Interpersonal relationships and policy workarounds: Using theories of practice to examine patient transitions from hospital to home

Each day over the next week I’ll post up an abstract for a paper being presented by a member of the Critical Physiotherapy Network at the In Sickness and In Health conference in Mallorca in June 2015.  (You can find more information on the conference here.)

Interpersonal relationships and policy workarounds: Using theories of practice to examine patient transitions from hospital to home

By Jay Shaw, Pia Kontos, Wendy Martin and Christina Victor

The advancement of neo-liberal policy initiatives and large-scale austerity measures has created intense challenges for health and social care systems around the world. This is particularly the case in England, where the National Health Service has recently undergone a complete reorganization in neo-liberal, privatizing directions. These efforts to cut costs in the publicly funded system have material consequences for efforts to develop integrated models of health and social care, with the risk of adversely and disproportionately affecting those with less social and economic support in the community. In this paper, we report on the findings of an ethnographic case study of patient transitions from hospital to home, a “paradigm case” for integrated care. We focus on the ways in which these broad contextual and policy forces impact efforts of health and social care practitioners to practice in more integrated ways.

The case study took place in a large urban health region in London, England. Drawing on 31 non-participant observations of discharge planning meetings in a large urban hospital, 30 interviews with administrators, practitioners, and patients/families, and a document analysis of 3 key policies, we show how practitioners and leaders sought to systematically work around policy barriers in order to provide more integrated care for patients. Drawing on the practice theories of Pierre Bourdieu and Michel Foucault, we describe the enactment of interpersonal relationships between practitioners that enabled such “policy workarounds” in everyday practice. We then draw on our data to redress the lack of attention to context and interpersonal relationships in theories of integrated health and social care. We conclude our paper with recommendations for future research on interpersonal relationships and policy workarounds, and address the implications of workarounds as opportunities for resistance to neo-liberal policy developments in health and social care.