Not infrequently, competent individuals come together to form an incompetent team, says Lorelei Lingard.
Joe got competent care in hospital. He recovered from his pneumonia. He got competent care from his family doctor, his diabetes specialist, his homecare nurses and the pharmacist. Each of those individuals, within their scope of practice, and acting on the information at hand, did the right thing for Joe. But the sum total of those care events is not overall competent care for Joe. [around 4:50]
Now this is a very complex problem, and it’s being tackled from a number of different angles. Systems engineers are trying to understand it better, to improve the situation. Organizational scientists are trying to work on it. Sociologists are working on it. Tonight, I’m going to shed some light on this problem from my perspective of a communications researcher trying to improve medical education. [around 5:20]
There are significant barriers that make it difficult for individual competence to translate into collective competence. I’m going to focus on three. [around 5:45]
The first is scientific reductionism. This refers to the way that we tackle complex scientific phenomena, by breaking them down into their component parts. [….] [around 6:00]
The second barrier between individual and collective competence is specialization. [….] [around 6:20]
The third barrier between individual and collective competence is the very concept of individual competence itself. The goal of producing an individually competent healthcare provider, with their own specific tightly-bounded expertise drives everything: in health profession education generally, and medical education specifically. [around 7:00]
Together, and kind of paradoxically, these three factors combine, to produce one of healthcare’s greatest weaknesses. That is, that providers work in isolation from one other, each person focused on the particular issue about which they are an expert. When that happens, patients can fall into the cracks between the individually competent healthcare providers. [around 8:00]
What do we need to adapt from? I would argue that we need to adapt from our exclusive focus on the goal of individual competence. Individual competence is a set of pervasive, and rarely challenged assumptions. It’s not unique to medical education, it’s true of education everywhere.
I would like to touch on three ways in which we are, right now, moving towards collective competence. [around 12:20]
Joe travels through the healthcare system more quickly than his healthcare information does. We have the technology to address this problem, to move information more efficiently. One example … is the global medication electronic record. [around 13:40]
The shift to delivery primary care through family health teams. [….]
The third way in which we’re moving toward collective competence is a more strategic way. [….] Take a look at the healthcare system, find those points in the system where a failure of collective competence can have dire consequences, and build initiatives to support collective competence in those moments.
Lorelei Lingard is founding director and senior scienist at the Centre for Education Research and Innovation, at the Schulich School of Medicine and Dentistry, at the Western University. Here’s her bio:
Dr. Lorelei Lingard is a leading researcher in the study of communication and collaboration on healthcare teams. She is a Professor in the Department of Medicine at the University of Western Ontario (UWO) and the inaugural Director of the Centre for Education Research & Innovation at the Schulich School of Medicine & Dentistry. Dr. Lingard obtained her Ph.D. in Rhetoric from the English Department at Simon Fraser University, specializing in rhetorical theory, genre theory, medical discourse, and qualitative methodology. As a rhetorician, she investigates ‘language as social action’: that is, how social groups use language to get things done, and how that language acts on them, their identities, their purposes, their situations, and their relationships. Her research program has investigated the nature of communication on inter-professional healthcare teams in a variety of clinical settings, including the operating room, the intensive care unit, the internal medicine ward, the adult rehabilitation unit, and the family health centre.
Via TedX Bayfield, Theme: Adaptation at http://www.ted.com/tedx/events/4674.