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