An exploration of best practice in multi-agency working and the experiences of families of children with complex health needs. What works well and what needs to be done to improve practice for the future?

J Clin Nurs. 2007 Mar;16(3):527-39. doi: 10.1111/j.1365-2702.2006.01554.x.


Aims and objectives: This Appreciative Inquiry study aimed to explore appreciatively examples of best multi-agency working practice with families (mothers, n = 20; fathers, n = 7; children, n = 1) and people working with children with complex needs (n = 41), to determine what works well, why it has worked well and what best practice in the future could be.

Background: The term 'children with complex health needs' encompasses a diverse group of children and this population is increasing. This diverse group of children often requires high levels of physiological, psychological and social care which brings them and their families into therapeutic contact with a wide range of health, social and education professionals and people from other agencies.

Design: The study used appreciative interviews, nominal group workshops and consensus workshops to develop a set of 10 'best practice' guidelines that reflected the views of all participants. Two of these are discussed in detail in this article. All participants were seen as co-researchers whose expert contributions were vital to understanding of what works well and what needs to be done in multi-agency working practice.

Results: The study resulted in 'best practice' statements that illuminated 'what works well' in multi-agency working practice that spanned issues including information, decision making, communication, accessibility, collaboration, respect and sharing a common vision.

Conclusions: The guidance that results from this study suggests that parents need the opportunity to share and receive support from other parents who understand the lived reality of caring for a child with complex needs. Parents and people from across various agencies need to work together to ensure that the most appropriate person acts in the role of a long-term coordinator, where the family wants this aspect of support. This study adds a multi-disciplinary and appreciatively oriented focus on what works well in complex care. It contributes to an understanding of the value of an Appreciative Inquiry approach within health-care research.

Relevance to clinical practice: The guidelines arose from and are grounded in practice and as such they provide clear, workable directions for enhancing practice and for considering what already does work well.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Attitude of Health Personnel
  • Attitude to Health*
  • Benchmarking / organization & administration*
  • Child
  • Child Health Services / organization & administration*
  • Communication
  • Consensus Development Conferences as Topic
  • Continuity of Patient Care / organization & administration
  • Cooperative Behavior
  • Disabled Children / rehabilitation
  • England
  • Focus Groups
  • Forecasting
  • Health Services Accessibility
  • Humans
  • Interinstitutional Relations*
  • Needs Assessment / organization & administration*
  • Nursing Methodology Research
  • Parents / education
  • Parents / psychology*
  • Practice Guidelines as Topic
  • Professional-Family Relations
  • Social Support
  • Surveys and Questionnaires
  • Total Quality Management / organization & administration