Mid Sweden University

The overall aim of this thesis was to explore the impact of workplace social relations on the implementation of return-to-work interventions. The thesis consists of four separate papers with specific aims. In Paper I, the overall purpose of the study was to analyse how a multi-stakeholder return-to-work programme was implemented and experienced from the perspective of the stakeholders involved, i.e. supervisors, occupational health consultants and a project coordinator. The objective was to identify and analyse how these stakeholders perceived that the programme had been implemented in relation to its intentions. In Paper II, the objective was to explore how workplace actors experience social relations, and how organisational dynamics in workplace-based return-to-work start before and extend beyond the initial return of the sick-listed worker to the workplace. In Paper III, the objective was to explore the meaning of early contact in return-to-work, and how social relational actions and conditions can facilitate or impede early contact among workplace actors. In Paper IV, the objective was to explore the role of co-workers in the return-to-work process, and their contribution to the process, starting from when a colleague falls ill, continuing when he/she subsequently becomes sick-listed and finally when he/she re-enters the workgroup.

The general methodological approach to the papers in this thesis has been explorative and interpretive; qualitative methods have been used, involving interviews, group interviews and collection of employer policies on return-to-work. The data material has been analysed through back-and-forth abductive (Paper I), and inductive (Papers II-IV) content analysis.

The main findings from Paper I show that discrepancies in the interpretations of policy intentions between key stakeholders (project coordinator, occupational health consultants and supervisors) created barriers for implementing the employer-based return-to-work programme, due to lack of communication, support, coaching and training activities of key stakeholders dedicated to the biopsychosocial intentions of the programme. In Papers II-IV, the workplace actors (re-entering workers, co-workers, supervisors and/or human resources manager) experienced the return-to-work process as phases (time before the sick leave, when on sick leave, when re-entering the workplace, and future sustainability). The findings highlight the importance and relevance of the varied roles of the different workplace actors during the identified phases of the return-to-work process. In particular, the positive contribution of co-workers, and their experience of shifting demands and expectations during each phase, is acknowledged. During the period of time before sick leave the main findings show how workplace actors experience the meaning of early contact within a social relational context, and how early contact is more than an activity that is merely carried out (or not carried out). The findings show how workplace actors experience uncertainties about how and when contact should take place, and the need to balance possible infringement that early contact might cause for the re-entering worker between pressure to return to work and their private health management.

The findings in this thesis show how the workplace is a socially complex dynamic setting, which challenges some static models of return-to-work. The biopsychosocial and ecological/case management models and policies for return-to-work have been criticised for neglecting social relations in a return-to-work process at the workplace. This thesis provides increased knowledge and explanations regarding important factors in workplace social relations that facilitate an understanding of what might “make or break” the return-to-work process.