Interprofessional Healthcare Collaboration on the Front Lines: A Qualitative Exploration of the Facilitators and Barriers to Effective Collaboration in Qatar.

Background:
Healthcare in Qatar is undergoing a period of major reform, driven by a strong economy and vision for a world-class healthcare system. One area identified as a potential contributor to developing a world-class healthcare system is interprofessional education (IPE), with the goal of facilitating healthcare workers to work together collaboratively. Several key steps have been taken towards developing IPE in Qatar, such as the formation of the Qatar Interprofessional Health Council (QIHC), the development of an IPE program for undergraduate healthcare students, the development of a set of shared core competencies, the receipt of substantial buy-in from leaders across the healthcare system, and recent approval of funding to develop a post-licensure healthcare IPE program. In order to improve IPE in Qatar, it is important to better understand the facilitators and barriers to interprofessional collaboration in Qatar. This study seeks to do so by qualitatively exploring facilitators and barriers to interprofessional collaboration for healthcare professional in Qatar from the perspective of health care professionals. By better understanding how health care workers give meaning to interprofessional education and collaboration, this research can assist in improving interprofessional activities in healthcare in Qatar.

Objectives
The purpose of this paper-presentation is to report on finding from a qualitative study that explored different facilitators and barriers of interprofessional practice in Qatar.

Method:
Ten healthcare professionals who work in Qatar were interviewed using semi-structured, open-ended interviews. Interview questions were organized by phenomenological (e.g. exploring the lived-experiences of healthcare workers) and ethnographic interviewing techniques (e.g. focusing on what people do). The questions explored the barriers, facilitators, and what is working well in terms of interprofessional practice for health care professional in Qatar.

Findings and Implications:
Different factors associated with interprofessional collaborations will be discussed. In doing so, this research adds to the literature on IPE by shedding light on interprofessional collaboration and education in the Middle East. Furthermore, this study identifies barriers for health care workers to work collaboratively in health care settings in Qatar. Addressing such barriers, and building off of what is working well, will facilitate Qatar in reaching one of the Vision 2030 goals of improving Qatar’s health and wellness.

Interprofessional Healthcare Collaboration on the Front Lines: A Qualitative Exploration of the Facilitators and Barriers to Effective Collaboration in Qatar.

Background:

Healthcare in Qatar is undergoing a period of major reform, driven by a strong economy and vision for a world-class healthcare system. One area identified as a potential contributor to developing a world-class healthcare system is interprofessional education (IPE), with the goal of facilitating healthcare workers to work together collaboratively. Several key steps have been taken towards developing IPE in Qatar, such as the formation of the Qatar Interprofessional Health Council (QIHC), the development of an IPE program for undergraduate healthcare students, the development of a set of shared core competencies, the receipt of substantial buy-in from leaders across the healthcare system, and recent approval of funding to develop a post-licensure healthcare IPE program. In order to improve IPE in Qatar, it is important to better understand the facilitators and barriers to interprofessional collaboration in Qatar. This study seeks to do so by qualitatively exploring facilitators and barriers to interprofessional collaboration for healthcare professional in Qatar from the perspective of health care professionals. By better understanding how health care workers give meaning to interprofessional education and collaboration, this research can assist in improving interprofessional activities in healthcare in Qatar.

Objectives

The purpose of this paper-presentation is to report on finding from a qualitative study that explored different facilitators and barriers of interprofessional practice in Qatar.

Method:

Ten healthcare professionals who work in Qatar were interviewed using semi-structured, open-ended interviews. Interview questions were organized by phenomenological (e.g. exploring the lived-experiences of healthcare workers) and ethnographic interviewing techniques (e.g. focusing on what people do). The questions explored the barriers, facilitators, and what is working well in terms of interprofessional practice for health care professional in Qatar.

Findings and Implications:

Different factors associated with interprofessional collaborations will be discussed. In doing so, this research adds to the literature on IPE by shedding light on interprofessional collaboration and education in the Middle East. Furthermore, this study identifies barriers for health care workers to work collaboratively in health care settings in Qatar. Addressing such barriers, and building off of what is working well, will facilitate Qatar in reaching one of the Vision 2030 goals of improving Qatar’s health and wellness.

Panning for Gold: The Standardizing Work of Filling “Autistic” Shells – Using institutional ethnography to explore textually mediated health relations in the diagnostic process of autism.

Health reform practices in Canada and elsewhere have restructured the purpose and use of diagnostic labels and the processes of naming such labels. Diagnoses are no longer only a means to tell doctors and patients what may be wrong and indicate potential courses of treatment; some diagnoses activate specialized services and supports for persons with a disability and those who provide care for them. In British Columbia, a standardized process of diagnosis with the outcome of an autism spectrum disorder gives access to government provided health care and educational services and supports. Such processes enter individuals into a complex of text mediated relations, regulated by the principles of evidence-based medicine. However, the diagnosis of autism in children is notoriously uncertain. Because of this ambiguity, standardizing the diagnostic process creates a hurdle in gaining help and support for parents who have children with problems that could lead to a diagnosis on the autism spectrum. Such processes and their organizing relations are problematized, explored and explicated below. Grounded in the epistemological and ontological shift offered by Dorothy E. Smith (1987; 1990a; 1999; 2005), this article reports on the findings of an institutional ethnographic study that explored the diagnostic process of autism in British Columbia. More specifically, this article focuses on the processes involved in going from mothers talking from their experience about their childrens problems to the formalized and standardized, and thus “virtually” produced, diagnoses that may or may not give access to services and supports in different systems of care. Two psychologists, a developmental pediatrician, a social worker – members of a specialized multidisciplinary assessment team – and several mothers of children with a diagnosis on the autism spectrum were interviewed. The implications of standardizing the diagnosis process of a disability that is not clear-cut and has funding attached are discussed. This ethnography also provides a glimpse of the implications of current and ongoing reforms in the state-supported health care system in British Columbia, and more generally in Canada, for people’s everyday doings.

Assessment Work of Paramedics on the Front lines of Emergency Health Services

This article draws on an institutional ethnographic inquiry into the work of paramedics and the institutional setting that organizes and coordinates their work processes. Drawing on over 200 hours of observations and over 100 interviews with paramedics (average length of 18 minutes) and other emergency medical personnel, this article explores the standard and not so standard work of paramedics as they assess and care for their patients on the front lines of emergency health services. More specifically, I focus on the multiplicity of interfacing social, demographic, locational, situational, and institutional factors that shape and organize the work of paramedics. In doing so, this article provides insights into how paramedics orient to the social context in which their work occurs and contrasts this actual work with how their work is institutionally reported and made visible; what gets counted institutionally is not necessarily the same as what counts for the paramedics. This article problematizes this demarcation between what is known institutionally and “systematic practices of ‘not knowing’” (DeVault, 2008, p. 290).

Tullis Rennie's Muscle Memory: Listening to the Act of Listening

This paper explores a recent, broadly 'electroacoustic', fixed medium composition by Tullis Rennie, which uses his background in ethnographic fieldwork to explore (in this case through auto-ethnography) modes of listening, and the role of technologies in mediating this listening. Muscle Memory: A conversation about jazz, with Graham South (trumpet) (2014) begins to answer questions about how one work can comment on and analyse or critique another through its own agency as music, bringing composition and ethnography together in fruitful collision, and illuminating the human capacity to manipulate and be manipulated by musical activity. The paper uses the piece to test the extent to which four functions, identified by Simon Frith (1987. Towards an aesthetic of popular music. In R. Leppert & S. McClary (Eds.), Music and society (pp. 133-49). Cambridge: Cambridge University Press) as crucial to the meaningfulness of popular music may, in the context of ubiquitously technologised music, have broader application than he originally intended.

Street Medicine – Assessment Work Strategies of Paramedics on the Front lines of Emergency Health Services

This article is based on an institutional ethnographic inquiry into the work of paramedics and the institutional setting that organizes and coordinates their work processes in a major City in Canada. Drawing on over 200 hours of observations and over 100 interviews with paramedics (average length of 18 minutes) and other emergency medical personnel, this article explores the standard and not so standard work of paramedics as they assess and care for their patients on the front lines of emergency health services. The multiplicity of interfacing social, demographic, locational, and situational factors that shape and organize the work of paramedics are analyzed. In doing so, this article provides insights into the complex work of an understudied yet ever-important profession in healthcare.

‘At First I Saw It as a Toy’: Life Stories, Social Consciousness and Music Ethnography

This article examines the role of life narratives as discursive spaces for the performance of individual resistance. Through the inspection of three interviews with professional musicians in Athens, the essay will illustrate how the recounting of nodal events in their lives and careers facilitates an assertion of their current social ideology and their disillusionment with the popular music industry in which they operate. Ultimately, what follows will suggest a mode of listening to individual utterances and narratives as discursive forms of resistance that need to be appreciated as social acts as opposed to mere ethnographic data.

Objects of Transcendence: Scots Protestantism and an Anthropology of Things

This anthropological essay takes as its ethnographic point of departure two apparently contrasting deployments of the Bible within contemporary Scotland, one as observed among Brethren and Presbyterian fisher-families in Gamrie, coastal Aberdeenshire, and the other as observed among the Orange Order, a Protestant marching fraternity, in Airdrie and Glasgow. By examining how and with what effects the Bible and other objects (plastic crowns, ‘Sunday clothes’, Orange regalia) enter into and extend beyond the everyday practices of fishermen and Orangemen, my aim is to sketch different aspects of the material life of Scottish Protestantism. By offering a critique of Bruno Latour’s early writing on ‘quasi-objects’ via Alfred Gell’s notion of ‘distributed personhood’, I seek to undermine the sociological assumption that modernity and enchantment are mutually exclusive.

Approaches through Materiality

Religion is a funny thing, because it always seems to be riding two horses at once. One could describe these horses in a number of different ways, using all sorts of familiar dichotomies; practice and belief, body and soul, earthly and heavenly, here and hereafter. “Give us this day our daily bread and forgive us our trespasses”. Here, food and forgiveness, or, perhaps more accurately, ingestion and salvation, are claimed, simultaneously – even seamlessly – by religion. This list could (and does) go on, being inclusive of, for example, immanence and transcendence – but more on this below. Yet these binary pairs can clearly be observed bleeding into one another. Ingesting pork, for example, often appears to be religiously more troublesome than does ingesting bread. This is because matter matters. We may ask, then, is religion really riding two horses, or are these ‘familiar dichotomies’ so familiar because they are false? Rephrasing the question in terms that partially echo the title and subtitle of Morgan’s (2010) landmark edited volume Religion and Material Culture: The Matter of Belief, is, I think, helpfully clarifying. What, then, is the matter with religion? The answer presented below is that, very often, the matter with religion is the matter of religion. Put more simply still, the problem with religion is its materiality. This chapter examines the whys and wherefores of this problem for the anthropology of religion – its ethnographic puzzles and methodological opportunities, as well as its conceptual impasses and theoretical insights.

Dual Classification Revisited: Rodney Needham and Vertical Asymmetry aboard Scottish Trawlers

Drawing on ethnographic data collected while working as a deckhand on two Scottish trawlers, this article analyses the spatialisation of social, religious and economic inequalities that marked relations between crew members while they hunted for prawns in the North Sea. Moreover, it explores these inequalities as a wider feature of life in Gamrie, Aberdeenshire, a Brethren and Presbyterian fishing village riven by disparities in wealth and religion. Inequalities identified by fishermen at sea mirrored those identified by residents onshore, resulting in fishing boats being experienced as small 'floating villages'. Drawing on the work of Rodney Needham, this article suggests that these asymmetries can be traced along a vertical axis, with greater to lesser wealth and religiosity moving from top/above to bottom/below. The article seeks to understand the presence and persistence of these hierarchies at sea and on land, by revisiting dual classification within anthropological theory.

Praying for Salvation: A Map of Relatedness

This article attempts to push Mauss’ work on the sociality of prayer (1909) to its fullest conclusion by arguing that prayer can be viewed anthropologically as providing a map for social and emotional relatedness. Based on fieldwork among deep-sea fisher families living in Gamrie, North-East Scotland (home to 700 people and six Protestant churches), the author takes as his primary ethnographic departure the ritual of the ‘mid-week prayer meeting’. Among the self-proclaimed ‘fundamentalists’ of Gamrie’s Brethren and Presbyterian churches, attending the prayer meeting means praying for salvation. Yet, contrary to the stereotype of Protestant soteriology as highly individualist, in the context of Gamrie, salvation is not principally focused upon the self, but is instead sought on behalf of the ‘unconverted’ other. Locally, this ‘other’ is made sense of with reference to three different categories of relatedness: the family, the village and the nation. The author’s argument is that each category of relatedness carries with it a different affective quality: anguish for one’s family, resentment toward one’s village, and resignation towards one’s nation. As such, prayers for salvation establish and maintain not only vertical – human-divine – relatedness, but also horizontal relatedness between persons, while also giving them their emotional tenor. In ‘fundamentalist’ Gamrie, these human relationships, and crucially their affective asymmetries, may be mapped, therefore, by treating prayers as social phenomena that seek to engage with a world dichotomised into vice and virtue, rebellion and submission, and, ultimately, damnation and salvation.

Establishing the ‘Truth’ of the Matter: Confessional Reflexivity as Introspection and Avowal

The conceptualisation of reflexivity commonly found in social anthropology deploys the term as if it were both a ‘virtuous’ mechanism of self‐reflection and an ethical technique of truth telling, with reflexivity frequently deployed as an moral practice of introspection and avowal. Further, because reflexivity is used as a methodology for constructing the authority of ethnographic accounts, reflexivity in anthropology has come to closely resemble Foucault’s descriptions of confession. By discussing Lynch’s (2000) critical analysis of reflexivity as an ‘academic virtue’, I consider his argument through the lens of my own concept of ‘confessional reflexivity’. While supporting Lynch’s diagnosis of the ‘problem of reflexivity’, I attempt to critique his ethnomethodological cure as essentialist, I conclude that a way forward might be found by blending Foucault’s (1976, 1993) theory of confession with Bourdieu’s (1992) theory of ‘epistemic reflexivity’.

Exploring communication between social workers, children and young people

A key issue for the social work profession concerns the nature, quality and content of communicative encounters with children and families. This article introduces some findings from a project funded by the Economic and Social Research Council (ESRC) that took place across the United Kingdom between 2013 and 2015, which explored how social workers communicate with children in their everyday practice. The Talking and Listening to Children (TLC) project had three phases: the first was ethnographic, involving observations of social workers in their workplace and during visits; the second used video-stimulated recall with a small number of children and their social workers; and the third developed online materials to support social workers. This paper discusses findings from the first phase. It highlights a diverse picture regarding the context and content of communicative processes; it is argued that attention to contextual issues is as important as focusing on individual practitioners’ behaviours and outlines a model for so doing.

The Evolution of Extreme Cooperation via Shared Dysphoric Experiences

Willingness to lay down one’s life for a group of non-kin, well documented in the
historical and ethnographic records, represents an evolutionary puzzle. Here we
present a novel explanation for the willingness to fight and die for a group, combining evolutionary theorizing with empirical evidence from real-world human groups. Building on research in social psychology, we develop a mathematical model showing how conditioning cooperation on previous shared experience can allow extreme (i.e., life-threatening) pro-social behavior to evolve. The model generates a series of predictions that we then test empirically in a range of special sample populations (including military veterans, college fraternity/sorority members, football fans, martial arts practitioners, and twins). Our results show that sharing painful experiences produces “identity fusion” – a visceral sense of oneness – more so even than bonds of kinship, in turn motivating extreme pro-group behavior, including willingness to fight and die for the group. These findings have theoretical and practical relevance. Theoretically, our results speak to the origins of human cooperation, as we offer an explanation of extremely costly actions left unexplained by existing models.
Practically, our account of how shared dysphoric experiences produce identity fusion, which produces a willingness to fight and die for a non-kin group, helps us better understand such pressing social issues as suicide terrorism, holy wars, sectarian violence, gang-related violence, and other forms of intergroup conflict.

Language anxiety in English teachers during their teaching practice

Este estudo explora a influência da ansiedade linguística em futuros professores de Inglês em situação de prática pedagógica. Setting the Scene descreve o aumento de interesse pela ansiedade linguística por parte dos investigadores no contexto da aprendizagem e do ensino, e a relevância desta questão para professores estagiários fazendo a transição de aluno para professor. O autor também considera a sua própria experiência de ansiedade – enquanto estudante e investigador – de modo a gerar um maior entendimento desta emoção complexa. O Capítulo 1 da Parte 1 descreve como o afecto na aprendizagem e na investigação da língua tem vindo a ser um factor preponderante no interesse mais alargado sobre as emoções em contextos educacionais. A recente influência da teoria social na aquisição de uma segunda língua e como esta pode ajudar a repensar a investigação das emoções é discutida antes do final do capítulo, onde se examina ainda como as emoções são expressas na comunicação e interacção. O Capítulo 2 concentra-se na ansiedade na aprendizagem da língua e em como o peso da noção em contexto social alargado tem provavelmente influenciado uma abordagem dominantemente de cariz positivista na investigação sobre a ansiedade linguística. Controvérsias e variáveis da personalidade relacionadas com a ansiedade linguística são discutidas, considerando-se a possibilidade de novas direcções para a investigação. A prática pedagógica é vista como um campo fértil de investigação sobre a ansiedade linguística em estagiários, com estilos de supervisão e discursos – nomeadamente estratégias de delicadeza e de mitigação – sendo considerados influências importantes na experiência desta emoção. O Capítulo 3 da Parte 2 detalha a abordagem etnográfica e etnometodológica do estudo e o procedimento de investigação em si. Os dados foram recolhidos em três momentos distintos. Primeiro, através de inquéritos aplicados aos estagiários antes do começo do estágio. Numa segunda fase, durante o estágio, os dados principais foram recolhidos através das aulas e duma entrevista semi-estruturada com os estagiários, ambas vídeo gravadas, e dos encontros de pós-observação áudio-gravados. Os dados subsidiários recolhidos nesta mesma fase incluem reflexões escritas e dossiers dos estagiários, observações escritas das aulas do investigador e o relatório intercalar dos professores supervisor e cooperante. Na última fase, posterior às aulas, a recolha dos dados principais foi realizada através de uma vídeo gravação da reunião de avaliação final com todos os participantes e de stimulated recall protocols com cada professor estagiário. O Capítulo 4 é predominantemente uma análise qualitativa de discurso, utilizando categorias de análise para identificar sinais de ansiedade emergentes dos dados. Os resultados mostram que um dos estagiários pode ser caracterizado como tendo uma experiência de ansiedade mais debilitadora, outro uma ansiedade mais facilitadora, enquanto a experiência do terceiro é menos pronunciada e mais difícil de caracterizar. Sinais e fontes múltiplos e complexos de ansiedade foram identificados mas as próprias autoimagens dos sujeitos como professores de Inglês, construídas em interacção ao longo do estágio, estão no centro desta experiência emocional. O Capítulo 5 considera as implicações e as conclusões deste estudo. São dadas indicações para a relação estagiário-supervisor e quanto aos estilos do supervisor no quadro da prática pedagógica assim como sugestões para que a ansiedade linguística seja explicitamente abordada na formação em supervisão. Finalmente, é ponderada se a experiência da ansiedade linguística destas estagiárias e as suas fontes têm ou não implicações na formação dos alunos de línguas.