Thursday, September 3, 2015

Preconference Tidbit #8 - Social Field Model

by Paul Uhlig

This is the last of the three Tidbits about conceptual models. This one is about the Social Field Model.

The Social Field Model was developed by Paul Uhlig and Ellen Raboin in collaboration with research colleagues Jeff Brown, Cindy Dominguez, and Lorri Zipperer. It is based on their work implementing and studying collaborative care over many years.

The Social Field Model is a way of explaining how collaborative care arises and develops, with special emphasis on how collaborative care can be intentionally implemented through structural and social interventions in care environments. The model has been used to implement collaborative care with notable improvements in measured team performance, patient satisfaction, and care outcomes, but needs to be more rigorously evaluated by additional objective research.

The model is based on the concept of “social fields.” A social field is a way of visualizing the shared knowledge, mutual expectations, emotions, and collective capabilities that develop among a group of people who are able to work and learn together over time. Social Fields are the reason that the fifth floor feels different than the third floor, in a way you can sense when you first get off the elevator. They are why a certain care environment is a delight to work in, while another is a very different kind of place where certain things just aren’t possible.

Social fields carry the connections, abilities to coordinate, and sense of “oughtness” that develop as people do things together. A social field is similar to culture, but is highly local and specific to a particular care environment and the people who work there. The abilities of a collaborative care team to connect, coordinate, make decisions, manage differences, actively engage patients and families, and achieve reliability and resilience are carried in the team’s social field.

A theory at the core of the Social Field Model is called Social Construction. Social Construction theory proposes that people are active social participants in creating their own realities, through ongoing patterns of interactions and conversations. Social fields are continuously being made and remade as people the in care environments do things together and talk together. A group can either participate in patterns of interaction and conversations that reinforce certain ways of relating; or, in some way, break those patterns and begin to establish new ones.

If a social field seems stable, that is because people are doing the same things they have always done. If, in some way, people change how they interact and what they talk about, their social field will evolve to reflect the new ways. Collaborative care is implemented by making intentional changes in the care environment that produce new relationships, and new patterns of interaction. “We become the things we do together. If you want to see the future, look at what we are doing now."

The Social Field Model was created by asking: “If you wanted to build a place that is really good at collaborative care, what would you do, and what would it be like?” An analogy is growing a garden.

The wise gardener tends carefully to the soil, the sunlight, the moisture, and other growing conditions more than to the plants themselves. If the growing conditions are right, the garden will very likely grow beautifully.

Based on studying the “growing conditions” of really great collaborative care environments, the social field model proposes a set of “social and structural preconditions” that can be intentionally implemented and will lead naturally to the growth and development of collaborative care.

The preconditions of the Social Field Model include structuring the environment so people across professions can work together consistently, collaborative leadership, active engagement of patients and families, regular team meetings, daily bedside rounds, use of data to monitor and improve systems of care, and thoughtful connections with the larger organization. When these are carefully put in place, collaborative care is very likely to arise, develop, and be sustained.

The model also proposes ways that a care team can assess the evolution of its care environment by taking stock of certain “resources” that can be expected to develop. As these resources, such as "knowing what to do and expect" and "a web of monitoring," develop within the care environment, they enable the emergence of collaborative care, high reliability, and resilience.

A diagram showing the preconditions and resources is attached.


Three team-based inventories have been developed to guide team self-assessments for implementing collaborative care. 

The Collaborative Care Toolkit, consisting of the inventories, and a book based on the Social Field Model, called Field Guide to Collaborative Care: implementing the Future of Health Care, can be downloaded without cost at the Collaborative Care Alliance website

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