[Script Info]
Title: 
[Events]
Format: Layer, Start, End, Style, Name, MarginL, MarginR, MarginV, Effect, Text
Dialogue: 0,0:00:12.15,0:00:17.60,Default,,0000,0000,0000,,>> Good evening everyone.
Dialogue: 0,0:00:17.60,0:00:21.65,Default,,0000,0000,0000,,I am a Communications Researcher and I study healthcare teams,
Dialogue: 0,0:00:21.65,0:00:24.89,Default,,0000,0000,0000,,that means I follow them around while they do their work,
Dialogue: 0,0:00:24.89,0:00:29.74,Default,,0000,0000,0000,,and I talk to them afterwards about why it is that they work the way they do.
Dialogue: 0,0:00:29.74,0:00:34.85,Default,,0000,0000,0000,,I've studied teams in all kinds of healthcare settings; operating rooms,
Dialogue: 0,0:00:34.85,0:00:37.76,Default,,0000,0000,0000,,intensive care units, emergency departments,
Dialogue: 0,0:00:37.76,0:00:42.44,Default,,0000,0000,0000,,pediatric hospitals, rehab hospitals, transplant units.
Dialogue: 0,0:00:42.44,0:00:44.25,Default,,0000,0000,0000,,Whenever I study a team,
Dialogue: 0,0:00:44.25,0:00:45.90,Default,,0000,0000,0000,,I ask three questions.
Dialogue: 0,0:00:45.90,0:00:48.62,Default,,0000,0000,0000,,How does this team communicate?
Dialogue: 0,0:00:48.62,0:00:53.80,Default,,0000,0000,0000,,How does their communication influence the patient care they can deliver?
Dialogue: 0,0:00:53.80,0:00:57.74,Default,,0000,0000,0000,,How would we educate healthcare professionals and students,
Dialogue: 0,0:00:57.74,0:01:02.80,Default,,0000,0000,0000,,so that their team communication and their patient care improve?
Dialogue: 0,0:01:02.80,0:01:07.03,Default,,0000,0000,0000,,I've been studying healthcare teams for about 15 years,
Dialogue: 0,0:01:07.03,0:01:11.57,Default,,0000,0000,0000,,and one of the most important things I've learned to date is this.
Dialogue: 0,0:01:11.57,0:01:20.38,Default,,0000,0000,0000,,Healthcare is full of highly competent individuals, competent family physicians,
Dialogue: 0,0:01:20.38,0:01:25.58,Default,,0000,0000,0000,,competent nurses and nurse practitioners, competent specialists,
Dialogue: 0,0:01:25.58,0:01:32.55,Default,,0000,0000,0000,,competent pharmacists, dietitians, home-care workers, social workers.
Dialogue: 0,0:01:32.80,0:01:40.22,Default,,0000,0000,0000,,But only sometimes do these competent individuals come together to form a competent team.
Dialogue: 0,0:01:40.22,0:01:43.04,Default,,0000,0000,0000,,In fact, not infrequently,
Dialogue: 0,0:01:43.04,0:01:48.62,Default,,0000,0000,0000,,competent individuals come together to form an incompetent team.
Dialogue: 0,0:01:49.79,0:01:52.02,Default,,0000,0000,0000,,You might be wondering,
Dialogue: 0,0:01:52.02,0:01:54.49,Default,,0000,0000,0000,,how is that possible?
Dialogue: 0,0:01:54.53,0:01:57.48,Default,,0000,0000,0000,,Well, let me tell you a story.
Dialogue: 0,0:01:57.48,0:02:05.05,Default,,0000,0000,0000,,This is Joe, he's 75 years old and he lives at home alone since his wife died a year ago.
Dialogue: 0,0:02:05.05,0:02:07.78,Default,,0000,0000,0000,,Joe had his first heart attack at 55,
Dialogue: 0,0:02:07.78,0:02:09.68,Default,,0000,0000,0000,,and he has had three more since.
Dialogue: 0,0:02:09.68,0:02:12.70,Default,,0000,0000,0000,,He's been a diabetic for 25 years and
Dialogue: 0,0:02:12.70,0:02:16.34,Default,,0000,0000,0000,,because of his diabetes he has some mild kidney trouble.
Dialogue: 0,0:02:16.35,0:02:20.72,Default,,0000,0000,0000,,A month ago, Joe was admitted to hospital for pneumonia,
Dialogue: 0,0:02:20.72,0:02:22.72,Default,,0000,0000,0000,,and while he was in hospital,
Dialogue: 0,0:02:22.72,0:02:24.47,Default,,0000,0000,0000,,his kidney troubles worsened due to
Dialogue: 0,0:02:24.47,0:02:28.08,Default,,0000,0000,0000,,a drug side effect from one of his blood pressure pills.
Dialogue: 0,0:02:28.08,0:02:32.54,Default,,0000,0000,0000,,The hospital doctors stopped this pill and Joe did well,
Dialogue: 0,0:02:32.54,0:02:35.97,Default,,0000,0000,0000,,recovered from his pneumonia and went home.
Dialogue: 0,0:02:36.58,0:02:39.24,Default,,0000,0000,0000,,About a week after he went home,
Dialogue: 0,0:02:39.24,0:02:42.12,Default,,0000,0000,0000,,he had a follow-up appointment with his family doctor,
Dialogue: 0,0:02:42.12,0:02:44.60,Default,,0000,0000,0000,,but the discharge note hadn't made it to
Dialogue: 0,0:02:44.60,0:02:47.22,Default,,0000,0000,0000,,the family doctor's office yet from the hospital.
Dialogue: 0,0:02:47.22,0:02:51.75,Default,,0000,0000,0000,,So, the doctor doesn't know about his kidney trouble in hospital,
Dialogue: 0,0:02:51.75,0:02:54.44,Default,,0000,0000,0000,,Joe doesn't have any medication list to bring with
Dialogue: 0,0:02:54.44,0:02:56.96,Default,,0000,0000,0000,,him but he does bring all of his pill bottles
Dialogue: 0,0:02:56.96,0:02:58.97,Default,,0000,0000,0000,,including the pill that was stopped in
Dialogue: 0,0:02:58.97,0:03:02.04,Default,,0000,0000,0000,,hospital because Joe restarted it when he got home,
Dialogue: 0,0:03:02.04,0:03:04.46,Default,,0000,0000,0000,,he didn't know he wasn't supposed to.
Dialogue: 0,0:03:04.46,0:03:07.75,Default,,0000,0000,0000,,The family doctor is looking at the blood test results
Dialogue: 0,0:03:07.75,0:03:10.48,Default,,0000,0000,0000,,from about six weeks before Joe went into hospital,
Dialogue: 0,0:03:10.48,0:03:13.52,Default,,0000,0000,0000,,and she's concerned about his blood sugar control.
Dialogue: 0,0:03:13.52,0:03:18.65,Default,,0000,0000,0000,,So, she refers him to a diabetes specialist who he has seen in the past.
Dialogue: 0,0:03:19.23,0:03:22.94,Default,,0000,0000,0000,,But two weeks later when Joe goes to this appointment,
Dialogue: 0,0:03:22.94,0:03:28.09,Default,,0000,0000,0000,,the diabetes specialist shares the family doctor's concern about the blood sugar control,
Dialogue: 0,0:03:28.09,0:03:32.53,Default,,0000,0000,0000,,and he decides that Joe's current medication must not be working well enough.
Dialogue: 0,0:03:32.53,0:03:36.70,Default,,0000,0000,0000,,So he prescribes a new blood sugar control medication.
Dialogue: 0,0:03:36.70,0:03:39.82,Default,,0000,0000,0000,,On his way home from that specialist appointment,
Dialogue: 0,0:03:39.82,0:03:44.87,Default,,0000,0000,0000,,Joe pulls into a pharmacy he doesn't usually go to and he fills this new prescription.
Dialogue: 0,0:03:45.74,0:03:48.74,Default,,0000,0000,0000,,Now, for the last number of months Joe has been
Dialogue: 0,0:03:48.74,0:03:51.36,Default,,0000,0000,0000,,having homecare nurses come visit him in his home,
Dialogue: 0,0:03:51.36,0:03:56.06,Default,,0000,0000,0000,,and one of the things they'd become concerned about is his medication compliances.
Dialogue: 0,0:03:56.06,0:03:59.12,Default,,0000,0000,0000,,You see sometimes Joe forgets to take his pills,
Dialogue: 0,0:03:59.12,0:04:01.10,Default,,0000,0000,0000,,sometimes when Joe remembers,
Dialogue: 0,0:04:01.10,0:04:04.36,Default,,0000,0000,0000,,he doubles the dose to make up for not taking them.
Dialogue: 0,0:04:04.36,0:04:07.70,Default,,0000,0000,0000,,Now the nurses are working with Joe and they're teaching him
Dialogue: 0,0:04:07.70,0:04:10.79,Default,,0000,0000,0000,,new medication management strategies to deal with this problem,
Dialogue: 0,0:04:10.79,0:04:14.27,Default,,0000,0000,0000,,and they're recording the problem in the home care binder.
Dialogue: 0,0:04:14.27,0:04:16.64,Default,,0000,0000,0000,,But the family doctor doesn't know about it
Dialogue: 0,0:04:16.64,0:04:20.17,Default,,0000,0000,0000,,nor is communicated to the diabetes specialist.
Dialogue: 0,0:04:20.96,0:04:23.06,Default,,0000,0000,0000,,Now as it happens,
Dialogue: 0,0:04:23.06,0:04:27.15,Default,,0000,0000,0000,,the new medication that the specialists prescribed is a little hard on the kidneys,
Dialogue: 0,0:04:27.15,0:04:29.99,Default,,0000,0000,0000,,and the specialist wouldn't have prescribed it if he'd
Dialogue: 0,0:04:29.99,0:04:33.84,Default,,0000,0000,0000,,known of Joe's recent kidney trouble in hospital.
Dialogue: 0,0:04:33.88,0:04:38.27,Default,,0000,0000,0000,,But he didn't know, and Joe shows
Dialogue: 0,0:04:38.27,0:04:41.99,Default,,0000,0000,0000,,up in the emergency room couple days after starting his new prescription,
Dialogue: 0,0:04:41.99,0:04:44.79,Default,,0000,0000,0000,,with a low blood sugar reaction.
Dialogue: 0,0:04:44.81,0:04:48.43,Default,,0000,0000,0000,,Does any on these sound familiar?
Dialogue: 0,0:04:50.09,0:04:53.06,Default,,0000,0000,0000,,What's going on here?
Dialogue: 0,0:04:53.06,0:04:55.70,Default,,0000,0000,0000,,Joe got competent care in hospital,
Dialogue: 0,0:04:55.70,0:04:57.42,Default,,0000,0000,0000,,he recovered from his pneumonia.
Dialogue: 0,0:04:57.42,0:05:00.11,Default,,0000,0000,0000,,He got competent care from his family doctor,
Dialogue: 0,0:05:00.11,0:05:03.56,Default,,0000,0000,0000,,his diabetes specialist, his homecare nurses, and the pharmacist,
Dialogue: 0,0:05:03.56,0:05:06.44,Default,,0000,0000,0000,,each of those individuals within their scope of
Dialogue: 0,0:05:06.44,0:05:09.59,Default,,0000,0000,0000,,practice and acting on the information at hand,
Dialogue: 0,0:05:09.59,0:05:11.66,Default,,0000,0000,0000,,did the right thing for Joe,
Dialogue: 0,0:05:11.66,0:05:18.93,Default,,0000,0000,0000,,but the sum total of those care events is not overall competent care for Joe.
Dialogue: 0,0:05:19.78,0:05:23.27,Default,,0000,0000,0000,,Now this is a very complex problem
Dialogue: 0,0:05:23.27,0:05:26.15,Default,,0000,0000,0000,,and it's being tackled from a number of different angles,
Dialogue: 0,0:05:26.15,0:05:30.26,Default,,0000,0000,0000,,systems engineers are trying to understand it better to improve the situation,
Dialogue: 0,0:05:30.26,0:05:32.63,Default,,0000,0000,0000,,organizational scientists are trying to work on it,
Dialogue: 0,0:05:32.63,0:05:34.40,Default,,0000,0000,0000,,sociologists are working on it.
Dialogue: 0,0:05:34.40,0:05:38.63,Default,,0000,0000,0000,,Tonight, I'm going to shed some light on this problem from my perspective as
Dialogue: 0,0:05:38.63,0:05:43.77,Default,,0000,0000,0000,,a communications researcher who's interested in improving medical education.
Dialogue: 0,0:05:45.28,0:05:49.70,Default,,0000,0000,0000,,There are significant barriers that make it difficult for
Dialogue: 0,0:05:49.70,0:05:53.96,Default,,0000,0000,0000,,individual competence to translate into collective competence,
Dialogue: 0,0:05:53.96,0:05:56.70,Default,,0000,0000,0000,,I'm going to focus on three.
Dialogue: 0,0:05:56.72,0:06:00.24,Default,,0000,0000,0000,,The first is scientific reductionism,
Dialogue: 0,0:06:00.24,0:06:02.60,Default,,0000,0000,0000,,this refers to the way that we tackle
Dialogue: 0,0:06:02.60,0:06:08.03,Default,,0000,0000,0000,,complex scientific phenomena by breaking them down into their component parts.
Dialogue: 0,0:06:08.03,0:06:10.52,Default,,0000,0000,0000,,Now scientific reductionism has produced
Dialogue: 0,0:06:10.52,0:06:14.98,Default,,0000,0000,0000,,some spectacular advances in our knowledge but translated into patient care,
Dialogue: 0,0:06:14.98,0:06:18.11,Default,,0000,0000,0000,,it means that Joe's heart disease, his diabetes,
Dialogue: 0,0:06:18.11,0:06:22.62,Default,,0000,0000,0000,,and his kidney troubles are all treated as separate entities.
Dialogue: 0,0:06:22.84,0:06:29.34,Default,,0000,0000,0000,,The separate barrier between individual and collective competence is specialization.
Dialogue: 0,0:06:29.34,0:06:32.22,Default,,0000,0000,0000,,Now medical specialization is necessary,
Dialogue: 0,0:06:32.22,0:06:35.18,Default,,0000,0000,0000,,no physician can know everything there is to know about
Dialogue: 0,0:06:35.18,0:06:38.92,Default,,0000,0000,0000,,medicine but specialization has consequences.
Dialogue: 0,0:06:38.92,0:06:42.27,Default,,0000,0000,0000,,If I have heart disease, ovarian cancer,
Dialogue: 0,0:06:42.27,0:06:48.00,Default,,0000,0000,0000,,and depression, all three of those issues will be treated by three different specialists.
Dialogue: 0,0:06:48.00,0:06:50.26,Default,,0000,0000,0000,,If I live in a rural area,
Dialogue: 0,0:06:50.26,0:06:55.10,Default,,0000,0000,0000,,those three specialists will likely work for three distinct healthcare organizations,
Dialogue: 0,0:06:55.10,0:07:00.54,Default,,0000,0000,0000,,which will likely be located in three different cities.
Dialogue: 0,0:07:01.55,0:07:04.38,Default,,0000,0000,0000,,The third barrier between
Dialogue: 0,0:07:04.38,0:07:10.92,Default,,0000,0000,0000,,individual and collective competence is the very concept of individual competence itself.
Dialogue: 0,0:07:10.92,0:07:12.86,Default,,0000,0000,0000,,The goal of producing
Dialogue: 0,0:07:12.86,0:07:15.92,Default,,0000,0000,0000,,an individually competent healthcare provider with
Dialogue: 0,0:07:15.92,0:07:20.14,Default,,0000,0000,0000,,their own specific tightly bounded expertise,
Dialogue: 0,0:07:20.14,0:07:22.49,Default,,0000,0000,0000,,drives everything in health professions
Dialogue: 0,0:07:22.49,0:07:26.49,Default,,0000,0000,0000,,education generally and medical education specifically.
Dialogue: 0,0:07:26.72,0:07:30.80,Default,,0000,0000,0000,,Now each of these three things: reductionism,
Dialogue: 0,0:07:30.80,0:07:36.17,Default,,0000,0000,0000,,specialization, and the goal of individual competence are in and of themselves good.
Dialogue: 0,0:07:36.17,0:07:40.20,Default,,0000,0000,0000,,Reductionism allows us to understand complex problems,
Dialogue: 0,0:07:40.20,0:07:45.54,Default,,0000,0000,0000,,specialization allows us to build a deep expertise in a particular area,
Dialogue: 0,0:07:45.54,0:07:48.05,Default,,0000,0000,0000,,and individual competence well everybody
Dialogue: 0,0:07:48.05,0:07:51.32,Default,,0000,0000,0000,,wants an individually competent healthcare provider right?
Dialogue: 0,0:07:51.32,0:07:55.06,Default,,0000,0000,0000,,But together and kind of paradoxically,
Dialogue: 0,0:07:55.06,0:08:00.82,Default,,0000,0000,0000,,these three factors combine to produce one of healthcare's greatest weaknesses.
Dialogue: 0,0:08:00.82,0:08:05.46,Default,,0000,0000,0000,,That is the providers work in isolation from one another,
Dialogue: 0,0:08:05.46,0:08:11.10,Default,,0000,0000,0000,,each person focused on the particular issue about which they are an expert.
Dialogue: 0,0:08:11.10,0:08:14.63,Default,,0000,0000,0000,,When that happens, patients can fall into
Dialogue: 0,0:08:14.63,0:08:19.50,Default,,0000,0000,0000,,the cracks between individually competent care providers.
Dialogue: 0,0:08:20.91,0:08:23.29,Default,,0000,0000,0000,,The theme of tonight's event in
Dialogue: 0,0:08:23.29,0:08:27.72,Default,,0000,0000,0000,,adaptation and one way of expressing the meaning of adaptation
Dialogue: 0,0:08:27.72,0:08:30.66,Default,,0000,0000,0000,,is that it's a process of change by which an organism
Dialogue: 0,0:08:30.66,0:08:34.48,Default,,0000,0000,0000,,or a species becomes better suited to its environment.
Dialogue: 0,0:08:34.48,0:08:37.91,Default,,0000,0000,0000,,I'm suggesting tonight that we need to adapt
Dialogue: 0,0:08:37.91,0:08:42.38,Default,,0000,0000,0000,,our thinking so that we can provide better patient care.
Dialogue: 0,0:08:42.72,0:08:46.57,Default,,0000,0000,0000,,What do we need to adapt from?
Dialogue: 0,0:08:46.57,0:08:49.88,Default,,0000,0000,0000,,Well, I would argue that we need to adapt from
Dialogue: 0,0:08:49.88,0:08:54.58,Default,,0000,0000,0000,,our exclusive focus on the goal of individual competence.
Dialogue: 0,0:08:54.58,0:08:59.59,Default,,0000,0000,0000,,Individual competence is a set of pervasive and rarely challenged assumptions.
Dialogue: 0,0:08:59.59,0:09:01.69,Default,,0000,0000,0000,,It's not unique to medical education,
Dialogue: 0,0:09:01.69,0:09:04.26,Default,,0000,0000,0000,,it's true of education everywhere.
Dialogue: 0,0:09:04.26,0:09:08.47,Default,,0000,0000,0000,,Three of these assumptions are very important to my argument tonight.
Dialogue: 0,0:09:08.47,0:09:12.70,Default,,0000,0000,0000,,One is the premise that competency is a quality the individuals possess.
Dialogue: 0,0:09:12.70,0:09:14.59,Default,,0000,0000,0000,,So, I'm competent because of,
Dialogue: 0,0:09:14.59,0:09:17.94,Default,,0000,0000,0000,,for instance, the knowledge I possess in my head.
Dialogue: 0,0:09:17.94,0:09:21.40,Default,,0000,0000,0000,,Related to this is the premise that competence is
Dialogue: 0,0:09:21.40,0:09:24.98,Default,,0000,0000,0000,,a state to be achieved so that we can take naive learners,
Dialogue: 0,0:09:24.98,0:09:27.52,Default,,0000,0000,0000,,put them through a medical education process,
Dialogue: 0,0:09:27.52,0:09:33.84,Default,,0000,0000,0000,,fill their empty vessels up with competence and graduate them in a state of competence.
Dialogue: 0,0:09:33.84,0:09:36.82,Default,,0000,0000,0000,,Related to this is the third premise,
Dialogue: 0,0:09:36.82,0:09:39.92,Default,,0000,0000,0000,,which is that, competence is context-free.
Dialogue: 0,0:09:39.92,0:09:42.79,Default,,0000,0000,0000,,Its independent of time and space.
Dialogue: 0,0:09:42.79,0:09:45.64,Default,,0000,0000,0000,,So, if I'm competent tonight in Bayfield,
Dialogue: 0,0:09:45.64,0:09:50.24,Default,,0000,0000,0000,,I'll be competent next week in Toronto and next year in Paris, France.
Dialogue: 0,0:09:50.24,0:09:56.05,Default,,0000,0000,0000,,Now, this notion of individual competence drives everything in medical education,
Dialogue: 0,0:09:56.05,0:09:59.53,Default,,0000,0000,0000,,from the way we select candidates for entry into medical school,
Dialogue: 0,0:09:59.53,0:10:02.24,Default,,0000,0000,0000,,to the way that we teach and assess their performance,
Dialogue: 0,0:10:02.24,0:10:05.04,Default,,0000,0000,0000,,to the way that we license them for practice,
Dialogue: 0,0:10:05.04,0:10:09.91,Default,,0000,0000,0000,,monitor their practice over the course of their career and if we smell a problem,
Dialogue: 0,0:10:09.91,0:10:12.74,Default,,0000,0000,0000,,we look for the individual most responsible,
Dialogue: 0,0:10:12.74,0:10:14.78,Default,,0000,0000,0000,,we pull them out of the system,
Dialogue: 0,0:10:14.78,0:10:17.89,Default,,0000,0000,0000,,remediate them if necessary and put them back in.
Dialogue: 0,0:10:17.89,0:10:21.08,Default,,0000,0000,0000,,Individual competence everywhere.
Dialogue: 0,0:10:21.57,0:10:28.28,Default,,0000,0000,0000,,Now, this educational model made sense in the environment which created it,
Dialogue: 0,0:10:28.28,0:10:32.40,Default,,0000,0000,0000,,and that healthcare environment was this;
Dialogue: 0,0:10:32.40,0:10:39.92,Default,,0000,0000,0000,,a single patient visiting their physician for the care of an ailment.
Dialogue: 0,0:10:40.98,0:10:44.40,Default,,0000,0000,0000,,The healthcare environment has changed.
Dialogue: 0,0:10:44.40,0:10:49.21,Default,,0000,0000,0000,,This is a report published in 2011 by the Canadian Institute of Health Information.
Dialogue: 0,0:10:49.21,0:10:50.95,Default,,0000,0000,0000,,You can find it online.
Dialogue: 0,0:10:50.95,0:10:56.22,Default,,0000,0000,0000,,In a nutshell, what it tells us is that Joe is an average patient.
Dialogue: 0,0:10:56.22,0:11:01.16,Default,,0000,0000,0000,,A quarter of Canadian seniors report having three or more chronic conditions.
Dialogue: 0,0:11:01.16,0:11:03.16,Default,,0000,0000,0000,,That's about a million people.
Dialogue: 0,0:11:03.16,0:11:09.29,Default,,0000,0000,0000,,These same people report over 13 million healthcare visits per year.
Dialogue: 0,0:11:09.54,0:11:12.94,Default,,0000,0000,0000,,We're no longer talking about patients going to
Dialogue: 0,0:11:12.94,0:11:16.10,Default,,0000,0000,0000,,see their single physician with a single ailment.
Dialogue: 0,0:11:16.10,0:11:18.56,Default,,0000,0000,0000,,The environment has radically changed,
Dialogue: 0,0:11:18.56,0:11:22.18,Default,,0000,0000,0000,,but the way we think about competence has not.
Dialogue: 0,0:11:22.18,0:11:26.00,Default,,0000,0000,0000,,So, what do we need to adapt to?
Dialogue: 0,0:11:26.88,0:11:33.96,Default,,0000,0000,0000,,We need to broaden our notion of competence to include collective competence.
Dialogue: 0,0:11:33.96,0:11:36.25,Default,,0000,0000,0000,,What do I mean by that?
Dialogue: 0,0:11:36.25,0:11:41.78,Default,,0000,0000,0000,,Collective competence is a distributed capacity of a system.
Dialogue: 0,0:11:41.78,0:11:45.25,Default,,0000,0000,0000,,It's not reducible to a single individual.
Dialogue: 0,0:11:45.25,0:11:49.04,Default,,0000,0000,0000,,Collective competence is also an evolving dynamic.
Dialogue: 0,0:11:49.04,0:11:52.45,Default,,0000,0000,0000,,It's not a stable trait, it changes.
Dialogue: 0,0:11:52.45,0:11:55.33,Default,,0000,0000,0000,,It changes in relation to context.
Dialogue: 0,0:11:55.33,0:11:57.94,Default,,0000,0000,0000,,It is intimately tied to context.
Dialogue: 0,0:11:57.94,0:12:01.93,Default,,0000,0000,0000,,The competence of my performance is influenced by
Dialogue: 0,0:12:01.93,0:12:07.73,Default,,0000,0000,0000,,the limitations and the affordances of the situation that I'm in at this moment.
Dialogue: 0,0:12:08.88,0:12:14.41,Default,,0000,0000,0000,,I'm talking about an enormous adaptation, a game changer.
Dialogue: 0,0:12:14.41,0:12:17.70,Default,,0000,0000,0000,,For hundreds of years in Madison we've thought about
Dialogue: 0,0:12:17.70,0:12:20.17,Default,,0000,0000,0000,,individual competence and I'm talking about
Dialogue: 0,0:12:20.17,0:12:24.19,Default,,0000,0000,0000,,changing that notion to include something very different.
Dialogue: 0,0:12:24.19,0:12:27.86,Default,,0000,0000,0000,,You might wonder, is this even possible?
Dialogue: 0,0:12:28.44,0:12:33.28,Default,,0000,0000,0000,,Not only is it possible but I'd like to touch on three ways in
Dialogue: 0,0:12:33.28,0:12:38.11,Default,,0000,0000,0000,,which we are right now moving towards collective competence.
Dialogue: 0,0:12:38.11,0:12:41.36,Default,,0000,0000,0000,,The first, I think, is a relatively simple way.
Dialogue: 0,0:12:41.36,0:12:43.26,Default,,0000,0000,0000,,Let's go back to Joe.
Dialogue: 0,0:12:43.26,0:12:48.13,Default,,0000,0000,0000,,The fundamental problem at the crux of Joe's situation is this.
Dialogue: 0,0:12:48.13,0:12:53.92,Default,,0000,0000,0000,,Joe travels through the healthcare system more quickly than his health information does.
Dialogue: 0,0:12:53.92,0:12:58.21,Default,,0000,0000,0000,,We have the technology to address this problem,
Dialogue: 0,0:12:58.21,0:13:00.54,Default,,0000,0000,0000,,to move information more efficiently.
Dialogue: 0,0:13:00.54,0:13:06.54,Default,,0000,0000,0000,,One example of relevance to Joe's story is the global medication electronic record.
Dialogue: 0,0:13:06.54,0:13:10.26,Default,,0000,0000,0000,,This would have allowed the pharmacist that Joe went to,
Dialogue: 0,0:13:10.26,0:13:13.38,Default,,0000,0000,0000,,to view the prescription in light of all of
Dialogue: 0,0:13:13.38,0:13:16.71,Default,,0000,0000,0000,,Joe's current medications and his past medications.
Dialogue: 0,0:13:16.71,0:13:19.70,Default,,0000,0000,0000,,Unfortunately, the pharmacist in Joe's jurisdiction
Dialogue: 0,0:13:19.70,0:13:23.06,Default,,0000,0000,0000,,didn't have access to a global medication electronic record.
Dialogue: 0,0:13:23.06,0:13:25.85,Default,,0000,0000,0000,,But many jurisdictions do.
Dialogue: 0,0:13:26.48,0:13:31.23,Default,,0000,0000,0000,,A more sophisticated way in which we're moving towards collective competence right
Dialogue: 0,0:13:31.23,0:13:35.84,Default,,0000,0000,0000,,now is an experiment that we're all involved in in this room.
Dialogue: 0,0:13:35.84,0:13:40.96,Default,,0000,0000,0000,,That's the shift to deliver primary care through family health teams.
Dialogue: 0,0:13:40.96,0:13:45.55,Default,,0000,0000,0000,,A family health team brings together a primary care physician,
Dialogue: 0,0:13:45.55,0:13:51.85,Default,,0000,0000,0000,,a primary care nurses and a number of other health professionals: pharmacists,
Dialogue: 0,0:13:51.85,0:13:55.84,Default,,0000,0000,0000,,social workers, dietitians, physical therapists, et cetera.
Dialogue: 0,0:13:55.84,0:14:00.14,Default,,0000,0000,0000,,It puts them all under one roof so that Joe
Dialogue: 0,0:14:00.14,0:14:05.99,Default,,0000,0000,0000,,doesn't have to go off to six different places to have six different needs met.
Dialogue: 0,0:14:06.75,0:14:13.58,Default,,0000,0000,0000,,Family healthcare teams offer a better model for teamwork and collective competence.
Dialogue: 0,0:14:13.58,0:14:17.65,Default,,0000,0000,0000,,They also come with new funding mechanisms that ought to promote
Dialogue: 0,0:14:17.65,0:14:22.58,Default,,0000,0000,0000,,collective competence in a way that the traditional funding mechanisms never could.
Dialogue: 0,0:14:24.39,0:14:30.74,Default,,0000,0000,0000,,But it takes more than putting people under one roof to get to collective competence.
Dialogue: 0,0:14:30.74,0:14:34.72,Default,,0000,0000,0000,,Listen to these pharmacists from a new family health team.
Dialogue: 0,0:14:34.72,0:14:39.13,Default,,0000,0000,0000,,"I'm a pharmacist, so I know how to be a pharmacist.
Dialogue: 0,0:14:39.13,0:14:41.11,Default,,0000,0000,0000,,I don't know how to be a pharmacist in
Dialogue: 0,0:14:41.11,0:14:44.36,Default,,0000,0000,0000,,a family health team because nobody knows about that yet.
Dialogue: 0,0:14:44.36,0:14:48.55,Default,,0000,0000,0000,,I walked in and I did pharmacy things but I didn't know what
Dialogue: 0,0:14:48.55,0:14:52.92,Default,,0000,0000,0000,,that meant in relation to what the nurse does or what the dietitian does."
Dialogue: 0,0:14:52.92,0:14:54.85,Default,,0000,0000,0000,,This pharmacist is saying,
Dialogue: 0,0:14:54.85,0:15:01.02,Default,,0000,0000,0000,,I'm individually competent but I'm not so sure about how to be collectively competent.
Dialogue: 0,0:15:01.02,0:15:04.36,Default,,0000,0000,0000,,The structural change involved in family health teams is
Dialogue: 0,0:15:04.36,0:15:07.80,Default,,0000,0000,0000,,an enormously positive first step but it's insufficient.
Dialogue: 0,0:15:07.80,0:15:11.66,Default,,0000,0000,0000,,We need an educational change to go along with it.
Dialogue: 0,0:15:13.11,0:15:17.20,Default,,0000,0000,0000,,The third way in which we're moving towards collective competence is
Dialogue: 0,0:15:17.20,0:15:20.90,Default,,0000,0000,0000,,a more strategic way and I've picked one of many examples here.
Dialogue: 0,0:15:20.90,0:15:23.46,Default,,0000,0000,0000,,By strategic, I mean,
Dialogue: 0,0:15:23.46,0:15:25.69,Default,,0000,0000,0000,,take a look at the healthcare system,
Dialogue: 0,0:15:25.69,0:15:30.13,Default,,0000,0000,0000,,find those points in the system where a failure of collective competence can have
Dialogue: 0,0:15:30.13,0:15:32.41,Default,,0000,0000,0000,,dire consequences and build
Dialogue: 0,0:15:32.41,0:15:36.60,Default,,0000,0000,0000,,initiatives to support collective competence in those moments.
Dialogue: 0,0:15:36.60,0:15:40.09,Default,,0000,0000,0000,,What I'm going to talk about is an initiative to build
Dialogue: 0,0:15:40.09,0:15:44.77,Default,,0000,0000,0000,,collective competence in the operating room to help surgical teams communicate better.
Dialogue: 0,0:15:44.77,0:15:47.44,Default,,0000,0000,0000,,This is an initiative that my research team and others
Dialogue: 0,0:15:47.44,0:15:50.53,Default,,0000,0000,0000,,around the world have had intimate involvement with.
Dialogue: 0,0:15:50.53,0:15:55.48,Default,,0000,0000,0000,,Now, why pick the operating room as a moment in the healthcare system?
Dialogue: 0,0:15:55.48,0:16:01.00,Default,,0000,0000,0000,,Well, when they analyze errors in the operating room such as wrong site surgery,
Dialogue: 0,0:16:01.00,0:16:04.75,Default,,0000,0000,0000,,they find that the root cause is far more likely to be a breakdown in
Dialogue: 0,0:16:04.75,0:16:09.95,Default,,0000,0000,0000,,communication on the team than it is technical skill or a lack of knowledge.
Dialogue: 0,0:16:10.26,0:16:13.81,Default,,0000,0000,0000,,So, a number of us around the world conducted research,
Dialogue: 0,0:16:13.81,0:16:15.43,Default,,0000,0000,0000,,myself for about a decade,
Dialogue: 0,0:16:15.43,0:16:19.52,Default,,0000,0000,0000,,in operating rooms trying to figure out how could we help this situation.
Dialogue: 0,0:16:19.52,0:16:22.34,Default,,0000,0000,0000,,What arose from that international research
Dialogue: 0,0:16:22.34,0:16:25.69,Default,,0000,0000,0000,,was what's called by the World Health Organization now,
Dialogue: 0,0:16:25.69,0:16:28.34,Default,,0000,0000,0000,,the Safe Surgery Saves Lives initiative.
Dialogue: 0,0:16:28.34,0:16:33.61,Default,,0000,0000,0000,,What it is, is a protocol for surgeon and their citizens and nurse to come together at
Dialogue: 0,0:16:33.61,0:16:36.19,Default,,0000,0000,0000,,points in a surgical procedure and make sure
Dialogue: 0,0:16:36.19,0:16:39.80,Default,,0000,0000,0000,,they're sharing the critically salient information.
Dialogue: 0,0:16:39.80,0:16:42.95,Default,,0000,0000,0000,,This initiative has in fact become so
Dialogue: 0,0:16:42.95,0:16:46.06,Default,,0000,0000,0000,,successful that it's had enormous international uptake.
Dialogue: 0,0:16:46.06,0:16:50.69,Default,,0000,0000,0000,,You can go to the WHO website and actually zoom in on your own jurisdiction.
Dialogue: 0,0:16:50.69,0:16:53.58,Default,,0000,0000,0000,,I tested it. I zoomed in on us here.
Dialogue: 0,0:16:53.58,0:16:59.20,Default,,0000,0000,0000,,You can see the hospitals that are registered in this particular checklist initiative.
Dialogue: 0,0:16:59.20,0:17:04.31,Default,,0000,0000,0000,,In fact, it's become mandatory in this country and many others for
Dialogue: 0,0:17:04.31,0:17:06.71,Default,,0000,0000,0000,,surgical teams to do some kind of
Dialogue: 0,0:17:06.71,0:17:10.98,Default,,0000,0000,0000,,preoperative briefing or checklist before they start an operation.
Dialogue: 0,0:17:12.27,0:17:17.63,Default,,0000,0000,0000,,I've described to you three advances that I think are important ones
Dialogue: 0,0:17:17.63,0:17:19.79,Default,,0000,0000,0000,,and show the potential and the work on
Dialogue: 0,0:17:19.79,0:17:23.32,Default,,0000,0000,0000,,the ground to move towards collective competence now.
Dialogue: 0,0:17:23.32,0:17:28.37,Default,,0000,0000,0000,,But collective competence is about more than good software,
Dialogue: 0,0:17:28.37,0:17:32.20,Default,,0000,0000,0000,,good Internet use, checklists, other tools.
Dialogue: 0,0:17:32.20,0:17:36.29,Default,,0000,0000,0000,,Collective competence must be a value and
Dialogue: 0,0:17:36.29,0:17:40.90,Default,,0000,0000,0000,,underpinning philosophy and an educational mission.
Dialogue: 0,0:17:40.90,0:17:46.18,Default,,0000,0000,0000,,If I picture curiosity tonight and you want to think more about this problem,
Dialogue: 0,0:17:46.18,0:17:48.47,Default,,0000,0000,0000,,I have a book coming out with my colleagues later
Dialogue: 0,0:17:48.47,0:17:51.16,Default,,0000,0000,0000,,in the floor called The Question of Competence.
Dialogue: 0,0:17:51.16,0:17:54.90,Default,,0000,0000,0000,,For tonight, let me summarize my argument this way.
Dialogue: 0,0:17:54.90,0:17:59.90,Default,,0000,0000,0000,,Medical education is driven by the goal of individual competence.
Dialogue: 0,0:17:59.90,0:18:05.93,Default,,0000,0000,0000,,Consequently, healthcare is full of highly competent individuals.
Dialogue: 0,0:18:05.93,0:18:08.57,Default,,0000,0000,0000,,This is a very good thing.
Dialogue: 0,0:18:08.57,0:18:12.42,Default,,0000,0000,0000,,Individual competence is absolutely necessary but it's
Dialogue: 0,0:18:12.42,0:18:16.73,Default,,0000,0000,0000,,insufficient to meet the needs of the current healthcare environment.
Dialogue: 0,0:18:16.73,0:18:21.82,Default,,0000,0000,0000,,Collective competence is an urgently needed adaptation.
Dialogue: 0,0:18:21.82,0:18:27.26,Default,,0000,0000,0000,,It will require healthcare professionals to think and act differently,
Dialogue: 0,0:18:27.26,0:18:31.32,Default,,0000,0000,0000,,and it will require patients to think and act differently too.
Dialogue: 0,0:18:31.32,0:18:33.56,Default,,0000,0000,0000,,When we achieve it,
Dialogue: 0,0:18:33.56,0:18:35.18,Default,,0000,0000,0000,,I believe it will look something
Dialogue: 0,0:18:35.18,0:18:36.75,Default,,0000,0000,0000,,like this.
Dialogue: 0,0:19:25.42,0:19:27.99,Default,,0000,0000,0000,,Thank you.