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Social Network Theory in Interprofessional Education: Revealing Hidden Power
... The researcher Nimmon et al. (2019), define Social Network Theory as a comprehensive theoretical framework that amalgamates various theories aimed at dissecting human behavior across multiple social units-ranging from individuals and teams to organizations [28] This theory is particularly geared towards understanding the intricate web of interpersonal relationships that shape human actions within social contexts (See Figure3). ...
... The researcher Nimmon et al. (2019), define Social Network Theory as a comprehensive theoretical framework that amalgamates various theories aimed at dissecting human behavior across multiple social units-ranging from individuals and teams to organizations [28] This theory is particularly geared towards understanding the intricate web of interpersonal relationships that shape human actions within social contexts (See Figure3). ...
Peer-to-peer (P2P) energy trading has gained significant importance in recent years due to the growing energy needs worldwide. To ensure the effective and efficient implementation of P2P energy trading, it is necessary to analyze the concept from multiple dimensions. This study aims to investigate the challenges that may hinder the smooth flow of P2P energy trading and identify strategies to overcome them. Technical, cybersecurity, renewable energy integration, economic, pricing mechanisms, and regulatory challenges are among the key obstacles that may curtail the full potential of P2P energy trading. In addition, the full achievement of the P2P energy trading potential requires a global response from stakeholders to ensure widespread acceptance and adoption. Game theory and agent-based modeling can effectively address these challenges and facilitate the successful implementation of P2P energy trading.
... 229), "contact is not enough to build respect and change stereotypes and long-held attitudes" as several other conditions that impact the quality of contact should be taken into account. For instance, bringing together learners with distinct professional identities, while assuming equal group status can, according to Nimmon et al. [164] (p. 247), be "ineffective because coercing individuals into intergroup interactions can reinforce stereotypes, especially when power relations that traverse health care's professional hierarchy are obscured or ignored". ...
... 247), be "ineffective because coercing individuals into intergroup interactions can reinforce stereotypes, especially when power relations that traverse health care's professional hierarchy are obscured or ignored". Hence, one of the main challenges in IPE is to emphasize the value of equality and foster the construction of beliefs that power is to be distributed flexibly, depending on the situation and expertise and not on the basis of traditions or the resulting inequal distribution of power [164,165]. According to Amerongen et al. [166], a promising approach to achieve relative equality between learners is by ensuring that the content of IPE is relevant for each participant, and that cases entail complementarity of professionals' roles and perspectives and require equal task efforts and distribution to reach a shared goal. ...
Interprofessional identity (IPI) development is considered essential in reducing incongruency and improving interprofessional collaboration. However, noticeable differences in conceptualizations are being put forward in the literature, hindering interpretation of research findings and translation into practice. Therefore, a Concept Analysis and Critical Interpretative Synthesis of empirical research articles were conducted to explore the assumptions and conceptions of IPI. Independent literature screening by two researchers led to the inclusion and extraction of 39 out of 1334 articles. Through critical analysis, higher order themes were constructed and translated to a synthesizing argument and a conceptual framework depicting what constitutes IPI (attributes), the boundary conditions (antecedents) and the outcomes (consequences) of its development. The attributes refer to both IPI’s structural properties and the core beliefs indicative of an interprofessional orientation. The antecedents inform us on the importance of IPI-fitting constructivist learning environments and intergroup leadership in enabling its development. This development may lead to several consequences with regard to professional wellbeing, team effectiveness and the quintuple aim. Given the educational orientation of this study, ways for facilitating and assessing the development of IPI among learners across the professional continuum have been proposed, although empirical research is needed to further validate links and mediating and moderating variables.
... This observation mirrors existing discourses on how power relations are often invisible in interprofessional education, research, and practice. Several authors argue that the current state of the IPC literature lacks a robust analysis of how power dynamics and hierarchy influence different professions as they engage in collaborative processes (Nimmon et al., 2019;Paradis & Whitehead, 2015). Our review sought to address this gap in the literature by exploring power through the lens of implicit bias. ...
... Although material forces played an important role in both perpetuating and mitigating the influence of bias, there was a general lack of attention to materiality in the studies we analyzed. Since enhancing collaboration requires awareness of how different professions view themselves and their roles within a broader health system, we had hoped our use of McMurtry's framework would make the invisible somewhat visible (Huq et al., 2017;Nimmon et al., 2019). Despite our attempt at utilizing a framework that could potentially trace both social and material elements of collaboration, we found articles that captured only a basic level of materiality. ...
Interprofessional collaboration (IPC) is fraught with multiple tensions. This is partly due to implicit biases within teams, which can reflect larger social, physical, organizational, and historical contexts. Such biases may influence communication, trust, and how collaboration is enacted within larger contexts. Despite the impact it has on teams, the influence of bias on IPC is relatively under-explored. Therefore, the authors conducted a scoping review on the influence of implicit biases within interprofessional teams. Using scoping review methodology, the authors searched several online databases. From 2792 articles, two reviewers independently conducted title/abstract screening, selecting 159 articles for full-text eligibility. From these, reviewers extracted, coded, and iteratively analyzed key data using a framework derived from socio-material theories. Authors found that many studies demonstrated how biases regarding dominance and expertise were internalized by team members, influencing collaboration in predominantly negative ways. Articles also described how team members dynamically adapted to such biases. Overall, there was a paucity of research that described material influences, often focusing on a single material element instead of the dynamic ways that humans and materials are known to interact and influence each other. In conclusion, implicit biases are relatively under-explored within IPC. The lack of research on material influences and the relationship among racial, age-related, and gender biases are critical gaps in the literature. Future research should consider the longitudinal and reciprocal nature of both positive and negative influences of bias on collaboration in diverse settings.
... While not formally trained as citizen scientists, two barbers had prior CS training (Watson et al., 2020). SNT focused on leveraging individuals' interpersonal relationships, with two barbers recruited through social networks (Nimmon et al., 2019). We utilized the barbers' clientele as part of a multilayered recruitment strategy to enhance our approach. ...
Health disparities persist among Black men, notably in the context of lung cancer and stress-related health outcomes. This study explores these disparities through a community-based participatory research (CBPR) approach, citizen science, and social network theory, leveraging the expertise and trust of Black barbers as community leaders. The purpose is to understand the nuanced connections between stress and lung cancer in this demographic. Engaging 161 Black men across four Chicago neighborhoods, the study successfully collected hair samples and survey data, emphasizing the importance of culturally sensitive recruitment strategies. Findings highlight the effectiveness of the collaboration, showcasing the role of barbershops as community hubs for research. The study concludes by advocating for sustained partnerships with community leaders, emphasizing transparency in research communication, and promoting culturally grounded approaches to address health disparities and enhance research participation among underrepresented populations.
... These interactions can be represented as a network. In recent years, network theory has developed to model different phenomena using complex networks, considering components as vertices and connections between them as edges [1][2][3][4][5][6]. This approach facilitates a comprehensive analysis of existing linear, non-linear, and multivariate relationships. ...
In this paper, we propose a reverse game approach to network-modeled games in order to determine the network structure between players that can achieve a desired Nash equilibrium. We consider three network games: the majority game, the minority game, and the best-shot public goods game. For any hypothetical Nash equilibrium, we determine the conditions and constraints of the network structure that can create the desired Nash equilibrium in each game. The first step in the mechanism design is to identify the network between players that can reach the desired Nash equilibrium. This is important because there exist structures between players that will not generate the considered Nash equilibrium under any circumstances. Acceptable networks are not unique and their numbers grow exponentially based on the number of players and the combination of strategies. We provide mathematical relations to obtain the exact number of networks that can create the considered Nash equilibrium in the best-shot public goods game. Moreover, in the majority and minority games, the relations presented under special conditions specify the number of networks. We also investigate the distribution of acceptable networks as microsystems associated with the existing Nash equilibrium and the probability of their occurrence. The results of our simulations show that the distribution of acceptable networks according to the density is normal, and the probability of their occurrence is increasing. In other words, dense networks are more likely to lead to the desired Nash equilibrium.
... 28-31 A social network approach aligns with our research question as it assumes connectedness and dependency between interlinked individuals and examines the qualitative interplay of identity and meaning within social relations. 26,29,31 Setting and subjects This study was conducted at a large Canadian medical school distributed across four regional campuses. In Canada, students enter a 3-4 year medical degree program following their undergraduate studies. ...
Background:
Medical curricula are increasingly providing opportunities to guide reflection for medical students. However, educational approaches are often limited to formalized classroom initiatives where reflection is prescriptive and measurable. There is paucity of literature that explores the personal ways students may experience authentic reflection outside of curricular time. The purpose of this study was to understand how social networks might shape dimensions of reflection.
Methods:
This study employed a qualitative social network analysis approach with a core sample of seven first year undergraduate medical students who described their relationships with 61 individuals in their networks. Data consisted of participant generated sociograms and individual semi-structured interviews.
Results:
Many learners struggled to find significant ways to involve their social networks outside of medicine in their new educational experiences. It appeared that some medical students began in-grouping, becoming more socially exclusive. Interestingly, participants emphasized how curricular opportunities such as reflective portfolio sessions were useful for capturing a diversity of perspectives.
Conclusions:
Our study is one of the first to characterize the social networks inside and outside of medical school that students utilize to discuss and reflect on early significant clinical experiences. Recent commentary in the literature has suggested reflection is diverse and personal in nature and our study offers empirical evidence to demonstrate this. Our insights emphasize the importance of moving from an instrumental approach to an authentic socially situated approach if we wish to cultivate reflective lifelong learning.
... A broader look at leadership teaching is needed, beyond individual capability, using concepts of collective (team) competency and learning within social networks, including the interplay in the virtual context. [100][101][102][103] Taking advantage of continuity across the learning continuum with spiral progression from UGME to PGME should be leveraged; the LEADS Framework has a spiral learning architecture, from leading self (awareness and regulation) to engaging others (relationship development and communication) then moving to the remaining domains. 99,104 The following specific educational methods lend themselves well to leadership content, with contextual reference in Table 2. Case-based learning (CBL) with reflection is a strong educational tool that can highlight micro/meso/macro considerations. ...
The need for effective leadership by physicians is clear, yet the design/delivery of curricula, and assessment of leadership competencies, in Undergraduate Medical Education (UGME) continues to need work. In reappraising their UGME assessment strategies, the Medical Council of Canada (MCC) invited position papers across diverse lenses, including the CanMEDS Intrinsic Roles. This article is foundational work derived from the report on leadership assessment to the MCC. Using Kern's Model of Curriculum development as a guide, we reviewed the landscape of Canadian UGME leadership education through an environmental scan of the published and grey literature, Canadian leadership frameworks and resources, and consultation with learner and faculty leadership. Leadership education across programs was highly variable and learners were often unaware of available opportunities. In response, we have suggested processes for curricular development, including strategies for key content, teaching and assessment, and program evaluation considerations. Leadership education cannot remain another checkbox on a list of UGME experiences. Such training necessitates focused attention and investment to foster ongoing identity formation toward becoming a good doctor.
... Power dynamics are a key factor in interprofessional collaboration, and it is important to teach residents and fellows to understand how these dynamics impact patient care through such mechanisms as to how and whether team members are offered an opportunity to speak and to be heard. It is essential that residents and fellows understand the ways in which the exercise of topdown authority can lead to "team conflict, poor performance, low morale and inferior decisionmaking" [11]. On the other end of the continuum, modeling exclusively flattened hierarchy can lead psychiatry trainees to have trouble understanding when their expertise is needed, when to exercise authority, and the concept of respondent superior (a legal doctrine, most commonly used in tort, that holds an employer or principal legally responsible for the wrongful acts). ...
Managing a psychiatry graduate medical education (GME) program in the twenty-first century demands the involvement of resident or fellow learners, faculty members, and others across many different professions. Interprofessional education and teams require shared or common goals, education/training, experience, feedback over time, and processes for improvement. The interprofessional team – sometimes known as a multidisciplinary team – plays a key role in clinical care, education, and administrative workflows. This rich and valuable collaboration creates both opportunities and challenges for faculty, program directors, and other departmental leaders. In working with learners and professionals from other professions, psychiatry trainees benefit from opportunities to learn alongside other trainees, practitioners, and leaders, which helps them to develop skills, attitudes, and knowledge that inform work going forward. However, such learning must be designed and taught explicitly and deliberately, and time and experience are essential in order to develop residents’ and fellows’ roles and identities as psychiatrists. This chapter is a practical guide, which introduces interprofessional education and interprofessional team functioning, gives examples of common approaches, and highlights some of the opportunities and challenges.
... Yapılan literatür araştırmasında çalışmaların büyük bir çoğunluğunda göçmen ilişkileri ağının mülteci ve göçmenlerin sosyo-ekonomik uyumları ve yeni bir hayat kurmaları üzerindeki etkilerini ele aldığı görülmektedir (Ayrıntılı bilgi için bak. Akbaş, 2012;Adıgüzel, 2013;Görgün, 2017;Haug, 2008;Jenssen, 2002;Kaya, 2017;Nimmon, 2019). Toplumsal cinsiyet ile ilgili olan çalışmaların bir kısmı; göç sürecinde genel anlamda kadının yaşadığı sorunlar, verdiği yaşam ve uyum mücadelesi, sosyal ağların kadın göçmenler üzerindeki olumlu ve olumsuz etkileri üzerine yoğunlaşmaktadır (örneğin, Aydın, 2016;Barın, 2015;Demirbaş & Ak-yiğit, 2018;Ulutaş & Kalfa, 2009;). ...
Bu çalışmanın amacı zorunlu göç sürecini toplumsal cinsiyet temelinde derinlemesine anlamak, yorumlayabilmektir. Göç sürecinde Suriyeli dul kadınların karşılaştıkları zorluklar, başvurdukları mekanizmalar analiz edilmektedir. Bu bağ-lamda göçmen ilişkileri ağı çerçevesinde Türkiye’de bulunan 5 Suriyeli geçici korunan dul (eşi vefat etmiş) kadınların aldığı kamusal destekler (Kızılay kart, belediyelerin verdiği destek kartları vb.) ve onlar için özel yaşamda kurgulanan destekler (evlilikler, aileyle birlikte oturma vb.) şeklindeki mekanizmalara erişimde kullandıkları sosyal ağları analiz etmek ve yaşanılan deneyimlerin ortaya konmasını sağlamaktır. Araştırma, nitel araştırma yöntemiyle yürütülmüş; veri toplamada ise derinlemesine görüşme tekniğinde yarı yapılandırılmış mülakat soruları kullanılmıştır. Verilerin toplanması ve analiz edilmesinde anlatı araştırma tekniğinden de yararlanılmıştır. Anahtar Kelimeler: Uluslararası Göç, Göçmen İlişkileri Ağı, Toplumsal Cinsiyet
... Jaringan sosial adalah jaring-jaring hubungan interpersonal atau antar organisasi yang memberikan efek pada tindakan manusia dalam sistem sosial (Nimmon, Artino Jr, & Varpio, 2019). Jaringan sosial dapat bersifat vertikal atau horizontal atau campuran. ...
Dalam buku ini, penulis mengenalkan sebuah konsep baru, yaitu Pengembangan Kesesuaian Produk Ekspor (Export Product Fit Development). Konsep baru ini dibangun berdasarkan pada Contingency Theory, dimana kinerja perusahaan akan lebih efisien jika derajat perbedaan antara karakteristik internal perusahaan dan lingkungan eksternal tidak terlalu lebar, sehingga perlu dilakukan standarisasi dan rutinisasi aktivitas (Ruekert, Walker, dan Roeming, 1984). Demikian juga untuk membangun strategi dalam pemasaran internasional, perusahaan harus mampu menyesuaikan lingkungan eksternal dengan karakteristik perusahaan sehingga kinerja internasional akan lebih mudah dicapai (Katsikeas, Samiee, dan Marios, 2006). Strategi yang dikonsep dengan menstandarkan program pemasaran dengan lingkungannya akan berpengaruh positif pada kinerja bisnis (Venkatraman dan Prescott, 1990).
Dalam penelitian Hultman, Robson, dan Kasikeas (2009) dihasilkan temuan bahwa dengan kemampuan beradaptasi dan melakukan standarisasi produk akan menjadi strategi yang memiliki kekuatan tinggi di era globalisasi, namun juga penting untuk membangun strategi produk yang disesuaikan dengan kondisi makro, mikro, dan lingkungan internal.
Sementara itu, pengetahuan mengenai pasar internasional masih sangat minim bagi para pelaku UMKM di Indonesia sehingga para produsen masih lemah dalam menangkap peluang pasar asing terutama dalam menciptakan produk yang sesuai dengan harapan konsumen asing. Keterbatasan ini berimbas pada kemampuan merespon kebutuhan pasar yang kurang agresif.
Oleh karena itu, diperlukan sebuah strategi dan langkah-langkah yang komprehensif untuk meng-upgrade keterbatasan mereka, di samping ketersediaan infrastruktur yang mendukung mereka.
... Jaringan sosial adalah jaring-jaring hubungan interpersonal atau antar organisasi yang memberikan efek pada tindakan manusia dalam sistem sosial (Nimmon, Artino Jr, & Varpio, 2019). Jaringan sosial dapat bersifat vertikal atau horizontal atau campuran. ...
Tujuan umum dari penelitian ini adalah mengembangkan pendekatan teoritis baru pada pengembangan produk untuk konsumen asing dalam hubungan antara kapabilitas jaringan dengan kinerja internasional UMKM. Konsep yang dibangun adalah pengembangan kesesuaian produk ekspor. Penelitian ini juga bertujuan untuk mengisi kesenjangan hasil penelitian mengenai peran pengetahuan tentang pasar asing sebagai penyedia informasi dalam pengembangan produk yang akan memediasi kapabilitas jaringan dengan kinerja internasional UMKM. Konsep Pengembangan Kesesuaian Produk Ekspor (Export Product Fit Development) dalam penelitian ini merupakan konsep yang dibangun dari sintesa Export Product Strategic Fit dan Foreign Customer Knowledge dalam konsep Foreign Market Knowledge. Populasi dalam penelitian ini adalah pemilik, pengelola, pemilik dan pengelola UMKM sektor industri kreatif subsektor kerajinan dan fashion yang telah melakukan penjualan ke luar negeri (ekspor) di Provinsi Jawa Tengah tahun 2019. Jumlah sampel penelitian adalah 177 UMKM kerajinan dan fashion. Proses pengambilan sampel dan untuk menentukan sampel dilakukan dengan kriteria tertentu dari yang bersedia mengisi kuesioner dan yang tidak bersedia digantikan dengan yang lain sehingga memenuhi kriteria yang ditentukan pada UMKM yang telah melakukan ekspor. Jumlah sampel ditentukan dengan melihat syarat minimum jumlah sampel dalam analisis SEM (Structural Equation Modeling) yang merupakan metode analisis data dalam penelitian ini. Hasil pengujian hipotesis menunjukkan bahwa: 1) kapabilitas jaringan tidak berpengaruh positif terhadap kinerja internasional, 2) pengalaman bisnis internasional berpengaruh positif terhadap kinerja internasional, 3) kapabilitas jaringan berpengaruh positif terhadap pengembangan kesesuaian produk ekspor, 4) pengalaman bisnis internasional tidak berpengaruh positif terhadap pengembangan kesesuaian produk ekspor, 5) pengembangan kesesuaian produk ekspor berpengaruh positif terhadap kinerja internasional, 6) pengembangan kesesuaian produk ekspor memediasi hubungan kausal antara kapabilitas jaringan dengan kinerja internasional, dan 7) pengembangan kesesuaian produk ekspor tidak memediasi hubungan kausal antara pengalaman bisnis internasional dengan kinerja internasional. Temuan utama dalam penelitian ini adalah berhasil membuktikan bahwa konstruk baru yang dikembangkan yaitu pengembangan kesesuaian produk ekspor mampu mengatasi kesenjangan hasil penelitian kapabilitas jaringan terhadap kinerja internasional pada UMKM. Konstruk baru dalam penelitian ini juga memiliki peran paling besar dalam mempengaruhi kinerja internasional dibandingkan dengan kapabilitas jaringan maupun pengalaman bisnis internasional.
Following diagnosis, individuals with chronic conditions such as inflammatory arthritis (IA) face learning how to manage multiple new healthcare relationships. Despite existing literature on team care for people with IA, little is known about how teams negotiate care from perspectives of all team members.
Objective
To explore how communication is perceived and care is negotiated amongst IA healthcare teams by drawing on the perspectives of each team member.
Method
This analysis drew on data from an ongoing three-year study exploring team-based IA care. We interviewed 11 participants including two men with IA and their family care providers and healthcare providers. We used a three-staged analytic process and integrated broad tenets of social network theory to understand the relational dimensions of team members experiences.
Result
Analysis revealed three themes regarding communication and care: (1) seeking/sharing information, (2) striving to coordinate unified care, and (3) providing patients a voice.
Discussion
This study emphasizes the importance of understanding team dynamics beyond the dyad of patient and care provider. Negotiating power and decision-making in IA care is a dynamic process involving shifting levels of responsibility amongst a care team. Communication-based strategies that extend dyadic interactions may enhance teamwork and health outcomes in chronic conditions.
Purpose:
Faculty development is increasingly acknowledged as an important aspect of health professions education. Its conceptualization has evolved from an individual skills training activity to contemporary notions that draw on an organizational model. This organizational model recognizes relationships and networks as important mediators of knowledge mobilization. Although such conceptual advancements are critical, we lack empirical evidence and robust insights into how social networks function to shape learning in faculty development. The purpose of this study was to understand how informal professional social networks influence faculty development learning in the health professions.
Method:
This study used a qualitative social network approach to explore how teaching faculty's relationships influenced their learning about teaching. The study was conducted in an undergraduate course at a Canadian medical school. Eleven faculty participants were recruited and three methods of data collection were employed; semi-structured interviews, participant drawn sociograms, and demographic questionnaires.
Results:
The social networks of faculty participants influenced their learning about teaching in the following four dimensions: enabling and mobilizing knowledge acquisition, shaping identity formation, expressing vulnerability, and scaffolding learning.
Conclusions:
Faculty developers should consider faculty's degree of social embeddedness in their professional social networks, as our study suggests this may influence their learning about teaching. The findings align with recent calls to conceptually re-orient faculty development in the health professions as a dynamic social enterprise.
Background
Guidance for measuring team effectiveness in dynamic clinical settings is necessary; however, there are no consensus strategies to help health care organizations achieve optimal teamwork. This systematic review aims to identify validated survey instruments of team effectiveness by clinical settings.
Methods
PubMed, MEDLINE, and ISI Web of Knowledge were searched for team effectiveness surveys deployed from 1990 to 2016. Validity and reliability were evaluated using 4 psychometric properties: interrater agreement, internal consistency, content validity, and structural integrity. Two conceptual frameworks, the Donabedian model and the Command Team Effectiveness model, assess conceptual dimensions most measured in each health care setting.
Results
The 22 articles focused on surgical, primary care, and other health care settings. Few instruments report the required psychometric properties or feature non-self-reported outcomes. The major conceptual dimensions measured in the survey instruments differed across settings. Team cohesion and overall perceived team effectiveness can be found in all the team effectiveness measurement tools regardless of the health care setting. We found that surgical settings have distinctive conditions for measuring team effectiveness relative to primary or ambulatory care.
Discussion
Further development of setting-specific team effectiveness measurement tools can help further enhance continuous quality improvements and clinical outcomes in the future.
Effective healthcare requires both competent individuals and competent teams. With this recognition, health professions education is grappling with how to factor team competence into training and assessment strategies. These efforts are impeded, however, by the absence of a sophisticated understanding of the the relationship between competent individuals and competent teams . Using data from a constructivist grounded theory study of team-based healthcare for patients with advanced heart failure, this paper explores the relationship between individual team members’ perceived goals, understandings, values and routines and the collective competence of the team. Individual interviews with index patients and their healthcare team members formed Team Sampling Units (TSUs). Thirty-seven TSUs consisting of 183 interviews were iteratively analysed for patterns of convergence and divergence in an inductive process informed by complex adaptive systems theory. Convergence and divergence were identifiable on all teams, regularly co-occurred on the same team, and involved recurring themes. Convergence and divergence had nonlinear relationships to the team’s collective functioning. Convergence could foster either shared action or collective paralysis; divergence could foster problematic incoherence or productive disruption. These findings advance our understanding of the complex relationship between the individual and the collective on a healthcare team, and they challenge conventional narratives of healthcare teamwork which derive largely from acute care settings and emphasize the importance of common goals and shared mental models. Complex adaptive systems theory helps us to understand the implications of these insights for healthcare teams’ delivery of care for the complex, chronically ill.
Background
Modern healthcare is burgeoning with patient centered rhetoric where physicians “share power” equally in their interactions with patients. However, how physicians actually conceptualize and manage their power when interacting with patients remains unexamined in the literature. This study explored how power is perceived and exerted in the physician-patient encounter from the perspective of experienced physicians. It is necessary to examine physicians’ awareness of power in the context of modern healthcare that espouses values of dialogic, egalitarian, patient centered care.
Methods
Thirty physicians with a minimum five years’ experience practicing medicine in the disciplines of Internal Medicine, Surgery, Pediatrics, Psychiatry and Family Medicine were recruited. The authors analyzed semi-structured interview data using LeCompte and Schensul’s three stage process: Item analysis, Pattern analysis, and Structural analysis. Theoretical notions from Bourdieu’s social theory served as analytic tools for achieving an understanding of physicians’ perceptions of power in their interactions with patients.
Results
The analysis of data highlighted a range of descriptions and interpretations of relational power. Physicians’ responses fell under three broad categories: (1) Perceptions of holding and managing power, (2) Perceptions of power as waning, and (3) Perceptions of power as non-existent or irrelevant.
Conclusions
Although the “sharing of power” is an overarching goal of modern patient-centered healthcare, this study highlights how this concept does not fully capture the complex ways experienced physicians perceive, invoke, and redress power in the clinical encounter. Based on the insights, the authors suggest that physicians learn to enact ethical patient-centered therapeutic communication through reflective, effective, and professional use of power in clinical encounters.
ContextInterprofessional education (IPE) aspires to enable collaborative practice. Current IPE offerings, although rapidly proliferating, lack evidence of efficacy and theoretical grounding.Objectives
Our research aimed to explore the historical emergence of the field of IPE and to analyse the positioning of this academic field of inquiry. In particular, we sought to investigate the extent to which power and conflict – elements central to interprofessional care – figure in the IPE literature.Methods
We used a combination of deductive and inductive automated coding and manual coding to explore the contents of 2191 articles in the IPE literature published between 1954 and 2013. Inductive coding focused on the presence and use of the sociological (rather than statistical) version of power, which refers to hierarchies and asymmetries among the professions. Articles found to be centrally about power were then analysed using content analysis.ResultsPublications on IPE have grown exponentially in the past decade. Deductive coding of identified articles showed an emphasis on students, learning, programmes and practice. Automated inductive coding of titles and abstracts identified 129 articles potentially about power, but manual coding found that only six articles put power and conflict at the centre. Content analysis of these six articles revealed that two provided tentative explorations of power dynamics, one skirted around this issue, and three explicitly theorised and integrated power and conflict.Conclusions
The lack of attention to power and conflict in the IPE literature suggests that many educators do not foreground these issues. Education programmes are expected to transform individuals into effective collaborators, without heed to structural, organisational and institutional factors. In so doing, current constructions of IPE veil the problems that IPE attempts to solve.
Modern healthcare is delivered by multidisciplinary, distributed healthcare teams who rely on effective teamwork and communication to ensure effective and safe patient care. However, we know that there is an unacceptable rate of unintended patient harm, and much of this is attributed to failures in communication between health professionals. The extensive literature on teams has identified shared mental models, mutual respect and trust and closed-loop communication as the underpinning conditions required for effective teams. However, a number of challenges exist in the healthcare environment. We explore these in a framework of educational, psychological and organisational challenges to the development of effective healthcare teams. Educational interventions can promote a better understanding of the principles of teamwork, help staff understand each other's roles and perspectives, and help develop specific communication strategies, but may not be sufficient on their own. Psychological barriers, such as professional silos and hierarchies, and organisational barriers such as geographically distributed teams, can increase the chance of communication failures with the potential for patient harm. We propose a seven-step plan to overcome the barriers to effective team communication that incorporates education, psychological and organisational strategies. Recent evidence suggests that improvement in teamwork in healthcare can lead to significant gains in patient safety, measured against efficiency of care, complication rate and mortality. Interventions to improve teamwork in healthcare may be the next major advance in patient outcomes.
This article uses an ecological approach to analyze factors in the effectiveness of work teams—small groups of interdependent individuals who share responsibility for outcomes for their organizations. Applications include advice and involvement, as in quality control circles and committees; production and service, as in assembly groups and sales teams; projects and development, as in engineering and research groups: and action and negotiation, as in sports teams and combat units. An analytic framework depicts team effectiveness as interdependent with organizational context, boundaries, and team development. Key context factors include (a) organizational culture, (b) technology and task design, (c) mission clarity, (d) autonomy, (e) rewards, (f) performance feedback, (g) training/consultation, and (h) physical environment. Team boundaries may mediate the impact of organizational context on team development. Current research leaves unanswered questions but suggests that effectiveness depends on organizational context and boundaries as much as on internal processes. Issues are raised for research and practice. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The importance and necessity of interprofessional collaboration (IPC) present challenges for educators as they determine how best to achieve IPC through interprofessional education (IPE). Simulation-based teaching has been shown to enhance students' understanding of professional roles and promote positive attitudes toward team members; yet, empirical evidence providing direction on the conditions necessary to promote these positive outcomes is lacking. This study used a quasi-experimental design with a pre-/post-test to examine changes in undergraduate healthcare students' perceptions and attitudes toward IPC following their participation in an interprofessional simulation program. Allport's (1954) intergroup contact theory was used to help understand the nature of this IPE workshop and its reported outcomes. Participants included students in the final year of their respective programs (n = 84) such as pharmacy technician, paramedic, nursing and occupational therapy assistant/physical therapy assistant programs. These students were engaged in simulation exercises with interactive contact opportunities. Using the interdisciplinary education perceptions scale, statistically significant increases in positive attitudes in three of four sub-scales were found. An analysis of the structure and format of the workshop suggests that this IPE initiative fulfilled the key conditions suggested by intergroup contact theory. Attention to the key conditions provided by Allport's theory in the context of successful intergroup relationships may help provide direction for educators interested in planning IPE initiatives with student groups enrolled in various health programs.
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Effective communication and teamwork is essential for the delivery of high quality, safe patient care. Communication failures are an extremely common cause of inadvertent patient harm. The complexity of medical care, coupled with the inherent limitations of human performance, make it critically important that clinicians have standardised communication tools, create an environment in which individuals can speak up and express concerns, and share common "critical language" to alert team members to unsafe situations. All too frequently, effective communication is situation or personality dependent. Other high reliability domains, such as commercial aviation, have shown that the adoption of standardised tools and behaviours is a very effective strategy in enhancing teamwork and reducing risk. We describe our ongoing patient safety implementation using this approach within Kaiser Permanente, a non-profit American healthcare system providing care for 8.3 million patients. We describe specific clinical experience in the application of surgical briefings, properties of high reliability perinatal care, the value of critical event training and simulation, and benefits of a standardised communication process in the care of patients transferred from hospitals to skilled nursing facilities. Additionally, lessons learned as to effective techniques in achieving cultural change, evidence of improving the quality of the work environment, practice transfer strategies, critical success factors, and the evolving methods of demonstrating the benefit of such work are described.
This paper highlights the research challenges that face researchers wishing to build the evidence base around interprofessional education (IPE). It concentrates specifically on the short-term impact of IPE on a student population. The Contact Hypothesis is a particularly useful theoretical framework to address these challenges as well as guide the development of IPE interventions. A brief description of this theory and the closely-related theories of social identity and categorization is made in order to support and clarify this theoretical position. The application of the Contact Hypothesis as it has already been made in the IPE field is also described. The paper then addresses how the Contact Hypothesis can be further utilized to address IPE research needs. Through consideration of critique of this theory outside of this field, the development of this framework beyond its early applications to the IPE field are addressed in terms of future direction, the caveats and models of IPE that now require empirical testing.
Resistance is classified as a reaction against confining social structures. During their education, medical students encounter traditional medical and interprofessional hierarchies as they learn to become doctors. These create a power disparity that may prevent their empowerment and ability to resist. Despite their subordinate position, students are not always powerless when encountering situations that contradict their ethical, moral, and professional understandings of appropriate medical practice – so called ‘professionalism dilemmas.’ A qualitative analysis of over 1500 narratives from interviews, focus groups, and questionnaires with 808 medical students in the UK and Australia highlights how students draw on a number of direct and indirect, verbal and bodily, instantaneous and delayed forms of resistance to counter the professionalism lapses of their seniors, which they face in everyday clinical and educational interactions. Within students’ narratives of resistance we come to see how they resist hegemonic practices and their reasons for doing so, such as to prevent patient and student abuse, promote hygienic practice, and uphold patient consent. Through these various acts of resistance (and their narration), medical students may promote the subtle transformation of the dominant medical structure either consciously or unconsciously. They may do this through reflecting on acts of resistance to professionalism lapses, making sense of their moral position and the development of their professional identities, by encouraging others to also resist through sharing resistance narratives, and finally, by altering the professional conduct of their seniors. We encourage all workplace learning stakeholders to better understand the social dynamics of hierarchies and resistance and to encourage the enactment of resistance in the face of professionalism lapses in order to protect the health and wellbeing of learners and patients.
The authors compare and contrast the concepts of networks and systems in an effort to disentangle definitional confusions of importance to health professional education.
Interprofessional education (IPE) is an increasingly popular educational model that aims to educate health care students to be better collaborators by enabling them to learn with, from, and about each other. IPE's rising popularity is evident in the increase in scholarship on this topic over the last few decades. In this Perspective, the authors briefly describe three historical "waves" of IPE: managing the health workforce through shared curriculum, maximizing population health through health workforce planning, and fixing individuals to fix health care. Using insights from the social sciences and past practice, they then discuss six reasons why the current third wave of IPE is likely to fall short of meetings its goals, including that: (1) IPE is logistically complex and costly, (2) IPE is developmentally inappropriate, (3) the link between IPE and key outcomes is still missing, (4) IPE insufficiently engages with theory, (5) IPE rarely addresses power and conflict, and (6) health care is an inertial system that IPE is unlikely to change. The authors conclude by sharing their vision for a fourth wave of education for collaboration, addressing workplace systems and structures, which would combine undergraduate, uniprofessional education for collaboration with practice-based interventions.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
Approach:
Using an ethnographic and a social network analysis research design, participants' patterns of social interaction around health information were investigated over a yearlong period (2012-2013) in a small rural community in Western Canada. Data included (a) individual interviews, (b) focus group interviews, and (c) field notes. Data were analyzed in a three-stage process: (a) item analysis, (b) pattern analysis, and (c) structural analysis.
Findings:
The findings highlight how physicians are only one nodal point in patients' broad, multilayered networks of communication. Interactions around health topics were not isolated events but rather occurred in various patterns of social interactions that were longitudinal and iterative. Meaning making around health topics was constructed, shared, elaborated, reconstructed, and interpreted in participants' social networks, as information was distributed through a complex temporal system of interpersonal ties. Insights: Issues concerning physician communication have been a long-standing conversation in the field of medical education. Many competency frameworks have attempted to encompass this core competency in their elaboration of the physician communicator. However, most representations and discussions in the field tend to depict physician communicators as experts who translate their knowledge to patients in a simplified way, in a single moment in time. This study suggests that educational initiatives in physician-patient communication would benefit from contextualizing physicians as part of patients' resource-rich, temporally extended, iterative process of meaning making. This alternative framing has the potential to support physicians' continuing engagement with patients as a meaningful and responsive node in patients' meaning-making networks.
Patient safety is compromised by medical errors and adverse events related to miscommunications among healthcare providers. Communication among healthcare providers is affected by human factors, such as interpersonal relations. Yet, discussions of interpersonal relations and communication are lacking in healthcare team literature. This paper proposes a theoretical framework that explains how interpersonal relations among healthcare team members affect communication and team performance, such as patient safety. We synthesized studies from health and social science disciplines to construct a theoretical framework that explicates the links among these constructs. From our synthesis, we identified two relevant theories: framework on interpersonal processes based on social relation model and the theory of relational coordination. The former involves three steps: perception, evaluation, and feedback; and the latter captures relational communicative behavior. We propose that manifestations of provider relations are embedded in the third step of the framework on interpersonal processes: feedback. Thus, varying team-member relationships lead to varying collaborative behavior, which affects patient-safety outcomes via a change in team communication. The proposed framework offers new perspectives for understanding how workplace relations affect healthcare team performance. The framework can be used by nurses, administrators, and educators to improve patient safety, team communication, or to resolve conflicts.
Content:
Humans are fundamentally social beings. The social systems within which we live our lives (families, schools, workplaces, professions, friendship groups) have a significant influence on our health, success and well-being. These groups can be characterised as networks and analysed using social network analysis.
Social network analysis:
Social network analysis is a mainly quantitative method for analysing how relationships between individuals form and affect those individuals, but also how individual relationships build up into wider social structures that influence outcomes at a group level. Recent increases in computational power have increased the accessibility of social network analysis methods for application to medical education research.
Application to medical education:
Social network analysis has been used to explore team-working, social influences on attitudes and behaviours, the influence of social position on individual success, and the relationship between social cohesion and power. This makes social network analysis theories and methods relevant to understanding the social processes underlying academic performance, workplace learning and policy-making and implementation in medical education contexts.
Conclusions:
Social network analysis is underused in medical education, yet it is a method that could yield significant insights that would improve experiences and outcomes for medical trainees and educators, and ultimately for patients.
How do we interact with people in our everyday life? Who are the people we are connected to? What are the consequences of overlapping social circles and how people deal with the potential emerging conflicts? What are the structural and cultural mechanisms that regulate social worlds? Network science is a scientific approach to the study of network dependencies and associations which tries to answer these and many other questions. This book explores the underlying mechanisms that regulate social life as they are produced, reproduced, modified, and abandoned in the spatial and temporal patterns of interactions. The mixed methods approach, that combines formal network analysis with qualitative materials and statistical tools, shows the importance of contextualising structural mechanisms in their social and cultural environment, and allows overcoming the traditional methodological boundaries that shape the field of social sciences.
This paper offers an overview of relational sociology as developed by and around Harrison White. Relational sociology provides a substantial account of social networks, conceptualizing them as real social structures interwoven with meaning. Forms of meaning connected to network configurations (as part of their ‘domains’) include stories, identities, social categories (including role categories), and institutions. Recent advances lead to a network perspective on culture, and to an emphasis on communicative events in networks. In contrast to other strands of relational sociology, the approach aims at a close connection between empirical research and theoretical reflection. Theoretical concepts and arguments are geared at empirical applicability in network research, rather than mainly providing a theoretical description of the social world. Finally, the author's own version of relational sociology is sketched: social networks are seen as dynamic constructions of relational expectations. These emerge and develop over the course of communication (in the sense of Niklas Luhmann), in turn effectively channeling communicative sequence.
The purpose of medical education is to benefit patients by improving the work of doctors. Patient centeredness is a centuries old concept in medicine, but there is still a long way to go before medical education can truly be said to be patient centered. Ensuring the centrality of the patient is a particular challenge during medical education, when students are still forming an identity as trainee doctors, and conservative attitudes towards medicine and education are common amongst medical teachers, making it hard to bring about improvements. How can teachers, policy makers, researchers and doctors bring about lasting change that will restore the patient to the heart of medical education? The authors, experienced medical educators, explore the role of the patient in medical education in terms of identity, power and location. Using innovative political, philosophical, cultural and literary critical frameworks that have previously never been applied so consistently to the field, the authors provide a fundamental reconceptualisation of medical teaching and learning, with an emphasis upon learning at the bedside and in the clinic. They offer a wealth of practical and conceptual insights into the three-way relationship between patients, students and teachers, setting out a radical and exciting approach to a medical education for the future.
This study tests a comprehensive model of group effectiveness with 100 sales teams in the communications industry. Results indicate that traditional theories of group effectiveness match the implicit theories of team members. These theories account for 90 percent of the variance in team satisfaction and self-reported effectiveness but none of the variance in the teams' sales performance. The findings suggest that theories of group effectiveness need to be revised to include the way in which teams manage interactions across their boundary and the impact of the organizational context.
"… it is simply not possible to deal adequately with data which are clearly social psychological without getting involved with matters of power." Relevant research in the fields of leadership, communication, prejudice, and interpersonal relations is reviewed. 33 refs. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The effect of teamwork on team performance is broadly recognised in the medical field. This recognition is manifested in educational programmes in which attention to interpersonal behaviours during teamwork is growing. Conflict and power differences influence interpersonal behaviours and are marked topics in studies of group functioning in the social and organisational psychology literature. Insights from the domain of social sciences put the ongoing improvement of teamwork into broader perspective.
This paper shows how knowledge from the domain of social and organisational psychology contributes to the understanding of teamwork in the medical environment. More specifically, this paper suggests that unfolding the underlying issues of power and conflict within medical teams can be of extra help in the development of educational interventions aimed at improving team performance.
We review the key social psychology and organisational behaviour literature concerning power and conflict, and relate the insights derived from this to the team process of ad hoc medical action teams.
We present a theoretical framework in which insights into power and conflict are used to explain and predict team dynamics in ad hoc medical action teams.
Power and conflict strongly influence interpersonal behaviour. Characteristics of medical action teams give rise to all kinds of issues of disagreement and are accompanied by complex issues of intra-team power distribution. We argue that how team members coordinate, cooperate and communicate is steered by members' personal motivations, which, in turn, strongly depend on their perceptions of power and conflict. Given the importance of the performance of these teams, we suggest future directions for the development of training interventions building on knowledge and theories derived from social and organisational psychology.
If graph drawing is to become a methodological tool instead of an illustrative art, many concerns need to be overcome. We discuss the problems of social network visualization, and particularly, problems of dynamic network visualization. We consider issues that arise from the aggregation of continuous-time relational data ("streaming" interactions) into a series of networks. We discuss our experience developing SoNIA (Social Network Image Animator, http://sonia.stanford.edu) as a prototype platform for testing and comparing layouts and techniques, and as a tool for browsing attribute-rich network data and for animating network dynamics over time. We discuss strengths and weakness of existing layout algorithms and suggest ways to adapt them to sequential layout tasks. As such, we propose a framework for visualizing social networks and their dynamics, and we present a tool that enables debate and reflection on the quality of visualizations used in empirical research. 1 This in an equally co-authored paper (names in alphabetical order). The project was generously supported by a research incentive award given to McFarland by Stanford University's Office of Technology and Licensing (grant# 2-CDZ-108). We thank the editor and anonymous JOSS reviewers for their insightful comments, and extend special thanks to Kaisa Snellman, Ben Shaw, Ozgecan Kocak, and James Moody for their contributions at various stages of this project. We also benefited from valuable feedback from participants of James G. March's "Monday Munch" at Stanford University and participants at the satellite symposium run by Tom Snijders, "Dynamics of Networks and Behavior," in Portoroz, Slovenia (2004). Please send all correspondence to Daniel A.
Because research on team mental models is still in its formative stages, there is a need for continued conceptual development of the construct and direct empirical support linking team mental models to team outcomes. Researchers in other fields have developed concepts that are distinct from, but clearly related to team mental models, including information sharing, transactive memory, group learning, and cognitive consensus. Although these research streams currently exist in parallel with little cross-fertilization, there is much to be gained from integration across disciplinary boundaries. Therefore, the purpose of this paper is to enrich the theoretical understanding of team mental models and to broaden the empirical research base by adopting a cross-disciplinary focus and incorporating related team knowledge domains from other literatures. Based on a synthesis of various literatures, we develop a framework that delineates the relationships among team knowledge constructs. Copyright © 2001 John Wiley & Sons, Ltd.
This article develops a relational perspective on the coordination of work. Existing theory suggests that relational forms of coordination should improve performance in settings that are highly interdependent, uncertain and time-constrained. Going beyond previous work, we argue that relational coordination should also improve job satisfaction by helping employees to accomplish their work more effectively and by serving as a source of positive connection at work. Using a cross-sectional sample of nursing aides and residents in 15 nursing homes, we investigate the impact of relational coordination on quality outcomes and job satisfaction.
The application of non-technical skills (NTSs) in health care has previously been described in other health-care educational programmes. NTSs are behavioural principles such as leadership, task distribution and communication. The aim of this study was to identify NTSs suitable for improving team performance in multi-professional cardiac arrest teams, and to describe barriers to the use and implementation of such NTSs by using a qualitative method.
Individual semi-structured interviews were conducted with 11 Danish Advanced Life Support instructors during the period April 2006 to November 2006. Interviews were focussed on barriers and recommendations for teamwork in the cardiac arrest team, optimal policy for improvement of resuscitation training and clinical practice, use of cognitive aids and adoption of European Resuscitation Council (ERC) Guidelines 2005. Interviews and data analysis were supported by a template describing 25 NTSs derived from other educational programmes in health care.
A framework with five categories relating to NTSs was identified: leadership, communication, mutual performance monitoring, maintenance of standards and guidelines and task management. Important barriers that were identified were inexperienced team leaders, task overload and hierarchic structure in the teams' inability to maintain focus on chest compressions.
Interview participants pointed out that NTSs of teams could improve the treatment of cardiac arrest, but several barriers to this exist. Improving resuscitation training should include considerations regarding team leader experience, structured communication, mandatory use of cognitive aids, avoidance of task overload and mutual performance monitoring to avoid unnecessary interruptions in chest compressions.
Previous studies found that medication errors result from lack of sufficient information during the prescribing step. Therefore, it is proposed that having a pharmacist available when patients are evaluated during the rounding process may reduce the likelihood of preventable adverse drug events (ADEs). The objectives of this study were to evaluate the impact of having a pharmacist participate with a physician rounding team on preventable ADEs in general medicine units and to document pharmacist interventions made during the rounding process.
A single-blind, standard care-controlled study design was used to compare patients receiving care from a rounding team including a pharmacist with patients receiving standard care (no pharmacist on rounding team). Patients admitted to and discharged from the same general medicine unit were included in the study. The main outcome measure of this study was preventable ADEs. Patient records were randomly selected and evaluated by a blinded process involving independent senior pharmacist specialists and a senior staff physician. Interventions made by the pharmacists in the treatment group were documented.
The rate of preventable ADEs was reduced by 78%, from 26.5 per 1000 hospital days to 5.7 per 1000 hospital days. There were 150 documented interventions recommended during the rounding process, 147 of which were accepted by the team. The most common interventions were (1) dosing-related changes and (2) recommendations to add a drug to therapy.
Pharmacist participation with the medical rounding team on a general medicine unit contributes to a significant reduction in preventable ADEs.
Organizations are increasingly becoming dynamic and unstable. This evolution has given rise to greater reliance on teams and increased complexity in terms of team composition, skills required, and degree of risk involved. High-reliability organizations (HROs) are those that exist in such hazardous environments where the consequences of errors are high, but the occurrence of error is extremely low. In this article, we argue that teamwork is an essential component of achieving high reliability particularly in health care organizations. We describe the fundamental characteristics of teams, review strategies in team training, demonstrate the criticality of teamwork in HROs and finally, identify specific challenges the health care community must address to improve teamwork and enhance reliability.
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Nadel's paradox revisited: relational and cultural aspects of organizational structure
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Power and conflict in health care: everyone's responsibility
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