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PULLING TOGETHER THE THEORETICAL THREADS: TOWARDS

2 DEVELOPING A THEORETICAL FRAM EW OR K

2.8 PULLING TOGETHER THE THEORETICAL THREADS: TOWARDS

This Chapter started with an account of the origins of this study, and considered the theoretical implications of replicating a research design pioneered in a previous investigation. Following this came an analysis of sociological theories which emphasise the ideas of work as interaction and systems of work. Noting that the main concern of Hughes (1971) and Abbott

(1988) is in the systemic outworkings of work-oriented interaction rather than in the characteristics of interactions perse, this Chapter then proceeded to an analysis of the negotiated order perspective as a framework for investigation into interactions ‘as interactions’. Selected studies into the negotiated order were reviewed with the aim of learning from previous researchers’ attempts at using a negotiations perspective to underpin and inform their empirical work. Finally, the idea of complex trajectories was introduced. In this closing section a theoretical synthesis is attempted. The intention here is to draw on the preceding analysis to construct a sound conceptual framework with which the work of delivering community mental health care might be better understood, and within which this study can be theoretically located.

A first theoretical proposition underpinning this study is that the division of work is accomplished interactively. However, work-oriented interaction is not an unfettered activity, but is one which occurs within particular contexts which constrain and frame action:

...however central social interaction is to the division o f labour, it is also the case that abstract conceptions of roles and responsibilities are made - in formal organisational policy and, in the case of certain occupations, in state legislature - and while they may not determine work boundaries in a straightforward way, they certainly help to fashion their contours.

(Allen, 2000a, p328, emphasis in original)

This proposition is reflected in this study by an analytic stance which includes accounts of the ‘patterning’ effects of constraint on interaction, and of the

‘lines of impact’ running between macro, meso and micro-levels of organisation.

Second, analysis in this study encompasses the idea that the world of work is best understood as an interrelated system. Reflecting ecological assumptions, analysis includes study of the contributions to systems of work made by paid and unpaid workers and by multiple agencies and organisations. Work

undertaken by unpaid workers, including recipients of services, is often not thought of as being ‘work’ at all (Strauss et al., 1985). Here, however, an attempt is made to analyse the work of all principal workers, and to locate the contribution of each within the context of the whole.

A negotiated order perspective permits theoretical linkages to be made between everyday workplace interactions and the overarching structural context within which such interactions take place. ‘Negotiating’ is an enduring feature of human social organisation, but is not the only way in which ‘things get done’. During times of upheaval and change, and in instances where the system of work encompasses multiple social actors drawn from a variety of backgrounds and organisations, the negotiated order perspective holds out particular promise as a framework for empirical investigation. Both these conditions applied in the context of the present study. The general treatment of the negotiated order perspective here is to use this as a tool for analysis and investigation into both micro-level interactive processes, and the macro­ level structural features which frame and constrain those interactions.

Explicit use of a ‘negotiations’ perspective is made to drive forward an analysis of the overarching, and dynamic, structural context for the

organisation and delivery of community mental health care. The largest-scale structural conditions within which services were organised in each of the two sites in which data were generated, and in which everyday community care was delivered, are ultimately the product of social interactions. However, from the vantage point of social actors participating in meso and micro-level

systems of work these large-scale contours of mental health service

organisation typically appear, in effect, to be ‘constant’. In a different context and for different conceptual purposes, an adjustment of the analytic lens

would permit the apparently fixed, or stable, structural parameters surrounding the everyday world of mental health care at meso and micro-levels to be

treated as both mutable and subject to interactive processes.

In later data analysis Chapters, accounts of negotiations (and alternatives to negotiations) are located within the particular negotiation contexts in which these interactions took place. The review of negotiated order studies undertaken earlier in this Chapter reveals considerable differences in the interpretation of the term ‘negotiation context’, reconcilable only when the different analytic foci of each study are taken into account. In this study, the analytic focus and related data generation strategy has been a two-pronged one. First, in each of two study sites data were created relating to the general organisation of community mental health services. Through interviews with senior managers and practitioners employed in different agencies, through observations of community mental health team meetings, and through the

location and analysis of documents it became possible to compare and contrast two local ecologies of mental health work. These data are presented in Chapter 5, where these two local systems of work are described as

constituting two contrasting ‘meso-level negotiation contexts’ (cf. Mesler’s (1989) identification of the ‘negotiation context’ for his study of the negotiated order of clinical pharmacy as comprising the two hospitals in which he

conducted his fieldwork).

In Chapter 5 it has been possible to explore the extent to which the structural context analysed in Chapter 3 helped pattern the interactions taking place in each study site ‘meso-level negotiation context’, and the extent to which local systems for organising mental health work reflected interactive and other processes. The term ‘meso-level’ is used here with care, in the sense that analysis of the system of mental health work in each study site ‘sits between’ analysis of the larger structural context (Chapter 3) and the more micro-level analysis of the networks of care surrounding each of the six case study subjects (Chapter 6 onwards).

Fieldwork in this study also focused on an exploration of the delivery of everyday mental health care to three exemplar users of community mental health services in each of two distinct study sites. From this, more micro, vantage point, it is analytically possible to treat the negotiated order of local mental health services delivery explored in Chapter 5 as now being part of an expanded and overarching structural context. For the purposes of this part of the analysis, the ‘micro-level negotiation contexts’ are the systems of work as

these specifically surrounded each of the exemplar users of mental health services whose care I was able to follow during periods of data generation (cf. Sugrue’s (1982) description of a ‘negotiation context’ as the network of care surrounding her single case study subject). This approach means that, as the analytic lens shifts from the macro-level ‘downwards’, each negotiation

context subsequently becomes subsumed within an expanded structural context as a new, more micro, negotiation context comes into view. Figure 2.1 below illustrates these relationships.

Figure 2.1

Structural and negotiation contexts

Structural context Macro

Meso-level negotiation contexts: systems of work in

both study sites

lines of impact-

Micro-level

negotiation contexts:

networks of care actual interactions

m

Micro

Handling of the problematic concept of the ‘negotiation’ has been informed by the work of Strauss and colleagues (Strauss, 1978), and by the thinking of Maines and Charlton. Their view has been noted in detail above, and includes the idea that ‘negotiating’ is a broadly defined sociological phenomenon which

takes place between social actors in conditions marked by the absence of either complete consensus or non-consensus, in which exchange is possible, and in which particular strategies are used (Maines and Charlton, 1985). I make the normative assumption that, in most circumstances, strategies of negotiation are preferable to the alternatives (such as the use of coercion) as a way of getting things done. To link this observation to the aims of my study, I advance the view here that negotiations are likely to be ‘helpful’ rather than ‘hindering’ in the context of community mental health care provision. Analysis has, then, encompassed particular consideration of the characteristics of negotiation contexts which either promote, or detract from, the likelihood of negotiations taking place. In this study I also characterise ‘negotiations’ as potentially encompassing a range of activities. These include face-to-face interactions between social participants, but also interactions mediated by advances in technology such as through the use of written records,

telephones and computers.