Building a system-wide approach to community relationships with the findings of a scoping review in health and social care

Purpose: For leadership and management of western health systems, good quality relationships are a fundamental cornerstone of organising health and social care delivery, delivering benefits across organisations and communities. The purpose of this work is explore the extant management, health and social care literature, grounded in older people care, to reveal behaviours, processes and practices that if readily identified across a context will support healthy relationships across the ‘whole system’ of stakeholders. Design/methodology/approach: An academic/practitioner group designed and guided a scoping literature review of the health and social care and broader management literature to identify and extract important behaviours, processes and practices underlying the support of high quality relationships. A search strategy was agreed and key health and management databases were interrogated and 51 papers selected for inclusion. Working with the practitioners, the selected papers were coded and then organised into emergent themes. Findings: The paper outlines the relational behaviours, processes and practices elements that should be present within an older peoples care community, to support a healthy relational environment. These elements are presented under the five emergent literature themes of integrity, compassion, respect, fairness and trust. These five topics are examined in detail. A way forward for building statements using the review material, that may be developed to reveal relational patterns within older people care, is also explored and outlined. Research limitations/implications: All literature reviews are subject to practical decisions around time, budget, scope and depth restraints. Therefore potentially relevant papers may have been missed in the review process. The scoping review process adapted here does not seek to make any major considerations with regards to the weighting of evidence behind the primary research. Originality/value: This work contributes to a growing need for designers of health systems to more fully understand, measure and draw on the value of relationships to help bridge the gap between diminishing resources and the expanding demand on health and social care services

An extra care community's perceived priorities for 'whole system' relationships: A Q-methodological study

Health and social care settings worldwide need to sustainably improve the quality of relationships across communities or 'whole systems'. This research informs the development of a relational framework based on stakeholder perspectives. It is grounded in an action research project with practitioners, and draws on a previous literature review, to present the underpinning elements of quality relationships as statements, organised under the headings of integrity, respect, fairness, compassion and trust. Using Q methodology, 27 participants, comprising a range of stakeholders (staff, residents, family and service providers), rank-ordered 48 statements based on perceptions of the importance of differing aspects of relationships. By-person factor analysis was used to create five factors or viewpoints by comparing and contrasting using the composite rankings alongside interview data collected for each participant. The first view 'Altogether now' prioritises compassionate engagement. Second, 'Respect is a two-way street' emphasises the need for reciprocal respect and recognition of history. The factor labelled 'Free spirits' posits the dominant view of freedom. The fourth view 'Families ... strengths and challenges' focuses on the necessary and complex involvement of families and finally, 'Helping hands' emphasises the role of relationships in increasing previously low expectations of social integration for previously isolated residents. The different views that exist on the composition of quality relationships can be used to help extra care communities to understand and utilise relationships as a powerful and effective resource