Anesthesia, Covid… how interdisciplinarity benefits healthcare innovation

No one will deny the seriousness of the health crisis we have just gone through. But, beyond the shortcomings and deficiencies of our health system, the Covid pandemic has also been revealing on multiple levels. In particular, there was an awareness of the value of health, and the importance of having a hospital capable of adapting and developing to meet the challenges of tomorrow.

However, if we have been talking for years about the transformation of the health system, it must be emphasized that it no longer follows the rhythms of societal changes. There is an important reflection to be had there, other visions and other proposals to be considered.

Among the possible springs, we are working, at theInstitute for the training of health executives, to initiate a new momentum. The future of the hospital system cannot, in fact, be disconnected from the evolution of health training: it is through the initial and continuous training of its actors that any organization is transformed.

One of the avenues we are exploring, to promote better adaptation, is based on the construction of a real interdisciplinarity and on the use of the Anglo-Saxon concept of “cross-fertilization” (cross fertilization).

The (ephemeral) impact of the health crisis

If the term is little known, it is not an abstract concept: such cross-fertilization operations, relayed by the media, took place during the Covid crisis. A multitude of skills and knowledge from different backgrounds, and carried by enarques, computer scientists, caregivers and other specialists, then combined to enable patient care.

Speed, adaptability and creativity seemed, for a time, to be the watchwords shared by all, resulting in the development of patient call and follow-up platforms (such as Covidom), computer tracking systems or the use of 3D printers to manufacture protective glasses for caregivers, etc.

Unfortunately, the enthusiasm died down too quickly. No doubt we were not able to capitalize on these encounters.

We are investigating how to incorporate this concept of cross-fertilization more sustainably into medical practice. For this, it is important to define it well beforehand, to show its interest for our training systems and more broadly in health. This is what this article intends to shed light on.

The paradox of the hospital: interdisciplinarity, myth or reality?

The hospital and university world is still distinguished today by its very compartmentalized disciplines – structural and organizational compartmentalization, linked in particular, in health, to the initial compartmentalization of the training provided. Medical hyperspecialization still today fragments the care of patients in disciplinary furrows.

However, the complexity of decisions has never ceased to feed the need for interdisciplinarity, as evidenced by the explosion of publications on this theme since the 1970s. that awareness in this area dates from this key period. According to him, the idea of ​​interdisciplinarity emerges around four “inventions”:

Therapeutic patient education (1972),

The concept of risk management (risk management) to the hospital (1975),

The biopsychosocial model which integrates psychosocial factors in the same way as biological factors (1977),

Recognition of the ethical principles of autonomy (respect for patient choice) the right to care (1979).

It is in this context that the first publications on interdisciplinarity emerged: no longer a simple superimposition or juxtaposition of the action of health professionals, but real consultation, collaboration between different actors without the prevalence of one discipline in relation to to the other.

Number of publications on the theme of interprofessional collaboration and major historical turning points explaining the need for interprofessionality.
D. Naudin, according to PubMed publications (June 2020), Author provided

In practice, theinterdisciplinarity is often undermined by budgetary issues, power… or simply by lack of time or places to bring professionals to really work together. So the interdisciplinary Copernican revolution, which is no longer a new idea, has in fact not really taken place.

Also, contrary to popular belief, measured benefits of this interprofessionality are still modest for patients (2017 data). However, they would be particularly valuable at a time when developments are accelerating.

Technological changes, the advent of telemedicine and telemonitoring in e-health, the use of connected objects, robots and even the metaverse in the future require more and more cross-expertise, going beyond simple inter-professionalism.

To cite a few examples, the big data revolution is still in its infancy and the use of networked ecosystems will only increase. Issues of cybersecurity, right of access anduse of medical data are already pregnant. L’use of artificial intelligencerobotics, augmented reality and virtual reality headsets, 3D printers should increase.

These technological challenges impose new skills on other organizations, and call for an openness to other areas. This is the whole point of cross-fertilization.

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A proven concept

The concept of cross-fertilization was born from research and development in the field of industry. The aim was to encourage interactions between various disciplinary fields and bring together people with different skills, working methods and tools in order to produce innovative and creative solutions. A fertile approach in the development of prototypes.

Such a crossing of eyes is not unheard of in health. In the early 2000s, for example, anesthesia approached aeronautical experts to develop its risk management culture. Professor of medicine René Amalberti, director of the Foundation for an Industrial Safety Culture (FONCSI), was a great help. Moving from medicine to psychology and ergonomics, via engineering and organizational and risk sciences, he knew how to bring together these disciplines to create an ultra-safe system. Aeronautics brought theuse of checklist or some cognitive aids in the operating room. The document “From the operating theater to the cockpit of an airliner”issued by the Directorate General for Civil Aviation, shows the bridges established between these two worlds.

Anesthetist caring for a patient
Anesthesia is one of the areas where cross-fertilization, in this case with aeronautics, has been particularly beneficial.
Nestor Rizhniak/Shutterstock

More recently, the team of Rhona Flin, professor of psychology at the Aberdeen Business School, contributed to the understanding of soft skills in the risk and security management. The use of tools such as health simulation has been largely inspired by this work.

Other examples can be cited, such as the use of augmented reality for walking rehabilitation of children with paralysis which required the work of a researcher in walking physiology and the creation of suitable digital tools.

However, while technological progress has accelerated with the Covid-19 crisis, the courses that prepare students have not evolved at the same speed. They did not fully anticipate telemedicine, connected objects, artificial intelligence… At the same time, the emergence over the past few years of alternative treatment techniques (hypnosis, meditation, yoga, Qigong…) also requires rethinking another form of relationship to academic knowledge.

The question of the future organizations of care brought about by these innovations requires us to train professionals prepared not just to accompany these transformations but to contribute to them. New hospital structures must also prospectively incorporate plural visions.

The training of future caregivers must become a space of openness

It is in this perspective that health training courses must take up a double challenge: to accentuate openness to other health training courses and to open up to disciplines outside the field of health. Rehabilitation courses are already good examples of cross-fertilization between technology “geeks”, computer designers, robotics and ergonomics.

Healthcare executives have a lot to gain from frequenting specialists in communication, marketing, social work or architecture, future project managers, etc. to design the care organizations and spaces of tomorrow.

We could multiply the examples at will… The question is to politically create (in the noble sense of the term) areas of cross-fertilization. The creation of projects with a strong challenge in terms of innovation is structuring for this type of fertilization: it is therefore around projects between different courses that this cross-fertilization could be created.

Research, often interdisciplinary, is another major avenue. Recently, the training of AP-HP health managers decided to have the final dissertation work carried out in groups: an entire team must contribute, together, to answering a research question that is useful for the community. We could also imagine joint research work with other training than those from the world of care.

Initiating these steps helps to erase the disciplinary resistance that maintains routines and habits… and sometimes prevents us from really thinking about the hospital of tomorrow. Training is no longer just about training competent professionals: it should be a place for experimentation and innovation.

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Anesthesia, Covid… how interdisciplinarity benefits healthcare innovation

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