Health care management of sickness certification tasks: results from two surveys to physicians

Abstract

BackgroundHealth care in general and physicians in particular, play an important role in patients’ sickness certification processes. However, a lack of management within health care regarding how sickness certification is carried out has been identified in Sweden. A variety of interventions to increase the quality of sickness certification were introduced by the government and County Councils. Some of these measures were specifically aimed at strengthening health care management of sickness certification; e.g. policy making and management support. The aim was to describe to what extent physicians in different medical specialties had access to a joint policy regarding sickness certification in their clinical settings and experienced management support in carrying out sickness certification.MethodA descriptive study, based on data from two cross-sectional questionnaires sent to all physicians in the Stockholm County regarding their sickness certification practice. Criteria for inclusion in this study were working in a clinical setting, being a board-certified specialist, <65 years of age, and having sickness certification consultations at least a few times a year. These criteria were met by 2497 physicians in 2004 and 2204 physicians in 2008. Proportions were calculated regarding access to policy and management support, stratified according to medical specialty.ResultsThe proportions of physicians working in clinical settings with a well-established policy regarding sickness certification were generally low both in 2004 and 2008, but varied greatly between different types of medical specialties (from 6.1% to 46.9%). Also, reports of access to substantial management support regarding sickness certification varied greatly between medical specialties (from 10.5% to 48.8%). More than one third of the physicians reported having no such management support.ConclusionsMost physicians did not work in a clinical setting with a well-established policy on sickness certification tasks, nor did they experience substantial support from their manager. The results indicate a need of strengthening health care management of sickness certification tasks in order to better support physicians in these tasks.

Obstetricians/Gynecologists’ Problems in Sickness Certification Consultations: Two Nationwide Surveys

“…However, in 2012, a larger proportion of O/Gs experienced lack of time every week to manage patient-related aspects, such as documentation and contacts with other stakeholders, compared to 2008. This is a perturbing development that needs to be addressed at organizational levels in healthcare [27]. …”

“…In between these surveys, several educational interventions were initiated (e.g., courses and accessibility to expertise in insurance medicine) [10, 27]. Only a few studies have evaluated the effects of such interventions and have suggested that well-established workplace policies and education improve physicians' competence and self-efficacy for sickness certification tasks in Sweden, as well as in other countries [11, 12].…”

“…In 2012, almost half of the O/Gs reported a need to develop their competence in insurance medicine, for example, regarding the employers', the SIA's, and Employment Office's responsibilities in sickness certification cases. In Sweden, it has also been underscored that these issues need to be addressed at healthcare management levels, by, for example, supportive leadership, workplace policies, and supervision [27, 29]. …”

Problems experienced by gynecologists/obstetricians in sickness certification consultations

“…However, fewer than one‐fifth reported that they had a well‐established workplace policy for handling sickness certification issues. Such a workplace policy could provide organizational support, especially for younger physicians . There were substantial age differences in the experienced severity of problematic situations.…”

Registered nurses’ work with sick leave questions by telephone in primary health care

“…Support from one's immediate manager seems to be experienced as higher by RNs than physicians (Lindholm et al . ).…”