Viljan att vara reko: biopolitik och professionsetik – rehabkoordineringens janusansikte
Authors:   , Flädjemark Ulrika 
Published: May 2023

The Rehabilitation coordinator (ReCo) has been added as a new, statutory function in line with making return to work for those on sick leave a priority area in healthcare. ReCo´s task is to support the patient, coordinate the internal organization in the sick leave process and collaborate with external actors; such as an employer and Swedish Social Insurance Agency (Försäkringskassan) administrator. The taken-for-granted metaphor is that the ReCo acts as the "spider-in-the-web" to accomplish this. This thesis aims to study the ReCo´s role in the sick leave process within the framework of organizational and professional studies. Based on the purpose, two main questions have been formulated; how the ReCo´s role and function are made visible in a professional care context, as well as how the ReCo appears as organizational subjectivity in relation to the function's assignment. The thesis' theoretical frame of reference is based on Michel Foucault's political philosophy with governmentality in the fore. The dissertation's 19 semi-structured interviews with rehab coordinators, together with observations and public documents where the ReCo's tasks are described, have been analyzed with a thematic network analysis. In the analysis, an abductive approach based on a dispositive analytical strategy has been used. The analysis shows that the function needs to be clarified in daily operations. Ambiguities in how the assignment should be designed are expressed in relation to the ReCo's own experience and are also expressed in relation to how local operational management and colleagues experience the assignment. Despite the ambiguity, a willingness to help and support the patient is expressed. Thus, the ambiguity and the motivation of doing good will in relation to how the rehab coordinator chooses to act in the role, create two themes that go hand in hand and interact with each other. In governing documents, the manifestation is that the logic of the care profession with its intuitive individual centering and biopolitical logic as overall legal governance, can easily be brought together in the one and same role, which gives the appearance of a Janus-face of rehabilitation coordination that is unproblematic. However, the dual nature of the Janus-face requires clarification. Clarification is achieved by the ReCo using different strategies, for example through clothing and using spatiality in a way that the ReCo finds appropriate based on the personal interpretation of how the role should be formed. Developing strategies regarding how the role should act in relation to other care professions, preferably the physician, are other ways to create clarity. Based on public documents, an action on the part of the ReCo is anticipated that transfers expected norms to the patient and others within the care organization in a way that makes the patient understand their own best interest and act accordingly. In the role of subject, the ReCo moulds how the function will express itself through compliance or resistance to the expected norms that prevail in governing documents. In the subjectivation process, the rehab coordinator as an individual chooses with which knowledge in the foreground the action is exercised and through this, how subjectivity is formed. Here, metaphors other than the taken-for-granted “spider-in-the-web” help express how the subjectivity is formed; e. g. to act as a detective, valve, pilot, bridge. The thesis contributes to understanding how state-run governance constitutes self-governance and formation of organizational subjectivities. In this case, the shaping that the rehab coordinator expresses through the subjectivity that is enacted to clarify the ambiguity that can be seen from two perspectives, as enabling and as hindering. In order to not lead to role ambiguity, a two-way communication needs to take place within the care organization – with managers and with colleagues – with the starting point of speaking clearly about the controversial nature of the ReCo assignment where actions are expected to be guided by the insurance medical paradigm.