liu.seSök publikationer i DiVA
Ändra sökning
Avgränsa sökresultatet
12 1 - 50 av 56
RefereraExporteraLänk till träfflistan
Permanent länk
Referera
Referensformat
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Annat format
Fler format
Språk
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Annat språk
Fler språk
Utmatningsformat
  • html
  • text
  • asciidoc
  • rtf
Träffar per sida
  • 5
  • 10
  • 20
  • 50
  • 100
  • 250
Sortering
  • Standard (Relevans)
  • Författare A-Ö
  • Författare Ö-A
  • Titel A-Ö
  • Titel Ö-A
  • Publikationstyp A-Ö
  • Publikationstyp Ö-A
  • Äldst först
  • Nyast först
  • Skapad (Äldst först)
  • Skapad (Nyast först)
  • Senast uppdaterad (Äldst först)
  • Senast uppdaterad (Nyast först)
  • Disputationsdatum (tidigaste först)
  • Disputationsdatum (senaste först)
  • Standard (Relevans)
  • Författare A-Ö
  • Författare Ö-A
  • Titel A-Ö
  • Titel Ö-A
  • Publikationstyp A-Ö
  • Publikationstyp Ö-A
  • Äldst först
  • Nyast först
  • Skapad (Äldst först)
  • Skapad (Nyast först)
  • Senast uppdaterad (Äldst först)
  • Senast uppdaterad (Nyast först)
  • Disputationsdatum (tidigaste först)
  • Disputationsdatum (senaste först)
Markera
Maxantalet träffar du kan exportera från sökgränssnittet är 250. Vid större uttag använd dig av utsökningar.
  • 1.
    Karlsson, Elin
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Seing, Ida
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Pedagogik och sociologi. Linköpings universitet, Filosofiska fakulteten.
    Sandqvist, Jan
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Avdelningen för arbetsterapi. Linköpings universitet, Medicinska fakulteten.
    Ståhl, Christian
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Communication characteristics between clients and stakeholders within the Swedish sickness insurance system: a document analysis of granted and withdrawn sickness benefit claims2019Ingår i: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165Artikel i tidskrift (Refereegranskat)
    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.

  • 2.
    Ståhl, Christian
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. HELIX Competence Centre, Linköping University, Linköping, Sweden.
    Seing, Ida
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Gerdle, Björn
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum.
    Sandqvist, Jan
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Avdelningen för arbetsterapi. Linköpings universitet, Medicinska fakulteten.
    Fair or square? Experiences of introducing a new method for assessing general work ability in a sickness insurance context2019Ingår i: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 6, s. 656-665Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

  • 3.
    Lundmark, Åse
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Medicinska fakulteten.
    Ståhl, Christian
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Företagshälsovård mot sjukskrivning?: Företagshälsovårdstjänster i förebyggande och rehabiliterande syften i Norrköpings kommun2019Rapport (Övrigt vetenskapligt)
    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.

  • 4.
    Ståhl, Christian
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Linköpings universitet, 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 strategies2018Ingår i: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 40, nr 8, s. 952-959Artikel i tidskrift (Refereegranskat)
    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

  • 5.
    Ståhl, Christian
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Linköpings universitet, HELIX Competence Centre.
    Gustavsson, Maria
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Arbete och arbetsliv. Linköpings universitet, Institutionen för beteendevetenskap och lärande, Pedagogik och sociologi. Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, HELIX Competence Centre.
    Introducing motivational interviewing in a sickness insurance context: Translation and implementation challenges2018Ingår i: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 28, nr 2, s. 357-364Artikel i tidskrift (Refereegranskat)
    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. 

  • 6.
    Fagerlind Ståhl, Anna-Carin
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Ståhl, Christian
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    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 resources2018Ingår i: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 18, artikel-id 915Artikel i tidskrift (Refereegranskat)
    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.

  • 7.
    Ståhl, Christian
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Seing, Ida
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Pedagogik och sociologi. Linköpings universitet, Filosofiska fakulteten.
    Reforming Activation in Swedish Work Disability Policy2018Ingår i: The Science and Politics of Work Disability Prevention / [ed] Ellen MacEachen, New York: Routledge, 2018, s. 125-140Kapitel i bok, del av antologi (Övrigt vetenskapligt)
    Abstract [en]

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

  • 8.
    Ståhl, Christian
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Andersson, Frieda
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten.
    Shifting to Value-Based Principles in Sickness Insurance: Challenges in Changing Roles and Culture2018Ingår i: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 28, nr 4, s. 730-739Artikel i tidskrift (Refereegranskat)
    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.

  • 9.
    Ståhl, Christian
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Sandqvist, Jan
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Avdelningen för arbetsterapi. Linköpings universitet, Medicinska fakulteten.
    Seing, Ida
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Aktivitetsförmågeutredning (AFU): Tillämpning, upplevelser och utfall2017Rapport (Övrigt vetenskapligt)
    Abstract [sv]

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

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

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

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

  • 10.
    Andersen, Åsa
    et al.
    Uppsala University, Sweden.
    Ståhl, Christian
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    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 study2017Ingår i: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 17, artikel-id 790Artikel i tidskrift (Refereegranskat)
    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.

  • 11.
    Ståhl, Christian
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    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 project2017Ingår i: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 17, artikel-id 431Artikel i tidskrift (Refereegranskat)
    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.

  • 12.
    Neher, Margit
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Ståhl, Christian
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Festin, Karin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Nilsen, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Implementation of Evidence-Based Practice in Rheumatology: What Sociodemographic, Social Cognitive and Contextual Factors Influence Health Professionals’ Use of Research in Practice?2016Ingår i: Journal of rheumatic diseases and treatment, ISSN 2469-5726, Vol. 2, nr 3, s. 1-8Artikel i tidskrift (Refereegranskat)
    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.

  • 13.
    Ståhl, Christian
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Placing people in the same room is not enough: An interprofessional education intervention to improve collaborative knowledge of people with disabilities2016Ingår i: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567, Vol. 30, nr 3, s. 331-337Artikel i tidskrift (Refereegranskat)
    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.

  • 14.
    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
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    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 implementation2016Ingår i: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 42, nr 1Artikel, forskningsöversikt (Refereegranskat)
    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.

  • 15.
    Strindlund, Lena
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Ståhl, Christian
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Vägen till arbetsgivarna2016Rapport (Övrigt vetenskapligt)
    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.

  • 16.
    Back, A.
    et al.
    Karolinska Institute, Sweden; Stockholm County Council, Sweden.
    Ståhl, Christian
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    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 practice2016Ingår i: INTERNATIONAL JOURNAL OF MENTAL HEALTH SYSTEMS, ISSN 1752-4458, Vol. 10, artikel-id 75Artikel i tidskrift (Refereegranskat)
    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.

  • 17.
    Müssener, Ulrika
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet.
    Ståhl, Christian
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet.
    Söderberg, Elsy
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet.
    Does the quality of encounters affect return to work? Lay people describe their experiences of meeting various professionals during their rehabilitation process2015Ingår i: Work: A journal of Prevention, Assesment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 52, nr 2, s. 447-455Artikel i tidskrift (Refereegranskat)
    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.

  • 18.
    Seing, Ida
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet.
    MacEachen, Ellen
    School of Public Health and Health Systems, Faculty of Applied Health Sciences, University of Waterloo, Canada.
    Ståhl, Christian
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet. Linköpings universitet, HELIX Vinn Excellence Centre.
    Ekberg, Kerstin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet. Linköpings universitet, HELIX Vinn Excellence Centre.
    Early-Return-to-Work in the Context of an Intensification of Working Life and Changing Employment Relationships2015Ingår i: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 25, nr 1, s. 74-85Artikel i tidskrift (Refereegranskat)
    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.

  • 19.
    Ståhl, Christian
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Gustavsson, Maria
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Pedagogik och sociologi. Linköpings universitet, Filosofiska fakulteten.
    Ekberg, Kerstin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Böhm, Liselotte
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Förutsättningar för implementering och användning av motiverande samtal (MI) inom Försäkringskassan: Slutrapport2015Rapport (Övrigt vetenskapligt)
    Abstract [sv]

    Detta är slutrapporten från det utvärderingsprojekt som studerat implementering och användning av motiverande samtal (MI) inom Försäkringskassan. Satsningen på MI har genomförts för att utveckla och förstärka metoder inom sjukförsäkrings- och samordningsprocessen, med syftet att skapa bättre förutsättningar för personliga handläggare att arbeta tidigt och aktivt i sjukfallen. För att professionalisera handläggarna avsatte Försäkringskassan under 2012 särskilda medel för att utbilda och kompetensutveckla handläggare som arbetar med sjukpenning och samordning kring samordningsuppdraget, där en utbildning i motiverande samtal (MI) ingick.

    I projektet har en tidigare delrapport publicerats (Socialförsäkringsrapport 2014:16) där fokus var på implementeringen av MI. En av de farhågor som rapporterades i delrapporten var att inte kunna integrera och vidmakthålla användningen av MI i det dagliga arbetet. I denna slutrapport undersöks förutsättningar för användning av MI i det dagliga arbetet inom Försäkringskassan, samt upplevda effekter av satsningen på individ- och verksamhetsnivå.

    Specifika frågeställningar är:

    • Vilka individuella och organisatoriska–praktiska förutsättningar har underlättat respektive försvårat handläggares fortsatta användning av MI i dagligt arbete?
    • Vilka effekter av satsningen på MI kan identifieras på individ- och verksamhetsnivå?

    Rapporten bygger på ett datamaterial bestående av en enkät till handläggare (n=880), samt intervjuer med 5 enhetschefer och 16 handläggare vid fyra lokalkontor. Intervjuerna är uppföljande intervjuer från en större datainsamling som rapporterades i projektets delrapport.

    Resultaten av studien tyder på att många av handläggarna en tid efter MIutbildningen fortfarande har ett engagemang kring metoden, och att många anger att de tillämpar den i möten med sjukskrivna, dock med stor variation avseende vilka av metodens verktyg som används. Merparten av handläggarna har gått utbildningen och tyckt att den har varit bra, och det finns ett intresse hos många handläggare för att fortsätta använda och utveckla sin tillämpning av metoden. Många handläggare anser också att de har kunnat se förbättringar i mötet med sjukskrivna i de fall där de tillämpat MI.

    Samtidigt riktas mycket kritik mot hur Försäkringskassan har hanterat satsningen på MI, där den genomgående bilden är att organiserad uppföljning och träning har saknats. Det finns en allmänt spridd uppfattning att MI inte har prioriterats i verksamheten, och att chefer inte har visat intresse för huruvida metoden tillämpas eller ej. Således kan det konstateras att den utvecklingspotential och det engagemang som handläggarna uppvisar inte har tagits om hand i verksamheten. Handläggare är också starkt kritiska till möjligheterna att använda och utveckla sin kunskap i metoden i relation till rådande arbetssituation. I intervjuer och enkäter beskrivs en mycket pressad verksamhet där inget utrymme finns för reflektion och lärande.

  • 20.
    Neher, Margit
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Ståhl, Christian
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Ellström, Per-Erik
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Pedagogik och sociologi. Linköpings universitet, Filosofiska fakulteten.
    Nilsen, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Knowledge Sources for Evidence-Based Practice in Rheumatology Nursing.2015Ingår i: Clinical Nursing Research, ISSN 1054-7738, E-ISSN 1552-3799, Vol. 24, nr 6, s. 661-679Artikel i tidskrift (Refereegranskat)
    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.

  • 21.
    Neher, Margit Saskia
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Ståhl, Christian
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Nilsen, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Learning opportunities in rheumatology practice: a qualitative study2015Ingår i: Journal of Workplace Learning, ISSN 1366-5626, E-ISSN 1758-7859, Vol. 27, nr 4, s. 282-297Artikel i tidskrift (Refereegranskat)
    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.

  • 22.
    Seing, Ida
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet.
    MacEachen, Ellen
    Department of Public Health and Health Systems, Faculty of Applied Public Health, University of Waterloo, Ontario, Canada.
    Ekberg, Kerstin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet. Linköpings universitet, HELIX Vinn Excellence Centre.
    Ståhl, Christian
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet. Linköpings universitet, HELIX Vinn Excellence Centre.
    Return to work or job transition?: Employer dilemmas in taking social responsibility for return to work in local workplace practice2015Ingår i: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 37, nr 18-19, s. 1760-1769Artikel i tidskrift (Refereegranskat)
    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.
  • 23.
    Ståhl, Christian
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    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 study2015Ingår i: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 15, nr 1083Artikel i tidskrift (Refereegranskat)
    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.

  • 24.
    Seing, Ida
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet.
    MacEachen, Ellen
    Department of Public Health and Health Systems, Faculty of Applied Public Health, University of Waterloo, Ontario, Canada.
    Ekberg, Kerstin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, HELIX Vinn Excellence Centre. Linköpings universitet, Hälsouniversitetet.
    Ståhl, Christian
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet.
    Activation Policies and Sick-Listed Workers’ Experiences and Trust in the Sickness Insurance System in Local Practice2014Manuskript (preprint) (Övrigt vetenskapligt)
    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.

  • 25.
    Dannapfel, Petra
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet.
    Peolsson, Anneli
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Ståhl, Christian
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet.
    Öberg, Birgitta
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Nilsen, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet.
    Applying self-determination theory for improved understanding of physiotherapists rationale for using research in clinical practice: a qualitative study in Sweden2014Ingår i: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 30, nr 1, s. 20-28Artikel i tidskrift (Refereegranskat)
    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.

  • 26.
    Ståhl, Christian
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet.
    Seing, Ida
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet.
    Arbetslinjer och arbetsförmåga i det svenska socialförsäkringssystemet2014Ingår i: Den relativa arbetsförmågan: teoretiska och praktiska perspektiv / [ed] Kerstin Ekberg, Lund: Studentlitteratur AB, 2014, s. 75-93Kapitel i bok, del av antologi (Övrigt vetenskapligt)
    Abstract [sv]

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

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

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

  • 27.
    Ståhl, Christian
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet.
    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 Interactions2014Ingår i: Journal of Business Ethics, ISSN 0167-4544, E-ISSN 1573-0697, Vol. 120, nr 2, s. 237-250Artikel i tidskrift (Refereegranskat)
    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.

  • 28.
    Ståhl, Christian
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Gustavsson, Maria
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Pedagogik och sociologi. Linköpings universitet, Filosofiska fakulteten.
    Ekberg, Kerstin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Böhm, Liselotte
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Implementering och användning av motiverande samtal (MI) inom Försäkringskassan2014Rapport (Övrigt vetenskapligt)
    Abstract [sv]

    Inom ramen för en satsning på att utveckla samordningsuppdraget avsatte Försäkringskassan under 2012 särskilda medel för att utbilda och kompetensutveckla samtliga handläggare i motiverande samtal (MI). Syftet var att professionalisera handläggarna och att utveckla och förstärka metoder inom samordningsuppdraget.

    MI är en klientcentrerad samtalsmetod med syfte att underlätta beteendeförändringar. Metoden fokuserar på motivationsfrågor och ska användas när en person känner sig ambivalent inför en förändring. MI har främst använts inom behandling av alkohol- och drogmissbruk. Då individer med sjukskrivningsproblematik ofta kämpar med sviktande motivation kan det antas att MI har potential att vara användbar som en utgångspunkt för handläggares möten med sjukskrivna, särskilt i de fall då problematiken berör ambivalens eller behov av att ändra livsstil. Det finns dock i dagsläget mycket begränsad empirisk forskning om användningen av MI i relation till sjukskrivna, och den evidens som finns för metoden berör andra tillämpningsområden.

    Syftet med föreliggande rapport är att kartlägga och analysera implementeringen av MI och förutsättningar för tillämpning av metoden inom Försäkringskassan. I rapporten analyseras hur olika aktörer inom organisationen uppfattar implementeringen och tillämpningen av MI i arbetet, vilka förutsättningar som finns för införande och användning av MI, samt hur sjukskrivna uppfattar mötet med handläggare som utbildats i metoden. Rapporten bygger på intervjuer med chefer, koordinatorer, handläggare och samordningscoacher inom Försäkringskassan, samt observationer av möten mellan handläggare och sjukskrivna och därpå följande intervjuer med de sjukskrivna.

  • 29.
    Ståhl, Christian
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet.
    Edvardsson Stiwne, Elinor
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Pedagogik och vuxnas lärande. Linköpings universitet, Filosofiska fakulteten.
    Narratives of Sick Leave, Return to Work and Job Mobility for People with Common Mental Disorders in Sweden2014Ingår i: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 24, nr 3, s. 543-554Artikel i tidskrift (Refereegranskat)
    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.

  • 30.
    Nilsen, Per
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet.
    Ståhl, Christian
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet.
    Roback, Kerstin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet.
    Cairney, Paul
    University of Stirling, Scotland.
    Never the twain shall meet? - a comparison of implementation science and policy implementation research2013Ingår i: Implementation Science, ISSN 1748-5908, E-ISSN 1748-5908, Vol. 8Artikel i tidskrift (Refereegranskat)
    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.

  • 31.
    Ståhl, Christian
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Arbetslivsinriktad rehabilitering. Linköpings universitet, Hälsouniversitetet.
    Toomingas, Allan
    Karolinska Institute, Sweden.
    Aborg, Carl
    Karolinska Institute, Sweden.
    Ekberg, Kerstin
    Linköpings universitet, Institutionen för medicin och hälsa, Arbetslivsinriktad rehabilitering. Linköpings universitet, Hälsouniversitetet.
    Kjellberg, Katarina
    Karolinska Institute, Sweden.
    Promoting occupational health interventions in early return to work by implementing financial subsidies: a Swedish case study2013Ingår i: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 13Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    In 2010, the Swedish government introduced a system of subsidies for occupational health (OH) service interventions, as a part in a general policy promoting early return to work. The aim of this study was to analyse the implementation of these subsidies, regarding how they were used and perceived.

    Methods

    The study was carried out using a mixed-methods approach, and comprises material from six sub-studies: a register study of the use of the subsidies, one survey to OH service providers, one survey to employers, one document analysis of the documentation from interventions, interviews with stakeholders, and case interviews with actors involved in coordinated interventions.

    Results

    The subsidized services were generally perceived as positive but were modestly used. The most extensive subsidy – for coordinated interventions – was rarely used. Employers and OH service providers reported few or no effects on services and contracts. OH service providers explained the modest use in terms of already having less bureaucratic routines in place, where applying for subsidies would involve additional costs. Information about the subsidies was primarily communicated to OH service providers, while employers were not informed.

    Conclusions

    The study highlights the complexity of promoting interventions through financial incentives, since their implementation requires that they are perceived by the stakeholders involved as purposeful, manageable and cost-effective. There are inherent political challenges in influencing stakeholders who act on a free market, in that the impact of policies may be limited, unless they are enforced by law.

  • 32.
    Ståhl, Christian
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Arbetslivsinriktad rehabilitering. Linköpings universitet, Hälsouniversitetet.
    Müssener, Ulrika
    Linköpings universitet, Institutionen för medicin och hälsa, Arbetslivsinriktad rehabilitering. Linköpings universitet, Hälsouniversitetet.
    Svensson, Tommy
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Pedagogik och sociologi. Linköpings universitet, Filosofiska fakulteten.
    Implementation of standardized time limits in sickness insurance and return-to-work: Experiences of four actors2012Ingår i: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 34, nr 16, s. 1404-1411Artikel i tidskrift (Refereegranskat)
    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.

  • 33.
    Ståhl, Christian
    Linköpings universitet, HELIX Vinn Excellence Centre. Linköpings universitet, Institutionen för medicin och hälsa, Arbetslivsinriktad rehabilitering. Linköpings universitet, Hälsouniversitetet.
    Implementing Interorganizational Cooperation in Labour Market Reintegration: A Case Study2012Ingår i: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 22, nr 2, s. 209-219Artikel i tidskrift (Refereegranskat)
    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.

  • 34.
    Seing, Ida
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Arbetslivsinriktad rehabilitering. Linköpings universitet, Hälsouniversitetet.
    Ståhl, Christian
    Linköpings universitet, Institutionen för medicin och hälsa, Arbetslivsinriktad rehabilitering. Linköpings universitet, HELIX Vinn Excellence Centre. Linköpings universitet, Hälsouniversitetet.
    Nordenfelt, Lennart
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Filosofiska fakulteten.
    Bülow, Pia
    Avdelningen för beteendevetenskap och socialt arbete, Hälsohögskolan, Jönköping.
    Ekberg, Kerstin
    Linköpings universitet, Institutionen för medicin och hälsa, Arbetslivsinriktad rehabilitering. Linköpings universitet, HELIX Vinn Excellence Centre. Linköpings universitet, Hälsouniversitetet.
    Policy and Practice of Work Ability: A Negotiation of Responsibility in Organizing Return to Work2012Ingår i: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 22, nr 4, s. 553-564Artikel i tidskrift (Refereegranskat)
    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.

  • 35.
    Ståhl, Christian
    Linköpings universitet, Institutionen för medicin och hälsa, Arbetslivsinriktad rehabilitering. Linköpings universitet, HELIX Vinn Excellence Centre. Linköpings universitet, Hälsouniversitetet.
    Att implementera rehabiliteringssamverkan: en fallstudie2011Ingår i: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 88, nr 5, s. 418-427Artikel i tidskrift (Refereegranskat)
    Abstract [sv]

    Samordningsförbund är en struktur för interorganisatorisk samverkan inom rehabiliteringsområdet mellan kommun, landsting, Försäkringskassan och Arbetsförmedlingen. I denna fallstudie har implementeringsprocesser kring samverkansteam i två samordningsförbund studerats, med fokus på utveckling av strategier för implementering, hur berörda organisationer involverades i denna process, samt hur strategierna påverkade hållbarheten i samverkansarbetet. Studien omfattar individuella intervjuer, fokusgrupper och dokumentstudier. Studien visar två olika strategier för implementering med olika utfall. Medan förbund ett försökte (men misslyckades) att implementera specifika samverkansprojekt hade förbund två en bredare interaktiv strategi för att åstadkomma en lokal samverkansstruktur. Denna strategi innebar att ett centralt samverkansteam kunde startas och drivas vidare, med stöd från samtliga parter.

  • 36.
    Seing, Ida
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Arbetslivsinriktad rehabilitering. Linköpings universitet, Hälsouniversitetet.
    Ståhl, Christian
    Linköpings universitet, Institutionen för medicin och hälsa, Arbetslivsinriktad rehabilitering. Linköpings universitet, HELIX Vinn Excellence Centre. Linköpings universitet, Hälsouniversitetet.
    Nordenfelt, Lennart
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Hälsouniversitetet.
    Bülow, Pia
    Avdelningen för beteendevetenskap och socialt arbete, Hälsohögskolan, Jönköping.
    Ekberg, Kerstin
    Linköpings universitet, Institutionen för medicin och hälsa, Arbetslivsinriktad rehabilitering. Linköpings universitet, HELIX Vinn Excellence Centre. Linköpings universitet, Hälsouniversitetet.
    Avstämningsmötet som arena för förhandling om arbetsförmåga.2011Ingår i: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 88, nr 5, s. 408-417Artikel i tidskrift (Refereegranskat)
  • 37.
    Ståhl, Christian
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Arbetslivsinriktad rehabilitering. Linköpings universitet, HELIX Vinn Excellence Centre. Linköpings universitet, Hälsouniversitetet.
    Svensson, Tommy
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Avdelningen för sociologi (SOC). Linköpings universitet, Filosofiska fakulteten.
    Ekberg, Kerstin
    Linköpings universitet, Institutionen för medicin och hälsa, Arbetslivsinriktad rehabilitering. Linköpings universitet, HELIX Vinn Excellence Centre. Linköpings universitet, Hälsouniversitetet.
    From Cooperation to Conflict? Swedish Rehabilitation Professionals' Experiences of Interorganizational Cooperation.2011Ingår i: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 21, nr 3, s. 441-448Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

    Results Interorganizational cooperation in rehabilitation is generally perceived as promoting coherence and communication. Nevertheless, there are several contradictory factors in the implementation of such work forms, primarily inflexible sickness insurance regulations and inability of managers to implement cooperation in regular practice.

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

  • 38.
    Ståhl, Christian
    Linköpings universitet, Institutionen för medicin och hälsa, Arbetslivsinriktad rehabilitering. Linköpings universitet, HELIX Vinn Excellence Centre. Linköpings universitet, Hälsouniversitetet.
    Implementing interorganisational cooperation in labour market reintegration: a case study2011Konferensbidrag (Refereegranskat)
  • 39.
    Ståhl, Christian
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Arbetslivsinriktad rehabilitering. Linköpings universitet, HELIX Vinn Excellence Centre. Linköpings universitet, Hälsouniversitetet.
    Müssener, Ulrika
    Linköpings universitet, Institutionen för medicin och hälsa, Arbetslivsinriktad rehabilitering. Linköpings universitet, Hälsouniversitetet.
    Svensson, Tommy
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Avdelningen för sociologi (SOC). Linköpings universitet, Filosofiska fakulteten.
    Sjukskrivningssystemet och dess aktörer: Efter införandet av rehabiliteringskedjan2011Rapport (Övrigt vetenskapligt)
    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. 

  • 40.
    Ståhl, Christian
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Arbetslivsinriktad rehabilitering. Linköpings universitet, Hälsouniversitetet. Linköpings universitet, HELIX Vinn Excellence Centre.
    Svensson, Tommy
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Avdelningen för sociologi (SOC). Linköpings universitet, Filosofiska fakulteten.
    Petersson, Gunilla
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Avdelningen för sociologi (SOC). Linköpings universitet, Filosofiska fakulteten.
    Ekberg, Kerstin
    Linköpings universitet, Institutionen för medicin och hälsa, Arbetslivsinriktad rehabilitering. Linköpings universitet, HELIX Vinn Excellence Centre. Linköpings universitet, Hälsouniversitetet.
    Swedish Rehabilitation Professionals’ Perspectives on Work Ability Assessments in a Changing Sickness Insurance System2011Ingår i: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 33, nr 15-16, s. 1373-1382Artikel i tidskrift (Refereegranskat)
    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.

  • 41.
    Ståhl, Christian
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Arbetslivsinriktad rehabilitering. Linköpings universitet, Hälsouniversitetet. Linköpings universitet, HELIX Vinn Excellence Centre.
    Svensson, Tommy
    Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Institutionen för beteendevetenskap och lärande, Avdelningen för sociologi (SOC).
    Petersson, Gunilla
    Linköpings universitet, Institutionen för beteendevetenskap och lärande. Linköpings universitet, Filosofiska fakulteten.
    Ekberg, Kerstin
    Linköpings universitet, Institutionen för medicin och hälsa, Arbetslivsinriktad rehabilitering. Linköpings universitet, HELIX Vinn Excellence Centre. Linköpings universitet, Hälsouniversitetet.
    A Matter of Trust?: A Study of Coordination of Swedish Stakeholders in Return-to-Work2010Ingår i: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 20, s. 299-310Artikel i tidskrift (Refereegranskat)
    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.

  • 42.
    Ståhl, Christian
    et al.
    Linköpings universitet, HELIX Vinn Excellence Centre. Linköpings universitet, Institutionen för medicin och hälsa, Arbetslivsinriktad rehabilitering. Linköpings universitet, Hälsouniversitetet.
    Svensson, Tommy
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Avdelningen för sociologi (SOC). Linköpings universitet, Filosofiska fakulteten.
    Petersson, Gunilla
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Avdelningen för sociologi (SOC). Linköpings universitet, Filosofiska fakulteten.
    Ekberg, Kerstin
    Linköpings universitet, HELIX Vinn Excellence Centre. Linköpings universitet, Institutionen för medicin och hälsa, Arbetslivsinriktad rehabilitering. Linköpings universitet, Hälsouniversitetet.
    Discretion, governance and cooperative learning: Swedish rehabilitation professionals’ experiences of financial cooperation2010Konferensbidrag (Refereegranskat)
  • 43.
    Ståhl, Christian
    Linköpings universitet, Institutionen för medicin och hälsa, Arbetslivsinriktad rehabilitering. Linköpings universitet, Hälsouniversitetet.
    In Cooperation We Trust: Interorganizational Cooperation in Return-to-Work and Labour Market Reintegration2010Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    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.

    Delarbeten
    1. The Work Ability Divide: Holistic and Reductionistic Approaches in Swedish Interdisciplinary Rehabilitation Teams
    Öppna denna publikation i ny flik eller fönster >>The Work Ability Divide: Holistic and Reductionistic Approaches in Swedish Interdisciplinary Rehabilitation Teams
    2009 (Engelska)Ingår i: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 19, nr 3, s. 264-273Artikel i tidskrift (Refereegranskat) 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.

    Ort, förlag, år, upplaga, sidor
    Springer Netherlands, 2009
    Nyckelord
    Work ability, return to work, cooperation, team, interdisciplinary
    Nationell ämneskategori
    Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi Sociologi Tvärvetenskapliga studier inom samhällsvetenskap Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
    Identifikatorer
    urn:nbn:se:liu:diva-19739 (URN)10.1007/s10926-009-9183-2 (DOI)
    Anmärkning
    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/ Tillgänglig från: 2009-07-27 Skapad: 2009-07-27 Senast uppdaterad: 2018-01-13
    2. A Matter of Trust?: A Study of Coordination of Swedish Stakeholders in Return-to-Work
    Öppna denna publikation i ny flik eller fönster >>A Matter of Trust?: A Study of Coordination of Swedish Stakeholders in Return-to-Work
    2010 (Engelska)Ingår i: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 20, s. 299-310Artikel i tidskrift (Refereegranskat) 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.

    Ort, förlag, år, upplaga, sidor
    SpringerLink, 2010
    Nyckelord
    Work ability, Return to work, Cooperation Team, Interdisciplinary
    Nationell ämneskategori
    Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
    Identifikatorer
    urn:nbn:se:liu:diva-21379 (URN)10.1007/s10926-009-9205-0 (DOI)19787442 (PubMedID)
    Tillgänglig från: 2009-10-01 Skapad: 2009-10-01 Senast uppdaterad: 2017-12-05
    3. Discretion, governance and cooperative learning: Swedish rehabilitation professionals’ experiences of financial cooperation
    Öppna denna publikation i ny flik eller fönster >>Discretion, governance and cooperative learning: Swedish rehabilitation professionals’ experiences of financial cooperation
    (Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
    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.

    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-54891 (URN)
    Tillgänglig från: 2010-04-20 Skapad: 2010-04-20 Senast uppdaterad: 2013-09-03Bibliografiskt granskad
    4. Swedish Rehabilitation Professionals’ Perspectives on Work Ability Assessments in a Changing Sickness Insurance System
    Öppna denna publikation i ny flik eller fönster >>Swedish Rehabilitation Professionals’ Perspectives on Work Ability Assessments in a Changing Sickness Insurance System
    2011 (Engelska)Ingår i: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 33, nr 15-16, s. 1373-1382Artikel i tidskrift (Refereegranskat) 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.

    Ort, förlag, år, upplaga, sidor
    Informa Healthcare, 2011
    Nationell ämneskategori
    Medicin och hälsovetenskap Samhällsvetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-54893 (URN)10.3109/09638288.2010.532282 (DOI)000291886000010 ()
    Anmärkning
    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/ Tillgänglig från: 2010-04-20 Skapad: 2010-04-20 Senast uppdaterad: 2017-12-12
  • 44.
    Ståhl, Christian
    et al.
    Linköpings universitet, HELIX Vinn Excellence Centre. Linköpings universitet, Institutionen för medicin och hälsa, Arbetslivsinriktad rehabilitering. Linköpings universitet, Hälsouniversitetet.
    Svensson, Tommy
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Avdelningen för sociologi (SOC). Linköpings universitet, Filosofiska fakulteten.
    Petersson, Gunilla
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Avdelningen för sociologi (SOC). Linköpings universitet, Filosofiska fakulteten.
    Ekberg, Kerstin
    Linköpings universitet, HELIX Vinn Excellence Centre. Linköpings universitet, Institutionen för medicin och hälsa, Arbetslivsinriktad rehabilitering. Linköpings universitet, Hälsouniversitetet.
    Swedish Rehabilitation Professionals' Perspectives on Work Ability Assessments in a Changing Sickness Insurance System2010Konferensbidrag (Refereegranskat)
  • 45.
    Ståhl, Christian
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Arbetslivsinriktad rehabilitering. Linköpings universitet, Hälsouniversitetet.
    Rapp, Gunilla
    Linköpings universitet, Institutionen för ekonomisk och industriell utveckling. Linköpings universitet, Tekniska högskolan.
    Mellan sjukförsäkring och arbetsmarknad: Handläggares upplevelser och hantering av regelförändringar i sjukförsäkringen2009Rapport (Övrigt vetenskapligt)
    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.
  • 46.
    Ståhl, Christian
    Linköpings universitet, Institutionen för medicin och hälsa, Arbetslivsinriktad rehabilitering. Linköpings universitet, Hälsouniversitetet.
    Samverkan kring återgång i arbete: var är arbetsgivarna?2009Ingår i: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 86, nr 3, s. 265-274Artikel i tidskrift (Refereegranskat)
    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.

  • 47.
    Ståhl, Christian
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Arbetslivsinriktad rehabilitering. Linköpings universitet, Hälsouniversitetet.
    Svensson, Tommy
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Avdelningen för sociologi (SOC). Linköpings universitet, Filosofiska fakulteten.
    Petersson, Gunilla
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Avdelningen för sociologi (SOC). Linköpings universitet, Filosofiska fakulteten.
    Ekberg, Kerstin
    Linköpings universitet, Institutionen för medicin och hälsa, Arbetslivsinriktad rehabilitering. Linköpings universitet, Hälsouniversitetet.
    The Work Ability Divide: Holistic and Reductionistic Approaches in Swedish Interdisciplinary Rehabilitation Teams2009Ingår i: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 19, nr 3, s. 264-273Artikel i tidskrift (Refereegranskat)
    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.

  • 48.
    Ståhl, Christian
    Linköpings universitet, Institutionen för medicin och hälsa, Arbetslivsinriktad rehabilitering. Linköpings universitet, HELIX Vinn Excellence Centre. Linköpings universitet, Hälsouniversitetet.
    Coordinating welfare.2008Konferensbidrag (Övrigt vetenskapligt)
  • 49.
    Ståhl, Christian
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Arbetslivsinriktad rehabilitering. Linköpings universitet, HELIX Vinn Excellence Centre. Linköpings universitet, Hälsouniversitetet.
    Ekberg, Kerstin
    Linköpings universitet, Institutionen för medicin och hälsa, Arbetslivsinriktad rehabilitering. Linköpings universitet, HELIX Vinn Excellence Centre. Linköpings universitet, Hälsouniversitetet.
    Svensson, Tommy
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Avdelningen för sociologi (SOC). Linköpings universitet, Filosofiska fakulteten.
    Coordination between welfare authorities in promoting return-to-work2008Konferensbidrag (Refereegranskat)
  • 50.
    Ståhl, Christian
    Linköpings universitet, Institutionen för medicin och hälsa, Arbetslivsinriktad rehabilitering. Linköpings universitet, Hälsouniversitetet.
    Det mytologiska självskadebeteendet: Könade stereotyper och idealtypiska berättelser2007Ingår i: Socialvetenskaplig tidskrift, ISSN 1104-1420, Vol. 4, s. 280-294Artikel i tidskrift (Refereegranskat)
    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. 

12 1 - 50 av 56
RefereraExporteraLänk till träfflistan
Permanent länk
Referera
Referensformat
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Annat format
Fler format
Språk
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Annat språk
Fler språk
Utmatningsformat
  • html
  • text
  • asciidoc
  • rtf