Table 3 Factors beyond physicians’ behaviours influencing the number of MSD-related sick leave days

Treatment provided by the OHS multi-prosessional personnel (in addition to physicians)

Patients with minor symptoms are guided to effective self-care by nurses during the assessment of need for treatment ^a

Occupational health nurses provide non-pharmacological care for patients with chronic pain^a

Physiotherapists provide effective pain treatment and guide patients in self-care^a

Occupational health psychologists support patients with chronic pain^a

Full-time physiatrist and psychiatrist serve patients with chronic pain^a

Shortage of appointment hours for occupational health psychologists and physiotherapists^b

Policy, structures and processes in the OHS

OHS revenue logic allows professionals to focus on the prevention of work disability^a

Fairly well-operating assessment of need for treatment and referral to appropriate professionals^a

Well-functioning distribution of work among general practitioners and occupational physicians^a

Self referral to physiotherapists^a

Sick leave trends are systematically monitored in the OHS and possible setbacks are discussed in staff meetings^a

OHS actively informs workplaces about new policy and practices concerning e.g., sick leave prescribing^a

OHS actively supports workplaces in using alternatives to sick leave^a

Municipal client organization

Client organization is committed to enhancing the use of alternatives to full-time sick leaves^a

Client organization provides employees with services for enhancing health and preventing work disability, e.g., groups supporting healthy behaviours^a

Alternatives to full-time sick leave (e.g., work modifications) are difficult to carry out at some duties or workplaces^b

Employees of the client organization

Positive cultural change is noticed in most employees’ attitudes concerning absence from work^a

Employees’ willingness to avoid absence from work is influenced by current labour market situation and the level of unemployment benefits^a,b

Many employees engage in unhealthy behaviours, which affects work ability in the long run^b

Structures and processes in primary and special health care, and social insurance

Sick leaves are easily prolonging due to insufficient treatment of pain in primary and special health care^b

Long waiting lists to special health care (e.g., in need for operations) extend sick leaves^b

Social insurance regulations hinder the use of part-time sick leave^b