Reflective Practice: How the World Bank Explored Its Own Biases?

Stuckler, David

doi:10.15171/ijhpm.2015.216

Cited by 14 publications

(12 citation statements)

References 27 publications

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“…Arguably, this is the next question that researchers might turn to, taking their cue from the World Bank, which has set the standard for learning organisations to aspire to. 13 However, such research is unlikely to be undertaken any time soon.…”

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confidence: 99%

The weekend effect: now you see it, now you don’t

McKee

2016

BMJ

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confidence: 99%

The weekend effect: now you see it, now you don’t

McKee

2016

BMJ

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“…60 However, despite the widespread promotion of reflection as a tool for self-improvement, evidence that it actually improves performance is weak, [61][62][63] as is the evidence that feedback from patient experience surveys promotes effective reflection. 64 We are biased towards favourable events and judgements 65,66 and tend to reject adverse patient feedback, 67 thereby missing the opportunity to learn from either through critical analysis. Poor performers additionally lack insight into their abilities.…”

Section: How Does Reflection Stimulate Learning?mentioning

confidence: 99%

A framework and toolkit of interventions to enhance reflective learning among health-care professionals: the PEARL mixed-methods study

Bion

Brookes

Brown

et al. 2020

Health Serv Deliv Res

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Background Although most health care is high quality, many patients and members of staff can recall episodes of a lack of empathy, respect or effective communication from health-care staff. In extreme form, this contributes to high-profile organisational failures. Reflective learning is a universally promoted technique for stimulating insight, constructive self-appraisal and empathy; however, its efficacy tends to be assumed rather than proven. The Patient Experience And Reflective Learning (PEARL) project has used patient and staff experience to co-design a novel reflective learning framework that is based on theories of behaviour and learning. Objective To create a toolkit to help health-care staff obtain meaningful feedback to stimulate effective reflective learning that will promote optimal patient-, family- and colleague-focused behaviours. Design A 3-year developmental mixed-methods study with four interlinked workstreams and 12 facilitated co-design meetings. The Capability, Opportunity, Motivation – Behaviour framework was used to describe factors influencing the behaviour of reflection. Setting This took place at five acute medical units and three intensive care units in three urban acute hospital trusts in England. Participants Patients and relatives, medical and nursing staff, managers and researchers took part. Data sources Two anonymous surveys, one for patients and one for staff, were developed from existing UK-validated instruments, administered locally and analysed centrally. Ethnographers undertook interviews and observed clinical care and reflective learning activities in the workplace, as well as in the co-design meetings, and fed back their observations in plenary workshops. Main outcome measures Preliminary instruments were rated by participants for effectiveness and feasibility to derive a final set of tools. These are presented in an attractively designed toolbox with multiple sections, including the theoretical background of reflection, mini guides for obtaining meaningful feedback and for reflecting effectively, guides for reflecting ‘in-action’ during daily activities, and a set of resources. Results Local project teams (physicians, nurses, patients, relatives and managers) chaired by a non-executive director found the quarterly reports of feedback from the patient and staff surveys insightful and impactful. Patient satisfaction with care was higher for intensive care units than for acute medical units, which reflects contextual differences, but in both settings quality of communication was the main driver of satisfaction. Ethnographers identified many additional forms of experiential feedback. Those that generated an emotional response were particularly effective as a stimulus for reflection. These sources of data were used to supplement individual participant experiences in the nine local co-design meetings and four workshops to identify barriers to and facilitators of effective reflection, focusing on capability, opportunity and motivation. A logic model was developed combining the Capability, Opportunity, Motivation – Behaviour framework for reflection and theories of learning to link patient and staff experience to changes in downstream behaviours. Participants proposed practical tools and activities to enhance reflection ‘in-action’ and ‘on-action’. These tools were developed iteratively by the local and central project teams. Limitations Paper-based surveys were burdensome to administer and analyse. Conclusions Patients and health-care staff collaborated to produce a novel reflective learning toolkit. Future work The toolkit requires evaluating in a cluster randomised controlled trial. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 32. See the NIHR Journals Library website for further project information.

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“…4 Therefore, multipronged system-based approaches are needed to enhance patient safety across the continuum of care, and the integrated model provides an evidence-informed framework to evaluate strategies that may result in improvement. Reason's suggestions and those of others, including the roles of mindfulness and cognitive debiasing and strategic reliabilism, for enhancing rational decision making, represent potential protective gating mechanisms: These and other possible solutions 11,14,15,18,25,26,28,30,48,49,54,61,68,87,109,[114][115][116][117][118][119][120] are worthy of evidence-informed debate. Informed shared decision making is the critical cornerstone of patient safety.…”

Section: Reason Constantlymentioning

confidence: 99%

Gating the holes in the Swiss cheese (part I): Expanding professor Reason's model for patient safety

Seshia

Young

Makhinson

et al. 2017

Evaluation Clinical Practice

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IntroductionAlthough patient safety has improved steadily, harm remains a substantial global challenge. Additionally, safety needs to be ensured not only in hospitals but also across the continuum of care. Better understanding of the complex cognitive factors influencing health care–related decisions and organizational cultures could lead to more rational approaches, and thereby to further improvement.HypothesisA model integrating the concepts underlying Reason's Swiss cheese theory and the cognitive‐affective biases plus cascade could advance the understanding of cognitive‐affective processes that underlie decisions and organizational cultures across the continuum of care.MethodsThematic analysis, qualitative information from several sources being used to support argumentation.Discussion Complex covert cognitive phenomena underlie decisions influencing health care. In the integrated model, the Swiss cheese slices represent dynamic cognitive‐affective (mental) gates: Reason's successive layers of defence. Like firewalls and antivirus programs, cognitive‐affective gates normally allow the passage of rational decisions but block or counter unsounds ones. Gates can be breached (ie, holes created) at one or more levels of organizations, teams, and individuals, by (1) any element of cognitive‐affective biases plus (conflicts of interest and cognitive biases being the best studied) and (2) other potential error‐provoking factors. Conversely, flawed decisions can be blocked and consequences minimized; for example, by addressing cognitive biases plus and error‐provoking factors, and being constantly mindful. Informed shared decision making is a neglected but critical layer of defence (cognitive‐affective gate). The integrated model can be custom tailored to specific situations, and the underlying principles applied to all methods for improving safety. The model may also provide a framework for developing and evaluating strategies to optimize organizational cultures and decisions.LimitationsThe concept is abstract, the model is virtual, and the best supportive evidence is qualitative and indirect.ConclusionsThe proposed model may help enhance rational decision making across the continuum of care, thereby improving patient safety globally.

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Reflective Practice: How the World Bank Explored Its Own Biases?

Cited by 14 publications

References 27 publications

The weekend effect: now you see it, now you don’t

The weekend effect: now you see it, now you don’t

A framework and toolkit of interventions to enhance reflective learning among health-care professionals: the PEARL mixed-methods study

Gating the holes in the Swiss cheese (part I): Expanding professor Reason's model for patient safety

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