Integrating policy and practice in healthcare

• Main Author: Hostick, Anthony
• Published: Middlesex University 2007
• Subjects: 362.1
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.568360

There are national and local concerns about a policy-practice gap in healthcare services which bring into question the effectiveness of traditional mechanisms for policy implementation. Using clinical governance as a focus, this report describes the rationale, development and evaluation of an alternative approach designed to integrate health policy with practice within a Mental Health and Learning Disability NHS Trust through a programme of social opportunities. A number of methodological compromises were made due to the pragmatic nature of the project and limited availability of resources to undertake the evaluation. Not all disciplines and services were involved in the approach so different methods may be needed to engage these groups. However, the potential impact of the process for local policy, practice and aspects of practice culture has been critically evaluated using a framework for policy analysis and mixed methods for implementation, data collection and analysis. The findings suggest that the intervention was successful in providing an opportunity for practitioners to meet, network and discuss policy and practice issues and virtually all attendees valued the opportunity to participate. Contextually, the key focus was on meeting the needs of different client groups, i.e. working age adults, older people, children and people with a learning disability. Generally, all practitioners value the principles of user-centred, safe and effective practice that underpin national policy although some are valued more than others and practice in all areas can be improved. Personal responsibility is accepted and satisfactory levels of support are available and accessed. However, culturally there is evidence of conflict created by perceived differences between practitioner and organisational values, increased workload without added value and a need for improved interdisciplinary working and better service integration. This is particularly evident in the adult community mental health services. A theoretical model and process to integrate policy and practice is presented that needs embedding within an organisational approach to learning that provides supportive structures, processes and cultures requiring time, leadership and management commitment. Recommendations are made for the dissemination of findings, further development and testing of the theoretical model and process.