Implementation aspects | Intended outcomes | ||
---|---|---|---|
…models for learning | Educational alliances [10] | •Need to trigger interpersonal connections between trainee and supervisor | •Educational alliance – defined as partnership producing just the right amount of responsibility – a balance between support and challenge with professional acting as safety net for patient and trainee |
Beacon practices [67] | •Need to trigger inter-practice links | •Collaborative and extended roles in primary care for professionals | |
•Contextual infrastructure required | |||
•Need to trigger genuine team-working between patients, trainees and professionals | •Harnessing of emergent learning from practice and experience | ||
•Trust required between all and relationship building a crucial mechanism for interventions to work | •Dynamic approach to care aligned to shared goals | ||
•Studies of actual working practices including during interventions needed | •Able to capture in-practice learning and innovation to further develop and improve outcomes (emergent learning) | ||
•Any intervention needs to focus not just on education or decision-support for individuals but also the dynamic system in which they are situated | •Reciprocal learning and sharing of best practice through system adjustments to support this | ||
•Development of communities of practice | |||
•Need to trigger ‘virtuous learning cycles’ – participation, balance of support and challenge, graded responsibilities | •Practical competence | ||
•State of mind conducive to practice (confidence, motivation, sense of professional identity) | |||
Breakdowns [78] | •When a breakdown (a situation where a person is not achieving expected effectiveness) occurs then interventions must trigger reflective learning and an effective response from others | •Constructive learning for future practice | |
•Contextual factors: patient engagement, responsibility matched to authority, tools matched to task, information resources matched to need, values shared between co-participants, expectations matched to capacity | |||
Developmental space [79] | •Creation of developmental space to permit learning and development of professional identity – space created through workplace context, personal and professional interactions and emotions such as feeling respected and confident | •Mindful learning and development | |
…models for care delivery | Guided Care [66] | •Increased staff resources for patient support | •Increased satisfaction with communication and increased knowledge of patient clinical characteristics |
•Need to trigger social, psychological and physical assessment | •Holistic care developed through patient and professional collaboration | ||
•Need to trigger active patient and professional participation | |||
CARE approach [57] | •Need to trigger connections between patients and professionals | •Holistic assessment, appropriate responses and patient empowerment | |
Chronic Illness Care Plans [27] | •Need to trigger holistic assessment – requires professionals rethinking their roles | •Individualised care plans | |
•Need to trigger a patient centred approach including relational and management continuity | •Holistic care shared between patient and provider | ||
•Need to trigger reciprocal learning | •Sharing of best practice | ||
•Contextual factors are community resources and policies | |||
Self-management support five A’s [65] | •Need to trigger assessment, appropriate advice, agreement of goals, assistance in behavioural change, and monitoring | •Personal action plans for patients and increased purposeful self-management | |
•Context ‘self-management’ of some sort is inevitable as clinicians are only present for a fraction of a patient’s life | |||
•Need to trigger desire for patient involvement (varies according to reason for encounter) | •Appropriate shared decision making | ||
•Mechanism – education of health professionals about sharing decisions alongside patient mediated interventions | |||
…models for both | •Triggers are lived experiences combined with readiness for change leading to critical reflection, restructuring of meanings and development of new meanings | •New rules, ways or guidelines, new behaviours, feelings, beliefs, perspectives, identity | |
•Learning about self and chronic illness in an iterative and continually changing manner | |||
Response shift [44] | •Triggers are lived experiences combined with readiness for change leading to critical reflection, restructuring of meanings and development of new meanings | •New rules, ways or guidelines, new behaviours, feelings, beliefs, perspectives, identity | |
Education centred medical home [47] | •Need to trigger legitimate participation of trainees in continuity of patient care | •Increased patient support | |
•Practice based learning experiences |