Condition Critical: Overcoming Allergic Reactions

to Entrepreneurship and Enterprise in Healthcare

Education.

Stacy Johnson

Plan• Learner’s key questions• Relevance• Congruence• Utility• Pyramid exercise• Mapping exercise• Questions and Discussion

Disclaimers• My working definition of entrepreneurship• Entrepreneurship, enterprise, innovation: well

which is it?• My emphasis on praxis and emancipation• Emphasis on teaching and learning: reaching the

hard to reach • Holistic entrepreneurship education: the

triumvirate of knowledge, attitudes and skills

Entrepreneurship

“….the transformation of an idea into an enterprise that creates value: economic, social, cultural, or intellectual.” (University of Rochester 2008)

Enterprise, innovation and entrepreneurship

• The enterprise concept: the skills and mindset for making things happen

• The entrepreneurship concept: making it happen, transforming ideas into going concerns

• The innovation concept: entrepreneurship and enterprise are pre conditions for innovation

(NCGE 2009)

Learner’s key questions

Gaining “buy in” is contingent on supplying satisfactory answers to learners’ key questions.

1. What does this have to do with me?

2. Are these principles compatible with my professional and personal values?

3. How does it help me to meet my objectives (individual, professional, organisational)?

Establishing RelevanceWhat does this have to do with me (my job, my degree)?

• Understanding situation and unique challenges

• Understanding context

• Understanding the learner’s objectives

Nurses Oppressed?• There is some literature regarding the low status,

marginalisation, oppression and subordinate position of nurses

• Sociological perspectives: gender, women’s work, doctor/nurse relationship

• My conceptual analysis approaches the issue from the perspective of economic theory

• Monopsonic labour leads to poor terms and conditions and an element of professional and economic oppression

Monopsony in the UK Nursing Labour Market

Monopsony exists when there is a single employer

of a particular form of labour• 75% of UK nurses work in the NHS

(ICN 2008)• The UK nursing labour market operates under

monopsonistic conditions • UK Government/DoH is (currently) a

monopsonistic employer

Five faces of oppression (Young 1990)

• Exploitation

• Marginalisation

• Powerlessness

• Cultural imperialism

• Violence

ExploitationThe transfer of the results of the labour of

one social group to benefit another

• Economic oppression

• Professional oppression

Economic Oppression• Limited choice of employer: monopsonistic

employers can exploit their position and not employ those who refuse to work for a low wage

• Lower earnings than similar jobs: confronted with a monopsonist employer, workers are forced to accept a lower wage

• With the existence of a monopsony employer wages are likely to fall

• Opportunity deprivation: Less access to entrepreneurship education

Occupation Gross Annual Income 2006 2007 Nurses 21,871 23,044

School Teachers 30,428 31,340

Lawyers 49,378 50,649

Police officers 34,988 36,025Occ. therapists 22,316 23,778

Physiotherapists 21,894 23,153

Social workers 25,259 26,306

Source: UK National Office of Statistics 2008, Annual Survey of

Hours and Earnings (ASHE)

Professional Oppression• Nursing practice and education forced to change

to meet the needs of– The medical profession – The NHS: managerialism, costs containment – The political needs of the government of the time: the

replacement agenda, • Main employer, NHS

– pays to educate: pre-reg-deaneries, post-reg-hospitals managers

– determines numbers trained– Influences courses developed and provided

MarginalisationMarginalization is the process by which categories of people are sidelined from full participation aspects of social life

• Within the healthcare sector, organisational conditions offer less opportunity for participation in the knowledge economy e.g. – Insurance: indemnity– Insurance: reimbursement

• the styles of discourse, systems of power-knowledge, institutional structures and practices- all combine to marginalize nurses

• Nurses are prevented from fully benefiting from the commercial gains of innovation, entrepreneurship and enterprise in the way that other professions do

• Not exposed to or presented with the same access to entrepreneurship and enterprise education as other students in HEIs

PowerlessnessThe powerless are those who lack authority or power...those over whom power is exercised without their exercising it; the powerless are situated so that they must take orders and rarely have the right to give themThe current health service model disempowers nurses

– Nursing influence in the UK health sector– Education: funding – Monopsony power: employer has considerable power

over wage rates employee has lower relative bargaining power under monopsonic conditions

Cultural ImperialismHow the dominant meanings of a society render the particular perspective of one's own group invisible at the same time as they stereotype one's group and mark it as the other

– Clinical– Angels, poorly paid – Sexualised

• This form of oppression is particularly evident in mass media representations of oppressed groups,

The Public Image of the Modern Nurse?

The Public Image of the Modern Nurse?

(Horizontal) ViolenceHorizontal violence is hostile and aggressive behaviour by individual or group members towards another member or groups of members of the larger group. (Duffy1995)

• inter-group conflict• ‘bullying’ • associated with oppressed groups• results from an internalised negative self perception and

low self esteem arising form being part of the oppressed group

A solution in nursing entrepreneurship?

• Multiple firms: address monopsonic conditions• Increase wage rate: competition for labour • Increase professional influence: greater choice of employer

and self employment• Increase power: bargaining power• Professional Autonomy

And….• Innovation• Enterprise

Establishing CongruenceAre these principles compatible with my professional and personal values?

• Exploring attitudes and beliefs• Challenging attitudes and beliefs• Identifying core values and how entrep allows

them to maintain these: the best for the patient through increased professional power, innovating our way out of trouble

Entrepreneurship

“ the transformation of an idea into an enterprise that creates value: economic, social, cultural, or intellectual.”

(University of Rochester 2008)

Critical Pedagogy

“illuminates the relationship among knowledge, authority, and power” (Giroux, 1994: 30)

• Roots in the critical theory of the Frankfurt School, whose influence is evident in the emancipatory works of Paulo Friere, the most renowned critical educator

• The power to care

Rejection of the banking model of teaching and learning

Dialogue with nursing experts

Dialogue with nursing neophytes

We don’t have to answer pesky questions like “Are entrepreneurs born or taught” and “Can you teach entrepreneurship?”

Reflections of a Critical Pedagogue

The role of the educator in critical pedagogy

– Educational Arsonist

– Educational Activist

Transformation

• The primary preoccupation of Critical Pedagogy is with social injustice and educating people to be agents who transform inequitable, undemocratic, or oppressive institutions and social relations.

• To transform individuals from being objects of educational processes to subjects of their own autonomy and emancipation

Power

• power in the teaching and learning context • how and in whose interests knowledge is produced

and 'passed on' and view the ideal aims of education as emancipatory

• examination of what knowledge is the way in which one comes to know and who provides knowledge (Habermas, 1971).

“As a profession, we need to move beyond simply selling nursing labour to commercialising nursing knowledge”

Conscientization• Liberatory education focuses on the development

of critical consciousness• Seeks to enable learners to recognize connections

between their individual problems and experiences and the social contexts in which they are embedded.

• Coming to consciousness: “conscientization” is the necessary first step of praxis.

Praxis

The engagement in the cycle of theory, application, evaluation, reflection and then back to theory

• Social transformation is the product of praxis at the collective level

• Adopting an orientation towards critical praxis (synchronised reflection and action) will facilitate the examination of what knowledge is, the way in which one comes to know and who provides knowledge (Habermas, 1971).

Establishing utiltiy

How does it help me to meet my objectives? (individual, professional, organisational)?

• What personal objectives are there• What are the individual professional objectives?• What might be the current organisational

objectives?• How can entrep help them to meet those• What’s in it for them?

The Healthcare Entrepreneurship Pyramid

Roles of

staff

Proportion of staff involved in activity

Talent Management

Education and Training

Innovators: ideas

Entrepreneurs: new ventures

Managers;

•stewards

•infrastructure

Frontline staff

•pose clinical problems

•Apply solutions

•Engage in knowledge translation

Senior clinicians:

• lead/manage change

•provide problems

Knowledge mobilisation infrastructure

Creators of the environment in which entrepreneurship

and innovation flourish: enterprising

The Healthcare Entrepreneurship Pyramid

Roles of

staff

Proportion of staff involved in activity

Talent Management

Education and Training

Innovators

Entrepreneurs

Managers

Junior practitioners

Support staff

Senior practitioners

Knowledge mobilisation infrastructure

Creators of the environment in which entrepreneurship

and innovation flourish: enterprising

What is your pyramid?Unit of Analysis

• Sector/Economy

• Organisation

• Team

Context

• Policy landscape

Locate your learners in the pyramid

• Who are the creators of the environment in which entrepreneurship and innovation flourish?

• What activities do your innovators engage in in your pyramid?

• What activities do your entrepreneurs engage in in your pyramid?

Creators of the Environment

• What knowledge do they need

• What skills do they need?

• What attitudes need to be challenged/fostered?

Innovators

• What knowledge do they need

• What skills do they need?

• What attitudes need to be challenged/fostered?

Entrepreneurs

• What knowledge do they need

• What skills do they need?

• What attitudes need to be challenged/fostered?

Concept mapping and translationLevel of Practice

Level of Practice Professional Objectives

Organisational Objectives

Entrepreneurship concepts, skills and attitudes

Junior Clinicians Plan and deliver best patient care

Research utilisationEvidence based practice

Enterprising, ResourcefulnessEntrepreneurial orientation

Senior Clinicians Improve patient care and outcomes

Change practiceService InnovativeService improvement

Sustained regeneration Incremental innovationEntrepreneurial Leadership

(Clinical) Managers Cost effective service delivery

Service redesign New ways of workingCommissioningIncome generation

Renewal activityStrategic EntrepCorporate venturingEntrepreneurial Leadership

Concept mapping and translationLevel of Practice

Level of Practice Professional Objectives

Organisational Objectives

Entrepreneurship concepts, skills and attitudes

Junior Practitioners

Senior Practitioners

Managers

Concept mapping and translation:Level of study

Level of Study Individual objectives

Educational/Professional objectives

Entrepreneurship concepts, skills attitudes

Undergraduate Get a good jobFinish my course

Get a good degree EmployabilityEnterpriseResourcefulnessProactiveness

Masters Finish my Masters degreeMove up band

Change practiceService InnovationService improvement

Radical innovation Renewal activity Corporate entrepreneurship Sustained regeneration/incremental innovation

Doctoral Get my PhDGet lectureship

Generate new knowledge

Commercialisation of knowledgeProduct developmentBusiness plans

Concept mapping and translationLevel of study

Level of Study Individual objectives

Educational /Professional objectives

Entrepreneurship concepts, skills attitudes

Undergraduate

Masters

Doctoral

Concept mapping and translationOrganisational Level

Level Objectives (micro)

Objectives (macro)

Entrepreneurship concepts, skills and attitudes

References

• Duffy, E. (1995, April), Horizontal violence: a conundrum for nursing. Collegian. Journal of the Royal College of nursing Australia. 2(2), 5-17.

• Freire, P. (1972) Pedagogy of the Oppressed. Harmondsworth: Penguin.

• Giroux, H. A. (1994). Disturbing pleasures: Learning popular culture. New York: Routledge.

• Young, Iris. 1988. "The Five Faces Of Oppression." Philosophical Forum 19:270-90