Organisation of work and leadership approach |
Cross-jurisdiction and—profession collaboration Cocreative and inclusive teamwork Shared and collaborative leadership Flattened hierarchy and searching together for new ways of working.
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Monodisciplinary, often fragmented (eg, jurisdictional) orientation Top–down and hierarchical organisation Pure ‘professional’ environment ‘Physician–nurse dyad’ and ‘doctor’s orders’ paradigms Medical professional identity linked to ‘we are what we do’
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ML runs counter to physicians’ identity, roles and patient-related activities Persisting enculturation iterating ‘old’ norms Need for (re)balancing physicians’ professional autonomy and interprofessional work relations Shift required away from delegative, hierarchy-based interactions Allied professions must learn to ‘speak up’
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Problem-solving and reasoning approach |
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Biomedical (ie, linear, criteria based) reasoning and judgement Protocolisation (eg, Diagnosis → Treatment → Inference) ‘The solution will resolve the problem’ paradigm Scientific certitude in clinically trialled, verifiable approaches and solutions
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Leading change† Leading quality† Develops coalitions‡ Achieve outcomes/ results‡¶ System transformation‡ Improving services/ quality§** Managing services§ Drives innovation¶ To exert influence** To organise** Entrepreneurship and innovation**
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Creative and ‘out-of-the-box’ approach atypical for traditional clinical reasoning Collective problem formulation and negotiation (eg, time; facilitation) at odds with traditional work Iterative (re)evaluation and continuous flexibility needed (eg, ‘street level’ dynamics) and at odds with traditional work
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Accountability orientation |
Solutions involve (quasi-) normative judgements (ie, solutions have no stopping rules, are untestable and value laden) Solutions often unplannable, requiring unpredictable investments
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Focus on clinical/ technical skills Peer-group norms, standards and regulations Assessments of technical approach rather than (quasi-)normative judgements Relatively ‘rigid’ evidence based standardisation
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Responsibilities unclear (eg, when solutions ‘fail’) Uneasiness with collective and (quasi-)normative approaches Legislation/incentives hamper team- and network-based working (e.g, accountability; payment structures)
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Governance paradigm |
Regulators’ and executives’ more ‘hands off’ stance Networked and collaborative governance approaches that bring together stakeholders with different interests, perspectives and approaches
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Physicians highly autonomous and politically sovereign in controlling own work Physicians’ duties, work scope and standards defined within their own professional associations Bureaucracy to regulate and monitor
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