Researching the integration of disparate practices : a case study of policy and practice change in health and social care

Integration of working practices has been promoted by successive governments as a means of service improvement in a variety of contexts in health and social care and the term 'integration' has become a seductive, popularized and overused signifier. The rhetoric and conceptualization of integration as a working practice appears to be based on confused and contested notions of what a practice is, thus serving to undermine both the fundamental principles relating to professional learning, values and identity as well as the (ontological and epistemological positions which inform them. Using a theory of change approach to evaluation, (Weiss 1995, 1998; Chelimsky,1997) that combines mixed methods for data collection, including some interviews, observations and a case file study (Thorpe & Thorpe 1992; Thorpe 1994) of recorded practice outcomes for service users in pre and post integration comparative periods, this case study (Stake, 1981; 2006) explores the process of implementation of integrated care practice through the comparison of four sites within one Local Authority area. This study focuses on the whole process of change in this practice context, including: the development of national (macro) policy promoting integrated working; the interpretation of that policy at the strategic (meso) organisational level and the operattonalisation of the concepts, enacted at micro level. The first part of this thesis is concerned with setting the scene and presenting the context and issues that form the basis of the study. The middle part presents some explanatory frameworks, derived from Social Practice Theory, that are applied to the issues emerging from the data in order to develop an understanding of how chang~ is represented, symbolised and enacted in particular clusters of practice. The final part constitutes a discussion of the findings and the development of typologies of integrated practice that are used to develop a continuum of integrative practice that may assist in identifying how to unlock practices that have become stuck and unable to respond to the call for change. The thesis concludes with some observations on the applicability of this method to other contexts of complex change activity.EThOS - Electronic Theses Online ServiceGBUnited Kingdo