Connected Health and Social Care Communities

Lead Research Organisation: University of Cumbria
Department Name: Faculty of Health and Wellbeing

Abstract

In the context of service integration and development, communities in Health and Social Care require interrogation: analysis enables identification of community in relation to governance, professional practice and user/citizen constituencies. Knowledge, understandings and identities within different communities need recognition if cross-community engagement and development work is to be undertaken; those who themselves cross communities or identify with multiple health and social care communities may be valuable 'connectors', in either formal or informal roles. In contrast to predominant theories in organisational studies (e.g. functionalist; social learning), humanities offers the lens of virtue ethics with which to examine connectedness in communities and change over time. Workshop activity found that whilst policy can be disruptive of pre-existing communities in health and social care, communities can respond, to affirm their purpose and seek joint understandings of purpose with others. Future research should explore how communities in health and social care respond to changing circumstances, and what factors influence whether community forms and capacity are enabled or threatened by policy and practice developments.

Publications


10 25 50
 
Description The seminar suggested that the virtue continuum model was helpful to participants in
understanding connectedness of the health and social care community as a set of continuums. Participants talked about "moving
from the orange to the blue" and vice versa. It seemed to give them a way of expressing
their social reality of connectedness when working on projects together. Notable by their absence,
both in the workshop and feedback seminar, were accounts of sacred/profane or
moral/immoral continuums which is arguably consistent with MacIntyre's thesis that the
resources to maintain such ethical debates have become disrupted.
Exploitation Route Recommendations for future research:
Navigators and 'reticulists'
Research should identify opportunities for and barriers to community development,
foregrounding people"s lived conceptions of community. Multiple community
memberships, cross-community engagement, and the experience of managing different
identities in different communities (incorporating lay, political or professional health and
social care perspectives) should be priorities in future research. The developing research
focus on community/care navigators in the UK should be expanded to incorporate citizen
navigators (engaging with multiple H&SCCs in a personal capacity), formal (paid and
voluntary) navigators (engaged to link people of their own personal communities with
services), and professional navigators ("reticulists" who are able to enter different health
and social care policy/service realms and engage positively in different structural and
cultural environments).
Policy for generative health and social care communities?
The ways that communities transmit their practice ethics (MacIntyre, 1985) and support
membership generativity (i.e. their contribution to future generations of their material
creations, knowledge and culture: Imada, 2004) require research, policy and practice
attention, particularly when models of delivery are experiencing rapid change. By way of
example, the recent white paper (Department of Health 2010) issued under the Coalition
government presents a solution to the challenge of cost savings which is inherently
structural functional: removing layers of "bureaucracy" (SHAs and PCTs) and handing
responsibility for the commissioning of healthcare to new structures (GP Consortia). A
CoP lens shows the potential for shared learning and knowledge bonds being lost.
MacIntyre"s lens presents an even more disturbing loss, of practice ethics that build over
time in any community: the generational handing down of practice knowledge and ethics
is highly likely to be disrupted as we have seen previously, in mental health services
(Conroy, 2010).
Future research should explore how organisational, practice and user/citizen
communities which engage in health and social care respond to change, and what factors
influence whether community forms and capacity are enabled or threatened by policy
and practice developments.
Complexities of connectedness
Further research should contribute to our understanding of how health and social care
policy implementation impacts on communities" lived-experience, health and well being.
This paper offers a "connected continuum" model, based on MacIntyre"s virtue ethics
(1985), which has been shown to be helpful in understanding more about the complexity
of connectedness and its relationship to health and wellbeing and which has potential for
application with other communities.
Sectors Communities and Social Services/Policy,Education,Environment,Healthcare,Government, Democracy and Justice
URL http://www.ahrc.ac.uk/documents/project-reports-and-reviews/connected-communities/connected-health-and-social-care-communities/
 
Description I use the findings in teaching with my post-graduate students who are all managers, leaders or clinicians in the health and social care sector to help them improve their practices. The findings are also currently being used by doctors in my latest project 'Phronesis and the Medical Community' to gain a better understanding of their ethical decision making. The virtue continuum model helps them reflect on their practice and what they need to take into account before making an ethical decision which could have a life or death impact on one or more patients.
First Year Of Impact 2012
Sector Communities and Social Services/Policy,Healthcare
Impact Types Societal,Policy & public services
 
Description Workshop influence on policy makers
Geographic Reach Local/Municipal/Regional 
Policy Influence Type Influenced training of practitioners or researchers
Impact Workshop impact: Using a virtue continuum lens we mapped stories of connected communities from our workshop participants (see Figure 1 in the report at the URL). Within the workshop we heard examples of practice which countered policy and practice impositions perceived as potentially disruptive of communities by pre-defining the terms of engagement: the focus was the incremental development of working relationships within and across communities, engaging with the learning in communities and seeking to develop a common purpose. Feedback Seminar impact: The seminar suggested that the above theorising was helpful to participants in understanding connectedness as a set of continuums. Participants talked about "moving from the orange to the blue" and vice versa. It seemed to give them a way of expressing their social reality of connectedness when working in H&SCCs. Notable by their absence, both in the workshop and feedback seminar, were accounts of sacred/profane or moral/immoral continuums which is arguably consistent with MacIntyre"s thesis that the resources to maintain such ethical debates have become disrupted.
URL http://www.ahrc.ac.uk/documents/project-reports-and-reviews/connected-communities/connected-health-a...
 
Description Connected Communities
Amount £860,000 (GBP)
Funding ID RRBO18360 
Organisation Arts & Humanities Research Council (AHRC) 
Sector Public
Country United Kingdom of Great Britain & Northern Ireland (UK)
Start 05/2015 
End 05/2018
 
Title Scoping Review, workshop and feedback seminar using 'Virtue Continuum Model' developed as part of the research 
Description The scoping review mapped out: Conceptualisations and meanings of 'community' in health and social care: what is being invoked by "community" in the health and social care domain? Personalisation and health and social care communities: what is the relationship between personalised policy and practice, and communities? Connectivity within and between health and social care communities in the context of policy: how does connectivity function in changing governance and user community contexts? In order to apply the theoretical lens afforded by MacIntyre (1981) it becomes important to understand the notion of virtue as a mean growing out of engagement with that practice, not predefined. Any community needs rules or an ethos to hold it together: Aristotle in Nichomachean Ethics (1958) suggests a set of virtue continuums (Courage, Generosity, Magnificence, Pride, Anger, Truth and Indignation). MacIntyre was careful to avoid such definitions, and we therefore allowed the accounts from our workshop practitioners to define the virtues of connectedness in H&SCCs. Using a 'virtue continuum' lens we mapped stories of connected communities from our workshop participants (Figure 1 - see the URL report). Within the workshop we heard examples of practice which countered policy and practice impositions perceived as potentially disruptive of communities by pre-defining the terms of engagement: the focus was the incremental development of working relationships within and across communities, engaging with the learning in communities and seeking to develop a common purpose. The methods used were: Literature review: examining knowledge and debate concerning "communities" in health and social care. Networking/Collaborative Activity: 1. Workshop learning event to identify key communities in the lived experience of participants to inform the literature review. 2. A seminar event with invited participants to present findings and identify future directions in "health and social care communities" research. 
Type Of Material Improvements to research infrastructure 
Year Produced 2015 
Provided To Others? Yes  
Impact The seminar suggested that the theorising (virtue continuum model) was helpful to participants in understanding connectedness as a set of continuums. Participants talked about "moving from the orange to the blue" and vice versa. It seemed to give them a way of expressing their social reality of connectedness when working in H&SCCs. Notable by their absence, both in the workshop and feedback seminar, were accounts of sacred/profane or moral/immoral continuums which is arguably consistent with MacIntyre's thesis that the resources to maintain such ethical debates have become disrupted. 
URL http://www.ahrc.ac.uk/documents/project-reports-and-reviews/connected-communities/connected-health-a...
 
Title Virtue Continuum Model 
Description MacIntyre"s colossal body of writing on ethics that positions his mid career thesis After Virtue (1985) contain very strong arguments of what we have lost in our understanding of community and societal connections. That loss is of shared virtues which operate through practice in service of wellbeing for all in society. In MacIntyre"s virtues-goodspractices-institution schema (Moore and Beadle 2006) practice excellence offers rewards for practitioners and citizens (internal goods), binds practitioners in one practice group together, binds different practice groups together across institutional boundaries and further still binds people across sectors in any given community. The theory encompasses dynamic development of community connections by members who are continually clarifying their personal aims by meshing with collective aims in a way that serves the wellbeing of all in society. VE can be viewed as building on SF and social learning theories to encompass the ethical connections between all practitioners in any given society regardless of discipline. The way MacIntyre envisages the collective relationship of practices, the narrative of the institution and their potential disruption is summarised by McCann and Brownsberger (1990) who stress the centrality of telos (purpose) to human life. Disruption may involve loss of a shared sense of telos and a corresponding lack of agreement concerning social practices and the virtues that underpin them. For MacIntyre (1985) disruption and corruption derive more often than not from an (individual or collective) bias in focus on external goods (money, status and power) rather than on internal goods. Workshop illustration: virtue as a mean In order to apply the theoretical lens afforded by MacIntyre it becomes important to understand the notion of virtue as a mean growing out of engagement with that practice, not predefined. Any community needs rules or an ethos to hold it together: Aristotle in Nichomachean Ethics (1958) suggests a set of virtue continuums (Courage, Generosity, Magnificence, Pride, Anger, Truth and Indignation). MacIntyre was careful to avoid such definitions, and we therefore allowed the accounts from our workshop practitioners to define the virtues of connectedness in H&SCCs. Using a virtue continuum lens we mapped stories of connected communities from our workshop participants (Figure 1 - see the URL). Within the workshop we heard examples of practice which countered policy and practice impositions perceived as potentially disruptive of communities by pre-defining the terms of engagement: the focus was the incremental development of working relationships within and across communities, engaging with the learning in communities and seeking to develop a common purpose. The virtue continuum model has been developed in the subsequent 'Phronesis and the Medical Community' award 
Type Of Material Data analysis technique 
Year Produced 2015 
Provided To Others? Yes  
Impact The seminar suggested that the model was helpful to participants in understanding connectedness as a set of continuums. Participants talked about "moving from the orange to the blue" and vice versa. It seemed to give them a way of expressing their social reality of connectedness when working in Health and Social Care Communities. Notable by their absence, both in the workshop and feedback seminar, were accounts of sacred/profane or moral/immoral continuums which is arguably consistent with MacIntyre"s thesis that the resources to maintain such ethical debates have become disrup 
URL http://www.ahrc.ac.uk/documents/project-reports-and-reviews/connected-communities/connected-health-a...
 
Description Collaboration between Health Services Management Centre and Department of Social Policy and Social Work at University of Birmingham 
Organisation University of Birmingham
Department School of Education
Country United Kingdom of Great Britain & Northern Ireland (UK) 
Sector Academic/University 
PI Contribution Three main activities were carried out in partnership: 1) Scoping review 2) Literature review: examining knowledge and debate concerning "communities" in health and social care. 3) Networking/Collaborative Activity:
Collaborator Contribution The scoping review mapped out: Conceptualisations and meanings of 'community' in health and social care: what is being invoked by "community" in the health and social care domain? Personalisation and health and social care communities: what is the relationship between personalised policy and practice, and communities? Connectivity within and between health and social care communities in the context of policy: how does connectivity function in changing governance and user community contexts? The methods used were: Literature review: examining knowledge and debate concerning "communities" in health and social care. Networking/Collaborative Activity: 1. Workshop learning event to identify key communities in the lived experience of participants to inform the literature review. 2. A seminar event with invited participants to present findings and identify future directions in "health and social care communities" research.
Impact Conroy, M, Clarke, H. & Wilson, L. (2012) Connected Health and Social Care Communities. AHRC final report http://www.ahrc.ac.uk/documents/project-reports-and-reviews/connected-communities/connected-health-and-social-care-communities/
Start Year 2011
 
Title Virtue Continuum Model for mapping the stories of communities working together to bring successes 
Description In order to apply the theoretical lens afforded by MacIntyre it becomes important to understand the notion of virtue as a mean growing out of engagement with that practice, not predefined. Any community needs rules or an ethos to hold it together: Aristotle in Nichomachean Ethics (1958) suggests a set of virtue continuums (Courage, Generosity, Magnificence, Pride, Anger, Truth and Indignation). MacIntyre was careful to avoid such definitions, and we therefore allowed the accounts from our workshop practitioners to define the virtues of connectedness in H&SCCs. Using a virtue continuum lens we mapped stories of connected communities from our workshop participants (Figure 1 - see the URL report). Within the workshop we heard examples of practice which countered policy and practice impositions perceived as potentially disruptive of communities by pre-defining the terms of engagement: the focus was the incremental development of working relationships within and across communities, engaging with the learning in communities and seeking to develop a common purpose. 
IP Reference  
Protection Protection not required
Year Protection Granted 2011
Licensed No
Impact The seminar suggested that the above theorising was helpful to participants in understanding connectedness as a set of continuums. Participants talked about "moving from the orange to the blue" and vice versa. It seemed to give them a way of expressing their social reality of connectedness when working in H&SCCs. Notable by their absence, both in the workshop and feedback seminar, were accounts of sacred/profane or moral/immoral continuums which is arguably consistent with MacIntyre's thesis that the resources to maintain such ethical debates have become disrupted.
 
Title Virtue Continuum Model 
Description The seminar suggested that the virtue continuum model was helpful to participants in understanding connectedness as a set of continuums. Participants talked about "moving from the orange to the blue" and vice versa. It seemed to give them a way of expressing their social reality of connectedness when working in H&SCCs. Notable by their absence, both in the workshop and feedback seminar, were accounts of sacred/profane or moral/immoral continuums which is arguably consistent with MacIntyre"s thesis that the resources to maintain such ethical debates have become disrupted. This model is now being used in the 'Phronesis and Medical Community' which is a follow on project (Conroy et al 2015) focusing on doctors and ethical decision making. This research aims to answer what it means to doctors to make good ethical decisions. 
Type Health and Social Care Services
Current Stage Of Development Refinement. Clinical
Year Development Stage Completed 2016
Development Status Under active development/distribution
Clinical Trial? Yes
UKCRN/ISCTN Identifier AHRC Grant (RRBO18360)
Impact The seminar suggested that the model was helpful to participants (policy makers, practitioners and researchers) in understanding connectedness as a set of continuums. Participants talked about "moving from the orange to the blue" and vice versa. It seemed to give them a way of expressing their social reality of connectedness when working in Health & Social Care Communities. Notable by their absence, both in the workshop and feedback seminar, were accounts of sacred/profane or moral/immoral continuums which is arguably consistent with MacIntyre"s thesis that the resources to maintain such ethical debates have become disrupted.The It is early days on the Phronesis and the Medical Community project but we are already using the model to analyse the data and will be presenting it as an intervention as part of the early findings at the next workshop on 6 April 2017. 
URL http://www.ahrc.ac.uk/documents/project-reports-and-reviews/connected-communities/connected-health-a...
 
Description Engagement Activity: 1. Workshop learning event to identify key communities in the lived experience of participants to inform the literature review. 2. A seminar event with invited participants to present findings and identify future directions in "health and social care communities" research. 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact Identities, ascribed identities and the role of organisations in defining community/ies
were central to discussion. The value of the "reticulist" (who can carry knowledge and
understanding between communities) was posited, recognising that knowledge and
cultures in different sites requires acknowledgement and understanding. Change over
time and increased barriers around communities (e.g. practice-based; service-user
group) were identified as linked to resources and competition. Concerns included
marginalisation and restriction of engagement through top-down definitions of
community.

Top-down versus citizen-led approaches to community building were discussed:
health/patient-focused ascriptions of community membership were viewed as having a
narrower "vulnerability" focus and individualising impact, whilst a wider community
development remit was seen as more empowering, encompassing more citizens, and
involving wider influencers on well-being (e.g. housing). Whilst community building
with/by citizens in the health and social care arena was viewed positively as a balance
against consumer-based engagement, there was concern that individuals in communities
who can mobilise themselves will fare better, risking strengthening inequalities.
Individuals who belong to local communities acting as "connectors" between structures
and citizens were seen as a potentially inclusive model: this was explored in the
literature following the workshop, and reflects developing "community navigator" practice
in the UK (e.g. Care Navigators: Turning Point, 2010; Bruce et al 2011).

In order to apply the theoretical lens afforded by MacIntyre it becomes important to
understand the notion of virtue as a mean growing out of engagement with that practice,
not predefined. Any community needs rules or an ethos to hold it together: Aristotle in
Nichomachean Ethics (1958) suggests a set of virtue continuums (Courage, Generosity,
Magnificence, Pride, Anger, Truth and Indignation). MacIntyre was careful to avoid such
definitions, and we therefore allowed the accounts from our workshop practitioners to
define the virtues of connectedness in H&SCCs. Using a virtue continuum lens we
mapped stories of connected communities from our workshop participants (Figure 1 in the report at the URL).

Within the workshop we heard examples of practice which countered policy and practice
impositions perceived as potentially disruptive of communities by pre-defining the terms
of engagement: the focus was the incremental development of working relationships
within and across communities, engaging with the learning in communities and seeking
to develop a common purpose.

The seminar suggested that the above theorising was helpful to participants in
understanding connectedness as a set of continuums. Participants talked about "moving
from the orange to the blue" (see figure 1 in the report at the URL) and vice versa. It seemed to give them a way of expressing
their social reality of connectedness when working in H&SCCs. Notable by their absence,
both in the workshop and feedback seminar, were accounts of sacred/profane or
moral/immoral continuums which is arguably consistent with MacIntyre"s thesis that the
resources to maintain such ethical debates have become disrupted.

The ways that communities transmit their practice ethics (MacIntyre, 1985) and support
membership generativity (i.e. their contribution to future generations of their material
creations, knowledge and culture: Imada, 2004) require research, policy and practice
attention, particularly when models of delivery are experiencing rapid change. By way of
example, the recent white paper (Department of Health 2010) issued under the Coalition
government presents a solution to the challenge of cost savings which is inherently
structural functional: removing layers of "bureaucracy" (SHAs and PCTs) and handing
responsibility for the commissioning of healthcare to new structures (GP Consortia). A
CoP lens shows the potential for shared learning and knowledge bonds being lost.
MacIntyre"s lens presents an even more disturbing loss, of practice ethics that build over
time in any community: the generational handing down of practice knowledge and ethics
is highly likely to be disrupted as we have seen previously, in mental health services
(Conroy, 2010).

Future research should explore how organisational, practice and user/citizen
communities which engage in health and social care respond to change, and what factors
influence whether community forms and capacity are enabled or threatened by policy
and practice developments.

Further research should contribute to our understanding of how health and social care
policy implementation impacts on communities" lived-experience, health and well being.
This paper offers a "connected continuum" model, based on MacIntyre"s virtue ethics
(1985), which has been shown to be helpful in understanding more about the complexity
of connectedness and its relationship to health and wellbeing and which has potential for
application with other communities.
Year(s) Of Engagement Activity 2011
URL http://www.ahrc.ac.uk/documents/project-reports-and-reviews/connected-communities/connected-health-a...