1. At the Intersections:
Toward a Theory of
Compassionate, Collaborative
Person-centred Practice(s)
Marion C.E. Briggs, BScPT, MA, DMan
Assistant Professor, Clinical Sciences
Director, Health Sciences and Interprofessional Education
Fellow, AMS Phoenix Project
Northern Ontario School of Medicine
MUSTER Conference, Uluru, Australia
Wednesday, October 29, 1115-1145

2. Faculty/Presenter Disclosure
• Marion Briggs
• Relationships with commercial interests:
– I have no conflict of interest to declare
regarding relationship with commercial
interests
This research is currently funded by the AMS Phoenix “A Call to Caring” Project, focused on
making a positive and lasting difference in how health professionals develop and sustain
their abilities to provide humane, compassionate, person-centred care and to instill and
sustain compassion, empathy and professional values in the environments in which health
professionals learn and work.

3. Learning intentions ...
• Critique the monologic gaze on science as theoretical
framework that can adequately explain, direct, or
account for complex healthcare practices
• Articulate a socio-scientific theory of practice that finds
compassionate, collaborative person-centred care at
the intersection of three interdependent domains of
practice
• Explore what this thinking might mean for health
professional education

4. Brief discussion in pairs...
What is your theory of practice?
How would you explain “practice” to an alien?
A starting point might be ... “Practice, to me, is ... What I think we
are doing is ...”
(A “theory” is a set of ideas or principles on which the
practice of an activity is based ...)
2 minutes! Just focus on what first comes to mind!

5. Key Concepts in the Socio-scientific Theory of
Compassionate, Collaborative Person-centred Practice
• “Practices” have both scientific and social domains
– Specific practices operate and evolve together through the
everyday interactions between the members of a particular
community/unit/team
– Therefore, particular practices evolve in ways that are unique in
each practice community
• Knowledge-generating dialogues/conversations uniquely
characterize collaboration and distinguish collaboration
from communication, coordination, cooperation, co-location
…
• Relevant, meaningful, compassionate, collaborative,
person-centred practice are found in the intersections of
the scientific and social domains of practice
Briggs, 2012

6. When “science” or “evidence-based practice” is
the sole/predominant driver of our thinking …
There is a tacit assumption of “a right way”, the
“best practice”
How is this idea of “a right way” expressed in funding
and policy initiatives? In Education?
It is part of an “audit and compliance” culture that declares what
“best practices” is and holds practitioners accountable for meeting
established efficiency targets
HCP learners understand early in their training how important it
is to be “right” and to base their clinical decisions on the
evidence …
Bruner, 1990; Sandberg and Tsoukas, 2011: 340-341; Rorty, 1979; Stacey, 2007, 2010

7. The quest for certainty isn’t just an imperative
for policy makers ... clinicians participate in
many ways ... two examples ...
“How do you find relationships now between physicians
and chiropractors ...”
“There are two kinds of chiropractors – philosophical
and evidence-based. I’m the latter and the evidence
speaks for itself – it levels the playing field.”
In response to being asked help create a new bed map,
a department of medicine chair, who was also a
cardiologist found he could not participate ... He said
with a combination of intense distress and clear
frustration ... “I’m trained to be right, not creative. I
can’t do this.”

8. Why would having a clear focus on the science related
to practice matter? Surely that’s not a bad thing?
• This thinking led to the EBM movement and the
development of “implementation science” to ensure the proper
translation of science into practice – the “translation” metaphor
continues to dominate
• What matters most in improving practice is getting better evidence
and translating it more accurately …
• The “application (or not) of best practice” is an individual decision
• There is a profound effect on what we allow ourselves to talk about
or consider important, valid, worthy of study … namely the near
exclusion of the social aspects of practices … we know it’s there, we
just don’t find it important to talk about!
Bruner, 1990; Sandberg and Tsoukas, 2011: 340-341; Rorty, 1979; Stacey, 2007, 2010

9. Yet, healthcare is a profoundly human and moral
enterprise ... so can science be the whole story?

10. “... Professional practices are interpretive
practices, centrally concerned with how [and in
what context] practitioners … make judgments …
[and perform actions] …”
In EVERY clinical encounter,
we are called to know more
than we were taught.
Clinicians believe evidence ONLY to the extent that
the evidence matches their experience and (to a
lesser degree) on whether they know and respect
the person providing the evidence.
Kinsella, EA. (2012). Practitioner reflection and judgement as phronesis. In Kinsella, EA & Pitman, A (Eds).
Phronesis as professional knowledge: Practical wisdom in the professions. Rotterdam. Sense Publishers; Gabbay, J., & le May, A.
(2011) Practice-based evidence for healthcare: Clinical mindlines, New York: Routledge.

11. SAY WHAT???
Of course, science isn’t the whole story, even
though it is an important part of the story ...

12. To make sense of compassionate,
collaborative, person-centred care we need to
develop a “thick” understanding of practice …
Three interdependent
processes each of which
is very complex, partial,
critical …
These are fractal
processes …
Representation
Sense-making
Compassionate
Collaborative
Person Centred
Practice
Improvisation
Mandelbrot Set

13. Representation
What we “ought” to do ...
Intellectual tradition: Episteme
Science lives comfortably here ...
Representation
• Best practice guidelines
• Algorithms and practice guidelines
• Policies
• Professional regulation
• Translation metaphors
• Strategic Planning
• Assessments, lab values, imaging
• Principle-based ethical paradigms
• Knowledge is abstract, a-contextual
These helpfully influence activity and
thinking, but insufficient alone ...
Sense-making
Compassionate
Collaborative
Person Centred
Practice
Improvisation

14. Sense-making (Signification)
What it is “fitting” to do ...
Intellectual tradition: Phronesis
(practical wisdom)
Unique patients and contexts live
here ...
Representation
• Reflection-on-action
• Shared goals and values
• Power dynamics; identity formation
• Knowledge generating dialogues
• Collaborative decision-making
• Discerning what is salient
• Use multiple ways of thinking (e.g.
epistemic, technical, practical wisdom (phronesis),
critical deconstruction, imaginative, speculative,
innovative, “thick” contextual, cultural …
• Develop clinical and moral imagination
• Relational ethics paradigms
• Situational knowledge, context relevant
Sense-making
Compassionate
Collaborative
Person Centred
Practice
Improvisation

15. Improvisation:
What we “can” do ...
(In every clinical encounter, we are called to know more than we were taught.)
Intellectual tradition: Techne/Metis;
Praxis lives here – action, informed by
theory and experience, aimed toward
achieving a particular goal ...
• Reflection-in-action
• Technical skill; technique
• Interdependent interaction
• Bodily movement
• Negotiating position and priorities
• Building and using social capital
• Relational ethics
• Negotiating hierarchy and power
• Contextual, emergence of the
unexpected
• Knowledge as emergent
• The continuous evolution of particular
practices in particular communities
Representation
Sense-making
Compassionate
Collaborative
Person Centred
Practice
Improvisation

16. The practice/theory paradox ...
Representation
How does understanding the practices of communities in this way contribute
to or challenge your thinking about interprofessional collaboration?
Sense-making
Compassionate
Collaborative
Person Centred
Practice
Improvisation
• Algorithms and practice guidelines
• Policies
• Professional regulation
• Translation metaphors
• Strategic Planning
• Assessments, lab values, imaging
• Reflective/reflexive sense-making
• Shared goals and values
• Collaborative decision-making
• Discerning what is salient
• Use multiple ways of thinking (e.g. epistemic, technical,
practical wisdom (phronesis), critical deconstruction, imaginative,
speculative, innovative, “thick” contextual, cultural …
• Develop clinical and moral imagination
• Negotiating position
• Temporal sequencing
• Bodily movement
• Use of equipment, guidelines, policies
• Hierarchy and power
• Tyranny of the urgent over the important
• Contextual, emergent enactment
Briggs, 2012
Phronesis
Techne/Metis
yes
Episteme

17. What would it mean for HP education to take the idea seriously that
compassionate, collaborative, person-centred care lies at the
intersection between scientific and social aspects of practice …
• Social AND scientific domains of practice are present and equally
valued in conversation, curriculum, classroom, and clinical education
• Develop a “thick” understanding of practice, collaboration,
compassion, person-centredness …
• Value and integrate what we “ought” to do with what is also
“fitting” and “possible”
• Commit a relational ethics paradigm (inclusive of principle-based
ethics)
• Understand practice and theory not as a dualism, but as two sides of
the same coin with practice as primary since theoretical questions
arise from practice and answers are tested and elaborated in
practice
• Setting aside (for a moment) whether you agree with this, do you
find this thinking modelled, taught, or some way emphasized in
health professional education?
• In what ways would articulating this theory of practice for HCP’s
support and/or challenge, academics, learners and practitioners?
Deleuze, 1992

18. One way we are introducing this at
NOSM
• PGME longitudinal curriculum (Psychiatry)
– CANMEDS competency framework
– CIHC Interprofessional Practice Framework
– Socio-Scientific Theory of Practice
• Four academic half-day sessions/per plus a full day IP
TOSCE
• Resident-led, faculty-facilitated reflective and reflexive
engagement with resident’s current lived practice
experience
• Sessions include: 30 minute didactic (faculty); two one-hour
reflective discussions (residents); 30 minute
reflection to synthesize practice insights

19. Thank you!
We would love to collaborate if you are interested
in exploring/advancing this thinking and in
considering the ‘fit’ for your curriculum!