Knowledge for practice, management and development

Malcolm Payne, Director, Psycho-social and Spiritual Care, St Christopher’s Hospice,

London.

Social work knowledges and good practice

Social work, like many professions, is both a practice and a set of knowledges. That
is, people who form an occupational group that is seen as a profession, and people
who interact with members of the group, primarily see the occupation as about doing
something in the world. What they do is significantly affected by how they understand
the world – by their knowledge of it. Their skill in practice is developed by
incorporating those knowledges into actions that form practice. The occupation is
constructed by the practices; people look at what the professionals are doing and can
decide whether or not what is being done is that profession or not.

Behind the practice, however, the members of the profession use those knowledges as
the basis for managing and developing their work. Management is about controlling
the practice so that it meets the needs that it is intended to meet to the standards that
the people whom the profession serves require. Development is about strengthening
the practice. Practice, management and development are therefore entwined together,
but they are different aspects of professional practice. Management and development
work is often done separately from professional practice and is part of the managerial
function of the agencies in which practice takes place. They may, therefore, be
experienced as separate activities from practice, the three activities interacting or
contributing to each other, but being separated in an agency because they are done by
different people or as part of separate organisational structures.

When we look at most social work services, many of the aspects that give them their
highest quality are about the characteristics of the interpersonal relationships between
staff and the users of the service. By developing staff skills and maintaining good
morale within the agency, we can develop and support this kind of quality, but very
often the skills and knowledge that create the right atmosphere and standards are hard
to assess, to describe and to encourage. For example, a disabled user who was close to
death went on a seaside visit; a member of staff noticed that she was staring at the
water, and discovered that she had been born near the sea, and wanted to paddle in the
water again, for one last time. It was difficult, but it proved possible to arrange this.
While we can organise and train staff to be flexible when they are asked for
something of this kind, it is hard to train staff to ‘notice’ someone’s preoccupations.

However, the ‘skill of noticing’ is not wholly a personal trait. It is a behaviour that is
learned. We can reinforce it when individuals show it, we can point it out to others as
a useful behaviour when it occurs, we can support it by responding positively to
suggestions when it arises. If a team leader had not said ‘Great, we’ll organise to get
her into the water,’ to the member of staff who noticed, she would be less likely to
notice something in the future.

One of the important aspects of a successful caring organisation, therefore, is

identifying what happens when ‘good practice’ occurs, managing the organisation in
such a way that this is recorded and built into knowledge in such a way that it can be
 Knowledge for practice… - 2

widely used. This can only be a collective endeavour, since to reinforce good practice
consistently requires everybody in the organisation to reach agreement about what
good practice is, so that ‘mixed messages’ are not conveyed, by some staff who do not
want to be inconvenienced by flexible responses, for example. Another factor is the
management of recording. Records are always written to respond to the needs of their
audience, not necessarily to present an ‘accurate’ account of an event (Askeland and
Payne, 1999). For example, if records are used to check on performance, staff will
record things that are approved by the management, rather than reflecting their own
judgements about what is important (Garfinkel, 1967). Processes also have to exist in
the organisation to convert piecemeal understandings within an organisation into
structured knowledge that can then be tested by more formal means.

What is needed therefore, is a process of organisational reflection. Individual

reflection is a widely acknowledged process in professions that work with all the
variability of human beings. Instead of ‘technical rationality’ in which evidence is
accumulated through formal research and knowledge-building processes, Schön
(1983) argues that professions such as social work, teaching and nursing undertake a
process of ‘practical experimentation’ as they practise. From this process, they
develop additional guidelines for practice. The problem with this formulation is that
there is no way in which individual practical experiments can be developed into
formal knowledge (Payne, 2002). A process of organisational reflection is one way in
which this can be achieved.

To build knowledges in a social work organisation, therefore, structures of

organisational learning and reflection need to build practice understanding into
knowledges that can be used in management and development. This enables them to
be generalised more widely in the organisation and then beyond it as a contribution to
professional knowledges. But how is it possible to do this in a working organisation?

One requirement is to believe that knowledges emerge from continuing practice and
that organisations need to be managed to do so. Currently, the assumption of much
knowledge development activity is that it is separate from practice activity, and that
the separation is required in order to give rigour and unbiased independence to
evidence that contributes to practice, management and development. For example,
research is seen as undertaken primarily in universities primarily by scholars, and
development is seen as primarily undertaken by managers in development
departments of agencies. To try to incorporate these activities into everyday practice is
seen by many managers as deviation from the main purpose of the service, by
practitioners as presenting them with impossible conflicts in priority and by
academics as risking bias and priority to ‘spin’ on behalf of the organisation or
practitioners instead of independent observation and knowledge development.

However, the qualitative argument is that knowledges for management and

development will be more effective if developed from practice. Debate about the
interaction between theory and practice has resolved itself to the point where a variety
of potential interactions are assumed to be possible. This paper argues that such
interactions have to be actively sought and developed of they are to be successful in
organisations.
 Knowledge for practice… - 3

Related to this, present-day social work is often carried out in multiprofessional

settings or in agencies where the social work is a ‘secondary’ profession; that is, the
ethos and work of the agency is dominated by other perspectives and knowledges.
This is true of health care, education and criminal justice organisations where social
work is a contributor but not the main profession involved.

Case study: St Christopher’s Hospice

The following account of knowledge management at St Christopher’s Hospice, a
palliative care service in south London, provides a case study of how some of the
knowledge management issues for social work within a multiprofessional service may
be dealt with. I have chosen to present a case study in order to describe the variety of
possible routes by which knowledge might emerge from practice, and also to provide
a model of generalising from practice to knowledge and development. After an initial
description of the organisation and its work, to place the discussion of knowledge
management in context, the case study examines how knowledge emerges from
formal research, user and carer involvement and clinical governance processes.

St Christopher’s Hospice is a palliative care service for people who are dying,
providing medical and nursing care with 48 beds to alleviate symptoms and manage
the disabilities and illnesses of life-limiting illness. It also provides nursing care and
medical consultation at home for about 500 patients at any one time. Like much social
provision, it is multiprofessional, to integrate a range of professions and services.
These include a day care service, with artists and physical care, complementary
therapies, such as reflexology and massage, spiritual care both for people who are
religious and others provided by chaplains and a social work service and welfare
benefits advocacy, to help people sort out their finances, which are often disrupted by
serious illness. After death, the social work service and chaplaincy provides
bereavement care to families and carers. The Hospice also has an education centre
providing courses for its staff, for the locality, nationally and internationally; we are
the largest provider of palliative care training in the world. The principle of our
education is that learning about our professional work must be based firmly on
practice.

Sources of knowledge
There are a number of sources of knowledge relevant to the Hospice, used by
practitioners to acquire knowledge to use in their practice. Each of these sources
involves different kinds of partnership with other organisations. The National Health
Service, in particular its public health function, local councils and organisations such
as the Office for National Statistics provide knowledge at the level of population
statistics and area data. Research findings, government guidance and reports provide
authoritative data based on a focused study of information. These might come from
partnerships with researchers, and organisations such as university departments as
well as government. The skill and experience of the workforce provide less
comprehensive, perhaps more qualitative information, but knowledge that is directly
relevant to the needs of patients and professionals as they work together. This
involves professional contacts and meetings, relationships with local and community
partners, and involvement in joint activities such as education and conferences. Thus,
more formal knowledge interacts with informal knowledge and understanding to
influence practice.
 Knowledge for practice… - 4

That interaction is not unproblematic, since while in principle these sources of

knowledge add to each other, knowledge always represents the interest of the
organisation than produces and disseminates it. For example, the Department of
Health, the government ministry, seeks to use knowledge to push policy n desired
political directions. Professional organisations may have projects to press forward,
incorporating a wish for influence for their position. Information sources are also an
important influence on the direction of knowledge. For example, the Office of
National Statistics finds it difficult to collect census information from some part sof
the community, particularly minority ethnic groups and people who do not wish to be
identified in official data gathering activities.

These forms of knowledge become incorporated into the organisation’s work through
different processes. For example, the Hospice is a member of national bodies
concerned with co-ordination of organisations working in palliative care, Help the
Hospices and the National Council for Palliative Care. Through working parties,
conferences and joint projects, knowledge and understanding can be developed.
Partnerships with government are also often achieved through such joint processes, by
which practitioners can influence government policy and practice, by lending their
expertise tot the development of guidance and regulatory practice. For example,
recently the National Council organised a joint working party to identify varying costs
in different aspects of services aimed to move towards a more standardised
framework for managing finances, which in turn will affect how the National Health
Service allocates funding to hospices nationally. The periodic publication of
information from the ten-yearly population census allows the calculation of
deprivation indexes for different areas of the country, and for understanding about the
numbers of people from different ethnic minority groups in the area served by the
Hospice, so that it can respond to different cultural needs. Government guidance and
regulation affects how practitioners interpret their work, and practitioners’
interpretations eventually influence government guidance.

This process of incorporation is also not unproblematic and a smooth incorporation of

knowledge cannot be taken for granted. For example, different sized hospices have
different interests in funding, and so cost analyses can provoke conflict between
organisations in membership of co-ordinating bodies. For the members, the benefits
from involvement and influence have to be balanced against disadvantages in
participating in an agreed view that may not always benefit the particular
organisation.

Partnerships in research are organised in different ways. Sometimes, members of staff

develop a research project on their work, and will work with colleagues form a local
university in carrying it out. Staff who attend higher degree courses ay universities
supervised by university staff carry out research for their dissertations in the Hospice,
or students placed at the Hospice will carry out research on their work as part of their
dissertation for their award. Sometimes the Hospice will contract with a university
department to carry out a piece of research in which it has an interest. For example,
the Hospice has recently awarded a grant to a local university to study the ways in
which service users perceive complementary therapies to be beneficial. Sometimes a
university will approach the Hospice on behalf of a PhD or other researcher who
needs access to its patients to carry out a project. For example, a PhD researcher from
Ireland, based at a university in the Netherlands has recently used the Hospice as a
 Knowledge for practice… - 5

source of subjects for an international qualitative study on how service users perceive
the shift from curative to palliative care. Sometimes the Hospice will negotiate a
strategic piece of research with a university department or the university will agree a
joint project to pursue research as part of its own programme – funding for projects is
more easily obtained from some sources if it involves both university and practice
agencies. For example, the Hospice has recently been involved in a project examining
the use of an outcome scale as part of its staff’s practice. It is also working with a
university on a project to train nurses to carry out cognitive-behavioural therapies; the
research is examining whether the short training in CBT is effective and whether this
improves outcomes for service users.

However, to discuss this process as ‘partnership’ conceals competition and conflicting

interests that may also exist. An agency such as a hospice might benefit from or seek
to downplay particular research findings, or give access to research perceived to
benefit its particular view, or deny access where the research might be
disadvantageous. Professional groups may obstruct research that conflicts with their
interests. Thus, as with participation in co-ordination, partnerships in research for
knowledge creation may bring different interests into play.

In any service, there are a number of these knowledge interests, individuals or

organisations that have a stake in how knowledge is both interpreted and used in
practice. An important recent document, the NICE guidance manual on palliative care
for adults with cancer (NICE, 2004) illustrates this. It was produced by an
independent organisation supported and promoted by government to give guidance on
the most effective way of carrying out clinical practice in health care. To promote a
policy to improve services for adults with cancer, the government included this
project in NICE’s work programme. Research reviews were commissioned from
authoritative researchers, some of whom worked on research at St Christopher’s,
groups of practitioners and service users were consulted through various drafts,
including staff from St Christopher’s, and the final document contains detailed
guidance about what treatments are most effective according to research evidence and
established practice. This guidance is multiprofessional: it includes social work. A
similar organisation (the Social Care Institute for Excellence - SCIE) carries out the
same function in social care, where social work is the main focus of a service.

Involvement in knowledge development in any agency depends on a number of

factors that creates a more of less powerful role for it in knowledge development. A
crucial factor is the history and record of research in the agency and in the professions
that make it up. St Christopher’s started from research: the historic work of Dame
Cicely Saunders in the 1950s in pain control was the origin of its foundation
(Saunders, 1963, 2004). Many agencies were set up to implement legislation or the
ideals and commitment of their founders. An important way of developing research is
to incorporate it as a crucial part of the organisation’s activities.

Another important factor will be how research is managed: St Christopher’s has a

clear research governance process, which helps people to understand how to take up
research ideas and implement them. It has a representative research committee, which
has a regular review of research ideas, puts them in priority and follows them up.
Outside researchers approach the committee with their ideas, which can gain
approval, and a senior manager is allocated responsibility for smoothing their path
 Knowledge for practice… - 6

within the organisation, and organising ethical approval for research with patients and
service users. An audit committee representing practitioners can then meet to discuss
the practicalities of recruiting subjects for the research and carrying it out in the
everyday work of the Hospice. This generates commitment to particular projects and
helps staff understand why they are asked to collect information or work in a
particular way. The research committee also allocates a small research budget to
internal projects, provides training and support in writing up and presenting results
through academic and professional journals. While all this potentially benefits
knowledge development more widely, governance procedures also form arenas in
which particular kinds of research may be advanced or impeded by particular
interests. So, to understand knowledge development within an organisation, we must
also explore the political processes through which interests have an impact on what
knowledge is created and rejected.

Carer and user involvement

Involvement in knowledge development by carers and users is an important source of
knowledge. It provides feedback on service quality, it helps to obtain funding by
demonstrating the effectiveness of the service and it gives patients and involvement
and a sense of purpose as participants in the work of the Hospice, instead of their
being merely objects of care. It is also an important government priority that patients
should have choice in the services they receive and influence on the management of
their care.

There are particular problems with carer and user involvement. Ultimately, people
who are dying cannot tell you about their experience. Patients are often very ill, and it
is hard to involve them in conventional information techniques. Since the service is
intended to provide for a ‘good death’, bothering people for information can seem
unethical. However, patients often appreciate being able to make a contribution to
standards of care for people who will use the services after them. The research
governance process is important here for identifying and dealing with the practical
and ethical problems that may arise. It is also important to distinguish between user
and carer involvement, since the interests of service users may be different from the
interests of their caregivers.

Other problems may reflect a conflict in interest between users’ and carers’ concerns
and professional or organisational concerns. For example, many patients say that they
appreciate day care and complementary therapies as part of their treatment, such as
massage, reflexology and acupuncture. However, the complexity of the social
outcomes of such interventions means that they do not offer clear evidence of
achievement of political health care objectives. the NICE guidance (2004), for
example, does not propose enhancement of day care or complementary therapies for
this reason. In this way, knowledge development processes may conflict with user or
carer interests, and user and carer responses may implicitly criticise research
achievements and priorities and policy based on this. Such conflicts can be
uncomfortable to professionals and researchers.

The Hospice uses three main processes for user and carer involvement: quality
assurance processes as part of its clinical governance processes, a series of user
forums, and user involvement in audit of particular services. These are considered in
 Knowledge for practice… - 7

turn in the following sections, which give a broader overview of clinical governance
as part of the process of creating knowledge from practice.

Knowledge for management: clinical governance

Clinical governance is different from research governance, discussed above, but is
another important way of generating knowledge from practice. Clinical governance
processes allow multiprofessional teams to collect knowledge from a range of sources
and make recommendations for future development. Monthly meetings of staff
involved in services to patients and their families are divided into two: a general
meeting to ensure co-ordination and developing procedures and policies by agreement
and a review meeting every two months, interspersed with meetings to co-ordinate
specific aspects of the services. A variety of mechanisms are used to feed the
experience of the Hospice into these committees, so that knowledge can be developed
from within them.

User feedback
Feedback from users of services is crucial to the quality of services; it often gives
insights into the experience of receiving services that professionals do not have; it
identifies practical difficulties that often do not occur to staff. It may also provide
evidence for seeking funding, partly because it is a government priority to pay
attention to user choices and because other funders seek evidence of user satisfaction.
Most important, the use of open discussion through user forums gives both users and
staff a sense of involvement and participation in a joint endeavour. Particular aspects
of the service offer different opportunities. For example, every few weeks a group of
attenders at the Hospice day centre take part in a ‘goldfish bowl’ in which they discuss
their experiences, watched by a group of medical students who can then ask questions.
This connects user experience with training, and the sessions are recorded and the
discussion sued as the basis for a qualitative research project.

The Hospice also gives all users and carers questionnaires, and these are also widely
available around the Hospice. They are collated periodically, and a six-monthly report
is prepared. This gives an indication of trends, since deterioration from the usually
high satisfaction levels can be immediately detected and inquired into. Each
individual comment can also be helpful, because an individual suggestion can give an
idea about how to deal with an issue that might not have occurred to staff.

Comments, suggestions and complaints

The Hospice is keen to learn from ideas and things that go wrong. It has an integrated
comments, suggestions and complaints system because many people because
complaining is not their overall reaction to the service they receive and they ‘do not
want to cause any trouble’. Therefore, a positive approach to getting ideas and
suggestions is important to allowing problems to emerge, and when problems emerge,
it is important to have a positive ‘we aim to improve’ approach to responding to them,
otherwise both patients and staff will try to suppress them. We have an integrated
form for suggestions, which are investigated by a middle manager and the responded
to within a published, short timescale by senior managers. Comments and suggestions
are diverted into ‘user feedback’ in the clinical governance system. The outcomes of
complaints are recorded in a register and reported on to the clinical governance
committee every six months, so that any trends and needs for wider action can be
identified.
 Knowledge for practice… - 8

This kind of approach, which responds positively to complaints rather than seeing
them as an opportunity for criticising staff, is important in avoiding distortions arising
from the recording effects discussed above.

Audit
The Hospice also audits its work. Every department produces statistics and qualitative
information about its work twice a year, for discussion in the clinical governance
committee. Then, every department chooses an aspect of its work for more
comprehensive audit every year. Part of the work may also be identified for
development work. Thus, everyday present practice is audited and this may lead to
developments; often areas thought to need development will be audited to identify
what approach should be taken to the prospective changes.

In a recent example, the welfare benefits advocacy service that is part of the social
work department was audited. A recording instrument was developed for staff to
complete to identify the problems raised and work done in two months of cases. A
10% sample of multiprofessional case records was reviewed by an independent
member of staff to identify whether problems noted were identified and referred.
Finally, it was noticed that there was a small number of complex cases involving a lot
of work, and the case records for this work was analysed. The annual workload of the
service was calculated from these samples, and difficulties in providing the service
identified. The study showed a high workload, handled efficiently, and producing
outcomes for clients that far outweighed the cost of providing the service. The
complex cases analysis identified the social security benefits that were producing the
most problems. The case records review showed that potential referrers did not
consistently identify even quite serious financial problems among clients. The audit
led to the allocation of another member of staff, validated staff and their achievements
and strengthened support for the work.

Another recent example was two audits on arrangements for discharge of patients
from the Hospice. In different ways, these showed that this was happening efficiently
and without problems. However, the feedback when this outcome was reported to
nurses, was that they experienced the process as very stressful. So, a project was set
up to examine precisely what caused aggravation in discharge.

Clinical events analysis

The Hospice brings together three elements of review of clinical events, to learn from
them: learning reviews, critical incidents and clinical reviews. Learning reviews are
regular meetings to discuss cases, from which learning points are drawn and reported.
There are multiprofessional events, and specialist events. Critical incidents are where
there is a major event in a patient’s treatment, often where a risk arose, for example
when a frail person falls, or where someone attempts suicide. A meeting of those
involved is chaired ‘from the top down’ by an independent manager to find out
precisely what happened and report on learning. Clinical reviews arise ‘from the
bottom up’, where a difficult or complex situation was dealt with. Again, a meeting of
those involved is called to identify learning. Reports from all these sources are
accumulated and reviewed annually; this allows learning to be drawn from events,
without criticising people for what went wrong, although if things went well, the
meetings often apportion praise.
 Knowledge for practice… - 9

Ethics panel
The Hospice maintains an ethics panel. This is separate from the research ethics
management process, and examines and develops understanding about ethical issues
faced in practice. It has both internal and external members from a range of
professionals, but includes external specialist ‘ethicists’. The Panel reviews and
reports on events that raised ethical issues, to develop learning, and examines policies
and initiatives that might raise ethical problems. Teams of two or three independent
people, drawn from the Panel, can be called on to act as consultants if there is a
difficult decision to be made: the outcomes are then re-ported to the Panel, so that
ethical guidelines can be improved.

Knowledge for development

So far, I have been discussing how knowledge from practice is constructed to emerge
from practice through various organisational processes. In doing so, I have noted
some of the ways in which conflicts about priorities and perspectives may emerge in
the organisational processes through which such knowledge emerges form practice.
Many of the same processes also contribute to development, and also produce the
same kinds fo conflicts of interest. Development includes the emergence or creation
of new services or new aspects of services, achieving improvements in how present
services are delivered and increasing knowledge and understanding through research
and education as a way of providing a foundation for further improvement. An
important area of conflict of interest here may derive from the need for championship
of innovation as a way of achieving public and financial support for the organisation
conflicting with the need for dispassionate analysis of outcomes.

Impetus for development may come from practice experience and research identifying
where interventions work or do not work, pushing people to change their practice in
the future. It may also come from the mission and vision of an organisation (Payne,
2000, ch 4), which may draw attention to failings in coverage or ethical and practice
issues that require attention. It may also come from the impact of policy, particularly
government policy, and professional ideas on an organisation and its practice. Policy
developments often reflect changes in social attitudes or expectations and an attempt
by people with social power to incorporate them into the practice of organisations.

Development is often approached by research and evaluation. For example, staff in

the Hospice’s day care centre were concerned because external researchers had
questioned the value of day care as an element of palliative care service. Research
discerned few clear outcomes form day care. Therefore, they used the ‘goldfish bowl’
user forums, discussed above, as a way of identifying users’ objectives.
Complementary therapists responded to other professionals’ comment that while
patients said they liked reflexology or massage, it was unclear why, or whether they
might be helped equally or better by other interventions or ordinary social
experiences. Therefore, the Hospice financed a study to identify precisely why
patients valued complementary therapies and how this compared in contributing to
their well-being with their medical treatment and other well-liked social experiences.
However, such approaches to research to ‘prove what we know’ or to present an
organisational message make it difficult to understand how organisational interests
may be interacting with research outcomes.
 Knowledge for practice… - 10

Another way of achieving development is by setting up an innovative service, based

on new opportunities. For example, the day care centre established a project for
patients to use new digital technologies to create artistic expression of their
experience of illness and their lives. These are often placed on a website
(http://www.rosettalife.org/) provided by a co-ordinating and development
organisation in this field. This is an extension of the kind of experience provided by
art or craft activities, updated with attention to modern technology, which may engage
some service users more than the traditional technologies.

Development may also be achieved through training and management systems. For
example, many staff were anxious about working with patients with mental illnesses –
anxiety and depression are common in dying people (Henderson, 2004; Hotopf,
2004). The Hospice established a three-day training course, with a concentration on
practical skills, to increase confidence and understanding. It then established a system
whereby a member of each multiprofessional team went on the course and then acted
as a consultant and supporter to other team members as they dealt with particular
difficulties among their patients.

Conclusion
Our professional knowledge for management and development emerges from our
practice in agencies. I have suggested that this cannot just be assumed to happen, an
agency must establish processes by which knowledge can emerge and be formulated
in ways that can be practised and used. But as it does so, it will also incorporate into
organisational structures for research and knowledge governance, conflict or
competition between knowledge interests for control of the knowledge creation
process, and in turn for the outcomes of knowledge development.

Knowledge can only be developed in partnerships, because there are many people
with knowledge interests, stakes in the information used to create knowledge, and
particular roles. Among the most important sets of relationships, however, are
between agencies and higher education institutions. However, these have substantial
differences in interest. Consequently, claiming ‘partnerships’ as a taken-for-granted
approach to co-operation conceals the potential difficulties. As with all co-operative
mechanisms, knowledge develop usually requires careful work, so that interests are
aligned and conflicts defused. The source of agency approaches to knowledge
development tends to be their vision and mission, while the mission of a university if
knowledge development. What brings them together is practice: universities develop
knowledge to influence the real world, the world of practice, while agencies aim at
improved practice as the main objective of their knowledge development. Agencies
nowadays are often multiprofessional, whereas universities are typically discipline-
based. Again, it is how people from different disciplines practice in relationships with
other professionals that allows knowledge development to have a wide impact on
services. Small research projects can be carried out by practitioners in agencies and as
small projects in universities, but large projects will always require the combined
expertise and commitment of a partnership between university and agency.

There are conflicts in priority that different knowledge interests may give to particular
knowledge, forms of knowledge and uses to which it may be put. In particular,
powerful interests, such as government, may not be interested in applications of
knowledge to practice, but only in its policy or management potential. This means that
 Knowledge for practice… - 11

professional knowledge relevant for practice may have a lower priority for many
organisations. Consequently, it may be important for social work agencies to identify
partnerships in which professional and practical knowledge can be made more
powerful in the battle for knowledge influences.

Knowledge from practice can be made powerful for management and development by
being relevant to a range of members of the multiprofessional teams, by drawing on
the perspectives of users and carers, and adding to that partnership a range of different
knowledge interests. Because the partners inevitably have different interests, there
will be conflicts of priority. Sometimes, the objective of influence on practice in the
field can unite universities, agencies, practitioners and carers and users in a
partnership for better practice, better management and renewed development in social
work services. Alternatively, the need to influence practice in the direction of
particular knowledge interests can generate conflicts and difficulties in knowledge
relationships which requires careful analysis, understanding and effective structures of
research governance to overcome.
 Knowledge for practice… - 12

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