Search

Background: Patient safety requires mindful routines in the operating room. Usually, time pressure is presented as an unavoidable constraint to mindful routines and a consequence of workload imposed on teams. We aim to understand time pressure and how it interacts with developing mindful routines. Methods: This naturalistic case study was conducted with a surgical team in a Dutch academic hospital using ethnographic methods including participant observation, interviews, and fieldnotes. The researcher observed the team for 103 h. Our analysis integrates habit theory and mindful organising principles. Results: Team culture reflected deference to speed, preoccupation with productivity, conflict avoidance, and value on affective relationships. Conflicting priorities arose from differences in safety norms, worries about time, and beliefs about what saves time. Addressing these conflicting priorities, however, was rare. Creating shared Situational Awareness (SA) helped prevent or mitigate time pressure, though it was not a consistently embedded routine. New routines were often compromised under time pressure, while established habits showed resilience to time constraints. Conclusions: Rather than being workload-driven, time pressure emerged as a co-constructed outcome of conflicting priorities and the preservation of affective relationships. The imperative to save time motivated shared situational awareness and the formation of new mindful routines. We recommend enhancing mindful routines by refining current practices in mortality and morbidity meetings, expanding stakeholder involvement, and addressing prevailing concerns.

Abstract Background Distributed healthcare settings such as district hospitals, primary care, and public health facilities are becoming the real-life settings for workplace-based learning required to educate the future healthcare workforce. Therefore, a major focus should be on designing and developing workplace-based learning in these learning environments. Healthcare professionals and educational policymakers play a significant role in these settings as role models in workplace-based learning, and as leaders in integrating learning into their work environments. It is relevant to explore their beliefs, attitudes, and behaviors towards workplace-based learning in their own settings, in order to provide context-relevant recommendations that can assist in shaping workplace-based learning environments. Methods We used individual interviews to understand professionals’ experiences with workplace-based learning in distributed healthcare settings. We - three clinicians, an educationalist, and a philosopher - thematically analyzed transcripts of 13 interviews with healthcare professionals and educational policymakers from different healthcare settings who were involved in the clinical phase of undergraduate medical education. Results Clustering and categorizing of the data led to the construction of five overarching themes: Identification with and attitude towards medical education, Sense of ownership, Perceived time and space, Mutual preconceptions and relations, and Curriculum for a changing profession. Conclusions These themes accentuate aspects relevant to the development of workplace-based learning in distributed healthcare settings on the individual, team, or organizational level. We highlight the significance of individual professionals in the development of workplace-based learning and emphasize the need for recognition and support for those occupying the ‘broker’ role at the intersection of education and practice. For future research and educational practice, we recommend prioritizing initiatives that build on good-practices in workplace-based learning and involve dedicated individuals in distributed healthcare settings.

The GAME 2019 #FuturistForum involved an exchange of ideas and perspectives on the future of learning in healthcare and necessary evolutions to sustain future health systems. This event allowed for reflection and discourse around a) what medical learning or learning in healthcare may look like 10-15 years from now, b) how technology would impact that evolution, and c) what collaborative roles distinct stakeholders would play. Seventy-five (75) key stakeholders, experts from various fields, participated in the two-day event. Four multifaceted themes were uncovered from the qualitative analysis, which are: learning will be lifelong and outcome-based, the health system will follow a preventive care model, technology will be an enabler of evolution in education and health systems, and that multi-level collaboration will support and sustain future progress. Future implications, exacerbated by the ongoing COVID-19 pandemic, and study limitations are described., Competing Interests: Werner Bill, Eric Bonnefoy, Susanna Price, Olaf Wokenhauer and Nabil Zary have no relevant financial or non-financial competing interests to report that may be affected by the research reported in the enclosed paper. Jur Koksma and Dale Kummerle serve on the Board of the Global Alliance for Medical Education. Suzanne Murray serves on the Board of JECME and the Global Alliance for Medical Education. Aviad Haramati serves on the Board of Directors of the Association of American Medical Colleges and on the Academic Advisory Board of ScholarRx., (© 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)