Susanna Paloniemi

Promoting inter‐professional teamwork and learning – the case of a surgical operating theatre

Hospitals, and surgical operating theatres (OTs) in particular, are environments in which inter‐professional teamwork and learning are essential to secure patient safety and effective practice. However, it has been revealed in many studies that inter‐professional collaborative work in hospital organisations faces many challenges and constraints. In this study we examine surgical operations as participatory practices from the perspective of inter‐professional learning and cooperation. We ask what kinds of shared practices enable learning and collaboration within the surgical operating team. We used an ethnographic approach to data collection including observations and interviews of surgical residents and nursing staff. Observations were conducted in the OTs of one non‐academic hospital in Finland in 2007. The transcripts and episodes were analysed qualitatively. We suggest that inter‐professional teamwork can be implemented by collegial support, transgressing professional roles and sustaining an inclusive atmosphere. There is a need to strengthen and develop the practices of inter‐professional education, not only in formal educational but, especially, in practical clinical settings.

Identity and Agency in Professional Learning

This chapter elaborates professional learning from two complementary perspectives, namely professional identity and agency. Starting with the conceptualization of identity and agency, the chapter illustrates how professional identity and agency are intertwined with workplace learning at the individual and social levels. In theoretical terms we adhere to a subject-centred socio-cultural approach. This implies that professional learning is seen as a dual process, involving identity negotiation and the development of work practices (including the practice of agency), with both aspects taking place within the socio-cultural and material conditions of the workplace. We see professional identity as constituted by subjects’ conceptions of themselves as professional actors, i.e. as individuals with professional commitments, ideals, interests, beliefs, values, and ethical standards. Agency is needed for the renegotiation of work identities, and for the continuous and innovative development of work practices. We see professional agency as being exercised when professional subjects and/or communities influence, make choices, and take stances on their work and/or their professional identities. The chapter summarizes evidence on the constraints and resources that appear to be most influential for professional identity negotiations and for the practice of professional agency at work, especially in education and health care work. Empirical evidence is presented on aspects operating at the work community, work organization, and individual levels. As a practical conclusion, it is suggested that there is a need for practice-based interventions that will promote professional learning concurrently at the individual and social levels. Such interventions will involve agency-centred couplings between these levels.

Work, power and learning in a risk filled occupation:

In this article we describe various ways in which power is exercised between personnel in a hospital operating theatre. We aim to investigate how the forms of discursive power and workplace learning are intertwined with each other by utilizing an ethnographic approach in the fieldwork. Our data were collected mainly through observations and interviews with surgical residents, physicians and nurses. In the article we describe the delicate ways in which power is exercised and resisted in everyday practices. We argue that there is a close relationship between learning and manifestations of power, together with the various forms of these manifestations and the restrictions that may be placed on them. Additionally, we show how learning takes place in terms of finding, experimenting with and transgressing participatory agency among nurses and residents in the work community.

Ways of Interprofessional Collaboration and Learning in Emergency Work.

In the paper we aim to identify various ways of interprofessional collaboration and learning in an emergency unit at a hospital in Finland. According to previous studies, health care work faces various constraints which also challenge interprofessional interaction and learning. We ask what kinds of learning situations and challenges are manifested in moments of interprofessional practice. Ethnography was applied as a methodological approach. Empirical data were collected with the help of observations, audio taping, individual and focus group interviews, and suitable qualitative methods were utilised in the analysis. It was found that multi- and interprofessional collaboration and learning was present in many ways in emergency practice, for instance, in mutual planning of patient care and in situations where specific patient groups were treated. However, collaboration and learning were also challenged in these situations. Although collaborative practice was mostly fluent, coordination between professions need to be developed more collaboratively to promote learning and shared understanding among all employees.

Professional learning and agency in an identity coaching programme

This article addresses the professional learning that occurred in an identity coaching programme. The arts-based programme aimed to enhance the participants’ professional learning, notably through helping them to process their professional identities. Professional learning was seen as resourced by the participants’ professional agency, and by the promotion of such agency. Through interviews, we investigated what the participants perceived they had learnt during the programme, and the potential differences in learning outcomes between professional groups from university and hospital contexts. The findings showed that the programme was perceived as a rich learning arena in the domains of the professional self (involving a crafted professional identity), professional relationships (involving increased knowledge of colleagues and becoming an active participant in the work community) and professional competencies (involving socio-emotional knowledge and skills). The professionals (academics and administrative personnel) from a university learnt more during the programme than did the nurses and physicians working in a hospital. The findings suggest that the primary emphasis in professional learning should be on professional identity and agency within the social relationships that exist in training and work settings. The article also presents our theoretical considerations regarding the connection between professional agency and learning.

Professional Agency and Creativity in Information Technology Work

The meaning of professional agency in the context of professional learning, as well as in the development of working practices and work organisations, is pivotal. The role of creativity is also crucial for long-term economic growth in the current global environment, which is characterised by rapid changes in both technology and economy. Hence, it is important to study the relationship between professional agency and creativity. In this chapter, we explore professional agency and creativity within two Finnish information technology organisations. This study’s data include interviews with staff members and open-ended questionnaire responses to the question ‘What is creativity in your work?’. We conducted a qualitative data-driven thematic analysis and a theory-driven analysis. Based on the data, creativity was divided into five themes, with particular choices and decisions (i.e. manifestations of professional agency) being found to be linked to each of those themes. Based on the findings, it appears that creativity and agency are strongly related, although their manifestations depend on both the definition of creativity and the space and environment where the phenomena occur. On the one hand, agency manifests as a prerequisite for creativity, while on the other hand, it is an outcome of creativity. In addition, creativity and professional agency can also be seen as synonymous.

An Agency-Promoting Learning Arena for Developing Shared Work Practices

Despite the emerging recognition of the pivotal role played by professional agency within work contexts, little is known about how agency is promoted and enacted in organised work-related learning settings. This chapter focuses on the work conference as an orchestrated agency-promoting learning arena. We understand professional agency as a necessary precondition of work-related learning, and we emphasise the potential of work conferences to activate and promote such agency. Our empirical study investigated three work conferences in education and healthcare organisations in Finland. Utilising assessments, the investigation addressed how the participants perceived the conditions for learning and the learning outcomes in these conferences. The work conference was mostly viewed as a worthwhile learning arena. The conference advanced participants’ professional agency and participation across entrenched professional boundaries, and work-related learning occurred at both individual and collective levels. A comparison of the three work conferences indicated that in terms of the generation and actualisation of innovative developmental discussions, the most prominent learning outcomes occurred when the participants were able to enact substantial professional agency, when there was comprehensive participation from the work community, and when boundary crossing occurred. This paper contributes to the understanding of the conditions that impede or support work-related learning.

INPROF--Promoting Teamwork Processes and Interprofessional Collaboration in Emergency Work (2010-2012).

This paper summarises the findings of a research project on interprofessional collaboration in the emergency unit of a major Finnish hospital. The findings are discussed through a broad conceptual framework which involves work process knowledge and interprofessional collaboration. The project, carried out from 2010–2012, investigated different forms of, prerequisites for, and barriers to, collaboration, and the aim was to develop the work together with staff at the unit. An ethnographically informed research strategy was utilised, with observations and interviews as the main data collection methods. On the whole, collaboration in the emergency unit was found to function rather well; i.e. patients receive good-quality treatment within the ideal time frame. We found that in the unit, the most suitable form for the majority of collaborations is multi-professional collaboration, in which professionals exchange information but still adhere strongly to their own professional groups. More interprofessional collaboration is required particularly in leadership and management, to create further improvements in (1) the coordination of work as a whole, and (2) the implementation of organisational changes and new professional roles. Obstacles to interprofessional collaboration in particular appear to be: (1) diverging professional values and core professional identities, and (2) power relations that create inequality.

Agentic perspective on fostering work-related learning

ABSTRACT Despite the increased recognition of the role that professional agency plays in work-related learning, little is known about what supports it. Based on current theoretical notions, the first purpose of this paper is to show that professional agency is closely intertwined with work-related learning. The second purpose is to introduce some main principles that promote professional agency and describe three work-related training settings that are aimed at fostering learning by taking into account agentic perspectives. These complementary settings include an identity coaching programme, a leadership coaching programme, and a work conference. Based on the qualitative meta-synthesis, the paper further provides an empirical overview of professional agency and learning in these settings. The paper contributes to the understanding of the potential of professional agency at the heart of work-related learning. To foster learning, it is necessary to create social events for the enactment and activation of agency so that social and individual resources (e.g. experiences) are utilised. Overall, the paper emphasises that individuals and communities are active crafters of their professional identities and practices, and it provides viewpoints to support their agency in work and training settings.

The Reciprocal Relationship Between Emotions and Agency in the Workplace

In conjunction with a growing interest in professional agency, there is a need to understand how emotions are embedded in agentic practice. This chapter examines the emotions bound up with work and how these emotions are related to professional agency. The subjects of our study were leaders (middle management) and employees working in Finnish education and health-care organisations. A qualitative meta-synthesis was conducted to describe the relationship between professional agency and emotions. The study revealed a variety of emotions, including fear and enjoyment, related to professional identity, work, and social relationships. Among both employees and leaders, emotions were found to play an important role in the enactment of agency. Negative emotions seemed to trigger the enactment of professional agency regarding one’s professional career and work practices, while positive emotions activated agency in terms of renegotiating professional identities. On a reciprocal basis, the enactment of agency seemed to foster positive emotions. Weak agency, for its part, seems to arouse negative emotions. The study suggests that the relationships between professional learning, agency, and emotions seem likely to provide avenues for research in the future.