On collective self-healing and traces: How can swarm intelligence help us think differently about team adaptation?

Using starling murmuration as a model for creating a global health community of practice to advance equity in scholarship

BACKGROUND

Disparities in scholarship exist between authors in low- or middle-income countries (LMIC) and high-income countries. Recognizing these disparities in our global network providing pediatric, adolescent, and maternal healthcare to vulnerable populations in LMIC, we sought to improve access and provide resources to address educational needs and ultimately impact the broader scholarship disparity.

METHODS

We created a virtual community of practice (CoP) program underpinned by principles from starling murmuration to promote interdisciplinary scholarship. We developed guiding principles- autonomy, mastery and purpose- to direct the Global Health Scholarship Community of Practice Program. Program components included a continuing professional development (CPD) program, an online platform and resource center, a symposium for scholarship showcase, and peer coaching.

RESULTS

From February 2021 to October 2022, 277 individuals joined. Eighty-seven percent came from LMIC, with 69% from Africa, 6% from South America, and 13% from other LMIC regions. An average of 30 members attended each of the 21 CPD sessions. Thirty-nine authors submitted nine manuscripts for publication. The symposium increased participation of individuals from LMIC and enhanced scholarly skills and capacity. Early outcomes indicate that members learned, shared, and collaborated as scholars using the online platform.

CONCLUSION

Sharing of knowledge and collaboration globally are feasible through a virtual CoP and offer a benchmark for future sustainable solutions in healthcare capacity building. We recommend such model and virtual platform to promote healthcare education and mentoring across disciplines.

Building Resilient Healthcare Teams: Insights from Analogy to the Social Biology of Ants, Honey Bees and Other Social Insects

The resilience of a healthcare system hinges on the adaptability of its teams. Thus far, healthcare teams have relied on well-defined scopes of practice to fulfill their safety mandate. While this feature has proven effective when dealing with stable situations, when it comes to disruptive events, healthcare teams find themselves navigating a fine balance between safety and resilience. Therefore, a better understanding of how the safety vs resilience trade-off varies under different circumstances is necessary if we are to promote and better train for resilience in modern healthcare teams. In this paper, we aim to bring awareness to the sociobiology analogy that healthcare teams might find useful during moments when safety and adaptability have the potential to conflict. Three principles underpin the sociobiology analogy: communication, decentralization, and plasticity. Of particular interest in this paper is plasticity whereby swapping roles or tasks becomes an adaptive, rather than a maladaptive, response teams could embrace when facing disruptive situations. While plasticity has naturally evolved in social insects, infusing plasticity in healthcare teams requires intentional training. Inspired by the sociobiology analogy, such training must value the ability: a) to read each other's cues and miscues, b) to step aside when others had the necessary skills, even if outside their scope, c) to deviate from protocols, and d) to foster cross-training. If the goal is to increase a team's behavioural flexibility and boost their resilience, this training mindset should become second nature.

State-of-the-art literature review methodology: A six-step approach for knowledge synthesis

INTRODUCTION

Researchers and practitioners rely on literature reviews to synthesize large bodies of knowledge. Many types of literature reviews have been developed, each targeting a specific purpose. However, these syntheses are hampered if the review type's paradigmatic roots, methods, and markers of rigor are only vaguely understood. One literature review type whose methodology has yet to be elucidated is the state-of-the-art (SotA) review. If medical educators are to harness SotA reviews to generate knowledge syntheses, we must understand and articulate the paradigmatic roots of, and methods for, conducting SotA reviews.

METHODS

We reviewed 940 articles published between 2014-2021 labeled as SotA reviews. We (a) identified all SotA methods-related resources, (b) examined the foundational principles and techniques underpinning the reviews, and (c) combined our findings to inductively analyze and articulate the philosophical foundations, process steps, and markers of rigor.

RESULTS

In the 940 articles reviewed, nearly all manuscripts (98%) lacked citations for how to conduct a SotA review. The term "state of the art" was used in 4 different ways. Analysis revealed that SotA articles are grounded in relativism and subjectivism.

DISCUSSION

This article provides a 6-step approach for conducting SotA reviews. SotA reviews offer an interpretive synthesis that describes: This is where we are now. This is how we got here. This is where we could be going. This chronologically rooted narrative synthesis provides a methodology for reviewing large bodies of literature to explore why and how our current knowledge has developed and to offer new research directions.

Interchangeability in Military Interprofessional Health Care Teams: Lessons Into Collective Self-healing and the Benefits Thereof

INTRODUCTION

Interchangeability-i.e., the capacity to change places with another-is necessary for military interprofessional health care teams (MIHTs) to provide around-the-clock patient care. However, while interchangeability is clearly a necessity for modern health care delivery, it raises uncomfortable questions for civilian health care teams where it is usually labeled as unsafe. This perception surfaces because interchangeability runs counter to some of health care's cultural beliefs including those around patient ownership and professional scopes of practice. It is, therefore, not surprising that little is known about whether and how some level of interchangeability can be harnessed to improve the productivity of health care teams overall. In this article, we explore the notion of interchangeability in the particular context of MIHTs given that these health care teams are familiar with it. This exploration will offer insights into how interchangeability could maximize civilian health care teams' capacity to adapt.

MATERIALS AND METHODS

We conducted a secondary analysis of interview data as an analytic expansion: "the kind of study in which the researcher makes further use of a primary data set in order to ask new or emerging questions that derive from having conducted the original analysis but were not envisioned within the original scope of the primary study aims". Within our secondary analysis approach, we used thematic analysis as our analytical tool to describe (1) what interchangeability looks like in MIHT teams, (2) how it is fostered in MIHTs, and (3) how it is enacted in MIHTs.

RESULTS

Interchangeability was realized in MIHTs when individual team members adapted to take on roles and/or tasks that were not clearly niched in their specific areas of expertise but instead drew on the broad foundation of their clinical skill set. Cross-training and distributed leadership were ways in which MIHT members described how interchangeability was fostered. Furthermore, five features of working within MIHT teams were identified as key conditions to enact interchangeability: knowing your team members; being able to work with what/who you have; actively seeking others' expertise; situating your role within the broader picture of the mission; and maintaining a learning/teaching mindset.

CONCLUSIONS

Interchangeability can be understood through the theoretical lens of Swarm Intelligence and more specifically, the principle of collective self-healing-which is the ability of collectives to continue to successfully perform despite disruption, challenges, or the loss of a team member. Our findings highlight how MIHTs have adopted interchangeability in a wide array of contexts to realize collective self-healing. Despite the discomfort it provokes, we suggest that interchangeability could be a powerful asset to civilian health care teams.

Military Interprofessional Healthcare Teams: Identifying the Characteristics That Support Success

Military interprofessional healthcare teams (MIHTs) are foundational to the care provided to military members and their families. However, to date, very little research has investigated MIHTs. Notably, we have few insights into what distinguishes successful MIHTs. This manuscript presents findings from a program of research that was carried out to address this gap. We review what is known about MIHTs to date and the Uniformed Services University's (USU) focused efforts to ensure that greater understanding of MIHTs was developed. We provide an overview of the USU-supported research and of the findings that were generated by that inquiry. After summarizing the manuscripts included in this special edition of Military Medicine, we close by acknowledging and thanking key members of the U.S. military healthcare system who supported this research.