Professionalising interprofessional practice

We often hear that agencies ‘can’t do it alone’, whether that’s safeguarding or crime prevention. Whilst the labels of interagency, multi-agency working or problem solving or interprofessional practice are referred to an awful lot – section 17 of the Crime and Disorder Act even made such working a statutory requirement – it’s surprising how the actual professional practice of it is left too much to chance.

Each agency is trained professionally in its own vacuum, whilst the competing narrative is that only joined-up working can really achieve the outcomes. Much safeguarding work, for example, operates in a matrix team fashion – in other words, different professionals from different agencies come together in safeguarding forums. In that matrix team setting, there can be difficulties in getting beyond input and outputs at a singular level to actual joint outcomes.

Serious Case Reviews

Professor Eileen Munro (London School of Economics) led an enabling  review in 2012 that explained the importance of empowering professionals to allow them to make things happen and do the right thing. The reason such things really did need saying – although they do sound pretty much like common sense – is that there is a long and troubled history of stubbornly dysfunctional working and poor communication. Brandon (2008), Rose & Barnes (2008) and Brandon et al (2011), amongst others, have charted the rather ignoble findings of numerus serious case reviews (SCR), that have pointed to a lack of cohesion and explicit joint practice for decades.

O’Connell (2019) has pointed to one of the fundamental reasons for this dysfunctionality (which can germinate defensive competitiveness) is that, quite simply, many professionals do not connect with why they are doing what they doing, and this affects how they operate when working in a team. That’s about a problem of myopic or missing explicit practice.

Learning to work together & working to learn together

There is a powerful, and damning, evidence base that should not be ignored by anyone who is remotely interested in keeping people safer. The thing is, though, what do we do about it – how do we learn from the apparent problem and make a change?

One of the root causes of dysfunctional interprofessional practice is that professionals are educated and trained in trenches; they are specialists in a particular thing in a particular organisation, who do particular things in particular ways. It’s almost like a multi-institutionalised culture of silos, where processes seem to dominate by keeping people apart and disempower professionals doing the things that actually matter – and it’s so impervious people feel they just can’t break free from it.

There’s another way of looking at things here too – which more directly addresses the ‘what’s in it for me?’ stance. We’ve already covered that evidence pointing out the gaps in professional practice, which attracts lots of negative criticism for all involved. The other angle to this is to consider the benefits.

Learning more and quicker is an output that is a more healthy alternative to energising blame and division. Working together unleashes multiple opportunities for accelerated insight, and means any team actually working together can achieve way more than any of its individual component parts can alone.  If you inhabit a space with others but don’t work as a team you are not only putting yourself and your outputs at risk, but you’re also wasting valuable time when you could  – all of you – be achieving better joint outcomes. That choice, in summary, is work alone to stumble and fall, work together to achieve better for all. ‘What’s in it for me?’ – look at what you’re in for if you don’t.

There is an approach offered here that builds on various evidence bases, that charts a way forward to more professional  interprofessional practice. The approach is bounded together by the principles of Koinagogy. ‘What’s Koinagogy?’  you ask – well let’s explain that right now, because there is an imperative and urgency for us to improve, and improve fast.

Koinagogy

A group of people in one place do not make a team. Koinagogy is trying to professionalise matrix team working  because it’s too important to be left to chance.

Koinagogy (2019) is a neologism, a new word, to encapsulate a concept, taken from the Greek word Koinonia, meaning ‘joint participation’. This new holistic concept builds upon previous valuable contributions from Kolb (1910), Knowles (1984), Agyris and Schon (1996), Ford (1997), Hase and Kenyon (2000), Edmonson (2011), Vaughan (2016), Coyle (2018) and O’Connell (2019) by utilising concepts such as double loop learning, but in an interprofessional practice setting. Culturally, Koinagogy asks why if professionals are due to work together why they aren’t trained and educated together? It asks if a common goal is what is needed why are many different and apparently siloed and competitive performance measures in the way?

People coming together in a matrix ‘fix-it’ fashion when they have their own competitive pressures upon them means we get… well what we have been getting for decades. Single profession accountability, finger pointing and blame, piles of documentation to satisfy some hidden auditor, and often defensiveness when things go wrong.

Koinagogy is all about authentically empowering people working together to pursue a common goal, focussed on outcomes; to surrender individual professional myopia and work as a team. This means collectivity of learning and creativity – and enabling such transformational change through a collective and joint interprofessional practice route. Koinagogy draws upon the why of interprofessional practice, to tap into the fundamental rather than the illusory technical. The benefit is to enable outcome focussed teamwork, similar to the eventual ethos in Twelve Angry Men (1957), by using explicit practice conversation to proactively focus on what matters.

Looped learning, in a team

The term pedagogy is used a lot, but its meaning, from the Greek, is to ‘lead a child’. In terms of advancing adult learning, Malcolm Knowles (1984) helped develop andragogy, as theoretical reasoning to enable better approaches to resonate with instinctive applied problem solving tendencies.

Agyris and Schon (1996) and Hase and Kenyon (2000) have all offered useful insights into how single, double and triple loop learning can be enabled, and these concepts are key to heutagogy, which is all about self-directed learning.

Single loop learners, with single loop environments, controlled by single loop managers live in a world where what’s gets ordered, gets done – literally. But nothing more. It’s a nice little simple word of inputs and a few outputs; you can see why it’s such a fit for command and control cultures. It’s almost robotic in its rigidity.

That’s why double loop learning is better in that it allows space for initiative; to focus on the outcome more and adjust the inputs and outputs more towards an end goal, and is less of a slave to the process or system.

Triple loop learning, well that takes us to a whole new level, that really thinks for itself to consider what the end goal should be, what it’s all about, and how we should get there, often in a dynamic and creative way.

Heutagogy may be unfamiliar to many people as a term but it’s actually how many of us live our lives for real – you really couldn’t not unless you were sat around all the time waiting to be told by someone what to do next.

Taking heutagogical approaches (that self-directedness) into the plural, into the team, is about moving into Koinagogy: moving a bunch of soloists into a harmonious choir.

A new programme

Koinagogy offers a long overdue theoretical rationale to enabling matrix teams to do exactly what the Munro Review (2012) said should be happening. Munro called out the ‘what’; Koinagogy offers us the ‘how’, based on the ‘why’ of collective explicit practice.

There is a new, accredited, programme delivered at a postgraduate level (Level 7) that is about raising awareness of the evidence base and the theoretical framework of Koinagogy and promoting a learning by doing approach in the professional field. So we now have a Post Graduate Certificate in Interprofessional Practice: how we have gone for so long without a professional accreditation pathway is bad news, but now we can make that old news and fix it.

The programme is of benefit to anyone who works in a matrix team fashion, that is they are employed by a single agency, but they work together with others in various ways and formats to try and achieve a common goal. It’s facilitated on-line and flexibly part-time because the educational philosophy here is that as a reflective practitioner you learn by doing in your busy workspace, so tearing you away from that would miss the point – the learning has to be with you, where you are, when is good for you.

The basic structure is 30 credits to initially raise awareness and get you thinking about the theoretical and reflective perspectives, alongside the core policy and practice literature; then a further 30 credits which takes the form of a work-based reflective journal report that is similar in ethos to a professional doctorate, where the focus is on applied theory into  professional practice to make some impact (the notion of ‘praxis’).

The programme draws together what have been those missing ingredients of explicit practice to enable a joint agency (the verb, not the noun) that drives communication about what matters and gets things done that need doing – cutting through the dysfunctions of the past.

It’s surprisingly fundamental and simple. The problem of our modern world is over-complexity that binds us in a spaghetti of processes, imprisoning people from actually sorting out the things that actually matter.

Now we have the chance to professionalise and accredit the actual explicit practice of us working together at a matrix team level so we can move beyond the paralysis and dysfunction of the past – we can get on with making a difference.

If you want to get on the programme contact John Coxhead, Professor of Interprofessional Practice, at j.coxhead@keele.ac.uk.

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