Author: e.van.kemenade

Just recently I heard that my latest article will be published in TQM Journal. It is a concept analysis – following Walker and Avant – of Emergence. Walker and Avant (2014) suggest writing several cases to clarify the concept: a model case, a borderline case, a related case, a contrary case and an illegitimate case. Here I present  the modelcase on the teaching team Master Integrated Care Design.

The Master Integrated Care Design from the Utrecht University of Applied Sciences started in 2007 as a not government financed course with 4 students and 4 part-time teachers. The external developments in the world of work ask for healthcare and social work professionals who are capable to make connections, to design innovative interventons and who can make integrated carehappen. Participants in the two-year program exactly develop these competences. The program appeared to be very popular. Since the start the amount of  students gradually increased to 133 first year students and 64 second year students in 2018-2019. Since 2017 the master program got its official financing from the Ministry of Education and Sciences in the Netherlands. In 2018 the program is  (re-)accredited by the Dutch-Flemish Accreditation Organisation (NVAO). The growth of the program led to increased pressure on the teachers. They searched in their network within (internal interaction) and outside the university (external interaction) for  completion. That caused an exponential growth of the teacher team to 20 staff members. The team that emerged is different than the sum of its parts. It is extraordinary in its diversity of gender, ages, experience, scientific discipline. Yet it is very harmonious in a sense that it is new to all members (novelty) and that is not easy to explain. The harmony stays also when new members are asked to join in (synchronicity). Synchronicity can also be noted in the way team members fit in the curriculum. The quality of the cooperation creates continuous learning of the group as a whole and of individuals within (synergy). The new pattern is coherent, was unexpected and unpredictable. It is not the result of planning (unplanned). Some instruments are used to sustain the team coherence (co-teaching, journalclub en social events). Result is that the master program is highly appreciated by the students, even now it has grown,  as the data of the National Dutch Student Survey (Nationale Studenten Enquete) 2018 show (score 92 on a 100 point scale). The master program takes the shared third place of all masters in the Netherlands as mentioned in the ‘Keuzegids’.

This might clarify the concept of Emergence, so crucial for quality management in the 21st century.

Walker L.O. and 
Avant K.C. (2014),
“Strategies for 
Theory Construction in Nursing”,
Pearson Prentice Hall, Upper Saddle River, NJ.

On June 21^stthe Neuman Systems Model (NSM) conference on “Exploring Population Health: Building Bridges with the Neuman Systems Model” started with a Gala.

A video was shown in which Betty Neuman welcomed the guests (not being able to come herself). She honoured Marlou de Kuiper for her efforts for the NSM. The evening continued with a World Café . Unfortunately this was the only not-lecture of the conference. It is time conference organizers understand people cannot listen for eight hours a day.

I spoke to Jacquie Fawcett about the Created Environment, the part of the model that interests me most. That’s why I was also very pleased with the content of the workshop by Rachel Coffey about how they teach students to take more care about themselves and how they increase their self-efficacy.

Nice also the workshop on concept mapping and its use for care planning.

Interesting how Jacquie Fawcett translates the NSM to population health, creating  the “Conceptual Model of Nursing and Population Health: Neuman Systems Model Perspective. A pity that the visual representation is so linear and so little systemic.

I presented my poster on The Quality Paradigms and the NSM.

As a result of the conference, I definitely will study more about Neuman’s Created Environment and ways to increase self-care of care professionals.

On May 29th the Dutch Academy for Quality held a meeting, that partly was meant to discuss the topic of “emergence”. Emergence is – to put it simply- the phenomenon that a new pattern arises from interaction of different actors. Partners in the discussion were Teun Hardjono, Arend Oosterhoorn,  Peter Noordhoek, , Henk de Vries, Kees Ahaus,  Marius Buiting, Kees de Vaal and Everard van Kemenade.

Marius Buiting stated that management thinking has developed towards strategy and policy in function of progress. Around 2005 however, the crisis arose. It was financial, but even wider, a crisis on values. Kids did not get richer than their parents anymore, living longer was not always better. We have to look back, look into our tacit knowledge. From there the new pattern will ’emerge’. We need a rebellious longing. We need to see the examples of emergence that are already there. He mentions a report by Thijs Homan about changing municipalities [1]. There, another way of perception is visible, not measurable but noticeable.

Henk de Vries mentions his book “Kwaliteitsorg zonder onbehagen” and cites   Dooyeweerd who speaks about ‘disclosure in creation’. The possibilities that are hidden and emerge in the course of time.

Peter Noordhoek outlines a quadrant with two axes rational versus irrational and distrust versus trust. Marius Buiting adds wondering as extra to rational/irrational and longing as extra to distrust and trust. On the cutting edge of wondering and longing emergence occurs.

Arend Oosterhoorn states that the quality profession has fallen victim to people without longing.  The profession  delivers false promises. 
Teun Hardjono agrees and states that the world of quality is not able to  deliver on its promises:  “If you do what we say, you will not make mistakes” However, mistakes are needed to improve.

In the next post Everard wil give a summary of his concept analysis of “emergence’ and its importance for quality

[1]Zie https://thijs-homan.nl/wp-content/uploads/2019/03/Boek_DeVeranderendeGemeente_05-002-definitieve-versie.pdf

 

From 14th til 20th of April Everard worked on an assignment from Maastricht School of Management at the Regional Training Facility (RTF) on Prevention and Suppression of Sexual Gender Based Violence (SGBV) for the Great Lakes Region (GLR), situated in Kampala, Uganda (NICHE-GLR-258). The core of the assignment was to provide RTF with a simple but effective quality management system for their trainings. In cooperation with the Regional Director, the Training Coordinator, some of the Master Trainers, one of the National Trainers and all other staff of RTF a Handbook was produced for the Monitoring and Evaluation of the National Trainer’s Courses by RTF.  The Handbook will support them to provide trainings of even higher quality on their way to become a Centre of Excellence on SGBV. What struck me most during the week is the enormous passion of the team to end the horror of Sexual Gender Based Violence.

From 1 – 4 April the 19th ICIC conference took place in San Sebastian, organised by the International Foundation for Integrated Care. Van Kemenade presented his poster on Four Paradigms and a fifth quadrant: The R2E2-Model © and Integrated Care.

Van Kemenade and Hardjono (2018) discern four quality paradigms in quality management: the Empirical Paradigm, the Reference Paradigm, the Reflective Paradigm and the Emergence Paradigm (the R2E2-Model©). The use of these paradigms differs according to the context.  Together they form a concept of Total Quality Management.

These paradigms can be used for other disciplines and purposes as well. One could state that professionals need to be competent in ‘epistemic fluency’. Epistemic fluency is the capacity to understand, switch between and combine different kinds of knowledge and different ways of knowing about the world (Markauskaite and Goodyear, 2017). In other words professionals need to be able to use all four paradigms of the R2E2-Model © depending on the context they are in.

The Master Program of Integrated Care at Utrecht University of Applied Sciences embraced the R2E2-Model © and its four paradigms to account for the quality of the content of the program. Starting point is that the alumni should be able to switch between and combine the four paradigms. And that means that in the curriculum all four must get equal attention.

This poster presents how the four paradigms can present themselves in Integrated Care and how they are covered by the two year Master Integrated Care. Special attention is given to leadership.

Markauskaite, L and Goodyear, Peter (2017) Epistemic Fluency and Professional Education Innovation, Knowledgeable Action and Actionable Knowledge, Springer, Netherlands

Van Kemenade and Hardjono (2018), Twenty First Century Total Quality Management: The Emergence Paradigm, TQM Journal, https://doi.org/10.1108/TQM-04-2018-0045