Dialogue: The Art of Thinking Together

Book Club: Isaacs, W. (2008). Dialogue: The art of thinking together. Crown Business. [GoodReads review]

This book was suggested as part of preparation for participating in an Unconference. The purpose for this resource was to maximise the limited time, within a group of people with an interest in education but who were not known to each other, so to enable conversation and dialogue to occur in the one day timeframe. 

Dialogue is about “shared inquiry, a way of thinking and reflecting together”(pg. 9). 

This inquiry can involve telling stories and the ability to think and talk together. How we think does affect how we talk, with relation to our held memory and emotions.

“Dialogue is a practice for deliberately and consciously evoking powerful conversations like these” (pg 70).

The aim is to create mutual respect, coordination and connection within a group of people.  

  1. Listening
  2. Respecting
  3. Suspending
  4. Voicing 

Why is this important, well dialogue occurs in all walks of life. This approach can be used to work together, resolve conflicts (be warned this is not an easy process, the book provides many examples of dialogic discussion) and solve problems. The aim is to empower and create new ways of thinking and working together.

3 Levels of action in a dialogue (pg. 29-30):

  1. Produce coherent actions: do what we say,
  2. Create fluid structures of interaction,
  3. Provide an environment for dialogue to occur.

Path to Dialogue

Purpose of Dialogue

  • determine what is the problem?
  • In the world of information overload, dialogue can determine what truly matters to us?
  • Build capacity for new behaviour.
  • Learn to inquire together.

4 Principles of Dialogue

  1. Participation
  2. Unfolding
  3. Awareness
  4. Coherence

Learn to Listen

  • Prepare to listen
  • Learn to be present
  • What are you thinking?
  • Use reflective listening, see how others are experiencing the situation
  • Listen together

Listening Together

  • Respecting boundaries, but not being passive
  • Wholeness of the conversation
  • Awareness, the ability to suspend directions/opinions using reflection in action
  • Foster enquiry
  • Voice

The Environment

  • The container: for a rich field of interaction
  • Psychological safety

Keywords: Dialogue; Dialogic: Listening; Respect; Voice; Change Management

References

Argyris, C. (1977). Double loop learning in organizationsHarvard business review55(5), 115-125.

Argyris, C., & Schon, D. A. (1974). Theory in practice: Increasing professional effectiveness. Jossey-Bass.

Bohm, D., & Peat, F. D. (2010). Science, order and creativity. Routledge.

Isaacs, W. (2008). Dialogue: The art of thinking together. Crown Business. [GoodReads review]

Isaacs, W. N. (1993). Taking flight: Dialogue, collective thinking, and organizational learningOrganizational dynamics22(2), 24-39.

Yacavone, M. (2010). A Summary of… David Kantor’s Four-Player Model of Communication.

‘Do not interrupt’ Bundled Intervention to Reduce Medication Interruptions.

Journal Club Article: Westbrook, J. I., Li, L., Hooper, T. D., Raban, M. Z., Middleton, S., & Lehnbom, E. C. (2017). Effectiveness of a ‘Do not interrupt’ bundled intervention to reduce interruptions during medication administration: a cluster randomised controlled feasibility studyBMJ Qual Saf, bmjqs-2016.

Aim: Evaluate the effectiveness of a ‘Do not interrupt’ bundled intervention to reduce non-medication-related interruptions to nurses during medication administration.

Method:parallel eight cluster randomised controlled study. Nurses were informed that the study was a direct observational study of medication administration and preparation tasks. Nursing staff were blinded to the study aim focused on interruptions and at baseline were blinded to the intervention. Only intervention ward staff were informed of the intervention subsequently.

Use of real time collected data using the Work Observational Method by Activity Timing Software (WOMBAT).

Setting: 4 wards in 1 hospital. Over 8 weeks and 364.7 hours, 227 nurses were observed administering 4781 medications.

Intervention: Wearing a vest when administering medications; strategies for diverting interruptions; clinician and patient education; and reminders.

Outcome Measures: 

  1. Primary outcome was non-medication-related interruptions during individual medication dose administrations.
  2. Secondary outcomes were total interruption and multitasking rates. A survey of nurses’ experiences was administered.

Intervention: The ‘Do not interrupt’ intervention comprised five ‘bundled’ elements:

  1. Wearing of a ‘Do not interrupt’ medication vest by nurses when preparing and administering medications,
  2. Interactive workshops with nurses regarding the purpose of the intervention to reduce non-medication-related interruptions and to identify local barriers and enablers to intervention use (eg, where to store vests),
  3. Brief standardised education sessions with clinical staff (eg, doctors, allied health),
  4. Patient information, which included why nurses were wearing a vest, and a request not to interrupt nurses during medication administration unless their concern was serious and urgent, or related to their medication. Patients were informed of other nurses and staff from whom to seek help if required,
  5. The use of reminders such as posters and stickers to inform health professionals, patients and visitors not to interrupt nurses during medication rounds for safety reasons.

Results: Baseline characteristics for control and interventions wards were similar.  Due to the observational approach of the study, the impact on influencing behaviours must be considered.

  • At baseline, nurses experienced 57 interruptions/100 administrations, 87.9% were unrelated to the medication task being observed.
  • A significant reduction of 15 non-medication-related interruptions/100 administrations compared with control wards.
  • Medication
  • The intervention more effective reducing interruptions from other nurses, no substantial impact from patient interruptions.
  • Intervention ward nurses reported that vests were time consuming, cumbersome and hot.
  • Only 48% of nurses indicated that they would support the intervention becoming hospital policy.
  •  There was reduction in multitasking rates in the intervention wards compared to control wards.

Discussion: The main aspect was the reduction of interruptions (30%) which potentially (as reduction in medication errors was not measured) translates to a reduction in medication administered errors (MAEs) of 1.8%.

This study was conducted in a paper system, so the impact of electronic medication administration records (eMARs) on reducing medication errors needs to be considered.

If visual aids such as vests are not a preference for nurses, also the infection control issue moving around the ward then educating nurses to deal with interruptions is advocated.

Resources

Hayes, C., Jackson, D., Davidson, P. M., & Power, T. (2015). Medication errors in hospitals: a literature review of disruptions to nursing practice during medication administrationJournal of Clinical Nursing24(21-22), 3063-3076.

Westbrook, J. I., Woods, A., Rob, M. I., Dunsmuir, W. T., & Day, R. O. (2010). Association of interruptions with an increased risk and severity of medication administration errorsArchives of Internal medicine170(8), 683-690.

Westbrook, J. I., & Ampt, A. (2009). Design, application and testing of the Work Observation Method by Activity Timing (WOMBAT) to measure clinicians’ patterns of work and communication. International Journal of Medical Informatics78, S25-S33.

The Applicability of Community of Inquiry Framework (Journal Club)

Journal Club Article: Smadi, O., Parker, S., Gillham, D., & Müller, A. (2019). The applicability of community of inquiry framework to online nursing education: A cross-sectional studyNurse education in practice34, 17-24.

Background

The lack of rigorous evidence based research to guide e-learning in higher education, which is especially relevant with the rapid adoption of e-learning, which is often part of a blended learning approach (Garrison, 2011).

“While discussion forums and video conferencing are very common in online courses, LMS also include a range of more interactive features and advanced functions such as customized learning pathways, collaborative content, peer interaction and assessment workshops, file sharing, real-time messaging, and wiki forums. However, according to Christie and Jurado (2009), these interactive features are not widely used by the course designers. Shea and Bidjerano (2009b) report that designers of online courses and educational providers are often confused about how to integrate new technologies into online learning environments in ways that will enrich student learning.”

The Community of Inquiry Framework

“The Community of Inquiry framework originated in the work of Dewey (1938), Peirce (1955), and Lipman (2003). Garrison et al. (2000) broadened and adapted the Community of Inquiry framework for e-learning education by viewing it through the lens of social, cognitive, and teaching presences.”

Community of Inquiry framework (Garrison et al., 2000):

  1. Social Presence
  2. Cognitive Presence
  3. Teaching Presence

Study Aim

The projects aims were to explore the following questions:

1. What is the awareness and knowledge of Australian nursing educators about the CoI framework?
2. What is the participants’ attitudes on the applicability of the CoI framework to online nurse education courses?

Study Design

An online survey tool which was divided into three sections:

  1. Demographic information,
  2. The applicability of community of inquiry presences,
  3. Awareness and knowledge of  Community of Inquiry.

Participants: Nurse educators from 34 higher education universities providing nurse education to international students.

Limitations: The survey tool was an adaptation of a validated tool. The limited response from using an online survey approach.

Results

From 138 respondents from a possible 1201 (response rate 11.5%):

    • The current used mode of teaching is blended learning (BL) (83%).
    • Nurse educators ranked BL as the best suited teaching mode for nursing education (90%).
    • Ninety percent (90%) of the participants are involved in curriculum design.
    • (90%) of the participants viewed instructional design and framework as significant to build an online course.
    • However, (70%) declared they don’t use explicit theoretical framework to guide the design/evaluation of online education.
    • Participants highly ranked the three core concepts of CoI framework as applicable for online nursing education.
  • (20%) of the participants are familiar with CoI framework, of them (79%) are likely to recommend CoI framework to a colleague.

Summary

“This study has shown the perceived importance of instructional design and theoretical framework to build an online courses for nurse educators using blended learning. Since Community of Inquiry framework has been shown to improve student satisfaction and decrease attrition in non-health disciplines, the implementation of Community of Inquiry framework in nurse education should be investigated more. Community of Inquiry provides a comprehensive framework relevant to face-to-face, blended, and online education with the potential to embed numerous technology-linked interventions within a Community of Inquiry framework.

These results provide the impetus for further investigation of factors influencing the development of online nurse education including the specific consideration of CoI frameworks.”

Keywords: Community of inquiry; Online education; Theoretical framework; Blended learning; E-learning

Reference

Smadi, O., Parker, S., Gillham, D., & Müller, A. (2019). The applicability of community of inquiry framework to online nursing education: A cross-sectional studyNurse education in practice34, 17-24.

IRIS Cricoid Pressure Trial & Deimplementation (Journal Club)

Journal Club Article: Birenbaum, A., Hajage, D., Roche, S., Ntouba, A., Eurin, M., Cuvillon, P., … & Menut, R. (2018). Effect of Cricoid Pressure Compared With a Sham Procedure in the Rapid Sequence Induction of Anesthesia: The IRIS Randomized Clinical Trial. JAMA Surgery.

Background: 

Cricoid pressure or Sellick’s maneuver (first described by Dr. Sellick in the 1960’s) aims to reduce the risk of regurgitation. The technique involves the application of pressure over the cricoid cartilage with the thumb and 1-2 additional fingers, to to occlude the esophagus and prevent regurgitation of stomach contents into the upper airway.

Study Aim:

Does the cricoid pressure prevent pulmonary aspiration in patients undergoing rapid sequence induction of anesthesia?

Study Design:

A randomized, double-blind, noninferiority trial conducted across 10 academic centers. Patients undergoing anesthesia with rapid sequence intubation (RSI) were enrolled from February 2014 until February 2017 and followed up for 28 days or until hospital discharge. 3472 patients were assigned to cricoid pressure (Sellick group) or a sham procedure group. Mean age was 51 years and 51% were men. Inclusion: all adults; Exclusion: pregnancy.

Key Results: 

Primary measure of pulmonary aspiration, occurred in 10 patients (0.6%) in the Sellick group and in 9 patients (0.5%) in the sham group.

Secondary Measures:

  • No significant difference in pneumonia, length of stay and mortality.
  • The Cricoid (Sellick maneuver) group had significantly longer intubation time (median, 27 vs. 23 seconds).
  • Longer intubation time >30 seconds, Cricoid 47% vs Sham 40%; P <.001.
  • Comparison of the Cormack and Lehane grade (Grades 3 and 4) in Cricoid (10%) vs Sham (5%; P <.001).
  • All suggests an increased difficulty of tracheal intubation in the Cricoid (Sellick) group.

Summary: 

Investigators summary: “the results failed to demonstrate the noninferiority of a sham procedure in preventing pulmonary aspiration compared with the cricoid pressure. Mortality, pneumonia, and length of stay did not differ significantly between groups, and differences in intubation time and laryngoscopic exposure suggest more difficulties in the Sellick group”.

Nursing Clinical Questions:

  • Is cricoid pressure needed if there is no harm prevention and gives inferior views of the airway?
  • This study population was in theatre, can the results be transferred into the pre-hospital, ED or ICU populations (and in pregnancy)?
  • Should nurses use the evidence base to encourage the deimplementation of ‘ritualistic’ practice? See below in Deimplementation Resources.
  • Should nurses just refuse to perform a non-evidence based procedure?

Additional Resources:

Recommended Viewing on Cricoid: Cricolol by John Hinds on Vimeo.

Deimplementation Resources

Rogers, E. M. (1995) Diffusion of innovations. (5th ed.) Simon and Schuster, New York, USA. [summary article]

Nursing Education Network. (2017) Deimplementation of Practice.

Nursing Education Network. (2016) Human Centred Design.

 

 

 

 

 

Barriers to using research findings in practice: The clinician’s perspective

Journal Club Article: Funk, S. G., Champagne, M. T., Wiese, R. A., & Tornquist, E. M. (1991). Barriers to using research findings in practice: The clinician’s perspective. Applied Nursing Research4(2), 90-95. [abstract]

In 1991, Funk and colleagues highlighted the progress made in the quantity, quality and new areas of nursing research being instigated.  This paper produced the BARRIERS scale, which has been used as a validated tool to further investigate research in nursing in different settings and countries.

Aim: To determine clinicians’ perceptions of the barriers to using research findings in practice and to solicit their input as to what factors would facilitate such use.

Method:  Questionnaires to 5000 selected full time working nurses based on five educational strata (those with diplomas, associate degrees, bachelor’s, master’s, and doctoral degrees). 40% completion of the questionnaire.

Nice touch part: “Each questionnaire included an individual packet of coffee and a letter inviting the recipient to take a few moments to relax and complete the questionnaire”.

BARRIERS scale: 28-item scale requires respondents to rate the extent to which they think each item is a barrier to nurses’ use of research to alter or enhance their practice. Responses are circled on a 4-point scale (I, to no extent; 2, to a little extent; 3, to a moderate
extent; and 4, to a great extent).

The scale is divided into four subscales:

  1. characteristics of the nurse (related to the nurse’s research values, skills, and awareness).
  2. characteristics of the setting (related to the barriers and limitations perceived in the work setting).
  3. characteristics of the research (methodological soundness and the appropriateness of conclusions drawn from the research).
  4. characteristics of the presentation of the research and its accessibility.

Results:  “Insufficient time on the job to implement new ideas was cited most frequently, with lack of support from administration and physicians following closely behind.

The two greatest barriers were the nurse’s not feeling that she/he had “enough authority to change patient care procedures” and “insufficient time on the job to implement new ideas,” both of which are barriers of the setting.

The characteristics of the setting were rated among the top 10 barriers. They included lack of cooperation and support from physicians, administration, and other staff; inadequate facilities for implementation; and insufficient time to read research.”

The characteristics of the nurse in recognising the limits of their knowledge and skills to review and conduct research.

Summary: Nurses need to use and understand research to deliver evidence based practice. Research improves critical thinking and clinical decision making in clinicians. There are numerous barriers that hinder the use of research in the clinical setting, mainly linked to culture and traditional leadership hierarchies.

Limitation: The world and healthcare has changed since 1991, so aspects such as technology and the mass of information may lead to questions of validity for the BARRIERS scale, despite it’s historic use. Take a read of this systematic review by Kajermo et al. (2010). It may also help to understand the drivers of change, which can then be replicated in other settings to increase nurses involvement in research.

Resources

The Barriers Scale. (2018). The BARRIERS to Research Utilization Scale. UNC.edu

Kajermo, K. N., Boström, A. M., Thompson, D. S., Hutchinson, A. M., Estabrooks, C. A., & Wallin, L. (2010). The BARRIERS scale–the barriers to research utilization scale: A systematic reviewImplementation Science5(1), 32.

Journal Club: Defining the key roles and competencies of the clinician–educator of the 21st century.

Journal Club: Sherbino, J., Frank, J. R., & Snell, L. (2014). Defining the key roles and competencies of the clinician–educator of the 21st century: a national mixed-methods studyAcademic Medicine89(5), 783-789.

Background

This paper looks at the challenges of the clinician educator in the medical profession, the challenge of being a clinician and an educator. Defining an educator and the roles they perform in the clinical and educational environments varies considerably in terms of the scope of abilities or competencies.

Aims

  1. Create a consensus definition of what is a clinician–educator.
  2. Understand the domains of competence of being a clinician–educator.
  3. Types of training and preparation is required for the clinician–educator.

Method

Two-phased mixed method study:

  • Phase 1: focus groups using a grounded theory analysis.
  • Phase 2: a survey of 1,130 deans, academic chairs, and residency program directors to validate the focus group results.

Results

Results from phase 1 focus groups:

  1.  Being active in clinical practice,
  2. Applying education theory to education practice,
  3. Engaging in education scholarship.

Results from phase 2 survey:

Domains of competence and core competencies for clinician–educators:
  1. Designs assessment designs programs.
  2. Employs effective communication strategies.
  3. Learning theories and best practice for curriculum development, and conducts evaluations.
  4. Knowledge of education theory and application to education practice.
  5. Leadership in educational programs.
  6. Scholarship: “Contributes to the development, dissemination, and translation of health
    professions education knowledge and practices.”
  7. Uses effective teaching in teaching environments. Develops other faculty members.

Conclusion

Key roles of the clinician-educator: participates in clinical practice, applies theory to education practice, engages in education scholarship and consults on education issues. Identified the need for clinician-educator formal training programs.

Relevance For Nursing

What is interesting in this article is the continued mention of clinical competence or expertise in medical education. In nursing is the higher education setting seen as the source of educational knowledge, research and scholarship? But is higher education too far removed from the clinical environment to understand real world clinical challenges? Is there a different approach to engage both worlds for delivery of evidence based practice?

Resources

ICE Blog. (2014). Defining a Clinician Educator.

Sherbino, J., Frank, J. R., & Snell, L. (2014). Defining the key roles and competencies of the clinician–educator of the 21st century: a national mixed-methods studyAcademic Medicine89(5), 783-789.

The Role of Debriefing in Simulation-Based Learning. 

Journal Club Article: Fanning, R. M., & Gaba, D. M. (2007). The role of debriefing in simulation-based learning. Simulation in Healthcare, 2(2), 115-125.

Purpose

Determining what is important in the aspects of debriefing within simulation based learning.

Background

The importance of remembering the adult learner, and all the experience they bring through knowledge, assumptions and feelings. Active participation and leveling (#Heutagogy) of the traditional hierachies between teacher and learner are part of the adult learning philosophy. The adult learner is seen as self-directed, motivated and learns from meaningful and work related education that can applied in workplace.

“Adults learn best when they are actively engaged in the process, participate, play a role, and experience not only concrete events in a cognitive fashion, but also transactional events in a emotional fashion. The learner must make sense of the events experienced in terms of their own world” (pg. 115).

“The concept of reflection on an event or activity and subsequent analysis is the cornerstone of the experiential learning experience.” (pg. 116).

Origins of debriefing in simulation were from critical stress incident debriefing and to do this in a timely manner post incident, with the aim to stimulate group cohesion and empathy.

The Debriefing Process

  • Supportive climate; open, sharing, honest, free to learn.
  • Environment of trust; the pre-brief to explain the purpose of the simulation and what is to be expected.
  • The roles of debriefer and those to be debriefed.

Models of Debriefing

The aim of the debrief is to make sense of the event. The structure of the simulation may be:

  1. Experience the event,
  2. Reflect on the event,
  3. Discuss the event with other participants,
  4. Learn and modify behaviour learnt from the experience.

Objectives

As ever match learning such as the debriefing to the learning objectives. Allow emergent and evolving learning that occurs throughout the simulation process. “Two main questions:

  1. Which pieces of knowledge, skills, or knowledge are to be learned?
  2. What specifically should be learned about each of them?”

Role of The Facilitator

The facilitator will be a Co-learner in the simulation with the aim to guide and direct, rather than a traditional lecture based authoritarian approach. Debriefing is a skill and requires training and development. Resources such as the support from experts to guide and develop are important in developing simulation skills.

Debriefing 

Dismukes & Smith (2017) describe three levels of facilitation:

  1. High: High level facilitation actually requires low level of involvement from the facilitator. “Participants largely debrief themselves with the facilitator outlining the debriefing process and assisting by gently guiding the discussion only when necessary, and acting as a resource to ensure objectives are met” (pg 119).
  2. Intermediate: “An increased level of instructor involvement may be useful when the individual or team requires help to analyze the experience at a deep level, but are capable of much independent discussion” (pg 119).
  3. Low: “An intensive level of instructor involvement may be necessary where teams show little initiative or respond only superficially” (pg 120).

Summary 

The debrief is described as ” the heart and soul of the simulation”.

Resources

Dismukes, R. K., & Smith, G. M. (2017). Facilitation and debriefing in aviation training and operations. Routledge.

Fanning, R. M., & Gaba, D. M. (2007). The role of debriefing in simulation-based learning. Simulation in Healthcare, 2(2), 115-125.

Lederman, L. C. (1991, July). Differences that make a difference: Intercultural communication, simulation, and the debriefing process in diverse interaction. In Annual Conference of the International Simulation and Gaming Association, Kyoto, Japan (pp. 15-19).

Petranek, C. (1994). A maturation in experiential learning: Principles of simulation and gaming. Simulation & Gaming25(4), 513-523.

Thatcher, D. C., & Robinson, M. J. (1985). An introduction to games and simulations in education. Hants: Solent Simulations.

Book Club: Visible learning for teachers: Maximizing impact on learning by John Hattie

Book Club: Hattie, J. (2012). Visible learning for teachers: Maximizing impact on learning. Routledge.

6 signposts towards education excellence:

  1. Teachers are one of the most powerful learning influencers,
  2. Teachers need to be passionately engaged,
  3. Teachers need to provide effective individualistic feedback,
  4. Both student and teacher need to know and understand the learning intentions,
  5. The learners construction of knowledge and ideas is critical,
  6. Safe learning environments where mistakes are encouraged and exploration of knowledge occurs.

Education Holy Grail improving education and interactions between student and teacher.

What are the core attributes to schooling that make the difference? The focus is not the buildings or programs but on the practice of teaching. Students learn to become their own teacher, to exhibit attributes of self-monitoring, self-evaluation, self-assessment and self-teaching.

Visible teaching and learning occurs when there is feedback given and sought, and when there are active, passionate, and engaging people (teacher, students, peers) participating in the act of learning” (pg 18).

“The act of teaching requires deliberate interventions to ensure that there is a cognitive change in the student” (pg 19).

Safe Environment

Idea rich environment where experimenting can occur and sharing ideas.

“A safe environment for the learner (and for the teacher) is an environment in which error is welcomed and fostered” (pg 19).

The Challenge

“When students become their own teachers, they exhibit the self-regulatory attributes that seem desirable for learners (self-monitoring, self-evaluation, self-assessment, self-teaching)” (pg 19).

Deliberate practice needs to occur and the student to be challenged in this safe environment, to aid the construction of knowledge.

“It is challenge that keeps us investing in pursuing goals and committed to achieving goals” (pg 57).

Preparing Lessons

4 critical parts in planning:

  1. “Students starting levels of performance (prior),
  2. The desired level of performance (target),
  3. Rate of progress (progression),
  4. Teacher collaboration and critique in planning” (pg. 41).

Best Practice Lesson Plans

  1. Know the learning intentions (the teacher),
  2. Understand expected standards of performance (the student),
  3. Build commitment and engagement in the learning task.
  4. Guide for the teacher on best delivery of the lesson (guided delivery),
  5. Guided practice for students to complete a task and receive constructive feedback,
  6. Closure provides clear cues when students are at important points in learning,
  7. Independent practice follows mastery of a topic.

Structured of Observed Learning Outcomes (SOLO)

SOLO taxonomy: Levels of understanding can be grouped as surface, deep and conceptual and the use of SOLO taxonomy can integrate them into learning intentions and achievement criteria.

Starting The Lesson

The climate of the classroom is a critical factor in promoting learning. A high level of relational trust and respect for each person’s role in learning. The classroom is a place for the student to dominate, not the teacher where there is a “need to talk, listen and do”.

Learning

Start with the desired results and then work backwards, the focus is then on the gap. This knowledge gap is where the teachers focus on the student and how they learn. The importance of motivation on goal setting and strategies to close the gap, and to recognise motivation varies at any given time.  Deliberate practice allows learning to meaningful and a meta-cognitive approach to instruction allows multiple opportunities for practice.

Visual Learning Infographics

Resources

Hattie, J. (2012). Visible learning for teachers: Maximizing impact on learning. Routledge. [GoodReads review]

Hattie, J. (2008). Visible learning: A synthesis of over 800 meta-analyses relating to achievement. Routledge [sample].

Nursing Education Network. (2017). John Hattie and Visible learning for Teachers.

 

Dialogic Leadership by William Isaacs

Journal Club Article: Isaacs, W. (1999). Dialogic leadership. The Systems Thinker, 10(1), 1-5.

“Human beings create, refine, and share knowledge through conversation.”

The Concept of Dialogue

“In the new knowledge-based, networked economy, the ability to talk and think together well is a vital source of competitive advantage and organizational effectiveness.

Think Together

A hallmark for many of us is that there are “no surprises” in our meetings. Yet this is the antithesis of dialogue. In dialogue people learn to use the energy of their differences to enhance their collective wisdom.

Dialogue Versus Discussion

Dialogue signifies a flow of meaning while “discussions are conversations where people hold onto and defend their differences. The hope is that the clash of opinion will illuminate productive pathways for action and insight. Yet in practice, discussion often devolves into rigid debate, where people view one another as positions to agree with or refute, not as partners in a vital, living relationship. Such exchanges represent a series of one-way streets, and the end results are often not what people wish for: polarized arguments where people withhold vital information and shut down creative options.”

Dialogic Leadership

“Dialogic leadership” is the term given to a way of leading that consistently uncovers, through conversation, the hidden creative potential in any situation. Four distinct qualities support this process, the abilities:

  1. to evoke people’s genuine voices,
  2. to listen deeply,
  3. to hold space for and respect as legitimate other people’s views, and
  4. to broaden awareness and perspective.

Four-Player Model

Four distinct kinds of actions that a person may take in any conversation:

  1. Move
  2. Follow
  3. Oppose
  4. Bystand

Balancing Advocacy & Inquiry 

To advocate well, you must move and oppose well; to inquire, you must bystand and follow.

Four Practices for Dialogic Leadership

  1. Listening: the ability to listen together
  2. Respecting: true respect enables genuine inquiry
  3. Suspending: to bystand with awareness
  4. Voicing: courageous speech

Changing the Quality of Action

Dialogic leadership focuses attention on two levels at once: the nature of the actions people take during an interaction and the quality of those interactions.  Dialogic leadership implies being a living example of what you speak about – that is, demonstrating these qualities in your daily life.”

Keywords: Advocacy; Inquiry; Dialogic; Leadership.

Thanks to Intensivist and Education Specialist Cameron Knott for guiding towards this resource (#CoP).

Resources:

Isaacs, W. (2008). Dialogue: The art of thinking together. Crown Business. [GoodReads review]

Isaacs, W. (1999). Dialogic leadership. The Systems Thinker, 10(1), 1-5.

Coelho Amestoy, S., Schubert Backes, V. M., Buss Thofehrn, M., Gue Martini, J., Schlindwein Meirelles, B. H., & de Lima Trindade, L. (2014). Dialogic leadership: strategies for application in the hospital environmentInvestigacion y educacion en enfermeria32(1), 119-127.

Teamwork and team training in the ICU: Where do the similarities with aviation end?

Journal Club Article: Reader, T. W., & Cuthbertson, B. H. (2011). Teamwork and team training in the ICU: Where do the similarities with aviation end?Critical care15(6), 313.

Background

Comparing the lessons learnt and development of team training approaches in the aviation industry to the complex needs of the Intensive Care Unit (ICU). The importance of teamwork and the coordination of behaviours in terms of patient care provided and subsequent outcomes. Higher levels of doctor-nurse collaboration improve safety and mortality rates. The recognised importance of poor communication which has been identified as a factor in medical error.

Team input and team processes = team output

  • Teamwork

“Team skills are important for maintaining safety in both domains, as multidisciplinary teams must work effectively under highly complex, stressful, and uncertain conditions. ”

  • Active & Latent Failures

“team-related ‘active failures’ (for example, failures to communicate the proximity of nearby aircraft) and ‘latent failures’ (for example, lack of team training, poor ergonomic design, and organizational culture) that influence behavior and error in the cockpit.”

  • Decision Making Under Stress

“Techniques include exposing teams to high-stress situations, training pilots to facilitate team discussions before and after stressful team activities, and cross-training aircrew team members to understand the demands and needs of one another’s role. Teams are trained in a multidisciplinary environment…….”

  • Hierarchical Team Structures

The ability to understand other roles, so in stressful events still work together as a team and negative behaviours and attitudes don’t effect performance.

  • Environmental Factors

“Fatigue and stress are known to negatively influence performance in the ICU, and non-technical factors such as team communication, situation awareness, and decision making frequently underlie error.”

Developing a workplace culture based upon safety requires supporting and valuing staff in the high risk environment of ICU, with models of training and supervision that focuses not only on the norms of practice (normative) and educative training, but on restorative and supportive resources to improve stress and burnout, and aid personal development.

Keywords: Intensive Care Unit; Team Performance; Human FactorsTeam Training; Aviation Industry; Cognitive Load; Situation Awareness.

Relevant additional resources around some of the themes identified in this articles to aid collaborative educational teamwork: