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.
People |
ORCID iD |
| Mervyn Conroy (Principal Investigator) |
| 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 | 2011 |
| Sector | Communities and Social Services/Policy,Financial Services, and Management Consultancy,Healthcare,Government, Democracy and Justice |
| 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 |
| 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' (1981) contains 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-goods-practices-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. Virtue ethics in this form can be viewed as building on 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. Using a virtue continuum lens we mapped stories of connected communities from our workshop participants (Figure 1 - see the URL) Within the workshop from the first study (and in the data from the PMC study) we have examples of practice which counters policy and practice impositions. 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 to consolidate 15 virtues from the narratives of 131 medical community participants. |
| 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 disrupted. 'Phronesis and the Medical Community' has used and built on this virtue continuum model and has captured 15 VCs that were conveyed in the stories from the 140 participants. |
| 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 Manchester |
| Department | Department of Social Policy and Social Work |
| Country | United Kingdom |
| 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/ Professor Robin Miller, Head of Department, Social Work & Social Care and Co-Director, Centre for Health & Social Care Leadership has taken up a Co-I role and agreed to collaborate on a Bilateral Anglo-German comparative study of 'Inter-Professional Phronesis' in mental health services as part of a new submission to the AHRC. |
| Start Year | 2011 |
| Description | The Phronesis Foundation and University of Warwick Medical School |
| Organisation | University of Warwick |
| Department | Warwick Medical School |
| Country | United Kingdom |
| Sector | Academic/University |
| PI Contribution | We have co-produced two more research proposals as a follow on to the original AHRC funded Phronesis and the Medical Community awards: 1) AHRC Standard Researcher Led Call - 2) NIHR HS&DR |
| Collaborator Contribution | They have been fully involved in the proposals' design and writing of the two proposals: AHRC Standard Call: Phronesis and Mental Health (MH) Inter-Professional Ethical Decision-Making NIHR HS&DR 135058 Research Proposal: To better engage children and young people (CYP) associated with the care system with support to improve their mental health (MH): How might an understanding of the role of CYP narratives in interprofessional decision-making lead to better engagement by CYP in MH care and support processes? |
| Impact | Both the above proposals were submitted to earlier calls in 2021 to the same funders and feedback received from peer reviewers. All that feedback has been incorporated and we are now about to submit for the latest round of these calls. |
| Start Year | 2020 |
| Title | Virtue Continuum Model for mapping the stories of communities working together to bring successes |
| Description | This discovery was originally made in a previous study that the PI completed in 2012 for the AHRC and it has now been developed in the PMC project. The discovery is described in previous sections. |
| IP Reference | tba |
| Protection | Patent application published |
| Year Protection Granted | 2011 |
| Licensed | No |
| Impact | The original study 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. The initial pilot for the PMC project again indicates this to be a useful model for practitioners to understand and apply to their discipline. |
| 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 Phronesis and the Medical Community project has used 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 22 March 2018. |
| URL | http://www.ahrc.ac.uk/documents/project-reports-and-reviews/connected-communities/connected-health-a... |
| Company Name | The Phronesis Foundation (TPF) Community Interest Company (CIC) |
| Description | TPF is now a fully registered not for profit research spin out CIC operating as a hybrid: research and application. It provides professional education, CPD and one-to-one coaching to suit your requirements and time availability. As part of the package, we have an app and a film series that make the learning process enjoyable and easy to access either face to face or online. Once you have taken part in a train the trainer programme, you will also be able to use the resources to run training for others in your organisation. TPF can also provide the research and development to produce bespoke resources for your practice whether that be in the healthcare sector or any other sector. |
| Year Established | 2021 |
| Impact | Still awaiting approval for the CC to set up the charity. |
| Website | https://www.thephronesisfoundation.com |
| Company Name | PHRONESIS RESEARCH AND DEVELOPMENT LTD |
| Description | This company is a trading subsidiary of The Phronesis Foundation CIC and managed all the commercial side of the spin out activity until the CIC was fully registered in September 2021. A request for this company to be closed down has was sent to companies house in February 2022. |
| Year Established | 2021 |
| Impact | This company was used to contract with the RCGP so those impacts relating to that initial collaboration in 2021 are applicable here. |
| Website | https://find-and-update.company-information.service.gov.uk/company/13220245 |
| 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... |