Saturday, September 12, 2015

Interprofessional education; some research in progress

Building a Safer Health System (2000) documents risks associated with adverse events in hospitals in the USA. Such adverse events are not new. In 1976 Illich named such adverse events as iatrogenesis, the preventable harm that people experience in association with health practitioners. In a New Zealand study, Davis, Lay-Yee, Bryant, Scott, Johnson, and Bingley, (2002) reported an iatrogeneic rate 12.9% for those hospitalised. This involved a retrospective study of documented incidences across 13 NZ hospitals. The undocumented adverse event rate can be presumed to be much higher.

Evans (2007) reified the staggering size of these preventable events by providing the following provocative illustration: These 1500 deaths are equivalent to four Boeing 747’s crashing in New Zealand every year, a rate that is three times the road traffic death rate, and double the deaths from both homicide and suicide (Evans 2007, p. 16).[Computer generated photo of the collision. Photo/]
This study set out to investigate the concerns raised with regard to communications being implicated in the preventable harm caused by health practitioners in New Zealand in current times. The safe provision of health and disability services in New Zealand is overseen by the Office of the Health and Disability Commissioner(HDC).

Miscommunication is a significant contributor to iatrogenesis in healthcare practice in New Zealand.

In studying this, our analysis of complaints made to the HDC (100 complaints lodged with the HDC between February 2012 and May 2014) we found miscommunications implicated in 99 out of 100 case notes reviewed. Of particular note expanding on earlier research into communications related iatrogenesis is the multi-model nature of health related communications in current times. One third of the cases analysed involved technologically mediated communications, these included telephone calls, text messaging, faxed communications, and computer mediated communications such as emails.
However, while the technology is recognised as having influence, miscommunications do not occur in any of the reported discussions and case notes without there also being human involvement. While media representation tends to conflate what is new with also being causative, this is an attribution error.

Our findings provide irrefutable evidence of the need for healthcare practitioners to have well-developed interpersonal communication skills. The analysis also identified the need for health practitioners working with emergent technologies to understand how these technologies enhance or hinder practice. Of further significance is the amount of error that occurs involving communications between health practitioners.

Conclusions: As has been previously reported in the literature, the incidence of miscommunication within the health sector remains a serious and critical concern, one implicated in preventable deaths, as well as in the development of significant and ongoing disability, delays to treatment and the development of needless distress.
What is reported on here is an uncomfortable truth. However, there is scope to alter how communications are taught and learned by health professionals. Shifting the acquisition of communication skills from mastery of content to instead sharing a common skill set and practicing these inside of processes where we as health professionals learn to talk with each other,is but one step forward on this much needed path. This argument supports providing greater opportunities for interprofessional education, of having diverse groups of health professionals learning with and from each other rather than within siloed curricula.


Davis, P., Lay-Yee, R., Briant, R., Ali, W., Scott, A. J., & Schug, S. (2002). Adverse events in New Zealand public hospitals I: Occurrence and impact. The New Zealand Medical Journal, 115(1167).
Evans, S. (2007). Silence kills--challenging unsafe practice. Kai Tiaki: Nursing New Zealand, 13(3), 16-19.
Illich, I. (1976). Limits to medicine; Medical nemesis: The expropriation of health. London, England: Marion Boyars.

Tuesday, May 12, 2015

Interfering in Hinterlands of Discontent: Making a difference, differently

Given youth work is frequently entered into with the intention of making a difference in young people's lives, this article has been undertaken with the intention of making a difference differently. Drawing on actor-network theory, and the concept of hinterlands, influences shaping the practice of text counselling at a youth oriented helpline are discussed. This is however a contested space. There is no evidence base for such practice; but for new practices there never is. How then does novel practice come into being and become accepted? And how does this occur for people whose ways of engaging involves being neither seen nor heard? In presenting stories of practice as it is shaped there is opportunity to consider whose stories are heard and perhaps whose should be. In uncovering relations that would hold this particular practice more and less stable, scope is also provided for considering how making a difference might also be done differently.

Realities get made for better, or for worse, in practice. That some people’s realities might be made better or worse through the provision of a helpline service draws attention to the practices provided. Taking Law’s stance that practices always demand effort (Law, 2009) and therefore that such effort might be channeled otherwise, I argue for making a difference differently in the lives of young people.

Haxell, A. (2015). Interfering in Hinterlands of Discontent: Making a Difference Differently. International Journal of Actor-Network Theory and Technological Innovation (IJANTTI), 7(2), 30-40. doi:10.4018/IJANTTI.2015040103 New Zealand (hereafter referred to as Youthline), provides a 24/7 crisis helpline for young people, and has done so since 1976. With recent changes in mobile telephony their helpline hardly rings anymore; young people still have problems, and Youthline continues to provide help through this helpline, however, to a large extent, this now occurs silently. Mobile telephony provides us with more options than making a phone call, and as with any technology, those who would make use of a technology as well as the work that would be undertaken, are simultaneously being reconfigured. That work predicated on talking therapies would shift to a near silent medium, and one that places extreme limits of brevity on each interaction, was not an anticipated outcome in the provision of a text messaging service. The expectation that was described in the launch of this service by Youthline, was that this service would be a portal to the telephone helpline or to the face to face counselling services Youthline offers (Simpson Grierson, 2004).

There was no planned roll out of this innovative practice such as diffusion of innovation studies might suggest (see for example Rogers, 2003). Nor was it the result of reflective practitioners actively seeking a solution to named and framed problems (see for example Argyris, 1997; Argyris, 2004; Schön, 1990; Schön & Rein, 1994). And while a community of young people could be described as having influence on the changes that occurred and which continue to occur, this was not the outcome of a group of people coming together to effect change; the young people making use of this helpline never met to share ideas on the shape of the service. For these reasons it would also be wrong to name this as a user-initiated consumer innovation (see for example van Oost, Verhaegh, & Oudshoorn, 2009). The use of text messaging was initiated by Youthline, albeit, with an expectation that texting might provide a means for young people to contact the service when they might not otherwise. Texting for young people, at least in New Zealand and at least in these times, is very much the commonest way of reaching out when at a distance (Office of Film and Literature Classification and UMR Research, 2010). Youthline’s provision of a text service at least in the form of texting being a portal to other services, was a considered response to the ways in which young people were relating. To attribute such changes to a disruptive technology (see for example Bower & Christensen, 1995) would, therefore, also be wrong. While this change has occurred for Youthline, the technology has not resulted in texting being widespread in similar services, not even by other helpline services that this organization helps to staff. Attempts to explain this in terms of contextual determinants (see for example Schatzki, 2002), are similarly flawed. With the context of same staff and same building, and even same-target population, the unique phenomenon of a silent helpline is accordingly worthy of further exploration.

However, more than curiosity is at stake here; the practice of providing a texting service is one for which there is no evidence base for practice (EBP). How then does an organization justify new practice? How might it be known as to whether new practice is “doing good” or at least that it does no harm? And if a practice is to make a positive difference for people, what might be needed to support such difference making? While there is no evidence base for this particular practice it is also worth noting that for new practice there never is. This provides a conundrum: how can practices evolve when tied to measures developed in a past? In wanting to be responsive to current demands how is this space of past and present to be traversed? The current article explores these concerns through use of the metaphorical construct of hinterlands.

This article is available at

Haxell, A. (2015). Interfering in Hinterlands of Discontent: Making a Difference Differently. International Journal of Actor-Network Theory and Technological Innovation (IJANTTI), 7(2), 30-40. doi:10.4018/IJANTTI.2015040103