Being person driven in a service driven organisation: a grounded theory of revisioning service ideals and client realities
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Breckenridge, J. (2011) Being person driven in a service driven organisation: a grounded theory of revisioning service ideals and client realities, , , , ,
This paper presents the theory of 'Revisioning Service Ideals and Client Realities', which emerged from a classic grounded theory study of health care practitioners working within Condition Management Programmes. As part of a UK government initiative, Condition Management Programmes provided back to work support for incapacity benefit claimants. Practitioners' main concern was identified as being person driven within a service driven organisation. While the diverse needs of individual clients could not be met by a 'one size fits all' approach, practitioners were aware that the service could not be so individualised as to deconstruct its purpose. The theory emerging from this PhD study offers a conceptual explanation of the means through which this concern is resolved, explaining the way in which practitioners make situational adaptations to their practice in order to deviate from or retreat within service boundaries. By cycling iteratively between deconstructing and reinstating service ideals, practitioners are able to create a reverberating equilibrium between the expectations and realities of practice, negotiating a person driven approach without compromising service structures completely. The theory was developed using the full complement of classic grounded theory procedures and is based on interviews with 35 practitioners and observations of 26 client sessions. Informal observations, programme documentation, case notes and extant literature were also included as data. Although developed within the substantive area of Condition Management Programmes, by offering a conceptual explanation of the behaviour of service workers at a ground level, the theory has relevance to wider areas, most notably to theories of bureaucracy, organisations and policy implementation.