In November this year I wrote about Paul Barach‘s work in developing team work in health care. I have been thinking about his insights since my encounter with his work.

I have found this paper (Barach et al, 2008) subsequently and note from its conclusion that:

Pediatric cardiac surgery is an ideal model to study the coordinated efforts of team members in a complex organizational structure. Adverse events occurred routinely during pediatric cardiac surgery and were mostly compensated. Case complexity was a significant predictor of major adverse events. The number of major adverse events per patient correlated with clinical outcomes.

A more recent paper (Schraagen et al, 2010) provides details about observation protocols for recording intraoperative non-routine events (NREs). The paper has some interesting points to make about inter-observer agreement and the training required:

The authors trained human factors observers to observe and code the NRE’s and teamwork from time of arrival of the patient into the operating room (OR) to the patient handover in the intensive care unit. The observers underwent immersive training in which each observer attended 10 operations, learnt in detail about the technical procedures and clinical tasks and received practice in coding teamwork. Two observers were used interchangeably to observe OR teamwork. The authors instigated a rigorous training and assessment protocol, with independent assessment of their performance by both senior medical and human factors experts using video-based assessment. Real-time teamwork observations were supplemented with process mapping, questionnaires on safety culture, level of preparedness by the team, difficulty of the operation and outcome measures.

I have have been thinking a great deal about error, harm and care in the last month and have shared Paul’s insights with a number of people working in team contexts. My original contact with his work was through his interview with Norman Swan (link to podcast) on Radio National’s Health Report.

More Examples of Care

Yesterday (20 December) I learned of the release of the ANZASM 2009 Annual Report by the Australian and New Zealand Audit of Surgical Mortality (ANZASM). This report is based on the activities and outcomes during 2009. The announcement of the report’s availability notes that:

The primary objective of the audit is peer review of all deaths associated with surgical care. The audit process is designed to highlight system and process errors and trends associated with surgical mortality.

I learned yesterday too about the work of Anna Tharyan (Professor of Psychiatry, Christian Medical College,
Vellore, Southern India) and Prathap Tharyan (Professor of Psychiatry, Christian Medical College, Vellore,
Southern India). I found out about Cochrane Collaborations and in passing the work of Clive Adams (Professor of Mental Health Services Research,University of Nottingham, UK). What fascinated me about their work was their sense of caring and the use of a collaborative approach to care. A transcript of the Health Report program about their work can be found here.

In the program Anna starts the interview with this observation:

After 26 years of working within the confines of a large teaching department of psychiatry I was invited by a man who had organised a not for profit organisation to just, as he said, do rounds on the street. He says doctor, you’re going round and round your hospital wards, would you care to come with me down the street and see how many of your patients sit by the roadside? And this man who hasn’t completed a school education opened my eyes to the vast section of the people who need professional psychiatric help who were not existing as far as we were concerned.

Prathap discusses evidence-based medicine in his interview and shares his insights into low cost, clinic-based research design involving real life patients and the kind of working conditions found:

This was a real world trial and we didn’t exclude large numbers of people because most trials tend to exclude somebody with this condition or that condition. But a clinician doesn’t have that luxury, you’ve got to treat everybody who comes so a lot of that evidence isn’t applicable to us. So we decided to create our own evidence using our own patients using our usual clinical practice.

With Clive Adams he has been investigating effective medication for violent patients. Their work exemplified for me the possibilities created by collaborative caring.

Collaborating to Care

I was fascinated to learn about Cochrane Centres in the Health Report and was attracted immediately to the democratic potential of such collaboration.  I have discovered that the Cochrane Collaborative is made up of contributors and entities based all around the world. The majority of the Collaborative’s work is conducted online.

Each entity is a ‘mini-organisation’ in itself, with its own funding, website and workload. Contributors affiliate themselves to an entity, or in some cases several entities, based on their interests, expertise and/or geographical location.

The Collaborative produces Cochrane Reviews which are systematic reviews of primary research in human health care and health policy:

They investigate the effects of interventions (literally meaning to intervene to modify an outcome) for prevention, treatment and rehabilitation. They also assess the accuracy of a diagnostic test for a given condition in a specific patient group and setting. (For information about the structure of these reviews see here.)

I was interested to read about the impact these Reviews have on practice in the UK National Health Service.


Paul Barach’s work has taken me on a journey of discovery. I was attracted intuitively to his approach to systematic observation and how teams might use observation to enhance performance and promote trust. The link between Paul, Anna, Prathap and Clive was made for me by Norman Swan. The Cochrane Collaborative is a real bonus in this wayfinding.

I am hopeful that by exploring a range of contexts for caring that my understanding and practice of care is developed. I am looking forward to exploring inter-professional learning in much more depth in 2011.

Photo Credits

Baby in Hand

PS Asleep on a Bench


Blogging 2010: Celebrating and Recognising Reciprocal Altruism

I was fascinated to read about this year’s nominations for the Edublog Awards.

There are thirty-one nominations for the Individual Edublog Award.

Always Learning
An A-Z of ELT
Cool Cat Teacher
Dangerously Irrelevant
Educational Origami
Free Technology for Teacher
Kevin’s Meandering Mind
iLearn Technology
Integrating Technology in the Primary Classroom
Jane’s eLearning Pick of the Day
Kalinago English
Kirsten Winkler
Larry Ferlazzo’s Websites of the Day
Learning with ‘e’s
Moving at the Speed of Creativity
Never Ending Search
Not So Distant Future
Pair-a-Dimes for your Thoughts
School Finance 101
Science Teacher
Speech-Language Pathology Sharing
Spencer’s Scratchpad
Teacher Reboot Camp
The Innovative Educator
The Principal’s Page
Think Thank Thunk
What Ed Said

There are thirty-four nominations for the Best New Edublog Award.

About A Teacher
bcnpaul1′s blog
Be Cunning and Full of Tricks
Blogging through the Fourth Dimension
Box of Chocolates
Connected Principals
Culture of Yes
Digital Dervish
Educating Grace
Eliterate Librarian
Emma Herrod
Experts and Newbies
Hack Education
Language Garden
Libraries and Transliteracy
New City Arts
Michelle’s Musings
MrK’s Professional Reflections
Quantum Progress
Reflections of a teacher and a learner
Teaching Literacy in the Early Years
Speech Techie
The Nerdy Teacher
Think Thank Thunk
Turklish TEFL
Upside Down Education
Venture Pragmatist
Walt Gardner’s Reality Check
Webb’s Wide World
Whose Learning Is It Anyway?

Voting concludes shortly and am keen to find out who has set THE standard in the twenty-three award categories. I was interested to see that the twenty-third category is a Lifetime Achievement Award. There are some incredible bloggers here.

Alan Levine
Alec Couros
Bernie Dodge
Chris Betcher
Chris Lehmann
Dan Myer
Danah Boyd
Doug Johnson
Gary Stager
Gavin Dudeney
Howard Rheingold
Ira Socol
Jane Hart
Joseph Pisano
Joyce Valenza
Karl Fisch
Kevin Honeycutt
Kyle Pace
Larry Ferlazzo
Linda Yollis
Richard Byrne
Scott McLeod
Sean Banville
Sir Ken Robinson
Steve Hargadon
Sue Waters
Vicki Davis
Wesley Fryer
Will Richardson

There are twenty-four nominations for the Best Resource Sharing Blog:

Around the
Art is Messy
Bits and Pieces places
Box of Tricks
Bright Ideas
Continuous Everywhere but Differentiable Nowhere
doug – off the record
El escaparate de Rosa
Free Technology for Teacher
I Hope This Old Train Breaks Down
iLearn Technology
InTec Insights
Jane’s Pick of the Day
Kirsten Winkler
Larry Ferlazzo’s Websites Of The Day
Librarian in Black
Moodle News
Moving at the Speed of Creativity
Nik’s Quick Shout
SCC English
Teacher Boot Camp
Technology Tidbits
The OLDaily
The Pursuit of Technology Integration Happiness
Videoonferencing Out on a lim
Web 2.0 Classroom Blog

I am surprised constantly by the reciprocal altruism of the blogosphere and am in awe of the contributions all of these nominees have made to 2010. It is very obvious to me that I have a lot of catch up reading to do.

Thinking About Words

Last Wednesday staff from Sport Studies at the University of Canberra met the poet Harry Laing at the Old Cheese Factory at Reidsdale to develop our writing skills as part of the Faculty of Health‘s 2010 Writing Week. I have been thinking about the workshop a good deal since then.

On one of my journeys into the University of Canberra I caught a Book Show discussion of Paul Celan.The program note included the quote “There is nothing in the world for which a poet will give up writing, not even when he is a Jew and the language of his poems is German.” Ramona Koval discussed with Charlotte Ryland the limits and possibilities of language in relation to Celan’s poetic project.

The interview was prompted by the publication of Charlotte’s book Paul Celan’s Encounters with Surrealism: Trauma, Translation and Shared Poetic Space. The Legenda summary of the book is:

Paul Celan (1920-1970), one of the most important and challenging poets in post-war Europe, was also a prolific and highly idiosyncratic translator. His post-Holocaust writing is inextricably linked to the specific experiences that have shaped contemporary European and American identity, and at the same time has its roots in literary, philosophical and scientific traditions that range across continents and centuries – surrealism being a key example. Celan’s early works emerge from a fruitful period for surrealism, and they bear the marks of that style, not least because of the deep affinity he felt with the need to extend the boundaries of expression. In this comparative and intertextual study, Charlotte Ryland shows that this interaction continued throughout Celan’s lifetime, largely through translation of French surrealist poems, and that Celan’s great oeuvre can thus be understood fully only in the light of its interaction with surrealist texts and artworks, which finally gives rise to a wholly new poetics of translation.

I like the idea of a ‘poetics of translation’ and its resonance with developing ideas. I ought to track down the book to learn more about Paul Celan and Charlotte’s account of poetics. This may take me to Jacques Derrida too!

It is surprising where a misty day in Reidsdale can lead you.