Danish and Norwegian hospital social workers’ cross-institutional work amidst inter-sectoral restructuring of health and social welfare

ABSTRACT

Starting in the 2000s, Denmark and Norway have undergone extensive restructuring of their health-related social benefit programmes, including how they are governed. Several reforms have sought to enhance inter-sectoral collaboration. Aiming at ensuring patients’ faster return to work, policy-makers have instituted economic incentives to both individuals and the health and welfare organisations who handle them. Through an institutional logics approach, this paper explores how hospital social workers in these countries are experiencing these changes. The ‘social’ part of post-treatment care and rehabilitation receives more attention in the Norwegian institutional set-up than in the Danish, and whilst challenges are experienced in both countries, in group interviews Danish social workers in particular express concerns about the implications of the accelerated return-to-work focus. In both countries, they report increasing difficulties in ‘making their way through’ the state-municipal bureaucracy. However, by drawing on the formal health knowledge derived from medical settings and the symbolic capital it bestows on them, they often manage to negotiate the work-and-welfare services, thereby transforming the social context for the patients.

SAMMENDRAG

Danmark og Norge har de seneste 15 år gennemgået store ændringer på sundheds- og socialområdet, både når det gælder tjenester og ydelser og styringen af området. Gennem reformer har man forsøgt at styrke koblingerne mellom sundheds- og velfærdsinstitutionerne. For at sikre en hurtigere tilbagevenden til arbejde for patienterne har man satset på økonomiske incitamenter for individer og de sundheds- og velfærdsorganisationer som håndterer dem. Denne artikel undersøger ud fra et institutionel logik-perspektiv, hvordan danske og norske hospitalssocialrådgivere i deres daglige sagsarbejde oplever disse ændringer., i deres arbejde med at ændre deres patienters sociale kontekst. Det ‘sosiale’ element i rehabilitering og behandling er bedre varetaget i det norske institutionelle set-up sammenlignet med det danske, og selvom der er udfordringer i begge lande, viser gruppeinterview da også at det er blandt de danske hospitalssocialrådgivere, at man oplever de største vanskeligheder med at tilpasse sig det øgede fokus på hurtigt at returnere patienterne til arbejdslivet. De interviewede rapporterer om stadig stigende vanskeligheder med at trænge igennem i det statslige og kommunale bureaukrati. Dog viser det sig at de i interaktionen med de sociale myndigheder og andre aktører, i ganske høj grad kan trække på den formaliserede kundskab om sundhed, om den relaterede symbolske kapital, som de har adgang til qua deres udsigelsesposition i hospitalssystemet.

KEYWORDS:

• Denmark
• hospital social workers
• institutional logics
• institutional work
• Norway
• rehabilitation
• return-to-work policies

NØGLEORD:

• Danmark
• førtidspension
• hospitalssocialrådgivere
• institutionel logik
• institutionelt arbejde
• Norge
• rehabilitering
• reintegrering i arbejdslivet

Acknowledgements

The authors wish to thank participants in the COST Action IS1102, Social services, welfare state and places workshop, Bratislava, November 3–7, 2014, participants in the PHLEGETHON research network, as well as two anonymous referees, for their comments on previous drafts of this paper. Professor Kristian Larsen participated in conducting two of the interviews.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes on contributors

Ivan Harsløf is Associate Professor at the Department of Social Work, Child Welfare and Social Policy, Oslo and Akershus University College of Applied Sciences (HiOA), Norway. Research interests include comparative welfare state research and European social policy, the organisation of social services and social inequalities in health.

Ulla Søbjerg Nielsen is Senior Lecturer at the Department of Social Work, Metropolitan University College, Denmark. She has done research into labour unions and the work life and attitudes of unskilled workers employed in the public sector, and on social and occupational rehabilitation.

Marte Feiring is Associate Professor at HiOA, where she is head of the Master programme in rehabilitation and habilitation. Feiring has lectured and researched on welfare services, professions and rehabilitation practices.