Constructing the social: an evaluation study of the outcomes and processes of a ‘social participation’ improvement project

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  Quality improvement collaboratives strive to improve health care on certain topics. Improvements are often investigated in terms of outcomes defined before start of the project. However, in this paper we also explore other ways to conceptualize improvement.
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  We evaluated a ‘social participation’ improvement project that aimed to widen clients’ social networks and to make them feel less lonely. Most of these clients were psychiatric or intellectually disabled clients.
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  Clients’ social networks were not widened over the project, but clients reported to experience less loneliness. Furthermore, two different ways of improving clients’ social lives were attempted. One was an individualizing approach, with improvement actions targeted at individual clients and their individual wishes, rather than at a client ward as a whole. Individual clients were encouraged to verbalize their wishes and to be enterprising in fulfilling these. The second approach was one of normalization. Clients ideally were to participate in ‘normal’ community, doing the same things and having the same social contacts as the general population.
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  The two ways of assessing the impact of the quality improvement collaborative sometimes pointed in the same direction. But our alternative way also brought to light aspects of the improvement project that would have gone unnoticed by using only the predefined outcomes. Therefore, we argue that it is valuable to explore (changes made during) quality improvement initiatives in various ways.

This paper reports on an evaluation of a ‘social participation’ improvement project in a mental health care and care for the intellectually disabled setting. The main research question is how sociality (i.e. clients’ social lives) was constructed and what consequences this had for the project and for the clients. We undertook a dual approach: investigating the predefined outcomes and analysing the improvement processes in terms of how these processes construct sociality. As to the predefined outcomes, clients’ social networks were not widened, but clients felt significantly less lonely at the end of the project. In a bottom-up analysis of data gathered on the improvement processes, we articulated two ways of constructing sociality: individualization, in which clients had to verbalize their wishes (verbalization) and to act upon them more actively (enterprising); and normalization, in which a good social life was one embedded in ‘normal’ community. We argue that this (explorative) way of conceptualizing change corresponds with some of the quantitative findings but also brings to light aspects that would have gone unnoticed by using only the predefined outcomes. Therefore, a mixed methods approach in studying effectiveness is a fruitful addition to the quality improvement literature.