Mellan morot och piska : en fallstudie av 1992 års rehabiliteringsreform

Sammanfattning: This thesis is a case study of the Swedish Rehabilitation Reform of 1992. Vocational rehabilitation is described as an organizational activity which takes place in the interaction between social policy regulations and organizational execution. The analytical point of departure is made up of two complementary theoretical perspectives (Chapter 3): New institutional theory and the concept of 'negotiated order'. New institutional theory can aid inter-organizational analysis as it assumes that organizations are not only influenced, but also permeated by institutional and technical frameworks. The 'negotiated order' perspective can provide an understanding of actors' motives when they work together. This perspective also acknowledges that actors are able to exercise 'episodic power', and that this differs from 'formal power'. The first empirical study (Chapter 4) analyses the political motives behind the Rehabilitation Reform of 1992. It shows that at the time of the Rehabilitation Reform economical and political interests were pushing for a tighter regulations in Swedish social policy. The following three empirical studies focus on the 'organizational field' in which rehabilitation is practised. This field consists of the social insurance office, employment agencies, primary health care centres and occupational health service centres. Chapter 5 deals with the regulations and environmental factors influencing the various organizations and their representatives. It points to five external forces that influence the performance of the four type of actors. The social insurance office is influenced by a judicial social insurance logic, the employment agencies by a holistic labour market policy logic, and the physicians in primary health care centres and in occupational health centres by a 'holistic' medical frame of reference, which contrasts with that often found in other medical sub-specialities. Finally, employers are influenced first, by a logic of profit which has a technical and institutional dimension and second, by an institutional welfare state logic.Chapter six shows that the largest 'domain conflict' in the initial phase of the rehabilitation trajectory has to do with defining 'capacity to work'. Domain conflicts are seen as resulting from different institutional logics, implying different views on illness and capacity to work. Numerous and frequent personal interaction make it possible for physicians and rehabilitation officials to avoid conflict. The operative phase is associated with two major domain conflicts. The first is related to negotiations between the social insurance office and the employers about transferring employees to other duties. Both sides avoid exercising power that may damage clients and future trust. Episodic power resources are used to exercise the strategy of 'the golden middle path'. The other domain conflict is related to the judgement of work capacity. The labour market officials' view of work capacity differs from that of the officials at the social insurance office.Chapter seven compares cooperative rehabilitation projects with regular rehabilitation activity. The results show that actors in cooperative projects break the sequential work order used in regular rehabilitation activity and thereby projects quickly collect comprehensive information about individuals. Cooperative projects can also achieve flexible solutions tailored to an individual clients needs. Further, cooperative projects allow time for unconventional initiatives, which regular activity do not. The process of 'returning to work' poses a challenge both kinds of work organizations. Individuals who are disabled in some way are required to meet the same labour market demands as healthy and well educated are expected to meet. Finally, regular rehabilitation work tends uses standardize clients while cooperative projects tend to treat them as individuals.