PROBLEMS WITH NETWORK GROWTH

2.2.3 Internally focused 2.2.4 Interaction increased at _{facilitated level} 2.2.5 Hierarchy reduction _initiated 2.3 boundaries Permeable

developing 2.3.1 Within UoAs 2.3.2 Outside the UoAs 2.3.3 Between UoAs and _{CLAHRC organisation} 2.4 Developing process of knowledge

exchange 2.4.1 Initiation of common knowledge 2.4.2 Development of knowledge transfer and

sharing

2.4.3 Developing use of _knowledge 2.5 Driving force 2.5.1 Facilitation

Table 7.2: A table to show the framework concept, theme and sub-theme for ‘Evolution’ - ‘Development’

2.2 Network growth

The group has convened together and gone through the initial process of starting to use CLAHRC improvement tools, gain certain knowledge and actively meet and

135

communicate to a pre-defined agenda. COPD and IMPE H project teams (UoA 1 and 2) were both at this stage within the process at the time of data collection and therefore the SNA data analysis highlighted within this section relates to these two UoAs.

2.2.1 Problems with network growth

There were issues experienced at this part of the process predominantly concerned with the perceived mandated nature of the approach, understanding of the process and the extra overhead incurred by the CLAHRC work to the teams.

There was, for example, concern that despite the mandated approach ‘one size doesn’t fit all’. This was specifically commented on with reference to the context within which CLAHRC were expecting the methodologies learnt to be applied. A number expressed that CLAHRC did not understand the context i.e. the NHS and how it functions. This created a tension and led to the validity and relevance of the methodology to be questioned.

‘CLAHRC’s doing research to better the quality of services, service provision for the patients, but we find very few clinicians there, so all of the managers, the support officers, or whatever they are, the backgrounds are very different, so I sometimes question myself how much do they know about the NHS and how it functions.’ (10072)

As a result there was a separation perceived between the CLAHRC organisation and the participants. For example, one participant suggested that they are separate and in an ‘ivory tower’, which in turn impacted the participant’s engagement with the process.

‘I’ve just felt them [CLAHRC] a bit ivory tower. And they’ve not got a foot in reality. So the ivory tower syndrome....I think it prevents me from necessarily engaging too much’. (10071)

Alongside the issue surrounding the application within the context of the NHS concerns were raised with regard to the terminology of the CLAHRC approaches and language used. There was a view that there was too much jargon being used and that the language used demonstrated a lack of understanding and hence had a negative impact on communication.

136

‘The whole language and way of working is very different, They seem to me to be rather cultish, they have their own personal way of doing things that they’re evangelising about. And it is quite foreign to me’. (10154)

‘there’s a whole lot of other jargon. A lot of it I don’t really understand, the jargon that’s used’. (10134)

Also, data showed an issue around the additional workload created as being part of the process. There was a considerable additional workload to the participants partly because of the project itself, but the foremost aspect appeared to be the overhead that the CLAHRC methodology and administration created. The two quotes below aptly highlight both these aspects. The first one relates to the extra work the CLAHRC methodology and approach creates and the second relates to the administrative burden.

‘I think, in its entirety it’s [CLAHRC methodology] very heavy. It’s definitely a lot of, stuff to do and stuff to make people do, who are already fighting for every minute of time of the day’. (10159)

‘I do a lot of the admin, which is a pain……it’s just taking over’. (10080)

This additional requirement created difficulty for the participants in terms of balancing their day job and their project/CLAHRC responsibilities.

‘From CLAHRC’s point of view, they should be getting time off in their day to do CLAHRC things but that it clearly doesn’t happen in practice’. (10134)

The conflict with day to day responsibilities was observed most starkly with the fellows. This is because they were solely responsible for attendance at CLAHRC events and their project. Within the setting up of becoming a fellow the organisational agreement was a day a week of time to be committed to the CLAHRC fellowship. This was agreed with the organisation via the matched funding approach outlined earlier. However, it was clear that this rarely actually happened predominantly due to job responsibilities. This tension between day job and the responsibilities to CLAHRC created an emotional tension for some as outlined in the quote below.

‘The struggles were around time, mainly, but I think that’s probably echoed by just about everyone……. I’m a bit sad about that, really’. (10088)

This went on to open up the question as to whether or not being part of the process was really ‘open’ to certain people. The reality was that despite the ‘agreement’ with

137

the host organisation the day a week to work on the CLAHRC project was rarely achieved.

‘It’s just an interesting aspect, whether or not this is really, truly open to people like me,….you know, when there’s knowledge that you won’t really be given your day a week……you know you’re not going to get it’. (10088)

In terms of how the participants actually dealt with this tension between their ‘day job’ and the CLAHRC commitment they primarily ‘fit’ the CLAHRC work in as and when they could even to the extent of doing it in their ‘own time’.

‘it’s just a balancing act, I suppose, and sometimes the CLAHRC ends up getting done at lunchtimes’. (10142)

Another aspect relating to the balance of time came from problems experienced in teams that did not have a dedicated project manager. For example, a team that experienced a turnover in personnel with regard to the project manager found that the momentum of the project was checked and progress stalled.

‘we’ve had a real, I don’t know the word to describe it, but kind of a stop and start kind of approach because we didn’t have a project manager for quite a while’. (10141)

Also, other project managers commented that if they were not able to dedicate their time as employed to do they felt that conducting a successful project within CLAHRC would be difficult.

‘I had a lot of dedicated time to put into the project, which a lot of people don’t get, which is, I’m sure, part of the success story’. (10086)

Despite the negative views expressed above regarding the mandated nature and understanding there were notions that suggested that in fact there needed to be more training early on in the programme. This primarily came from participants with experience of other methodologies and that were not necessarily clinically trained. This meant that the issue of administrative overhead was not an issue for them.

‘I think it needs a much more intense training, right at the beginning, before people launch on the CLAHRC journey’. (10159)

It is worth highlighting at this point that there was an opposing viewpoint that resulted from the fellows UoAs. This was with regard to the structure and mandated nature experienced by the project UoAs. The fellows followed a slightly different programme

138

and whilst they were made aware of aspects such as the CLAHRC improvement methodologies they were not mandated with regard to learning in any way. As a result I found there was a lack of understanding of the methodologies, a lack of purpose within the group and confusion as to what was being achieved and gained through the fellowship. The following three quotes represent each one of these aspects.

‘I was a bit, like, I’m not really sure what this is about, I haven’t quite worked it out yet’. (10131)

‘I got a bit frustrated with the meetings, because we would meet and we’d discuss about whether we were happy with where we were going, but we wouldn’t actually go anywhere. So, it felt like there was a lot of talking about what we were doing, and not much doing’. (10131)

‘there didn’t seem to be an expectation; and you didn’t really know what you…what they wanted from you’. (10131)

Although there were issues as raised above there was a commitment to deliver regardless of an individual’s view. A part of this I found came from the group coming together at this point and having a shared perspective.