How Weak Relational Ties and Counterproductive Communication Sustain Collaborative Challenges in Vocational Rehabilitation for People on Long-term Sick Leave due to Common Mental Disorders: A Case Study in Denmark

2PurposeExplore why collaborative challenges emerge in vocational rehabilitation for citizens on long-term sick leave due to common mental disorders (CMDs), and how they are experienced and navigated by key actors in the Danish sick leave system: citizens, caseworkers (CWs), and general practitioners (GPs). MethodsA case study in two Danish municipalities, including semi-structured interviews with seven citizens, seven GPs and six focus group interviews with 31 CWs. The data were inductively analysed via systematic text condensation followed by abductive analysis using relational coordination theory. ResultsThe lack of shared goals among key actors led them to campaign for their agendas, turning collaboration into a competition over the agenda. Limited shared knowledge resulted in repeated efforts to clarify expectations, making collaboration feel "colossally labouring." A lack of mutual trust and respect triggered distancing communication strategies, resulting in a relational divide. ConclusionLack of relational coordination, marked by weak relational ties and counterproductive communication, explains how collaborative challenges emerge and persist in vocational rehabilitation for people on long-term sick leave due to CMDs. The self-perpetuating nature of these dynamics highlights the need for rethinking how organisational structures can promote relational coordination. Future research should investigate the contextual factors influencing relational coordination.