1 00:00:12,150 --> 00:00:17,600 >> Good evening everyone. 2 00:00:17,600 --> 00:00:21,650 I am a Communications Researcher and I study healthcare teams, 3 00:00:21,650 --> 00:00:24,890 that means I follow them around while they do their work, 4 00:00:24,890 --> 00:00:29,735 and I talk to them afterwards about why it is that they work the way they do. 5 00:00:29,735 --> 00:00:34,850 I've studied teams in all kinds of healthcare settings; operating rooms, 6 00:00:34,850 --> 00:00:37,760 intensive care units, emergency departments, 7 00:00:37,760 --> 00:00:42,440 pediatric hospitals, rehab hospitals, transplant units. 8 00:00:42,440 --> 00:00:44,250 Whenever I study a team, 9 00:00:44,250 --> 00:00:45,900 I ask three questions. 10 00:00:45,900 --> 00:00:48,615 How does this team communicate? 11 00:00:48,615 --> 00:00:53,800 How does their communication influence the patient care they can deliver? 12 00:00:53,800 --> 00:00:57,739 How would we educate healthcare professionals and students, 13 00:00:57,739 --> 00:01:02,800 so that their team communication and their patient care improve? 14 00:01:02,800 --> 00:01:07,030 I've been studying healthcare teams for about 15 years, 15 00:01:07,030 --> 00:01:11,570 and one of the most important things I've learned to date is this. 16 00:01:11,570 --> 00:01:20,379 Healthcare is full of highly competent individuals, competent family physicians, 17 00:01:20,379 --> 00:01:25,580 competent nurses and nurse practitioners, competent specialists, 18 00:01:25,580 --> 00:01:32,550 competent pharmacists, dietitians, home-care workers, social workers. 19 00:01:32,800 --> 00:01:40,220 But only sometimes do these competent individuals come together to form a competent team. 20 00:01:40,220 --> 00:01:43,035 In fact, not infrequently, 21 00:01:43,035 --> 00:01:48,620 competent individuals come together to form an incompetent team. 22 00:01:49,790 --> 00:01:52,020 You might be wondering, 23 00:01:52,020 --> 00:01:54,490 how is that possible? 24 00:01:54,530 --> 00:01:57,480 Well, let me tell you a story. 25 00:01:57,480 --> 00:02:05,050 This is Joe, he's 75 years old and he lives at home alone since his wife died a year ago. 26 00:02:05,050 --> 00:02:07,780 Joe had his first heart attack at 55, 27 00:02:07,780 --> 00:02:09,685 and he has had three more since. 28 00:02:09,685 --> 00:02:12,700 He's been a diabetic for 25 years and 29 00:02:12,700 --> 00:02:16,340 because of his diabetes he has some mild kidney trouble. 30 00:02:16,350 --> 00:02:20,725 A month ago, Joe was admitted to hospital for pneumonia, 31 00:02:20,725 --> 00:02:22,720 and while he was in hospital, 32 00:02:22,720 --> 00:02:24,470 his kidney troubles worsened due to 33 00:02:24,470 --> 00:02:28,085 a drug side effect from one of his blood pressure pills. 34 00:02:28,085 --> 00:02:32,540 The hospital doctors stopped this pill and Joe did well, 35 00:02:32,540 --> 00:02:35,970 recovered from his pneumonia and went home. 36 00:02:36,580 --> 00:02:39,245 About a week after he went home, 37 00:02:39,245 --> 00:02:42,125 he had a follow-up appointment with his family doctor, 38 00:02:42,125 --> 00:02:44,600 but the discharge note hadn't made it to 39 00:02:44,600 --> 00:02:47,225 the family doctor's office yet from the hospital. 40 00:02:47,225 --> 00:02:51,750 So, the doctor doesn't know about his kidney trouble in hospital, 41 00:02:51,750 --> 00:02:54,440 Joe doesn't have any medication list to bring with 42 00:02:54,440 --> 00:02:56,960 him but he does bring all of his pill bottles 43 00:02:56,960 --> 00:02:58,970 including the pill that was stopped in 44 00:02:58,970 --> 00:03:02,045 hospital because Joe restarted it when he got home, 45 00:03:02,045 --> 00:03:04,465 he didn't know he wasn't supposed to. 46 00:03:04,465 --> 00:03:07,750 The family doctor is looking at the blood test results 47 00:03:07,750 --> 00:03:10,479 from about six weeks before Joe went into hospital, 48 00:03:10,479 --> 00:03:13,525 and she's concerned about his blood sugar control. 49 00:03:13,525 --> 00:03:18,650 So, she refers him to a diabetes specialist who he has seen in the past. 50 00:03:19,230 --> 00:03:22,945 But two weeks later when Joe goes to this appointment, 51 00:03:22,945 --> 00:03:28,090 the diabetes specialist shares the family doctor's concern about the blood sugar control, 52 00:03:28,090 --> 00:03:32,530 and he decides that Joe's current medication must not be working well enough. 53 00:03:32,530 --> 00:03:36,700 So he prescribes a new blood sugar control medication. 54 00:03:36,700 --> 00:03:39,820 On his way home from that specialist appointment, 55 00:03:39,820 --> 00:03:44,870 Joe pulls into a pharmacy he doesn't usually go to and he fills this new prescription. 56 00:03:45,740 --> 00:03:48,740 Now, for the last number of months Joe has been 57 00:03:48,740 --> 00:03:51,365 having homecare nurses come visit him in his home, 58 00:03:51,365 --> 00:03:56,060 and one of the things they'd become concerned about is his medication compliances. 59 00:03:56,060 --> 00:03:59,125 You see sometimes Joe forgets to take his pills, 60 00:03:59,125 --> 00:04:01,100 sometimes when Joe remembers, 61 00:04:01,100 --> 00:04:04,355 he doubles the dose to make up for not taking them. 62 00:04:04,355 --> 00:04:07,700 Now the nurses are working with Joe and they're teaching him 63 00:04:07,700 --> 00:04:10,790 new medication management strategies to deal with this problem, 64 00:04:10,790 --> 00:04:14,270 and they're recording the problem in the home care binder. 65 00:04:14,270 --> 00:04:16,640 But the family doctor doesn't know about it 66 00:04:16,640 --> 00:04:20,170 nor is communicated to the diabetes specialist. 67 00:04:20,959 --> 00:04:23,060 Now as it happens, 68 00:04:23,060 --> 00:04:27,150 the new medication that the specialists prescribed is a little hard on the kidneys, 69 00:04:27,150 --> 00:04:29,990 and the specialist wouldn't have prescribed it if he'd 70 00:04:29,990 --> 00:04:33,840 known of Joe's recent kidney trouble in hospital. 71 00:04:33,880 --> 00:04:38,270 But he didn't know, and Joe shows 72 00:04:38,270 --> 00:04:41,989 up in the emergency room couple days after starting his new prescription, 73 00:04:41,989 --> 00:04:44,790 with a low blood sugar reaction. 74 00:04:44,810 --> 00:04:48,430 Does any on these sound familiar? 75 00:04:50,090 --> 00:04:53,055 What's going on here? 76 00:04:53,055 --> 00:04:55,695 Joe got competent care in hospital, 77 00:04:55,695 --> 00:04:57,420 he recovered from his pneumonia. 78 00:04:57,420 --> 00:05:00,110 He got competent care from his family doctor, 79 00:05:00,110 --> 00:05:03,560 his diabetes specialist, his homecare nurses, and the pharmacist, 80 00:05:03,560 --> 00:05:06,440 each of those individuals within their scope of 81 00:05:06,440 --> 00:05:09,590 practice and acting on the information at hand, 82 00:05:09,590 --> 00:05:11,665 did the right thing for Joe, 83 00:05:11,665 --> 00:05:18,930 but the sum total of those care events is not overall competent care for Joe. 84 00:05:19,780 --> 00:05:23,270 Now this is a very complex problem 85 00:05:23,270 --> 00:05:26,150 and it's being tackled from a number of different angles, 86 00:05:26,150 --> 00:05:30,259 systems engineers are trying to understand it better to improve the situation, 87 00:05:30,259 --> 00:05:32,630 organizational scientists are trying to work on it, 88 00:05:32,630 --> 00:05:34,405 sociologists are working on it. 89 00:05:34,405 --> 00:05:38,630 Tonight, I'm going to shed some light on this problem from my perspective as 90 00:05:38,630 --> 00:05:43,770 a communications researcher who's interested in improving medical education. 91 00:05:45,280 --> 00:05:49,700 There are significant barriers that make it difficult for 92 00:05:49,700 --> 00:05:53,959 individual competence to translate into collective competence, 93 00:05:53,959 --> 00:05:56,700 I'm going to focus on three. 94 00:05:56,720 --> 00:06:00,240 The first is scientific reductionism, 95 00:06:00,240 --> 00:06:02,600 this refers to the way that we tackle 96 00:06:02,600 --> 00:06:08,030 complex scientific phenomena by breaking them down into their component parts. 97 00:06:08,030 --> 00:06:10,520 Now scientific reductionism has produced 98 00:06:10,520 --> 00:06:14,980 some spectacular advances in our knowledge but translated into patient care, 99 00:06:14,980 --> 00:06:18,110 it means that Joe's heart disease, his diabetes, 100 00:06:18,110 --> 00:06:22,620 and his kidney troubles are all treated as separate entities. 101 00:06:22,840 --> 00:06:29,345 The separate barrier between individual and collective competence is specialization. 102 00:06:29,345 --> 00:06:32,225 Now medical specialization is necessary, 103 00:06:32,225 --> 00:06:35,180 no physician can know everything there is to know about 104 00:06:35,180 --> 00:06:38,925 medicine but specialization has consequences. 105 00:06:38,925 --> 00:06:42,270 If I have heart disease, ovarian cancer, 106 00:06:42,270 --> 00:06:48,005 and depression, all three of those issues will be treated by three different specialists. 107 00:06:48,005 --> 00:06:50,260 If I live in a rural area, 108 00:06:50,260 --> 00:06:55,100 those three specialists will likely work for three distinct healthcare organizations, 109 00:06:55,100 --> 00:07:00,540 which will likely be located in three different cities. 110 00:07:01,550 --> 00:07:04,385 The third barrier between 111 00:07:04,385 --> 00:07:10,925 individual and collective competence is the very concept of individual competence itself. 112 00:07:10,925 --> 00:07:12,860 The goal of producing 113 00:07:12,860 --> 00:07:15,920 an individually competent healthcare provider with 114 00:07:15,920 --> 00:07:20,140 their own specific tightly bounded expertise, 115 00:07:20,140 --> 00:07:22,490 drives everything in health professions 116 00:07:22,490 --> 00:07:26,490 education generally and medical education specifically. 117 00:07:26,720 --> 00:07:30,795 Now each of these three things: reductionism, 118 00:07:30,795 --> 00:07:36,170 specialization, and the goal of individual competence are in and of themselves good. 119 00:07:36,170 --> 00:07:40,195 Reductionism allows us to understand complex problems, 120 00:07:40,195 --> 00:07:45,540 specialization allows us to build a deep expertise in a particular area, 121 00:07:45,540 --> 00:07:48,050 and individual competence well everybody 122 00:07:48,050 --> 00:07:51,315 wants an individually competent healthcare provider right? 123 00:07:51,315 --> 00:07:55,060 But together and kind of paradoxically, 124 00:07:55,060 --> 00:08:00,820 these three factors combine to produce one of healthcare's greatest weaknesses. 125 00:08:00,820 --> 00:08:05,465 That is the providers work in isolation from one another, 126 00:08:05,465 --> 00:08:11,095 each person focused on the particular issue about which they are an expert. 127 00:08:11,095 --> 00:08:14,630 When that happens, patients can fall into 128 00:08:14,630 --> 00:08:19,500 the cracks between individually competent care providers. 129 00:08:20,910 --> 00:08:23,290 The theme of tonight's event in 130 00:08:23,290 --> 00:08:27,715 adaptation and one way of expressing the meaning of adaptation 131 00:08:27,715 --> 00:08:30,655 is that it's a process of change by which an organism 132 00:08:30,655 --> 00:08:34,480 or a species becomes better suited to its environment. 133 00:08:34,480 --> 00:08:37,914 I'm suggesting tonight that we need to adapt 134 00:08:37,914 --> 00:08:42,380 our thinking so that we can provide better patient care. 135 00:08:42,720 --> 00:08:46,570 What do we need to adapt from? 136 00:08:46,570 --> 00:08:49,885 Well, I would argue that we need to adapt from 137 00:08:49,885 --> 00:08:54,580 our exclusive focus on the goal of individual competence. 138 00:08:54,580 --> 00:08:59,590 Individual competence is a set of pervasive and rarely challenged assumptions. 139 00:08:59,590 --> 00:09:01,690 It's not unique to medical education, 140 00:09:01,690 --> 00:09:04,255 it's true of education everywhere. 141 00:09:04,255 --> 00:09:08,470 Three of these assumptions are very important to my argument tonight. 142 00:09:08,470 --> 00:09:12,700 One is the premise that competency is a quality the individuals possess. 143 00:09:12,700 --> 00:09:14,590 So, I'm competent because of, 144 00:09:14,590 --> 00:09:17,935 for instance, the knowledge I possess in my head. 145 00:09:17,935 --> 00:09:21,400 Related to this is the premise that competence is 146 00:09:21,400 --> 00:09:24,984 a state to be achieved so that we can take naive learners, 147 00:09:24,984 --> 00:09:27,520 put them through a medical education process, 148 00:09:27,520 --> 00:09:33,835 fill their empty vessels up with competence and graduate them in a state of competence. 149 00:09:33,835 --> 00:09:36,820 Related to this is the third premise, 150 00:09:36,820 --> 00:09:39,925 which is that, competence is context-free. 151 00:09:39,925 --> 00:09:42,790 Its independent of time and space. 152 00:09:42,790 --> 00:09:45,640 So, if I'm competent tonight in Bayfield, 153 00:09:45,640 --> 00:09:50,245 I'll be competent next week in Toronto and next year in Paris, France. 154 00:09:50,245 --> 00:09:56,050 Now, this notion of individual competence drives everything in medical education, 155 00:09:56,050 --> 00:09:59,530 from the way we select candidates for entry into medical school, 156 00:09:59,530 --> 00:10:02,245 to the way that we teach and assess their performance, 157 00:10:02,245 --> 00:10:05,035 to the way that we license them for practice, 158 00:10:05,035 --> 00:10:09,910 monitor their practice over the course of their career and if we smell a problem, 159 00:10:09,910 --> 00:10:12,745 we look for the individual most responsible, 160 00:10:12,745 --> 00:10:14,784 we pull them out of the system, 161 00:10:14,784 --> 00:10:17,890 remediate them if necessary and put them back in. 162 00:10:17,890 --> 00:10:21,080 Individual competence everywhere. 163 00:10:21,570 --> 00:10:28,285 Now, this educational model made sense in the environment which created it, 164 00:10:28,285 --> 00:10:32,395 and that healthcare environment was this; 165 00:10:32,395 --> 00:10:39,920 a single patient visiting their physician for the care of an ailment. 166 00:10:40,980 --> 00:10:44,395 The healthcare environment has changed. 167 00:10:44,395 --> 00:10:49,210 This is a report published in 2011 by the Canadian Institute of Health Information. 168 00:10:49,210 --> 00:10:50,950 You can find it online. 169 00:10:50,950 --> 00:10:56,215 In a nutshell, what it tells us is that Joe is an average patient. 170 00:10:56,215 --> 00:11:01,165 A quarter of Canadian seniors report having three or more chronic conditions. 171 00:11:01,165 --> 00:11:03,160 That's about a million people. 172 00:11:03,160 --> 00:11:09,290 These same people report over 13 million healthcare visits per year. 173 00:11:09,540 --> 00:11:12,940 We're no longer talking about patients going to 174 00:11:12,940 --> 00:11:16,105 see their single physician with a single ailment. 175 00:11:16,105 --> 00:11:18,565 The environment has radically changed, 176 00:11:18,565 --> 00:11:22,180 but the way we think about competence has not. 177 00:11:22,180 --> 00:11:26,000 So, what do we need to adapt to? 178 00:11:26,880 --> 00:11:33,955 We need to broaden our notion of competence to include collective competence. 179 00:11:33,955 --> 00:11:36,250 What do I mean by that? 180 00:11:36,250 --> 00:11:41,785 Collective competence is a distributed capacity of a system. 181 00:11:41,785 --> 00:11:45,250 It's not reducible to a single individual. 182 00:11:45,250 --> 00:11:49,045 Collective competence is also an evolving dynamic. 183 00:11:49,045 --> 00:11:52,450 It's not a stable trait, it changes. 184 00:11:52,450 --> 00:11:55,330 It changes in relation to context. 185 00:11:55,330 --> 00:11:57,940 It is intimately tied to context. 186 00:11:57,940 --> 00:12:01,930 The competence of my performance is influenced by 187 00:12:01,930 --> 00:12:07,730 the limitations and the affordances of the situation that I'm in at this moment. 188 00:12:08,880 --> 00:12:14,410 I'm talking about an enormous adaptation, a game changer. 189 00:12:14,410 --> 00:12:17,695 For hundreds of years in Madison we've thought about 190 00:12:17,695 --> 00:12:20,170 individual competence and I'm talking about 191 00:12:20,170 --> 00:12:24,190 changing that notion to include something very different. 192 00:12:24,190 --> 00:12:27,860 You might wonder, is this even possible? 193 00:12:28,440 --> 00:12:33,280 Not only is it possible but I'd like to touch on three ways in 194 00:12:33,280 --> 00:12:38,110 which we are right now moving towards collective competence. 195 00:12:38,110 --> 00:12:41,363 The first, I think, is a relatively simple way. 196 00:12:41,363 --> 00:12:43,255 Let's go back to Joe. 197 00:12:43,255 --> 00:12:48,130 The fundamental problem at the crux of Joe's situation is this. 198 00:12:48,130 --> 00:12:53,920 Joe travels through the healthcare system more quickly than his health information does. 199 00:12:53,920 --> 00:12:58,210 We have the technology to address this problem, 200 00:12:58,210 --> 00:13:00,535 to move information more efficiently. 201 00:13:00,535 --> 00:13:06,535 One example of relevance to Joe's story is the global medication electronic record. 202 00:13:06,535 --> 00:13:10,260 This would have allowed the pharmacist that Joe went to, 203 00:13:10,260 --> 00:13:13,380 to view the prescription in light of all of 204 00:13:13,380 --> 00:13:16,710 Joe's current medications and his past medications. 205 00:13:16,710 --> 00:13:19,695 Unfortunately, the pharmacist in Joe's jurisdiction 206 00:13:19,695 --> 00:13:23,060 didn't have access to a global medication electronic record. 207 00:13:23,060 --> 00:13:25,850 But many jurisdictions do. 208 00:13:26,480 --> 00:13:31,230 A more sophisticated way in which we're moving towards collective competence right 209 00:13:31,230 --> 00:13:35,840 now is an experiment that we're all involved in in this room. 210 00:13:35,840 --> 00:13:40,960 That's the shift to deliver primary care through family health teams. 211 00:13:40,960 --> 00:13:45,550 A family health team brings together a primary care physician, 212 00:13:45,550 --> 00:13:51,850 a primary care nurses and a number of other health professionals: pharmacists, 213 00:13:51,850 --> 00:13:55,840 social workers, dietitians, physical therapists, et cetera. 214 00:13:55,840 --> 00:14:00,145 It puts them all under one roof so that Joe 215 00:14:00,145 --> 00:14:05,990 doesn't have to go off to six different places to have six different needs met. 216 00:14:06,750 --> 00:14:13,585 Family healthcare teams offer a better model for teamwork and collective competence. 217 00:14:13,585 --> 00:14:17,650 They also come with new funding mechanisms that ought to promote 218 00:14:17,650 --> 00:14:22,580 collective competence in a way that the traditional funding mechanisms never could. 219 00:14:24,390 --> 00:14:30,745 But it takes more than putting people under one roof to get to collective competence. 220 00:14:30,745 --> 00:14:34,720 Listen to these pharmacists from a new family health team. 221 00:14:34,720 --> 00:14:39,130 "I'm a pharmacist, so I know how to be a pharmacist. 222 00:14:39,130 --> 00:14:41,110 I don't know how to be a pharmacist in 223 00:14:41,110 --> 00:14:44,365 a family health team because nobody knows about that yet. 224 00:14:44,365 --> 00:14:48,550 I walked in and I did pharmacy things but I didn't know what 225 00:14:48,550 --> 00:14:52,915 that meant in relation to what the nurse does or what the dietitian does." 226 00:14:52,915 --> 00:14:54,850 This pharmacist is saying, 227 00:14:54,850 --> 00:15:01,015 I'm individually competent but I'm not so sure about how to be collectively competent. 228 00:15:01,015 --> 00:15:04,360 The structural change involved in family health teams is 229 00:15:04,360 --> 00:15:07,795 an enormously positive first step but it's insufficient. 230 00:15:07,795 --> 00:15:11,660 We need an educational change to go along with it. 231 00:15:13,110 --> 00:15:17,200 The third way in which we're moving towards collective competence is 232 00:15:17,200 --> 00:15:20,905 a more strategic way and I've picked one of many examples here. 233 00:15:20,905 --> 00:15:23,455 By strategic, I mean, 234 00:15:23,455 --> 00:15:25,690 take a look at the healthcare system, 235 00:15:25,690 --> 00:15:30,130 find those points in the system where a failure of collective competence can have 236 00:15:30,130 --> 00:15:32,410 dire consequences and build 237 00:15:32,410 --> 00:15:36,595 initiatives to support collective competence in those moments. 238 00:15:36,595 --> 00:15:40,090 What I'm going to talk about is an initiative to build 239 00:15:40,090 --> 00:15:44,770 collective competence in the operating room to help surgical teams communicate better. 240 00:15:44,770 --> 00:15:47,440 This is an initiative that my research team and others 241 00:15:47,440 --> 00:15:50,530 around the world have had intimate involvement with. 242 00:15:50,530 --> 00:15:55,480 Now, why pick the operating room as a moment in the healthcare system? 243 00:15:55,480 --> 00:16:01,000 Well, when they analyze errors in the operating room such as wrong site surgery, 244 00:16:01,000 --> 00:16:04,750 they find that the root cause is far more likely to be a breakdown in 245 00:16:04,750 --> 00:16:09,950 communication on the team than it is technical skill or a lack of knowledge. 246 00:16:10,260 --> 00:16:13,810 So, a number of us around the world conducted research, 247 00:16:13,810 --> 00:16:15,430 myself for about a decade, 248 00:16:15,430 --> 00:16:19,525 in operating rooms trying to figure out how could we help this situation. 249 00:16:19,525 --> 00:16:22,345 What arose from that international research 250 00:16:22,345 --> 00:16:25,690 was what's called by the World Health Organization now, 251 00:16:25,690 --> 00:16:28,345 the Safe Surgery Saves Lives initiative. 252 00:16:28,345 --> 00:16:33,610 What it is, is a protocol for surgeon and their citizens and nurse to come together at 253 00:16:33,610 --> 00:16:36,190 points in a surgical procedure and make sure 254 00:16:36,190 --> 00:16:39,805 they're sharing the critically salient information. 255 00:16:39,805 --> 00:16:42,950 This initiative has in fact become so 256 00:16:42,950 --> 00:16:46,055 successful that it's had enormous international uptake. 257 00:16:46,055 --> 00:16:50,690 You can go to the WHO website and actually zoom in on your own jurisdiction. 258 00:16:50,690 --> 00:16:53,580 I tested it. I zoomed in on us here. 259 00:16:53,580 --> 00:16:59,205 You can see the hospitals that are registered in this particular checklist initiative. 260 00:16:59,205 --> 00:17:04,310 In fact, it's become mandatory in this country and many others for 261 00:17:04,310 --> 00:17:06,710 surgical teams to do some kind of 262 00:17:06,710 --> 00:17:10,980 preoperative briefing or checklist before they start an operation. 263 00:17:12,270 --> 00:17:17,630 I've described to you three advances that I think are important ones 264 00:17:17,630 --> 00:17:19,790 and show the potential and the work on 265 00:17:19,790 --> 00:17:23,315 the ground to move towards collective competence now. 266 00:17:23,315 --> 00:17:28,369 But collective competence is about more than good software, 267 00:17:28,369 --> 00:17:32,195 good Internet use, checklists, other tools. 268 00:17:32,195 --> 00:17:36,290 Collective competence must be a value and 269 00:17:36,290 --> 00:17:40,905 underpinning philosophy and an educational mission. 270 00:17:40,905 --> 00:17:46,175 If I picture curiosity tonight and you want to think more about this problem, 271 00:17:46,175 --> 00:17:48,470 I have a book coming out with my colleagues later 272 00:17:48,470 --> 00:17:51,165 in the floor called The Question of Competence. 273 00:17:51,165 --> 00:17:54,900 For tonight, let me summarize my argument this way. 274 00:17:54,900 --> 00:17:59,895 Medical education is driven by the goal of individual competence. 275 00:17:59,895 --> 00:18:05,930 Consequently, healthcare is full of highly competent individuals. 276 00:18:05,930 --> 00:18:08,570 This is a very good thing. 277 00:18:08,570 --> 00:18:12,425 Individual competence is absolutely necessary but it's 278 00:18:12,425 --> 00:18:16,730 insufficient to meet the needs of the current healthcare environment. 279 00:18:16,730 --> 00:18:21,825 Collective competence is an urgently needed adaptation. 280 00:18:21,825 --> 00:18:27,260 It will require healthcare professionals to think and act differently, 281 00:18:27,260 --> 00:18:31,315 and it will require patients to think and act differently too. 282 00:18:31,315 --> 00:18:33,565 When we achieve it, 283 00:18:33,565 --> 00:18:35,180 I believe it will look something 284 00:18:35,180 --> 00:18:36,750 like this. 285 00:19:25,420 --> 00:19:27,990 Thank you.