Measuring the length of a physician’s arms – or ensuring the competencies of healthcare staff

INNO-X Healthcare discuss their efforts to ensure the healthcare staff of the future are equipped with the skills and competencies they need to best serve patients.

Physicians are some of the world’s most dedicated and specialised professionals, yet they lag behind when it comes to crucial attributes related to the demands of future healthcare staff. Health Europa talks with Kathrine Arlander at INNO-X Healthcare, who discusses how the company wants to change this by means of their research.

With the ultimately longest education in the Danish educational system, healthcare staff are academically and vocationally characterised by high professionalism and a strong set of core competencies. But despite the strong foundation many physicians lack the ability to reach out to people with other areas of expertise and understand the value of other professions – their arms are, so to speak, not long enough. The problem with this emerges when physicians are put at the frontline of development tasks in the ward.

At INNO-X Healthcare we work with the representation of a T-shaped person¹ – someone who has a strong subject matter core and arms that reach out to both sides, creating a ‘T’.

The T-profile is closely related to so-called ‘21st Century skills’, which have been on the top of the agenda of education across disciplines since the World Economic Forum published a defined set of 16 crucial proficiencies for future education in 2015.² In our research we examine the status of the Danish healthcare education and experienced healthcare staff in relation to these skills.

As a sub-division of the Department of Clinical Medicine, Aarhus University, we do competency development within the domain of healthcare in the areas of innovation, creativity and entrepreneurship. A leading factor in our approach is theories of mastering 21st Century skills and how we balance these with the vocational skills in the healthcare sector.

Examining the ‘arms’ of Danish physicians

A work environment that promotes risk taking and creativity is seldom sought when health authorities try to create the best possible organisations to treat patients. On the other hand, creativity and complex problem solving are evaluated as some of the most important skills for leaders of the future³ and are considered essential drivers of new solutions.

In 2013, the Danish Health Authority published a report on the core roles of a Danish physician for accommodating the needs of the future Danish healthcare sector.⁴ However, there was no mention of creative and innovative competences. A gap emerges between what the healthcare staff are currently being educated to master and what the future needs of the sector point towards. With the PhD study ‘Enhancing Innovative Competences in the Danish Health Care Sector – A Mixed Methods Study’, we are currently investigating:

1. What are the needs for innovative competences of physicians and what is currently done to support these?
2. How can innovative competences of physicians be enhanced through healthcare innovation education?

The project is designed as a twofold investigation employing the existing evidence-based literature and a mixed methods research design. The first part consists of a systematic literature review of existing evidence followed by a twofold qualitative study. This forms the grounds for the development of a programme theory and the details of an intervention to be tested in the second part of the study which consists of a quantitative quasi experimental study. A leading component of the project is the theory of creative self-efficacy and how or if this is relevant in the future education of medical doctors.

Creative self-efficacy refers to the “belief one has in the ability to produce creative outcomes”.⁵ The term ‘self-efficacy’ has its roots in social cognitive theory,⁶ and theoretical literature argues that self-efficacy plays a motivational role in the process of creativity and innovation.^7,8

The self-perception of Danish physicians

With creativity and complex problem solving being critical to the future development of the healthcare sector, we are conducting another study, ‘Physicians’ self-evaluation of skills in relation to development and creativity – perception of intelligence and clinical work environment’, to gain insight into how 21st Century skills fit the profile of an average Danish physician. How does the healthcare staff perform when it comes to creating a safe and productive space for realising new ideas and thereby making room for complex problem solving? To explore this, we look towards theories of overconfidence and the perception of intelligence – two parameters that are of great relevance to the emergence of T-profiles.

Overconfidence describes the tendency to assume that you are right rather than being open to the fact that you might be wrong or inaccurate. In a clinical setting this occurs when clinicians overestimate the accuracy of their clinical judgement⁹ In relation to creative and innovative competencies this is of highest relevance since a determined belief in one’s own accuracy creates a culture of non-openness towards supplemental perspectives and hinders peers from opting in. Studies conducted in New Zealand in 1997 show that physicians tend to be overconfident in regard to job-related knowledge and skills.¹⁰

In this study we test 450 Danish physicians across areas of specialisation, using a meta-knowledge test¹¹ involving estimates of general knowledge to see to what degree they tend to be overconfident. Straight afterwards they are assigned a post-test questionnaire¹² addressing their experience of the meta-knowledge test and thereby mapping their reflections on operating outside their comfort zone.

The results of the study serve as a baseline for further work on addressing the need of future competency development within the Danish healthcare sector, and more importantly the healthcare staff. Furthermore, they serve as a stepping stone for examining the correlation of Danish physicians being overconfident and choosing job-related tasks within the area of their comfort zone.¹³

Perception of intelligence

In continuation we test for the perception of intelligence through a ‘theories of intelligence’ test.¹⁴ Studies show an alignment between how we perceive intelligence and our tendency to be overconfident. It has been demonstrated that if you consider intelligence to be fixed it promotes greater overconfidence, whereas a belief in intelligence as malleable has the opposite effect.10 Using the data from the 450 Danish physicians we test the transferability of this thesis to the Danish physicians.

‘Stretching the arms’

The results from the described studies will be used to adjust current courses led by INNO-X Healthcare and to design new ones with the overall purpose of mitigating the need for innovative competences in Danish healthcare and providing healthcare staff with the necessary T-shaped profile. Our most recent initiative in this direction is our upcoming fellowship programme, the BioMedical Design Novo Nordisk Foundation Fellowship Programme, which will admit fellows of different backgrounds as doctors and designers.

But to walk the talk of T-shaped professionals we ourselves also need to stretch our arms and reach out to other professionals with competencies that differ from our own. We are already engaged in projects crossing the boundaries of university faculties including business and social science, science and technology, the Arts and of course health, but we want to add more perspectives to our work. This article is therefore an invitation for others to opt in. If you are engaged in similar research, if you have complementary or even opposing theses, or if this thematic simply piques your interest, then please don’t hesitate to contact us.

References

1. The T-ACADEMY: http://tsummit.org
2. New Vision for Education: Unlocking the Potential of Technology, World Economic Forum, 2015
3. International Business Machines Corporation (IBM). Capitalizing on Complexity: Insights from the global Chief Executive Office study. Available at: https://www-01.ibm.com/common/ssi/cgi-bin/ssialias?htmlfid=GBE03297USEN. Accessed 9/2, 2017
4. Danish Health Authority. De syv lægeroller. 2013
5. PT, SMF. Creative Self-Efficacy: Its Potential Antecedents and Relationship to Creative Performance. The Academy of Management Journal 2002;45(6):1137-1148
6. Bandura A. Social cognitive theory: an agentic perspective, Annu Rev Psychol 2001;52(1):1-26
7. Puente-Díaz R. Creative Self-Efficacy: An Exploration of Its Antecedents, Consequences, and Applied Implications. J Psychol 2016;150(2):175-195
8. Bandura A. Self-efficacy: Toward a unifying theory of behavioral change. Psychol Rev 1977;84(2):191-215
9. Deborah J Miller, Elliot S Spengler, and Paul M Spengler, A Meta-Analysis of Confidence and Judgment Accuracy in Clinical Decision Making. Journal of Counseling Psychology, 2015, Vol. 62, No. 4, 553–567
10. Joyce Ehrlinger, Ainsley L. Mitchumb, Carol S. Dweck, Understanding overconfidence: Theories of intelligence, preferential attention, and distorted self-assessment. Journal of Experimental Social Psychology 6 (2016)94-100
11. Inspired by: J Edward and Schoemaker, Paul J H, Managing Overconfidence, Sloan Management Review; Winter 1992;33,2;ProQuest pg. 7
12. Design by: Benoît, Jean-Pierre and Dubra, Juan and Moore, Don (2008): A proper test of overconfidence
13. This is based on the work of: Joyce Ehrlinger, Ainsley L Mitchumb, Carol S Dweck, Understanding overconfidence: Theories of intelligence, preferential attention, and distorted self-assessment. Journal of Experimental Social Psychology 63 (2016) 94-100
14. Dweck,CS (2000). Self-theories: Their role in motivation, personality and development. Taylor & Francis: Philadelphia, PA

Kathrine Arlander
INNO-X Healthcare
+45 9350 9080
kathrine@innox.au.dk
http://innox.au.dk/en/

This article will appear in issue 7 of Health Europa Quarterly, which will be published in November 2018.