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Talking it better: conversations and normative complexity in healthcare improvement

In this paper, we consider the role of conversations in contributing to healthcare quality improvement. More specifically, we suggest that conversations can be important in responding to what we call ‘normative complexity’. As well as reflecting on the value of conversations, the aim is to introduce...

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Autores principales: Cribb, Alan, Entwistle, Vikki, Mitchell, Polly
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8867266/
https://www.ncbi.nlm.nih.gov/pubmed/34035179
http://dx.doi.org/10.1136/medhum-2020-012129
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author Cribb, Alan
Entwistle, Vikki
Mitchell, Polly
author_facet Cribb, Alan
Entwistle, Vikki
Mitchell, Polly
author_sort Cribb, Alan
collection PubMed
description In this paper, we consider the role of conversations in contributing to healthcare quality improvement. More specifically, we suggest that conversations can be important in responding to what we call ‘normative complexity’. As well as reflecting on the value of conversations, the aim is to introduce the dimension of normative complexity as something that requires theoretical and practical attention alongside the more recognised challenges of complex systems, which we label, for short, as ‘explanatory complexity’. In brief, normative complexity relates to the inherent difficulty of deciding what kinds of changes are ‘improvements’ or, more broadly, what is valuable in healthcare. We suggest that explanatory and normative complexity intersect and that anyone interested in healthcare improvement needs to be sensitive to both. After briefly introducing the idea of normative complexity, we consider some contrasting examples of conversations, reflecting on how they do and might contribute to healthcare quality. We discuss both conversations that are deliberately organised and facilitated (‘orchestrated conversations’) and more informally occurring and routine conversations. In the first half of the paper, we draw on some examples of orchestrated and routine conversations to open up these issues. In the second half of the paper, we bring some more theoretical lenses to bear on both conversations and normative complexity, summarise what we take to be the value of conversations and draw together some of the implications of our discussion. In summary, we argue that conversations can play a crucial role in negotiating the normative complexity of healthcare quality improvement because of their capacity to hold together a plurality of perspectives, to contribute and respond to emergence and to help underpin institutional conditions for empathy and imagination.
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spelling pubmed-88672662022-03-15 Talking it better: conversations and normative complexity in healthcare improvement Cribb, Alan Entwistle, Vikki Mitchell, Polly Med Humanit Original Research In this paper, we consider the role of conversations in contributing to healthcare quality improvement. More specifically, we suggest that conversations can be important in responding to what we call ‘normative complexity’. As well as reflecting on the value of conversations, the aim is to introduce the dimension of normative complexity as something that requires theoretical and practical attention alongside the more recognised challenges of complex systems, which we label, for short, as ‘explanatory complexity’. In brief, normative complexity relates to the inherent difficulty of deciding what kinds of changes are ‘improvements’ or, more broadly, what is valuable in healthcare. We suggest that explanatory and normative complexity intersect and that anyone interested in healthcare improvement needs to be sensitive to both. After briefly introducing the idea of normative complexity, we consider some contrasting examples of conversations, reflecting on how they do and might contribute to healthcare quality. We discuss both conversations that are deliberately organised and facilitated (‘orchestrated conversations’) and more informally occurring and routine conversations. In the first half of the paper, we draw on some examples of orchestrated and routine conversations to open up these issues. In the second half of the paper, we bring some more theoretical lenses to bear on both conversations and normative complexity, summarise what we take to be the value of conversations and draw together some of the implications of our discussion. In summary, we argue that conversations can play a crucial role in negotiating the normative complexity of healthcare quality improvement because of their capacity to hold together a plurality of perspectives, to contribute and respond to emergence and to help underpin institutional conditions for empathy and imagination. BMJ Publishing Group 2022-03 2021-05-25 /pmc/articles/PMC8867266/ /pubmed/34035179 http://dx.doi.org/10.1136/medhum-2020-012129 Text en © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
spellingShingle Original Research
Cribb, Alan
Entwistle, Vikki
Mitchell, Polly
Talking it better: conversations and normative complexity in healthcare improvement
title Talking it better: conversations and normative complexity in healthcare improvement
title_full Talking it better: conversations and normative complexity in healthcare improvement
title_fullStr Talking it better: conversations and normative complexity in healthcare improvement
title_full_unstemmed Talking it better: conversations and normative complexity in healthcare improvement
title_short Talking it better: conversations and normative complexity in healthcare improvement
title_sort talking it better: conversations and normative complexity in healthcare improvement
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8867266/
https://www.ncbi.nlm.nih.gov/pubmed/34035179
http://dx.doi.org/10.1136/medhum-2020-012129
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