{"id":2401,"date":"2026-07-29T08:28:40","date_gmt":"2026-07-29T08:28:40","guid":{"rendered":"https:\/\/sites.exeter.ac.uk\/apex\/?p=2401"},"modified":"2026-07-31T08:15:32","modified_gmt":"2026-07-31T08:15:32","slug":"looking-inside-the-black-box-of-integrated-neighbourhood-team-int-development-reflections-of-an-early-career-researcher","status":"publish","type":"post","link":"https:\/\/sites.exeter.ac.uk\/apex\/2026\/07\/29\/looking-inside-the-black-box-of-integrated-neighbourhood-team-int-development-reflections-of-an-early-career-researcher\/","title":{"rendered":"Looking\u00a0inside the\u00a0black\u00a0box of\u00a0integrated\u00a0neighbourhood\u00a0team\u00a0(INT)\u00a0development: reflections of an\u00a0early career researcher.\u00a0\u00a0"},"content":{"rendered":"\n<figure class=\"wp-block-image size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"606\" height=\"208\" src=\"https:\/\/sites.exeter.ac.uk\/apex\/wp-content\/uploads\/sites\/249\/2026\/07\/VF1.jpg\" alt=\"\" class=\"wp-image-2403\" style=\"aspect-ratio:2.91350531107739;width:789px;height:auto\" srcset=\"https:\/\/sites.exeter.ac.uk\/apex\/wp-content\/uploads\/sites\/249\/2026\/07\/VF1.jpg 606w, https:\/\/sites.exeter.ac.uk\/apex\/wp-content\/uploads\/sites\/249\/2026\/07\/VF1-300x103.jpg 300w\" sizes=\"auto, (max-width: 606px) 100vw, 606px\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"333\" height=\"70\" src=\"https:\/\/sites.exeter.ac.uk\/apex\/wp-content\/uploads\/sites\/249\/2026\/07\/VF2.jpg\" alt=\"\" class=\"wp-image-2405\" srcset=\"https:\/\/sites.exeter.ac.uk\/apex\/wp-content\/uploads\/sites\/249\/2026\/07\/VF2.jpg 333w, https:\/\/sites.exeter.ac.uk\/apex\/wp-content\/uploads\/sites\/249\/2026\/07\/VF2-300x63.jpg 300w\" sizes=\"auto, (max-width: 333px) 100vw, 333px\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">NTs\u00a0bring health, social care,\u00a0the\u00a0voluntary sector,\u00a0and community services together to provide more joined-up support for people living in a local area.\u00a0In a recent conversation with an ICB director, they described the\u00a0implementation of such initiatives as \u2018Tight-Lose-Tight\u2019 in that\u00a0while the financial inputs\u00a0and expected outcomes\u00a0of Integrated\u00a0Neighbourhood\u2019s\u00a0are\u00a0clearly defined,\u00a0implementation is\u00a0largely up\u00a0to\u00a0local teams.\u00a0\u00a0<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">                                                                                              <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">                                                                                                                        <strong>When A+B = C<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>The &#8216;Tight-Lose-Tight&#8217; implementation strategy<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">As an experienced clinician, I am&nbsp;used to making&nbsp;high impact decisions based on heuristics, tacit knowledge, and pattern recognition.&nbsp;For&nbsp;example,&nbsp;during home visits,&nbsp;a&nbsp;problem solving&nbsp;approach&nbsp;enables me to&nbsp;identify&nbsp;sepsis&nbsp;through the presence of symptoms&nbsp;A&nbsp;and&nbsp;B,&nbsp;and I can be confident that&nbsp;A+B&nbsp;= sepsis (C).&nbsp;This is referred to a \u2018recognition-primed\u2019&nbsp;decision-making. In addition, I&nbsp;frequently&nbsp;utilise \u2018naturalistic decision-making\u2019&nbsp;processes&nbsp;where decision-makers&nbsp;operate&nbsp;within uncertainty and time pressure to come to a workable arrangement. Useful in \u2018here and now\u2019 make safe scenarios.&nbsp;&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>How does someone get from A to C without knowing B?&nbsp;<\/strong>&nbsp;<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"241\" height=\"164\" src=\"https:\/\/sites.exeter.ac.uk\/apex\/wp-content\/uploads\/sites\/249\/2026\/07\/VF3-1.jpg\" alt=\"\" class=\"wp-image-2419\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">Bringing a group of professionals together to decide on\u00a0the\u00a0contents of the\u00a0INT\u00a0black box is logical,\u00a0but through our own experiences of A+B = C, clinicians may not always be best placed to identify or articulate theory that we assume is in there somewhere.\u00a0When we apply pattern recognition and rapid\u00a0decision making\u00a0processes to complex system problems, we may\u00a0fail\u00a0to\u00a0recognise,\u00a0consider,\u00a0or understand the evidence base and how or why a change is expected to occur.\u00a0We\u00a0are far more likely to go straight to a wish list of resources without first really understanding the upstream issue\u00a0or articulating a theory of change or action.\u00a0\u00a0<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">During INT conversations I am seeing increasing reference to a concept in which people are described as living with a deficit, and if we just provided them with additional missing pieces through referrals to services, a person would become whole and their dependence on health and social care will lessen&nbsp;<strong>A+B = C<\/strong>.&nbsp;However,&nbsp;research has taught me that&nbsp;A + B does not always equal C,&nbsp;and resource 1 will not automatically lead to outcome 1.&nbsp;&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">As an early career researcher, with an interest in clinical decision-making approaches, I can see that system transformation may require a different cognitive approach and&nbsp;skill set.&nbsp;I am increasingly thinking, \u2018why and how&nbsp;might the&nbsp;addition of this resource enable this outcome to occur&nbsp;within this context?\u2019&nbsp;If&nbsp;we&nbsp;miss&nbsp;opportunities to&nbsp;look beyond our instinctual reasoning&nbsp;processes&nbsp;to&nbsp;identify&nbsp;the context and&nbsp;mechanisms through which change is expected to&nbsp;occur, INT development teams may go down rabbit-holes&nbsp;over an&nbsp;idea they could have&nbsp;dismissed earlier.&nbsp;Therefore, being able to&nbsp;identify&nbsp;and&nbsp;critique&nbsp;my&nbsp;assumptions&nbsp;regarding&nbsp;what might work for whom, in what context, and why we may see different results in different people, is an important development in my&nbsp;applied&nbsp;knowledge and skill.&nbsp;&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>What&nbsp;could be&nbsp;in the black box?&nbsp;<\/strong>&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Through a clinical lens,&nbsp;the black box of integration&nbsp;might&nbsp;contain&nbsp;an intertwined, messy pile of spaghetti, each&nbsp;representing&nbsp;a different&nbsp;priority,&nbsp;outcome,&nbsp;context, resource, or mechanism.&nbsp;Using this metaphor, we&nbsp;can\u2019t&nbsp;separate&nbsp;INT&nbsp;priorities, with their associated statements&nbsp;of how and why&nbsp;we expect things to change, or the&nbsp;proposed&nbsp;operational plan to achieve such outcomes. It all appears just a bit messy, hope for the best,&nbsp;and&nbsp;vague.&nbsp;My research training has allowed&nbsp;my&nbsp;to recognise that different decisions need&nbsp;different&nbsp;ways&nbsp;of thinking&nbsp;and&nbsp;different&nbsp;information. In response to this&nbsp;I\u2019ve&nbsp;started to look at the idea of system transformation and change as a more fragile and uncertain&nbsp;concept that requires depth of understanding and interrogation&nbsp;over non-empirical assumptions.&nbsp;&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>In summary<\/strong>&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Research has given me the theory and language to work through the concept of change more assuredly with accountability and transparency. While different teams will have different black boxes, mine is likely to&nbsp;contain&nbsp;system maps, mind maps, initial programme&nbsp;theories,&nbsp;and logic models.&nbsp;With that in mind,&nbsp;I\u2019d&nbsp;best get online and order a bigger whiteboard.&nbsp;&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Vicky Farrell&nbsp;&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Advanced Practice Physiotherapist, Cornwall Foundation NHS Partnership Trust&nbsp;&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">NIHR predoctoral clinical academic research fellow, University of Exeter.&nbsp;&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">e-mail&nbsp;<a href=\"mailto:v.farrell@exeter.ac.uk\" target=\"_blank\" rel=\"noreferrer noopener\">v.farrell@exeter.ac.uk<\/a>&nbsp;&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Date: 18.06.2026&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>NTs\u00a0bring health, social care,\u00a0the\u00a0voluntary sector,\u00a0and community services together to provide more joined-up support for people living in a local area.\u00a0In a recent conversation with an ICB director, they described the\u00a0implementation of such initiatives as \u2018Tight-Lose-Tight\u2019 in that\u00a0while the financial inputs\u00a0and expected outcomes\u00a0of Integrated\u00a0Neighbourhood\u2019s\u00a0are\u00a0clearly defined,\u00a0implementation is\u00a0largely up\u00a0to\u00a0local teams.\u00a0\u00a0 When A+B = C The &#8216;Tight-Lose-Tight&#8217; implementation strategy [&hellip;]<\/p>\n","protected":false},"author":989,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[47],"tags":[239,61,243],"class_list":["post-2401","post","type-post","status-publish","format-standard","hentry","category-rehab","tag-clinical-decision-making","tag-ecr","tag-integrated-neighbourhood-teams"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.0 - 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