Being in the same boat, in two ways : Conflict metaphors in health care

In research on conflicts, the systematic study of metaphors is playing an increasingly prominent role. In the context of a U.S. – Swiss–Hungarian international collaboration investigating conflicts through interviews with healthcare professionals,the present chapter analyzes linguistic and conceptual metaphors in Hungarian interviews. The theoretical background for the analysis is provided by the cognitive theory of metaphor, while its methodology is based on MIPVU. Moving away from linguistic representations, this study aims to analyze the role of metaphors in the conceptualization, interpretation, and management of conflicts. The chapter presents general, conventionalized orientational and ontological metaphors of conflict, also exploring the core metaphors of the metaphor families of competition and cooperation as well as correlations between conflicts and power structures

The Role of Power in Health Care Conflict: Recommendations for Shifting Toward Constructive Approaches

Purpose The combination of power and conflict is frequently reported to have a detrimental impact on communication and on patient care, and it is avoided and perceived negatively by health care professionals. In view of recent recommendations to explicitly address power and conflict in health professions education, adopting more constructive approaches toward power and conflict may be helpful. Method The authors used social bases of power (positional, expert, informational, reward, coercive, referent) identified in the literature to examine the role of power in conflicts between health care professionals in different cultural settings. They drew upon semistructured interviews conducted from 2013 to 2016 with 249 health care professionals working at health centers in the United States, Switzerland, and Hungary, in which participants shared stories of conflict they had experienced with coworkers. The authors used a directed approach to content analysis to analyze the data. Results The social bases of power tended to be comparable across sites and included positional, expert, and coercive power. The rigid hierarchies that divide health care professionals, their professions, and their specialties contributed to negative experiences in conflicts. In addition, the presence of an audience, such as supervisors, coworkers, patients, and patients’ families, prevented health care professionals from addressing conflicts when they occurred, resulting in conflict escalation. Conclusions These findings suggest that fostering more positive approaches toward power and conflict could be achieved by using social bases of power such as referent power and by addressing conflicts in a more private, backstage, manner

Continuities in health care work: group processes and training at two academic medical centers in Switzerland and California

The health care environment has experienced important changes in recent decades. However, processes of health care work have persisted in spite of these changes. These continuities are widely acknowledged but difficult to explain. This dissertation explores how processes of health care work persist through case studies of two academic medical centers, one located in Switzerland and the other one in California. Building upon a year-long ethnographic research in the internal medicine and surgery wards of both medical centers, it addresses different elements of persistence through five scientific articles. As a whole, this dissertation provides a model for understanding continuities in processes of health care work. It explains how training, hospital structures, change, and conflict contribute to these continuities

Individual and collective strategies in nurses' struggle for professional identity

Individuals' perception of their work as meaningful contributes to their sense of identity. While individual processes of identity development through work have been studied extensively, we know little about how social processes may contribute to this development. This article seeks to better understand social processes of professional identity development through work by examining nurses' reactions to changes in their end of shift reports. Field observations were conducted with two healthcare teams on the internal medicine ward of a Swiss teaching hospital. During the observation period, organisational changes in end of shift reports, a crucial time in nurses' shift, were introduced to the teams and then implemented. Before the changes, nurses used individual and collective strategies to make their work meaningful and to affirm their professional identity. Individually, nurses sought recognition from their co-workers during end of shift reports. Collectively, nurses resorted to professional values and discourses that set them apart from other professional groups. However, changes in shift reports threatened these strategies. This article shows how nurses make their work meaningful in the eyes of others and how others' recognition contributes to nurses' sense of professional identity

From ideal to real: a qualitative study of the implementation of in situ interprofessional simulation-based education.

BackgroundDespite the widespread adoption of interprofessional simulation-based education (IPSE) in healthcare as a means to optimize interprofessional teamwork, data suggest that IPSE may not achieve these intended goals due to a gap between the ideals and the realities of implementation.MethodsWe conducted a qualitative case study that used the framework method to understand what and how core principles from guidelines for interprofessional education (IPE) and simulation-based education (SBE) were implemented in existing in situ IPSE programs. We observed simulation sessions and interviewed facilitators and directors at seven programs.ResultsWe found considerable variability in how IPSE programs apply and implement core principles derived from IPE and SBE guidelines with some principles applied by most programs (e.g., "active learning", "psychological safety", "feedback during debriefing") and others rarely applied (e.g., "interprofessional competency-based assessment", "repeated and distributed practice"). Through interviews we identified that buy-in, resources, lack of outcome measures, and power discrepancies influenced the extent to which principles were applied.ConclusionsTo achieve IPSE's intended goals of optimizing interprofessional teamwork, programs should transition from designing for the ideal of IPSE to realities of IPSE implementation

Does the single-item self-rated health measure the same thing across different wordings? Construct validity study

The self-rated health (SRH) item is frequently used in health surveys but variations of its form (wording, response options) may hinder comparisons between versions over time or across surveys. The objectives were to determine (a) whether three SRH forms are equivalent, (b) the form with the best construct validity and (c) the best coding scheme to maximize equivalence across forms

Towards equitable learning environments for medical education : bias and the intersection of social identities

Context: Medical educators are increasingly paying attention to how bias creates inequities that affect learners across the medical education continuum. Such bias arises from learners' social identities. However, studies examining bias and social identities in medical education tend to focus on one identity at a time, even though multiple identities often interact to shape individuals' experiences. Methods: This article examines prior studies on bias and social identity in medical education, focusing on three social identities that commonly elicit bias: race, gender and profession. By applying the lens of intersectionality, we aimed to generate new insights into intergroup relations and identify strategies that may be employed to mitigate bias and inequities across all social identities. Results: Although different social identities can be more or less salient at different stages of medical training, they intersect and impact learners' experiences. Bias towards racial and gender identities affect learners' ability to reach different stages of medical education and influence the specialties they train in. Bias also makes it difficult for learners to develop their professional identities as they are not perceived as legitimate members of their professional groups, which influences interprofessional relations. To mitigate bias across all identities, three main sets of strategies can be adopted. These strategies include equipping individuals with skills to reflect upon their own and others' social identities; fostering in-group cohesion in ways that recognise intersecting social identities and challenges stereotypes through mentorship; and addressing intergroup boundaries through promotion of allyship, team reflexivity and conflict management. Conclusions: Examining how different social identities intersect and lead to bias and inequities in medical education provides insights into ways to address these problems. This article proposes a vision for how existing strategies to mitigate bias towards different social identities may be combined to embrace intersectionality and develop equitable learning environments for all.</p

Exploring group boundaries and conflicts: a social identity theory perspective

CONTEXT In the clinical environment, health care professionals self-categorise into different groups towards which they develop positive attitudes, whereas they view other groups less favourably. Social identity theory purports that these attitudes influence group processes and may foster conflicts that impede collaborative practice, although this relationship is poorly understood. This study used concepts from social identity theory to examine the interplay between group processes and conflicts, as well as the consequences of these conflicts, with the goal of identifying educational strategies to favour teamwork. METHODS Semi-structured interviews with 82 randomly selected physicians and nursing professionals working at a Swiss academic medical centre explored participants' experiences of conflicts. Data analysis was informed by social identity theory and focused on interviews where group processes were highlighted by participants. The analysis sought to uncover how group processes were intertwined with conflicts and how they affected health care professionals. RESULTS A total of 42 participants out of the initial pool of 82 interviews shared 52 stories of conflicts involving group processes. Most of these stories were shared by physicians and involved groups of physicians at different hierarchical levels. Conflicts and group processes were linked in two ways: (i) through processes of group membership when individuals struggled to join a relevant group, and (ii) through intergroup boundaries, such as when participants perceived that power differentials disadvantaged their own groups. Conflicts could lead to difficult experiences for clinicians who questioned their abilities, became disillusioned with their professional ideals and developed negative perceptions of other groups. CONCLUSIONS This study suggests that conflicts involving group processes may lead to stronger intergroup boundaries, challenging current educational efforts to favour teamwork in health care. Taking steps to create more inclusive groups and to encourage perspective taking may help manage intergroup conflict