lorelei lingard
TRANSCRIPT
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Plenary 1
Lorelei LingardCentre for Education Research & Innovation (CERI)
Schulich School of Medicine and Dentistry Western University
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The role of communication in Collective Competence
Lorelei Lingard, PhDCentre for Education Research & Innovation
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My task
• To discuss “Communication as an enabling competency for collective competence”
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My Objectives
• To complicate the idea of ‘communication’• To expand the notion of ‘competence’• In order to encourage us to grapple more
robustly with the complexities of communication on healthcare teams
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‘The Doctor’, Sir Luke Fildes 1891
Healthcare then.
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Healthcare now.
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• 24% of all Canadian seniors report having 3 or more chronic conditions
• These seniors report 13.3 million healthcare visits per year
(CIHI, 2011)
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Healthcare is a team sport
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JCAHO. Sentinel event statistics. www.jcaho.org.
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My Objectives
• To complicate the idea of ‘communication’• To expand the notion of ‘competence’• In order to encourage us to grapple more
robustly with the complexities of communication on healthcare teams
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3 stories
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Sharing knowledge in the OR team
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On the frontlines of simple checklist interventions
“We did the big launch, the leadership walk-abouts. And something called a checklist is being
counted as ‘done’ here. But there’s such variability in terms of who’s there, what they
bother to talk about, how seriously they take the whole thing … we’ve had surgical site errors
twice in the last month, both in cases where the checklist was ‘done’. Who’s kidding who? “
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Communicating complexity on the inpatient teaching team
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Documentation is translation
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Communication on distributed care teams
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Individual Competence
≠Good Healthcare
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Safety at HomeJuly 2013
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Competence is
• a constantly evolving set of multiple, interconnected behaviors
• achieved through participation and enacted in time and space
Collective way of seeing Competence
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Distributed cognition
Collaborative work as ‘joint cognitive accomplishment not attributable to any individual’.
(Hutchins 1991)
Theoretical roots
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Socio-material and system theories
Individuals are shaped by social, technological and physical structures – the ‘activity system.’
(Engestrom 1987; 1995; 2002)
Complex systems are inherently unstable; a change anywhere produces a nonlinear ripple effect. Competence is highly context -dependent.
(Sveiby 1997; Zimmerman 2004)
Theoretical roots
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Two ‘ways of seeing’ competence
Individual
• Individual possession• Stable• Context-free
Collective
• Distributed capacity• Evolving• Based in situations
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3 stories
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Sharing knowledge in OR teams
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Progressive collaborative refinement on teaching teams
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Communication on distributed care teams
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Communication is shaped by…
• Relationships• Varying levels of experience• Distribution of tasks• Scheduling of team members• Passage of time• Available technology• Scope of practice
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Very few of these can be reduced to a focus on PEOPLE
and their communication skill
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And very few of these operate exclusively at the
individual level – they operate at the points of connection
among parts of the team
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And YET
Our education and assessment efforts privilege individual parts of the system
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Two ‘ways of seeing’ competence
• Individual possession• Stable• Context-free
• Distributed capacity• Evolving• Based in situations
NOT a simple binary opposition. Collectivist not a ‘solution’ to individualist.
Each ‘selects’ and ‘deflects’.
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In summary: A call to…
• Complicate our idea of ‘communication’• Expand our notion of ‘competence’• Create education and assessment practices
commensurate with the complexities of communication on healthcare teams
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Plenary 1
Lorelei LingardCentre for Education Research & Innovation (CERI)
Schulich School of Medicine and Dentistry Western University