Balancing participation in writing meeting minutes online in video-mediated return-to-work negotiations

Weiste, Elina; Koskela, Inka; Kallio, Aku; Keränen, Hanna; Pesonen, Sanna; Sormunen, Erja; Juvonen-Posti, Pirjo; Ruusuvuori, Johanna

doi:10.3389/fcomm.2023.1205706

ORIGINAL RESEARCH article

Front. Commun., 07 July 2023

Sec. Health Communication

Volume 8 - 2023 | https://doi.org/10.3389/fcomm.2023.1205706

This article is part of the Research Topic Integrating Digital Health Technologies in Clinical Practice and Everyday Life: Unfolding Innovative Communication Practices View all 9 articles

Balancing participation in writing meeting minutes online in video-mediated return-to-work negotiations

$\r\nElina Weiste$ Elina Weiste¹^*

Inka Koskela¹

Aku Kallio²

Hanna Keränen¹

Sanna Pesonen¹

Erja Sormunen¹

Pirjo Juvonen-Posti¹

Johanna Ruusuvuori²

¹Finnish Institute of Occupational Health, Helsinki, Finland
²Tampere University, Department of Social Science, Tampere, Finland

Introduction: Balancing participation in multiparty negotiations in healthcare and vocational rehabilitation processes is an interactional challenge, especially when the participants interact online. Participants in multiparty video-mediated context have limited and asymmetric access to each other's activities. Also the different meeting tasks cause an imbalance in their opportunities to participate. At the same time, contemporary clinical practice rests on the ideal of reciprocal, balanced participation.

Method: We used conversation analysis to examine the participants' construction of the meeting memo as a joint document in video-mediated return-to-work (RTW) negotiations. We aim to observe how participants views are invited, receipted, and jointly formulated, both verbally and writing, when constructing the meeting memo. RTW negotiations are common collaboration arenas of vocational rehabilitation in Finland which aim to support the employee's return to work, for instance, after sickness absence. The meeting memo is a summary of the negotiation and its concrete decisions which may affect the employee's disability-based vocational rehabilitation services and benefits.

Results: The way in which the meeting memo is produced in RTW negotiations plays a significant role in the participants' opportunities for participation. Sharing the screen view to the already written text, enable participants to comment on and correct the text, reinforcing its joint approval. Involvement of participants in co-producing memo texts allow the participants not only produce the content to the text but also to formulate the publicly available form of the text.

Discussion: These practices for constructing the memo in and through the unfolding of interaction may be considered as enhancing more balanced participation. However, they may also require extra interactional effort in multiparty video-mediated negotiations.

Introduction

The idea of client participation has become a guiding principle in social and healthcare services (e.g., Crawford et al., 2002; Thompson, 2007). It means reciprocal communication and narrowing the knowledge gap between professionals and clients, in order to allow clients to voice their views and influence issues that concern their lives (Charles et al., 1997; Roter, 2000; Epstein et al., 2005; Thompson, 2007). In contemporary healthcare, digital client-accessible health records are one vehicle for the “power shift” toward clients (Benjamins et al., 2021). Accessible records enhance client participation, knowledgeability and empowerment, creating better opportunities for collaboration and improved communication among clients and professionals (Benjamins et al., 2021). Although accessible records mean the documents are better shared among clinicians and clients, the clients rarely contribute to their writing. In some contexts, co-writing is considered equally useful, as it offers the client an active role and balances the asymmetries between expert and client positions (Lindholm et al., 2020; Faccio et al., 2023). In this article, we take a novel approach to the research on writing in healthcare by studying video-mediated, multiparty return-to-work negotiations (from here on RTW negotiations), which are part of vocational rehabilitation, aiming to support employee's return to work, for instance, after sickness absence. We aim to observe how participants views are invited, receipted, and jointly formulated, both verbally and writing, when constructing the meeting memo.

In the field of conversation analysis, participation may be defined as “actions demonstrating forms of involvement performed by parties within evolving structures of talk” (Goodwin and Goodwin, 2004, p. 222). When studying participation from this perspective, the interest lies in how speakers attend to their hearers and modify their talk according to the engagement (or disengagement) their hearers display through constant adjustment of their bodies and talk (Goodwin and Goodwin, 2004).

Our data from video-mediated, online and hybrid, multiparty meetings impose particular constraints on participants to monitor and contribute to the unfolding interaction. Due to the participants' physically distant locations and the technical limitations of the communication channel, they need to cope with asymmetrical perspectives when producing, interpreting, and coordinating their joint actions (Heath and Luff, 2000; Büyükgüzel and Balaman, 2023). A video-mediated multiparty meeting can be characterized as “a fractured ecology” of action (Luff et al., 2003) meaning that the participants have limited and “asymmetric access to each other's activities” (Heath and Luff, 2000, p. 86). For instance, participants' screen activities are not accessible to others if the screen view is not publicly shared (Balaman and Pekarek Doehler, 2022; Ilomäki, 2022). Indeed, the coordination and organization of participation in video-mediated multiparty interaction is heavily dependent on visibility (Licoppe and Morel, 2012; Licoppe, 2017), audibility (Dalley et al., 2021), and mutual perceptibility (Stommel et al., 2019). For instance, although writing can be considered as inescapably embodied activity (Haas and Witte, 2001), the online participants in our data only have access to the writing activity taking place on a screen. The clerk's use of fingers, hands, arms and other embodied conduct required in typing (Haas and Witte, 2001), remain out of mutually shared visibility. For the onsite participants in hybrid meetings, the embodied writing activity may be observable, but they may not have access to the screen view. The same hold for us as researchers: we only have limited access to the multimodal resources used by participants in situated moments of interaction “behind the screen”.

Prior research has pointed out that this limitedness of access to the interlocutors' multimodal resources in interaction makes turn-taking and reciprocal communication more demanding in technology-mediated interaction than in face-to-face situations (McColl and Michelotti, 2019; Ilomäki, 2022). For instance, gaze and pointing function differently as interactional resources. Consequently, multiparty and video-mediated meetings need specific verbal practices to allocate participation opportunities to everyone (Ilomäki, 2022). For instance, the chair can invite others to contribute to the interaction by asking questions (see Kozar, 2016), explicitly allocating a turn to another party (see Hansen and Svennevig, 2021), opening a general space for commenting (Weiste et al., 2020a) or inviting participants to comment on each other's turns (Weiste et al., 2020a). In this article, we are interested in these verbal practices for allocating participation opportunities, but also more subtle ways the participants' views are receipted and jointly formulated by writing.

Writing with a help of digital tool is a multifaceted activity providing participants with specific affordances to share, inspect, or jointly work on the text. In digital writing, the embodied and visuo-spatial aspects of the activity itself (e.g., use of fingers, hands, and tools for writing and sharing), properties of the physical and digital world and sequential organization of interaction intertwine (Due and Toft, 2021). Further, the activity of writing can have different primaries according to an occasion (Magnusson, 2021); it can be a side side-activity among other businesses, it can be a main task of the occasion and a shared concern for the participants, but only one person is engaged in inscribing, or it can be a collaborative accomplishment by many/all participants. Prior conversation analytic research has shown that writing can take place in many kinds of activity contexts including writing on a paper in co-present interaction (e.g., Jakonen, 2016), computer-supported digital writing in co-present (e.g., Due and Toft, 2021), or online interaction (Abe, 2020). Naturally, the socio-material and praxeological properties of digital writing lead to different kind of practices and temporalities of text production and participation configurations in “writing-in-interaction” (Mondada and Svinhufvud, 2016) compared to texts written on paper.

There are couple of aspects affecting the interactional dynamics of writing in multiparty video-mediated settings, including the distribution of possibilities to produce the text and participants' visual access to the text. In multiparty co-present or online meetings, where the written document is a joint endeavor, participation in the writing activity has to be somehow organized. Often this means using a facilitator, who plays a specific role in establishing the mutual understanding in the group (Nissi, 2015; Mondada, 2016), and inviting participants to take part in the producing the text (Lindholm et al., 2020). Nissi (2015) has shown that a facilitator also plays an important role as a clerk and for instance the way they topicalize their own writing can function as a display of an orientation toward shared text production while the other participants are monitoring “writing in progress”. Although the group participants suggest what to write in the text, it is the facilitator who has the power to write the final formulation (Nissi, 2015).

On the other hand, when the text under construction is shared via computer screen, all participants have more balanced opportunities to inspect text already written or text under construction. The shared computer view is an important mutual resource for the participants to co-coordinate their own actions in relation to the activity of writing. For instance, visual accessibility to the texts provides opportunities to assess both the content of the text and its linguistic realization in vivo (Lindholm et al., 2020) even though only one person is responsible for writing. As Cekaite (2009) has pointed out, what is seen on the screen can itself draw participants' attention and initiate repair work to solve any trouble identified, such as misspelled words. Particularly when it comes to the writing tasks in institutional settings, the “appropriateness” of the texts in terms of their institutional or organizational purpose becomes a general and joint concern of the participants. This necessitates that participants agree upon the text as a product including exact wordings as well as the decisions that the written text carries (see Magnusson, 2021; Nissi and Lehtinen, 2022). Nissi and Lehtinen (2022) use the term documentability to describe the process that transforms the content of the discussion into a written, publicly available form. Documentability is a feature of all kinds of institutionally foregrounded texts, including the digital ones. By orienting to documentability, the participants consider the institutional purposes of the written document, which may be consequential for the participants after the writing process (Nissi and Lehtinen, 2022).

In sum, video-mediated interaction brings both specific affordances and constrains to writing as a social practice, as the accessibility of the text under construction is shaped by the properties and resources of the technology being used (Nissi and Lehtinen, 2022). Further, participants' different opportunities and rights to contribute to the production of the text are given in situ and shaped by the institutional setting and the division of the meeting roles (Mondada and Svinhufvud, 2016; Balaman, 2021; Nissi and Lehtinen, 2022). We focus on this organization by examining how meeting memos are constructed in video-mediated RTW negotiations by inviting, receipting, and jointly formulating participants' views both verbally and writing.

Return-to-work negotiation as an institutional context

RTW negotiations are an essential means of cooperation between occupational health services and the employer to support the employee's return to work, for instance, after a long sickness absence. The goal of RTW negotiations is to make joint decisions on the employee's future return to work. These decisions may concern workplace modification, such as excluding specific work tasks or cutting working hours for a certain period. It has been shown that sustainable return to work can be enhanced by arranging such workplace modifications (van Vilsteren et al., 2015; Cullen et al., 2018). Previous studies have shown that arranging RTW negotiations is profitable: the lengths of sickness absences decrease, and work participation is enhanced after RTW negotiations (Reho et al., 2018; Lappalainen et al., 2019).

In Finland, RTW negotiations are usually attended by an employee, a representative of employer [manager(s)], and an occupational health physician. Other professionals may also participate in the negotiations, such as an occupational health nurse, an occupational physiotherapist or psychologist, a safety representative from the workplace or HR representatives (Reho et al., 2018). Recently in Finland, an increasing number of RTW negotiations are held via video-conferencing, due to the digital transition in working life having been accelerated by the COVID-19 pandemic.

In successful negotiations, joint solutions are achieved through collaboration in which all the negotiation parties participate actively (Lappalainen et al., 2021). In practice, however, the distribution of power among cooperating actors in this type of multi-stakeholder meeting may often be unequal (Seing et al., 2012). The employer may dominate the meeting because they are able to offer workplace adjustments and ultimately determine whether the employee can return to work. On the other hand, occupational health physicians are meant to provide an objective medical viewpoint and are able to legitimize different stakeholders' perspectives (Seing et al., 2012). In fact, the occupational health physician, who often acts as the chair of the meeting, needs to construct the negotiation as a collaborative effort to indicate all participants being eligible in taking part in the discussions and decisions concerning the employee's return to work (Ristimäki et al., 2020). This is often achieved through non-verbal means, such as gestures and gazing each participant (Ristimäki et al., 2020).

All the central conclusions of the negotiations, joint decisions and the need for possible follow-up meetings are documented in a memo which is part of the employee's work-related rehabilitation plan. The memo is often written and accepted during the negotiation. The meeting memo can be structured or narrative, depending on the agreements made between occupational health services and the workplace (Juvonen-Posti et al., 2019). In our data, all the occupational health service organizations used a structured form for the memo. The titles in the memo forms were slightly different in all the organizations, but generally they involved sections on (1) the aim and goal of the negotiations, (2) the description of the present situation (employee's view, employer's view, prior workplace modifications, and other RTW decisions), (3) the decisions made in the negotiations, and (4) plans for a follow-up. The memo document is significant for the participants after the negotiations. The information written in the memo is used in the planning of work disability-based vocational rehabilitation services and benefits. The memo is also a routine document used by Finnish occupational pension institutions in decision-making. Among other things, information on whether employers have offered work or workplace modifications is of interest when pension decisions are made (MacEachen and Ekberg, 2019). Consequently, it is important for all the participants that the information they consider relevant is written down in the memo. Despite its importance, however, the memo and its creation in the negotiation has not been previously studied. The aim of this article is to fill this gap.

Research question

This article aims to investigate what kind of interactional practices support balanced participation upon the construction of the meeting memo in video-mediated RTW negotiations. We focus on the role of a meeting memo for two reasons. First, sharing access to documents has become a conventional practice in online meetings, giving the memo a more central role in video-mediated RTW negotiations. As the practices for sharing the text still vary, it is important to better understand how they affect participation in these negotiations. Second, the meeting memo is important for all RTW negotiation participants. As noted above, the memo may later be pivotal for the participants (e.g., MacEachen and Ekberg, 2019), making it important to have all the relevant information written down. Our analysis is guided by the research question: how participants views are invited, receipted, and jointly formulated, both verbally and writing, when constructing the meeting memo?

Materials and methods

This study is part of a joint research project of the Finnish Institute of Occupational Health and Tampere University called “Remote joint negotiations – new practice and well-functioning interaction in supporting work ability”. This project aims to produce information on the good practices of video-mediated RTW negotiations and to support their implementation. Nine video-mediated negotiations were video-recorded from March 2022 to December 2022 in different parts of Finland. During data collection, we recruited occupational health physicians, who then recruited other participants from negotiations in which at least one person was participating online. Consequently, we had negotiations in which all the participants were online as well as hybrid negotiations in which some of the participants took part onsite, typically in the facilities of the occupational health service clinic. All the negotiations were held on Microsoft Teams, which the occupational health service organizations used in their work. The occupational health physicians, who were responsible for organizing the negotiations, recorded the meetings in Teams. The hybrid onsite meetings were also video-recorded by two cameras in the meeting room. The researchers were not present in any of the negotiations.

The data of the present study comprised five negotiations in which the meeting memo was written by the occupational health physician or occupational health nurse during the meeting and shared on the screen at some point during the meeting. In the last four, which were excluded from the sample, the memo was only written after the meeting and shared with the participants via email. How the memo is written is often decided before the negotiation in the agreement between occupational health service provider and the employer. The memo can be written either by the representative of occupational health service or employer but not by an employee. Typically, according to our experience, the writer is a representative of occupational health service. How the memo is written (during or after the meeting, is the screen view shared or not) depend on the individual practitioner.

The five negotiations were held in three different occupational health service organizations in different parts of Finland. In each negotiation, the participants included an occupational health physician, an employer (manager) and an employee. In addition, an occupational health nurse participated in two negotiations, and representatives of HR management and a work ability coordinator participated in one (see Table 1). In total, the sample consisted of 18 different participants: three occupational health physicians, five employees, five employers, two occupational health nurses, two HR management representatives, and one work ability coordinator. All the negotiations were in the native language (Finnish) of the participants.

TABLE 1

Table 1. Descriptions of the negotiations.

The length of the negotiations varied from 33 to 56 min and comprised 221 min of interaction in total. The general structure of the negotiation involved the physician typically opening the meeting by telling participants the aim and the practicalities of the negotiation. In some of the negotiations, the physicians also referred to the memo and its construction during the session (e.g., “I'll write the memo, as I typically do in these negotiations. I will share the text, so your video frames might become smaller.”). Next, the physician usually asked the employee to describe their situation (see Weiste et al., 2020b), and invited the participants to suggest solutions for the employee's return to work. In three of the negotiations, the occupational health physician acted as chair and clerk, and wrote the memo online as the spoken interaction took place (see Table 1). In two of the negotiations, the occupational health nurse wrote the memo and the physician acted as chair. In these cases, the memo was shared on the screen at the end of the session. In all the negotiations, the participants were given the opportunity to read through the text and to give their agreement at the end of the meeting. The final memo documents were not available for our research. This means that we only had access to the texts that were shared on the screen.

The study was conducted in accordance with the premises for the responsible conduct of research (Finnish National Board on Research Integrity, https://tenk.fi/en). The research and data management plan were reviewed by the Ethics Committee of the Finnish Institute of Occupational Health (decision date: November 10, 2021). Informed, written consent was obtained from all the participants individually before the negotiation, including the right to withdraw from the study at any point during the data collection. The identity of the participants has been carefully protected by altering their names and other identifying details in the text.

In our analysis, we used institutional conversation analysis (CA) (e.g., Arminen, 2005; Heritage and Clayman, 2010) as a method. CA is a data-driven, micro-analytical method that regards interaction as collective production, the meaning of which is constructed through co-operation between the conversationalists in subsequent turns of talk (Schegloff, 2007). Institutional CA builds on this basic view and explains how the sequences of turns-of-talk contribute to the performance of the goals of the institution at hand (Arminen, 2005; Heritage and Clayman, 2010). As the institutional interaction in our case takes place in a digital environment, we lean on recent applications of research in video-mediated interaction (e.g., Arminen et al., 2016; Due and Licoppe, 2021) and pay analytical attention to the materiality of interaction (Nevile et al., 2014; Licoppe, 2017; Mondada, 2019). This enables us to discern how objects (including digital objects such as meeting memos) are made recognizably relevant to the ensuing talk-in-mediated-interaction, how they are used as situated resources of meeting interaction, and how they become the participants' practical interaction accomplishment (see Nevile et al., 2014). Our analytical interest was in how participants views were invited, receipted, and jointly formulated, both verbally and writing, when constructing the meeting memo. Using a microanalytic approach to analyzing video-mediated RTW negotiations allowed us to investigate the conventions of online interaction in depth, and to offer concrete evidence of how equal participation can be supported in this specific socio-material and digitally mediated context.

The analytic process first involved transcribing the recordings (see Appendix for abbreviations). We then watched the recordings, together with transcriptions, several times and identified all the sequences in which the meeting memo was relevant to the participants (e.g., sequences in which a participant's talk was written into the memo or any of the participants commented on the written text). After identifying the cases, we began to work with the collection in a data-driven way, comparing each single data extract against other segments of data. Next, focusing on the chair's ways of inviting participation and the others' ways of participating, we conducted a more specific analysis of their interactional resources for participating in the production of the memo. Next, we present six data examples to demonstrate the pattern we found in the data.

Results

Our results indicate that the way in which the meeting memo is produced in RTW negotiations plays a significant role in the participants' opportunities for participation. We present the results in two sections. First, we demonstrate how sharing the screen view to already written text enable participants to comment on and correct the text, reinforcing its joint approval. Second, we show how the involvement of the participants in co-producing memo texts allow the joint formulation of the publicly available form of the text. Through six data extracts we show that that achieving balanced participation (e.g., Collins et al., 2007) requires extra interactional effort in multiparty video-mediated negotiations.

Commenting and correcting the written text

In our data, we found two types of sequences in which the negotiation participants commented and corrected the text written by the clerk. These sequences were found in two interactional environments. In the first, the memo was written during the meeting discussion without sharing it with others. At the end of the negotiation, the clerk shared the screen view, and the chair invited each participant to verify the accuracy of the description written in the text. This type of request for approval, which was directed toward some specific participant, established a mutual understanding of the issues agreed on in the negotiations. Typically, they were, however, followed by only minimal approval, without almost any substantial contributions to the text. In the second, the participants self-selected themselves as the next speaker and proposed a correction to the written text. These corrections were infrequently found when the participants were verifying the accuracy of the description at the end of the negotiation, and when the memo was written online as the spoken interaction took place. By making a correction, the participants proposed substantial contributions to the text, but making such corrections required extra interactional work (Stommel et al., 2019) that hampered the progressivity of the negotiation.

We show first an example of a case in which negotiation participants are invited to verify the accuracy of the description that had already been written during the meeting. Extract 1 is taken from the end of the meeting. The occupational health nurse has written the memo during the meeting discussion, from the beginning to this point, without sharing it with the others. Now the nurse shows what they have written by opening a screen view displaying the text segment entitled “Employee's view of the situation”. The text reads: “The employee is willing to start their work trial on September first. The employee has suggested that when they return to work, they would no longer unload the deliveries because of the physical strain.” In the first lines of the extract, the physician is reading the text aloud as the employee, who is present in the occupational health facility, sits a part (due to the COVID-19 restrictions) and struggles to see the text on a screen.

EXTRACT 1

Extract 1. Case 2 22:42-23.02. hybrid meeting; P, physician; E, employee.

In all the extracts, the bold part corresponds to written text. The beginning and end of the writing activity is marked within the transcribed talk with ^* -symbol (see Appendix).

In lines 1–4, the physician goes through the written text, mainly reading the memo. As part of the memo concerns the employee's view of the situation, the physician directs their talk specifically to the employee, and thus recognizes the employee's primary epistemic access to their own experience (Heritage, 2013). First, when reading the part about the employee's willingness to do the work trial, the physician uses the second-person singular “you”, emphasizing that they are now taking the employee's views into account. Second, after reading the text, the physician directs the turn to the employee and asks if they have anything to add to or comment on the text (line 5). Following the structure of the polar yes/no question, the employee responds “no” and adds that the text is “good as it is” (line 6).

In sum, the employee is offered a sequential slot to comment on the accuracy of the description, thus establishing a mutual understanding of the employee's own view of the situation. In this way, the employee is given the possibility to participate in verification of the accuracy of the description in an already written text.

Next, we show two extracts how the participants self-select themselves as the next speaker and propose a correction to the written text. These corrections were initiated when some identifiable trouble occurred in the text. The “trouble” in this context refers to small-scale practical mistakes in the written task, or the selection of the correct words when the text concerned the views of a specific participant (e.g., “The employer's view of the situation”).

The next extract is taken from the same negotiation as Extract 1, and it shows a case in which a correction is suggested in the activity context in which the participants are reading through the memo at the end of the meeting. The extract demonstrates how proposing a correction is a delicate action also in this context, even though the participants are asked to “check through the memo and say if there is anything that needs fixing”. The occupational health nurse has acted as the clerk and written the memo. Right before the extract, the physician, acting as chair, has asked the nurse to share the memo on the screen. In the first lines, the physician reads through the basic information written at the beginning of the document, involving the employee's regular working hours (written as: “working hours in the contract 37 h/week”).

EXTRACT 2

Extract 2. Case 2 21:30-22:02 hybrid meeting. P, physician; N, nurse; M, manager; H, human resource manager.

Reading the text aloud (lines 1–4) provides participants a slot for evaluating the accuracy of the description. In line 5, the HR manager initiates the correction by pointing out incorrectly written information on screen (see Cekaite, 2009). They point out that the correct number of working hours in the employee's contract is 37.5 h, and not 37 h shown on the screen. The correction is presented with an epistemic downgrade, displaying hesitation toward their entitlement to make a correction. In this case, the correction focuses on the factual employment contract information, which can be considered as belonging to the epistemic domain of the HR manager.

Right after the suggestion, the physician minimally agrees (line 6) and the nurse, who has written the text, compliments the HR manager's correction (“good”, line 7). Next, the HR manager looks for the manager's reaffirmation and asks if their understanding is right (line 8). At the same time, the occupational health nurse makes the suggested correction to the text. The manager confirms (line 10), and the nurse scrolls the view of the memo to the first main title. At this point, when the correction sequence is seemingly ready, the HR manager returns to it. Now they explicitly propose making the correction (“let's fix it”, line 11), framing it as a joint matter. Then they account for making the correction, providing justifications: the error just “stood out” in the text. One-sided laugh particles interpolate the HR manager's turn, marking trouble and the delicacy of the interaction (e.g., Haakana, 2001; Potter and Hepburn, 2010). The other participants do not join in with the laughter, and the physician moves on into the next title on the screen.

To conclude, the extract shows the interactional delicacy related to correcting the text. Even though the “trouble” in the text belonged to the epistemic domain of the negotiation participant who initiated the correction, an un-invited correction seemed to require extra interactional work (Stommel et al., 2019) that hampered the progressivity of the negotiation.

Extract 3 exemplifies the delicacy of making the correction also in the activity context in which the memo was written online as the spoken interaction took place. In this negotiation, all participate online. The employee is using a mobile app which limits their access to the text on a screen. Prior to the extract, the employee has been describing their concerns about coping with an increased workload. The manager has stated that they should have two to four successful work weeks with the current work arrangements in place before they can make any new modifications to the employee's workload. In this case, the memo form, which was shared on the screen, had five sections: (1) The employee's view of the situation (2) The employer's view of the situation, (3) The occupational health professional's assessment of work ability, (4) Work modification options, and (5) Alternative work options. In the extract, the physician is writing the second section. The text, written right before the extract takes place, states: “In September return to work was planned so that first, the work would be supervising exams, no substituting. Can work e.g., in the library. Working days Mon, Tue, Thu and Fri so that Wed is a rest day. 2–4 successful adjusted work weeks should be completed before the return to normal work can be planned.” In the sequential environment in which the employee and physician are still discussing the employee's ability to cope, the manager initiates a correction to the text (line 2).

EXTRACT 3

Extract 3. Case 5 31:02-31:58 online meeting. P, physician; E, employee; M, manager.

The manager, in line two, initiates a new sequence, in which they display their access to the text, shared on the screen, by proposing a correction to it. By proposing a correction, the manager orients to themselves as a person who has the right to edit the text. It is important to note that the text the manager corrects is marked “Manager's view of the situation”. Thus, the manager may consider themselves entitled to correct the text that concerns their own view of the situation.

Regardless of this entitlement, several aspects in their turn indicate the delicacy of the corrective action. First, the manager makes a self-repair in line 2. The manager opens their turn politely “if I may” which is repaired into a more general request “is it possible to”, asking for the floor. Second, the manager describes their action as “nitpicking the wording” (line 2). As “nitpicking” can be understood as something applied to the design of the finalized text, the word choice downgrades the impression that they consider the errors in the text serious. “Nitpicking” is also said in a smiley tone of voice, further reinforcing the delicacy of the situation (e.g., Haakana, 2001). Third, the manager accounts for suggesting the correction (lines 4, 6–7, 10–11), establishing more symmetric positions between the participants (Antaki, 1994).

Although the manager frames their correction as “nitpicking”, and basically suggests adding just one word (“lightened”) into the text, they are actually proposing a substantial correction. From the manager's point of view, it is important to make all the work adjustments at the workplace visible. Incrementing the word “lightened” shows that the situation at work will not be normal even after a successful work trial. The employee's workload still needs to be “lightened”, meaning that the employee will not participate in all tasks “that belong to a teacher's normal work” (line 11). This requires extra arrangements at the workplace.

Immediately after the manager suggests the correction, the physician writes down the requested word “lightened” and also acknowledges the suggestion verbally (“mm”, line 5). Even if the correction has already been made, the manager orients toward their need to account for it. This continues until the physician, in lines 18 and 20, encourages the manager to tell them about any other needs for corrections. Overlapping with physician's talk, the manager immediately initiates another correction (line 21). Even though the manager has the physician's “permission” to suggest corrections, they still utilize several interactional resources to mitigate their action. The manager positions themselves as a teacher of the Finnish language, known as “nitpickers” in a culturally shared stereotype (line 21). Next, the manager suggests adding the daily working hours (“2–3 hours per day”) to the text. The employee minimally agrees (“mm”, line 25) and the physician corrects the text according to the manager's suggestion. At the same time as writing, the manager accounts for their correction, explaining and justifying it (line 26). At this point, in line 29, the employee topicalizes their limited access to the screen-share due to the use of a mobile app, and humorously claims that this restricts any “nitpicking” opportunities (lines 29 and 30). This humorous stance is shared by the physician (lines 31–32 and 36). The laughter shared by all three participants (lines 32–35) may also indicate that a mutual understanding has been reached and that the tension in the delicate situation is released (Kangasharju and Nikko, 2009). This is followed by the employee topicalizing the physician's task of writing the memo (line 39), invoking the physician to explain their writing practices (lines 40–43).

In sum, the manager proposed a correction to the text written by the physician. The proposed correction was directed at the text on the employer's view of the situation. Thus, although the manager had an epistemically grounded entitlement to make the correction (see Bolden, 2018), proposing it was marked as an interactionally delicate action. This delicacy seemed to considerably hamper the progression of the negotiations' interaction (Stivers and Robinson, 2006), invoking self-repairs, accounts, humor and laughter, fairly long explanations, and eventually the topicalization of the writing activity, even though the correction was unproblematically made directly after its suggestion.

To conclude, the already written memo text provided two types of possibilities for the participants to contribute. They were given an opportunity to approve the description provided in the text, and by this way to establish a mutual understanding of the issues agreed in the negotiation. These requests for approval were followed mainly by minimal agreement without almost any substantial contributions to the text. The participants were also able to make initiatives for correcting the text. In these cases, the participants proposed substantial contribution to the text, but proposing corrections required extra interactional work that hampered the progressivity of the negotiation.

Co-producing memo texts

In addition to providing participation opportunities for commenting and correcting the already written text, the memo texts were sometimes co-produced online by the negotiation participants. In all these cases, the occupational health physician, acting as chair and clerk, writes the meeting memo at the same time as the spoken interaction takes place. Guided by the structure of the memo form, the physician selects parts of the discussion, transforming it incrementally into a written, publicly available form (Nissi and Lehtinen, 2022). Staying close to what the participants are suggesting, there is no need for the participants to intervene on the text. Sometimes the physicians also explicitly invite meeting participants to take the initiative in the formulation of text, for instance, by downgrading the epistemic status of the physician as the producer of the text. This allows the participants not only produce the content to the text but also to formulate the publicly available form of the text.

We first show two extracts in which the physicians incrementally produce the text along the participants talk. Extract 4 is taken from a hybrid meeting where physician and employee are face-to-face and manager online. The physician shares the screen view which allows the manager to see the memo text. The employee is sitting aside the physician's desk and has only partial access to the screen view. Before the extract, the participants have been talking about work modifications. The employee, who works as a teacher, is to try working for a short period of time with cut hours, teaching only small groups of pupils. The memo, shared on the screen, has four sections: (1) Aim of the negotiation, (2) Present situation (employee's and employer's views), (3) Decisions, and (4) Follow-up. In the extract, the physician is writing the second section. In line 1, the physician, acting as chair and clerk, asks the employee to describe what they consider to be stressful at work.

EXTRACT 4

Extract 4. Case 1 12:37-13:30; hybrid meeting. P, physician; E, employee.

The physician's question invites the employee to give their own thoughts on what they think will be stressful when they return to work (lines 1–3). The employee responds by naming noise and sensory overload as the most stressful things (lines 4 and 5). Already overlapping with the employee's turn, the physician starts writing, designing the text to repeat what the employee has just said. The physician first writes “According to employee, noise and sensory overload”, then stops and asks a follow-up question on how the noise could be reduced (lines 8 and 9). As the text is not ready yet, there is a quite long opportunity for the employee to expand on their list. The physician produces laugh particles when asking the question, possibly orienting to the impossibility of reducing noise when working with a group of young children. The employee responds humorously (lines 10 and 11), and during the response, the physician writes down the rest of the sentence “are the most stressful”. Thus, the text is produced incrementally, along the lines of employee's answers.

In a multiparty context in which various participants present their own views, the physician often needs to balance between whose views are written down. Extract 5 is taken from the same negotiation as Extract 4, and it shows an example of a case in which the manager proposes a work modification, the employee disagrees, and the physician compromises by writing down both views in the form of a general recommendation. Here, the physician is writing the third section, entitled “Decisions”. Before the extract, the participants have been talking about ear protectors and the physician has written down the decision on acquiring them.

EXTRACT 5

Extract 5. Case 1 31:47-33:39; hybrid meeting. P, physician; E, employee; M, manager.

In the first lines (1–5), the manager initiates the new topic of recess. The manager initiates their turn with a recommendation (“you should think”, line 2) and then proposes two alternatives: to stay in a quiet classroom during recess (lines 3 and 4) or “to go somewhere else” (line 5), advising the employee to decide for themselves what feels best. This type of advice invites only a minimal confirmation from the participant, which the employee provides in line 7. In line four, while the manager is still formulating their turn, the physician initiates to write down the key words “during recess”. After the employee's minimal confirmation, the physician asks for information on how the employee has spent recesses in the past. The employee answers that they have only participated in few of them (after their sick leave) and the physician continues writing by designing the still uncompleted text entry as a recommendation “it would be good” (lines 11 and 12).

At this point (line 13), the employee continues with the particle “mutta” (“but”) and changes direction (Hakulinen et al., 2004, p. 1098). The employee states that the noise is less stressful outdoors, and that they can tolerate it better there than indoors (lines 13–21). In line 20, when the employee has already made their point, the physician continues writing and records the manager's viewpoint (the physician writes: “to go to a quiet place or outdoors”). The manager acknowledges the employee's diverging view (lines 22 and 23) and emphasizes again their right to choose what is best for them (lines 24 and 25). Thus, both the manager's viewpoint and the employee's diverging views are written into the memo in the form of a general recommendation.

In sum, the occupational health physician, acting as chair and clerk, incrementally produces the text by moving forward along the employee's and manager's negotiation and agreement. The text presents tiny portions of a content at a time and provides a syntactically complete structure relatively late. Thus, although at least the manager has access to the text through screen-share, they do not comment on the writing. Also, as the physician stays close to what the participants are suggesting, there is no need for the participants to intervene on the text.

Sometimes, however, the occupational health physicians, acting as a chair and clerk, involved meeting participants into the formulation of the text. This was often achieved by downgrading the epistemic status of the physician as the producer of the text. Extract 6 provides an example of this. The extract is taken from the same negotiation as Extract 3: all participate online but the employee is using a mobile app which limits their access to the text on a screen. In the extract, the participants are talking about possible work modifications. The memo form has five sections: (1) The employee's view of the situation (2) The employer's view of the situation, (3) The occupational health professional's assessment of work ability, (4) Work modification options, and (5) Alternative work modifications. In the extract, the physician is about to write the fourth section. The empty “slot” with entitled “Work modification option” is shared on the screen. This title is what the physician refers to in the first line.

EXTRACT 6

Extract 6. Case 5 29:08-29:59; online meeting. P, physician; E, employee; M, manager.

In the first line, the physician refers to the title of the memo on the screen (“so here's this”), reads it, and concludes that this is the topic the participants have already discussed during the meeting. By referring to the topic as something the participants have talked about together, the physician evens out the epistemic relations of the participants (Raymond and Heritage, 2006): All the participants have equal access to jointly discussed matters. The employee minimally agrees (line 4), and the physician starts to formulate the written text based on their prior talk. The physician hesitates and searches for the right wording (“somehow”, line 5), displaying a non-knowledgeable stance. Then, the physician writes, partially saying aloud (line 6) “The present work trial's job description is”. At this point, the physician stops and laughs, implying that the activity of proposing (or its non-fluency) is, in some respects, a delicate activity (Haakana, 2001). Next, the physician proposes if “as light as possible” would be suitable wording (line 8). By asking the participant's opinion, the physician is downgrading their own epistemic status as the producer of the text and supporting the participants take the initiative in producing the memo. As Mlynár (2023) has noted, this type of requesting assistance (Drew and Couper-Kuhlen, 2014) is endogenous to the activity of writing together. The request is further reinforced in line 9, when the physician asks the participants an open-ended question about how they think the text should be constructed.

Overlapping with the physician's talk, the manager takes a turn and proposes an altered version of the physician's suggestion. Both employee and physician minimally agree (lines 12 and 13) and the physician writes down the manager's suggestion (“modified to be as light as”). The employee also steps in and suggests adding the word “flexible” to the description (line 16). The physician writes down the employee's suggestion and they move on to the next subject.

In sum, the physician requests participants assistance, and downgrades physician's epistemic status as the producer of the text. In this way, they support the employee and manager to participate in collaborative formulation of the memo text, reinforcing its joint nature.

Discussion

In this article, we have examined how participants views were invited, receipted, and jointly formulated, both verbally and writing, when constructing the meeting memo in video-mediated RTW negotiations. The construction of memo provided diverging possibilities for participation in two different activity contexts. Sharing the screen view to already written text, enabled participants to comment on and correct the text, reinforcing its joint approval. Involvement of participants in co-producing memo texts allowed the participants not only produce the content to the text but also to formulate the publicly available form of the text. These practices for constructing the memo in and through the unfolding of interaction may be considered as enhancing more balanced participation. Although only one person is responsible for actual writing, the content and form of the text is co-produced and approved by all. Our findings also indicate that achieving the ideals of balanced participation (e.g., Collins et al., 2007) often require extra interactional effort in multiparty video-mediated negotiations. This is an important observation, as previous research has shown that the active participation of all those attending the meeting is a major success factor in RTW negotiations (Lappalainen et al., 2021).

In terms of participation, our study demonstrates the participants' practical challenges for producing, interpreting, and coordinating their joint actions through asymmetrical perspectives provided by the technology mediated communication channel (Heath and Luff, 2000; Büyükgüzel and Balaman, 2023). Especially, our study highlights the importance of the mutual visual accessibility to the screen view (Balaman and Pekarek Doehler, 2022; Ilomäki, 2022) and emerging production of text (Nissi, 2015). The online participants in our data only had access to the writing activity taking place on a screen, limiting their access to the embodied writing activity onsite. For the onsite participants in hybrid meetings, the embodied writing activity may have been observable, but they often lacked the access to the screen view. In Extracts 4, 5, we cannot be sure how well the employee, who is sitting aside the physician's desk, sees the memo texts the physician is writing. It may be that they refrain commenting on them due to their lack of access to the text. In Extracts 1, 2 this becomes clearly visible when the chair reads the text aloud to provide the access to the text for the employee. Also, in online meetings the access to the text may be limited. In Extracts 3, 6, the employee participated in the meeting with a mobile app which restricted their access to the text. In this case, the employee used this restricted access as an explanation for not interfering with the correction of text (Extract 3). Thus, the lack of mutually shared visibility may sometimes also be used for justifying the momentary disengagement of a hearer (Goodwin and Goodwin, 2004).

Suggesting corrections to the already written text (Extracts 2, 3) was marked as an interactionally delicate action. These corrections were designed to mark some trouble or insufficiency in the interaction (e.g., Potter and Hepburn, 2010). The hesitations, epistemic downgrades, one-sided laughter particles, and accounts seemed to hamper the progressivity of the negotiation interaction (Stivers and Robinson, 2006). It is also noteworthy that when the participants suggested corrections to the text, they were only initiated at moments in which the participant had an epistemically grounded entitlement to do so (see Bolden, 2018). In these moments, the physician wrote the text that concerned the view of the participant who made the correction (Extract 3). And finally, even when the correction concerned factual information belonging to the epistemic domain of a certain participant, these participants treated the correction as something they had to account for Extract 2. When the physicians specifically invited the participants to check the accuracy of the already written text (Extract 1) or contribute to the formulation of the text (Extract 6), this type of delicacy was not observed.

By proposing corrections, the participants also displayed their orientation toward the documentability (Nissi and Lehtinen, 2022) and public nature of the text, and its possible consequentiality for the participants after the meeting. As noted at the beginning of the article, the information written in the memo is used for deciding on vocational rehabilitation services and benefits, as well as occupational pensions. The participants also adhered to the RTW procedures written in the memo. This is why the exact formulations and “nitpicking” about one word (Extract 3) may be crucial for some participants. By agreeing with the formulations, the participants were committing themselves to the future actions documented in the text (Nissi, 2015). This type of “nitpicking” may hardly be possible if the participants are given the opportunity to read the memo only after the negotiation and they need to email their possible needs for corrections.

Considering the importance of the participants' opportunity to have their say when formulating the memo text, and the interactional challenges related to taking such turns, our findings highlight the significance of the role of the chair in providing opportunities to jointly produce the text. In video-mediated multiparty contexts, participants have limited possibilities to use the multiple resources (e.g., gaze direction) used in face-to-face interactions for negotiating who takes the next turn (Hjulstad, 2016; cf. Ristimäki et al., 2020). Thus, the chair needs to specifically provide the participants with opportunities to present their views (e.g., Weiste et al., 2020a). The physicians in our data supported the participants take the initiative in the production of the text, by asking for their approval of the text (Extract 1) and downgrading their own epistemic status as the producer of text (Extract 6) reinforcing the joint nature of the memo.

The strength of this study is its detailed micro-analytic view of the interactional patterns that can be observed in video-mediated multiparty meetings. However, it also has certain limitations. First, in terms of the negotiations being held via videoconferencing, our data contained both online and hybrid meetings. In the case of the hybrid meetings, a video-recorder was placed in the room in which two or more participants were present, face-to-face. For the online meetings, we only had the Teams recordings. Due to the COVID-19 restrictions and instructions, most of the participants onsite in the hybrid meetings used face masks and sat at a safe distance from each other, and this made finding the right camera angle complicated. Consequently, we had varying access to the non-verbal behavior of the participants in the different negotiations, which restricted systematic analysis of the multimodal resources that the participants used. In future, it would be important to study multimodal interaction in hybrid settings to provide more nuanced understanding of the interactional dynamics when participants' visual accessibility to the ongoing activity differ remarkably. Second, the relatively small number of negotiations (n = 5) in our data means that the interactional practices that we found for balancing participation through writing of a memo do not represent all the various RTW negotiations, let alone other comparable negotiations in healthcare systems. We had to exclude four of the meetings in our dataset from the analysis of this article, because the memos were written after the negotiation and emailed to the participants. We do not know if the participants in these cases responded to these emails or suggested any corrections to the texts. In our cases, the data were still comprehensive enough for us to be able to identify in detail the real-life interactional patterns through which the participants took part in producing the text.

On the basis of our findings, we argue that studies of the use of digital technologies in healthcare and rehabilitation should focus on the ways in which digital writing is part of the participants' situated institutional practice, intertwined with other forms of communication. Presumably, when the functionalities of digital client-accessible health records improve in the future in accordance with client-centered care and rehabilitation, the documents may be increasingly co-produced by clients and professionals. This means that clients will not only have access to the documents, but that they will also be able to participate their constitution, i.e., the content and final formulation of the text. In addition, screen sharing has become a conventional practice in video-conferencing, and enables the co-production of documents in various meetings in healthcare. Our findings indicate that access to the document is a prerequisite for participation in the production of text. The chair, or other facilitator of the meeting, needs to support participants take the initiative in its production. In this way, the documents can truly be written as joint endeavors, and provide a resource for balanced participation in healthcare.

Practical implications

Video-mediated negotiations make it possible for memos to be shared among all the participants and for them to write it collectively. However, in video-mediated contexts, taking turns and contributing to the writing of a memo may be challenging for the participants. As the chair of the meeting, the physician should be aware of this. It is important to discuss how the memo is jointly constructed at the beginning of the negotiation and to state that comments and corrections while the negotiation is still ongoing are permitted. It is also advisable to discuss how the memo will be used after the meeting (for instance, whether it is sent to the employer's occupational pension institution or the social insurance institution) so that the participants understand to check that the different stakeholders' responsibilities and obligations are described in sufficient detail.

During video-mediated negotiations, constructing the memo as a shared document requires conscious actions from the physician as chair. Occupational health physicians should offer the participants turns-of-talk to comment on and correct the already written text. By downgrading their epistemic status, physicians can facilitate the participants' involvement in the writing of the memo and reduce the extra interactional work that is otherwise required for contributing to the memo-writing in this context. By doing this, the physicians may support the participation and advance the goals of the different stakeholders acting in co-operation to promote the work ability of an employee.

Data availability statement

The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.

Ethics statement

The studies involving human participants were reviewed and approved by Ethics Committee of the Finnish Institute of Occupational Health (decision date: November 10 2021). The patients/participants provided their written informed consent to participate in this study.

Author contributions

EW, IK, and AK contributed to the conception and design of the study. EW organized the data collection, conducted the formal analysis, and wrote the first draft of the manuscript. The analysis was discussed together with EW, IK, AK, SP, ES, PJ-P, and JR. IK, AK, HK, SP, ES, PJ-P, and JR wrote sections of the manuscript. JR and SP did project administration and funding acquisition. All authors contributed to the manuscript's revision, read, and approved the submitted version.

Funding

This research was financially supported by the Finnish Work Environment Fund (grant numbers 210048 and 210158).

Acknowledgments

We gratefully acknowledge the important contribution of all the study participants and the organizations who took part in the research. We also thank occupational health physician Soile Seppänen from the Finnish Institute of Occupational Health for their valuable comments on the manuscript.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

References

Abe, M. (2020). Interactional practices for online collaborative writing. J. Sec. Lang. Writ. 49, 100752. doi: 10.1016/j.jslw.2020.100752

ORIGINAL RESEARCH article

Balancing participation in writing meeting minutes online in video-mediated return-to-work negotiations

Introduction

Return-to-work negotiation as an institutional context

Research question

Materials and methods

Results

Commenting and correcting the written text

Co-producing memo texts

Discussion

Practical implications

Data availability statement

Ethics statement

Author contributions

Funding

Acknowledgments

Conflict of interest

Publisher's note

References

Appendix

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