Experiential knowledge in action: Consulting practitioners for policy change

Abstract

The success of practitioner involvement in a policy consultation process is usually taken to be evident in the extent to which the resulting policy document is shaped by their views. Taking as its case study a public consultation for a new Scottish mental health policy, and drawing on theories of knowledge, this paper finds that for practitioner involvement in this consultation it is not possible to measure impact in this way. This is because the experiential and verbal knowledge of practitioners is not easily transferable through the different stages of the consultation process and into the final policy document. Instead, another significant effect resulting from practitioner involvement in the consultation is identified. Practitioner participation in the consultation is found to be a productive process of learning or education which produces a policy community more aware of its role in relation to the new policy.

1 Introduction

Since 2001 Scottish public mental health policy has centred around the work of the National Programme for Improving Mental Health and Wellbeing (the ‘National Programme’). This programme aims to raise awareness and promote ideas of mental health and wellbeing, challenge stigma and discrimination, prevent suicide and promote recovery (Scottish Executive, 2007; Smith-Merry, 2008). In 2007 a consultation process revolving around the document Towards a Mentally Flourishing Scotland (TAMFS) was launched in order to guide the development of the next stage of the National Programme. The consultation process consisted in a range of public and invited consultation events and meetings, deliberation by a national reference group and the submission and synthesis of consultation response documents.

This paper describes the participation of practitioners in the TAMFS consultation process. I track the way practitioner knowledge was mobilised by practitioners themselves and used by others in the process. This research derives from a larger study which examined how particular forms of knowledge function in relation to policy making for mental health in Scotland.¹ The TAMFS consultation process was chosen as a research site through which to visualise these processes in the context of a public policy consultation. Public consultation processes are becoming a common part of policy making in liberal democratic countries such as those of the UK and as they do a wider variety of voices are being asked to participate in and comment on the development of policy (Gustafsson & Driver, 2005; Martin, 2008). Where policy making was once viewed as an activity for bureaucrats and organised lobby groups, the individuals whose lives and work are the subject of policy action are now being invited to contribute to the process (Cook, 2002). For this reason, individual practitioners are increasingly being included as key stakeholders in policy consultation processes for social and health related policies. Given this context, my interest was on how practitioner knowledge was actually utilised and included in the consultation and how this knowledge influenced policy. To reflect on this, the TAMFS case study was explored via interviews with the main actors involved in the consultation, observation of a range of consultation events and meetings, and documentary analysis of key documents.

2 Practitioner knowledge

The term ‘practitioner’ is used throughout the paper to refer to individuals trained for a ‘guiding’ role and involved in directly administering and delivering programmes and services to members of the public. An example of the roles of those practitioners who attended the consultation events for TAMFS are medical practitioners, social workers, outdoor education officers, teachers, librarians, nurses, and service coordinators and managers.

Practitioner knowledge is largely (though not only) tacit in nature and is known through being experienced. Schön (1983) describes practitioner knowledge as ‘knowing-in-action’ where the experience gained through doing work is central to the development of their knowledge. Likewise Hiebert, Gallimore, and Stigler (2002) describe practitioner knowledge as ‘craft knowledge’ which is “characterised more by its concreteness and contextual richness than its generalizability and context independence” (p. 3). This means that while practitioners will often come from a background in which they were taught their skills through structured training, it is the ‘action’ component of their work which is most important to their knowledge. This knowledge is built up through the practice of doing tasks, reflecting on them personally, discussing them with other practitioners and noting them through the structured processes of documentation which accompany most practitioner roles. Bartunek, Trullen, Bonet, and Sauquet (2003) discuss this sharing of practitioner knowledge as the transmission of “stories of practice” built around “…the richness of the contextual details” (p. 63). The contextual nature of the knowledge means that it is difficult to encode and formalise within documents (Bartunek et al., 2003).

Recent work on practitioner knowledge has focused on how practitioners use knowledge in the everyday tasks they are involved in, and how this knowledge is transferred to other practitioners and to those working outside of their area of practice (Nutley, Walter, & Davies, 2003; Peters, 2003). For example, there has been significant work examining how particular types of practitioner, such as medical practitioners, draw on knowledge in the work they do (e.g. André, Borgquist, Feldevi, & Mölstad, 2002; Malterud, 2001). This work is important as it allows educators and service managers to design training and other interventions which more effectively target practitioners in order to enhance implementation. Accordingly there has been a strong emphasis on the dynamics of practitioner knowledge within educational research and organisational research including organisational psychology.

Within organisational psychology the focus has generally been on the flow of knowledge within and between organisations and actors and the barriers to effective knowledge translation. One particular area of work, pertinent to this research, has been on the functioning and transfer of tacit knowledge within organisational settings (Newell, 2005; Newell, Edelman, Scarbrough, Swan, & Bresnen, 2003; Schulz & Jobe, 2001; Swan, Newell, & Scarbrough, 2010) and the difficulty associated with codification of tacit or experiential knowledge within documents and information technology processes (e.g. Bresnen, Edelman, Newell, Scarbrough, & Swan, 2003). Other scholarship has been concerned with the transferability of research knowledge into practitioner knowledge and vice versa (e.g. Nutley & Davies, 2000). There has also been ongoing debate about the validity of practitioner knowledge in relation to other types of knowledge such as theoretical, academic or ‘evidence-based’ knowledge (Anderson and Herr, 1999; Hiebert et al., 2002; Nutley et al., 2003; Peters, 2003).

Little research has been conducted into the use of practitioner knowledge in the context of policy consultation processes. What has been written in this area comments on the need for practitioners to be more organised in the way they are involved in such processes or provides a simple description of the opinions given by practitioners as part of a general discussion of consultation results (see for example, Sherraden, Slosar, & Sherraden, 2002; Spenceley, Reutter, & Allen, 2006). It does not, as is attempted here, seek to understand the ways in which practitioner knowledge is actually used across a consultation process. This is a significant gap because, as will be outlined in the next section of the paper, consultation events are designed to collect the knowledge of practitioners and others in order for this knowledge to impact on policy, and practitioners are included in policy consultations to this end. It is therefore highly important that we understand the way that this knowledge functions within consultation processes.

3 Consultation processes

Consultation processes are forums specifically formulated in order to allow new policy ideas to be argued, tested, upheld or dismissed. They usually consist in the initial production of a policy document by the government, against which responses are collected. These responses are either written, through the submission of response documents (often pre-formatted by the government) by interested groups and individuals, or are collected and collated from the dialogue at engagement ‘events’ designed to promote discussion around the topic of the consultation.

Public consultation processes became common in the UK in the 1990s as part of the move towards greater public participation championed by organisations such as the public policy think tank Demos and taken up by the new Blair Labour Government after its 1997 election win (Gustafsson & Driver, 2005; Martin, 2008). Public participation has also been a key focus for the post-devolution Scottish Government, with multiple public consultations taking place on a wide range of topics, from genetic information to a national dialogue around education (Stafford, Laybourn, Hill, & Walker, 2003; Haddow, Cunningham-Burley, Bruce, & Barry, 2008; Munn et al., 2004; Scottish Government, 2007b).

Greater consultation with practitioners was included in the drive for wider participation in government decision making in the UK (Newman, 2001, p. 67). Particular groups of practitioners, broadly referred to as ‘stakeholders’, are usually identified in the planning stages of a consultation and are generally invited to participate by appearing before inquiries, attending consultation events or making written submissions to the inquiry. Practitioners are usually invited to provide a response to the consultation based on their experiences or to provide evidence as ‘expert’ practitioners (e.g. Macintyre, Chalmers, Horton, & Smith, 2001). It is the experiential component of practitioner knowledge which is generally identified as being most useful for those conducting the consultation but, as shall be discussed here, it is this experiential nature of their knowledge that makes it difficult, in turn, for their knowledge to have an impact on the resulting policy.

Policy consultation processes are designed as deliberate disruptions to the operation of policy. Ideally they function as mechanisms which allow for new approaches to policy to emerge from a consultative process which brings in new voices that disrupt the hegemonic policy order and bring forth innovative policy responses. This, of course, is the ‘ideal type’ and there has been a significant amount of literature critiquing the extent to which this actually happens (Cook, 2002; Gollust, Apse, Fuller, Miller, & Biesecker, 2005; Rowe & Frewer, 2000). The concern of this paper, however, is not in the success or failure of the consultative exercise but in the way in which different types of knowledge are utilised in the process. Consultation processes allow for the foregrounding of new policy ideas by both the government and the consultation ‘public’ in order to ‘answer’ a policy problem. Through analysing the discourse of policy documents, public responses, and consultation events we are able to examine how the knowledge of particular actors is promoted and used within the consultation.

4 Methods

Policy consultations are complex processes and a range of different methods needs to be utilised in order to interrogate each stage. The TAMFS consultation consisted in a series of consultation events, meetings and the production of a number of documents by the government and key stakeholders (these can be visualised in Table 1). In order to collect a broad range of data three different data collection methods – documentary analysis, interviewing and observation – were used to explore these different facets of the consultation process. The use of multiple methods aimed to provide as full a picture as possible of the way particular forms of knowledge functioned in relation to the consultation process.

Interviews were conducted with a broad range of relevant individuals.² Amongst these respondents were those who contributed to the construction of the consultation document and final policy and action plan, those who developed consultation events and response documents, and those who were responsible for the creation of the synthesis document based on these responses. A semi-structured interviewing process was used, with questions revolving around the actor's experience of their involvement in the consultation process. Interviews were recorded and transcribed.

I conducted an observation of a range of consultation events and meetings. The data from this observation comprised detailed notes of the content of presentations and discussion which took place at consultation events, including recording specific quotations or interactions representative of discussion content. All information distributed at events was collected, including delegate lists, PowerPoint slide handouts and so forth. All notes taken by facilitators in discussion groups were photographed and analysed in order to understand how group moderators mediated the group discussion. Documents central to the consultation process were collected and analysed.

All data from the interviews, observation and documents were entered into the qualitative data analysis programme NVivo. The data were hand-coded according to actor and theme. I used an open coding scheme where core codes were gradually built up over the course of the analysis as themes and identities emerged within the texts. Because of the large number of quite lengthy response documents received in the consultation in depth hand-coding of response documents was only conducted for response documents which directly related to the consultation events included in the observation. All other response documents were auto-coded through text searches based on the core codes that had been identified from the in-depth analysis of the primary texts. Table 2 presents the most frequently occurring themes that emerged from the data. As a result of the analysis practitioners were identified as one of the most prominent groups of actors involved in the consultation and that their largely experience-based knowledge dominated the consultation process at various points, particularly the first ‘event’ stage of the process.

Fig. 1. Timeline of key events and documents in the TAMFS process.

5 The TAMFS consultation

In late 2007 the consultation document Towards a Mentally Flourishing Scotland was launched and a consultation process was initiated in order to formulate the next stage of the National Programme (Scottish Government, 2007a). The document asked for responses in relation to the questions listed in Box 1.

The document carefully defined notions of positive mental health, population health and inequality. This focus on defining these core theoretical concepts was seen as central to the consultation process as it was felt that despite the National Programme being in place since 2001 the theories behind the strategy were not well understood and that this impeded the proper implementation of the Programme's goals (270309).³ The document gave examples of possible actions that might achieve improvements in the mental health of the Scottish population. It also identified key target groups that needed to be addressed in future work of the National Programme.

The consultation process consisted in the production of a series of meetings and documents. Fig. 1 presents these events in chronological order.

Practitioner involvement and knowledge was included most prominently in the initial stages of the consultation process, during the consultation events and within the consultation submissions. The following sections of the paper will highlight how practitioner knowledge functioned at different stages in the process.

6 Consultation events

The initial stages of the consultation process revolved around a set of consultation events hosted by local authorities and health board areas (whose events were mandated by the government), NGOs and other interested groups. Many consultation events were quite large with, for example, over 150 participants attending the event run by Greater Glasgow and Clyde health board. Practitioners were the most numerous actors present at the consultation events, comprising approximately 80% of delegates at those events observed. They were included as key stakeholders to provide help with answering the three questions guiding the consultation (listed in Box 1) (Scottish Government, 2007c). Practitioners took both an official role in consultation events as guest presenters, and as members of the consultation ‘public’.

Consultation events were conducted across a full or half day and usually consisted in presentations followed by discussion groups which were designed to collect feedback on the policy from event participants. The initial presentation was usually given by a government speaker who would introduce the consultation document and explain the notions of population health and positive mental health through providing definitions. In doing so they aimed to educate the consultation ‘public’ about positive mental health in order to demonstrate the possibilities of the new policy and set it apart from previous manifestations of policy for mental health (270309).

Practitioners made presentations at all of the consultation events that were observed. Practitioners presenting at events seemed to have been chosen because of their ability to provide an insight into the way that the goals of the National Programme could be manifested in the work that took place ‘on the ground’, in their programmes (290508; 080408). At the Greater Glasgow consultation event, for example, the focus of one of the main presentations was on the “innovative approaches, service developments and community responses across the [Health] Board area.” This presentation highlighted the need that exists in Glasgow and the raft of different programmes already in place to address poor mental health. This presentation provided examples of ‘good practice’ which demonstrated work that was appropriate to the goals of the TAMFS policy document. Another example of this was from the National Dialogue event which took place in Perth, where several practitioner presentations elaborated on the work taking place within their organisations. This presentation reflected on a range of different programmes in place in Dundee addressing the problems associated with poverty and inequality. The presentation highlighted the level of need in the target community (through the presentation of statistics), the services that were offered to address this need and the outcome of the programme, which was said to “transform people's lives” (Practitioner presentation 1, National Dialogue Event, Perth).

Presentations of good practice served an important purpose for those working within the Scottish government and those in health boards and local authorities who would be charged with implementing the policy agenda as suggested in the TAMFS document (080408). This is because, the presentations demonstrated that the agenda being promoted was relevant and realistic. They did this in four ways, by proving that the TAMFS agenda:

1.	was possible – through showing examples of work in the area already being conducted.
2.	was necessary – through the presentation of disturbing statistics on the levels of mental ill-health in the community.
3.	could be realised, as the goals of TAMFS were well aligned with the way services for mental health were currently ordered.
4.	demonstrated tangible outcomes for the population targeted by the programme.

Practitioners also presented examples of good practice through the facilitation of workshops. In these workshops, practitioners introduced a small group to their experience of carrying out a particular programme, following which the workshop group would review the example given in relation to both their own experiences and the questions listed in the TAMFS document (listed in Box 1).

The authority of practitioners to present their knowledge in the discussion setting of the workshops was clearly based in their own experience of working in the field. This was demonstrated by the frequency with which they drew attention to the type of work that they did or the population they worked with in order to validate their contributions. In making a point or an argument practitioners variously referred to their own direct experience, the methods or experience of the organisation they worked with, or that of other practitioners working in the same field. Arguments were usually made through the presentation of small vignettes. The following quotations are examples of this:

“[We] need programs that support all vocations in schools. For example healthy living initiatives in schools – where kids run their own tuckshop – they developed their own business and made a profit – this gave more opportunity for further development of skills and other benefits.”

- (Discussion group, Lanarkshire consultation event)

“People working in local services need better training. Some areas have people going into services. For example a library and declaring that they have a mental illness and seeing what the reaction is – like a ‘mystery shopper”’

- (Discussion group 2, National Dialogue event, Perth)

As these quotations demonstrate, these vignettes usually articulated examples of ‘good practice’ in work on population mental health at a local level. Examples of ‘bad practice’ or problems with the provision of services and policy were also provided:

“They need to create a mentally healthy work/life balance and workplace culture. [In this organisation] there is awareness raising but it is not followed through. Everyone is working over their hours. Here people live to work, not work to live…. If your own manager is working 24/7 then that is not making a good example for rest of the staff.”

- (Discussion group 1, Highlands consultation event)

“[The] problem is that people associate LGBT issues with sex education and so it is hard for them to get into schools. The impact of discrimination for LGBT people is that the normal avenues for mental health support and services are closed. Services need to state that they are open to talking about LGBT issues. The elephant in the room is that there are Roman Catholic schools that would not talk about it.”

- (Discussion group 2, National Dialogue event, Glasgow)

The examples of good or bad practice being drawn on here were not those codified in documents or passed on through teaching. Instead they were validated through the experience of those working in the area, who ‘knew’ what the problems and solutions were for the situations they faced in their work. As is the case with the tacit knowledge of practitioners, the knowledge they used in the consultation process came from and was authorised by the experience which they had derived through their work (Newell, 2005). It was not the general training that practitioners received for their roles that was viewed as important in attaching “meaning” to their knowledge but the particular practical experiences gained while carrying out their work (Spender, 1996).

In the discussion and workshop groups instances of good and bad practice were traded in a dialogue between the participants. This process was educational in that it taught the practitioners, who were those who would have to implement the new policy, about how the implementation of the policy might be successfully enacted. For example, in the dialogue during one discussion group an example of good practice in innovative service design was offered by the workshop presenter (Discussion group 2, National Dialogue event, Glasgow). Participants then used this to discuss innovation further. One started by discussing an anti-stigma programme operating in Glasgow. This gave way to a vignette on suicide:

“In Derry there is high suicide mostly centred around a particular bridge in town, so hairdressers and taxi drivers have been trained in what to do with a person expressing desire to suicide.”

This was followed by an account of a service which had developed innovative practices to assist deaf clients. This went on, with other people's own examples of good working then added through the discussion. This dialogue gradually built up a sense of what might be appropriate practice in innovative service design in the context of the TAMFS consultation document. In another group observed during the same event, a similar process was witnessed with regards to joint working (Discussion Group 1, National Dialogue Event, Glasgow). Through these interactions the consultation process acted as a way of cementing the new policy in the minds of those who would have to do the work and armed them with strategies for how this could be taken forward in practice.

In their work on how knowledge functions in organisations Bresnen et al. (2003) have written that the social processes of such a dialogue generate “shared meanings and understandings amongst those involved.” In effect the trading of good and bad practice in the consultation events allowed the boundaries of work in the area to be ‘rehearsed’ in the context of the new policy. Through a succession of such dialogues throughout the consultation events appropriate practices for the new policy were gradually developed. This idea also fits well with Schön's (1983, pp. 26,183) ‘reflection-in-action’ and ‘reflection-on-action’ models which posit that professionals are involved in a continual learning process in which they are presented with a succession of new situations which they make sense of in relation to their own previous experience. In the context of the consultation events, this learning occurred through the discursive presentation of possible situations and actions, which practitioners were then able to reflect on, individually and collectively, in relation to their past practice. Throughout the practitioner involvement in the consultation there was little resistance to the government's agenda as presented in the consultation document. This meant that the conversation amongst practitioners was able to focus on how the agenda could be taken forward in practice rather than the validity of the agenda. If there was marked opposition to the policy being consulted on sharing of knowledge by practitioners might have had a very different effect.

For those organising the events the educative purpose of the consultation was clear and important. One of the respondents, who had been charged with organising a consultation event, spoke in detail about the benefits of the presentation of practitioner knowledge in workshops at the events (080408). He described how he had deliberately included these examples of good practice within the event in order to demonstrate to his staff the ways in which they might introduce the work of the National Programme into their own work (080408). Examples of good practice were seen to make the TAMFS agenda “real” and thus help in what he felt to be the inevitable process of implementation of this agenda. The benefits of these presentations of good practice in a workshop setting were also reflected on in one of the response documents:

“Around 25 colleagues from a broad range of agencies agreed to present updates of current innovative work areas from across Greater Glasgow and Clyde … this was in order to “bring to life” the themes of the national document with real examples of practice. There has been significant feedback since the event that these case studies helped delegates contribute better to the debate on Towards a Mentally Flourishing Scotland, and also had benefits for networking and practice sharing across the Board area.”

- (Greater Glasgow and Clyde area consultation response)

Organisations working more peripherally in relation to traditional mental health work used their involvement in the consultation process to educate both those within their own organisations and the sector as a whole about the valid role they had to play in the work of the National Programme. This can be seen in the following quotation from one of the interviews:

“Obviously we wanted the National Programme to be represented [at our event]…. We wanted to make sure [the event] had a very strong mental health slant and that very much the national mental health agenda recognised the impact and importance of [our organisation]…. So actually we were making a very strong statement not only to [our organisation's] practitioners but to health practitioners that there is a strong recognition of [our organisation's work].”

-(290508)

The consultation events thus afforded multiple opportunities for educating the sector about the possibilities for action and collaboration which would accompany the introduction of the new policy. That the policy would be introduced in a way very much in line with that already presented in the consultation document was not questioned by any of the interview respondents.

7 Consultation responses

The feedback collected at consultation events was synthesised by local areas into formal submissions made to the Scottish Government. Consultation responses were invited from individuals and organisations, and all health boards and local authorities were required to submit a response. More than 75 responses were received and ranged in length from a short paragraph to over 50 pages. There was an expectation expressed in many of the documents that the themes raised in the responses would be taken up in the final policy document. This is demonstrated in the following quotation:

“All agencies, organisations and lay people who participated in the consultation process look forward to seeing their feedback and comments inform the action plan for future delivery of the mental health and wellbeing agenda within Scotland.”

- (Ayrshire and Arran consultation response)

The overwhelming majority of response documents were from practitioner-based organisations that directly provided services and programmes for population mental health or services for those experiencing mental ill-health. Unlike the consultation events hosted by these organisations, there were few examples of good practice offered in the response documents of organisations that provided services. Most stories of good practice that were offered in the documents did not take the form of personal vignettes as they did at the events, but were instead backed up with ‘hard’ research-based evidence, rather than personal experience. For example:

“Review level evidence demonstrates that programmes promoting positive mental health are effective in improving multiple areas of functioning and in reducing the risk of mental health problems.”

- (Lanarkshire consultation response)

Here the process of academic review configures practitioner knowledge in a way that makes it more acceptable as a form of evidence. The practices of these more formalised consultation response documents, whose knowledge is provided as representative of the organisation as a whole, appear to need to rely on this ‘formal’ data to be valid in an environment where codified targets and evidence are the most respected form of knowledge.

For one of the respondents the consultation response was secondary to the consultation event – a necessary step in terms of an agency's responsibilities to government, but not greatly important as an exercise for informing government policy (080408). However for others the process of writing the consultation response worked in a similar way to the participation of practitioners in events in that it allowed the organisation to rehearse the actions that they might put in place when implementing the policy once it was released. Several of the response documents list local actions that would be implemented to support the TAMFS policy agenda (e.g. Lanarkshire response, Inverclyde Council response, Midlothian Council response). In this way the process of the consultation could be visualised as the ‘first stage of implementation’. Those in charge of mental health in these local areas had already, as a result of the consultation, investigated how they would need to implement the eventual policy.

8 Consultation response synthesis

The consultation responses were synthesised into a 32 page summary by an independent consultant hired by the Mental Health Division, and this synthesis was provided to the National Reference Group for consideration at its meetings. The synthesis represented a “high-level summary” of the documents and did not go into detail about the micro aspects of the responses (240608). It was an important stage of the process as the public servant charged with writing the final policy and action plan did not attend most of the events or the National Reference Group or read the individual consultation response documents (230109).

The document did not include many of the examples of good or bad practice, which as indicated in the discussion above, were the basis of dialogue at the consultation events and which figured, to a lesser extent, in the response documents. While good practice was seen as a positive thing, as reflected in the discussion in the synthesis document of the development of a ‘good practice’ database, the only example given of practice knowledge was the following:

“One respondent, representing a local authority, suggested that action at a local level in his area might involve the inclusion of actions on mental wellbeing in all council department service plans and strategic documents. Another respondent suggested that, to promote more positive mental health, it would make sense to tackle poverty and the lack of affordable housing first.”

There was thus a gradual lessening of the use of this form of practitioner knowledge the further it progressed through the chain of consultation events and texts. Good practice had a specific use within the discursive context of consultation events but has a much more limited role to play in documents. In the consultation events that were observed, good practice was discussed as a means of mutual education of a practice community through the sharing or ‘trading’ of practice examples. Good practice when used in the documents that followed from those events was not traded in this way, and instead took the form of singular exemplars of successful policy implementation. The consultation events created the circumstances where the good practice of practitioners, or the personal experience of service users, as expressed as vignettes, could emerge as a form of knowledge, but this knowledge did not easily flow into the next stage of the process. This is because the response and synthesis documents had a very different purpose and format which made it neither desirable nor possible to include the vast amounts of practice based anecdotes produced at the consultation events in these documents.

The complex, particularistic and personal knowledge held and transmitted by practitioners is ‘distinct’ to such an extent that it cannot be converted into explicit knowledge and is therefore very difficult to communicate (Bartunek et al., 2003; Bresnen et al., 2003). Consultation response documents and synthesis documents, as forms, are developed as a direct and focused response to those questions asked by the government in the consultation document. In order to be understood by the government and used to create a set of general policy recommendations these responses needed to be communicated in a strict form that had little room for vignettes such as those produced at events by practitioners or service users. The theme of the vignettes might have been taken up in the response documents, but the personal, experiential nature of the data, which gave it much of its power, was lost. This loss of the experience-based practitioner knowledge thus, at least partially, results from the structural ‘form’ that these documents conventionally take and the particular discursive practices surrounding their use (Alavi & Liedner, 2001; Fairclough, 1992).

9 From consultation to policy document

In addition to the ‘public’ stages of the consultation process there were a series of discussions which took place internal to the government, and between the Mental Health Division in the government and ‘experts’ such as public health academics. A National Reference Group consisting of academics, medical specialists, service users and high level representatives from local government, health administration, NGOs and further education met on five occasions and provided responses to the government on drafts of the policy and action plan.

Invitation-only meetings with key stakeholders such as the Convention of Scottish Local Authorities (COSLA) or specialist practitioner groups also took place during the months preceding the release of the final policy document in order to ensure that the final policy would be acceptable to these groups. These events advised on how the proposed TAMFS agenda would work in with other work being done in this area and to check that the recommendations being considered by the government would be acceptable to those who would be implementing them (230109). As one respondent noted, it was necessary to get COSLA and various practitioner groups ‘onside’ and agreeing with the process if the policy were to be successfully implemented (110110). This was the only stage in the process where practitioner knowledge could be seen to directly influence the content of the new policy through a direct dialogue between practitioners and the main public servant putting together the final policy document.

Despite these late-stage closed consultations with practitioner groups there remained a scepticism about the evidence provided by practitioners in the consultation process. Personal knowledge was seen to have little weight as a ‘valid’ form of evidence in the eyes of the policy makers devising the final policy document, and for this reason could not be included as evidence to inform the policy. This can be seen in the following quotations:

“Part of the challenge is drawing together all of this consultation stuff when you haven’t got such a concrete evidence base etc. You’ve got to weigh up what is opinion and what is truly underpinned by a theoretical, plausible argument.”

- (230109)

“As well as evidence we need to listen to what practitioners have said through the process, which may not be evidence based.”

- (230109)

The evidence being called for here is not the practice based knowledge directly expressed by practitioners but evidence from peer-reviewed journal articles in which practice based knowledge has been tested and formatted. For this reason the vast majority of the practitioner knowledge directed into the consultation process was not acceptable as a form of knowledge upon which the new policy could be based.

The final policy document, Towards a Mentally Flourishing Scotland: Policy and Action Plan 2009–2011, was put together by individuals working in the Mental Health Division of the Scottish Government and was released in April 2009. The document identified priority areas for action, the values and methods underpinning the delivery of the next stage of the National Programme and specific ‘commitments’ relating to each of the priority areas identified. It was not clear exactly where in the consultation process these commitments were determined but it seems that decisions about their content were derived during the final internal government process, as the content of the ‘draft policies’ released prior to this phase was significantly different to that of the final policy document.

As with the consultation response documents, the form and purpose of the policy document itself constrained the knowledge it contained and it was not possible to identify specific instances where the knowledge of practitioners was transferred directly into the document. Policy documents are texts whose purpose is to transmit as clearly as possible what needs to be implemented to those who are charged with their implementation. This is conventionally done, as it was in the TAMFS policy document, through the setting out of specific areas of action and associated indicators of success. In this case the indicators included things like:

• Commitment 1: “The Scottish Government will work with partners and existing networks to develop by 2010 a web portal on mental health improvement for those working with infants, children and young people.”

• Commitment 4: “NHS Health Scotland will work with key stakeholders to develop a set of national indicators for children and young people's mental well being, mental health problems and related contextual factors by 2011.”

Like the consultation response documents the highly formalised structure of the policy meant that it was not the type of document that could include the tacit, informal, experiential knowledge of practitioners. The document does show, however, an expressed commitment to ongoing consultation with ‘key stakeholders’ which makes it important that consultation truly utilises and understands the nature of the experiential knowledge that practitioners and other stakeholders bring to these processes.

10 Discussion and conclusions

This analysis has shown that there was limited opportunity for practitioners to directly influence the development of the TAMFS policy and action plan except in the final stages of the consultation process where a select, invited group was able to check that the policy would be relevant to their practice. The main reason for this was that practitioner knowledge did not flow easily and logically from one stage of the consultation process to another. This finding fits with the work of a number of organisational psychologists who have identified problems with tacit knowledge (e.g. Alavi & Liedner, 2001). The data presented here demonstrates that this is largely a function of the way that practitioner knowledge as a form is able to function in different contexts. The experiential basis of practitioner knowledge, which finds voice through the sharing of practice based anecdotes, is such that it is not easily transmitted from an oral form to the more conventionally rigid document formats which structure consultation responses and policy documents. This is problematic in this context as practitioners were specifically invited to take part in the consultation process with the expectation that their involvement would have some impact on the resulting policy. For practice knowledge to effectively flow it would need to be transmitted and encoded in appropriate ways (Newell, 2005). As Alavi and Leidner (2001, p. 121) state in their discussion of knowledge, “the most effective transfer mechanism depends on the type of knowledge being transferred.” For practitioner knowledge this would appear to be through either ‘practice’, verbal communication or ‘social’ processes (Alavi & Liedner, 2001; Bresnen et al., 2003). Using Bresnen et al.’s (2003) focus on the ‘social’, consultation events can be viewed as structured ‘social’ processes designed to allow knowledge to flow from one setting to another. Hypothetically, the knowledge of practitioners may in fact be transferred effectively to policy via the ‘social’ event stages of the consultation, but only if (1) those making the policy decisions are present at the practitioner focused events and (2) the policy makers sufficiently understand the practice context. As Newell (2005) points out, understanding can only truly be gained if the recipient of the knowledge understands the context in which it was created. These factors were not met in the case of this consultation event. More appropriate design of consultation processes, which take into consideration the way knowledge differentially functions and flows would thus lead to more effective consultation outcomes. That this does not happen already is a significant impediment to Scottish and UK government aims for increased consultation for policy. The findings reported here are thus an important disruption to the literature on consultation referred to early in the paper as they indicate the significant threats to effective ‘consultation for policy’ which can arise from a failure to engage with the peculiarities of different knowledge types.

It would be easy to assume that, because of the limited impact of the knowledge expressed by practitioners in the early stages of the consultation, practitioner involvement was meaningless. Rather the analysis has demonstrated that their involvement in the consultation process has had another significant impact. Despite the limited impact of practitioner knowledge on the final policy document, the consultation did serve to help in the conceptualisation of the new policy for the people who were going to implement it. This was because the ‘social’ processes of the consultation allowed the practitioners to share knowledge between each other. In this way the inclusion of this knowledge in the consultation process has had a productive outcome.

Indeed, it can be hypothesised that practitioner involvement could be viewed as key to the success of the eventual policy as their involvement forms an important educative process which sets up an environment necessary for the effective implementation of the policy. This educative function could be seen as complementary and necessary in relation to the process of consulting to influence the development of the next stage of the policy. As discussed above, similar to Schön's (1983) model of the development and use of practice knowledge, in the consultation events the practitioners can be seen to be reflecting on the new information presented by government speakers in order to devise a new ‘action’ response. This serves to develop the practitioner's knowledge/ action repertoire which can then be used to take forward the implementation of the new policy. The site of knowledge creation is in the discussion – the back and forth trading of theory, good practice, lived experience, opinion and so forth. Here knowledge is taken from one setting (academic theory, good practice, personal experience), reflected on in relation to a new setting and shared. This knowledge is a direct outcome of the consultation process, although, as argued here, it is not readily encoded in official documents and cannot flow through the consultation document into the final policy and action plan.

Through its educative function the consultation process for TAMFS has worked to carve out a new space for policy action leading to an easier transition to the new policy and a greater depth of policy awareness that would, in turn, lead to better policy implementation. In this way the consultation process can be visualised as functioning as the first stage of policy implementation and consultation processes in themselves can be viewed as acting as a macro instrument of policy. Given that this research project did not delve into the implementation phase of the new policy, the extent to which this educative process is in fact productive in terms of policy implementation is difficult to gauge, and more work could therefore be productively explored in this area.

Notes

1 The research related in this paper derives from work conducted as part of the KNOWandPOL research programme, a five year European-wide study funded by the European Commission within the Sixth Framework Programme (Project # 0288848-2) examining the role of knowledge in health and education policy by twelve research teams working within eight countries.

2 Consent was gained from each interview respondent. Consultation events were public events. Permission to observe the consultation events and reference group meetings for the purposes of research was given by the Mental Health Division in the Scottish Government. All groups observed were made aware of the observation.

3 Interviews are identified by the date on which it occurred.