Table 4

Key improvement initiatives implemented during the sick leave process and system improvement programme, categorized by changes in “ways of working” and/or performance outcomes

Improvement initiativeMain outcomeImprovementMain explaining factors in connection to management model in the public sector
1. Planning and carrying out a large-scale conference with central stakeholders (220 practitioners)Mapped areas for improvement; functioned as an “eye-opener” for certain attendees; generated heightened expectationsNone identified(A) Absence of focus on executing improvements
2. Attempt to form a management-level group targeting insurance medicine and the sick leave systemInitial dialogue followed by growing frustration among programme leadersNone identified(B) Unclear goals and purpose; (C) Insufficient interest and backing from senior management; (D) No straightforward way to measure effects
3. Production of videos to encourage collaboration between the Social Insurance Agency and the Region (government-funded)Spread of ideas and knowledge concerning cross-organizational cooperationNone identified(E) No sustained or coherent plan for using the training material
4. Embedding the sick leave process into the new digital care system via meetings, process mapping and workshopsStrengthened understanding of information flows and database handling; creation of templates for the digital systemNone identified(F) Overshadowed by the introduction of a new care information system
5. Process leader training in quality improvement (2019–2021, first round) through workshops, lectures, examinations and projectsExpanded knowledge and individual capacity for ongoing QI workA few successful projects(G) Varying conditions across individuals and home organizations; (B) Unclear goals and purpose; (H) Insufficient support and interest from adjacent management
6. Process leader training in quality improvement (2021–2022, second round) through workshops, lectures, examinations and projectsExpanded knowledge and individual capacity for ongoing QI workA few successful projects(B) (G) (H)
7. Establishment of a working group on data management and visualizationResulted in a scientific publication and identified needs that shaped Initiative 9; promoted cross-organizational collaborationNone identified(I) No mandate to act; (C) Insufficient senior management interest and support
8. Discussions and meetings around establishing a Centre for Insurance Medicine oriented towards system-level improvementsNone identifiedNone identified(J) No clear accountability for the sick leave system; (K) Low motivation
9. Development of an educational package on applying control charts for improvement purposesBroadened knowledge of improvement toolsNone identified(L) The work is perceived as too removed from direct patient care
10. Improvement update conference to disseminate examples from the sick leave systemHeightened attention and focus on the sick leave systemNone identified(L) The improvement work is perceived as too removed from direct patient care; (A) Absence of focus on executing improvements

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