Managed clinical and care networks (MCNs) and work: an ethnographic study for non-prioritised clinical conditions in NHS Scotland
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Managed clinical and care networks (MCNs) have emerged in Scotland as a collaborative form of organising within health and between health and social services. Bringing together disparate disciplines and professions their aim has been to allow work across service and sector boundaries to improve care for patients. Whilst MCN prevalence has increased and policy has moved to centralise this method of organising, many research questions remain. These include: how can we understand the form, function and impact of MCNs, and further, what are the underlying motivations for practitioners and managers to organise in this way? Focussing in on the work of 3 voluntary MCNs operating in Scotland, the centrality of practice emerges. Practice is defined broadly to encompass both the interactions between practitioner-patient and practitioner-population. From this, the MCN becomes conceptualised as a set of activities focussed around ground-level clinical MCN service issues and top-level policy direction. Through considering work the interplay between ethics and scientific evidence emerges. The inherent uncertainty and suffering of daily practice comes to the fore, these concepts are brought together within a framework, morals-in-practice. Further, using the hermeneutic dynamics of alterity, openness and transcendence, MCNs can be understood as providing a space to foster creative responses to the wicked problems created by health and social service design and delivery. The organising opportunities provided by MCNs thus arguably serve several organisational and social functions, providing a forum to: mutually support and respond to the intrinsically challenging nature of practice understood; debate morals-in-practice helping to ensuring collective clinical governance; sharing of organisational knowledge; planning, delivery and audit of services; and creatively respond to wicked problems. By focussing in on the work, the practice particularities of each individual MCN are resultantly emphasised, whilst still maintaining recognition that much of the NHS operational context is more widely shared. Through this these voluntary MCNs, at least, can be viewed as an organising form which has emerged in response to the complexities of modern health and social service, care, design and delivery.
Thesis, PhD Doctor of Philosophy
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