This paper explores health and social care integration (HSCI), a process of public service reform in Scotland, in which partnerships, co-production and creation of public value is central (Mitchell, 2015). Given limited practice informed, ethnographic literature in public administration (Boll and Rhodes, 2015), this paper reflects on applying an ethnographic sensibility with a praxeological lens for research, considering how this theory method package (Nicolini, 2017) might contribute to advancing public value management (Stoker, 2006) and collaborative governance (Osborne, 2006).
Doctoral research was undertaken with NHS and Local Government authorities implementing the Public Bodies (Joint Working) (Scotland) Act 2014, a mandated means to address the protracted policy problem of care for people with long term and complex needs, exploring how managers enacted collaboration, within an assemblage of situated, relational and material practices for making HSCI operational, but where public value was muddled.
This paper is informed by an inter-organisational, multi sited ethnographic study with the ‘Kintra’ Health and Social Care Partnership, whereby value is placed on ethnography as ‘a way of knowing’, for understanding collaboration (van Hulst et al, 2015), thus providing multiple lines of sight into how NHS and Social Care managers practice what it means to be in the interstitial spaces (Machado and Burns, 1998) of a mandated partnership (Glasby and Dickinson, 2014). It is also underpinned by a practice lens (Schatzki, 2002; Nicolini, 2012). Practice approaches offer a set of theoretical handles that enable a focus on the unremitting nature of the dynamics intrinsic to organising, which is why “practice theory is also useful for practitioners, for whom this perspective illuminates their potential for productivity in a collaborative world – to be capable of analysing the dynamic nature of public problems and understanding the potential we all have for addressing them” (Feldman, 2010).
Analytically, it was discerned that NHS Managers collaborative practices, were paradoxical, despite their support of collaboration (Machado and Burns, 1998). Constrictions emerged, in part, from the pre-eminence of effort required for national NHS performance reporting. Managerial exertions for controlling performance, overwhelmed other collaborative work that might foster processes of community care and deliver what could be framed as public value. NHS managers were bound by entangled practices contributing to concerns about the cogency of their collaborating. Council managers appeared to have more collaborative possibilities, nevertheless their efforts focussed on the domains of their responsibility, especially commissioning.
This paper seeks to make a contribution in two ways, firstly, to the value of ethnography for attending to the everyday situatedness of practices in the public sector. And, secondly, insights from practice scholarship revealing how the nexus of practices reinforce particular boundaries in relation to collaboration, as well as those for enabling change (Feldman and Orlikowski, 2011). These perspectives enhance understanding, and appreciation of, the challenges associated with public value management, as relational and reflexive practices in which, ‘[m]anagers have an active role in making the system work by recognizing that it will not work unless it is adjusted on a continuous basis” (Stoker, 2006:49).
22nd_Annual_IRSPM_Conference_-_New_Researcher_s_Panel_-_Final_Paper_20180322.pdf 