Showing papers by "Toomas Timpka published in 1997"

Dilemmas in the daily work of social insurance officers

Abstract: Social insurance officers, through their work with rehabilitation, have become an important part of the welfare state. The aim of this study was to explore the nature of the dilemmas they experience in their daily work using the critical incident technique. Dilemmas reported concerned 1) cooperation with other agents in the rehabilitation process, 2) internal social insurance routines and 3) direct client management. Consequences of dilemmas were delayed handling, extra work, emotional strain and ethical conflicts. The dilemmas were handled through continued rehabilitation, coordination measures and decision-making. The findings showed the division of medical investigation and benefit decision in two authorities, the lack of education in behavioral sciences among the officers and divergent goals in different authorities. Further studies are needed on the rehabilitation process as well as the daily practice of social insurance officers.

Long-term economic effects of team-based clinical case management of patients with chronic minor disease and long-term absence from working life.

Abstract: Objectives: To examine the socio-economic effects of team-based clinical case management of patients with chronic minor disease bound for early retirement.Design: Marginal analysis of programme cos ...

Study of situation-dependent clinical cognition: a meta-analysis and preliminary method.

Abstract: An integrated method was constructed for the study of in situ clinical reasoning A meta-analysis of existing theories and an exploratory case study were performed Twelve physicians at the department of otorhinolaryngology, and three physicians and three biomedical technologists at the clinical microbiological laboratory of an 800-bed university hospital were involved in the evaluation of the method The meta-analysis identified situations where practitioners face assignments for which they follow no routine strategy as suitable starting points for the development of the method, in which organizational processes are presented as workflow graphs Using the critical incident technique, problem situations in the processes are identified, and stimulated recall interviews are employed to construct a model of the situation-dependent logic used in decision-making The case study showed that the first levels of the method could easily be used by physicians without training in organizational development or cognitive psychology It is concluded that the method can be a means for case construction in problem-oriented learning programs that have an empirical background It can also be used in the development of clinical organization, where training is combined with the establishment of critical paths and computer support

Dilemmas in the daily work of social

Abstract: *Social insurance officers, through their work with rehabilitation, have become an important part of the welfare state. The aim of this study was to explore the nature of the dilemmas they experience in their daily work using the critical incident technique. Dilemmas reported concerned 1) cooperation with other agents in the rehabilitation process, 2) internal social insurance routines and 3) direct client management. Consequences of dilemmas were delayed handling, extra work, emotional strain and ethical conflicts. The dilemmas were handled through continued rehabilitation, coordination measures and decision-making. The findings showed the division of medical investigation and benefit decision in two authorities, the lack of education in behavioral sciences among the officers and divergent goals in different authorities. Further studies are needed on the rehabilitation process as well as the daily practice of social insurance officers. The social insurance system has become an increasingly important part of the Swedish welfare state. Gross payments from the social insurance amounted to approximately 35% of total private consumption in 1994 and social insurance expenditures were estimated at 20% of the gross domestic product. In 1994, the largest part, 45%, was expenditure for retirement pension, while 36% was due to compensation for sickness and handicap (National Social Insurance Board 1995). Both the economic problems of the Swedish state and the risk of the long-term sick-listed being marginalized have been used as arguments for restructuring social insurance legislation and administration. Over the past decade, “rehabilitation” has been put on its agenda as an instrument for lowering the insurance costs and for the individual to remain in the labor market. The traditional role of the social insurance officers has been that of the objective and impersonal civil servant, doing their job by putting regulations into practice, and has been characterized by “the spirit of formalistic impersonality” (Weber, 1947). However, recent changes in social policy have led to a new role with an increased number of face-to-face encounters with citizens, more active participation in the rehabilitation process and more money to spend on rehabilitation. The new role also includes duties such as coordinating the measures taken by different agents involved in the rehabilitation process. Governmental policy and legislation are mainly experienced by the citizens through the public service worker. These street-level bureaucrats have been de