This poster explores relations that emerge between professionals in different roles in the public health systems in low-and-middle income countries (LMICs) as they engage in activities related to the surveillance of antimicrobial resistance (AMR). It illustrates the potential for a designed learning activity to promote relational expertise among participants based at the same workplace. Grounded in sociocultural theory and leveraging theoretical contributions from the field of professional learning, we draw on qualitative digital data across a period of six months to examine the development of an AMR Toolkit - a set of activities to encourage dialogic reflection about new sets of relations that are needed as work evolves - and the organization of activities that the Toolkit enabled. Analysis of accounts generated by lead participants (written proformas (n=12); interviews (n=11)) across 12 public health organisations in two LMICs reveal how the concept of relational expertise combined with maintaining a view of the new object of activity in the local system serve in the design of an artefact that supports professionals to come to understanding and negotiate wider work arrangements and practices, envision new practices and engage in re-configurations of relational aspects of work

Charitonos, Koula

Dawadi, Saraswati

Giri, Santosi

Goshtasbpour, Fereshte

Littlejohn, Allison

Owusu-Ofori, Alex

Vaidya, Abhinav

English

UCL Discovery

DEVELOPING RELATIONAL WORK AS A DESIGN TOOL IN ACTIVITIES WITH HEALTH PROFESSIONALS  Who can be part of the team using the toolkit? Anyone who is a member of sta! in animal or human health healthcare settings or related organisations (such as environment or government organisation) and is involved in work associated with AMR could be part of the team using the toolkit. The team could be formed by people in junior or more senior positions that are already working together in a team or are brought together for the purposes of the toolkit activities. Member of the team could be in roles such as (but not limited to) microbiologists, lab scientists/technicians, pharmacists, physicians, nurses, administrators, biostatisticians, vets, paravets, or field o"cers. HOW TO USE THE AMR  SURVEILLANCE TOOLKIT? Why should I use the toolkit in my work?As a health professional, you have a key role to play in addressing the global threat of antimicrobial resistance (AMR). Our research has shown that sta! in healthcare facilities involved in AMR work face di"culties in implementing e!ective AMR surveillance, but are looking for opportunities to learn more about AMR. This toolkit supports you and your colleagues as a team to learn new knowledge and develop more e!ective ways of working together to address AMR.What does the toolkit include?The toolkit is a collection of three main tools. Each tool includes various tasks that you and your colleagues can do to develop new strategies around AMR practice that you can use in your day-to-day work:Can I be the facilitator? Yes! As long as you are a member of sta! in animal and human health healthcare settings or related organisations, and you have a management or leadership role. This means that you are in a position to bring together a team of people involved in work associated with AMR, and – importantly – you can influence relevant sta! in your organisation. Your role is important because you will facilitate or lead discussions in the team, listen to what your colleagues have to say, and follow up on specific actions agreed as a team. Facilitators could be in roles such as (but not limited to) managers and senior managers; supervisors; technical leads and site leaders; heads of units; administrators; or Fleming Fund Fellows.Tool 1: Your role in an  AMR surveillance networkThis tool includes tasks that can help you reflect on your own roles and responsibilities, as well as the roles of other people in the AMR network. Tool 2: Dealing with  AMR dataThe second tool helps you and your colleagues understand their contribution to data collection and management within AMR surveillance systems.  Tool 3: Reflecting on your work  and changing your workplaceThe third and final tool encourages you and your colleagues to develop strategies to apply your learning to day-to-day work and to overcome barriers that delay or stop you from doing this.   How can I use the toolkit?As a facilitator you are asked to identify a small group of co-workers (up to five to eight people) that are involved in AMR-related work in your organisation and bring them together as a team. These could be sta! in your team or representatives from other teams and various units in the organisation. It is good to set some regular team meetings over a specific period of time to go through the toolkit tasks. You can go through all three tools or you can choose the one(s) that are more relevant to the roles in your team or any existing issues around AMR surveillance that a!ect the way that your organisation or the team is working. How was the toolkit developed?The AMR surveillance toolkit was developed by The Open University UK as part of the Fleming Fund programme, a £265 million UK aid investment to tackle AMR in low- and middle-income countries around the world. The programme is managed by the UK Department of Health and Social Care (DHSC) in partnership with Mott MacDonald, the Fleming Fund Grants Management Agent. The toolkit was developed and evaluated in twelve public health organisations in Ghana and Nepal.Now go to the AMR surveillance toolkit.Who can be part of the t am using the toolkit? Anyone who is a me ber of sta! in a imal or human health healthcare settings or relat d organis tions (such as environme t or government organisation) and is involved in work associated with AMR could be part of the team using the toolkit. The team could be formed by people in junior or more senior positions that are already working together in a team or are brought together for the purposes of the toolkit activities. Member of the team could be in roles such as (but not limited to) microbiologists, lab scientists/technicians, pharmacists, physicians, nurses, administrators, biostatisticians, vets, paravets, or field o"cers. HOW TO USE THE AMR  SURVEILLANCE TOOLKIT? Why should I use the toolkit in my work?As a health professional, you have a key role to play in addressing the global threat of antimicrobial resistance (AMR). Our research has shown that sta! in healthcare facilities involved in AMR work face di"culties in implementing e!ective AMR surveillance, but are looking for opportunities to learn more about AMR. This toolkit supports you and your colleagues as a team to learn new knowledge and develop more e!ective ways of working together to address AMR.What does the toolkit include?The toolkit is a collection of three main tools. Each tool includes various tasks that you and your colleagues can do to develop new strategies around AMR practice that you can use in your day-to-day work:Can I be the facilitator? Yes! As long as you are a me ber of sta! in a imal and human health healthcare s ttings or related organisations, and you have a man gement or leadership role. This means tha  you are in a position to bring togeth r a team of people invol ed in work associated with AMR, and – importan ly – you can influence r levant sta! in your organisation. Your role is important because you will facilitate or lead discu sions i  the team, listen to what your colleagues have to say, nd follow up on specifi  a tions agreed as  team. Facilitators could be in roles such as (but not limited to) managers and senior man gers; supervisors; technical leads and site leaders; heads of units; administra ors; or Fleming Fund Fellows.Tool 1: Your role in an  AMR surveillance networkThis tool includes tasks that can help you reflect on your own roles and responsibilities, as well as the roles of other people in the AMR network. Tool 2: Dealing with  AMR dataThe second tool helps you and your colleagues understand their contribution to data collection and management within AMR surveillance systems.  Tool 3: Reflecting on your work  and changing your workplaceThe third and final tool encourages you and your colleagues to develop strategies to apply your learning to day-to-day work and to overcome barriers that delay or stop you from doing this.   How can I use the toolkit?As a facilitator y u are sked to identify a small group f co-workers (up to five to eight peo le) that are involved in AMR-relat d work in your rganis tion and bring them together as a te m. These could be sta! in your team or representatives from ther t ams and various units in the organis tion. It is good t  set ome regular team meetings over a specific period of time to g  through the oolkit tasks. You can go thr ugh all three tools r y u can choose th one(s) that are more rel vant to the roles in your team or any existing issues around AMR surveillance that a!ect the way that your rganis tion or the team is working. How as the toolkit developed?The AMR surveillance toolkit was developed by The Open University UK as part of the Fleming Fund programme, a £265 million UK aid investment to tackle AMR in low- and middle-income countries around the world. The programme is managed by the UK Department of Health and Social Care (DHSC) in partnership with Mott MacDonald, the Fleming Fund Grants Management Agent. The toolkit was developed and evaluated in twelve public health organisations in Ghana and Nepal.Now go to the AMR surveillance toolkit.Who can be part of the team using the toolkit? Anyone who is a member of sta! in animal or human health healthcare settings or related organisations (such as environment or government organisation) and is involved in work associated with AMR could be part of the team using the toolkit. The team could be formed by people in junior or more senior positions that are already working together in a team or are brought together for the purposes of the toolkit activities. Member of the team could be in roles such as (but not limited to) microbiologists, lab scientists/technicians, pharmacists, physicians, nurses, administrators, biostatisticians, vets, paravets, or field o"cers. HO  TO USE THE A R  S RVEI LA CE T LKIT? Why should I use the toolkit in my work?As a health professional, you have a key role to play in addressing the global threat of antimicrobial resistance (AMR). Our research has shown that sta! in healthcare facilit es in olved in AMR work face di"culties in impl menting e!ective AMR surveillance, but are looking for opportunities to learn more about AMR. This toolkit supports you and your colleague s a team to learn new knowledge and develop more e!ective ways of working tog ther to address AMR.What does the toolkit include?The toolkit is a collecti n of three main tools. Each tool includes various tasks hat you and your colleagues can d  to develop new strat gies around AMR practice hat you can use in your day-to-day work:Can I be t  f iliYes! As long as you are a e ber f t  i  i lhealth healthcare settings or relat  r i ti ,   have a management or leadershi  r l . i   t t  are in a position to bring together  t  f l  i l  in work associated with A R, an   i rta tly  y  ca  influence relevant sta! in your organisation. our role is important because you will facilitate or lead discussions in the team, listen to what your colleagues have to say, and follow up on specific actions agreed as a team. Facilitators could be in roles such as (but not limited to) managers and senior managers; supervisors; technical leads and site leaders; heads of units; administrators; or Fleming Fund Fellows.Tool 1: Your role in an  AMR surveillance net orkThis t ol include  tasks th t can l  you reflect on your own roles a  responsibilitie , as well as the rol s f other eople in the A R net rk. Tool 2: Dealing with  A R data  t l l   and your ll  r t  t ir c ntribution   ll i   a ent ill  syste s. Tool 3: R flecting on your work  and changing your workplaceThe third and final to l encourages you and your colleagues to develop strat gies to ap ly your learning to day-to-day work and to overcome barriers that delay or stop you from doing this.   o  can I use the toolkit?s  facilitator you are asked to identify a small group of co-rk rs (up to five to eight people) that are involved in AMR-r l t  ork in your organisation and bring them together as  t a . These could be sta! in your team or representatives fr  other teams and various units in the organisation. It is good to set so e regular tea  meetings over a specific period of ti e to go through the toolkit tasks. You can go through all three tools or you can choose the one(s) that are more relevant to the roles in your team or any existing issues around AMR surveillance that a!ect the way that your organisation or the team is working. How was the toolkit developed?The AMR surveillance toolkit was developed by The Open University UK as part of the Fleming Fund programme, a £265 million UK aid investment to tackle AMR in low- and middle-income countries around the world. The programme is managed by the UK Department of Health and Social Care (DHSC) in partnership with Mott MacDonald, the Fleming Fund Grants Management Agent. The toolkit was developed and evaluated in twelve public health organisations in Ghana and Nepal.Now go to the AMR surveillance toolkit.AMR toolkit online: http://bit.ly/3ORT1ZLAMR - a Global Health Challenge Antimicrobial resistance (AMR) is a leading global health issue with 1.27M deaths globally in 2019 making it the 12th leading cause of death, above HIV and malaria (AMR collaborators, 2022), with both social and economic costs (O-Neill, 2016). Low resource settings are more vulnerable to AMR’s impacts. It is expected that AMR will further widen global health inequalities. Addressing AMR requires inter-sectoral and multi-sectoral approaches, as well as intra-professional relations and collaborations. It requires professionals with different expertise to work together. The relational nature of this knowledge work is among the many challenges that professional face in this area, particularly in healthcare environments where systemic professional and cultural norms prevail (Charitonos & Littlejohn, 2021).Relational challenges in emerging professional practiceWorkplaces are dynamic and evolving contexts for practice and are also environments where significant learning takes place. Many professional interactions involve relational work, “sometimes visibly and sometimes hidden” (Edwards, 2017: 1). Relational expertise is the ability “to recognise and respond to what others might offer in local systems of distributed expertise” (Edwards, 2011, p.33) while at the same time being confident to engage with “the knowledge that underpins one's own specialise practice” (ibid). Relational expertise is particularly relevant to work that evolves rapidly in response to ongoing global challenges.Koula Charitonos (1), Allison Littlejohn (2), Saraswati Dawadi (1), Abhinav Vaidya (3), Santosi Giri (3),  Alex Owusu-Ofori (4), Fereshte Goshtasbpour (1)  1- Open University UK; 2- University College London; 3- Nepal Public Health Research & Development Centre;   4 - Kwame Nkrumah University of Science and Technology GhanaContact:  koula.charitonos@open.ac.uk; https://iet.open.ac.uk/peopleFigure 1: The process of co-designing the AMR Toolkit Objectives of the study Research around the potential for emerging complex global problems to trigger new relationships and design tools for more situated forms of professional learning remains relatively unexplored. This study explored whether a designed artefact, the AMR Toolkit, supports professionals in relating to people in diverse job roles and negotiating new objects of activity. M odol gy partici antsThe AMR Toolkit was drafted iteratively using participatory co-design meth d logy. 12 health facilities in Nepal and Ghana participat d in the proc ss (Figure 1). I  e c  facilit , a team l ad and a small group of staff (n=5 to 8) were engaged in transformative ch nge projects within th ir wn workplace with minimal ex ernal facilitation utilising he olkit. Qualitative data were generated from team leads through written proformas (n=12) and semi-structured o line interviews ( =11), as wel  as a virtual participat ry co- sign orks op i  each country. Data were analysed thematically. Conceptual framework Learning in professional settings cannot be viewed narrowly as a an individual’s acquisition of knowledge and skills. This study takes the view thatlearning is positioned as a situated, social practice. In this study we argue that we need to think about the ways in which inter- and intra-professional relationships may inform work activities and contexts for professional learning. Findings (1) The designed activities helped create teams and form relationships that were not governed by conventional hierarchies and power dynamics. (2) Participants self-organised informal spaces and gatherings that offered opportunity for personal and collective contributions to the evolution of AMR practice. (3) Participants could anticipate future AMR work activities, and recognise areas of change needed to allow new practices to evolve. (4) The AMR Toolkit helped to create an environment that encouraged relational agency—a “capacity for working with others to strengthen purposeful responses to complex problems” (Edwards, 2011:34). (5) The AMR Toolkit created the conditions in which forming a joint response and sharing of knowledge was made possible. 

Developing Relational Work as a Design Tool in activities with health professionals

https://discovery.ucl.ac.uk/10177908/1/F%20EARLI23%20Poster%20v2%20.pdf

Developing Relational Work as a Design Tool in activities with health professionals

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