Addressing complex healthcare problems in diverse settings: Insights from activity theory

Greig, Gail; Entwistle, Vikki; Beech, Nic

doi:10.1016/j.socscimed.2011.02.006

Cited by 79 publications

(48 citation statements)

References 38 publications

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“…An instrumental case study design (Stake, 2008) was chosen in order to explore the wider issue of complexity impacting on healthcare teamwork and it was anchored in the premises of activity theory (Engeström, 2001), which provides a rich approach to understanding the complexities of collaboration in the clinical context from a socio-cultural perspective (Bleakley, 2013;Greig, Entwistle, & Beech, 2012). The following questions guided the study: What are the types and characteristics of healthcare teams that facilitate patient-engaged care in the community hospital setting?…”

Section: Methodsmentioning

confidence: 99%

Enhancing patient-engaged teamwork in healthcare: an observational case study

Casimiro

Hall

O’Connor

et al. 2014

Journal of Interprofessional Care

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The purpose of this study was to describe how teamwork that effectively engaged patients and families, manifested itself in an acute rural care setting in order to inform the development of teamwork skills. One hundred and forty participants were included in the study representing providers, patients, family, hospital and clinical support personnel, education specialists and students. Using a modified grounded theory approach, and informed by activity theory, observational field notes and interview transcripts were analyzed. Through the analysis of 343 events of providers interacting with, or exchanging information about, patients, three patterns of teamwork emerged that facilitated patient-engaged care: uniprofessional, multiprofessional and interprofessional. The data indicated that providers navigated between these patterns, as well as others, throughout their workday. Providers should be skilled in applying the construct of situation awareness in order to adopt a pattern of teamwork that best facilitates patient-engaged care. Interventions that can enhance teamwork should focus on: valuing the perspectives of others; developing relational competence and resilience; employing reflective learning and shared decision-making skills; and incorporating principles of change theory for both individuals and systems.

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Section: Methodsmentioning

confidence: 99%

Enhancing patient-engaged teamwork in healthcare: an observational case study

Casimiro

Hall

O’Connor

et al. 2014

Journal of Interprofessional Care

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“…262-9). Our tenet is that they are helpful for understanding not only the case of the RSNO flash mob but also an increasing variety of other organisational/work situations that share similar characteristics (Blackler, 1993;Engestrom, 1987;2000;2008;Engestrom et al, 1999;Nicolini, 2011;Greig et al, 2012).…”

Section: Theorising Co-configured Musical Work Through Cultural Histomentioning

confidence: 99%

“…They become part of the overall, ongoing working. People may not share a view of the exact nature of the object of work, or the needs they seek to meet, but their mutual interest and motivation is sufficient to keep them involved (Blackler and Regan, 2006;Greig et al, 2012). For example, a musician may wish simultaneously to make a beautiful sound and to stir emotions in large audiences (the object) in order to establish reputation and critical esteem among other players (the objective).…”

Section: Object Of Work or Activitymentioning

confidence: 99%

Managing artistic work in the real world

Greig¹,

Nicolini²

2015

Organising Music

Self Cite

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“…It can also be argued that, to better reflect clinical practice, management of student supervision in the clinical environment should be a shared, rather than an individual responsibility. Activity theory, and the associated model of expansive learning provides a useful theoretical lens through which organisational changes in health services can be examined and understood [2–4]. Activity theory considers the various activities people engage in to achieve particular outcomes (the ‘object’ of the activity) as well as the ways in which these objects are achieved (tools).…”

Section: Introductionmentioning

confidence: 99%

Rethinking attitudes to student clinical supervision and patient care: a change management success story

et al. 2014

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BackgroundThe aim of this project was to explore the process of change in a busy community dental clinic following a team development intervention designed to improve the management of student supervision during clinical placements.MethodsAn action research model was used. Seven members of a community dental clinic team (three dentists, two dental therapists, one dental assistant and the clinic manager), together with the university clinical placement supervisor participated in the team development intervention. The intervention consisted of two profiling activities and associated workshops spread six months apart. These activities focused on individual work preferences and overall team performance with the aim of improving the functioning of the clinic as a learning environment for dental students. Evaluation data consisted of 20 participant interviews, fourteen hours of workplace observation and six sets of field notes. Following initial thematic analysis, project outcomes were re-analysed using activity theory and expansive learning as a theoretical framework.ResultsAt project commencement students were not well integrated into the day-to-day clinic functioning. Staff expressed a general view that greater attention to student supervision would compromise patient care. Following the intervention greater clinical team cohesion and workflow changes delivered efficiencies in practice, enhanced relationships among team members, and more positive attitudes towards students. The physical layout of the clinic and clinical workloads were changed to achieve greater involvement of all team members in supporting student learning. Unexpectedly, these changes also improved clinic functioning and increased the number of student placements available.ConclusionsIn navigating the sequential stages of the expansive learning cycle, the clinical team ultimately redefined the ‘object’ of their activity and crossed previously impervious boundaries between healthcare delivery and student supervision with benefits to all parties.

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Addressing complex healthcare problems in diverse settings: Insights from activity theory

Cited by 79 publications

References 38 publications

Enhancing patient-engaged teamwork in healthcare: an observational case study

Enhancing patient-engaged teamwork in healthcare: an observational case study

Managing artistic work in the real world

Rethinking attitudes to student clinical supervision and patient care: a change management success story

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