An overarching theme evolved: “The rehabilitation coordinator promotes security and reduces stress in the vocational rehabilitation process”, based on two themes: (1) “Adaptations and support based on the patient’s needs” and (2) “Rehabilitation coordinator efforts as relevant for care”. The themes, in turn, consist of six subthemes. The relationship between the overarching theme, themes, and subthemes is illustrated in Fig. 1.

Fig. 1

Overaching theme, themes and subthemes

The HCPs were positive about the introduction of the RC function at the care units and described that there is a need for rehabilitation efforts, with a focus on work/employment, within the patient group. Previously, the ability to offer such efforts had been limited. Given that some patients are on sick leave for longer periods, previous efforts related to employment were considered substandard. Many patients were perceived to require help with RTW/entry into work or studies, as they struggled to manage this process on their own, and their mental health often led to passivity. The RC was, therefore, seen as capable of providing more comprehensive support to patients during the rehabilitation process and motivating the patient to engage with it.

Theme 1: Adaptations and support based on the patient’s needs

This theme describes HCPs’ perception about the importance of different RC efforts, with regard to patients’ difficulties and needs in promoting the VR process and patients’ ability to RTW/entry into work or studies. The RC was described as ‘holding together’ the VR process and ensuring that it moves forward.

Comprehensive mapping and an adjusted rehabilitation plan

The RC’s mapping of the patient’s rehabilitation needs, with a focus on rehabilitation as needed for work, was seen as positive. Patients were often considered to have specific needs which had to be taken into account when planning for RTW/entry into work or studies; for example, patient-specific needs related to recovery. This was viewed as contributing to the patient’s personal commitment to subsequent rehabilitation efforts.

“I think that it is very important and extremely positive, since it often happens that people otherwise get sorted into some kind of category due to their diagnosis or length of sick leave and… this intervention is usually suitable for this type of patient.” (Nurse).

The mapping was considered to be capable of increasing the possibility of finding an occupation that met the patient’s needs, which was seen as a prerequisite for the patient’s progression in the VR process. The RCs work was described as being based on a holistic view, where various factors are taken into account, which may be of importance to the patients’ ability to either RTW or begin working. This could, for example, include initiating contact with other HCPs or actors as a first step in the patient’s VR process.

The RC’s methods of working were perceived as flexible and able to make adjustments according to the patient’s wishes and needs. HCPs also believed it was important that patients felt involved in the planning process and that the RC listened to them. This allowed the patients to have trust in the RC and in the efforts being proposed. Furthermore, both the mapping process and the support provided by the RC were seen as contributing to a sense of security for patients throughout the VR process.

“So I think that the mapping is at least as relevant as this general support function in order to make the patient feel more confidence in the rehabilitation process, because it might help us to actually find a place of employment where they would do well”. (Physician).

Having a particular rehabilitation plan for RTW/entry into work, hereinafter referred to as a VC plan—which the RC and the patient draw up together, after the mapping had been carried out—was believed to increase the focus on the patient’s needs when it came to rehabilitation efforts. Some HCPs believed that involving an occupational therapist was crucial for accurately assessing the patient’s functional ability and developing a perfectly good rehabilitation plan. RC support was viewed as contributing to a structured and well considered planning of the VR process, with a focus on establishing long-term and realistic goals for the patient, based on their individual conditions.

“What will work for this person, because it is quite easy to implement something that, yes…on paper increases the capacity for a short time but does not work in the long-term or does not lead anywhere”. (Nurse).

The VR plan was found to make it easier for the patients to follow the VR process step by step and thereby experience the process as more manageable, with the opportunity to prepare for each new step in the process. Having a VR plan included in the sickness certificate was also perceived to facilitate contact with SIA for some patients.

“Or it is positive for the patient partly because there is a plan included on the certificate of illness, which is usually helpful in contacts with the Social Insurance Agency”. (Nurse).

Coordination and collaboration

Patients were often described as having difficulties with coordination, planning, and establishing and maintaining contacts with several actors at the same time, and struggling to cope with this on their own. Interacting with different actors could also induce stress among patients. The possibility of support and help from the RC with coordination and collaboration was, therefore, described as significant for patients and as something that patients appreciated. The RC could instruct and prepare patients before they contacted, for example, the administrator at SIA, and if necessary, the RC could also initiate this contact for them.

“And I think that many get stuck in a state of stress as soon as they think that now I need to contact my case officer, that they need someone to help structure it all”. (Psychologist).

The RC had the opportunity to participate in various collaborations. HCPs described that meetings with, for example, PES or SIA could be experienced by patients as frightening. In addition, the RC was viewed as having the ability to advance patient’s cases in situations when the patients themselves were unable to do so. Thus, the RC was seen as a patient representative in these contexts. Furthermore, the RC could also ensure that the patient’s rights were not violated during the VR process. Altogether, the RC’s support and participation in coordinating and collaborating during the VR process were described as contributing to an increased experience of security among patients.

“…that it’s so difficult when you are already feeling bad and then you have to sit...so like, I think it’s actually a great relief to have someone come with them who can help them (the patients)”. (Nurse).

Individual guidance and practical help

The RC was described as both being able to guide patients during the VR process, and also collaborating with patients to investigate and identify different ways of moving forward. HCPs also perceived that patients they met felt supported by the RC in finding a way forward that took into account their individual conditions and interests.

“So it’s probably very good to not have staked out too many steps in advance but instead to perhaps look at, this opportunity and that opportunity…which one shall we do first, okay… And anyway my experience is that RCs keep doors open and don’t restrict themselves to following one single plan. And I think that is very important”. (Nurse).

Through the RC, patients gained insights into available and adapted interventions, leading them to discover new possibilities. Having a RC who remains with the patient in the event of any setbacks and who does not give up, and suggests other paths that the patient can try to advance in their VR process, was deemed significant. HCPs believed that the RC can help instil hope in patients, help them set goals, and explore options to move forward in the VR process.

“Because I think there is some significance in instilling hope in the existence of a future. You won’t always just lie here in the dark and you won’t be a disability pensioner at the age of 35”… (Social worker).

The RC provided information and knowledge to the patients about the VR process, as well as access to various forms of support and current regulations. This was seen to contribute to patients feeling more secure in the process and becoming more equipped to navigate it. In addition, the RC was described as being able to offer practical and administrative help, for example, helping to complete the right forms, and filling in certificates and applications of various kinds.

“The patient might want to study or something like that, but they feel that they can’t manage it at all because they have issues and then the RC can provide them with information about how to get support. For example, it might be someone with autism who is eligible for special accommodations that are helpful”… (Physician).

Ongoing contact with a clear focus

The RC’s specific work, with its focus on employment/RTW and the opportunity to provide regular support to the patient over time, was described as important. There was a perceived need for a function that could oversee the entire VR process. This was viewed by HCPs as activating empowering patients and as something that could actually move them forward in the process, leading to real change.

“Yes, I believe that having one rehabilitation-focused contact contributes something more than having it somewhat to the side of other contacts or working on it sporadically, because I believe that it evokes more, like…it activates these people more to have one specific contact for this, where there is not so much else involved, because then you can really make progress”. (Psychologist).

The RC was described as being available to support patients throughout the VR process, accessible to patients through personal meetings or over the phone. The RC was viewed as a personal contact, which was considered significant, as it made the patients feel secure in their situation. Creating this sense of security and alliance with the patient was perceived to take time, but judged as important to achieve success, and to help the patient cope with this changing process to ultimately achieve better health in the end. The regular contact with the patients was also viewed positively, as it was considered to create prerequisites for follow-up, allowing the RC to quickly identify any emerging patient needs and take action accordingly, thereby avoiding issues from lingering over time.

“Yes, or that there is also quite regular contact with the patients and that in those circumstances, things may come out…and it becomes a bit clearer that there is an impact from the patient flipping their day/night body clock and needs like, yes…has such difficulty sleeping that something maybe needs to be done about that in order to be able to get going to job training”… (Nurse).

Theme 2: Rehabilitation coordinator efforts as relevant for care

This theme highlights HCPs’ perception of the risks associated with a passive sick leave process and the importance of employment with regard to the patients’ health and well-being, whereas the efforts of the RC and VR are proposed to be a part of the patients’ care and treatment. The RC’s knowledge and involvement in the VR process was considered to lessen stress and anxiety in patients, thus reducing the need for other HCPs to address these issues.

Mitigating negative effects of sick leave

Employment in any form was described as able to contribute to improvement in mental health in the target patient group. For patients, employment could, among other things, provide a sense of purpose and structure in everyday life. This was something the HCPs felt that many of their patients needed. Furthermore, employment was seen as a means of normalisation, partly through self-sufficiency and coherence and because patients’ friends and acquaintances usually include working individuals.

“They (the patients) need employment for the sake of their health; they need routines. We know that this is something that provides support and security, that you have a place where you can go to meet people so that you avoid the isolation that many patients end up experiencing”. (Physician).

HCPs believed that the ability to offer VR efforts was a prerequisite for patients to have the opportunity to secure adapted and meaningful employment. It was noted that too little consideration is given to this aspect in the planning of patient care and treatment. Since employment was deemed crucial for improving patients’ mental health, it was considered beneficial to discuss this early in the sick leave process with all patients. Accordingly, HCPs would like to see RCs integrated into patients’ planned care, in parallel with other efforts. Enabling early interventions was deemed particularly important for younger patients to avoid negative effects on health.

“There is also an aspect that…many also feel worse because they don’t have anything to do all day; they go around in circles at home and get even more depressed”. (Nurse).

Reduced need for care and treatment

More resources and increased support for patients in the VR process were perceived as leading to reduced stress and accordingly, a decreased need for care and treatment. Therefore, RCs were seen as a necessary effort. HCPs also saw advantages in that the RC could assist patients in contacts with different authorities. Often, these interactions involved questions connected to the patients’ compensation, which could cause anxiety and stress, thus having a negative impact on their mental health. This, in turn, required attention from the healthcare team. Consequently, HCPs might spend a lot of time dealing with such issues during patient treatment; for example, when sick certificates were not approved and modifications were required. Access to a RC, with knowledge in the field— including these contacts—was therefore considered helpful in facilitating patients to navigate these situations.

“…it’s always like supplementary documentation is required for their certificate of illness; there is always something that doesn’t go smoothly and it becomes very stressful and they (the patients) might not receive their money on time. This becomes an enormous source of stress, which often becomes quite a lot to handle, like even as a part of a treatment contact for them, which is understandable. If it is your income that is basically at stake, then it becomes very stressful and I think that many perceive the Social Insurance Agency as very harsh, difficult to cooperate with, and such. I mean, it makes it so much easier if you have someone that you can trust, who knows how everything should be done”. (Psychologist).