Thinking on the hoof: a story about knowledge brokering in
community health & social care teams
by Vicky Ward with illustrations by
James McKay
This story is based on data collected by a researcher who observed the work of community health and social care teams and tried to help them share knowledge with each other. This work was undertaken during an independent research project funded by the
National Institute for Health Research.
Special thanks go to Rosemary Bayford, Lynne Carter, Sarah Edwards, Tessa Holmes, Joe Langley, Anne McGee, Alison Powell, Marie Walker and David Woodcock for their help with analysing the data and producing this story.
The materials contained in this booklet are free to use, but please contact me if you wish to do so. For more information about the project and how to get in touch please see the back page of this booklet.
The views expressed are those of the author and not necessarily those of the NHS, the NIHR or the Department of Health.
Š University of Leeds, April 2017
This story is about what it is like to help members of community health and social care teams to share knowledge with each other. The teams are made up of lots of different health and social care
professionals like nurses, social workers and physiotherapists. Their job is to work together to look after people living in the local community.
This is Vicky. Vicky is a knowledge broker and her role is to help people to share knowledge with each other. Recently, Vicky
has been working with a number of community health and social care teams.
Every week each team meets together to talk about the people they are looking after and are struggling to help. Vicky goes to these meetings too, but her role is very different to everyone else’s. The team’s role is to focus on each person they are looking after and how best to help them. Vicky’s role is to encourage the team to think about what they have learned in the past and help them to share different types of knowledge. Vicky often feels like an outsider and that she doesn’t really fit in.
Vicky often finds it difficult to get her role across to the teams she is working with. She tries to tell them that thinking about what they know can help them work out how to help the people they are looking after. And she tries to tell them that she is there to help them learn how to do that. But the teams sometimes struggle to get their heads around what she is trying to do.
Each team that Vicky is trying to help seems very different. Some teams don’t seem all that interested in thinking about how they share knowledge with each other. Other teams are more open to the idea of sharing knowledge, but are just too busy. Others jump to conclusions about Vicky and her role and are very defensive when she tries to help. Vicky often has to take a long time getting to know them before she can try to do anything.
During the meetings, Vicky asks questions to help team members to think and to share knowledge with each other. She has a list of questions to choose from, but the meetings are very fast-paced and don’t give Vicky much time to think about what question to ask or when to ask it. She usually ends up having to think on the hoof and respond quickly to what is happening in the meeting. This often makes her feel uncomfortable.
Between meetings Vicky spends a lot of time thinking about which questions she has asked and when she asked them. She finds it difficult to know what’s best and often feels very uncertain about what she has done.
The teams Vicky is working with react in different ways to the questions she asks. Sometimes they feel criticised and don’t recognise that Vicky is trying to help them to think and talk about what they know. Sometimes they try to give Vicky specific answers to the questions and don’t understand that she is trying to help them learn how to share knowledge with each other. Sometimes they get sidetracked trying to answer a question which doesn’t lead anywhere. When this happens Vicky feels very frustrated.
Sometimes Vicky’s questions help the teams to share knowledge that they haven’t shared before and develop new ideas about how to help someone they are looking after. At the time these lightbulb moments are very exciting, but Vicky often finds that she has to repeat her questions as soon as the teams start discussing someone new. Vicky is surprised that the teams don’t seem to remember the questions she has asked and sometimes feels as if she is having to start from square one each week. She worries about how dependent some teams are on her to help them to share knowledge.
Vicky spends lots of time trying things out and making changes to what she is doing. One of the things she tries is making the questions and her reasons for asking them more obvious by explaining more about what she is doing and putting the questions on the wall. Occasionally she tries to get another member of the team to ask the questions. She hopes that these approaches might help the teams understand what she is trying to do a bit better.
The thing that Vicky hopes for above everything else is that she can hand the questions over to the teams so that they can continue sharing knowledge when she isn’t there.
About the author Vicky Ward is an academic from the University of St Andrews. Her work focuses on how people share knowledge with each other and how they can be supported to do so. Between October 2014 and November 2016 she looked at how knowledge was shared during case management meetings in community health and social care teams. She also developed and tested a set of questions designed to help these teams to share knowledge.
To find out more about the project please visit https://mobilisinghealthandsocialcareknowledge.wp. st-andrews.ac.uk/ Email vlw4@st-andrews.ac.uk Twitter @VLWard