United Kingdom National Health Services: a case study of workforce transformation in an integrated care organisation using actor-network theory

Background: Since the 1950s the UK’s NHS went through many changes. Those changes including the most recent one; bringing care as close as possible to patients home have affected the services provided as well as those who provide them. One of the local acute health care organisations has chosen to integrate with the community and primary care services in response to this policy. A gap in literature about the role of the frontline health care professionals in the health care policy process was observed.
Aim: The primary aim of this study was to examine the role that the health care professionals have in relation to health policy processes and the implications of the service integration to their professional practice.
Methodology: To overcome the limitation of a single snapshot of the integration process that continues to emerge over the time, an instrumental case study approach to data collection was selected. To maintain the scope of the study, the case study approach also delineated the boundaries of what was to be studied. For the purpose of this study, two methods of data collection were utilised; in depth semi structured interviews with purposefully selected informants and documentary analyses. Actor Network Theory (ANT) was used as a theoretical framework to guide the research process.
Findings: Though it could be explicit for health organisations integration as a special form of change, this study suggests that, neither the context nor the actors were the sole determinants of the outcome of the integration, it was rather the dynamic interplay
between the actors, their context, the shared agency (social structures, rules, values, norms) and the resources available to them that shaped the end result.
Conclusion: This thesis addresses an important issue in UK health care policy in relation to the reciprocal effect of frontline health care professionals and other policy driver on the policy implementation process and result.