Exploring organisational support to apply best practice in the sick leave and rehabilitation process from a multiprofessional front-line perspective: a qualitative study.

objectivesTo explore the experiences of organisational support to apply best practices held by front-line employees working with patients in the sick leave and rehabilitation process (SRP).

designQualitative study design. Data were collected with focus group interviews in Region Västra Götaland, Sweden. Participants discussed their perceptions of organisational support to apply the best SRP practice in a primary healthcare context.

participantsPurposive sampling was conducted to capture a range of experiences among various professionals, including general practitioners (n=6), rehabilitation coordinators, other primary healthcare professionals (n=13) and caseworkers from the Social Insurance Agency, Employment Agency and Social Services (n=12).

resultsInformants perceived that their good intentions to work for the best interests of each patient were not enough to overcome inadequate organisational prerequisites. Identified themes described unequal care due to significant practice variation, conflicting messages, a situation where the patient loses control and mismatch between available support and patient needs. Perceived potential consequences for the patients included legal uncertainty of assessments, harmful passivity of the individual through misapplied sick leave and the risk of overlooking non-medical factors that could be managed in a safer and more well-adapted way.

conclusionsNeither guidelines on person-centred approaches, nor laws regulating the right to coordinated individual planning, seem to have fulfilled the intended purpose. The informants depicted an SRP obstructing individualised care, thus risking worsening patients' well-being and abilities. The opportunities to improve the quality of the processes within the SRP, and simultaneously make them more effective, appear to be extensive.