Background
Healthcare services worldwide are provided in increasingly complex, and always changing circumstances [
1]. These challenges and changes comprise those associated with i) the healthcare issues faced by the population, ii) the dynamic character, conditions, and existing health of that population, iii) emerging therapies and practices, iv) shifts in policies and practices associated with the physical, organisational, environmental, and v) social circumstances in which healthcare provisions are enacted. Addressing such complex changing circumstances, in terms of patients’ needs, emerging therapies and practices and settings, therefore, becomes a necessity for all healthcare systems and healthcare professionals [
2]. Recently, these complexities and constant changes have become more frequent and are of greater amplitude, such as illustrated by the Covid-19 pandemic. This implies the ability to enact adaptions and address these changes while continuing high quality service provision [
3‐
6]. Resilience in healthcare is defined as the capacity to adapt to challenges and changes at different system levels, to maintain high quality care [
7]. For healthcare organizations to strengthen their ability for resilient performance, a significant level of continuous learning is required [
7,
8]. Lately, there has been a growing consensus amongst safety experts, system engineers and healthcare professionals, calling for a new approach to learning, which is not just focused on learning from what goes wrong in healthcare, but also to take a more proactive and reflective approach through learning from what goes right in ordinary work processes [
9‐
12].
Resilience in healthcare builds on theory from other sectors such as societal safety, engineering (resilience engineering), social ecology and psychology, and is a theoretical perspective that explores how complex adaptive systems cope, respond, and adapt to stress [
5,
7]. Different from more traditional ways of studying and explaining healthcare quality, resilience in healthcare tends to focus on successful outcomes rather than failures [
13,
14]. This approach provides a more holistic and dynamic understanding of healthcare systems as it attempts to understand and explain the underlying processes of what contributes to the ability to handle unforeseen events, changes, and innovations. Recent studies report that capacities such as coordination, involvement, communication, leadership, and learning are key capacities for resilience in healthcare, all of which build on the need for engaging and interacting with a range of different stakeholders at different system levels in a collaborative effort [
15]. This is not surprising given that the complex nature of healthcare organizations means that healthcare provision has increasingly become a shared effort amongst the different stakeholders who work collaboratively, often across different professions, levels and contexts to address patients’ and families’ needs [
16]. More specifically, the ability to adapt and respond to challenges and changes relates to the ability to both work and learn, collaboratively, which enables healthcare professionals to actively develop a shared understanding and provide quality care [
15].
This high level of interdependence amongst healthcare professionals and other healthcare stakeholders mandates that enhanced collaborative learning skills, such as good communication and coordination of work tasks, both within and across different professions, teams, and team members can play key roles in improved healthcare performance [
17,
18]. Improved healthcare provision is, therefore, not just about learning as individuals, but also about working and learning collaboratively across stakeholders and system levels. There is no single definition of collaborative learning through work. However, there is consensus that it comprises a group of learners, working together to solve a problem or complete a task [
19] and it is through these activities and interactions that participants’ learning arises. In particular, it is through this joint problem solving, between more and less experienced interlocutors, that new insights, procedures, and sentiments are made accessible and learnt. Moreover, these engagements are both generative of new knowledge and extend what learners know, can do and value [
20,
21]. This recognition led to education models such as Reciprocal Teaching and Learning [
22], Cognitive Apprenticeships [
23] and Guided Learning at Work [
24].
In a collaborative learning setting, the learners are both informed by and challenged through listening to different perspectives, defending own ideas and creating own unique understandings, based on their experiences. Learning, therefore, occurs continuously in healthcare systems through healthcare professionals engagement in clinical work, and by interacting with co-workers, patients, and other stakeholders [
25]. Collaborative learning through engaging reciprocally with others through work practices such as teamwork and problem solving is also central in quality processes [
26,
27] as it is often in response to novel challenges of emerging problems. Researchers have, therefore, suggested practitioners’ on-going learning across their working lives, and in particular collaborative learning, as a prerequisite to operationalize resilience [
5,
6,
15,
28,
29].
Previous research shows how adaptation is linked to learning within the field of resilience [
8,
30‐
32]. Yet only limited systematic attention has been given to the collaborative learning element in these adaptive capacities [
5,
7]. Most frequently, resilience studies adress learning as an outcome, pointing at specific adaptive practices to handle capacity-demand misalignments, such as workarounds [
33], secret second handovers [
34], or next of kin agency [
35,
36]. More recently, some studies have focused on developing specific tools for strengthening resilient capacities, such as serious games [
37‐
40] and reflective spaces or narratives [
12,
28]. However, resilience studies are frequently tightly focused on individual learning,- such as people-technology interaction [
41], or openness for change,- [
42], with only limited focus on team learning or collaborative learning approaches. Furthermore, only a few studies focus on strengthening resilient capacities in a team setting [
43‐
45]. Recent studies have, therefore, indicated that to advance the field of resilience in healthcare there is a need to develop collaborative learning tools that aid healthcare organizations in strengthening their resilience performance through collaborative efforts that helps create awareness of what goes right, and understanding the underlying factors contributing to the desired outcome [
15,
46,
47].
Given the potential of these collaborative learning elements to promote resilience there is a need to explore the underlying collaborative learning processes and how and why collaborations occur during adaptations, trade-offs, and improvisations as a response to disruptions, challenges, and changes [
7,
46]. Exploring these underlying processes is the key to understanding how learning resources should be developed to translate resilience into practice and strengthen resilience capacities [
46], and our study addresses this knowledge gap.
Aim and research questions
The aim of this paper is to describe and discuss collaborative learning processes in relation to resilient healthcare based on investigation of empirical findings from diverse healthcare contexts and levels.
The research questions are:
1.
For which purposes do stakeholders in the healthcare system collaborate?
2.
Which activities and interactions constitutes those collaborations?
3.
Through which processes does collaborative learning arise?
This article contributes knowledge on the identification of how healthcare professionals and other stakeholders in the healthcare system collaborate and interact when responding and adapting to challenges and changes. This contribution is advanced from a resilient healthcare perspective to elaborate on the role of collaborative learning.
Conclusion
The aim here was to describe collaborative learning processes in relation to resilient healthcare based on an investigation of narratives from diverse healthcare contexts and levels. The findings show that across levels and contexts healthcare workers collaborate to adapt and respond to changes, to maintain processes and functions, and to improve quality and safety. The activities and interactions these collaborations comprise are exchanging information, coordinating, negotiating, and aligning needs and developing buffers. All of which occur through collaborative working and are generative of learning and changes to practice. The learning activities embedded in these collaborations are both activities of daily work, such as discussions, prioritizing and delegation of tasks, in addition to intentional learning or educational activities such as seminars or simulations.
Based on our findings, we propose resilience in healthcare is dependent on these collaborations and learning processes, across different levels and contexts, to adapt and respond to challenges and changes and maintain high quality patient care. This ability to adapt is closely linked to the ability to learn. The resilience in healthcare approach holds a systems perspective. Although individuals’ actions are important, a systems perspective demands collaboration and learning within and across all system levels. Creating space for individual and collective appraisals and awareness building could assist individual, team, and organizational-based learning. Efforts to strengthen or further enable resilient performance should consider the importance of the collaborative element and seek to develop framework and learning tools that can facilitate learning through work and while working and learning together: that is collaboratively.
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