Organisational paradoxes in speaking up for safety: Implications for the interprofessional field

Rowland, Paula

doi:10.1080/13561820.2017.1321305

Cited by 6 publications

(3 citation statements)

References 19 publications

(21 reference statements)

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“…Residents were more adaptive when they were allowed to be uncertain, and when this uncertainty did not impact how the context viewed their ability to be an authority. As such, this study shines light on how supervising practices and resident’s understanding of what professionals ‘do’ had an impact on their ability to develop adaptive expertise (Rowland, 2017 ; Rowland et al, 2020 ). The study describes the negative consequences for learning when this expectation is present.…”

Section: Discussionmentioning

confidence: 98%

“…This problem is especially unfortunate when uncertainty tolerance is linked with several desired healthcare-related outcomes amongst trainees (Strout et al, 2018 ), and uncertainty-related anxiety has a negative impact on the clinician’s own satisfaction with their decision-making competency (Libert et al, 2016 ). Here, studies argue that introducing a vocabulary for uncertainty in professional settings can mediate learning at all levels of experience (Lingard et al, 2003 ; Rowland, 2017 ). Uncertainty plays a role in developing adaptive practices and could be mediated through targeted verbalisation.…”

Section: Discussionmentioning

confidence: 99%

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Exploring adaptive expertise in residency: the (missed) opportunity of uncertainty

Gamborg

Mylopoulos

Mehlsen

et al. 2023

Adv in Health Sci Educ

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Preparing novice physicians for an unknown clinical future in healthcare is challenging. This is especially true for emergency departments (EDs) where the framework of adaptive expertise has gained traction. When medical graduates start residency in the ED, they must be supported in becoming adaptive experts. However, little is known about how residents can be supported in developing this adaptive expertise. This was a cognitive ethnographic study conducted at two Danish EDs. The data comprised 80 h of observations of 27 residents treating 32 geriatric patients. The purpose of this cognitive ethnographic study was to describe contextual factors that mediate how residents engage in adaptive practices when treating geriatric patients in the ED. Results showed that all residents fluidly engaged in both adaptive and routine practices, but they were challenged when engaging in adaptive practices in the face of uncertainty. Uncertainty was often observed when residents’ workflows were disrupted. Furthermore, results highlighted how residents construed professional identity and how this affected their ability to shift between routine and adaptive practices. Residents reported that they thought that they were expected to perform on par with their more experienced physician colleagues. This negatively impacted their ability to tolerate uncertainty and hindered the performance of adaptive practices. Thus, aligning clinical uncertainty with the premises of clinical work, is imperative for residents to develop adaptive expertise.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Exploring adaptive expertise in residency: the (missed) opportunity of uncertainty

Gamborg

Mylopoulos

Mehlsen

et al. 2023

Adv in Health Sci Educ

View full text Add to dashboard Cite

show abstract

“…Our findings suggest that the chances of such socialization, and thus the quality of interprofessional teamworking, may be significantly increased by embedding interprofessional teams in a single organization. Such a radical way of eliminating inter-organizational barriers to interprofessional collaboration, evading classification in terms of inter-organizational integration (Willumsen, 2008), was shown in the Utrecht case to support a high level of interpersonal integration (Willumsen, 2008), with professionals experiencing team psychological safety (O'Leary, 2016), having positive perceptions of each other (Widmark, Sandahl, Piuva, & Bergman, 2016), and being able to align different perspectives (Rowland, 2017).…”

Section: Discussionmentioning

confidence: 99%

Interprofessional teamwork in decentralized child welfare in The Netherlands: A comparison between the cities of Amsterdam and Utrecht

Kortleven

Lala

Lotfi

2018

Journal of Interprofessional Care

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The recent transformation of child welfare in the Netherlands has improved opportunities for interprofessional working. We compared two models of teamworking within newly established interprofessional teams in the cities of Amsterdam and Utrecht, conducting a secondary analysis of semi-structured interviews collected through three broader research projects. Respondents include seventeen interprofessional team members (six from Utrecht, eleven from Amsterdam), representing a variety of teams across city, as well as two policymakers from Utrecht and one from Amsterdam. Team members were approached using convenience sampling, policymakers were purposively recruited. In different rounds of open and focused coding, we found that differences in team organization between the two cities have led to differences in the quality of interprofessional teamworking. Teamworking is best developed in Utrecht partly because team members are recruited and employed by a single organization. This has enabled a more careful process of selection and team composition than in Amsterdam, where a delegation approach entailed fragmentation as well as the risk of divided loyalty between team and mother organization. In addition, while the development of interprofessional teamwork in Utrecht is served by certain structures, teams in Amsterdam have suffered from an imbalance between freedom and structure, causing insecurity amongst staff and reduced chances of interprofessional integration. Despite the apparent success of the Utrecht model of interprofessional teamworking, interprofessional collaboration across team boundaries might suffer from the fact that teams in Utrecht, unlike in Amsterdam, do not comprise representatives of relevant partner organizations.

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Integrating interprofessional education with needs-based health workforce planning to strengthen health systems

Murphy

Gilbert

Rigby

2019

Journal of Interprofessional Care

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Organisational paradoxes in speaking up for safety: Implications for the interprofessional field

Cited by 6 publications

References 19 publications

Exploring adaptive expertise in residency: the (missed) opportunity of uncertainty

Exploring adaptive expertise in residency: the (missed) opportunity of uncertainty

Interprofessional teamwork in decentralized child welfare in The Netherlands: A comparison between the cities of Amsterdam and Utrecht

Integrating interprofessional education with needs-based health workforce planning to strengthen health systems

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