Toward an Experiential Approach to Interprofessional Communication*

There is a famous quote from the movie Cool Hand Luke [1] when the prison warden
says to Luke right after hitting him, “What we’ve got here is failure to communicate;
some men you just can’t reach.” Aside from the entertaining drama, I keep
two implications from this quotation: communication is more than information
transfer, it is also about reach; and reach can be costly.

A dictionary definition reveals several meanings for the word “reach”: stretch out;
touch or grasp by stretching; arrive at; get in contact; and interestingly enough, “succeed
in having an effect on” [2]. I lean toward the latter, simply because thinking of
communication as exerting an influence offers a better chance of assessing that influence. Our goals must be smart and measurable. They must also consider local contexts.

Communication is central in an interprofessional context. Problems arise when
we treat communication mainly as an exchange of information and ignore all the
subtle non-verbal signifiers: attitudes, body language, cultural norms, and institutional
rules. Shannon and Weaver [3] offered a theory of communication as reliability
in encoding and decoding information as a set of symbols. We usually conceive
of communication as the transfer of a string of symbols with the assumption that the
syntactic rules are known—we get the meaning if we can decode the string. This
view is appealing. We see its usefulness in computers as they extend our minds every
day. It becomes, however, particularly costly with specialization and the increased
division of labour that is necessary for collective works. As it increases productivity,
specialization also brings with it elaborate algorithms that only experts know. A
higher level of energy must then be spent to encode and decode expert information—
a cost that can be prohibitive in an interprofessional context, which calls for
speed and efficiency in the integration and transfer of knowledge.

So if interprofessional communication is more than information transfer, and if
the division of labour increases both the productivity and the costs of communication,
what can we do? How can we better understand interprofessional communication?

First, we need to consider that an effective interprofessional group lowers the costs
of communication. The human history of collective work is filled with successive
attempts to reduce those costs and coordinate the exchange of energy—an important
part of what makes or breaks collective work. For what do groups do in the real world?
At a fundamental level, they exchange information and energy. In doing so, they
establish connections between agents and objects: the connections can be physical (as
in sharing the other end of the rope), symbolic (as in incentives), or mental (as in language and working memories in the brain). Group members not only exchange bits of information, they also negotiate meanings, and if they maintain long enough working
relationships, they can cultivate an enduring context for new knowledge [4,5].

Second, if as Lawn [6] suggests, we need to review our research agendas for interprofessional education, we surely need to review how we study interprofessional
communication. We can then choose Shannon and Weaver’s view of communication
as the transmission of symbols, or we can choose to view communication
through a more elaborate lens, one that considers how we live it every day. Lived
experience—an embodied approach—attests to the richness of what and how we
communicate. As Kogut and Zander [7] suggest, the word discourse is probably
more appropriate than information in this context. It draws attention to the critical
role played by language, symbol, and interpretation in the operations that bind
group members. There is probably much to gain by using an experiential approach
to research in interprofessional communication, one that recognizes that meaning
is based on the understanding of experience [8-10]. Knowledge thus acquired cannot
be dissociated from the experience of communication, rather than being framed
by an abstract theory (mathematical or otherwise). Models of experiential learning
and experiential research that combine experience with reflection, discussion, and
evaluation of that experience are a case in point [11,12]. The experiential here
includes all the basic sensory-motor, emotional, and social experiences available to
all human beings, and a balance is nurtured between head and heart, technical skills
and insightful compassion, and system design and the ethical dimensions of interprofessional practice [4,13].

The research agenda in interprofessional communication would then expand in
subject matter and methodologies (the plural is strongly intended). The subject is
indeed complex. Amid the variations in interpersonal styles of communication and
ways of transmitting what we know to others, there are also differences in perceptions
and how they can affect the participants in a discussion [14,15]. This complexity
is compounded by the speed of change in technology and how we adapt it to our
needs [16], whether in the real world or in a simulated one [17]. Added to this mix
is what the concept of a hidden curriculum implies: informal learning in interprofessional education cannot be denied [18], and in the same way that we know more than we can tell [19], we often express more than we can say.

To sum up, healthcare has one specific person-centered goal: solving patients’
problems. Communication is central to healthcare. It is more than information
transfer. It is also about reach, and reach can be costly. Interprofessional groups
have the potential to lessen the cost and create and communicate knowledge with
speed and efficiency. They are more likely to do so when they include an awareness
of human experience and use an experiential approach to understanding meaning
and communication. Otherwise, they are more likely to amplify the consequences
of the ongoing specialization and fragmentation of knowledge.

* Previously published as an editorial in JRIPE: http://jripe.org/index.php/journal/article/view/267

References
1. ginpole. (2010). Cool Hand Luke. YouTube. (Originally released in 1967) 1. URL: https://www.youtube.com/watch?v=yBBWUZfgRiw .
2. Dictionary of the English Language (5th ed). (2011). Reach. Boston, 2. MA: Houghton Mifflin Harcourt.
3. Shannon, C.E., & Weaver, W. (1949). The mathematical theory of communication. Chicago, IL: University of Illinois Press.
4. Soubhi, H., Colet, N.R., Gilbert, J.H.V., Lebel, P., Thivierge, R.L., Hudon, C., & Fortin, M. (2009). Interprofessional learning in the trenches: Fostering collective capability. Journal of Interprofessional Care, 23(1), 52–57.
5.Wenger, E., McDermott, R., & Snyder, W.M. (2002). Cultivating communities of practice : A guide to managing knowledge. Boston, Mass.: Harvard Business School Press.
6. Lawn, S. (2016). Moving the Interprofessional education research agenda beyond the limits of evaluating student satisfaction. Journal of Research in Interprofessional Practice and Education, 6(2), 1–11.
7. Kogut, B., & Zander, U. (1996). What firms do? Coordination,identity, and learning. Organization Science, 7(5), 502–518.
8. Dobie, S. (2007). Reflections on a well traveled path: Self-awareness, mindful practice, and relationship- centered care as foundations for medical education. Academic Medicine, 82(4), 422–427.
9. Ünal, S. (2012). Evaluating the effect of self-awareness and communication techniques on nurses’ assertiveness and self-esteem. Contemporary Nurse, 43(1), 90–98.
10. Beebe, S.A., Beebe, S.J., Redmond, M.V., & Geerinck, T.M. (2004). Interpersonal communication: Relating to others. Toronto, ON: Pearson Education Canada.
11. Henry, J. (1989). Meaning and practice in experiential learning. In S.W.I. McGill (Ed.), Making sense of experiential learning (pp. 29–33). Milton Keynes, UK: Open University Press.
12.Moustakas, C. (1990). Heuristic research: Design, methodology, and applications. London: Sage.
13. Lakoff, G. (1987). Women, fire, and dangerous things: What categories reveal about the mind. Chicago, IL: University of Chicago Press.
14. Buhler, A.V., Coplen, A.E., Davis, S., & Nijjar, B. (2016). Comparison of Communications Styles Among Students in Allied Health Professions Programs: How Do Our Students Communicate with Other Healthcare Providers? Journal of Research in Interprofessional Practice and Education, 6(2), 1–14.
15.McMillan, C., & Madill, J. (2016). A cross comparative study to examine beliefs and attitudes regarding food and eating between food and nutrition and social work students. Journal of Research in Interprofessional Practice and Education, 6(2), 1–17.
16. Graves, M. & Doucet, S. (2016). Factors Affecting Interprofessional Collaboration when
Communicating through the use of Information and Communication Technologies: A Literature Review. Journal of Research in Interprofessional Practice and Education, 6(2), 1–33.
17. Davis, D.L., Hercelinskyj, G., & Jackson, L.M. (2016). Promoting Interprofessional Collaboration: A Pilot Project Using Simulation in the Virtual World of Second Life. Journal of Research in Interprofessional Practice and Education, 6(2), 1–15.
18. Reade, M., Maar, M., Cardinal, N., Boesch, L., Lacarte, S., Rollins, T., & Jeeves, N. (2016). The impact of hidden curriculum in wilderness-based educational events on interprofessional competencies: A mixed-method study. Journal of Research in Interprofessional Practice and Education, 6(2), 1–16.
19. Polanyi, M. (205). Personal Knowledge. Chicago, IL: The University of Chicago Press.

Inching Away From the Barbarians*

Sociologist Talcott Parsons used the phrase “barbarian invasion” when he spoke of the birth of new generations of children [1]. I find a grain of truth in the phrase when I think of socializing new generations of healthcare students into their chosen professions. Acquiring the knowledge, attitudes, and values that would enable them to become functional members of their specific professional orders is a long, arduous, but necessary process—all the harder and all the more necessary when we try to socialize them into working with other professionals from different orders.

And doing so is unquestionable. For between the patient and the effective act of caring there has always been, and there will always be, a socialized group of assorted professionals—accepted and accepting members of society who fulfill the needed functions and roles of the group in solving the problems and riddles of illness.

I can see in the articles of this new issue of JRIPE (www.jripe.org) a complex view of such a group and the process of enculturation that is required to develop it. Time is not the only requirement. Layered upon time are other ingredients like favourable attitudes toward interprofessional education [2], interprofessional support for patient safety [3], accepting others on one’s own turf [4], understanding shared decision-making [5], enhancing students’ formulation of multidisciplinary roles [6], involving patients in health professional education [7], improving buy-in and sustainability of integrated models of care [8], and developing strategies for assessing collaborative competencies [9].

None of these ingredients are context-independent—to say nothing of their being assembled here for the purpose of this editorial. Another set of accepted articles might have garnered a different set of ingredients. So no one-size-fits-all solution will ever be in view. Complex problems require multiple platforms from which to handle them. Enculturation of successive generations of students and professionals into interprofessional working will have to continue, inching forward, with a rigorous scientific enterprise to light the way. That is the price to pay for a situated, contextualized, and responsible participation in healthcare. And we would be all the wiser to expect more new questions than answers from any research worth its salt.

* Published as an editorial in http://jripe.org/index.php/journal/issue/view/9         

References (available at http://jripe.org/index.php/journal/issue/view/9)

1. Parsons, Talcott. (1951). The social system. Glencoe, IL: Free Press.

2. Medves, J., Paterson, M., Broers, T., & Hopman, W. (2013). The QUIPPED project: Students’ attitudes toward integrating interprofessional education into the curriculum. Journal of Research in Interprofessional Practice and Education, 3(1), pp. 3–21.

3. Patterson, M., Medves, J., Dalgarno, N., O’Riordan, A., & Grigg, R. (2013). The timely open communication for patient safety project. Journal of Research in Interprofessional Practice and Education, 3(1), pp. 22–42.

4. Kornelsen, J., Iglesias, S., Humber, N., Caron, N., & Grzybowski, S. The experience of GP surgeons in western Canada: The influence of interprofessional relationships in training and practice. Journal of Research in Interprofessional Practice and Education, 3(1), pp. 43–61.  

5. Dunn, S., Cragg, B., Graham, I.D., Medves, J., & Gaboury, I. (2013). Interprofessional shared decision making in the NICU: A survey of an interprofessional healthcare team. Journal of Research in Interprofessional Practice and Education, 3(1), pp. 62–77.

6. Dalrymple, L., Hollins Martin, C., & Smith, W. (2013). Improving understanding of teaching strategies perceived by interprofessional learning (IPL) lecturers to enhance students’ formulation of multidisciplinary roles: An exploratory qualitative study. Journal of Research in Interprofessional Practice and Education, 3(1), pp. 78–91.

7. Doucet, S., Lauckner, H., & Wells, S. (2013). Patients’ messages as educators in an interprofessional health education program. Journal of Research in Interprofessional Practice and Education, 3(1), pp. 92–102.

8. Moore, A.E., Nair, K., Patterson, C., White, J., House, S., Kadhim-Saleh, A., & Riva, J. Physician and nurse perspectives of an interprofessional and integrated primary care-based program for seniors. Journal of Research in Interprofessional Practice and Education, 3(1), pp. 103–121.

9. Murray-Davis, B., Solomon, P., Marshall, D., Malott, A., Mueller, A., Shaw, E., & Dore, K. (2013). A team observed structured clinical encounter (TOSCE) for pre-licensure learners in maternity care: A short report on the development of an assessment tool for collaboration. Journal of Research in Interprofessional Practice and Education, 3(1), pp. 122–128.