Nottingham University Business School

Centre for Health Innovation, Leadership and Learning (CHILL)

Managing Long Term Conditions

Chronic illnesses, or long term conditions (LTC) are ones which at present cannot be cured but can be controlled by medication and other therapies.  70% of total expenditure on health and care in England is associated with the treatment of the 30% of the population with one or more LTC.  This issue is set to grow in magnitude and in the short term, the costs of managing LTCs is likely to add £5 billion to the annual costs of the NHS between 2011 and 2018.  One of the proposed solutions for this growing crisis is to support patients to manage their conditions themselves, thereby reducing hospital visits and lowering costs to the NHS overall.   Self management necessarily involves the patient having some level of knowledge regarding the LTC, the self management activities required and the context in which care is delivered.  In addition, there is a commitment within healthcare for patients to be involved in decision making regarding their healthcare needs with the mantra “no decision about me without me”.   In order for knowledge to be shared between health care professionals, patients and carers, movement of knowledge has to take place and this requires management of knowledge boundaries.

Project aims

Knowledge boundaries have been widely recognised in the management literature, but since Carlile’s seminal works, the understanding of knowledge boundaries has been largely unchallenged.   This work critiques some of the fundamental assumptions of Carlile’s typology and is developing a new typology which accounts more accurately for both knowledge boundaries, and the conflicts which may arise in their management. 

This typology is then being explored and developed further within the healthcare context and LTC management more specifically.  The aim is to understand better how health care professionals and patients can manage knowledge in order to enable patients to be more involved in care decisions and to facilitate self management activities as appropriate.

Project highlights

  • Ethnographic approach utilising observation and ethnographic interviewing
  • Data collection in Nottingham University Hospitals Trust Gastroenterology/Hepatology, and University Hospitals of Leicester Trust Renal departments
  • Data collection commenced and to be completed by end 2016


Project details

Student: Sarah Brand

Supervised by: Professor Justin Waring and Dr. Stephen Timmons

Funder: Health Education England working across the East Midlands and NIHR CLAHRC East Midlands

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