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I get back with a little help from my boss. What constitutes successful and valued leadership, as well as failed leadership, during the return-to-work process following mild traumatic brain injury for highly autonomous employees?
Get PDFThis doctoral thesis explores the importance of leadership for employees in jobs with high autonomy, who return to work (RTW) after mild traumatic brain injury (mTBI). Despite that there is extensive research on TBI and RTW, this area has not been researched from a leadership perspective. The leadership perspective is also rarely applied within the more general research on RTW, work inclusion, social work and social policy. Simultaneously, leadership literature does not focus on either TBI or RTW processes. The thesis thus aims to contribute new and practical insight to several research fields and at the same time strengthen the knowledge base for decision-makers, social workers and leaders, all of whom are groups that at different levels are involved in managing sickness absence. By delving into the complexity of leadership in mTBI and RTW processes, this study contributes valuable new knowledge. The thesis is based on qualitative in-depth interviews with ten employees who were in a RTW process after being exposed to an injury that resulted in mTBI, and interviews with their immediate leaders. In the interviews with the employees, the spotlight was put on how they experienced that their leaders handled RTW processes and how they assessed the leaders' efforts and actions. The interviews with the leaders were about the same process, seen from the leaders' perspective. During the interviews with both groups, a s practices that arise in RTW processes after mTBI. These interviews revealed that the employees divided into two different camps: 1) Employees who were satisfied with the leaders and who attributed much of the successful RTW to the leaders' role in the process, and 2) employees who were very dissatisfied with the leaders. The interviews with the leaders revealed that the leaders in the negative cases did not always share the same experience as the employees. In this study, seven cornerstones are identified which constitute successful and valued leadership in RTW processes after mTBI. These cornerstones include i) empathy and trust, ii) facilitation, flexibility and action orientation, iii) that the leaders take the lead to ensure a successful RTW process, iv) prioritizing the balance between work and private life, v) establishing personal relationships between the leader and employee, vi) innovative problem solving and vii) establishment of job security. The study of the successful cases shows that leaders play a protective role and frequently slows down the employees to protect them from setting too high goals in the RTW process. The attention these leaders pay to restitution and holding back challenges conventional leadership theories that focus on performance and productivity. Nevertheless there is resonance between these findings and the theory of transformational leadership. Transformational leadership is thereby considered as potential leadership input to successful RTW after mTBI. However, the study recognizes that even successful and valued leadership cannot handle all challenges and documents that in cases where employees experience extensive and persistent symptoms, good leadership also falls short. In the cases where leadership fails, it is illustrated how leaders can hinder the RTW process. It is also shown how leaders, even when acting with the best of intentions, can put their employees in situations where they feel frustrated, sad and abandoned. The study thereby illustrates how failed leadership in RTW processes can destroy the relationship between employees and leaders. The unsuccessful cases are characterized by a breakdown in communication and ineffective support, and these are findings that are echoed in the literature on laissez-faire leadership, unconscious leadership and tyrannical leadership. By emphasizing the central role leaders play in the RTW process, this study advocates that vocational specialists/job specialists should expand their competence base by combining more knowledge about organization and leadership. By increasing their competence in organization and leadership, job specialists will not only be able to actively assist with RTW after mTBI, but also act as valuable resources and advisors for leaders in the same processes. If job specialists acquire skills so that they can actively assist both parties in the future, they can play crucial roles for successful RTW processes. Furthermore, this study highlights the need for a nuanced approach in social policy, among other things by pointing out that the perspective that speaks for "the curative power of work" cannot be used as a premise for mTBI. In the case of mTBI, it is crucial to apply tailoring in the RTW processes to ensure that the unique needs of each individual are met. Furthermore, a proposal is presented on 'preventive sickness absence' after mTBI, which involves a reassessment of current sickness absence guidelines, with the aim of reducing the risk of potential setbacks in the recovery and RTW processes. This again emphasizes the necessity that job specialists can also function as support for leaders in the future. In conclusion, it is advocated that future studies must hold onto the leadership perspective and that further knowledge bridges should be built between research on RTW, work inclusion and leadership.
Denne doktorgradsavhandlingen utforsker hvilken betydning ledelse har for retur-til-arbeidprosesser (RTW) for arbeidstakere i jobber med høy autonomi, som vender tilbake til jobb etter mild traumatisk hjerneskade (mTBI). Til tross for at det foreligger omfattende forskning på TBI og RTW, har dette området hittil ikke blitt forsket på i et ledelsesperspektiv. Ledelsesperspektivet er også svært sjeldent anlagt innenfor den mer generelle forskningen på RTW, arbeidsinkludering, sosialt arbeid og sosialpolitikk. Til samme tid fokuserer ikke den generelle ledelseslitteraturen på hverken TBI eller RTW-prosesser. Avhandlingen tar dermed sikte på å bidra med ny og praktisk innsikt til flere forskningsfelt og samtidig styrke kunnskapsgrunnlaget for beslutningstakere, sosialarbeidere og ledere, som alle er grupper som på forskjellige nivå er involvert i å håndtere sykefravær. Ved å fordype seg i kompleksiteten ved ledelse i mTBI- og RTW-prosesser, bidrar denne studien med verdifull ny kunnskap. Avhandlingen er basert på kvalitative dybdeintervjuer med ti personer som var i en RTWprosess etter å ha blitt utsatt for skade som medførte mTBI, og intervjuer med deres nærmeste ledere. I intervjuene med de ansatte ble det rettet søkelys på hvordan de erfarte at lederne håndterte RTW-prosessen og hvordan de vurderte ledernes innsats og handlinger. Intervjuene med lederne handlet om samme prosess, sett fra ledernes perspektiv. Under intervjuene med både de ansatte og lederne ble det rettet et særskilt søkelys på lederens handlinger, med hensikt å gripe ulike former for ledelsespraksiser som oppstår i RTW-prosesser etter mTBI. Disse intervjuene avdekket at de ansatte delte seg i to forskjellig leire: 1) Ansatte som var fornøyde med lederne og som tilskrev mye av årsaken til vellykket RTW til ledernes rolle i prosessen, og 2) ansatte som var svært misfornøyde med lederne. Intervjuene med lederne avdekket at lederne i de negative casene ikke i alle tilfeller delte samme opplevelse som de ansatte. I avhandlingen identifiseres det syv hjørnesteiner (omtalt på engelsk som «cornerstones»), som konstituerer vellykket og verdsatt lederskap i RTW-prosesser etter mTBI. Disse hjørnesteinene omfatter i) empati og tillit, ii) tilrettelegging, fleksibilitet og handlingsorientering, iii) at lederne tar føringen for å sikre en vellykket RTW-prosess, iv) prioritere balansen mellom arbeid og privatliv, v) etablering av personlige relasjoner mellom leder og ansatt, vi) innovativ problemløsning og vii) etablering av jobbsikkerhet. Studien av de vellykkede casene viser at ledelse spiller en avgjørende rolle for RTWprosessen og understreker blant annet behovet for at ledere viser evne til å bremse de ansatte og beskytte dem fra å sette seg for høye mål i tilbakevendingsprosessen. Oppmerksomheten lederne retter mot restitusjon og å holde tilbake på kreftene utfordrer dermed konvensjonelle ledelsesteorier som fokuserer på ytelse og produktivitet. Til tross for dette finner studien gjenklang mellom funnene fra de vellykkede casene og teorien om transformasjonsledelse. Transformasjonsledelse betraktes dermed som en potensiell ledelsesinngang til vellykket RTW etter mTBI. Studien erkjenner imidlertid at selv suksessfull og verdsatt ledelse ikke kan håndtere alle utfordringer og dokumenterer at i tilfeller der ansatte opplever omfattende og vedvarende symptomer, så kommer også god ledelse til kort. I casene der lederne mislykkes blir det illustrert hvordan ledere kan hindre RTW-prosessen. Det blir også vist hvordan ledere, selv når de handler med de beste hensikter, kan sette sine ansatte i situasjoner der de føler seg frustrerte, triste og forlatt. Studien viser dermed også hvordan feilslått ledelse i RTW-prosesser kan ødelegge forholdet mellom ansatte og ledere. I de mislykkede casene går det igjen at de er preget av kommunikasjonssammenbrudd og ineffektiv støtte. Dette er funn som finner gjenklang i litteraturen om laissez-faire-ledelse, bevisstløs ledelse og tyranniske ledelse. Ved å vektlegge den sentrale rollen ledere spiller i RTW-prosessen tar denne studien til orde for at yrkesspesialister/jobbspesialister bør utvide sin kompetansebase ved å inkludere mer kunnskap om organisasjon og ledelse. Ved å øke sin kompetanse innenfor organisasjon og ledelse, vil jobbspesialister ikke bare bli i stand til å aktivt hjelpe personer som skal vende tilbake til jobb etter mTBI, men også fungere som verdifulle ressurser og veiledere for ledere i de samme prosessene. Hvis jobbspesialister tilegner seg kompetanse slik at de aktivt kan bistå begge parter i fremtiden, kan de spille avgjørende roller for vellykkede RTW-prosesser. Videre fremhever denne studien behovet for en nyansert tilnærming i arbeids- og sosialpolitikken, blant annet ved å påpeke at perspektivet som taler for «arbeidets kurative kraft» ikke kan anlegges som premiss ved mTBI. Ved mTBI er det avgjørende å anvende skreddersøm i RTW-prosessene slik at de unike behovene til hver enkelt blir ivaretatt. Videre presenteres et forslag om ‘forebyggende sykefravær’ etter mTBI, som innebærer en revurdering av gjeldende sykefraværsretningslinjer, med sikte på å redusere faren for potensielle tilbakeslag i tilfrisknings- og RTW-prosessene. Dette understreker igjen nødvendigheten av at jobbspesialister i fremtiden også kan fungere som støtte for ledere. Avslutningsvis tas det til orde for at fremtidige studier må holde tak i ledelsesperspektivet og at det bør bygges ytterligere kunnskapsbroer mellom forskning på RTW, arbeidsinkludering og ledelse.publishedVersio
How care holds humanity: the myth of Cura and theories of care
Get PDFModern medicine has often struggled to grasp the cultural aspects of interpersonal care. The medical humanities, on the other hand, have struggled to grasp the embodied, intimate character of care. In a recent appeal to the medical humanities, Julia Kristeva et al argue that care can be a point of crossing between these two ’ontological domains’. They evoke the myth of Cura, referring to previous utilisations by such diverse thinkers as Heidegger and Kleinman, as well as Kristeva’s previous work. This study adds to these bodies of work by using the original text from Hyginus in much greater detail. Textual analysis, theoretical discussions and autotheoretical work unpack care as (1) a fundamental aspect of the human condition, (2) a holding-together of different domains of knowledge, (3) a withholding from these domains and (4) the site of intimate knowledge that both ’ontological domains’ struggle to grasp.publishedVersio
How care holds humanity: the myth of Cura and theories of care
No full textModern medicine has often struggled to grasp the cultural aspects of interpersonal care. The medical humanities, on the other hand, have struggled to grasp the embodied, intimate character of care. In a recent appeal to the medical humanities, Julia Kristeva et al argue that care can be a point of crossing between these two ’ontological domains’. They evoke the myth of Cura, referring to previous utilisations by such diverse thinkers as Heidegger and Kleinman, as well as Kristeva’s previous work. This study adds to these bodies of work by using the original text from Hyginus in much greater detail. Textual analysis, theoretical discussions and autotheoretical work unpack care as (1) a fundamental aspect of the human condition, (2) a holding-together of different domains of knowledge, (3) a withholding from these domains and (4) the site of intimate knowledge that both ’ontological domains’ struggle to grasp
The urge to work: Normative ordering in the narratives of people on long-term sick leave
No full textThis study analyses the narratives of people on long-term sick leave due to low back pain. We draw upon the theory of justification – as developed by the French sociologists Luc Boltanski and Laurent Thévenot – to investigate how the informants’ narratives evoke and rely upon three ‘orders of worth’. These are the industrial order concerning being a productive citizen, the domestic order of home and family, and the civic order positioning the citizen in the regulations of the welfare state. In-depth interview interpretations map a strongly normative urge to work. The interviews also demonstrate how this urge in interwoven with social interactions in specific arenas: a troubled home life when not working, ways of keeping in touch with work, and complex negotiations of the possibility of non-work. The different orders of worth do more than point towards their ‘own’ arena: Norms and values of the domestic order, in particular, point toward the need for return to work rather than towards life at home (non-work). We conclude that the narratives deal more with the trouble of sick leave than with the enjoyment of work. Hence, the urge to work is just as much a turn away from non-work
Rethinking empathy: professional work with persons with PIMD
Get PDFThis article combines ethnographic interpretations with analyses of the conceptual history of empathy. Moving beyond the more common notions, which often rely in psychological theories and terminologies, the conceptual-historical analyses trace its roots to 18th and 19th century notions of ‘Einfühlung’. As the ethnographic work follows the professional work with two young women with profound intellectual and multiple disabilities, the article makes a fivefold argument. First, we argue that empathy is often considered a matter of individual cognition but should be rethought as an embodied process of feeling-into. Second, we argue that this process is characterised by incompleteness—and hence must acknowledge that empathy is always partial, always on the way to understanding. Third, we argue that this incompleteness forces us to think about the underlying ‘connecting force’, and that the conceptual history suggests that we should think about this force as a form of love. Fourth, we suggest that this ‘love’ is highly embodied, and that this suggests that theoretical notions of empathy should relate to notions of kinship. Fifth, we suggest that the combination of this love (affection, appreciation), embodied kinship and incompleteness suggests a final rethinking, namely the notion of empathy as a form of longing.publishedVersio
The urge to work: Normative ordering in the narratives of people on long-term sick leave
Get PDFThis study analyses the narratives of people on long-term sick leave due to low back pain. We draw upon the theory of justification – as developed by the French sociologists Luc Boltanski and Laurent Thévenot – to investigate how the informants’ narratives evoke and rely upon three ‘orders of worth’. These are the industrial order concerning being a productive citizen, the domestic order of home and family, and the civic order positioning the citizen in the regulations of the welfare state. In-depth interview interpretations map a strongly normative urge to work. The interviews also demonstrate how this urge in interwoven with social interactions in specific arenas: a troubled home life when not working, ways of keeping in touch with work, and complex negotiations of the possibility of non-work. The different orders of worth do more than point towards their ‘own’ arena: Norms and values of the domestic order, in particular, point toward the need for return to work rather than towards life at home (non-work). We conclude that the narratives deal more with the trouble of sick leave than with the enjoyment of work. Hence, the urge to work is just as much a turn away from non-work.acceptedVersio
Holding and professional care: On self-determination for persons with profound and intellectual and multiple disabilities
Get PDFPersons with profound intellectual and multiple disabilities (PMID) are in danger of not being granted the human right to experience self-determination. Attitudes questioning the relevance of the rights of persons with significant support needs and a lack of guidance on how to practically go about ensuring selfdetermination might explain this. Providing knowledge about this matter, this article contributes through an ethnography highlighting the relationship between persons with PIMD and professionals. The concept of holding another’s identity was found to be a possible, fruitful approach toward self-determination in this context. Descriptions of holding dialogues with an ethics of care suggest specific conditions for moving practices toward self-determination: recognize the role of the professional, emphasize embodied empathy, and enable involvement. The ethnography suggests a broadened understanding of self-determination, pinpointing the importance of sensitivity toward the other’s particularity.publishedVersio
Self-Determination: What can we Learn from Persons with Profound Intellectual and Multiple Disabilities?
Get PDFThis is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC-BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Self-determination is often equated with independence and individual choices, which limits its relevance for persons with profound intellectual and multiple disabilities (PIMD) due to their dependency. This paper challenges the notion of independence by arguing for a rethinking of self-determination that is sensitive to lives characterised by dependency and non-verbal being. An ethnographic study informed by phenomenology emphasising embodiment shed light on how self-determination can unfold in the lives of persons with PIMD in relationships with professionals. These data are engaged in a theoretical discussion, dialoguing with theories of self-determination and ethics of care. We advocate that a rethinking involving embodied communication, partnership and ongoing processes of being understood can offer a sound way of grasping the phenomenon of self-determination, both for persons with and without PIMD.publishedVersio
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