Occupational Therapy Service redesign for care of the elderly: Measuring up to a joint future?
Ait-Hocine, N. (2016) Occupational Therapy Service redesign for care of the elderly: Measuring up to a joint future?, no. 408.
Partnership working between Health and Social Care is the Scottish Government's strategy to affect major policy and practice level changes within public services in order to meet the fiscal challenges arising from the ageing demographic profile within our society. The Joint Future Group Report, published by the Scottish Government in 2002, specifically identified the profession of occupational therapy as central to the strategy for public service reform and inspired an inter-organisational occupational therapy service redesign within Lanarkshire. The practice and system service redesign transcended Acute, Primary Care and Local Authority care of the elderly occupational therapy services, introducing measures to promote patient continuity of care at an informational, management and relational level. The aim was to promote longitudinal models of patient care that minimised the incidence of patients being transitioned between occupational therapy services. This PhD adopted a critical realism research approach with a mixed method sequential explanatory research design. The aim was to develop a theoretical understanding of the structural and agential influences at the macro meso and micro levels that gave rise to the service redesign outcomes. The results provided illuminating insights as to the agential and structural barriers to partnership working. Service specific patterns emerged that suggested structural and cultural influences on occupational therapy practice resulted in service specific variation in the ability to deliver on the continuity of care service redesign intentions. The agency of the occupational therapists was explored through mechanism based theorising in order to identify morphogenetic influences (facilitators to change) and morphostatic influences (barriers to change) in engaging in the service redesign measures in practice. The results reflect that the occupational therapists within all three service sectors enacted their agency to preserve their respective pre-existing organisational service structures. These results suggest that the learning strategies and associated behaviours of the participating occupational therapists were not conducive to transformational change. The practical insights of the conditioning power of structure vis a vis the discrete reflexive power of agency outlined within this thesis offers the profession of occupational therapy within public services the means of exploring and conceptualising the complex implications of partnership working.