Structural Barriers Limit Collaboration in Healthcare Return-to-Work Processes

A qualitative interview study of general practitioners (GPs) and case workers (CWs) investigated the inter-organisational interactions within return to work (RTW) processes, revealing that while cooperation functions as a functional interaction mode for routine RTW processes, the limited capacity to shift toward coordination or collaboration is a reflection of structural features within the system rather than individual shortcomings.

The research, titled “Unpacking inter-organisational interactions in return to work processes – a qualitative interview study of general practitioners and case workers” (E0001, E0012), employed a qualitative design. Semi-structured interviews were conducted with 30 GPs and 20 CWs across different Danish municipalities between February and October 2024 (E0025). The study utilized McNamara’s framework, which distinguishes between cooperation, coordination, and collaboration, to examine the everyday interactions between these two professional groups in RTW processes (E0023, E0025).

The study aimed to generate empirically grounded insights into the nuanced professional frontline interactions in RTW processes, moving beyond merely identifying barriers to interaction (E0023). By applying McNamara’s framework, the researchers analyzed how these interactions were structured and enacted in practice (E0025). The findings illustrated how these interactions were structured and enacted in practice through two primary themes (E0027).

The first theme focused on the structural conditions shaping interaction. The researchers found that legislation, formal agreements, financial arrangements, and organizational structures supported stable, largely cooperative forms of interaction (E0027). These structural elements provided a foundation for stable, cooperative interaction modes within the RTW system (E0027).

The second theme examined interaction within individual RTW processes. The research revealed that written communication functioned as the default mode of interaction, structuring information sharing between GPs and CWs (E0027). In most RTW processes observed, this written communication was perceived as sufficient for managing the necessary information flow (E0027).

However, the study highlighted a critical divergence when examining more complex RTW processes. In these intricate scenarios, written communication was often perceived as insufficient by both GPs and CWs (E0027). Professionals pointed to a clear need for verbal communication in these challenging situations (E0027). They argued that verbal exchanges were essential because they enabled clarification of ambiguous points, supported mutual understanding and trust between the parties, and facilitated more aligned decision-making regarding the individual’s return to work (E0027).

Despite recognizing the vital role of verbal communication in complex cases, the study found a persistent gap between need and reality. While GPs and CWs acknowledged the necessity of verbal interaction for achieving deeper alignment and trust, this form of communication was rarely enacted in practice (E0027). This discrepancy suggests a systemic constraint—a structural feature of the current system—that inhibits the shift from the default written, cooperative mode toward the more dynamic and integrated modes of coordination or collaboration (E0027).

The conclusions drawn from applying McNamara’s framework to the Danish context indicate that cooperation is a functional interaction mode for routine RTW processes. This level of interaction is sufficient when the case parameters are straightforward and the information requirements are clear (E0029). However, as the complexity of the individual’s condition or the RTW process increases, cooperation alone proves insufficient to meet the demands of effective care and decision-making (E0029).

The limited capacity observed within the system to shift towards coordination—where activities are synchronized—or collaboration—where true partnership exists—is not attributed to individual shortcomings of the GPs or CWs. Instead, the authors strongly attribute this limitation to the structural features inherent in the system itself (E0029). This finding provides conceptual clarity regarding the challenges in inter-organizational healthcare delivery, suggesting that the current organizational setup appears rigid, favoring the documented, cooperative exchange over the fluid, nuanced exchanges required for high-stakes, complex cases (E0029).

The research concludes that McNamara’s framework enabled a nuanced analysis of how and why different types of interactions occur in RTW processes (E0029). The findings highlight the need for interactional infrastructures that encourage flexible shifts in interaction according to case complexity (E0029).

Subject of Research: Analysis of inter-organizational interactions between general practitioners and case workers in return-to-work processes using McNamara's framework.

Article Title: Unpacking inter-organisational interactions in return to work processes -a qualitative interview study of general practitioners and case workers

Article References: Poulsen, A. G., Nielsen, C. P., van Meerkerk, I., Rolving, N., & Jensen, L. G. (2026). Unpacking inter-organisational interactions in return to work processes -a qualitative interview study of general practitioners and case workers. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15914-z

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15914-z

Keywords: Healthcare Administration, Return to Work, Inter-organizational Interaction, General Practice, Case Management, Qualitative Research, Organizational Structure, Denmark, McNamara's Framework, Unpacking, inter-organisational, interactions