I get back with a little help from my boss

What constitutes successful and valued leadership, as well as failed leadership, during the return-to-work process following mild traumatic brain injury for highly autonomous employees?

Abstract

This doctoral thesis explores the importance of leadership for employees in jobs with high autonomy, who return to work (RTW) after mild traumatic brain injury (mTBI). Despite that there is extensive research on TBI and RTW, this area has not been researched from a leadership perspective.

The leadership perspective is also rarely applied within the more general research on RTW, work inclusion, social work and social policy. Simultaneously, leadership literature does not focus on either TBI or RTW processes. The thesis thus aims to contribute new and practical insight to several research fields and at the same time strengthen the knowledge base for decision-makers, social workers and leaders, all of whom are groups that at different levels are involved in managing sickness absence. By delving into the complexity of leadership in mTBI and RTW processes, this study contributes valuable new knowledge.

The thesis is based on qualitative in-depth interviews with ten employees who were in a RTW process after being exposed to an injury that resulted in mTBI, and interviews with their immediate leaders. In the interviews with the employees, the spotlight was put on how they experienced that their leaders handled RTW processes and how they assessed the leaders' efforts and actions. The interviews with the leaders were about the same process, seen from the leaders' perspective. During the interviews with both groups, a special spotlight was directed at the leaders’ actions, with the intention of grasping different forms of leadership practices that arise in RTW processes after mTBI. These interviews revealed that the employees divided into two different camps: 1) Employees who were satisfied with the leaders and who attributed much of the successful RTW to the leaders' role in the process, and 2) employees who were very dissatisfied with the leaders. The interviews with the leaders revealed that the leaders in the negative cases did not always share the same experience as the employees.

In this study, seven cornerstones are identified which constitute successful and valued leadership in RTW processes after mTBI. These cornerstones include i) empathy and trust, ii) facilitation, flexibility and action orientation, iii) that the leaders take the lead to ensure a successful RTW process, iv) prioritizing the balance between work and private life, v)

establishing personal relationships between the leader and employee, vi) innovative problem solving and vii) establishment of job security.

The study of the successful cases shows that leaders play a protective role and frequently slows down the employees to protect them from setting too high goals in the RTW process. The attention these leaders pay to restitution and holding back challenges conventional leadership theories that focus on performance and productivity. Nevertheless there is resonance between these findings and the theory of transformational leadership. Transformational leadership is thereby considered as potential leadership input to successful RTW after mTBI.

However, the study recognizes that even successful and valued leadership cannot handle all challenges and documents that in cases where employees experience extensive and persistent symptoms, good leadership also falls short.

In the cases where leadership fails, it is illustrated how leaders can hinder the RTW process. It is also shown how leaders, even when acting with the best of intentions, can put their employees in situations where they feel frustrated, sad and abandoned. The study thereby illustrates how failed leadership in RTW processes can destroy the relationship between employees and leaders. The unsuccessful cases are characterized by a breakdown in communication and ineffective support, and these are findings that are echoed in the literature on laissez-faire leadership, unconscious leadership and tyrannical leadership.

By emphasizing the central role leaders play in the RTW process, this study advocates that vocational specialists/job specialists should expand their competence base by combining more knowledge about organization and leadership. By increasing their competence in organization and leadership, job specialists will not only be able to actively assist with RTW after mTBI, but also act as valuable resources and advisors for leaders in the same processes. If job specialists acquire skills so that they can actively assist both parties in the future, they can play crucial roles for successful RTW processes.

Furthermore, this study highlights the need for a nuanced approach in social policy, among other things by pointing out that the perspective that speaks for "the curative power of work" cannot be used as a premise for mTBI. In the case of mTBI, it is crucial to apply tailoring in

the RTW processes to ensure that the unique needs of each individual are met. Furthermore, a proposal is presented on 'preventive sickness absence' after mTBI, which involves a reassessment of current sickness absence guidelines, with the aim of reducing the risk of potential setbacks in the recovery and RTW processes. This again emphasizes the necessity that job specialists can also function as support for leaders in the future.

In conclusion, it is advocated that future studies must hold onto the leadership perspective and that further knowledge bridges should be built between research on RTW, work inclusion and leadership.