Moral Learning in an Integrated Social and Healthcare Service Network

Abstract

The traditional organizational boundaries between healthcare, social work, police and other non-profit organizations are fading and being replaced by new relational patterns among a variety of disciplines. Professionals work from their own history, role, values and relationships. It is often unclear who is responsible for what because this new network structure requires rules and procedures to be re-interpreted and re-negotiated. A new moral climate needs to be developed, particularly in the early stages of integrated services. Who should do what, with whom and why? Departing from a relational and hermeneutic perspective, this article shows that professionals in integrated service networks embark upon a moral learning process when starting to work together for the client's benefit. In this context, instrumental ways of thinking about responsibilities are actually counterproductive. Instead, professionals need to find out who they are in relation to other professionals, what core values they share and what responsibilities derive from these aspects. This article demonstrates moral learning by examining the case of an integrated social service network. The network's development and implementation were supported by responsive evaluation, enriched by insights of care ethics and hermeneutic ethics.

Learning to Learn: towards a Relational and Transformational Model of Learning for Improved Integrated Care Delivery

“…Knowledge differs from information in that it contains the interpretation and framing of the knower [52,66,67]. Knower and known engage in a dialogue and as a result, both may experience change in understanding as a new perspective may emerge from the specific context of the interaction [12]. New knowledge and new ways of knowing emerge when knowledge is used as a tool for knowing through productive inquiry.…”

“…We drew from Bailey and Koney [92] and Gajda [99] to group together the most common concepts into three types of relationships: (1) co-existence and communication, (2) cooperation and coordination, and (3) collaboration and co-ownership (See definitions in Figure 1). Inter-organizational and interprofessional relationships characterized by collaboration and co-ownership are more likely to contribute to L2L because of the more frequent and deeper levels of interaction, which enable individuals to co-produce values, roles and relationships by accepting, refuting, re-interpreting, and re-negotiating responsibilities [12]. Through this continuous self-organizing learning process, relational identities are socially constructed [100,101] and knowledge is shared and co-created.…”

“…The development of integrated care is a multifaceted and demanding learning process for those involved, where knowledge is an ongoing product of practice created and diffused across professional and organizational boundaries through interaction and dialogue [5][6][7]. Although efforts to integrate health and social care inherently involve knowledge exchange and creation, a learning perspective is rarely applied in conceptual or empirical studies of integration [8][9][10][11][12][13]. Most integration efforts and research focus instead on the redesign of organizational structures and processes [14,15].…”

“…It is our premise that collective action as it relates to integration is dependent on collective learning in the context of institutionalized values, structures, and social interactions whereby individuals mutually define each other's roles as a function of relations. Visse and her colleagues, for example, conceptualize integration as a "moral learning process" in which people interactively assign, re-interpret and re-negotiate their identities, relations and values [12]. We thus, take a relational approach to integration where learning and change are attributed to interrelations and not coercive policies, intervention or reorganization.…”

“…A learning lens requires attention to the importance of integrating different types of knowledge in the establishment and interpretation of meaning; often, in health and social care, the focus is on the challenge of bringing together professionals with conflicting paradigms rooted in differing subject or technical knowledge and professional experiences [12,13,25]. The boundaries between professional groups and organizations produce strong social and cognitive barriers that facilitate learning within boundaries, but make knowledge "sticky", or difficult to move, across boundaries [26][27][28].…”