Background

In Sweden, large variations were identified in sick-leave duration also in episodes with the same diagnoses. A decision support was developed to ensure more uniform assessment of sick leave. The present qualitative study aimed at examining the process of construction and development of the new decision support.

Methods

Qualitative analyses of data from interviews and documents were performed. Participants (n = 15) in in-depth interviews were medical and insurance experts from the Social Insurance Agency involved in the development of the decision-support. Interviews with the medical experts focused on how well their specific medical field of expertise fitted the format suggested for the decision support and how a ‘‘standard patient’’ looked like in their clinical everyday work. For both groups of interviewees, issues regarding assessment of work capacity were discussed. The documentary analysis was done reading investigations, memos, reports and minutes. Themes identified in the interviews were compared with the overall documentary analysis and constituted the basis for an epistemic analysis.

Results

The analyses showed that the decision-support was developed under a tight schedule and with strict templates for its format. The decision support was built around diagnostic categories and a majority of the experts that were used were specialized in medicine. A difficulty in the process was according to participants to produce standardised medical assessments of how a particular illness was expected to affect patients’ work capacity rather than how the illness affected the patient. The evidential basis for such assessments was scant. Findings show that conditions that were not somatic or could not be ‘measured objectively’ proved extra problematic, since much of the assessment in these situations hinges on physicians’ experience-based expertise combined with their understanding of the circumstances of individual patients.

Conclusion

The analysis indicates that ‘work capacity’ does not fall squarely within the remit of medical expertise, but is an example of ‘post-normal science’ that requires a broad range of experts from different fields both inside and outside of science coming together to pool their knowledge and build new expertise.