Ways of 'appealing to the institution' in interprofessional rehabilitation team decision-making

Making decisions in interprofessional team meetings about clients' employability and entitlements to welfare benefits is a balancing act between institutional resources and constraints on the one hand and professional expertise and responsibility on the other. Despite a growing focus, only a handful of discourse and communication oriented studies engage focally on decision-making processes involving different professionals. We specifically address the following research question: how do professionals appeal to the existing institutional norms and frameworks in a contingent manner while processing client cases to arrive at decisions? Our study context is the rehabilitation team meetings in the Danish social work setting. Based on 18 recordings of rehabilitation team meetings we adopt the framework of activity analysis to identify the distributional patterns of appeals to the institution vis-à-vis professional expertise and role-responsibility. Our findings suggest that appeals to the institution can be differentiated at the level of five sub-types depending on what is at stake, e.g. (i) the legal/institutional framework; (ii) the institutional criteria for eligibility; (iii) the institutional categories; (iv) the institutional procedures for case-processing; and (v) anticipating future institutional scenarios. Despite this differentiation, these sub-types of appeal to the institution are interwoven in any stretch of decisional team talk and point to an inherent tension between the so-called institutional order and (inter)professional order.