Releasing the grip of managerial domination

Abstract

Purpose – The purpose of this paper is to discuss “system transformation” in the context of different workforces and organisations seeking to support people experiencing multiple exclusion homelessness (MEH). From a relational and integrated care perspective it aims to identify barriers to achieving more effective ways of working in the prevailing context of “managerial domination”. Communities of practice (COPs) are evaluated to identify their potential to overcome some of these barriers. Design/methodology/approach – The paper presents a theoretical and conceptual discussion of a project in which a number of COPs were established and evaluated to ascertain their value in developing more relational ways of working in the context of MEH. Case studies of COPs operating in the context of MEH are explored and discussed. Findings – It is concluded that COPs have the potential to deliver small-scale changes (“little miracles”) which are characteristically more subversive than transformative. Nevertheless, the authors still see these small gains as significant when compared to the inertia that is often found in local systems of care where more traditional management techniques (such as “payment by results”) prevail. The authors also draw attention to the scope for much improved service quality which flows from moving beyond the “tick box” and into the realms of what it really takes to tackle homelessness and multiple exclusion. In other words, although often requiring considerable amounts of “craft and graft” to deliver seemingly very small amounts of change, these “little miracles” may actually be more conducive in the long run to delivering the kind of tangible “real” change that is often aspired to by both workers and service users and their carers. Research limitations/implications – The COPs project was limited in terms of time and scale and, hence, further research would be needed to, for example, ascertain their longer-term potential. Practical implications – There is merit in the theoretical perspectives discussed and, from these, of understanding how best to establish and operate COPs as a vehicle for achieving better outcomes through integrated or collaborative working. Social implications – There is much scope for better integrated or more collaborative working in the context of MEH and this paper draws attention to how COPs could be one means of achieving better outcomes for people experiencing MEH. Originality/value – This is the first paper to set out the theoretical analysis of COPs as a means of achieving better integrated or collaborative working.

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Homelessness and integrated care: an application of integrated care knowledge to understanding services for wicked issues

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