A Case Study of Knowledge Management in Multiagency Consumer-Informed `Communities of Practice': Implications for Evidence-Based Policy Development in Health and Social Services

We report a study that facilitated and evaluated two multiagency Communities of Practice (CoPs) working on improving specific aspects of health and social services for older people, and analysed how they processed and applied knowledge in formulating their views. Data collection included observing and tape-recording the CoPs, interviewing participants and reviewing documents they generated and used. All these sources were analysed to identify knowledge-related behaviours. Four themes emerged from these data: (1) the way that certain kinds of knowledge became privileged and accepted; (2) the ways in which the CoP members transformed and internalized new knowledge; (3) how the haphazard processing of the available knowledge was contingent upon the organizational features of the groups; and (4) the ways in which the changing agendas, roles and power-relations had differential effects on collective sense making. We conclude by recommending ways in which the process of evidence-based policy development in such groups may be enhanced.

Involving consumers in assessing service quality: benefits of using a qualitative approach

Although important to users, practice standards rarely incorporate users' views of care provided. These views are a valuable source of information, even though there are limits to their value. To improve the standards of care in a 20 bed hospital elderly care unit caring for acute medical conditions a qualitative approach was used. Patients' and carers' perceptions of care and problems with the process of care in the unit were elicited with a specially designed semistructured interview schedule in 83 separate tape recorded interviews with a research nurse in patients' homes. In all, 50 patients and 35 carers were interviewed between 6 June 1991 and 28 May 1992. Of the 50 patients, 33 were female; seven patients were aged less than 80 years, 16, 80-85; 21, 86-90; and six over 90. A total of 16 patients lived with spouses or other carers, two with non-carers, and 32 lived alone, 18 of whom received informal care. Content analysis of the interviews disclosed patients' and carers' general satisfaction with individualised professional care and planning of follow up services on discharge but dissatisfaction in the lack of information about and involvement in treatment and care and about specific staff notes. These findings have prompted remedial changes in clinical practice in the unit; they have also formed the structure of a criterion based survey of practice. The authors conclude that the qualitative approach suited elderly users and also provided the basis for the findings to be incorporated into a continuous audit cycle through a process of feedback and standard setting.

Assessing the social support needs of visually impaired people: the impact of 'Community Care'

This paper reports on the first phase of a study examining the accessibility to visually impaired people of appropriate assessment and social support in the context of the implementation of the NHS and Community Care Act 1990. It describes how the 1992/93 and 1993/94 Community Care Plans, produced by local authority social services departments in collaboration with health and other agencies, discussed the needs of visually impaired people and the services available or planned to meet them, and how social services departments' community care assessment arrangements were set out in these plans. The findings suggest a lack of specific attention to the referral and assessment of visually impaired people. The system of certification and registration using Form BD8 seems not to have been integrated into the new 'generic' assessment arrangements for community care. The promise held out by 'community care' therefore seems, so far, not to have made a positive impact on the long-standing problems surrounding BD8 procedures and the low priority typically given to visual impairment.

The development of community based adult mental health services — a research contribution

The desire to provide care and services for people with mental health problems in a community context, rather than in large institutions, is a long-established feature of Government policy. In the more local context of the Portsmouth and South East Hampshire District Health Authority, a strategy of decentralising both the organisation and the delivery of services for adults with mental health problems began to be implemented early in 1986. Five multi-disciplinary area community mental health teams would work with and alongside other service-providers in their localities to provide a range of support, including residential, day and other community and domiciliary services.

Formalising partnerships: the changing role of voluntary organisations

The involvement of voluntary organisations in the provision of services for visually impaired people is of long standing. It was explicitly acknowledged in many of the Community Care Plans examined in phase 1 of a wider study (Lovelock, R. and Powell, J. with Craggs, S. Shared Territory: Assessing the Social Support Needs of Visually Impaired People. Joseph Rowntree Foundation, York, 1995) of how the social support needs of visually impaired people are being assessed in the context of the National Health Service (NHS) and Community Care Act 1990. This Paper discusses the current evolution of formalised partnerships between local authorities and voluntary agencies to provide help to visually impaired people, as these were being developed in the two local authority areas which were the subject of case studies in phase 2 of the research. The findings from these two case studies together identify issues which are relevant not only to the development of better services for visually impaired people but in the wider context of community care policy and practice. They indicate a need for some flexibility in contractual arrangements between purchasers and providers to ensure that the more 'simple' but nonetheless vital needs of visually impaired people are not 'prioritised out'. This requires a contract culture and actual contracts which are collaborative and obligational rather than competitive and adversarial.

Using a softer approach. Techniques for interviewing older people

1. There is an increasing population of older people, many of whom need health and social care. 2. It is important to obtain their viewpoints in order to provide services that meet their needs. 3. Consideration must be given to the way their views are obtained. 4. The information must be fed back to service providers.

Accessing an assessment of social support needs: perspectives on the process

This paper reports on the second phase of a study examining the accessibility to visually impaired people of appropriate assessment and social support in the context of the implementation of the National Health Service (NHS) and Community Care Act 1990. It draws upon interviews with visually impaired people who have recently experienced an assessment, with relatives or other people giving them significant informal support and with front-line workers who assessed their needs.