Swedish social insurance officers' experiences of difficulties in assessing applications for disability pensions – an interview study

<p>Abstract</p> <p>Background</p> <p>In this study the focus is on social insurance officers judging applications for disability pensions. The number of applications for disability pension increased during the late 1990s, which has resulted in an increasing number of disability pensions in Sweden. A more restrictive attitude towards the clients has however evolved, as societal costs have increased and governmental guidelines now focus on reducing costs. As a consequence, the quantitative and qualitative demands on social insurance officers when handling applications for disability pensions may have increased. The aim of this study was therefore to describe the social insurance officers' experiences of assessing applications for disability pensions after the government's introduction of stricter regulations.</p> <p>Methods</p> <p>Qualitative methodology was employed and a total of ten social insurance officers representing different experiences and ages were chosen. Open-ended interviews were performed with the ten social insurance officers. Data was analysed with inductive content analysis.</p> <p>Results</p> <p>Three themes could be identified as problematic in the social insurance officers' descriptions of dealing with the applications in order to reach a decision on whether the issue qualified applicants for a disability pension or not: 1. Clients are heterogeneous. 2. Ineffective and time consuming waiting for medical certificates impede the decision process. 3. Perspectives on the issue of work capacity differed among different stakeholders. The backgrounds of the clients differ considerably, leading to variation in the quality and content of applications. Social insurance officers had to make rapid decisions within a limited time frame, based on limited information, mainly on the basis of medical certificates that were often insufficient to judge work capacity. The role as coordinating actor with other stakeholders in the welfare system was perceived as frustrating, since different stakeholders have different goals and demands. The social insurance officers experience lack of control over the decision process, as regulations and other stakeholders restrict their work.</p> <p>Conclusion</p> <p>A picture emerges of difficulties due to disharmonized systems, stakeholder-bound goals causing some clients to fall between two stools, or leading to unnecessary waiting times, which may limit the clients' ability to take an active part in a constructive process. Increased communication with physicians about how to elaborate the medical certificates might improve the quality of certificates and thereby reduce the clients waiting time.</p

Usefulness and engagement with a guided workbook intervention (WorkPlan) to support work related goals among cancer survivors

Background: Returning to work after cancer is associated with improved physical and psychological functioning, but managing this return can be a challenging process. A workbook based intervention (WorkPlan) was developed to support return-to-work among cancer survivors. The aim of this study was to explore how participants using the workbook engaged with the intervention and utilised the content of the intervention in their plan to return-to-work. Methods: As part of a feasibility randomised controlled trial, 23 participants from the intervention group were interviewed 4-weeks post intervention. Interviews focussed on intervention delivery and data was analysed using Framework analysis. Results: Participants revealed a sense of empowerment and changes in their outlook as they transitioned from patient to employee, citing the act of writing as a medium for creating their own return-to-work narrative. Participants found the generation of a return-to-work plan useful for identifying potential problems and solutions, which also served as a tool for aiding discussion with the employer on return-to-work. Additionally, participants reported feeling less uncertain and anxious about returning to work. Timing of the intervention in coordination with ongoing cancer treatments was crucial to perceived effectiveness; participants identified the sole or final treatment as the ideal time to receive the intervention. Conclusions: The self-guided workbook supports people diagnosed with cancer to build their communication and planning skills to successfully manage their return-to-work. Further research could examine how writing plays a role in this process

Hotel housekeeping work influences on hypertension management

Background Characteristics of hotel housekeeping work increase the risk for hypertension development. Little is known about the influences of such work on hypertension management. Methods For this qualitative study, 27 Haitian immigrant hotel housekeepers from Miami‐Dade County, FL were interviewed. Interview transcripts were analyzed with the assistance of the Atlas.ti software for code and theme identification. Results Influences of hotel housekeeping work on hypertension management arose both at the individual and system levels. Factors at the individual level included co‐worker dynamics and maintenance of transmigrant life. Factors at the system level included supervisory support, workload, work pace, and work hiring practices. No positive influences were reported for workload and hiring practices. Conclusions Workplace interventions may be beneficial for effective hypertension management among hotel housekeepers. These work influences must be considered when determining effective methods for hypertension management among hotel housekeepers. Am. J. Ind. Med. 56:1402–1413. © 2013 Wiley Periodicals, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/101773/1/ajim22209.pd

Implementing a collaborative return-to-work program: lessons from a qualitative study in a large Canadian healthcare organization

BACKGROUND: Comprehensive workplace return-to-work policies, applied with consistency, can reduce length of time out of work and the risk of long-term disability. This paper reports on the findings from a qualitative study exploring managers’ and return-to-work-coordinators’ views on the implementation of their organization’s new return-to-work program. OBJECTIVES: To provide practical guidance to organizations in designing and implementing return-to-work programs for their employees. METHODS: Semi-structured qualitative interviews were undertaken with 20 managers and 10 return-to-work co-ordinators to describe participants’ perspectives on the progress of program implementation in the first 18 months of adoption. The study was based in a large healthcare organization in Ontario, Canada. Thematic analysis of the data was conducted. RESULTS: We identified tensions evident in the early implementation phase of the organization’s return-to-work program. These tensions were attributed to uncertainties concerning roles and responsibilities and to circumstances where objectives or principles appeared to be in conflict. CONCLUSIONS: The implementation of a comprehensive and collaborative return-to-work program is a complex challenge. The findings described in this paper may provide helpful guidance for organizations embarking on the development and implementation of a return-to-work program

A Stakeholder Generated Conceptualization for Successful Return to Work Outcome Evaluation: A Concept Mapping Approach

Measurement of return to work (RTW) lacks attention to outcomes of relevance to all stakeholders. The objective of this thesis was to define what constitutes a successful RTW outcome from a stakeholder perspective and determine how to best measure it. A concept mapping method was used to create a conceptualization of successful RTW outcome based on indicators of interest and importance to various stakeholders. RTW researchers were questioned and the literature was searched for measures that mapped to the conceptualization and concepts. Stakeholders, made up of RTW consumers and providers, generated 48 indicators of successful RTW which were subsequently grouped into six concepts. Stakeholders also rated the importance of each of the indicators. In preparation for creating a final conceptualization the stakeholder-generated concepts and rating data were presented to a researcher group who were invited to comment and provide further input. The researcher group confirmed the inclusiveness of the generated concepts and discussed various aspects of the resulting conceptualization. Names of measures that appeared to evaluate various concepts were also offered. The final conceptualization was constructed in an attempt to reflect both practice and research realities. The stakeholder-generated data, discussion points from RTW researcher focus groups and the investigator’s intimate knowledge of both practical RTW issues and RTW literature were used in the creation of a logic model. Final concepts were support and collaboration, stakeholder perspectives, rights, respect and dignity, maintenance of well-being, worker job function and worker job satisfaction. The logic model was developed to illustrate temporal aspects and the relationships among the concepts of this RTW outcome evaluation theory. This project is the first that identifies shared and clear goals of RTW program outcomes. Results suggest that there are measures that fully capture some concepts but aspects of other concepts will likely need development of new measures. Further study is needed to determine the ability of the model to differentiate between successful and unsuccessful RTW outcomes and to develop an outcome measure that targets the concepts of the model explicitly

Reabilitação profissional como política de inclusão social

Este artigo faz uma breve análise de aspectos históricos e institucionais da reabilitação profissional no Brasil, e propõe desafios conceituais e estruturais a serem superados, condição necessária para que seja construída uma política de inclusão social nessa área. Aborda o uso da Classificação Internacional de Funcionalidade, Incapacidade e Saúde – CIF, criada Organização Mundial de Saúde (OMS), no ano de 2001, como ferramenta na reabilitação profissional.This paper briefly analyzes the historical and institutional aspects of occupational rehabilitation in Brazil and presents the conceptual and structural challenges to be overcome, a condition necessary for constructing a social inclusion policy in this field. It includes the use of the International Classification for Functionality, Disability, and Health (CIF) - created by the World Health Organization (WHO) in 2001 - as a tool in occupational rehabilitation

Evaluation of the functionality of workers with Repetitive Strain Injury (RSI)/ Work-related musculoskeletal disorders (MSDs): the construction of the ICF Core Set for RSI/MSDs

This study presents the ICF Core Set for Repetitive Strain Injury (RSI)/ Work-related musculoskeletal disorders (MSDs) and its construction process. The ICF Core Set for RSI/MSDs was created through successive consensuses among specialists in the workers' healthcare area throughout six phases, which involved from the assessment and the study of the ICF, followed by its reading and discussion, to the establishment of codes and comparison with the core sets of generalized pain and depression. For the "body functions" component, the chosen codes were related to the following aspects: mental, sensory, pain and neuromusculoskeletal functions, as well as movement functions. For the "body structures" component, the chosen codes were related to the following aspects: nervous system structures and those related to movement. For the "activity and participation" component, the chosen codes were related to: mobility, personal care, domestic life, interpersonal relations and interactions and the main areas of life. For "environmental factors", the codes chosen were related to: support and relationships, attitudes and services, systems and policies. The environment component was the most limited for the description within the work context. This study represents the effort of constructing a core set based on an interdisciplinary approach, viable to be applied during the treatment and rehabilitation process of workers presenting RSI/MSDs and can contribute to bring Brazil into the international discussion that deals with the consequences of human disease from a social-medical model, displacing the scientific debate and the creation of public policies from the context of disability/incapacity into the health context.O presente artigo apresenta o Core set da CIF para LER/DORT e seu processo de construção.  O Core set da CIF para LER/DORT foi elaborado por meio de consensos sucessivos entre especialistas do campo da saúde do trabalhador em seis etapas, que envolveram desde a aproximação e estudo da CIF, leitura, discussão até a eleição de códigos e comparação com os core sets de dor generalizada e de depressão. Para o componente ‘funções do corpo’ foram escolhidos códigos relacionados aos aspectos: funções mentais, sensoriais, de dor e neuromusculoesqueléticas e relacionadas ao movimento. Para ‘estruturas do corpo’ foram escolhidos códigos relacionados aos aspectos: estruturas do sistema nervoso e relacionadas ao movimento. Para ‘atividade e participação’ foram escolhidos códigos relacionados à: mobilidade, cuidado pessoal, vida doméstica, relações e interações interpessoais e áreas principais da vida. Para ‘fatores ambientais’ foram escolhidos códigos relacionados à: apoio e relacionamentos, atitudes e serviços, sistemas e políticas. O componente ambiente foi o mais limitado para a descrição dentro do contexto do trabalho. Este artigo apresenta o esforço de construção de um core set, a partir de uma abordagem interdisciplinar, viável à aplicação no processo de tratamento e reabilitação de trabalhadores com LER/DORT e poderá contribuir para inserir o Brasil na discussão internacional que trata das conseqüências do adoecimento humano a partir do modelo sócio-médico, deslocando o debate científico e a produção de políticas públicas do contexto da deficiência/incapacidade para o contexto da saúde