Policy and practice of work ability: a negotiation of responsibility in organizing return to work.
OBJECTIVE
In welfare policy and practical work it is unclear what the concept of work ability involves and assessments may be different among involved actors, partly due to a lack of theoretical research in relation to regulations and practice. Based on theoretical and legal aspects of work ability the aim of the study is to analyze stakeholders' perspectives on work ability in local practice by studying multi-stakeholder meetings.


METHODS
The material comprises nine digitally recorded multi-stakeholder meetings. Apart from the sick-listed individual, representatives from the public Social Insurance Agency, health care, employers, public employment service and the union participated in the meeting. The material was analyzed using qualitative content analysis.


RESULTS
Three perspectives on work ability were identified: a medical perspective, a workplace perspective and a regulatory perspective. The meetings developed into negotiations of responsibility concerning workplace adjustments, rehabilitation efforts and financial support. Medical assessments served as objective expert statements to legitimize stakeholders' perspectives on work ability and return to work.


CONCLUSIONS
Although the formal goal of the status meeting was to facilitate stakeholder collaboration, the results demonstrates an unequal distribution of power among cooperating actors where the employers had the "trump card" due to their possibilities to offer workplace adjustments. The employer perspective often determined whether or not persons could return to work and if they had work ability.
Department of Medical and Health Sciences, National Centre for Work and Rehabilitation, Linköping University, 581 83, Linköping, Sweden. ida.seing@liu.se
Ida
I
Seing
Christian
C
Ståhl
Lennart
L
Nordenfelt
Pia
P
Bülow
Kerstin
K
Ekberg
D006233:Persons with Disabilities / Q000534:rehabilitation*; D004651:Employment; D006801:Humans; D009786:Occupational Health Services / Q000458:organization & administration*; D016134:Organizational Policy; D036301:Qualitative Research; D012050:Rehabilitation, Vocational; D062707:Return to Work; D013548:Sweden; D014938:Work Capacity Evaluation; D017132:Workplace