| dc.description.abstract | Current literature regarding quality health services frequently identifies
interprofessional collaboration (IPC) as essential to patient-centred care, sustainable
health systems, and a productive workforce. The IPC literature tends to focus on
interprofessionalism and collaboration and pays little attention to the concept of
practice, which is thought to be a represented world of objects and processes that have
pre-given characteristics practitioners can know cognitively and apply or manage
correctly. Many strategies intended to support IPC simplify and codify the complex,
contested, and unpredictable day-to-day interactions among interdependent agents
that I argue constitute the practices of a community. These strategies are based in
systems thinking, which understand the system as distinct from experience and
subject to rational, linear logic. In this thinking, a leader can step outside of the
system to develop an ideal plan, which is then implemented to unfold the
predetermined ideal future. However, changes in health services and healthcare
practices are often difficult to enact and sustain.This thesis problematises the concept of ‘practice’, and claims practices as
thoroughly social and emergent phenomenon constituted by interdependent and
iterative processes of representation (policies and practice guidelines), signification
(sense making through negotiation and reflective and reflexive practices), and
improvisation (acting into the circumstances that present at the point and in the
moments of care). I argue that local and population-wide patterns are negotiated and
iteratively co-expressed through relations of power, values, and identity. Moreover,
practice (including the practice of leadership or consulting) is inherently concerned
with ethics, which I also formulate as both normative and social/relational in nature. I
argue that theory and practice are not separate but paradoxical phenomena that remain
in generative tension, which in healthcare is often felt as tension between what we
should do (best practice) and what we actually do (best possible practice in the
contingent circumstances we find ourselves in). I articulate the implications this has
for how knowledge and knowing are understood, how organisations change, and how
the role of an internal practice consultant is understood. An important implication is
that practice-based evidence and evidence-based practice are iterative and coexpressed(not sequential), and while practice is primordial, it is not privileged over theory.I propose that a practice consultant could usefully become a temporary participant in the practices of a particular community. Through a position of ‘involved
detachment’, a consultant can more easily notice and articulate the practices of a
community that for participants are most often implicit and taken for granted.
Reflective and reflexive consideration of what is taken for granted may change
conversations and thus be transformative. | en_US |
