Clinicians’ experience of providing care: a rapid review

Background: Health care services internationally are refocussing care delivery towards patient centred, integrated care that utilises effective, efficient and innovative models of care to optimise patient outcomes and system sustainability. Whilst significant efforts have been made to examine and enhance patient experience, to date little has progressed in relation to provider experience. This review aims to explore this knowledge gap by capturing evidence of clinician experience, and how this experience is defined and measured in the context of health system change and innovation. Methods: A rapid review of published and grey literature review was conducted utilising a rapid evidence assessment methodology. Seventy-nine studies retrieved from the literature were included in the review. Fourteen articles were identified from the grey literature search and one article obtained via hand searching. In total, 94 articles were included in the review. This study was commissioned by and co-designed with the New South Wales, Ministry of Health. Results: Clinician experience of delivering health care is inconsistently defined in the literature, with identified articles lacking clarity regarding distinctions between experience, engagement and work-related outcomes such as job satisfaction. Clinician experience was commonly explored using qualitative research that focused on experiences of discrete health care activities or events in which a change was occurring. Such research enabled exploration of complex experiences. In these contexts, clinician experience was captured in terms of self-reported information that clinicians provided about the health care activity or event, their perceptions of its value, the lived impacts they experienced, and the specific behaviours they displayed in relation to the activity or event. Moreover, clinician’s experience has been identified to have a paucity of measurement tools. Conclusion: Literature to date has not examined clinician experience in a holistic sense. In order to achieve the goals identified in relation to value-based care, further work is needed to conceptualise clinician experience and understand the nature of measurement tools required to assess this. In health system application, a broader ‘clinician pulse’ style assessment may be valuable to understand the experience of clinical work on a continuum rather than in the context of episodes of change/care

The development of a culture-based tool to predict team performance

The effect of national culture on the performance of teams is becoming an increasingly important issue in advanced western countries. There are many interlinked reasons for this, including the increasing globalisation of companies and the use of joint ventures for the development of expensive platforms. A further issue relates to the export of complex sociotechnical systems, where a culture clash between designer/manufacturer and user can lead to significant problems. This report describes research work that was carried out to analyse the cultural factors that influence the performance of teams (including researchers, designers, operators and crews), and to determine whether these factors could be captured in a tool to provide assistance to team managers and team builders. The original point of interest related to the development of increasingly complex sociotechnical systems, for example nuclear power stations, oil refineries, offshore oil platforms, hospital systems and large transport aircraft. Answers that might be sought, in particular by the senior managers of global companies, include (1) the best teams (or best national locations) for fundamental research, industrial research & development, product/system improvement and other key activities, and (2) the implications for system performance and, as a result, for system design, of targeting an eastern Asian market, a South-American market, etc. A literature review was carried out of the effects of culture on team performance, of culture measures and tools and of task classifications; in addition, empirical evidence of the validity of measures and tools was sought. Significant evidence was found of the effects of culture on teams and crews, but no national culture-based team performance prediction tools were found. Based on the results of the literature review, Hofstede's original four-dimension cultural framework was selected as the basis for the collection and analysis of empirical data, including the results of studies from the literature and the researcher s own empirical studies. No team or task classification system was found that was suitable for the purposes of linking culture to team performance, so a five-factor task classification was developed, based on the literature review, to form the basis of the initial modelling work. A detailed analysis of results from the literature and from the author s pilot studies revealed additional culture-performance relationships, including those relating to cultural diversity. Three culture-performance models were incorporated into software tools that offered performance prediction capabilities. The first model was primarily a test bed for ideas; the second model incorporated a task/behavioural approach which achieved limited success; the third and final model was evaluated against a range of team and crew performance data before being tested successfully for acceptability by users. The research results included the discovery that the effects of cultural diversity must be sought at the individual cultural dimension level not at the composite level, that the effects of national culture on team performance are consistent and strong enough to be usefully captured in a predictive culture tool and that the relation¬ship between culture and behaviour is moderated by contextual factors

The 'whole of the wall' : a micro-analytic study of informal, computer-mediated interaction between children from a marginalised community

PhD ThesisAs a prominent symbol of the free-market, liberationist approach to International Development (ID), the Self-Organised Learning Environment (Mitra, 2006) has been presented as a bona-fide revolution in primary education provision, a means by which the global poor can finally gain a legitimate foothold in modernity with nothing more than a computer and an internet connection (Tooley, 2006). Naturally, the notion of a credible, teacher-less environment characterised by a spontaneous and coherent pedagogy of enquiry is a remarkable yet, highly emotive hypothesis with potential consequences far beyond the domain of ID. Indeed, a review of the associated literature attributes a raft of learning claims to the SOLE, not to mention supplementary social and psychological benefits (Mitra 2012). On the other hand, an overtly foundational approach to SOLE research is neither supported by an empirical study of participant interaction nor a coherent definition of learning, presenting the participants as nothing more than `ghosts with a machine`. On the understanding that self-organisation can only truly exist as an emergent practice, where talk-in-interaction is presumed to reside at the heart of social order (Boden & Zimmerman, 1991), this thesis represents a detailed micro-analysis of SOLE participation among children from a marginalised community resident in Boyacá, Colombia. In direct contrast to a large-scale, etic approach to educational research founded on a priori concepts, testing, statistics and generalisation (Mitra, 2006), the learning space is reconceived as a distinctly intimate, Community of Practice (Wenger, 2000). In which case, computer-mediated activity is characterised relative to an interactional paradigm (Hutchby, 2001) and Page 3 the canonical features of mundane conversation, including; turn-taking, repair and topic management (ten Have, 1999). To begin with, it is argued that SOLE interaction can be arranged in terms of the following series of interrelated routines: Entry; Challenge; Search; Tutorial; Evaluation; Outage; Fly-Solo. As Sacks anticipated (Silverman 1998), micro-analysis reveals that participation and computer-mediated multi-activity is broadly consistent with the exigencies of context. Self-organisation then is shaped by the social realities of identity and the seemingly paradoxical features of group belonging (sharing) and individual autonomy (control) manifest in practices of opposition, assessment and insult (Goodwin & Kyratzis, 2009; Corsaro, 2005). Secondly, the SOLE organisational and learning structure is distinctly intra-personal and autocratic in nature. Thereafter, peer-to-peers relations are subject to situated distributions of epistemic authority coupled with unilateral demonstrations of the deontic equivalent. Moreover, Mitra’s idealised representation of a learning environment free from institutional/ideological interference i.e. outdoctrination, is challenged by a conspicuous, politicisation of the SOLE by the participants themselves. Thirdly, the dyad is the principle mode of operation where participants orient towards the computer as a limited resource/object rather than an active participant or product of social construction. Forthly, interaction is broadly consistent with the principal features of canonical talk where accountability is sustained through a combination of linguistic and para-linguistic activity (Atkinson & Heritage, 1984). To this effect, participant intersubjectivity is produced and sustained through mutually supportive acts of mediated coherence relative to a recognisable series of emergent procedures, namely: dispute; action-listing; effectuated repair; reciprocal exchanges; place-saving. Finally, the Page 4 detailed linguistic features of interaction point to an object-oriented, `mobilising` speech-exchange system operating directly at the interface between talk and social action. Whilst the precise flow of interaction is virtual-activity dependent, the system is consistently characterised by abbreviated forms of talk, most conspicuously; deictic reference, directives and response cries supplemented throughout by embodied gesture/metanarrative. Irrespective of these linguistic shortcuts, not to mention limitations of computer affordance i.e. ambivalence, overload and diversions, the general absence of breakdown suggests a degree of communicative competence between the participants. In which case, notions of situated learning and knowledge are not so much cognitive and mechanical in nature but distinctly social and interactional (Hutchby & Moran-Ellis, 2001) with the principal aim of CoP assimilation: learning is not so much related to the acquisition of arbitrary, content-centric knowledge, as it is about play, identity and situated competency as part of an emergent social practice within an unfamiliar mediated context In conclusion, it is argued that a liberationalist approach to ID research and education is definitively and inexorably deterministic in nature. In the absence of interactional data, Mitra is seemingly obliged to co-opt the principle symbols of an alternative, social-cultural paradigm i.e. collaboration, agency, democracy, equality, criticality, in order to add intellectual ballast to the otherwise empty claims of self-organisation i.e. a `Trojan Mouse` approach to social and educational change (Selwyn, 2011). In broader terms of development policy, the issue of authentic representation is viewed as a priority. Thereafter, the study Page 5 recommends a context-sensitive paradigm of ID research as a meaningful supplement to the prevailing logo-centric orthodoxy. Consistent with the rhetoric of post-colonialism, emphasis is shifted to a post-structural sociology (Heritage, 1984) and educational curriculum (Slattery, 2006) supported by a counter-balancing emic approach to research i.e. micro-ethnography, one that seeks to give authentic voice not only to SOLE participants but to the multitude living extreme poverty as a relentless, day-to-day reality