Alongside the implementation of the NHS and Community Care Act 1990 came
the wide-scale introduction of a new style of case management. Care
management was to involve the design, monitoring and review of care packages
based on a thorough assessment of service user need. Official documentation
urged practitioners to "give full rein to their creativity in devising new ways of
meeting needs". However, it was unclear how it could be achieved, why it might
be beneficial and what factors might hinder or facilitate such practice. Two
studies were conducted to investigate how innovative care management
practice is characterised and undertaken by practitioners and what barriers and
supports to such practice exist. The first study used case study methodology to
examine in depth the innovative and non-innovative care management practice
of five social work care managers. A model of the innovative care management
process emerged along with provisional indicators of the factors influencing
innovative (and non-innovative) care management practice.
The second study involved a survey of care management practitioners in Wales
(N = 181 ). Since stress in the workplace is both deleterious, apparently on the
increase in community care practitioners and potentially has an adverse impact
on individual innovation, stress level change indicators were examined
alongside self-reports of innovative practice. Both quantitative and qualitative
findings from the survey provide insight into frequency, type and influencing
factors of innovative practice; levels of stress and job satisfaction; the demands
on and levels of discretion of care management practitioners; and the interrelationships between innovation frequency, stress level change, job demands, job discretion and other relevant variables. Methodological issues are
addressed and policy and practice implications outlined.