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Research output: Thesis › Doctoral Thesis
Research output: Thesis › Doctoral Thesis
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TY - BOOK
T1 - Quality improvement education and interprofessional learning of the perioperative team
T2 - [from theory to reality]
AU - Hlede, Vjeko
PY - 2019
Y1 - 2019
N2 - CONTEXT. Complex societal factors have been obstructing implementation of quality improvement education (QIE) and interprofessional learning (IPL) of perioperative teams. Mistrust between physician anesthesiologist and nurse anesthetist, and payment models that promote competition instead of teamwork, are two of the drivers that shape that picture.METHODOLOGY. In the first part of this critical-realist case study, thematic analysis and activity theory draw a complex picture of how perioperative clinicians perceive QIE, IPL, and technology-enhanced learning (TEL). Following that, critical realist abduction and retroduction logic define one mechanism shaping perceptions of QIE, IPL, and TEL in perioperative context. FINDINGS. Perceptions of QIE, IPL, and TEL of perioperative teams are intertwined, and perception of one phenomenon can have a transformative impact on perceptions of other phenomena in the context, creating a very dynamic picture. On the other hand, a learning healthcare system (LHS) is not part of the picture since technocentric and managerial visions of LHS promoted by the Institute of Medicine don’t support social complexity of QIE and IPL. THE MECHANISM shaping complexity of perceptions is: Our world acts as an agglomeration of nested learning systems. On each level, the mechanism is guiding ontological and epistemological transformation of the learning system, through four phases: egocentric >> technocentric >> ecocentric >> holocentric. Those transformations emerge on any level of agglomeration: from cells gathered to create the first multicellular organism to networks of individuals and groups creating professional societies or perioperative teams. The thesis contributes to knowledge by shedding additional light on how the complex world of perioperative healthcare is structured and how various systems involved in perioperative care interact. On a practical level, the map of QIE, IPL, and TEL perceptions, and insight into one mechanism that is shaping those perceptions, can help perioperative leaders better navigate the transformative changes affecting perioperative teams.
AB - CONTEXT. Complex societal factors have been obstructing implementation of quality improvement education (QIE) and interprofessional learning (IPL) of perioperative teams. Mistrust between physician anesthesiologist and nurse anesthetist, and payment models that promote competition instead of teamwork, are two of the drivers that shape that picture.METHODOLOGY. In the first part of this critical-realist case study, thematic analysis and activity theory draw a complex picture of how perioperative clinicians perceive QIE, IPL, and technology-enhanced learning (TEL). Following that, critical realist abduction and retroduction logic define one mechanism shaping perceptions of QIE, IPL, and TEL in perioperative context. FINDINGS. Perceptions of QIE, IPL, and TEL of perioperative teams are intertwined, and perception of one phenomenon can have a transformative impact on perceptions of other phenomena in the context, creating a very dynamic picture. On the other hand, a learning healthcare system (LHS) is not part of the picture since technocentric and managerial visions of LHS promoted by the Institute of Medicine don’t support social complexity of QIE and IPL. THE MECHANISM shaping complexity of perceptions is: Our world acts as an agglomeration of nested learning systems. On each level, the mechanism is guiding ontological and epistemological transformation of the learning system, through four phases: egocentric >> technocentric >> ecocentric >> holocentric. Those transformations emerge on any level of agglomeration: from cells gathered to create the first multicellular organism to networks of individuals and groups creating professional societies or perioperative teams. The thesis contributes to knowledge by shedding additional light on how the complex world of perioperative healthcare is structured and how various systems involved in perioperative care interact. On a practical level, the map of QIE, IPL, and TEL perceptions, and insight into one mechanism that is shaping those perceptions, can help perioperative leaders better navigate the transformative changes affecting perioperative teams.
KW - quality improvement education
KW - QIE
KW - interprofessional learning
KW - IPL
KW - technology-enhanced learning
KW - TEL
KW - learning healthcare system
KW - LHS
KW - perioperative
KW - perioperative surgical home
KW - PSH
KW - pay for performance
KW - value based care
KW - teamwork
KW - physician anesthesiologist
KW - nurse anesthetist
KW - Surgical Care
KW - ANESTHESIA
KW - anesthesiologist assistants
KW - Case study
KW - Critical Realism
KW - Thematic analysis
KW - Activity Theory
KW - abduction
KW - retroduction
KW - mechanisms
KW - COMPLEXITY
KW - Learning systems
KW - egocentric
KW - technocentric
KW - ecocentric
KW - holocentric.
KW - evidence-based medicine
KW - epistemic fallacy
KW - epistemology
KW - Ontology
KW - continuing professional development
KW - continuing medical education
U2 - 10.17635/lancaster/thesis/579
DO - 10.17635/lancaster/thesis/579
M3 - Doctoral Thesis
PB - Lancaster University
ER -