Improving impact on practice and patient care outcomes of online healthcare continuing professional development with Reflexive Networking

This thesis theorizes and investigates Reflexive Networking, an innovative conceptual model for online healthcare continuing professional development (CPD) to improve impact on practice and patient care. Recently, financial pressures and the rise of the Internet have triggered a massive growth in online CPD globally. This shift assumes that online CPD causes behavior change and improves practice and care. Normative research on the impact of online CPD has mostly been in the form of positivist or realistic experiments. The evidence shows, however, that current online CPD models are failing. Because they do not affect the agency of professionals constrained by existing and new online structures, these models do not improve impact on practice and patient care. This design failure impels this thesis. I conceptualise online CPD as a dynamic process from Bourdieu’s sociological perspective on practice. Changing practice is an emergent outcome of the actions of various agents interacting across structures. I propose using technologies and pedagogies to enhance professionals’ capacity for agency and improve impact. This thesis critically and realistically evaluates the hypothesised model through an exploratory single case study with a commercial CPD provider. To test the intervention, a tutor delivered an online CPD programme to a small group of 7 doctors distributed across the UK. They had 4 facilitated online discussions over 2 months using a virtual classroom. I interpret data sets from online observations, interviews, and a before/after agency questionnaire-scale into a scientific narrative, with a touch of irony, to enable readers to understand if, how and why the process improves impact. The analysis suggests that in this case, participants’ capacity for agency increased by 13.4%. Participants were more likely to consider changing practice by discussing cases, exploring treatment options, and sharing information, opinions and advice on a targeted topic. Interpreting these findings, the more the process - including the technology – builds symbolic capital and exchanges social and cultural capital that counts as learning, the more likely busy professionals are to spend time online meshing scientific knowledge from clinical guidelines with their judgement and prior experiences, to produce practical knowledge on improving practice and patient care. Effective online CPD programmes should employ technologies and pedagogies strategically to design Reflexive Networking processes across organizations, time and distance and redirect the fields of healthcare and online CPD to deliver on ideals of evidence-based medicine. As one-off one-size-fits-all online CPD approaches such as communities of practice and e-learning modules do not affect the relative allocation of power (capitals) between professionals, educators and managers, they are disempowering. Rebooting Bourdieu for the Internet era disrupts structural boundaries and makes visible the hitherto invisible dimensions of agency for changing behaviour and practice, contributing a theoretically informed practical model to solve an urgent problem in healthcare human resource management. At a time when universal access to healthcare remains a hopeless goal, the dominant biomedical culture that has perverted online CPD to transmit knowledge and skills must be fought. Valuing ethical social relations and moral interactions is critical to produce pleasurable conformity as practice. Future researchers will craft self-regulating Reflexive Networking experiences in various CPD contexts to liberate educators and empower all practitioners - particularly those denied access in remote locations – to learn collaboratively across structures and continuously evaluate improvements in impact on practice and patient care.