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.
Highlights
Health care in general and physicians in particular, play an important role in patients’ sickness certification processes
The 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
Most 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
Summary
Health care in general and physicians in particular, play an important role in patients’ sickness certification processes. In Sweden, the National Board of Health and Welfare, which is the supervisory government agency, has stated that sickness certification is an aspect of health care and medical treatment and, as such, is to be managed according to the same laws and regulations as other types of medical treatment. This includes managerial responsibility to regularly and systematically develop and assure the quality of the health services provided and to organize health services so that safe and good care for patients can be delivered [22,23]. There were no strategies for quality assurance of how the tasks were performed, for developing competence in performing these tasks, for how to cooperate with others within and outside healthcare, or for generating knowledge within the area [10,23]
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