Facilitating participation: a health action zone experience

Abstract

Partnership working, engagement and participation of service recipients and providers are issues at the core of UK and international health and social care policies. Although always considered desirable, recent legislation makes this practice a legal imperative in England. However, the operationalization of the concepts pose a number of challenges. This paper draws on evaluative data to examine how these concepts were addressed within one of the largest health action zones (HAZ) in England. The research took a generative perspective and was intended to promote learning, deepen understanding, model actions and consequences, and to provide a guide to decision making. Three approaches of theories of change, pluralistic evaluation and soft systems methodology were combined in the research design. Data was collected through 39 individual tape-recorded interviews with people involved with HAZ at both strategic and operational levels. The findings allowed partnership and engagement activity to be categorized into two domains, those that led to entrenchment in old practices and those that facilitated engaging with a partnership and community involvement ethos. By making the facilitating and inhibiting variables more explicit, the potential for working to a partnership philosophy is enhanced.

Front-line perspectives on ‘joined-up’ working relationships: a qualitative study of social prescribing in the west of Scotland

“…Although this may affect the transferability of the findings, the tensions of collaborative working between statutory sectors and the third sector are well documented (Carr et al . ).…”

“…Without lines of effective communication, it is unlikely that the shared understandings necessary for the formation of a co‐operative relationship will develop (Carr et al . , Casey ).…”

“…Network ties enable the development of the processes of trust and communication (Carr et al . , Silk ). Trust relations are built through inter‐personal interaction.…”

A review of the recent contribution of systems thinking to operational research and management science

“…Complexity theory has also been used in the context of health care (Holden 2005;Tan et al 2005) and disease classification (Loscalzo et al 2007). Problem structuring methods (PSMs) have also often been applied (Midgley 2006), for example: SSM has been used to improve participation in Health Action Zones (Carr et al 2006), to evaluate complex interventions (Rose and Haynes 1999) and to help develop simulation models in health care (Kotiadis and Mingers 2006b;Lehaney and Paul 1996c); the Viable Systems Model (VSM) was used to diagnose problems with the organisational structure of an American hospital (Keating 2000); and critical systems thinking was used to examine the politics of waiting lists (Foote et al 2002).…”

Change and improvement 50 years in the making: a scoping review of the use of soft systems methodology in healthcare

“…The remaining studies had applied SSM to knowledge management improvements ( n = 3, 6.1%), for intervention/program/care model evaluation ( n = 3, 6.1%), to analyse/improve practice development ( n = 3, 6.1%), and to analyse/improve teamwork ( n = 2, 4.1%). Eight studies (16.2%) took to SSM for other purposes that could not be sorted into any of the categories, e.g., to explore the development of specialist staffing [ 39 ] and to examine community partnership, engagement and participation [ 40 ]. All the problem situations to which SSM was applied are described in Additional file 2 .…”