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

Abstract: In Sweden, therehas been a substantial increase in the number of people onlong-term sick leave. Thisphenomenon has awakened the interest of researchers forunderstanding its causes. So far, no simpleand unambiguous reason explaining this phenomenon has been found.However, previous studiesindicate that it may be caused by a combination of differentaspects such as the state of the nationaleconomy, an ageing labour force in Sweden, and inefficiencies inthe information exchange andcooperation among the participants in the sick leave process. Thisthesis deals with the informationexchange between two of these participants, namely physicians fromdistrict health care centres andinsurance officers from the Social Insurance Office.The information exchange between these two parties constitutes acritical aspect in the sick leaveprocess and has been reported in the scientific literature ashaving problems. Nevertheless, most ofearlier studies dealing with the interaction between physicians andofficers have been purelydescriptive, of quantitative nature and lack a common theoreticalbasis for analysing it.In this thesis, a philosophical theoretical framework, namelyActivity Theory (AT), is applied to gainunderstanding into the interconnection between physicians andinsurance officers and the problems oftheir information exchange. Based on concepts from AT, the elementsthat form the structure of theseplayers- work actions are identified and used to provide apicture of the interconnection between theseparties and to uncover some reasons for the failure in theirinformation exchange. Additionally, anactivity theoretical perspective about how to see the participationof these players in the sick leaveprocess is provided.The analysis in this thesis shows that physicians and insuranceofficers form a fragmented division oflabour of a common collective activity: the sick leave process. Inthis process physicians provide theofficers with a tool of their work: information fordecision-making. Physicians provide thisinformation through the sickness certificate, which sometimes doesnot carry the informationnecessary for the officers to do their work. This failure is partlya result of the complexity of theDepartment of Computer and Information ScienceLinköpings universitetSE-581 83 Linköping, SwedenISBN 91-85299-52-9 ISSN 0280-7971physicians- task to issue sickness certificates. Thiscomplexity lies in the characteristics of theelements forming the structure of the physicians- actions ofissuing these documents and incontradictions that exist among these elements.Additional aspects that affect the information exchange betweenphysicians and officers are that (1)these parties have different perceptions about how to approachtheir object of work in their jointactivity, (2) the lack of resources in district health care centresand local social insurance offices, and(3) the lack of shared artifacts for making the communicativeactions between physicians and officersmore efficient.