On the information exchange between physicians and social insurance officers in the sick leave process : an activity theoretical perspective

Abstract: In Sweden, there has been a substantial increase in the number of people on long-term sick leave. This phenomenon has awakened the interest of researchers for understanding its causes. So far, no simple and unambiguous reason explaining this phenomenon has been found. However, previous studies indicate that it may be caused by a combination of different aspects such as the state of the national economy, an ageing labour force in Sweden, and inefficiencies in the information exchange and cooperation among the participants in the sick leave process. This thesis deals with the information exchange between two of these participants, namely physicians from district health care centres and insurance officers from the Social Insurance Office.The information exchange between these two parties constitutes a critical aspect in the sick leave process and has been reported in the scientific literature as having problems. Nevertheless, most of earlier studies dealing with the interaction between physicians and officers have been purely descriptive, of quantitative nature and lack a common theoretical basis for analysing it.In this thesis, a philosophical theoretical framework, namely Activity Theory (AT), is applied to gain understanding into the interconnection between physicians and insurance officers and the problems of their information exchange. Based on concepts from AT, the elements that form the structure of these players' work actions are identified and used to provide a picture of the interconnection between these parties and to uncover some reasons for the failure in their information exchange. Additionally, an activity theoretical perspective about how to see the participation of these players in the sick leave process is provided.The analysis in this thesis shows that physicians and insurance officers form a fragmented division of labour of a common collective activity: the sick leave process. In this process physicians provide the officers with a tool of their work: information for decision-making. Physicians provide this information through the sickness certificate, which sometimes does not carry the information necessary for the officers to do their work. This failure is partly a result of the complexity of the physicians' task to issue sickness certificates. This complexity lies in the characteristics of the elements forming the structure of the physicians' actions of issuing these documents and in contradictions that exist among these elements.Additional aspects that affect the information exchange between physicians and officers are that (1) these parties have different perceptions about how to approach their object of work in their joint activity, (2) the lack of resources in district health care centres and local social insurance offices, and (3) the lack of shared artifacts for making the communicative actions between physicians and officers more efficient.