialists, while nursing research was used less. Facilitating informal learning and continuing formal education is proposed as a way toward a more evidence-based practice in extended roles.

  • 13.
    Neher, Margit
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. 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.
    Festin, Karin
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Implementation of Evidence-Based Practice in Rheumatology: What Sociodemographic, Social Cognitive and Contextual Factors Influence Health Professionals’ Use of Research in Practice?2016In: Journal of rheumatic diseases and treatment, ISSN 2469-5726, Vol. 2, no 3, p. 1-8Article in journal (Refereed)
    Abstract [en]

    Abstract

    Objective: Research on the use of research in rheumatology practice is largely lacking. This study attempts to fill this knowledge gap by exploring the degree to which evidence-based practice (EBP) is implemented in clinical rheumatology practice and identifying individual and organizational factors that may potentially affect research use in the clinical environment.

    Methods: A web-based questionnaire was distributed to members of health professional groups in clinical rheumatology by way of publicly available e-mail addresses. Data were collected on sociodemographic, social cognitive, and contextual factors deemed to potentially influence the use of research in practice. The outcome measure was the EBP Implementation Scale.

    Results: A complex range of factors was found to influence the outcome. The factors that were most clearly associated with research use were the perception of personal ability to use research knowledge, years of experience in clinical rheumatology, and experience of research activities.

    Conclusions: Our study results suggest a large variation in levels of implementation of EBP across work units and individuals, and although a low general standard is indicated (even if a gold standard does not exist), there was also a great interest in working according to EBP principles. Potential for change is apparent, but it seems necessary to examine the use of research evidence in rheumatology practice at the individual and work unit levels to accommodate local and individual needs and resources. Future studies are needed to examine the influence of contextual influences by other methods.

  • 14.
    Nilsen, Per
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. 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.
    Roback, Kerstin
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Cairney, Paul
    University of Stirling, Scotland.
    Never the twain shall meet? - a comparison of implementation science and policy implementation research2013In: Implementation Science, ISSN 1748-5908, E-ISSN 1748-5908, Vol. 8Article in journal (Refereed)
    Abstract [en]

    Background

    Many of society’s health problems require research-based knowledge acted on by healthcare practitioners together with implementation of political measures from governmental agencies. However, there has been limited knowledge exchange between implementation science and policy implementation research, which has been conducted since the early 1970s. Based on a narrative review of selective literature on implementation science and policy implementation research, the aim of this paper is to describe the characteristics of policy implementation research, analyze key similarities and differences between this field and implementation science, and discuss how knowledge assembled in policy implementation research could inform implementation science.

    Discussion

    Following a brief overview of policy implementation research, several aspects of the two fields were described and compared: the purpose and origins of the research; the characteristics of the research; the development and use of theory; determinants of change (independent variables); and the impact of implementation (dependent variables). The comparative analysis showed that there are many similarities between the two fields, yet there are also profound differences. Still, important learning may be derived from several aspects of policy implementation research, including issues related to the influence of the context of implementation and the values and norms of the implementers (the healthcare practitioners) on implementation processes. Relevant research on various associated policy topics, including The Advocacy Coalition Framework, Governance Theory, and Institutional Theory, may also contribute to improved understanding of the difficulties of implementing evidence in healthcare. Implementation science is at a relatively early stage of development, and advancement of the field would benefit from accounting for knowledge beyond the parameters of the immediate implementation science literature.

    Summary

    There are many common issues in policy implementation research and implementation science. Research in both fields deals with the challenges of translating intentions into desired changes. Important learning may be derived from several aspects of policy implementation research.

  • 15.
    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.

  • 16.
    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.
  • 17.
    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.

  • 18.
    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)
  • 19.
    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.

  • 20.
    Strindlund, Lena
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Abrandt Dahlgren, Madeleine
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. 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. Linköping University, Department of Behavioural Sciences and Learning, Education and Sociology. Linköping University, HELIX Competence Centre.
    Employers’ views on disability, employability, and labor market inclusion: A phenomenographic study2018In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165Article in journal (Refereed)
    Abstract [en]

    PURPOSE: 

    This study aims to increase our understanding of employers' views on the employability of people with disabilities. Despite employers' significant role in labor market inclusion for people with disabilities, research is scarce on how employers view employability for this group.

    METHODS: 

    This was a qualitative empirical study with a phenomenographic approach using semi-structured interviews with 27 Swedish employers from a variety of settings and with varied experience of working with people with disabilities.

    RESULTS: 

    The characteristics of employers' views on the employability of people with disabilities can be described as multifaceted. Different understandings of the interplay between underlying individual-, workplace-, and authority-related aspects form three qualitatively different views of employability, namely as constrained by disability, independent of disability, and conditional. These views are also characterized on a meta-level through their association with the cross-cutting themes: trust, contribution, and support.

    CONCLUSIONS: 

    The study presents a framework for understanding employers' different views of employability for people with disabilities as a complex internal relationship between conceived individual-, workplace-, and authority-related aspects. Knowledge of the variation in conceptions of employability for people with disability may facilitate for rehabilitation professionals to tailor their support for building trustful partnerships with employers, which may enhance the inclusion of people with disabilities on the labor market. Implications for rehabilitation Employers' views on employing people with disabilities vary with respect to individual-, workplace-, and authority-related aspects in relation to trust, contribution and support. Knowledge of the employers' views on the employability of people with disabilities can support professionals in authorities and in vocational rehabilitation. The findings illustrate the importance of analyzing what type of support employers need as a starting point for building trustful partnerships between authority actors and employers. The findings offer a vocabulary that can be used by professionals in authorities and in vocational rehabilitation in tailoring employer-oriented support to increase labor market inclusion of people with disabilities.

  • 21.
    Strindlund, Lena
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. 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.
    Vägen till arbetsgivarna2016Report (Other academic)
    Abstract [sv]

    Syfte: Det övergripande syftet med projektet är att få fördjupad kunskap om vad som påverkar arbetsgivares synsätt på arbetslösa från utsatta grupper, särskilt arbetslösa med funktionsnedsättning, och inställning till arbetsmarknadsinkludering, utifrån målsättningen att förbättra förutsättningarna för en ökad inkluderande arbetsmarknad.

    Metod: Urvalet bestod av 27 arbetsgivare med maximal variation gällande yrkesområde, sektor, storlek och erfarenhet av arbetsmarknadsinkludering av utsatta grupper. Datainsamling skedde genom kvalitativa forskningsintervjuer och materialet analyserades med kvalitativ innehållsanalys.

    Resultat: Arbetsgivarnas inställning till arbetsmarknadsinkludering påverkas av en mängd olika faktorer, av möjliggörande och hindrande karaktär, relaterade till arbetsplats, individ och myndighetsstöd och har samband med arbetsgivarnas olika synsätt på målgruppen; som belastning, resurs och miljörelativt.

    Diskussion: Utifrån framkommen kunskap om de olika faktorerna som påverkar arbetsgivarnas synsätt och inställning till arbetsmarknadsinkludering har en arbetsgivarorienterad modell tagits fram. Arbetssättet utgår ifrån en arbetsgivarkoordinator  som genom sin kännedom om arbetsgivaren och tillgång till adekvata stödinsatser kan möta och anpassa insatsen till arbetsgivarnas olika komplexa behov och förutsättningar.

    Konklusion: Metoden öppnar upp för utveckling av en tillitsfull och professionell samverkan mellan arbetsgivare och myndighetsaktörer vilket skapar ökade möjligheter till arbetsmarknadsinkludering av arbetstagare med funktionsnedsättning, och sannolikt även arbetslösa från andra utsatta grupper.

  • 22.
    Ståhl, Christian
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Behavioural Sciences and Learning, Education and Sociology. Linköping University, HELIX Competence Centre.
    Arbetets estetik2019In: Arbetsmarknad & Arbetsliv, ISSN 1400-9692, Vol. 25, no 2, p. 67-87Article in journal (Refereed)
    Abstract [sv]

    Denna essä undersöker hur arbete har visualiserats och presenterats i bildkonst, musik och litteratur. I texten ges exempel från historien, samtiden och framtiden. Från exemplen kan två teman identifieras. Det första berör hur estetiska uttryck förmedlar bakomliggande kulturella, politiska eller ideologiska idéer om arbete, exempelvis genom propagandakonst eller skildringar av prekära arbetsförhållanden. Det andra berör relationen mellan arbete och resten av livet – här ser vi en sammansmältning av arbete och identitet, illustrerat av influerare och livsstilsbutiker, där arbete endast särskiljs från andra aktiviteter genom dess kommersialisering – och hur detta i sin tur ändrar aktivitetens karaktär.

  • 23.
    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.
    Att implementera rehabiliteringssamverkan: en fallstudie2011In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 88, no 5, p. 418-427Article in journal (Refereed)
    Abstract [en]

    Coordination Associations is a structure for cooperation between public actors in the rehabilitation field. In this case study, the implementation processes of two cooperation teams are studied, focusing on strategies for implementation, and how these strategies affected the sustainability of the cooperation. The study illustrate two different strategies with different results; one that tried (but failed) to implement cooperative projects, and one interactive strategy aiming to create a local cooperation structure. The latter strategy resulted in a more successful implementation of the team.

  • 24.
    Ståhl, Christian
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Behavioural Sciences, Sociology.
    Beroende och befrielse: En diskussion om beroendeteori, ekologism och befrielseteologi2002Report (Other academic)
    Abstract [sv]

      

  • 25.
    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.
    Coordinating welfare.2008Conference paper (Other academic)
  • 26.
    Ståhl, Christian
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, Faculty of Health Sciences.
    Det mytologiska självskadebeteendet: Könade stereotyper och idealtypiska berättelser2007In: Socialvetenskaplig tidskrift, ISSN 1104-1420, Vol. 4, p. 280-294Article in journal (Refereed)
    Abstract [sv]

    Självskadebeteende betraktas genomgående som ett -tjejproblem-. Syftet med artikeln är att problematisera den utgångspunkten genom att kritiskt granska tidigare forskning i jakt på ursprunget till den stereotypa självskadaren. Femininitetsdiskursen framstår här som ett centralt element i skapandet av en identitet som självskadare. 

  • 27.
    Ståhl, Christian
    Linköping University, Department of Behavioural Sciences and Learning, Education and Sociology. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, HELIX Competence Centre.
    Det paradoxala arbetsförmågebegreppet: Recensionsessä2019In: Sociologisk forskning, ISSN 0038-0342, Vol. 56, no 2, p. 181-188Article in journal (Refereed)
  • 28.
    Ståhl, Christian
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Behavioural Sciences, Sociology.
    Från moral till estetik: Att förstå främlingskap i det moderna och det postmoderna2003Report (Other academic)
  • 29.
    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.
    Implementing interorganisational cooperation in labour market reintegration: a case study2011Conference paper (Refereed)
  • 30.
    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.

  • 31.
    Ståhl, Christian
    Linköping University, Department of Medicine and Health Sciences, Work and Rehabilitation . Linköping University, Faculty of Health Sciences.
    In Cooperation We Trust: Interorganizational Cooperation in Return-to-Work and Labour Market Reintegration2010Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

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

    Central questions for the thesis are:

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

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

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

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

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

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

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

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

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

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

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

    List of papers
    1. The Work Ability Divide: Holistic and Reductionistic Approaches in Swedish Interdisciplinary Rehabilitation Teams
    Open this publication in new window or tab >>The Work Ability Divide: Holistic and Reductionistic Approaches in Swedish Interdisciplinary Rehabilitation Teams
    2009 (English)In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 19, no 3, p. 264-273Article in journal (Refereed) Published
    Abstract [en]

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

    Place, publisher, year, edition, pages
    Springer Netherlands, 2009
    Keywords
    Work ability, return to work, cooperation, team, interdisciplinary
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology Sociology Social Sciences Interdisciplinary Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:liu:diva-19739 (URN)10.1007/s10926-009-9183-2 (DOI)
    Note
    The original publication is available at www.springerlink.com: Christian Ståhl, Tommy Svensson, Gunilla Petersson and Kerstin Ekberg, The Work Ability Divide: Holistic and Reductionistic Approaches in Swedish Interdisciplinary Rehabilitation Teams, 2009, Journal of occupational rehabilitation, (19), 3, 264-273. http://dx.doi.org/10.1007/s10926-009-9183-2 Copyright: Springer Science Business Media http://www.springerlink.com/ Available from: 2009-07-27 Created: 2009-07-27 Last updated: 2018-01-13
    2. A Matter of Trust?: A Study of Coordination of Swedish Stakeholders in Return-to-Work
    Open this publication in new window or tab >>A Matter of Trust?: A Study of Coordination of Swedish Stakeholders in Return-to-Work
    2010 (English)In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 20, p. 299-310Article in journal (Refereed) Published
    Abstract [en]

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

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

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

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

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

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

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

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

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

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

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

    Place, publisher, year, edition, pages
    Informa Healthcare, 2011
    National Category
    Medical and Health Sciences Social Sciences
    Identifiers
    urn:nbn:se:liu:diva-54893 (URN)10.3109/09638288.2010.532282 (DOI)000291886000010 ()
    Note
    Original Publication: Christian Ståhl, Tommy Svensson, Gunilla Petersson and Kerstin Ekberg, Swedish Rehabilitation Professionals’ Perspectives on Work Ability Assessments in a Changing Sickness Insurance System, 2011, Disability and Rehabilitation, (33), 15-16, 1373-1382. http://dx.doi.org/10.3109/09638288.2010.532282 Copyright: Informa Healthcare http://informahealthcare.com/ Available from: 2010-04-20 Created: 2010-04-20 Last updated: 2017-12-12
  • 32.
    Ståhl, Christian
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Placing people in the same room is not enough: An interprofessional education intervention to improve collaborative knowledge of people with disabilities2016In: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567, Vol. 30, no 3, p. 331-337Article in journal (Refereed)
    Abstract [en]

    This study evaluates a continuing interprofessional education (CIPE) intervention designed to improve the skills and knowledge related to managing people with disabilities (PWD) in the educational, healthcare, and social insurance systems, and to improve shared knowledge and promote inter-organisational collaboration. The intervention comprised both on-site and online courses where participants could design their own curriculum based on their perceived needs. A longitudinal survey study was conducted with questions about knowledge of other organisations work with PWD, knowledge concerning disability policies, competence in meeting PWD, shared values across organisations, and inter-organisational collaboration. Participants knowledge about disability, disability policy, and how other organisations work with PWD significantly increased after the intervention. Changes in shared values, attitude towards inter-organisational collaboration, or effects on actual collaboration could not be determined. The results suggest that CIPE interventions where participants are allowed to form customised curriculums may increase general knowledge about disability among professionals. Results on knowledge of and collaboration with other organisations were less conclusive, where this may be explained by an educational setting that included little interaction between course participants. To promote professional exchange and experiential learning activities, contextualized educational settings that place more focus on interaction between participants may be advised.

  • 33.
    Ståhl, Christian
    Linköping University, Department of Medicine and Health Sciences, Work and Rehabilitation. Linköping University, Faculty of Health Sciences.
    Resursteam som samverkansform: Ett personalperspektiv2007Report (Other academic)
    Abstract [en]

    I denna studie beskrivs och analyseras införandet av resursteam som en sam verkansform mellan primärvården och försäkringskassan. Resursteam syftar till att sänka sjukskrivningstalen och åstadkomma bättre samverkansrutiner. Införande och arbetsformer har undersökts via tre metodologiska ansatser: en enkätundersökning, tolv fokusgrupper med resursteam, samt tolv individuella intervjuer med vårdcentralschefer.

    Centrala frågor för studien har varit hur de deltagande professionerna upple ver och förhåller sig till arbetet i resursteamen, samt hur kommunikationen utvecklats mellan teamets medlemmar. Slutligen görs en analys av i vilken utsträckning resursteamen kan sägas vara förankrade på de olika vårdcentra lerna, samt vilka hinder och möjligheter som finns för en god samverkan.

    Resultatet av studien visar att merparten av personalen som arbetar i resurs teamen upplever arbetsformen som positiv. Den generella bilden är att teamen leder till ökad diskussion kring sjukskrivningsärenden, samt att det finns vins ter med att låta olika professioner mötas kring en gemensam uppgift.

    Kritiken som framkommer mot arbetsformen berör huvudsakligen brist på kommunikation i olika former. Relationen mellan läkare och handläggare på försäkringskassan framstår som ansträngd, och flera uppger att det finns stora skillnader i utgångspunkter mellan personal från olika verksamheter.

    Det framgår av studien att resursteamen endast i begränsad utsträckning an vänds för att utveckla bedömningen av arbetsförmåga, vilket såväl i studien som i tidigare forskning lyfts som ett problem för läkarna. I vissa team tycks en sådan funktion finnas, och teamens medlemmar upplever i de fallen att mö testiden med teamet är effektiv och stödjande.

    Det finns flera deltagare i studien som noterar hur starten av resursteamen var förvirrande, och att det tog lång tid innan teamet hittade sin form och sin in terna rollfördelning. Detta indikerar att implementeringen av resursteamen inte fungerat fullt ut. I de flesta team upplevs emellertid arbetsformen som accepterad och legitim.

    De flesta skillnader som noterats kan hänföras till skillnader mellan de olika professionerna och organisationerna, och de utgångspunkter dessa har. Det har inte varit möjligt att identifiera några regionala skillnader i hur arbetsfor men uppfattas och fungerar. I Norrköpings kommun har dock förekomsten av ett samordningsförbund inneburit att fler insatser kunnat erbjudas de sjuk skrivna, och fler parter har också kunnat medverka vid teamens möten på vis sa vårdcentraler.

  • 34.
    Ståhl, Christian
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, Faculty of Health Sciences.
    Samverkan kring återgång i arbete: var är arbetsgivarna?2009In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 86, no 3, p. 265-274Article in journal (Refereed)
    Abstract [sv]

    De senaste decennierna har samverkan mellan myndigheter kring återgång i arbete blivit allt vanligare. Dock ignorerar de svenska samverkansstrukturerna nästan helt arbetsgivarna som samverkanspart, trots att forskningen visar att det är i samverkan med arbetsgivare som samverkan ger bäst effekt. I de fall där sjukskrivna ska rehabiliteras till sitt tidigare arbete är kontakten med arbetsplatsen avgörande, och i de fall där arbetsgivare saknas är kontakten med arbetsmarknadens parter lika central. Om arbetsgivare inte involveras i samverkan är risken därför stor att de samverkande myndigheterna ägnar sig åt att rehabilitera människor till arbeten som inte finns.

  • 35.
    Ståhl, Christian
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Aborg, Carl
    Uppsala University, Sweden.
    Toomingas, Allan
    Karolinska Institute, Sweden.
    Parmsund, Marianne
    Stockholm County Council, Sweden.
    Kjellberg, Katarina
    Karolinska Institute, Sweden.
    The influence of social capital on employers use of occupational health services: a qualitative study2015In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 15, no 1083Article in journal (Refereed)
    Abstract [en]

    Background: Occupational health services may have a strategic role in the prevention of sickness absence, as well as in rehabilitation and return to work after sick leave, because of their medical expertise in combination with a close connection to workplaces. The purpose of this study was to explore how employers and occupational health service providers describe their business relations and the use of occupational health services in rehabilitation in relation to the organization of such services. The study uses a theoretical framework based on social capital to analyse the findings. Methods: Interviews and focus groups with managers with Swedish public employers (n = 60), and interviews with occupational health services professionals (n = 25). Results: Employers emphasized trustful relationships, local workplace knowledge, long-term contracts and dialogue about services for good relationships with occupational health providers. Occupational health providers strove to be strategic partners to employers, promoting preventive work, which was more easily achieved in situations where the services were organized in-house. Employers with outsourced occupational health services expressed less trust in their providers than employers with internal occupational health provision. Conclusions: Social capital emerges as central to understanding the conditions for cooperation and collective action in the use of occupational health services, with reference to structural (e.g. contracts), relational (e.g. trust) as well as cognitive (e.g. shared vision) dimensions. The study suggests that attention to the quality of relationships is imperative for developing purposeful occupational health service delivery in rehabilitation and return to work.

  • 36.
    Ståhl, Christian
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Andersen, Åsa
    Uppsala University, Sweden.
    Anderzen, Ingrid
    Uppsala University, Sweden.
    Larsson, Kjerstin
    Uppsala University, Sweden; Karolinska Institute, Sweden.
    Process evaluation of an interorganizational cooperation initiative in vocational rehabilitation: the Dirigo project2017In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 17, article id 431Article in journal (Refereed)
    Abstract [en]

    Background: This study analyzes the process of establishing and developing a cooperative vocational rehabilitation project with special focus on organizational and professional aspects. In the project, officials from the Swedish Social Insurance Agency and the Swedish Public Employment Service worked cooperatively with participants on long-term sick leave, youths with disability benefits, and people receiving social allowances. The officials used Motivational Interviewing (MI) as a method when meeting participants, and were able to offer flexible and tailored case management. The goal was to improve work ability and promote self-sufficiency. Methods: The process evaluation was carried out through continuous data collection throughout the project (2012-2014), resulting in a total of 28 individual interviews and 17 focus groups with officials and managers. The material was categorized through an inductive content analysis, and analyzed using social capital as a theoretical frame. Results: The evaluation points to how issues related to design, organization and management contributed to the project not reaching its goals, e.g. problems with recruitment of participants, the funding structure, and staffing problems on the managerial level. Still, officials reported positive effects of close cooperation, which was perceived as facilitating the case management by fostering a mutual understanding and access to resources and rehabilitation measures from more than one authority. Conclusions: Cooperative work combined with the use of MI and flexible case management seem to promote an increased trust between officials from different authorities and participants, which in the study is conceptualized as bonding and bridging social capital (between officials) and linking social capital (between officials and participants). The organizational problems combined with the relatively large differences in approaches between the project and regular practice obstructed implementation, where the authorities involved did not appear to be ready for implementing methodologies that require organizational restructuring.

  • 37.
    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.

  • 38.
    Ståhl, Christian
    et al.
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Behavioural Sciences, Sociology.
    Boman, John
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Behavioural Sciences.
    Klöfver, Helena
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Behavioural Sciences.
    BUS-projektet i Åtvidaberg: En utvärdering2004Report (Other academic)
    Abstract [sv]

        

  • 39.
    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.
    Costa-Black, Katia
    c School of Health Systems and Public Health, Faculty of Health Sciences , University of Pretoria , Pretoria, Republic of South Africa.
    Loisel, Patrick
    d Dalla Lana School of Public Health, University of Toronto , Toronto , Canada; e Canadian Memorial Chiropractic College , Toronto , Canada.
    Applying theories to better understand socio-political challenges in implementing evidence-based work disability prevention strategies2018In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 40, no 8, p. 952-959Article in journal (Refereed)
    Abstract [en]

    Purpose: This article explores and applies theories for analyzing socio-political aspects of implementation of work disability prevention (WDP) strategies.

    Method: For the analysis, theories from political science are explained and discussed in relation to case examples from three jurisdictions (Sweden, Brazil and Québec).

    Results: Implementation of WDP strategies may be studied through a conceptual framework that targets: (1) the institutional system in which policy-makers and other stakeholders reside; (2) the ambiguity and conflicts regarding what to do and how to do it; (3) the bounded rationality, path dependency and social systems of different stakeholders; and (4) coalitions formed by different stakeholders and power relations between them. In the case examples, the design of social insurance systems, the access to and infrastructure of healthcare systems, labor market policies, employers’ level of responsibility, the regulatory environment, and the general knowledge of WDP issues among stakeholders played different roles in the implementation of policies based on scientific evidence.

    Conclusions: Future research may involve participatory approaches focusing on building coalitions and communities of practice with policy-makers and stakeholders, in order to build trust, facilitate cooperation, and to better promote evidence utilization.

    • Implications for Rehabilitation
    • Implementation of work disability prevention policies are subject to contextual influences from the socio-political setting and from relationships between stakeholders

    • Stakeholders involved in implementing strategies are bound to act based on their interests and previous courses of action

    • To promote research uptake on the policy level, stakeholders and researchers need to engage in collaboration and translational activities

    • Political stakeholders at the government and community levels need to be more directly involved as partners in the production and utilization of evidence

  • 40.
    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.

  • 41.
    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.
    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.
    Multidisciplinary teams as an arena for the decision of work ability2007Conference paper (Refereed)
  • 42.
    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.
    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.
    Svensson, Tommy
    Linköping University, Department of Behavioural Sciences and Learning, Sociology. Linköping University, Faculty of Arts and Sciences.
    Coordination between welfare authorities in promoting return-to-work2008Conference paper (Refereed)
  • 43.
    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. 

  • 44.
    Ståhl, Christian
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Gustavsson, Maria
    Linköping University, Department of Behavioural Sciences and Learning, Education and Sociology. Linköping University, Faculty of Arts and Sciences.
    Ekberg, Kerstin
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Böhm, Liselotte
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Förutsättningar för implementering och användning av motiverande samtal (MI) inom Försäkringskassan: Slutrapport2015Report (Other academic)
    Abstract [en]

    This is the final report from an evaluation project that has studied implementation and use of Motivational Interviewing (MI) within the Swedish Social Insurance Agency (SSIA). MI was introduced in order to develop and improve methods within social insurance, aiming to promote insurance officials to intervene earlier in the sick leave process. During 2012, dedicated funds were targeted towards developing insurance officials’ competencies, where an education in MI was included.

    An earlier report has been published in the project (Social Insurance Report 2014:16), focusing on the implementation process. It was concluded that both insurance officials and managers were concerned about not being able to sustain and integrate the use of MI into regular practice. In this report, the conditions for use of MI in regular practice are in focus, along with perceived effects of the intervention on the individual and organizational level.

    Specific research questions are:

    • What individual and organizational/practical conditions has facilitated or prevented officials’ continuous use of MI in regular practice?
    • What effects of the intervention can be identified on an individual and an organizational level?

    The report is based on a survey to the insurance officials (n=880), and interviews with 5 managers and 16 insurance officials in four offices. The interviews are follow-ups from a larger data collection that was reported in the first report from the project.

    The results of the study show that many of the officials, some time after the educational intervention, are still committed to the method, and that many claim to use it in meetings with their clients. However, there is a large variation with regard to what parts of the method that are utilized. Most officials have participated in the educational intervention and perceived it as purposeful and interesting. Many officials claim that using the method has improved their meetings with clients.

    Much criticism is directed towards how the SSIA has managed the investment in MI, where officials do not think that the educational intervention has been followed up in any organized way, and that there has been a lack of the necessary training in order to develop and sustain competence in using the method. It is generally perceived that MI has not been a priority in the organization and that managers have not expressed interested in whether the method is used or not. Officials are also critical to their possibilities to use the method related to their current work situation, where heavy caseloads imply little or no time for reflection and learning.

  • 45.
    Ståhl, Christian
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Gustavsson, Maria
    Linköping University, Department of Behavioural Sciences and Learning, Education and Sociology. Linköping University, Faculty of Arts and Sciences.
    Ekberg, Kerstin
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Böhm, Liselotte
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Implementering och användning av motiverande samtal (MI) inom Försäkringskassan2014Report (Other academic)
    Abstract [en]

    In 2012, the Swedish Social Insurance Agency (SSIA) launched an educational intervention where all officials were to be trained in Motivational Interviewing (MI). The purpose of the intervention was to improve the quality of meetings with sickness benefit claimants, and in a long term to strengthen the legitimacy of the SSIA. The intervention comprised off-site education (2+2 days), and workplace coaches to support training and use of MI, through individual and group consultations.

    MI is a client-centered method aimed at facilitating behavior change through focus on motivation and management of ambivalence. The method has been evaluated with convincing results in several areas, e.g. smoking cessation and drug rehabilitation. While it has also been adapted to social work, its effects in such areas are less documented.

    The aim of the study was to elicit how officials, managers and other groups within the SSIA perceived the conditions for using MI, and the implementation process. The study comprises two comprehensive data collections in four insurance offices, comprising interviews with officials, managers, claimants and coaches, and observations at meetings; interviews with managers and coordinators; and a survey to all officials. In this report, data is presented from the first data collection, consisting of observations, and individual interviews with officials, managers, and claimants. A full report will be presented in 2015.

  • 46.
    Ståhl, Christian
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Education and Sociology. Linköping University, Faculty of Medicine and Health Sciences.
    Karlsson, Elin
    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.
    Hensing, Gunnel
    Univ Gothenburg, Sweden.
    Brouwer, Sandra
    Univ Groningen, Netherlands.
    Friberg, Emilie
    Karolinska Inst, Sweden.
    MacEachen, Ellen
    Univ Waterloo, Canada.
    Social insurance literacy: a scoping review on how to define and measure it2019In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165Article, review/survey (Refereed)
    Abstract [en]

    Purpose: Sickness insurance and workers? compensation systems decide on peoples? eligibility for benefits, and are commonly based on medical certificates and assessments of work ability. Systems differ in the extent to which they preserve clients? dignity and right to fair assessments. In this article, we define a new concept for studying interactions between individuals and systems: social insurance literacy, which concerns how well people understand the different procedures and regulations in social insurance systems, and how well systems communicate with clients in order to help them understand the system. Methods: The concept was defined through a scoping literature review of related concepts, a conceptual re-analysis in relation to the social insurance field, and a following workshop. Results: Five related concepts were reviewed for definitions and operationalizations: health literacy, financial/economic literacy, legal capability/ability, social security literacy, and insurance literacy. Conclusions: Social insurance literacy is defined as the extent to which individuals can obtain, understand and act on information in a social insurance system, related to the comprehensibility of the information provided by the system. This definition is rooted in theories from sociology, social medicine and public health. In the next step, a measure for the concept will be developed based on this review.

  • 47.
    Ståhl, Christian
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    MacEachen, Ellen
    Institute for Work & Health, University of Toronto, Toronto, ON, Canada and Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
    Lippel, Katherine
    Canada Research Chair on Occupational Health and Safety Law, Law Faculty, Civil Law Section, University of Ottawa, Ottawa, ON, Canada .
    Ethical Perspectives in Work Disability Prevention and Return to Work: Toward a Common Vocabulary for Analyzing Stakeholders’ Actions and Interactions2014In: Journal of Business Ethics, ISSN 0167-4544, E-ISSN 1573-0697, Vol. 120, no 2, p. 237-250Article in journal (Refereed)
    Abstract [en]

    Many studies have emphasized the importance of medical, insurance, and workplace systems treating individuals fairly in work disability prevention (WDP) and return-to-work (RTW). However, ethical theories and perspectives from these different systems are rarely discussed in relation to each other, even though in practice these systems constantly interact. This paper explores ethical theories and perspectives that may apply to the WDP–RTW field, and discusses these in relation to perspectives attributed to dominant stakeholders in this field, and to potential differences in different jurisdictional contexts. Literature was sought primarily in biomedical ethics, business ethics, and public administration ethics. In biomedical ethics, four ethical principles are dominant: autonomy, beneficence, nonmalevolence, and justice. Business ethics involve theories on Corporate Social Responsibility (CSR), social contracts, and organizational justice. Public administration ethics focus on constitutional theory, citizenship, social equity, virtue, and public interest. Several concepts were identified as relevant for ethical analyses in the WDP–RTW field, including justice; individual autonomy; nonmalevolence; economic and social responsibility; and social contracts. These concepts provide a vocabulary that may be used to analyze stakeholders’ actions and interactions in RTW processes. It was also noted how the power balance between stakeholders will influence which ethical perspectives will influence RTW. Jurisdictional differences that influence RTW processes with regard to stakeholder responsibilities were identified, as well as varying beliefs as to who is the client in different compensation systems. A social contractual approach may inform an analysis of cultural and legal differences.

  • 48.
    Ståhl, Christian
    et al.
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, Faculty of Health Sciences.
    Müssener, Ulrika
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, Faculty of Health Sciences.
    Svensson, Tommy
    Linköping University, Department of Behavioural Sciences and Learning, Education and Sociology. Linköping University, Faculty of Arts and Sciences.
    Implementation of standardized time limits in sickness insurance and return-to-work: Experiences of four actors2012In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 34, no 16, p. 1404-1411Article in journal (Refereed)
    Abstract [en]

    Purpose: In 2008, time limits were introduced in Swedish sickness insurance, comprising a pre-defined schedule for return-to-work. The purpose of this study was to explore experienced consequences of these time limits. Sick-listed persons, physicians, insurance officials and employers were interviewed regarding the process of sick-listing, rehabilitation and return-to-work in relation to the reform.

    Method: The study comprises qualitative interviews with 11 sick-listed persons, 4 insurance officials, 5 employers and 4 physicians (n = 24). Results: Physicians, employers, and sick-listed persons described insurance officials as increasingly passive, and that responsibility for the process was placed on the sick-listed. Several ethical dilemmas were identified, where officials were forced to act against their ethical principles. Insurance officials' principle of care often clashed with the standardization of the process, that is based on principles of egalitarianism and equal treatment.

    Conclusions: The cases reported in this study suggest that a policy for activation and early return-to-work in some cases has had the opposite effect: central actors remain passive and the responsibility is placed on the sick-listed, who lacks the strength and knowledge to understand and navigate through the system. The standardized insurance system here promoted experiences of procedural injustice, for both officials and sick-listed persons.

  • 49.
    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.
    Müssener, Ulrika
    Linköping University, Department of Medical 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.
    Sjukskrivningssystemet och dess aktörer: Efter införandet av rehabiliteringskedjan2011Report (Other academic)
    Abstract [sv]

    Sedan 2008 har ett antal större förändringar gjorts i sjukförsäkringen. Främst har rehabiliteringskedjan, dvs. införandet av fasta tidsgränser för bedömning av arbetsförmåga och rätt till ersättning, stått i fokus för debatten. Med tidsgränserna sattes en slutgräns för hur länge sjukpenning betalas ut, vilket tidigare inte fanns i försäkringen. I denna studie undersöks hur sjukskrivna, arbetsgivare, försäkringskassehandläggare och läkare resonerar kring dessa tidsgränser, arbetsförmågebedömningar, rehabilitering och återgång i arbete.

    Studien omfattar kvalitativa intervjuer med sjukskrivna, arbetsgivare, handläggare på Försäkringskassan samt primärvårds- och företagsläkare. Totalt intervjuades 24 personer.

    Sjukskrivna, arbetsgivare och läkare upplever att Försäkringskassans handläggare blivit mindre tillgängliga, och generellt uppfattas handläggarna som alltmer passiva i rehabiliteringsprocessen. Handläggare på Försäkringskassan menar att de senaste årens regeländringar har medfört en mer administrativ handläggarroll, där mer tid läggs på att hålla tidsgränser än att arbeta med faktisk rehabilitering. Handläggare upplever också att etiska dilemman uppstår när individuella bedömningar kommer i konflikt med tidsgränserna, vilket upplevs som stressande.

    De sjukskrivna upplever att Försäkringskassan borde ta ett större ansvar för att driva sjukskrivnings- och rehabiliteringsprocessen framåt, eftersom de själva har svårt att överblicka och navigera i sjukförsäkringssystemet. Även arbetsgivarna i studien förväntar sig att Försäkringskassan ska ta större ansvar för sjukskrivningsprocessen. Handläggarna på Försäkringskassan har å sin sida blivit alltmer benägna att lägga detta ansvar på de sjukskrivna.

    Studien identifierar också flera brister i samverkan mellan arbetsgivare, sjukvård och Försäkringskassan kring bedömningen av sjukskrivnas arbetsförmåga. Försäkringskassans handläggare lägger stor vikt vid de medicinska underlagen i bedömningarna, och ger uttryck för en tveksamhet inför att använda andra informationskällor (såsom SASSAMkartläggningar), då det upplevs som avsteg från rådande riktlinjer.

    Ett av syftena med rehabiliteringskedjan var att skapa en mer enhetlig och standardiserad sjukskrivningsprocess. Dock upplever såväl handläggare som sjukskrivna att systemet är oflexibelt och inte tar hänsyn till individers olikheter och skilda behov, och att de fasta tidsgränserna därmed medfört en ökad orättvisa för de sjukskrivna. Även om bemötandet från handläggare på Försäkringskassan i många fall upplevs som bra, uppfattas sjukförsäkringssystemet som orättvist; studien ger därmed i första hand exempel på upplevd proceduriell orättvisa, snarare än upplevelser av orättvist bemötande.

    Studien visar på ett ytterligare behov av att studera etik, rättvisa och kvalitet i sjukskrivningsprocessen. 

  • 50.
    Ståhl, Christian
    et al.
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, Faculty of Health Sciences.
    Rapp, Gunilla
    Linköping University, Department of Management and Engineering. Linköping University, The Institute of Technology.
    Mellan sjukförsäkring och arbetsmarknad: Handläggares upplevelser och hantering av regelförändringar i sjukförsäkringen2009Report (Other academic)
    Abstract [sv]

    Denna rapport bygger på en studie där handläggare från Försäkringskassan och Arbetsförmedlingen samt personal från primärvård och kommunala verksamheter samlats i två grupper som vid återkommande tillfällen diskuterat de förändrade reglerna i sjukförsäkringen, och hur dessa påverkar deras arbete.

    Syftet med projektet som ligger till grund för denna rapport har varit tvådelat. Det finns ett vetenskapligt syfte att generera kunskap om hur handläggare upplever och hanterar de förändringar som för närvarande sker i det svenska sjukförsäkringssystemet, med samverkansfrågor som ett genomgående tema. Samtidigt har ett syfte med projektet varit att handläggarna som deltagit i studien skulle ges möjlighet att använda gruppträffarna som ett sätt att utveckla strategier för att hantera dessa frågor i samverkan över myndighetsgränserna.

     

    I rapporten har framförallt följande huvudpunkter diskuterats:

    • De nya reglerna i sjukförsäkringen har olika konsekvenser för olika grupper, där de enligt deltagarna anses bra för ”normalfallet”, men sämre för dem med sämre förutsättningar.

     

    • De nya reglerna förutsätter en fungerande arbetsmarknad, och om en sådan saknas ökar risken för utslagning när ersättningstiden från Försäkringskassan tar slut.

     

    • Ansvaret för rehabilitering har förskjutits från stat till individ, vilket för dem som en längre tid varit sjukskrivna innebär en svår övergång.

     

    • Försäkringskassans handläggare upplever att deras handlingsutrymme minskar; samtidigt som de ska genomföra omfattande regelförändringar ökar detaljstyrningen.

     

    • Vårdens och Försäkringskassans bedömning av arbetsförmåga har liten koppling till arbetsmarknadens parters bedömning av anställningsbarhet.

     

    • Vårdens och Försäkringskassans bedömning av arbetsförmåga utgår ofta ifrån bristande underlag som en konsekvens av bristande samverkan med arbetsgivare och företagshälsovård.

     

    • Lokala samordningsförbund har bidragit med välfungerande samverkansstrukturer mellan Försäkringskassan, Arbetsförmedlingen, kommuner och landsting, men dessa strukturer riskerar att raseras när en långsiktig strategi för finansiering saknas.

     

    • Deltagarna upplever ett reellt behov och en stor nytta av lokal samverkan, såväl i formella som i informella ärenden.

     

    • Resurssamordnare på vårdcentraler, tillsammans med resursteam, fungerar väl som en centralpunkt för en sådan samverkan.
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