Tag: critical junctures

Critical junctures goes green

CJIn a series of earlier posts on this site (here and here), and in a piece for the LSE’s Impact Blog here, I wrote about Nicola Evans‘ and my article, ‘Critical junctures in health and social care: service user experiences, work and system connections’. This is published in the journal Social Theory & Health, and the behind-the-paywall link to the full text can be found here. Now that 18 months has passed since the article first appeared online, Palgrave’s copyright rules allow a post-peer-review, pre-copyedit, green open access version of the full text to be made publicly available. So, for a free copy of the paper downloadable from Cardiff University’s ORCA repository the link to follow is this:

Hannigan B. and Evans N. (2013) Critical junctures in health and social care: service user experiences, work and system connections. Social Theory & Health 11 (4) 428-444

The paper draws on data from Nicola’s PhD, ‘Exploring the contribution of safe uncertainty in facilitating change‘, and from my post-doctoral study of crisis resolution and home treatment services, ‘Mental health services in transition‘. For a reminder of what the paper is about, here’s the abstract in full:

This article makes an original contribution through the revitalisation, refinement and exemplification of the idea of the ‘critical juncture’. In the health and illness context, a critical juncture is a temporally bounded sequence of events and interactions which alters, significantly and in a lasting way, both the experience of the person most directly affected and the caring work which is done. It is a punctuating moment initiating or embedded within a longer trajectory and is characterised by uncertainty. As contingencies come to the fore, individual actions have a higher-than-usual chance of affecting future, enduring, arrangements. These ideas we illustrate with detailed qualitative data relating to one individual’s journey through an interconnected system of mental health care. We then draw on observations made in a second study, concerned with the improvement of mental health services, to show how micro-level critical junctures can be purposefully used to introduce instability at the meso-level in the pursuit of larger organisational change. In addition to demonstrating why scholars and practitioners should pay closer attention to understanding and responding to critical junctures we are, therefore, also able to demonstrate how their emergence and impact can be examined vertically, as well as horizontally.

Crossing disciplinary boundaries and sharing unrelated datasets

For anyone interested, follow this link for a post I’ve written which has just appeared on the LSE Impact of Social Sciences blog. It’s a reflection on working with Nicola Evans to produce our ‘critical junctures’ paper, which I’ve previously written about here and here.

Critical junctures (reprise)

This morning Nicola Evans’ and my paper on Critical junctures has appeared in advance online publication form on the Social Theory & Health website. This is very pleasing, though as I noted in my original post the terms of Palgrave’s copyright agreement mean that we have to wait for a period of 18 months from now before depositing a green open access version of the full text to accompany the article’s ORCA entry.

In the meantime, here again is the article’s abstract, which I hope at least whets readers’ appetites:

This article makes an original contribution through the revitalisation, refinement and exemplification of the idea of the ‘critical juncture’. In the health and illness context, a critical juncture is a temporally bounded sequence of events and interactions which alters, significantly and in a lasting way, both the experience of the person most directly affected and the caring work which is done. It is a punctuating moment initiating or embedded within a longer trajectory and is characterised by uncertainty. As contingencies come to the fore, individual actions have a higher-than-usual chance of affecting future, enduring, arrangements. These ideas we illustrate with detailed qualitative data relating to one individual’s journey through an interconnected system of mental health care. We then draw on observations made in a second study, concerned with the improvement of mental health services, to show how micro-level critical junctures can be purposefully used to introduce instability at the meso-level in the pursuit of larger organisational change. In addition to demonstrating why scholars and practitioners should pay closer attention to understanding and responding to critical junctures we are, therefore, also able to demonstrate how their emergence and impact can be examined vertically, as well as horizontally.

The accidental grounded theorists

On Friday I had reason to ponder the relationships between theory and data, and the boundaries between different types of qualitative research. This was day two of my Working and Leading in Complex Systems professional doctorate module. What I discovered is that I may, in fact, have become an accidental grounded theorist. Or possibly not…I’ll let the reader decide.

During a talk about critical junctures I said how, in our recent paper, Nicola Evans and I had elected to lay out our theoretical contribution (i.e., our idea of ‘critical junctures’ as pivotal, punctuating, moments initiating or taking place within longer individual trajectories of care) ahead of displaying our data. We had done this even though our ‘theory’ had in fact been fieldwork-driven, as we then demonstrated in our article with extended, illustrative, extracts. Quite reasonably, in the classroom I was asked if we had therefore used a grounded theory approach.

This question got me thinking. My immediate response was that Nicola and I had developed a concept from empirical data but had absolutely not claimed to be ‘doing grounded theory’. In fact, the thought had never occurred to us (or to me, at any rate).

And there’s the nub of it. What does it actually mean to ‘do grounded theory’? Follow a stepwise recipe from a methodological cookbook? Or range freely over one or more sets of data in the search for new insights? Without wanting to suggest that ‘anything goes’ in terms of methods, I wonder if we can sometimes get too hung up on techniques and ‘rules’ when it’s the principles which really matter? In our critical junctures paper these included a commitment to the inductive ‘drawing out’ of conceptual insights from an analysis of talk and action. They also included the idea of staying close to our data, and of offering fieldwork extracts in support of the theory. I personally have no wish to agonise over what flavour of ‘doing qualitative research’ we have done here, and I’m also not sure that all of the finer distinctions and sub-divisions necessarily matter or even make sense.

But perhaps I’m missing something.

Learning about complexity and systems

Today has reminded me of the pleasures of university teaching. A day in a classroom with lively doctoral students is to be savoured. Most (but not all) of the group were nurses, and most (but again, not all) were completing the taught elements of their professional doctorate programme ahead of beginning their research.

The module is concerned with understanding health system complexity, and is liberally sprinkled with local research (my own included). Today we began with an overview of the territory, and then discussed policy and services at the large scale using the idea of wicked problems. Pauline Tang gave a fabulous talk based on her study of electronic health records, before we closed with a whistlestop tour of systems of work and divisions of labour.

We meet again tomorrow for sessions led by students, to think about trajectories and critical junctures, and to hear Nicola Evans being interviewed about change in organisations. I’m looking forward.

Summer sun

Just as predicted by those nice people at the Met Office, South Wales is warming up. The sun is high, and I hear the voices of schoolchildren playing football. I’ve been stuck inside all day, which in the circumstances has been something of a drag, but in the last hour or so I’ve gravitated outside to soak up some of this long-awaited summer.

This has been a working week as varied as any. I had a couple of School committees to chair (research ethics, and scientific review), some teaching (MSc), and a meeting with colleagues to plan some pre-registration interprofessional education in the autumn. This is a continuing mental health nursing/occupational therapy initiative (which I’ve posted about before), and on this occasion we’re planning some technological innovation involving the use of video recording and playback. On the research front I’ve been working on RiSC and keeping in touch with COCAPP, and found myself contributing to a rapidly convened meet-up to talk through a brand new project idea. I received page proofs for our new Critical junctures paper, peer reviewed a manuscript submitted for publication, and received a citation alert from Scopus. This was particularly pleasing as it took my ‘h’ index to 15, for what that’s worth. I also completed preparations for a doctoral examination taking place next Tuesday, and managed to squeeze in a pleasant catch-up with an esteemed colleague working in NHS mental health services. Mostly we exchanged news of developments in practice, services and research locally.

And with that, I’m off. Beer in the back garden calls.

Meeting new students

This morning began in class with a group of 25 or so (very) new students of mental health nursing. The session revolved around a series of open-ended questions, in family therapy style, put to John Hyde and to me by Nicola Evans. Nic invited us to share something of our personal experiences in mental health nursing: as students, practitioners, educators and researchers. In a decidedly non-random way, one of Nic’s questions invoked the idea of ‘critical junctures’, echoing our paper in this area but referring, in this context, to pivotal moments within our individual careers thus far.

From a learning point of view the premise was to introduce new students to the rich and varied world of mental health nursing, via a listening in to a reflective conversation conducted on the same. I found it an interesting experience, and hope the students did too. In my early morning mental preparation before participating it became necessary to conjure up people, places and events dating back to at least the late 1980s. So today I remembered my first student placement working (in East London) with a community mental health nurse, my first job as a qualified practitioner, and my eventual move to Cardiff. Fascinating

Critical junctures

How pleasing it is to report that the paper I blogged about in this earlier post has now been accepted for publication. Co-written with Nicola Evans this (re)introduces the idea of ‘critical junctures’ and will appear in Social Theory & Health. We draw on two project datasets and show how action at pivotal moments can set individual service user trajectories on directions which are hard to reverse. We also show how, in certain circumstances, small-scale critical junctures can trigger (or be used to lever) larger organisational change.

Next up will be the checking of page proofs, and advance online publication via the journal’s website. What we won’t be able to do for another 18 months is upload a PDF of the post-peer review manuscript to ORCA. This is something Palgrave’s copyright rules are very clear about. In the meantime here’s the abstract which will, of course, be freely available:

Hannigan B. and Evans N. (in press) Critical junctures in health and social care: service user experiences, work and system connections. Social Theory & Health

This article makes an original contribution through the revitalisation, refinement and exemplification of the idea of the ‘critical juncture’. In the health and illness context, a critical juncture is a temporally bounded sequence of events and interactions which alters, significantly and in a lasting way, both the experience of the person most directly affected and the caring work which is done. It is a punctuating moment initiating or embedded within a longer trajectory and is characterised by uncertainty. As contingencies come to the fore, individual actions have a higher-than-usual chance of affecting future, enduring, arrangements. These ideas we illustrate with detailed qualitative data relating to one individual’s journey through an interconnected system of mental health care. We then draw on observations made in a second study, concerned with the improvement of mental health services, to show how micro-level critical junctures can be purposefully used to introduce instability at the meso-level in the pursuit of larger organisational change. In addition to demonstrating why scholars and practitioners should pay closer attention to understanding and responding to critical junctures we are, therefore, also able to demonstrate how their emergence and impact can be examined vertically, as well as horizontally.