Thursday, 30 June 2011

Thesis Writing

You might have seen my new posts - and perhaps wondered about my long silence. I started this blog to spread some of the ideas developed during my PhD (and hopefully obtain some feedback) until I get the chance to write them up as "proper" journal papers. The reason why I have been silent for so long was that I actually worked on writing up my PhD thesis. And indeed I now have a first draft (hurrah) and am right now waiting for the verdict from my supervisors .... To pass the time I went to the very interesting "Making health care safer" conference in Scotland. I already started to post about it - and will try to write more over the next couple of days :)

Also now all my thoughts about my PhD work are nicely ordered, I will have some more stuff to blog about in the coming weeks and I also have become really interested in the past year in the relationship between healthcare services and developmental work - so watch this space :)

Making health care safer: learning from social and organisational research (Day 1) - Part 3 Knowledge Flows

I also went to Curtis Olson’s session about team learning. He stressed that in practice change involved practical knowledge, experiential learning and practice-based evidence and that practioners are more than just users or customers of knowledge but should rather be seen as experimenters. He also mentioned the importance of not only having know-what but also know-how available and accessible.

I found that this resonated very well with my work around knowledge flows in healthcare design (see one of the older entries in this blog) which stresses both the importance of seeing knowledge not just as something that goes into the design process but also as something that is produced by the design process – amongst others by the practioners. My service design knowledge typology also draws attention to the fact that different types of knowledge differ in their tacit and explicit components. Something that conventional literature often neglects by assuming all knowledge to be explicit and readily sharable. However, as Curtis points out, some knowledge cannot be shared this way and rather has to be acquired through observation and experience.

Making health care safer: learning from social and organisational research (Day 1) - Part 2 Context

Another topic raised by Naomi Fulop was how media and political agenda play different roles for Healthcare Associated Infections (HCAI) and medication errors. This may explain why professional tend to accept much higher rates of error for the latter than for the former (Naomi did a study and found that on average 40% of patients in the ward studied had at least one drug omission in the past 24h) – the stronger external pressures lead to a much lower accepted level for errors.

This demonstrates the importance of context, something I also came across several times in my PhD. Naomi also touched on a particular type of context: contra-productive incentives, which lead to errors being hushed up instead of reported (which is the prerequisite for learning). For example, if a “never event” occurs during surgery and is reported the hospital will not be reimbursement for the procedure and faces potential fines. However, she also argued that more research is needed to investigate which contextual factors are related to safety and quality, which of these are modifiable, to which level and what their respective relevance is. 

I fully agree.

Tuesday, 28 June 2011

Making health care safer: learning from social and organisational research (Day 1) - Part 1 Complexity

The Social Dimension is Health Institute has put on a great event here in St Andrews and I am able to present some of my ideas around complexity in health care as a poster (pdf handout). The idea of the poster session was less to present traditional posters but rather find ways to trigger conversations – and I had some very interesting conversations indeed once my poster finally arrived (my luggage only got here 29h after myself, Easyjet had forgotten it in Luton).

The plenary sessions were also very interesting – I find it particularly interesting (and reassuring) that researchers from different backgrounds, such as the medical sociologists Mary Dixon-Wood and Naomi Fulop, come to similar conclusions to the ones I drew from my PhD work.

Mary talked about theories of change and how they are often not explicit or not articulated which leads to enthusiasm at the executive level while the frontline staff is not aware of the underlying rational and subsequently much less enthusiastic. Mary referred to the intervention which she and her team studied as a complex intervention. I think in particular the healthcare improvement community often uses the term for problems or interventions which are merely complicated (I will try to write a future post on this) but Mary did point out that the intervention does not just consist of the multiple components but also how it functions socially.

This is similar to the message of my poster: the real complexity of an organization lies in its social functioning. This social functioning emerges around the structure set through the formal organizational structure. The latter ticks all the boxes of a complicated system (and not the ones of a complex one) and thus it should be able to apply design principles to it.

Naomi raised a related point in her talk by pointing out the need to conceptualize and manage the coexistence of formal governance processes and informal professional processes.

I think one comparison could be a wisteria where the formal structure provides the scaffolding. Through the scaffolding I can exert some influence on how my wisteria will grow. A good scaffolding will increase the chances of having it grow the way I want it to (which can be further aided by pruning), with a bad scaffolding it will definitely be a mess.