Abstract

This paper draws upon selected findings from a small scale qualitative study of the situated practice of health visitors. The study was carried out in a context of local organisational change, after the merger of two primary care trusts in the north of England, and emergence of national policy drivers positioning health visitors in a leadership role in the delivery of integrated services to children and families. The findings from four focus groups give grounded and context specific examples of the types of knowledge that health visitors value and ways in which they exchange knowledge and draw upon the distributed knowledge and expertise of others. The results are interpreted through the lenses of different discourses of knowledge, and barriers to change are identified through an iteration between practice-based narrative and theoretical frameworks. These barriers include: dominance of linear and hierarchical transmission models of knowledge transfer rather than promotion of a knowledge sharing/creating culture; a devaluing of context specific and practice based knowledge in comparison to abstract knowledge; bureaucratisation of knowledge; defensive practices emerging from a perceived threat to professional identity; and limited tools and allocation of time for collaborative work within the profession and across professional boundaries. Recommendations and strategies to drive change and enable health visitors to take on leadership roles in multi skilled teams and a multi agency context are underpinned by the argument that what is needed in this context is a transformational model of knowledge exchange and co creation of knowledge that works with tensions between different discourses of knowledge and promotes collaborative dialogue and practice across professional and organisational boundaries.