12th June 2019

Incite for changeDr Linda Irvine Fitzpatrick

Tackling Health Inequalities: Schon, 1973; Chapman, 2009; Lindblom 1959; Rittlel and Weber, 1973; Weber and Khademian, 2008

Intersectoral Programmes (ISPs)

Working together

Public Sector e.g. NHS

Third Sector e.g. Charities

Private Sector e.gbusinesses

Cook, 2015; Butterfoss et al 1996; Lasker et al 2001; Provan et al 2005; Bracht and Tsouros, 1990; Roussos and Fawcett, 2000

Mechanism

(active ingredients that cause something to happen)

Context

(resources to enact decisions)

Outcomes

(patterns of programme outcomes)

The realist perspective: context, mechanism, outcomewhat works for whom in what set of circumstances

Pawson et al, 2005

Successful Inter-sectoral partnership have 5 mechanisms

Irvine Fitzpatrick (2019)

Momentum

• feel emotionally connected spurs further momentum

• this transforms their worldview

• which reshapes organisational cultures

• Partnerships need to: • interlock the “story” or the narrative with momentum and the

momentum will in turn become part of the story (rather than a more traditional narrative with beginning, middle and end).

“I think partly it’s an emotional feeling and it feels good to be good, it feels good to be involved, it feels good to be part of something”.

Irvine Fitzpatrick (2019)

Safe Spaces

• Creating a relational space

• a safe psychological space,

• Also needs to be seen in a temporal perspective

• Places with ascribed meaning increased the reach & impact of the partnership

• Fluctuates as the individuals are on different trajectories as relationships evolve.

“For me that is about the genuineness of it and being able to be transparent about, oh, I didn't quite do that, happy for you to give me that criticism.

Yeah, this is quite genuine. It's okay. Maybe we accept that sort of stuff from people that we feel are more genuine in relation to us” (Public Sector)

Irvine Fitzpatrick (2019)

Identity• initial motivation to become a health / social care

professional was “reactivated”

• enabled their personal identity, (value base), to become more enmeshed with their professional identity which reduced cognitive dissonance

• Significance of the interplay of professional & personal identity in relation to participants’ roles within the ISP and the subsequent impact of this in their life roles

“[service users] were speaking as equal partners and recognising the role they actually - what they were actually able to offer. For me, that's what was different. That was a shift in my thinking about how the [IPS] was actually working. It was about brokering these kinds of relationship.”

Irvine Fitzpatrick (2019)

Narrative• Identifying the shared values • viewing all perspectives as valid• creating appeal, whilst taking due cognisance

of historical perspectives of stakeholders around roles

• fluid and adaptable narrative• promote authenticity and lasting

commitment to the partnership.

“It's just like it's bonkers. Our own experience with 106 kids or whatever it was who had trouble managing their diabetes, was that they weren't going to

listen to clinicians but they listened to a football player. Go figure, go figure, you know. ” . (Private Sector)

Irvine Fitzpatrick (2019)

Power• power & power sharing from different

perspectives• power status they perceived their role or

organisation to have external to the partnership and internally within the partnership.

• Power sharing & power shifting were outcomes

“Without an analysis of power or neoliberalism (..) then service user involvement is being co-opted. If you don't unpick some of that power

stuff, then you're just replicating the same stuff” (3rd Sector)

Irvine Fitzpatrick (2019)

Successful Inter-sectoral partnership have 5 mechanisms

Irvine Fitzpatrick (2019)

a line on a page

3rd space.....

• capture what is a constantly shifting and changing milieu of ideas, events, appearances and meanings Soja, 1996: p2

• creating shared practices where people can be attentive and open with one another in ways which encourage mutual responsibility for the quality of “our lives together”

Soja, 1996; Fielding, 2004

Irvine Fitzpatrick (2019)

Importance of Phases : INVITE • Initial welcoming invite space evokes curiosity,

• Build on this curiosity by using different and novel approaches in the invite space

• shared inquiry

• desire for action.

• I can recall the first meeting where nearly 100 people turned up yet they didn’t know what the agenda was. I’m sure there were cynics in the room but I’m sure it was quite amazing that nearly 100 people from across statutory services, the third sector, individuals, people that live and around area, you know, policy level people, elected members, it was quite astonishing for me as no one knew what to expect. (Voluntary Sector)

Irvine Fitzpatrick (2019)

Importance of Phases : CREATE

• Acknowledging a plurality of discursive styles

• willingness to countenance the validity or value of alternative knowledge or practices in another.#

• I remember meeting in some various places. St Mary’s Street is one place I remember. We sat there, and we chewed it over. I just really enjoyed the involvement, listening to, you know, people like you, clinicians, met, you know, people who’ve been through the system, and I thought, hey, I like this. So, I really want to give it everything I can. That’s actually what set me up for the continuing relationship, until the present day.

(Private sector)

Irvine Fitzpatrick (2019)

Importance of Phases : ENACTMENT

• the need for “ (re) formulation” often occurred to enable new participants to reach that shared understanding of the ISP narrative

• . . . . people are growing in those, literally growing in their identity, growing in their confidence in those new spaces in a way, and they take that growth and that confidence back to some of the situations that they don't have as much control over and use it to their ability. (Voluntary Sector)

Irvine Fitzpatrick (2019)

opportunity

• Shared desire

• Policy permission

• The right thing to do

• Chance to think, to connect and to do

‘Can’t you?’ the Queen said in a pitying tone. ‘Try again: draw a long breath, and shut your eyes.’

Alice laughed. ‘There’s no use trying,’ she said: ‘one can’t believe impossible things.’

‘I daresay you haven’t had much practice,’ said the Queen. ‘When I was your age, I always did it for half-an-hour a day. Why, sometimes I’ve believed as many as six impossible things before breakfast.”

Irvine Fitzpatrick, Linda. (2019) An exploration of intersectoral partnerships

for people with multiple and complex needs: a realist informed qualitative

study. Doctoral dissertation. Queen Margaret University: Edinburgh