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Previous UK research suggests that the implementation of occupational health guidelines, particularly prompt intervention, may be hindered by organisational obstacles such as strict referral criteria [ 21].
Extending the authority to certify sickness absence beyond the medical profession in primary care is not a simple matter of addressing organisational obstacles.
Structural barriers mainly originated from the general conditions of the health care system, for example inadequate remuneration, organisational obstacles such as long distances, as well as questions of responsibility, referral, and the interface between inpatient and outpatient care.
Extending the authority to certify sickness absence beyond the medical profession is not simply a matter of addressing practical and organisational obstacles.
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Multifaceted approaches and country specific strategies are needed to address vaccine hesitancy in health care workers and in the population, and to manage organisational and financial obstacles.
This study demonstrated that although many recommendations for the ideal fit note are considered achievable, there are considerable financial, legal, organisational and professional obstacles to be overcome in order for the recommendations to be implemented successfully.
The major obstacles were organisational insufficiencies, which are currently typical for many healthcare settings such as the one in Switzerland, e.g. full bed capacity at receiving centres or at night and during weekends, which prevented better adherence to recommended triage pathways in both the proADM and the control group.
Despite its perceived strengths, it appears to have come up against many of the obstacles that other organisational change initiatives in the NHS, and healthcare more broadly, have encountered.
Most obstacles were cited at professional and organisational levels.
Obstacles to increasing access include inadequate training, organisational support and supervision, resulting in low levels of staff competence and confidence.
Intrapersonal, interpersonal, organisational and environmental factors may have facilitated participation or created obstacles for attendance [15].
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com