Creating practical knowledge for managing interprofessional health care teams : the promise of critical realism and the theory of action
Managing a multidisciplinary team in the interprofessional health care field is a fraught enterprise. Facing a turbulent and complex environment, managers have to confront the additional difficulties of aligning competing interests, accommodating diverse perspectives, and resolving interpersonal con...
Kaydedildi:
| OCLC: | 796829382 |
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| Yazar: | |
| Müşterek Yazar: | |
| Dil: | English |
| Baskı/Yayın Bilgisi: |
2005.
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| Konular: | |
| Online Erişim: | Center for Research Libraries |
| İlgili Kayıtlar: | Reprint version:
Creating practical knowledge for managing interprofessional health care teams. |
| Materyal Türü: | Tez Monograph Online Erişim |
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| 035 | |a (OCoLC)796829382 | ||
| 040 | |a CRL |c CRL | ||
| 049 | |a CRLL | ||
| 100 | 1 | |a Rogers, Tim. | |
| 245 | 1 | 0 | |a Creating practical knowledge for managing interprofessional health care teams : |b the promise of critical realism and the theory of action / |c Tim Rogers. |
| 260 | |c 2005. | ||
| 300 | |a 1 online resource (xvi, 210 leaves) : |b ill. | ||
| 336 | |a text |b txt |2 rdacontent. | ||
| 337 | |a computer |b c |2 rdamedia. | ||
| 338 | |a online resource |b cr |2 rdacarrier. | ||
| 500 | |a A thesis submitted to the International Centre for Management and Organisational Effectiveness, Division of Business and Enterprise. University of South Australia. | ||
| 502 | |b doctoral |c University of South Australia |d 2005. | ||
| 504 | |a Includes bibliographical references (leaves 195-207) | ||
| 520 | |a Managing a multidisciplinary team in the interprofessional health care field is a fraught enterprise. Facing a turbulent and complex environment, managers have to confront the additional difficulties of aligning competing interests, accommodating diverse perspectives, and resolving interpersonal conflicts withn their own team. Often these dilemmas feature incommensurate versions of the meaning of natural and social objects, including discrepancies in determining the correct identity of actions and roles. I have termed these difficulties 'problems of situated practice'. These problems take two typical forms. Firstly, difficulties arise as different models of practice compete. Since team members come from various professional backgrounds, they may hold divergent views of the issues they encounter. While this conveys advantages, and is indeed the rationale for the multidisciplinary team concept in the first place, it runs the evident risk of splintering the team. Secondly, there are difficulties managing the limits to professional autonomy. Because of the collegial aspirations implied by the very idea of a multidisciplinary decision making framework, disputes can arise with respect to the proper authority each member has, and in which situations it can be legitimately invoked. | ||
| 520 | 8 | |a While the difficulties dealing with these problems are extensively documented, there is little in the literature that attempts to offer direct help. This thesis aims to accomplish two things. Firstly, I explain this shortcoming in the literature through a critique of the epistemological positions that ground the vast majority of current research practices. Secondly, I offer an alternative approach and empirical example, grounded in a more adequate philosophy of science. The epistemological arguments begin with the notion that researchers wishing to kelp managers deal with problems of situated practice would ideally want to offer an explanation for the appearance and persistence of these problems. In other words, the principal goal of research should be to explain the meanings, actions and systems that give rise to and sustain these problems. The predominant epistemological positions of empiricism and hermeneutics, I argue, are not adequate to this task. Empiricist approaches concern themselves with the prediction of behaviour, and hermeneutic approaches with the understanding of social life. Both empiricism and hermeneuticism thus have significant weaknesses with respect to the goal of explanatory research: empiricism conflates prediction and explanation, in hermeneuticism understanding exhausts explanation. | |
| 520 | 8 | |a In examples from the literature I show how this leads empiricist research to ignore the meaningful nature of action and the crucial causal dimensions of agent reasons, rules and norms. The hermeneutic counterposition, while acknowledging meaning as central to understanding action, assumes the veracity of lay accounts of causation and makes it impossible to rationally discriminate between the competing versions of reality associated with problems of situated practice. There have been two notable responses to these limitations. The 'strong programme' social constructivists have argued that empiricism has ignored situated meaning in an attempt to illegitimately construct a reality that exists outside of discourse. From this radical discursive point of view the hermeneuticists fare no better, their attempt to identify the better interpretation is considered futile: no interpretation can be better than any other, each is a competing account that references its own internal logic. This is the relativist response. The most significant alternative response has been made by the critical realists. Like the social constructivists they see versions of social reality constructed by agents in their everyday discourse (but also through their non-discursive practical interactions). Unlike the social constructivists they claim that versions of reality can be more or less accurate, because social reality exists independently of any particular account of it. | |
| 520 | 8 | |a In fact, aspects of social reality may be the outcome of structures and ideologies that all agents are unaware of. The potential to discover, and perhaps remove or substitute, mechanisms that causally explain the misapprehension of social reality, marks the human sciences as emancipatory. Recently, this emancipatory aim has been the subject of various criticisms and doubts, including from within the critical realist community. These criticisms and doubts seem to be resistant to philosophical argument alone. Rather, their resolution and rebuttal appears to require actual empirical examples-illustrations of emancipatory potential-and here the critical realist enterprise is sorely lacking. A central concern is the possibility of any theory to empirically discriminate between lay causl accounts and scientific accounts of social world. That is, how does a theory adjudicate between competing versions of social reality? Following these philosophical considerations, I then explore the capacity of the 'theory of action' to both illuminate problems of situated practice and contribute to their resolution. The theory of action is a theory of interpersonal and organisational effectiveness whch posits 'theories-in-use', or constellations of norms, as causal mechanisms that are fundamental in the perception and filtering of environmental stimuli, the selection of goals, and the design of action to achieve those goals. | |
| 520 | 8 | |a Since theories-in-use are both tacit and automatic, people are unaware of their influence on their behaviour, and consequently are unaware of the meanings their actions hold for others, the roles these meanings play in group and organisational problems, and the subsequent patterns triggered within the organisational system. The theory of action methodology consists of the collaborative (with the manager) exploration of the causal influence of these theories and patterns on the problems the manager wishes to address, with the aim of remedying them. The theory of action, in contrast to empiricist approaches but in keeping with hermeneutic ones, is sensitive to the unique and meaningful dimensions of a manager's problems of situated practice. At the same time, in contrast to hermeneutic approaches but consistent with empiricist ones, it offers a causal account that potentially conflicts with a manager's lay account of cause. The theory of action offers, then, the capacity for a theory-derived critique of practice consonant with critical realist prescriptions for explanatory research in the social sciences. The plausibility of these claims is tested in an empirical example of a depth-investigation with one multidisciplinary team leader. This work demonstrates that the theory of action offers a more accurate account of the causal dimensions of her problems and provides more scope for effective intervention than her lay account will allow. Further, this critique lays the foundations for an intervention designed to help the manager resolve the difficulties associated with her most urgent issue. | |
| 520 | 8 | |a It also provides a deeper and more satisfactory description and explanation of the archetypal problems associated with multidisciplinary teams, i.e. dealing with the consequences of competing models of practice and setting the limits to autonomy in a collegial environment. The arguments and empirical evidence in this thesis contribute knowledge to three areas: critical realism, the theory of action, and management in interprofessional care. For critical realism it identifies a theory and methodology consistent wiih its premises, puts this into practice, and makes use of this to buttress critical realism's emancipatory claims in the social sciences. This entails a focus on the capacity to test competing accounts, which, somewhat controversially, I argue requires the use of conditional prediction. For the theory of action the very existence of independent empirical corroboration is of great value, given the dearth of published research. In addition this thesis applies the theory of action to a new domain and demonstrates its empirical power to illuminate central problems in novel environments. The philosophical arguments also clarify the theory's epistemological status: it is not in need of any special justification, as is usually assumed, but is a paragon of scientific practice. | |
| 520 | 8 | |a Finally, for management in interprofessional care, this thesis recasts the impotence of previous research as due to fundamental epistemological errors, offers a unique perspective on problems of situated practice, and models a normative approach that can be applied by researchers and practitioners alike. I conclude that a critical realist epistemology coupled with a theory of action methodology offers enormous promise to managers of multidisciplinary teams in interprofessional care who want to understand and resolve their problems of situated practice and develop a scientifically rigorous reflective practice. Finally, I suggest the need for further research that attempts to deepen and extend the changes in interpersonal theories-in-use, explore the wider organisational ramifications, and investigate the implications for learning and teaching. | |
| 588 | |a Description based on reprint version record. | ||
| 650 | 0 | |a Health care teams. | |
| 650 | 0 | |a Medical cooperation. | |
| 710 | 2 | |a University of South Australia. | |
| 752 | |a Australia. | ||
| 776 | 0 | 8 | |i Reprint version: |a Rogers, Tim. |t Creating practical knowledge for managing interprofessional health care teams. |d 2005 |w (OCoLC)271023112. |
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