Estrategias Utilizadas en Espacios Métricos

All integrated locality team staff, especially those of the North City Integrated Locality Team, found that one of the biggest changes the integration brought them was being co-located from different locations into one big office. Being in the same office with everybody else had had a significant impact on members of the two integrated locality teams. Every team member I talked to said that co-location with other disciplinary teams into the same office had changed them. It had brought down barriers and generated five secondary mechanisms: promoting communication; building trust; sharing roles; promoting joint working; and helping teams to ‘gel’. These secondary mechanisms were complementary to the main mechanism – ‘bringing down barriers’, were derived from it and would all consequently generate outcomes of their own. Like the complex, messy integration programme itself, these main and secondary mechanisms were also complex and messy.

Four members of staff (S2, S3, S4, S6) said that the basic idea of the integration was to get rid of barriers between different disciplinary teams and make them work together to produce better services. The co-location of everyone into the same office brought down not only the physical walls but also the mental barriers separating them. A member of staff said:

I think the idea is to get rid of the barriers there are between the different professionals of health and social services to provide, um, a better service really for the clients or patients. (S4)

being co-located in the same office had made face-to-face communication between the disciplines much easier and more convenient. More face-to-face communication was taking place. A member of staff said:

So before integration, I would say the important communication did take place even though we weren’t in the same office. More communication is liable to happen instantly just because you see someone and you tell them something else that could be useful to them or they might tell you something that’s useful to you that you possibly wouldn’t have communicated before. So I would see that the advantage really should be for the client user, should be in essence a better service, um, and I guess for the staff, it should be more satisfactory, a more satisfying job because you’re actually communicating more with the rest of the team. So, that’s more overt shared responsibility, I guess. (S4)

A member of staff thought that being co-located in the same office was very conducive to building a trusting work environment and to good teamwork. She reported:

But I certainly think being in the same office together and the management style that is here very conducive to good team working, it’s a very trusting sort of work environment; it’s not very controlling, it’s very trusting management. So, you sort of, um, I think everybody really works very hard here. And I feel that it definitely is happening here, yeah, which is good. (S4)

A member of staff thought that being in the same office made it difficult for some staff who had tried to keep their role separate from those of other disciplines. Being in the same office made it easier for them to know other people’s roles and to share roles with others. She said:

Well, I think you have to work at it. I don’t think you can keep your role completely separate. (S1)

This staff member was one of the nine hundred transferred from Cambridgeshire County Council Social Services into primary care NHS trusts. It was interesting to hear her say that the old Social Services’ way of working was not able to continue.

She told me:

S1: Some people really still like to keep their roles separate in the old Social Services way, and you can’t do that now. You’ve got to give.

Me: You’ve got to do –

S1: Some people are very protective of their roles: ‘Oh, that’s what I do’. But it’s interesting to see other people’s roles anyway, more health, district nurses, and things like that. I think we’ve worked at it very hard in this team and it’s a very happy team. And it works well.

Three members of staff (S4, S6 and S7) said that the co-location of different disciplinary teams in the same office and having tea breaks and staff meetings together was important for them to understand each other’s roles. It helped them change their practice to more joint working or to co-organise care with other disciplines. A member of staff explained:

I think that’s fundamental to it. And fortunately in North City we have co- location. I think that’s important. So having therapists, care managers and intermediate care team all in one building and that actually helps. Because the buildings, we have the meeting room and so on that the district nurses are coming into and so on. There is very much more joint working. (S7) When I asked one member of staff what had made her work with those of other disciplines, she said:

What made me change practice? I suppose it really is being literally desks away, you know, in the same office, also going to more meetings where these people are, starting to overhear things, and starting to understand more of their roles, what they get involved with, and it’s actually happened, to be fair. (S4)

Two senior members of staff (S1 and S6), one from of the two Cambridge City integrated locality teams, felt that being in the same office helped the integrated locality teams to gel. They both claimed that both integrated locality teams were beginning to integrate together. One claimed:

It’s beginning to gel. As far as care teams are concerned, it’s excellent, absolutely excellent, because they have been brought in and they actually feel part of the team. (S6)

When I asked her: ‘What’s the sign of gelling?’ she continued:

Just banter I suppose, just seeing them talking to each other, um, learning from each other, having a cup of coffee together, that sort of thing. And um, and asking each other, you know, professionally asking people, you know, people’s opinions. (S6)

Figure 4.8 illustrates the ‘bringing down barriers’ mechanism and its five secondary mechanisms. However, putting everyone in the same office did not mean that they would work together. A member of staff recognised that getting human beings to work together was and would continue to be a challenge. She said:

But has it been an easy ride? No, it hasn’t been easy at all. Getting everybody to think about a different way of providing care. I think that most people would appreciate that it’s much easier to get care. But getting human beings to work together has been quite a challenge. And I am sure it will continue to be a challenge because everybody is individual and everybody comes with their own agenda. (S6)

Figure 4.13 The ‘bringing down barriers’ mechanism