Third National Palliative Care Education Conference
Development of Workforce Capabilities in Palliative Care
Rod MacLeod
University of Auckland and North Shore Hospice, Takapuna
11 - 12 February 2010, QUT, Kelvin Grove Campus, Brisbane
There’s Nothing New in Education…
It is easy to perform a good action but not easy to acquire a settled habit of performing such actions.
Aristotle
384BC-322BC
“Where is the life we have lost in living?
Where is the wisdom we have lost in knowledge?
Where is the knowledge we have lost in information?”
Choruses from „The Rock‟ T. S. Eliot 1888-1965
Developing workforce capability
An organisation‟s ability to accomplish its work processes through knowledge, skills, abilities and competencies of its people
• “three way fit” as identified by Lorsch (1997)
– “individuals must have interests, skills and needs that are consistent with the work required”
Workforce planning
Workforce capability
• Shape strategic thinking
• Achieve results
• Engage stakeholders and support productive working relationships
• Personal drive and empathy
• Effective communication
Workforce planning
• Where are we heading?
• Where are we now?
• How are we going to get there?
• What will we be like when we get there?
• A sense of aequanimitas(serenity)
• „Dependable, confident, sympathetic and able to deal with uncertainty‟
Sir William Osler
Reciprocity of care
• Caring is not a one way relationship
...each cares for the other
Care
• tailored for each individual and family
• focussed on them and related to their needs
• provided through the presence of a caring relationship by staff who demonstrate involvement, commitment andconcern
Care
• Behavioural and motivational elements
• Physical manifestations but also psychological, spiritual and social dimensions
• “It is of great importance to the dying to feel that their cultural needs, values and practices are understood, accommodated and affirmed by those caring for them”
Influential Works on Virtues
Ed Pellegrino and David Thomasma
“The Virtues in Medical Practice”
André Comte-Sponville
“A Small Treatise on the Great Virtues”
MacLeod RD 2003 Wisdom and the Practice of Palliative Care. Journal of Palliative Care 19(2): 123-6
Developing workforce capability
• Identifying gaps
• Informing development
• Recruitment meets organisational requirements
• Assist performance management
• Personal career planning
Transformative Learning
Jack Mezirow and Ed Taylor,
Transformative Learning in Practice: Insights from community, workplace and higher education. Jossey-Bass, San Francisco, 2009.
Understanding Teaching
Teaching is not aimed at the production of something, but at developing and exercising the virtues of the group to which student and teacher belong – it is a moral enterprise not a technical one.
John Olsen
Understanding teaching
Philadelphia, PA: Open University Press 1992
Transformative learning
• Individual experience
• Promoting critical reflection
• Dialogue
Transformative learning - Experience
• What are the learner‟s value judgements and normative expectations?
• Life experience
• What kind of experiences do educators try to create?
• Experiential activities
Transformative learning - Reflection
• Questioning the integrity of deeply held beliefs...
• An awareness of conflicting thoughts...
• Content (perceive, think, feel, act)
• Process (how we perform the functions of perceiving)
• Premise (why we perceive)
Transformative learning - Dialogue
• With self and with others
• “highly personalised and self-disclosing”
• Need to develop a sense of trust in the process of dialogue
• Holistic orientation
Transformative learning
• Holistic orientation
– See-feel-change sequence
– Affective knowing
• Awareness of context
– Personal and professional situation of learners
• Authentic relationships
– Building trusting relationships
Study on Caring Doctors
• Interviews with people who were dying
• Caring doctors were those who were willing to, recognized and met the needs of the patient
Anna Janssen and Rod MacLeod
Enhancing the humanistic qualities of teachers
• critical incident reports
• giving feedback
• giving feedback to „difficult‟ learners
• learning to use reflection
• renewal and meaning in our professional lives
• teaching caring attitudes
• Balint-type groups
William Branch
Narrative medicine
Transformative learning
• “Imagining how things could be otherwise”
• Involve attitudinal and emotional domains
• Run counter to clinical detachment
• Run counter to student expectations
• Draw on the lifeworld at a time of transition
• Require personal disclosure and are predicated on trust
MacLeod RD, Egan AG 2009 Transformation in Palliative Care in Mezirow J, Taylor E (eds) Transformative Learning in Action: Insights from community, workplace and higher education. Jossey-Bass, San Francisco pp111-121
The Virtues
Power
• Aesculapian power
• Social power
• Charismatic power
• …and they use it
Howard Brody “The Healer‟s Power” Yale University Press 1993
The Virtues in Clinical Practice
Trust
• Truth telling
• Honesty
Compassion
• Distinguish from pity, empathy and mercy
The Virtues in Clinical Practice
Phronesis
• Link between intellectual and moral life
• The guiding virtue
Justice
• Fairness and equity
The Virtues in Clinical Practice
Fortitude
• Co-extensive with courage
• Implies temperance (restraint and humility)
Temperance
• Synonymous with virtue itself
• Closely allied to beneficence
The Virtues in Clinical Practice
Integrity
• Defines the nature of the individual and integrates all the values
• Balance between bodily, psychosocial and intellectual element
The Virtues in Clinical Practice
• personal responsibility
• the ethic of character and virtue
Two kinds of excellence
• Effective release of the sick and dying
• Excellence expressed in response to unique and personal suffering
Culture of the Facility/Organisation
• „Community of Practice‟
• shared understanding of values and virtues, displayed and lived out in our work
Etienne Wenger
Community of Practice
• Values and virtues
• Construction of narrative
• Vision of care using virtue based ethical framework
• Communication
Empathy
• the capacity to enter the subjective world of another (their lifeworld)
• shared concepts and shared human nature
• to feel as the other person is thought to feel
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www.empathysymbol.com
Just as treasures are uncovered from the earth, so virtue appears from good deeds, and wisdom appears from a pure and peaceful mind. To walk safely through the maze of human life, one needs the light of wisdom and the guidance of virtue.
Buddha
563-483 BC
Be the change you want to see in the world.
Mahatma Gandhi