# Presentation: 511681

## Technology and Adult Learning: New Tools and Strategies 

**Henry Bernstein, DO ****Professor of Pediatrics****Dartmouth Medical School****John Parboosingh, MB****Professor emeritus****University of Calgary**_*** ***_

**Notes:**
The term collaborative work methods means establishing new techniques and new opportunities for workers/ professionals to interact, use technology to manage the outcomes of these interactions, and establish a learning culture by “managing collaboration”.

## Strategies to enhancecollaboration and interactivity in practice, research and education

-      Why the focus on collaboration and 	interactivity?
-    Introduction to Communities of Practice
-    Strategies & techniques to enhance 	collaboration and interactivity
-    Enhancing collaboration and interactivity with 	technology

## Competitive advantage from better interactions

**Competitive advantage from better interactions**
**  **companies are looking for ways to improve the effectiveness of top talent
-    what makes these workers valuable is their ability to work collaboratively, to improvise and improve solutions within an environment that fosters trust and constant learning.

**Notes:**
Here is an article on the front page of a newsletter from a prestigious research organization, dated February of this year.  The new term here is the use of the word “relationship capital”,indicating that high quality collaborative work methods can increase the value of stock in a company.

## Changing nature of PRACTICE				

-  Involves complex problem solving, ambiguity, conflict and uncertainty,
- 	requiring judgment and drawing on tacit, experiential, knowledge.
**“****Tacit** **work”**

**C Cole 2000**
**M****cKinsey Quarterly, 2005 #**** **

**Notes:**
Why do we need to change our methods of acquiring new knowledge and skills 
Research done by Mc Kinsey shows that the shift from transactional to tacit work requires us to think differently about how to improve learning capabilities.

## Interaction and Research

- The new view does not deny the importance of experimentation, but it holds that
- knowledge advances by bringing experimental findings into a sustained discourse, the purpose of which is to advance the state of knowledge and understanding”

- Bereiter & Scardamalia  2005

**Interaction and Research**

**Notes:**
The movement towards focusing on interactivity in CoPs as a means of exchanging information and creating knowledge has reached the scientific world.

## E. Coiera,“Four rules for the reinvention of healthcare” BMJ, 2004;328:1197-1199. 

- the largest communication network is the web of **conversations** that binds them.
- Together, people, tools, and conversations—these form the “_**system**_.”

- E. Coiera,“Four rules for the reinvention of healthcare” BMJ, 2004;328:1197-1199.

**Notes:**
So, clearly there is the movement towards Collaborative Work Methods in health services.

## What is meant by the term communities of practice (CoPs)? 

Why are CoPs used in the practice of healthcare, education and research? 

- Why are CoPs used in the practice of healthcare, education and research?

**Communities of Practice 101**

**Notes:**
While we should have a slide that describes the objectives of the section, it should have less detail than this one, which is really to guide us.

## Communities of Practice 

- Groups of people with a passion for a practice who share their concerns, successes and challenges and who deepen their understanding and practical knowledge by engaging in a process of collaborative learning.
- ):

**Notes:**
CoPs is a way of achieving the new paradigm – investing in relationships
Here is definition of a community of practice. The learning is focused on how to solve problems related to their practice.  
What keeps the group together is their passion for their practice, and the motivation to solve problems related to that practice.
Cops  are voluntary groups interested in their practice and not necessarily aligned to the objectives of the organization.
So, if we are going to use CoPs to invest in relationships in a department. How would we go about it?

## CoPs are used in 3 scenarios

-  To enhance team cohesiveness and quality of care
-  To enhance collaborative learning and integration of knowledge into practice
-   In think tanks and high level research groups 	creating new evidence-based knowledge

## Impact of Relational Coordination on Quality of Care, Postoperative Pain and Functioning, and Length of Stay:  A Nine-Hospital Study of Surgical Patients

Gittell J et al.  Medical Care: 2000 vol 38(8): 807-819

- Gittell J et al.  Medical Care: 2000 vol 38(8): 807-819

**Notes:**
Describe Southwest airline study and its tranferability to health care

## Does collaboration enhance research?

- It took seven weeks for the infective agent in SARS to be isolated.”
- John G. Bartlett, MD
- Professor, Infectious Diseases,
- John Hopkins University School of Medicine

**Does collaboration enhance research?**

## Different types of conversations in practice
Practical approaches to enhancing conversations in existing groups

- Practical approaches to enhancing conversations in existing groups

***Techniques to enhance collaboration***

##   Three different types of conversations  in the workplace

**Practice level**

**Team level**

**CoP**

**Notes:**
This slide emerged out of a discussion with Dr Etienne Wenger. We concluded that health workers exchange information at three levels.  First during practice, second when as a team they discuss how to improve practice such as in grand rounds; and there is a third level when healthcare workers meet informally say during lunch or outside of work. These are the communities of practice or groups of workers who share stories with each other.  These are the workers who were noticed in industry two decades ago to be exchanging information and learning from each other.  
The communication is different when they function as a team compared with when they meet informally in CoPs. Here they tell stories and interact socially while still talking about their practice.  It was noticed in industry that the discussions at this stage help team cohesiveness and improve the quality of the product more effectively than formal in-service training.  

## CoPs use STORIES to build conversation

- "Story is a re-imagined experience narrated with enough detail and feeling to cause your listeners' imaginations to experience it as real.“
*From Annette Simmons: *
*“**Whoever Tells the Best Story Wins”*

**Notes:**

 Here are the latest updates for parboo@telusplanet.net

"Anecdote" - 1 new article
Stories create culture
It's said that stories create cultures; they propagate the assumptions and beliefs throughout the group in question.
Hearing a story is the second-best way to gain experience and in many cases it's the only available option. Sometimes it's too dangerous to gain first hand experience or the opportunity to gain first hand experience never presents itself. So the idea that a story is re-imagined experience is important and useful. And the impact of a story is heightened the more real it seems.
Leaders must be poised to lead a response to stories told. To disrupt a response if necessary. For leaders this is about self awareness and being aware of the stories being told (which means being able to identify stories) and observing how people respond--and being ready and willing to intervene.

## Traditional discourse: we are providing a point of view, seeking agreement or settling differences. It is directive, advocating and defensive.

Generative dialogue: We use stories to reconstruct practice and express perspectives on issues. 
Stories generate new understandings and new knowledge.
It is a “how can we do this better” conversation

_**Generative dialogue:**_** **We use stories to reconstruct practice and express perspectives on issues.
- Stories generate new understandings and new knowledge.
- It is a “how can we do this better” conversation

- Manoj Pawar (2006).
- Bereiter and Scardamalia. 2006)

**Notes:**
We find that many health professionals have difficulty moving into generative dialogue.
Arising from the The South African Truth and Reconciliation Commission , there is expertise in facilitating dialogue published by the Nelson Mandela Foundation in which it describes 10 tools to facilitate dialogue, some of which you will be familiar – for example Appreciative Inquiry.

## In CoPs we use “evidence” 

**RESEARCH**

**PRACTITIONER EXPERIENCE**

**CLIENT VALUES**

**LOCAL**
**INFORMATION**

**SYNTHESIS OF INFORMATION**

**In CoPs we use “evidence” **
**from 4 sources**

- What Counts As Evidence In Evidence-based Practice?
- Rycroft-malone J. , et al  (2004) Journal of Advanced Nursing 47(1), 81–90

**Notes:**
C. Knowledge Management experts talk about FOUR sources of EVIDENCE
Understanding that knowledge is more than research based protocols as in Cochrane’s systematic reviews is essential to valuing CoPs. In fact, there are four sources of information that need to be coordinated in the Management of Knowledge. We need to upgrade our use of the other 3 sources of information.

## Practice Talk has three components

**SERVICE PROVISION**
- Smooth running
- Job satisfaction
- ‘Keeps you going’

**WORK BARRIERS**
- Immediate problem solving
- Putting out fires
- Frustration generator

**CAREER**
** ****DEVELOPMENT**
- Achieving new competencies
- Following evidence
- Career plans

**Practice Talk has three components**

**Notes:**
Here is a suggestion for a structured approach to talking about one’s practice

## Mapping Dialogue: A research project profiling dialogue tools and processes for social change, 2006, Johannesburg, South Africa

**FACILITATION SKILLS ARE ESSENTIAL**

- Harvey G  et al (2002) Getting evidence into practice: the role and function of facilitation. Journal of Advanced Nursing 37(6), 577–588

## Technology to build community (social presence)
Technology to  support conversations

- Technology to  support conversations

***The role of technology in ***
***communities of practice***

**Notes:**
While we should have a slide that describes the objectives of the section, it should have less detail than this one, which is really to guide us.

## “The renewed emphasis on collaborative learning is pushing the educational community to develop new forms of interaction and assessment.”

## THE LEARNING COMMUNITY

***THE LEARNING COMMUNITY***
**(The next generation of collaborative learning)**

**The network is organized around people, rather than around content**
**The daily successes & challenges of the people determine the content**

## Examples of collaborative space

**Examples of collaborative space**
**(The next generation of collaborative learning)**

- Google groups
- CollectiveX
- CentralDesktop
- ning.com
- community.globeforum.com
- Sossoon.net

## DIGITAL STORYTELLING

- http://www.ustream.com

- http://voicethread.com/

**DIGITAL STORYTELLING**
**METHODS**

## Technology and Adult Learning: New Tools and Strategies 

**Henry Bernstein, DO**email: henry.bernstein@dartmouth.edu** ****John Parboosingh, MB**email: parboo@telusplanet.net

**Notes:**
The term collaborative work methods means establishing new techniques and new opportunities for workers/ professionals to interact, use technology to manage the outcomes of these interactions, and establish a learning culture by “managing collaboration”.