Ida Seing

Policy and Practice of Work Ability: A Negotiation of Responsibility in Organizing Return to Work

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.

Early-Return-to-Work in the Context of an Intensification of Working Life and Changing Employment Relationships

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.

Return to work or job transition? Employer dilemmas in taking social responsibility for return to work in local workplace practice

Abstract 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.

Fair or square? Experiences of introducing a new method for assessing general work ability in a sickness insurance context

Abstract 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.