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  • Author or Editor: Helen Dickinson x
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This chapter traces the broad contours of the implementation debates and in doing so attempts to do justice to the extensive literature surrounding policy implementation. It starts by offering a brief mention of definitions and a chronological account of the ways in which the issue of implementation has tended to be treated within the wider policy literature. It draws particular attention to the ways in which traditional models of policy have treated the identification of problems, the development of policies, and subsequent attempts at implementation as distinct stages. It critiques the more traditional and linear approaches that have sometimes been used to analyse the implementation of policy. It argues that the problem of policy implementation does not simply exist because local individuals or organisations fail to implement policy or lack the skill or will to do so. Policy implementation is a more complex and dynamic process than is often suggested. Instead it proposes that processes of sense making — how individuals and agencies give meaning to the world — are crucial in understanding policy implementation in a more nuanced and helpful way than traditional models of policy analysis have tended to allow.

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Collaborative working has assumed an important role within UK public services over the past 30 years, with successive national governments viewing greater inter-agency working as crucial to driving good government. But an awareness of the need for professions in medicine, health and social care to work together more effectively has been around for much longer, and not only in the UK (WHO, 1998). The idea that professionals should ‘learn together to work together’ – what has come to be called ‘interprofessional education’ (IPE) – is not a new idea by any means (for further discussion on this, see Szasz, 1969; Baldwin, 1996). Nevertheless, interest in this concept has grown dramatically over the last 15 years or so. As Barr et al (2011, p 5) argue,

The turn of the Century was a watershed in the short history of … IPE … in the UK … when the Labour government promoted “common learning” to be built in to the mainstream of pre-registration professional education for all the health and social care professions to help implement its modernisation strategy….The proposition was as seductive as it was simple: learning together would deliver not only a more collaborative but also a more flexible and more mobile workforce responsive to the exigencies of practice and the expectations of management.

As this quote illustrates, IPE has been perceived as one potential solution to a number of the practical difficulties associated with collaborative working. Health and social care collaborations bring together a range of different professions ostensibly to work together around the needs of service users.

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As suggested in the previous chapter, IPE presently occupies a central role within the education and ongoing training of health and social care students and practitioners. Although there is a large and growing literature relating to IPE, it is somewhat limited in its nature. Much of the academic literature is based on descriptions of programmes and processes, with rather less consideration of the outcomes of IPE. Furthermore, there has been a tendency for research into the outcomes of IPE to be methodologically weak. As such, it is difficult to tell whether IPE ‘works’, not just in terms of its impact on participants, but particularly in terms of whether it makes any difference to the quality of care provided and improved outcomes for those who use services. This chapter is an attempt to move beyond descriptions of programmes, while acknowledging the importance and practicalities of advice relating to how to‘do’ IPE. By drawing on a range of sources and case studies, the chapter aims to examine both the processes that make IPE effective, and the outcomes that it is thought to be able to deliver for service users.

Before moving on to consider these lessons in detail, it is perhaps first worth noting the nature of the IPE research evidence. Like most literatures, IPE has a positive slant in terms of reporting. That is, research and evaluations are much more likely to report positive than negative impacts, particularly in terms of entire programmes. However, some parts of the literature do flag up important areas where IPE has had negative impacts, and later in the chapter we offer an example of where this has happened.

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Having explored key concepts and summarised key findings from the research, this chapter examines three key issues concerning IPE in health and social care settings. These hot topics were chosen because they are the ones about which we are asked most:

  • How can we involve service users and carers within the process of IPE? Does this make any difference to outcomes for trainees and, ultimately, for people who use services themselves?

  • How can we‘mainstream’ and sustain IPE in education and training for health and social care?

  • How can IPE programmes be effectively evaluated?

A key theme of health and social care policy concerns enabling service users (patients/clients) and carers to take a more central and active role in the organisation and delivery of their care. This policy has been extended to education to the extent that the DH (2002b) required social work education to involve service users and carers in the design and delivery of programmes. The General Medical Council (GMC) set out similar requirements in 2009 followed by the Health and Care Professions Council (HCPC) which regulates educational standards for allied health professionals and social care (2014).

There are a variety of ways in which service users may be involved in IPE. The earliest examples in the literature describe service users or carers sharing their experiences with mixed groups of professionals, either through presentations (‘testimonials’) or by allowing themselves to be interviewed by the students. For example, Turner et al (2000) describe a series of palliative care workshops during which medical, nursing, social work and rehabilitation therapy students interviewed the family carers of people with a terminal illness.

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While previous chapters have provided an overview of the aims of IPE and guidance for readers in terms of how to plan, run and evaluate IPE programmes, these have often also raised a number of key questions about the nature of IPE and to some extent problematised the issue. This final substantive chapter is slightly different and seeks to develop previous discussions in order to summarise a series of useful theoretical frameworks and approaches that students and educators may use to help unpick some of the themes and issues highlighted earlier.

Reeves and Hean (2013) argued that an understanding and application of theory is necessary for appreciating the nature of interprofessional education, practice and care. They cited an influential review by Freeth and colleagues (2005a) to support their view that curriculum design for IPE and its evaluation had failed to employ theory in an explicit manner. As we suggested earlier, IPE programmes have generally suffered from a failure to be explicit about the nature of educational theories by which they are underpinned. Yet if IPE is to be considered a substantive and informed practice, it is important that its programmes are clearly and explicitly supported by educational theory. This section outlines some of the main educational theories that are associated with IPE, and the implications of such approaches in practice.

In Chapter 1 we outlined some of the main features of adult learning theory (Knowles, 1990) In order to produce an effective IPE initiative based on adult learning theory, there are several assumptions that need to be satisfied (see Box 4.1).

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Drawing on the questions, summaries and frameworks set out in this book, there are a series of practical recommendations and potential warnings that arise, for both policy and practice.

For policy-makers

  • Governments need to be clearer about what they expect IPE to deliver. IPE can, and should, play a major role in preparing professionals to work collaboratively to the ultimate benefit of service users and carers. But it is no substitute for removing the structural barriers to partnership working and providing local organisations with clear guidance about how they might go about working in partnerships.

  • As a practical step, it would be helpful for policy-makers to adopt clear definitions of the various forms of learning involving more than one professional group, including the CAIPE definition of IPE.

  • It is important to be clear about the motivation for, and goals of, IPE initiatives. Professionals and students accept the need to know about each other, and about how they can work together more effectively. Professional identities are important, and professionals may be more cautious if they perceive the goal as being role substitution. The notion of flexibility in career pathways may not be received with enthusiasm.

  • IPE cannot simply be treated as an add-on to existing programmes of education and training. Neither can it be simply restricted to either pre- or post-qualification students. If health and social care organisations are to work together more effectively in practice, then IPE needs to play an integral role in the education of professionals today and in the future.

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A thorough introduction to IPE in health and social care for students. This second edition includes updates to research and policy contexts and provides an essential set of IPE ‘do’s and don’ts’.

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The rate of adoption of new technologies into healthcare systems is considered to be slower than in other settings. A range of knowledge-based facilitators of adoption exist, including: technology specification and assessment; dissemination tools (including electronic decision support tools); networks and facilitated interaction; and skills and leadership development. A review of the evidence relating to each of these is reported in this paper. The authors identify the absence of a single knowledge-related ‘magic bullet’ before proposing an analytical framework for the future assessment of knowledge-based interventions and their impact on technology adoption.

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A robust guide for students to the leadership and management of inter-agency collaborative endeavours. It summarises recent trends in policy and uses international evidence to set out useful frameworks and approaches.

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Over the past century ideas derived from management, and more recently leadership, have become ubiquitous concepts in our everyday lives. There are countless books and articles that deal directly with these issues, and you would struggle to browse in a bookshop for more than a few minutes without finding several books on these topics. Flick through any newspaper, or watch any TV channel, and stories are invariably underpinned by discussions of responsibility and accountability. When an organisation – or groups in society more broadly – encounters difficulty, it almost invariably looks towards some form of individual leadership to guide it through the time of turbulence or to take the blame for failing to do so. Typically, media and public attention focuses on the person at the top who is presumed to have both the authority and the acumen to intervene to make things better. As has been argued elsewhere, ‘the “organisation in our heads” is still heavily influenced by the principles of classical management theory’ (Anderson-Wallace, 2005, p 171), which assumes hierarchical relationships between members of a single organisation. Yet the reality of the modern world is a proliferation of collaborative arrangements, where the important leadership activities are those that take place between a range of different partners. This poses significant challenges for traditional concepts of leadership and management, and is the focus of this book.

The number and range of public sector collaborations has grown considerably since the mid-1990s. Rather than collaborative working being an additional activity for public sector agencies, arguably it is now ‘the new normal’ (Sullivan, 2014).

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