Understanding complex trajectories in health and social care provision

Allen, Davina; Griffiths, Lesley; Lyne, Patricia

doi:10.1111/j.0141-9889.2004.00426.x

Cited by 80 publications

(106 citation statements)

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“…It also enriched our understanding of the diverse and complex transitions and trajectories experienced by women with dementia and their families. Allen, Griffiths, and Lyne (2004) caution that residents' journeys and experience often reflect a series of false starts, blind alleys, and changes in direction. Notwithstanding our quantitative data that suggest a limited number of fairly clearly defined and predictable care trajectories, as families, we often experienced the system in this unpredictable and nonlinear way.…”

Section: Resultsmentioning

confidence: 99%

Janus at the Crossroads: Perspectives on Long-term Care Trajectories for Older Women With Dementia in a Canadian Context

Cloutier¹,

Penning

2016

GERONT

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Purpose of the Study: Janus, the two-faced, Roman god of beginnings and transitions, is used as a metaphor to explore our personal narratives and our quantitative research on the experiences of older women with dementia in long-term care (LTC). Two research questions are addressed: (a) How do our quantitative data map onto our mothers' experiences? (b) What lessons do our mothers' experiences offer for the care of older women with dementia? Design and Methods: Informed by a life-course perspective, we triangulate administrative data on 3,717 women with dementia receiving LTC in British Columbia, Canada, with personal narratives-the stories of our mothers who made the transition from home care into residential (nursing home) care. Results: Our quantitative data reveal that the home care to residential care transition is the most common LTC trajectory for women with dementia who are most likely to be widowed and living alone in suburban areas. On entry into residential care, they exhibit greater frailty in terms of activities of daily living, cognition, aggression, and incontinence. Our personal narrative data on our mothers reveals that the relatively straightforward pathways through LTC for women with dementia, are often considerably more complex in a real-world context. Attention is drawn to the public and private services, hospitalization patterns, and substantial communication gaps experienced by our moms and families. Implications: A life-course perspective, and qualitative and quantitative data facilitate understanding the care journeyshealth and service trajectories of older women with dementia. Writing over a decade ago about their mother's experience of nursing home care after a serious stroke, Kane and West (2005) argued that society appears uninterested in making the necessary commitment to care for frail older adults in creative, compassionate, and appropriate ways aligned with goals of quality of care and quality of life. In this special issue called, Aging-It's Personal, we explore this concern by triangulating data from our funded research program with our personal narratives describing our mothers' experiences as clients of the long-term care (LTC) system.As social gerontologists, we have spent much of our careers studying health service provision for vulnerable older adults. As adult children, we have recent personal and family-centered experience related to our mothers' care journeys as women who began their service trajectory in home care and continued on to become clients of residential (nursing home) care until their deaths. In thisThe Gerontologist cite as : Gerontologist, 2017, Vol. 57, No. 1, 68-81 doi:10.1093 Advance Access publication November 16, 2016 article, we employ the metaphor of Janus, the two-faced Roman god of beginnings and transitions, to explore how our personal and professional worlds have intertwined, affecting us indelibly as family members, sparking our research questions, and giving us a greater appreciation for the ways that care is navigated. We consider ...

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Section: Resultsmentioning

confidence: 99%

Janus at the Crossroads: Perspectives on Long-term Care Trajectories for Older Women With Dementia in a Canadian Context

Cloutier¹,

Penning

2016

GERONT

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“…As Strauss (1978) describes in his work on 'negotiated orders', organisational features serve to frame, but not determine, the interactions which take place (which, in this context, means the interactions which shape critical junctures and the longer trajectories within which they become incorporated). In their work on trajectories, with a view to better understanding what happens in the interactional 'black box' through which these are created Allen et al (2004) draw on game theory, looking to the numbers of people interrelating and their characteristics.…”

Section: Resultsmentioning

confidence: 99%

“…They are temporally bounded sequences of events and interactions which alter, in lasting ways, both the personal health and illness experience and the caring work which is done. As contingencies come to the fore and as choices are faced, for the individual with ill-health and those surrounding the critical juncture stands out from the day-to-day as a punctuation, initiating or taking place within a longer trajectory of care (Strauss et al, 1985;Allen et al, 2004;Hannigan and Allen, forthcoming). To the person already living with ill-health it may appear as a singular perturbation, contributing to the biographical disruption (Bury, 1982;Williams, 2000) associated with chronic illness.…”

Section: Understanding Critical Juncturesmentioning

confidence: 99%

“…In their study of the trajectories of people recovering from stroke, Allen et al (2004) show how these are shaped by the relative availability of resources. The resources which are open to people with health and social care needs, and the preparedness of workers to access and use these, are organisational contingencies (Strauss et al, 1985) likely to have a bearing on the direction a trajectory will take.…”

Section: Findings: a Critical Juncture Beginning With A Health Continmentioning

confidence: 99%

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Critical junctures in health and social care: Service user experiences, work and system connections

Hannigan

Evans

2013

Soc Theory Health

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This paper makes an original contribution through the revitalisation, refinement and exemplification of the idea of the 'critical juncture'. In the health and illness context a critical juncture is a temporally bounded sequence of events and interactions which alters, significantly and in a lasting way, both the experience of the person most directly affected and the caring work which is done. It is a punctuating moment initiating or embedded within a longer trajectory and is characterised by uncertainty. As contingencies come to the fore individual actions have a higher-than-usual chance of affecting future, enduring, arrangements. These ideas we illustrate with detailed qualitative data relating to one individual's journey through an interconnected system of mental health care. We then draw on observations made in a second study, concerned with the improvement of mental health services, to show how micro-level critical junctures can be purposefully used to introduce instability at the meso-level in the pursuit of larger organisational change. In addition to demonstrating why scholars and practitioners should pay closer attention to understanding and responding to critical junctures we are, therefore, also able to demonstrate how their emergence and impact can be examined vertically, as well as horizontally.

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“…Policymakers may be underestimating the degree to which systems of work are liable to develop in unpredictable and unmanageable ways (Allen et al, 2004). …”

Section: Introductionmentioning

confidence: 99%

Complexity and Change in the United Kingdom's System of Mental Health Care

Hannigan

Allen

2006

Soc Theory Health

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COMPLEXITY AND CHANGE IN THE UNITED KINGDOM'S SYSTEM OF MENTAL HEALTH CARE ABSTRACTIn the context of wider efforts to improve efficiency and the user-centredness of health and social care provision, public policy in the United Kingdom (UK) demonstrates an explicit appeal to 'whole systems' management. This otherwise laudable attempt to develop services may, however, reveal an underestimation by policymakers of how complex systems of work can evolve in unpredictable ways. In this paper we utilise sociological theories of the division of labour to underpin a wide-ranging case study of the historical evolution and current characteristics of the ecology of mental health care in the UK. Beginning with an analysis of the development of a system in which psychiatry emerged as the lead profession, and progressing to a review of the challenges faced by psychiatric knowledge and practice, we highlight the interrelated and dynamic features of this system of work. Our paper closes with an examination of contemporary 'modernisation', which we argue has the potential for triggering widespread system disturbance. KEYWORDSdivision of labour; health care policy; mental health services; modernisation; occupations; organisational characteristics 3 INTRODUCTIONBeginning with the insights of one of sociology's founding fathers (Durkheim, 1933), ecological theories of work have been developed and refined by successive generations of scholars (E Hughes, 1971;Abbott, 1988). In this paper we draw on ecological ideas which emphasise the world of work as a complex, dynamic and interrelated system to underpin a wide-ranging case study of the historical evolution and contemporary characteristics of mental health care in the United Kingdom (UK).Trends in UK health and social care policymaking make our paper both timely and of interest to commentators and practitioners not otherwise concerned with the mental health field. Emerging policy reveals a shift towards 'whole systems' thinking (see for example: NHS Modernisation Agency, 2005). This development is driven by an explicit focus on improving both service efficiencies and how the needs of service users are met.Policy action is directed at managing the provision of integrated services through the development of system technologies aimed at engineering closer interoccupational and interagency working. Examples include the creation of shared standards, such as the use of national service frameworks, national guidelines and the development of integrated care pathways. Favourable conditions are also being created for the emergence of new occupational groups and for the configuration of new types of care team. For example, policy has explicitly contributed to the appearance of new mental health worker roles in primary care, and to the creation of new interprofessional teams focusing on the provision of services (such as assertive outreach) to closely-defined groups of users. The new policy context has also fostered conditions in which service providers are able to create 4 new groups of workers,...

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Understanding complex trajectories in health and social care provision

Cited by 80 publications

References 19 publications

Janus at the Crossroads: Perspectives on Long-term Care Trajectories for Older Women With Dementia in a Canadian Context

Janus at the Crossroads: Perspectives on Long-term Care Trajectories for Older Women With Dementia in a Canadian Context

Critical junctures in health and social care: Service user experiences, work and system connections

Complexity and Change in the United Kingdom's System of Mental Health Care

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