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Co-Producing Interprofessional Round Work: Designing Spaces for Patient Partnership
Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Jönköping University, Sweden.
Jonköping University, Sweden.
Karolinska Institute, Sweden.
Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.ORCID iD: 0000-0001-5066-8728
2017 (English)In: Quality Management in Health Care, ISSN 1063-8628, E-ISSN 1550-5154, Vol. 26, no 2, p. 70-82Article in journal (Refereed) Published
Abstract [en]

Within wide-ranging quality improvement agendas, patient involvement in health care is widely accepted as crucial. Ward rounds that include patients active participation are growing as an approach to involve patients, ensure safety, and improve quality. An emerging approach to studying quality improvement is to focus on "clinical microsystems," where patients, professionals, and information systems interact. This provides an opportunity to study ward rounds more deeply. A new model of conducting ward rounds implemented through quality improvement work was studied, using the theory of practice architectures as an analytical tool. Practice architecture focuses on the cultural-discursive, social-political, and material-economic conditions that shape what people do in their work. Practice architecture is a sociomaterial theoretical perspective that has the potential to change how we understand relationships between practice, learning, and change. In this study, we examine howchanges in practices are accomplished. The results show that practice architecture formed co-productive learning rounds, a possible model integrating quality improvement in daily work. This emerged in the interplay between patients through their " double participation" (as people and as information on screens), and groups of professionals in a ward round room. However, social interplay had to be renegotiated in order to accomplish the goals of all ward rounds.

Place, publisher, year, edition, pages
LIPPINCOTT WILLIAMS & WILKINS , 2017. Vol. 26, no 2, p. 70-82
Keywords [en]
clinical microsystem; co-production; practice architectures; sociomaterial practice theory; quality improvement; ward round; workplace learning
National Category
Social Sciences Interdisciplinary
Identifiers
URN: urn:nbn:se:liu:diva-137402DOI: 10.1097/QMH.0000000000000133ISI: 000399390400003PubMedID: 28375953OAI: oai:DiVA.org:liu-137402DiVA, id: diva2:1096667
Available from: 2017-05-18 Created: 2017-05-18 Last updated: 2018-04-20
In thesis
1. Läkare, lärande och interaktion i hälso-och sjukvårdspraktiker
Open this publication in new window or tab >>Läkare, lärande och interaktion i hälso-och sjukvårdspraktiker
2018 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [sv]

Bakgrund: Komplexiteten i hälso- och sjukvården blir kontinuerligt större, liksom möjligheterna till diagnostik och behandling. Samtidigt pressas hälso- och sjukvården av förändringar i demografier och sjukdomspanoraman, olika uttryck för globalisering och tillämpning av nya teknologier. Ett omfattande antal olika professioner förväntas genomföra och utveckla det dagliga arbetet med ännu mer involvering av patienter. Vi behöver mer kunskap om hur lärande sker och hur det underlättas och utvecklas i dagligt hälso- och sjukvårdsarbete för att kunna möta förändringar och utmaningar.

Syfte: Avhandlingens övergripande syfte är att fördjupa kunskap och förståelse om pedagogiska processer och lärande i hälso- och sjukvårdspraktiker, med särskilt fokus på läkare.

Metoder: Intervjustudier och fältstudie med interaktiv forskningsansats gav data med både bredd och djup från autentiskt hälso- och sjukvårdsarbete. I pågående hälso- och sjukvårdsarbete studerades läkare, vårdgivare i andra professioner, patienter, redskap som användes och praktikens rumsliga utformning. Data analyserades genom både kulturella och sociomateriella praktikteoretiska linser, vilket möjliggjorde att flera dimensioner av lärande och interaktion i hälso- och sjukvårdspraktiker kunde spåras.

Fynd: I arbetet med patienter agerade läkare och andra professioner pedagogiskt med eller utan intentioner, i pedagogiska processer som bestod av att avläsa-färdrikta-lärstödja. Den pedagogiska dimensionen av arbetet var inte synliggjord eller diskuterad i relation till patientarbetet. Dynamiskt inbäddat i arbetet lärde och stöttade läkare också yngre läkares och andra vårdgivares lärande. Läkarnas mobilitet i olika vårdsammanhang, såväl som ansvarsfördelning och delande av olika perspektiv, hade betydelse för vilket lärande som uppstod. Genom att betrakta specifika vårdsammanhang som hälso- och sjukvårdspraktiker under utövning, framträdde vid studiet av en rondmodell både samskapande lärande ronder och operativa ronder med begränsat lärande. Det framträdde genom sättet som deltagande personer, rumsliga och materiella förhållande samspelade på, som ömsesidigt utbyte respektive separata individuella arbetsprocesser. Samspelet mellan hälso- och sjukvårdspraktikers arrangemang (praktikarkitekturer) och genomförande snarare begränsade än underlättade underläkares lärandepraktiker. Underläkarnas arbete hade inte kontinuitet, koherens eller progression för att bredden av kunnande i medicinsk praktiskt arbete skulle kunna utvecklas bra.

Implikationer: Att förstå och synliggöra lärande i hälso- och sjukvårdens dagliga arbete genom att gemensamt prata om pedagogiska dimensioner i det arbete som pågår, kan utveckla lärande och lärstödjande ageranden. Samskapande lärande hälso- och sjukvårdspraktiker där alla deltagande gruppers behov och uppdrag medräknas, har implikationer på underläkares kompetensutveckling, studenters lärande, patienters involvering i sin vård och interprofessionellt och interdisciplinärt samarbete. Det ger också ledare möjlighet att knyta arbete med förbättringar av vårdens kvalitetet och säkerhet till dagligt vårdarbete.

Abstract [en]

Background: The level of complexity within healthcare services is continually increasing. These services are put under pressure by changing demographics and associated illness profiles, the influence of globalization, and the introduction of new technologies. Physicians are expected to perform and develop their daily work in cooperation with other healthcare professionals and in association with increasing levels of patient involvement. In such a changing and challenging healthcare environment, more knowledge is needed about how learning takes place and how learning can be facilitated and developed in the daily provision of healthcare services.

Aim: The overarching aim of this dissertation is to deepen our knowledge and understanding of the pedagogic processes and the learning that takes place in healthcare practices, with particular focus on physicians’ learning.

Methods: The research methodology employed in this dissertation includes interviews and field studies that used an interactive research approach. Authentic healthcare practices, including physicians, other care providers, patients, clinical tools in use, and the spatial arrangements within which the healthcare practices were performed were studied. The data that was collected was analyzed from a practice-theory perspective, thus allowing the researcher to identify and describe several dimensions of learning and interaction in healthcare practices.

Results: The pedagogic processes that were identified in the physicians’ and the other healthcare practitioners’ daily work with their patients can be described as read-guide-learning support. The pedagogic dimension of this work was not immediately revealed nor was it overtly articulated. The physicians dynamically, by themselves, taught and supported the junior physicians and other healthcare providers’ learning. The physicians’ mobility in a variety of healthcare contexts was of relevance to the learning that took place. By viewing specific healthcare contexts as performing health care practices during the study, a rounds work emerged which included both (i) co-produced learning rounds and (ii) operative rounds which gave rise to limited learning. The interaction between arrangements in healthcare practices, ‘practice architectures’, and the performance of the healthcare practices actually limited the junior physicians’ learning.

Implications of the study: A proper understanding of the learning that takes place during the daily work in the provision of healthcare – by revealing and examining the pedagogic dimensions of the work that is done – can contribute to the development of learning and learning support mechanisms. Co-produced learning healthcare practices, where each participant’s needs and contributions are taken into account, have direct implications for professional development initiatives and learning, for patient involvement in their healthcare arrangements, and for interprofessional and inter-disciplinary cooperation. Such practices also provide responsible leaders and decision-makers with the opportunity to tie in healthcare quality assurance work with the daily work that is performed by healthcare practitioners in the field. 

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2018. p. 107
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1615
National Category
Learning Other Medical Sciences not elsewhere specified
Identifiers
urn:nbn:se:liu:diva-147359 (URN)10.3384/diss.diva-147359 (DOI)9789176853368 (ISBN)
Public defence
2018-05-18, Rosensalen, Rosenlunds vårdcentrum, Jönköping, 13:00 (Swedish)
Opponent
Supervisors
Note

Mindre korrigeringar är gjorda i den elektroniska versionen (Sammanfattning sid. 3). / Minor corrections are maed in the electronic version (Swedish abstract p. 3).

Available from: 2018-04-20 Created: 2018-04-20 Last updated: 2018-04-26Bibliographically approved

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