Experiences of working from a freestanding position as a case manager when supporting clients in the Swedish welfare system

Abstract

The Swedish state uses a case management function known as Personligt Ombud (PO). The role as PO differs from the traditional professional roles. It has a freestanding position in the welfare system. The aim of this study was to investigate POs' experiences of working from a freestanding position when supporting clients. Telephone interviews were conducted with 22 POs across Sweden. The interviews were recorded, transcribed, and analyzed by latent qualitative content analysis. The findings were reflected in three categories - freedom-promoted flexibility, surfing through a complex welfare system, and working for legitimacy. POs developed a holistic view to both the client as well as to the welfare system. POs experienced solely representing the client, which is a positive feature because part of the POs' role is advocating for the clients rights. The PO service differs from the PO service from other existing case management models and may need to develop strategies for decision-making and support in their own role. For example, they may use group supervision teams or 'reflective teams'. The freestanding position may also entail problems in terms of lack of legitimacy. It is important for POs to develop good platforms with the surrounding actors among others things to improve the co-ordination process. It could be interesting if the PO model would be tested in other countries that have a fragmented welfare system. The PO model may also be useful to other 'target groups' who are in need of co-ordinated rehabilitation services.

Barriers in Case Managers’ Roles: A Qualitative Systematic Review

“…Ten studies met the inclusion criteria for this qualitative systematic review: Bamford et al (2014); Eack, Greeno, Christian-Michaels, Dennis, and Anderson, (2009); Gustafsson, Kristensson, Holst, Willman, and Bohman (2013); Iliffe et al (2011); Klockmo and Marnetoft (2016); Kolind, Vanderplasschen, and De Maeyer (2009); Moise and Mulhall (2016); O’Donnell (2007); Sandberg, Jakobsson, Midlöv, and Kristensson (2014); and You et al (2016). These studies were all published between 2007 and 2016.…”

“…You et al (2016) observed that case managers in general had to deal with multiple complex tasks to meet clients’ needs. Case managers in Klockmo and Marnetoft (2016) said that they experienced demanding activities under tight deadlines: “It [case management] requires the ability to work independently, a high degree of self-confidence, the ability to listen to the client, and balance this with the authorities’ framework while not succumbing to exhaustion or burnout” (p. 128). Finally, some studies reported that unfamiliar roles make the work more challenging: “Adherence to these diverse conditions, both as an individual and as a team member, challenged their [case managers’] current professional identity” (Gustafsson et al, 2013, p. 7).…”

“…Five studies pointed out that case mangers collaborate within multidisciplinary health-care teams (Bamford et al, 2014; Iliffe et al, 2011; Klockmo & Marnetoft, 2016; Moise & Mulhall, 2016; O’Donnell, 2007; You et al, 2016). In team meetings for most of these studies, however, case managers felt little involvement with leadership and that collaboration with the primary care team was poor (Bamford et al, 2014; Klockmo & Marnetoft, 2016; Moise & Mulhall, 2016; You et al, 2016).…”

“…Five studies pointed out that case mangers collaborate within multidisciplinary health-care teams (Bamford et al, 2014; Iliffe et al, 2011; Klockmo & Marnetoft, 2016; Moise & Mulhall, 2016; O’Donnell, 2007; You et al, 2016). In team meetings for most of these studies, however, case managers felt little involvement with leadership and that collaboration with the primary care team was poor (Bamford et al, 2014; Klockmo & Marnetoft, 2016; Moise & Mulhall, 2016; You et al, 2016). For example, in You et al (2016), case managers had little contact with the primary care team after an initial briefing despite the fact coordinating care and arranging services for clients requires close collaboration between teams.…”

“…The data synthesis identified five themes, all barriers to CM implementation: unclear scope of practice, diverse and complex CM activities, insufficient training, poor collaboration with other health-care providers, and client relationship challenges (see Table 2). (Kolind et al, 2009;Sandberg et al, 2014) • • Difficult to negotiate best solutions on behalf of clients and to advocate for patients, thus need to balance (Gustafsson et al, 2013;Klockmo & Marnetoft, 2016;O'Donnell, 2007) Note. CM = case management; NCM = nurse case manager.…”