A systems perspective on gaps in the person-centered sick leave and rehabilitation process: a Swedish interview study

Consensus on priorities to optimize the sick leave and rehabilitation process (SRP) is lacking. To explore perspectives of stakeholders in the SRP on bridging the gap between desired process scope, and actual practice, from a multi-professional, multi-organizational, and interdisciplinary approach. Focus group interviews were conducted with various SRP frontline professionals in Region Västra Götaland, Sweden, using purposive sampling to capture a range of experiences. Participants discussed their perceptions of critical changes and priorities needed to meet patients’ SRP needs in a primary care context. All interviews were analyzed using systematic text condensation, as described by Malterud. General practitioners (<i>n</i> = 6), rehabilitation coordinators and licensed healthcare professionals from primary healthcare (<i>n</i> = 13), administrators from the Social Insurance Agency, the Employment Agency and Social Services (<i>n</i> = 12). Through data analysis, the following themes emerged: 1) The need for rules and regulations to enable coherent process governance 2) Challenges and opportunities in person-centered SRP: Professional collaboration, organizational priorities, and the need for enhanced leadership, and 3) Balancing resources and patient needs in the SRP: How to improve care quality and accessibility. In summary, participants mainly discussed how to improve process efficiency and quality of care while balancing available resources and a heavy workload. A main goal was to prevent negative spirals of suboptimal decision-making in individual cases, which could lead to increased work, unfortunate outcomes, and patient suffering. This qualitative study indicated that gaps between a desired process scope and actual practice might be bridged by enabling coherent cross-organizational process governance, prioritizing person-centered ways of working, and balancing available resources and workload. The above changes were believed to improve process quality and overall efficiency. The study project plan was pre-registered on September 21st, 2020, in the database FOU i VGR (researchweb.org), project number 274941.

目前，针对优化病假与康复流程（Sick Leave and Rehabilitation Process, SRP）的优先级共识仍存在缺失。为从多专业、多组织、跨学科的视角，探究SRP利益相关方对弥合理想流程范围与实际实践之间差距的看法，研究团队在瑞典西约塔兰地区针对各类SRP一线从业人员开展焦点小组访谈，采用目的性抽样以获取多元实践经验。参与者围绕基层医疗场景下满足患者SRP需求所需的关键变革与优先级展开讨论。所有访谈均采用Malterud所述的系统文本凝练法进行分析。参与人员包括全科医生（n=6）、基层医疗体系内的康复协调员与执业医护人员（n=13），以及瑞典社会保险局、就业局与社会服务部门的行政人员（n=12）。经数据分析，共提炼出三大主题：1. 亟需建立规范与制度以实现统一的流程治理；2. 以患者为中心的SRP所面临的挑战与机遇：专业协作、组织优先级设定以及强化领导力的必要性；3. 平衡SRP中的资源与患者需求：如何提升照护质量与可及性。综上，参与者主要探讨了如何在平衡现有资源与繁重工作负担的同时，提升流程效率与照护质量。其核心目标之一是避免个案中出现次优决策的恶性循环——此类循环可能加剧工作负荷、引发不良结局并导致患者遭受痛苦。本质性研究表明，通过建立统一的跨组织流程治理机制、优先推行以患者为中心的工作模式，以及平衡可用资源与工作负担，或可弥合理想流程范围与实际实践之间的差距。上述变革被认为可有效提升流程质量与整体运营效率。本研究项目于2020年9月21日在FOU i VGR数据库（researchweb.org）完成预注册，项目编号为274941。