Quality improvement education and interprofessional learning of the perioperative team : [from theory to reality]

Hlede, Vjeko and McArthur, Jan (2019) Quality improvement education and interprofessional learning of the perioperative team : [from theory to reality]. PhD thesis, Lancaster University.

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Abstract

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.