title: Quality improvement education and interprofessional learning of the
      perioperative team
title: [from theory to reality]
titleType: Subtitle
Creators: name: Hlede, Vjeko
Publisher: name: Lancaster University
Year: 2019
Subjects: quality improvement education
QIE
interprofessional learning
IPL
technology-enhanced learning
TEL
learning healthcare system
LHS
perioperative
perioperative surgical home
PSH
pay for performance
value based care
teamwork
physician anesthesiologist
nurse anesthetist
Surgical Care
ANESTHESIA
anesthesiologist assistants
Case study
Critical Realism
Thematic analysis
Activity Theory
abduction
retroduction
mechanisms
COMPLEXITY
Learning systems
egocentric
technocentric
ecocentric
holocentric.
evidence-based medicine
epistemic fallacy
epistemology
Ontology
continuing professional development
continuing medical education

description: 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 &gt;&gt; technocentric
      &gt;&gt; ecocentric &gt;&gt; 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.