Disrupted rituals and relational ruptures: A decentred approach to integrated working in the English National Health Service

The implementation of Integrated Care Systems as statutory in the English National Health Service represented a significant shift away from service competition to service collaboration and ‘disrupted’ how services were organised and how different organisations interacted. Challenges of integrated working are well known, including differences in service organisation, funding, IT systems, and organisational cultures, and good communication with high levels of trust is essential for successful collaboration. The COVID-19 pandemic placed additional pressures on integrated working through the introduction of remote working for interactions traditionally performed face-to-face. Using the findings of two related qualitative studies conducted within integrated care systems, this paper combines a decentred theoretical approach with interaction ritual chain theory to understand how senior and front-line staff navigate the complexity of change and evolving relational dynamics. Service disruptions due to change can cause ruptures in relationships that, in turn, can give way to new traditions and modes of working. A focus on interaction rituals extends decentred theory by looking at the interactions that underpin the dilemmas and traditions during a service change. Working collaboratively through disruptions can strengthen social bonds through the re-alignment of the social order.