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Ok, so we're going to get started

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on your behalf this afternoon. I'd like to acknowledge the one who I runjury for our own. This is a clear native to you. and whose lands were never seeded. We pay respects to their elders passed in prison.

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and all first nation delegates here today we are all guests on their land.

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This was. make

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you. I also like that one better than the other.

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so first I would like to. I'll just say that I'm

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who only taking a role here in terms of timing. And now I don't even know how to see Gran again. Okay, that's okay. I'll I'll have no problem.

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So here we go.

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Oh, my.

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stop share. Okay? So

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all right. So I'd like to turn it as an organizer of this panel. You will do brief introduction. Is that what you said? And then?

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And then very quickly. Just so. An administrative thing. I think I sent messages to all the presenters that 15 min would be a good range, and then, if you go over a tad, that's all right, but then it'll give us some time for discussion at the end, and if you'd like, I can do the timing and then give you like a 5 min

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 and then

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Grainne Kearney: but anyway.

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I like to feel useful.

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all right, so I'll turn over to

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Grainne Kearney: Hello there. Yes, so thank you, Lauren, and it's very helpful for me certainly, to have somebody in the room. So thank you so much for that. It feels really strange to be linking in when most of you are in the room. So my name is Guanya Kearney, and I sometimes I say at the start is, Granny is a very unusual Irish name, so don't worry if it causes problems. Grace is the English equivalent. Sometimes people remember that better. But I'm

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Grainne Kearney: dialing in this morning as it is from us from a bit of a dark dump morning in Belfast and Northern Ireland. So it's lovely to be here. Carl and Cupid and I originally organized this session together. But unfortunately Caroline isn't here this morning as it is

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Grainne Kearney: for me. and maybe maybe, like many of you, I was at some of the I'll say earlier sessions. It was very late in my night, so I I I've had a sort of small number of our sleep. But I'm really excited to be here, and to hear from all these fantastic presenters today.

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Grainne Kearney: and in the interest of time. And on that note as Lauren said, we have 5 presenters, which is really great, but we want. I don't want to take up the time. Then, in chatting. I I'm really interested in having a big discussion afterwards. so I think, on that note. Then. I think our first speaker should be in the room. And that is

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Grainne Kearney: and May has sang Heish hopefully. They're ready there to present.

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Let me see how to get back to where we were so that they can. The

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okay

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should do it.

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so can the online folks see the

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Grainne Kearney: yes.

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Okay. Thank you for confirming.

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Hello.

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Hello, everyone! My name is Shimongshan. You can call me silly, and I come from Taiwan. My topic is choices under the intertwining of multiple professionals, and I eat analysis of participation in decision making of people with psychosocial disabilities.

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My research was down in a community rehabilitation center. So let me introduce mental health services service in Taiwan. Look at the 3 big bugs below. Community rehabilitation Center is a kind of community care. We can imagine that it's a relay station from illness to recovery

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and a different kind of background. Color of this service

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separates, belongs to different authority, like the Development Department of Mental Health, Social and Family affairs, administration and Workforce Development Agency

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community Rehabilitation Center is a service under Department of Mental Health. It operates with several regulations such as Mental Health Act, criteria for evaluation and major for the establishment.

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On the other hand, this service is paid for by health insurance, which means that the patient need to meet the service criteria and can use it for free.

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I am a part-time occupational therapist work in the community rehabilitation center. Here we help clients to recover and reach their desired growth. An important concept here is recovery which emphasize the autonomy of the disabled.

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However, I found the clients experience of exercising their rights. Here is complicated.

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For example, Mr. W. Wants to go to work as soon as possible, but in the center the case manager, the professionals, and their family members

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has have other opinions which make the recovery only longer.

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Mr. W. Thinks that if he seek a job by himself it might be faster. So I'm curious about how does he participate in the decision-making process? Here.

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therefore, I want to explore that. What kind of support or obstacles they will encounter when participating in decision making, and what are the interaction and power relations involved in the services?

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And how do participants response to each other's power?

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Comparing the development of Mental health service in the West and Taiwan. We have not experienced the institutionalization. We only start to have a lot of qualified institutional institutions since 1980 S.

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At the beginning of 2,000 the concept of recovery came into Taiwan, and it can be seen in many policies.

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Let's see the situation. In practice.

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Our service are provided according to the condition of the client. Clients, will go through different units and different professionals, so documents are important medium to transmit information.

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but the client is neither the designer nor the person who can build up these documents. So they are difficult to say something for themselves.

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Okay, there are many factors that affect the process of participating in decision making like translation of concept of human rights that involve the fusion of cultural policy and locality

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and the care project allocation. If the supplies and demands of the service are not matched, it may not support laws in need.

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The limitation of the evaluation is Max. The its necklace service to be in a particular way which may not meet the users need. and a substitute decision making still common in medical perspective, therefore, there are far few opportunities for clients to participate in.

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Based on this I use, i. E. To to analyze the power map here.

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starting from my own experience, I imagine that the clients have their fragmented experience about exercising their rights, and then go up to go up to low staff the documents and the regulations try to understand the power map here.

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And this is my interview. Guideline.

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Okay, let's see the result. First, how demands are contracted here

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using the service need a referral from from doctors and clients need to meet the acceptance criteria.

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Sometimes family member has their opinions about using the service or not.

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After entering the service. The staff will arrange. The training program depends on what they can provide. Instead of the client's preference

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for the end of the service. If the clients want to stay here. The stuff will adjust the writing, take out more problem to rationalize the person's day.

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Sometimes the clients will live here because they found the service are not what they want. This kind of record will be written. Us. Case leave clients list without motivation.

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so we can see how demands are constructed here

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under the medical model. Clients need to cooperate with the service in the institution.

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There are many voices need to be considered. So the clients may be.

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we could.

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Okay. In this field. Professionalism and academy qualification are paramount from this regulation.

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The service are assigned by professionals, and the documents are also designed according to this requirement

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that will result in first, under division of the prophet law. Professionals.

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clients are separated into different parts, which make them.

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which magn then cannot be seen as a complete person.

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and second, Tesla evaluation is more important.

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Document writing is prior to doing rehabilitation.

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Then I found that participants are divided rather than cooperative case. Manager will hand over the client's condition to the professionals, and the professional will evaluate the clients and write down professional devices

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after professional right after professionals. Writing a case manager is needed to carry out this training program every day.

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because the case manager has no major. They must follow the professional or devices. and the clients becomes a follower.

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Participation is represented by the client's signature in the professional report.

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So this kind of participation is superficial.

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Text record have some impact on the clients and the case managers. When the authority wants to check these documents. some clients will think that just to take them off.

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Documents which are originally intended to be a training ad have become

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the evidence of fabricated rehabilitation.

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and the case manager are as a as a be not only serving clients directly, but also design

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lost training at including documents which can be checked.

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A case manager said. It is difficult to concentrate on case work, because time is occupied by everything.

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As a result, participation in decision making becomes textualized all day to day. Practice have translated into words. If laws cannot be recorded, they cannot be seen and checked.

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Based on this.

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Based on this, we found that we realized that the clients are cut into small pieces

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due to the evaluation and division of professionals. So we try. So we start from March this year trying to make all participants discuss the plan together

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after list. We found we can reach consensus in the discussion rather than sending on realistic suggestions through documents.

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In addition, we try to, then let the clients write down what they want to be known, such as introduce themselves.

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In this way participants can

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join in the decision making process equally, even though the text still exists in the service.

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Okay? So I think community rehabilitation center is professionally governed and doubly vulnerable. The real participants in the centers are case manager and client. The professionals are outside instructor who has less service, time, but higher degrees of knowledge and power.

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Look at the Red Arrow. The professional or devices are important here, but these advice need a case manager to carry out on the client.

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and it is difficult to promote the autonomy of the client which is emphasized by recovery model, because case margin needs to consider a lot of aspect. Even if the clients come to the center every day, they are still weak.

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and another disadvantage is case manager in the setting standard, it is stimulated that case measures only need to graduate from high school and receive certain training program.

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So even if case manager spends a lot of a lot of time being with clients, they still need to follow professional or devices.

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In my opinion, in this field each participant faced their own disadvantage situation.

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Although I start from the clients experience, I want to explain both the clients and the case manager without focusing on only one site

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to describe the system completely.

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Okay, let's summarize my research. First, institutional concerns, written service delivery, such as test based work and division of professionals and second professionals are powerful.

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and, third, the clients and case measure are both vulnerable case. Manager needs to follow the advice from professionals, and the clients are difficult to participate in decision making.

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and most of them

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must most of them follow the exating service rules.

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There are 2 limitations. First, my research is like all family members. And this is a single case.

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You'll need my operates up

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or press differently. So if we can, we can focus on this above 2

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virtually

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okay. This is my, ie. Research in mental health community rehabilitation in Taiwan. And I plan to submit my research to a journal, but still have no idea which one is suitable. So if you have any ideas or a device, I will approach you to tell me or email me, and sorry that my listening and listening. Comprehension are insensitive. So please forgive me if my response is not accurate later. Thanks you. You're listening.

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Thank you. Very fascinating.

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So

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Grainne Kearney: did you wanna say anything or say yes, thank you very much. What a great presentation! And sorry. It's quite hard to maybe see. I'm not sure quite often when to take my queues from. So thank you, Lauren, for keeping me right. It's hard to see something so yes, lovely presentation, and lots of good for thought that we can come together at the at the end with all 5 presentations. So in the interest in moving on and the next presentation, I'm delighted to introduce.

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Grainne Kearney: Paul Fangsai, who is going to talk to us about the appearance to disappear of doctors, opinion paper and long term care.

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Grainne Kearney: Thank you.

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Okay, thank you everyone for joining us.

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  This paper is a collaborate work

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by me and Dr. Leo and other faculty in a triple factory hospital. So today I will try to present it very

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briefly. 50 min.

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It is not here. No, nothing happened

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to the captain.

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Okay, thank you. Okay. This is my type of content. I will.

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I'll use all things. The first one. I will introduce the context of

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discharge plan and the the doctor opinion paper, and then I will briefly talk about theoretical framework of institution, Nice and recovery, and then I will tell some information about data collection. Then my analyze will line in the appear and the disappear of those.

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and then I will give you a very short conclusion.

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Okay, the background information we need is that Taiwan is already in the aging society from now, and

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one or 2 decay after, and the Nh. I. In high one. They have

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shift the focus from the inpatient care or accurate pair to the continuity of care.

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And the third information is that Taiwan have a new health policy from the long-term K. One to long-term care. 2. So, which means

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the the health profession will have more budget to do or implement this kind of things. And the second backs information I think we need in understanding. This paper is about Phy training a postgraduate year training of a physician in Taiwan has very special origin.

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It's stuff from the South here, because, during like a pandemic, a Taiwan physician.

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very diversity experiment to deal with different health medical problems. So after 2,003 Taiwan physician, education

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already be added the ui trending year from swimmers to 6 months to one year, to 6 to 2 years, and recently P. Jo. Training have already also emphasized the importance of continuity of care especially.

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and this charge plan, and there are many policy to facilitate.

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And then.

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as a first line frontline educator

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as me and the bacteria we teaching physician in hospital to tell or educate them to highly valuable.

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We start this research.

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Okay. The theoretical framework. We have already searched a lot of theoretical framework, and finally we found the institution as or on the We. We hope that the

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this theoretical framework can help us of reinterpretting our data, our data of credit from 1918 to 1920

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among the hospital in North Taiwan. And we like 3 kinds of data. The secondary data is all

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policy document, for example, legal articles are

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some existing order, and the training manus

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and the primary data is about semi-structured interviewing and participant observation in the hospital.

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and why we tried to deploy the institutional ethnography as a theoretical framework.

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because we want to find out why they stop up here, and so that they disappear and continually disappear. And up here that make us.

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It's a very interesting issue to become our research question.

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you know.

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Okay? I try to explain how it appeared. first of all, it appear from very clearly. long-term care service action, because they have already right. The Dobs cannot be replaced by

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case abtract or sophisticated of diagonals. So it's a very legal status, and the the second one on both Central and the local government have already proposed some template.

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educate, how to write, they stop, and also they

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spend some budget on that

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which means, if you move into type a or new type of city, maybe you can get a door and send your parents or the parents to nursing house with commendation because you had to think the other financial supporting the

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and the third institutional moves is that a family medicine doctor? They have their own professional association, and they hold a lot of workshop, and they they publish the menus to educate all the spatial, all the different physicians, with different specialty.

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to learn how to issue or how to write the tops. So these 3 kind of institutional moves is the first

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those things we find. But

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it seems like this institutional move have 2 different kind of addresses.

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In the first of appearance you will find, okay, these kind of moves, that kind of move. addressed to

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you need to do that. You need to do that, and if you do that I will give you more incentive.

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But at the same time, when I analyze the data, we will find that the government also indirectly addressed to, or was to add, the audience. For example, they need a puppy

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sometimes some year after they will become the voter

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to learn. They take the responsibility of don't and care, and they also

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address to other workers that

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if you move to Taboo City or new type of city, you will get a much better situation to get the do and send you a parent to nursing house.

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and the the third one is also have the indirect and

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and the compared to the primary data we find

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in a hospital, we find there are some

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difficulty. To make the jobs disappear.

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The first one is the recalcination that the do so

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belong to family medicines as well.

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But no, in fact, every physician can learn, and legally to issue that, but they

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are always safe.

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Okay, that is your family. medicine people are my family medicine physician to do that, and I need to. add a very spatial context. In Taiwan health care system. We don't have the Gp institution, so every patient can make appointment with a specialty physician.

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So let's make the family medicine physician lose their status to transfer.

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So they are very hard to

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hold this kind of workshop, and, in the opinion, try to earn back their status.

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But it's very difficult.

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and the the second difficulty is that the labor, the division of labor within the hospital is still very hierarchical, so, physician, we are told. reson to do that and the rest, and we are told Mp. Nursing partitioner to do that.

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So maybe nobody would do that. or the older position was, they would say.

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I didn't learn this kind of things. So you need you, you you you're young, you are a young student, you should to learn and come back to teach us.

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It's very ridiculous, but that's the fact

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happened in the hospital, and the third The third of Ithaco is that

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we encountered some prejudice that they say, Okay, these kind of things discharge plan, or continuity of care is too difficult, so you need to hand over it to nursing people.

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Your physician, you try to. It should be more focused on medical things. So that is a very common thing, a stereotype. That

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nursing people is better or do better than position to be a

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leader in the discharge plan team.

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And

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also, I also find this kind of unknown.

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I also find this kind of

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different or dual carrier kick barrier in the front line working.

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So we will see that

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the people who

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should the red there, that responsibility would be here.

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I would be here. But, in fact, the directly bear the responsibility. Our family, medicine, physician, restaurant, and tea, or nursing is a a very realistic picture in hospital.

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So

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so the summarize of my finding is that I think the institution of this course

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excellent exercise is power. different label, institutional level from light label, and physician.

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but, in fact, and the power or the institution of this course they excuse the power over the public, the worker, and the other physician, and also in the front line.

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The responsibility. Our transfer from vision to

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family medicine relation to Western Mp. To nursing. So it's the whole picture. That is when why dogs appear and disappear and again appear to disappear. They co-exist at the same time.

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So here's my conclusion, my congregations that with the ie. theory, we can identify the ambiguous or ambiguity between appearing and disappearing, and we also can identify that this party of a power holder and the partitioner, or the partitioning medical profession.

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and

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the end or the third implication we draw on this kind of finding to have an implication to those medical education people like us. So finally, I think, maybe we will propose 3. Take on lesson, for example, we should build in confidence through issuing docs to every

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kind of specialty position, not only family medicine, and we should raise in their constant contribution

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to discharge planting. Not only let the responsibility to the nursing people, and then maybe, we will emphasize or cultivate it.

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The future position to recognize the importance of dogs, and also importance of discharge plan, and also the potency of continuity of care.

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Thank you

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to. I'm sorry.

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Grainne Kearney: Thank you so much. Another really interesting talk, and I can certainly see some sort of

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Grainne Kearney: unifying discussion points that we can have later. so so moving on to our next speaker. This is at Rhonda Mckelby.

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Hey? On? Yeah, it's been 6 years. How are you? It's lovely to see you. But good evening, everybody, and thank you for bringing your attention and energy to this session.

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I'm Dr. Wanda Mckelvie. I currently work at Ms. University in New Zealand, where I,

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in a scenario like this at home, I would acknowledge the Khanita vin Guamari people of the land of Museum

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as I'm standing here in Australia. I wish to do the same in order to give you

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Australia, and particularly the peoples and routes of this past Australia.

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So my session is some discoveries from my Ph. D project reduced, i. E.

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And I'd like to acknowledge my and thank my supervisors, which is Professor Jimmy Carri at Mes University

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Associate. Professor Jenner Rankin.

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We listed covering, and Dr. Kyan Hughes in this university.

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So I spent 7 years working in a national strategic unit commissioned by nurses, employers and the Nurses Union

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to

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act as stewards of those 2 representing organizations

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and to work on a safe staffing strategy for the New Zealand frontline nurse in the many New Zealand hospitals that we have. We have 20 at the moment we have 20

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district health boards and

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nice.

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So my role was to be part of a design team to work with nurses, with health care, with doctors, with everybody in the health care system, to design a strategy that would work in deal on hospitals, to get more nurses at the bedside.

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and to reduce the critical shortages of nurses at the bedside, and the risks that they carry

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to patient safety. So, after 7 years of doing that work we still hadn't solved the problem

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and couldn't really understand why. That was because

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solution was brilliant.

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utterly captured by the idea that we had the perfect solution to the problem of nursing shoulders at the bedside.

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So I started my Ph. D. With a working to. I know why the heck and heck has in this worked because it's beautiful.

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My assumption was that this beautiful solution just isn't being used right by the people.

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The problem doing it

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because the safe staffing strategies were designed for nurses at Frontline. That's where my standpoint North. That's where I started my data collection.

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So I discovered this thing called situated what ultimately it became who was situated intelligence having a better front. Lyme nurse myself for nearly 20 years.

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I know that nurses know that a shift is short-staffed, and that patients are not safe. I can't tell you what that knowing is made up of.

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I couldn't at the time tell you what that no means may happen, but I can claim the knowing. We know that it's short and it's risky. So I started with frontline nurses, and they do know, and they can explain what it's made up of that.

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And so I could see changeable things. They were talking about books of appointments, patient lists coming in

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screens, whiteboards, various

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texts in various forms.

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There is also the knowledge of this team. This group of people on this shift in this moment have this level of education background. They have this level of clinical experience. They are credentialed in these ways. They know these things.

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They have a working relationship. They're a synergistic team. They can communicate, they can share, they can work together, they can

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leverage each other's skills.

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They can also know all of the patients. They are looking after everything most patients might need in this particular moment, and everything those patients might need in the next moment of care.

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whether they're improving or declining.

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They can know how to adjust. When the doctors come in on doctors round and change a few things. Okay, let's adjust. They're holding all of this in the ear all the time. It's phenomenally dynamic because it's a moment to moment. Humans are notoriously human when it comes to recovering from illness or

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injury or dime.

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So it's very difficult to predict what's going to happen in a given human at any given time.

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Nurses know how to anticipate what's needed. Now, what's needed later, what's needed for some future calamity that almost invariably happens?

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The unexpected can be expected on a shift involving humans.

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So this beautiful, dense, rich. accomplished work of nurses can be described.

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and at some point trying to get time, I will write a paper about what that looks like.

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but that's not the topic of this particular.

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What I want to talk about is the tools we gave them to express this. The purpose of the safe stuffing tools

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was to support nurses, to express that beautiful dense which

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accomplished work

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in a form that made sense to people who are not nurses.

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People are right policy, people who hold budgets, people who decide how many nurses we need on a shift.

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These are some of the tools.

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and I expected to hear them saying, Oh, we love this tool because it's all about the hours of care required and the hours of nursing care required. And we can tell the organization. This is how many hours.

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And we like the heat map colors because that can tell the organization. Well, we're green, we're good. We're yellow. We're a bit stretched. We're orange, so they're tipped down the less, and that changes the color of the

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we're orange. It's risky. Some bad shit could happen.

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Red means that avoidable harm will occur for some of those patients.

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Then we wrap all those numbers up over a year, stick them in big numbers, and we make a budget decision about how many nurses are required on this shift

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for this ward for the whole year.

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And then we say, we need this many dollars for this many nurses, so I imagined I would hear from the frontline staff. These tools are smashing, and they do a fabulous job of communicating situated intelligence to the organization.

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Do you think that's what I heard?

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So what I heard was this tool tells us how many hours of care we can provide to this patient. This still tells us how many hours of care this patient deserves, based on how they are.

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This tool tells us how hot the temperature is in our care environment. So if our screen is showing us that we are green or yellow, we can't really complain. We can't really ask for help.

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because the temperature is falling. Somebody else has decided that

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which is fine.

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We think this tool should, in theory, and the annual budgeting cycle bring us more nurses on the roster and on the shift at Bitsoft

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we get told you're right. You definitely need more nurses. However, there are no dollars and no nurses.

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Nobody's coming.

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so

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I spent quite a long time with this face. I was hunting around on the Internet for a her face, and Jack

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Jake does the best her face there is. So I spent quite a long time here stuck in my her face like, how has this happened? And rest Jenet Rankin for her help?

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But moving past the her

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to a problematic, which was about, how has this come about? How has the best efforts of a group of nurses on behalf of nurses

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to make a difference, for nurses

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turned into something completely different which consistently subordinates their situated intelligence, replaces it with numbers of.

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you know.

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abstractions. How has that happened?

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Because it's certainly not what we set out to do, not what we intended.

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So

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I continued to map what the nurses the frontline nurses had told me. I went back to them with the map. I said, what do you think that I all here? And you're missing a bit? Add this in back again. War mapping back again.

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So what I'm showing you there is a piece. This big in the met was ultimately this big, a digital map

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on the crazy platform

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massive. If I printed it off it would take 120 pages

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to print the map off. But this is the work of nurses. This is the meetings. They tend, the calls, they have the books they read, the screens, they complete the data they enter. This is what nurses are doing

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to convey to the organization. We don't have enough nurses. Passions are also

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an example of what that looks like. If you're standing in the workplace. Now, when I was marketing show voting this program around and around New Zealand.

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I I can be as persuasive as here. I can convince people of anything. So I'm selling to them the idea that this will only take 5 min to do some data and boom! They'll appear on the screen, and everybody will come running to help, but we can.

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and they believed me. But what I observed and what I heard from them was, you know, it's taking me 15 min to work out

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of the 6 patients I've got. I've only got eight-hour shift, so I have to squash my 6 patients into 8 h because I can't claim to have more than 8 h worth of work.

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because then I can't do it.

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So they're adjusting the care needs of patients to fit into.

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And so it becomes a labor equation. You need this much care. I can provide this much care. It's a neighbour equation.

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I saw nurses sitting at desks

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eyes and hands off patients at the disk. Entering data.

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It goes away somewhere, and they have no idea what it goes to and who sees it and what they do.

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I just

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know that for safe staffing they have to leave the patient. Come to the desk.

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Then they go. Oh, I here at the time. Off I go to the operational meeting.

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where a stand in front of a screen and Dorothy's fantastic ritualities.

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this virtual screen that shows the whole hospital as a bunch of rows of patients.

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And all these heat maps, whether or not the ward is green, or orange or yellow or red.

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and these hours. Calculations like this. This is this one's okay. This one's in green. Their ours are okay. This one's not so great. So we're going to take a nurse from there and put them over there.

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Now I was a children's news for nearly 18 years I've got sent to adult vascular surgery.

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and

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I show up and go, hey? I'm here to help. I don't know. Your patients don't know the drugs.

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I don't know that I don't know where everything is.

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I don't know where the crash curve is and with the lumines, but I'm here to help.

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so you can imagine the quality of care I can provide to those patients on that walk.

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It's way down here. It's not qualified for the area.

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So these are the compromises that go with

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trying to patch up holes with this kind of process.

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So as I'm talking, I'm expecting to hear. And I did hear nurses and everybody else that I spoke to in a phase, 2 data collection.

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the language of the program that we've implemented. We've done a really good job of implementing this program nationwide. So now, people have adopted a new discourse. They think in new ways about safe staffing.

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So, as I said before, the safe doving unit where I was positioned was

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the

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on behalf of 2 employers and the Union, the Nurses Union.

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The employers were looking at the latest and anti- things going on and operating hospitals around the world. So we got the Nhs. Scotland understanding capacity and demand, and the Australian Clinical Operations Board information. So they wanted that woven in, because that's the new shiny stuff

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on the other side, you've got 30 plus years of nerve-staffing research that's mostly quantitative, and shows the relationship between nurse at the bid so, and patient deaths.

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morbidity, dollars wasted, etc. And I anticipated this was a counter-narrative. This research was a counter-narrative.

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but at 2,014 I discovered Professor Emeritus Professor Linda Aiken, who you can see in the picture there, presenting at a conference in Queensland

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about nurse suffering ratio save lives.

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And she said, none of the research of that 30 years was intended for nurses.

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because nurses know what the problem is. They don't need to be convinced of anything.

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This research was for policy writers and budget holders.

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because those people need to convince you.

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Therefore, it took up the language and the priorities of those people

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in order to communicate to them. So, therefore.

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the research we thought, was a counter-arrative

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is actually

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under the same hegemonic model. because it comes from the same priorities of new public management.

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So

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the kinds of priorities you might expect to see in a hospital around new private management hegemony would be things like priorities. They should flow particularly

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a nurse can be in the middle of a recess, but part of her brain is devoted to holy cow. This goes. This is going to slow people coming out of the Ed by about 20 min while this person died.

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Why is she even thinking about that? In that moment her priority is to keep this person alive, but she's devoting part of her brain to the organiser. Organisational priority of

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that's become her business. Somehow

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I imagined that hospital operations, managerial hegemony and medical hegemony were happening in the hospital, and they are, and they do.

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I expected that our work and the research was the counter narrator.

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but discovered that actually. it's

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it takes up the priorities of the master, the discourse of the master, the tools of the master.

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in order to try to convince them

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of money from the Us.

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So we have. I've played a part in systematically implementing something that does something that I didn't intend we didn't intend.

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and not unexpectedly has failed to solve the problem after a decade.

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So yeah, I'd be interested in your

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comments, questions, pondering

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the end of the decision.

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Wow! And everyone is just so

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Grainne Kearney: on time so impressive. The timings is amazing, and a lot another lovely presentation. Thank you so much, Rhonda. So yes, I think Danny Jacobson is next and is I'm just. I have to say, I don't see Danny online, but I'm hoped I hope I'm wrong about that.

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Yeah, now that you mentioned it. Let me check the participants.

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Grainne Kearney: No.

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hmm! I wonder if there was some confusion in the time zone or that sort of thing?

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Will you each have another 3 min. Okay, so so should we move to.

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Grainne Kearney: If that's okay with you, Rachel. he, I also met 6 years ago. So this is just lovely to see another familiar face. so I think we should. Is that fair where we move on? Let have Rachel speak, and then maybe Danny will hopefully come in that time.

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That sounds great.

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No time like

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having a chance just to over it for another 15 min. Right, Jor. Call Rachel Whibs to our host. I am Rachel Ribsche from New Zealand.

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my badge, says Mess University. I'm a bit of a roaming scholar these days. So if I can use that to

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yeah. Also acknowledgments to the people in the room. Thank you for your prisons here to to gran your Hello.

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And yeah, thank you for this for this moment, for your attention.

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I'd like to talk to you about a really

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small finding out of a a larger dissertation. but one that I didn't. I wasn't looking for. That's what I he does. Right? You open up doors and go. Oh, wow!

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And you follow it, or you carry on the other direction. So this is a path that I followed, and it

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it's probably led to some of the biggest thinking and biggest realizations for me out of it. And I wanted to share it with you because it it teases out some bits of methodology.

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So it's about yeah, managing health care professionals as resources and patients as a commodity. So this is new public management inaction. And I'm also acknowledging Dr. Sue Adams in the room, who was a supervisor for me, Professor Jenny Carrier, who's not joined us today.

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So

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the quote and bold. If I told you that 50% of the requests you get for same day appointments could be resolved on the phone. Would you believe me? So this is a quote that's come out of a medical conference.

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And then

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on the other end of that is how this conversation plays out, you know. Hello! How can I help?

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I like an appointment place, you know. Are you on? Wow! Is this another reason I'm unwell.

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Do you need to be seen today yesterday? All right, I'll get a Gp to call you

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so. What I'm going to try and do in this station is connect the logic from this medical conference

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to the lived reality of what's actually happening and unpack whose interests are being served, and how we've ended up in this position

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and a few points, I suppose primary care in New Zealand is a. We have a hybrid model. We claim, I suppose, internationally to have a universal health care system. We have a private business model that serves primary care. Patients pay a co-payment for every visit. but children are the other ones that are fully funded.

376
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So I'm starting from the patient. The patient is where my standpoint was. I suppose, my possessionality. I was a nurse. I'm a well-user of health care. I'm a

377
00:47:43.140 --> 00:47:45.100
yeah, I

378
00:47:46.360 --> 00:47:52.750
I suppose, connected to many users of health care. But this is not

379
00:47:52.910 --> 00:47:56.819
and not a journey neither overly familiar nor unfamiliar to me.

380
00:47:57.520 --> 00:48:10.350
So what I did find was when talking with patients. So patients have all of this work that they've done. They've done work to know that they need to see a health care professional, which is a socially learnt. practice over time.

381
00:48:10.450 --> 00:48:16.389
They understand that primary care workforce is under extreme pressure. Now, that's because they have been told this.

382
00:48:16.530 --> 00:48:26.209
They have been told there is a shortage of GPS. There is a shortage of nurses. There's a shortage of nurses, so you must rush in your use of our surfaces.

383
00:48:26.980 --> 00:48:35.030
patients would prefer to see their own Gp. Which links to their earlier discussion of continuity of care. Patients want it.

384
00:48:35.620 --> 00:48:50.829
and they've learnt that they've learnt that through their work because they have to do more work when they don't see their own. Own. Gp. We still have a very strong, deep rhetoric in New Zealand, despite a lot of our primary care being provided by nurses and yes practitioners. And that's a different problem.

385
00:48:53.170 --> 00:48:55.419
Big problem, different problem.

386
00:48:55.600 --> 00:48:59.710
so patients also feel that they're not receiving care that meets all of their needs.

387
00:48:59.850 --> 00:49:06.160
which is not the same as our national health.

388
00:49:06.340 --> 00:49:08.630
Strategy understands unmet need.

389
00:49:08.640 --> 00:49:17.040
The needs that patients described to me as not being met didn't quite match up again. It was just disjunctures and problems everywhere I looked.

390
00:49:18.010 --> 00:49:20.379
So I spoke to

391
00:49:20.420 --> 00:49:25.990
nurses. amongst other, I spoke to a layer of frontline workers.

392
00:49:26.180 --> 00:49:31.680
but this this one nurse in particular, who will feed into this story here tonight.

393
00:49:31.820 --> 00:49:45.140
She's telling me that patients are complaining that they're not able to see their own doctor. and that this came through in a patient satisfaction survey, which is another problem. Another chapter this this survey.

394
00:49:45.630 --> 00:49:54.699
But what this nurse was telling me that because patients were complaining if they couldn't see their own doctor, what they're going to do instead is introduce Gp triage.

395
00:49:55.180 --> 00:50:05.900
And this is quality improvement. And she says it's quite patient-centered. So patients are able to talk to a Gp, maybe even their Gp. And she says that the right people get seen in a timely fashion.

396
00:50:06.270 --> 00:50:08.130
I mean, how loaded

397
00:50:08.390 --> 00:50:18.550
that bottom quote. So the right people get seen. And this is this is Frank's. Who is the ideal client? What? What's the ideal

398
00:50:18.840 --> 00:50:20.280
victim?

399
00:50:20.860 --> 00:50:30.300
Who is the right people? And what is this triage process doing that we're getting to the right people. So that was troubling.

400
00:50:31.130 --> 00:50:41.540
So then we reformed this access to care. We reformed the triage process. We introduced a whole new step, more work.

401
00:50:41.560 --> 00:50:45.979
more work for patients, different work for clinicians, more work for patients.

402
00:50:46.320 --> 00:50:52.330
So we're based on this feedback. Patients want to see their own. Gp, so here we are.

403
00:50:53.470 --> 00:51:02.490
So we have this this phone call. Now that happens. So a patient rings up as we stood. I want to see, I like X. Cs, please. I'd like to see my Gp.

404
00:51:02.900 --> 00:51:06.030
they get the phone call back. It's probably not the

405
00:51:06.890 --> 00:51:14.530
it's another. It's a Gp or a nurse, practitioner, or a nurse prescriber as as we how we're using it, they'll ring up, and

406
00:51:15.000 --> 00:51:24.269
the idea is, when I look at the the transcript of what's supposed to play out in that conversation is you have 5 min to identify the need of the patient

407
00:51:24.610 --> 00:51:26.290
to direct them

408
00:51:26.680 --> 00:51:31.050
either away as a no, I don't need to see you. Or perhaps

409
00:51:31.190 --> 00:51:35.050
I've seen an email and a prescriptions at the pharmacy ran along.

410
00:51:35.220 --> 00:51:42.020
Or yes, you are the right patient, and I will see you, and we will see you on this day at this time.

411
00:51:42.570 --> 00:51:44.309
So we've got

412
00:51:45.390 --> 00:52:04.310
a set of needs being met, a set of needs not being met, and more work for the patient work to to be available. To answer this triage call, to have access to resources, to answer this toiological to have you know the space. Perhaps they're at work. And they they don't have a role where you can just stop and take a phone call.

413
00:52:04.490 --> 00:52:06.180
And there's so many

414
00:52:06.370 --> 00:52:12.889
assumptions built in that this is right for the patients. This is patient-centered as that nursing. This is patient centered really.

415
00:52:13.670 --> 00:52:19.179
so sort of thinking about whose interests I'm really saying to see that it's not the patient's interest

416
00:52:20.410 --> 00:52:24.510
they wanted to see. They wanted continuity of care. They wanted.

417
00:52:24.620 --> 00:52:29.970
They needs met. they didn't want a phone call. So.

418
00:52:31.050 --> 00:52:38.349
and I must. I must say that clinicians I spoke to doctors, nurses, us practitioners. They were trying

419
00:52:39.030 --> 00:52:42.840
to do good care, as they understood good care to be.

420
00:52:42.970 --> 00:52:53.750
They really were genuinely trying to work in and around somewhat extremely captured, and others could see that these conditions I'm working under aren't really

421
00:52:54.280 --> 00:52:59.620
relating to what I would like to be delivering. So

422
00:53:00.720 --> 00:53:04.170
I explicated this

423
00:53:04.900 --> 00:53:08.749
knowledge behind the Gp triage

424
00:53:08.810 --> 00:53:14.530
and what it led me to. You know I opened that door to the social, and what I found was there was an issue with resource.

425
00:53:15.000 --> 00:53:17.939
limited resources. We didn't have enough

426
00:53:18.040 --> 00:53:24.459
doctors, nurses, nurse practitioners. So we need to ration our resources because this demand is huge

427
00:53:28.550 --> 00:53:35.219
by rationing those resources by saying, What if I told you you could. You know, 50% of your

428
00:53:35.310 --> 00:53:41.420
patients could be seen on the phone. And you know we're talking about decreased if you required to decrease

429
00:53:41.520 --> 00:53:44.869
work hours of clinicians to see these patients.

430
00:53:45.210 --> 00:53:50.739
We are achieving more care, more here, with fewer resources.

431
00:53:50.890 --> 00:53:53.309
Right? So

432
00:53:53.490 --> 00:53:58.410
as far as that rationing of resources. That's our. And

433
00:54:00.260 --> 00:54:12.290
that's the, I suppose when you think of the factory of health, that's your machine, your your reason. You're rationing that use of your machine, you're speeding it up. You're making it work faster, do things slightly differently, doing more for this.

434
00:54:13.910 --> 00:54:20.549
But it doesn't change the demand, because what it did. Instead, it increased the demand because

435
00:54:21.140 --> 00:54:35.330
the the acuity of the patients is going up. The comorbidities of patients are going up when you limit your time to just a 5 min phone call instead of perhaps mildly more comprehensive 15 min face to face assessment.

436
00:54:35.340 --> 00:54:42.709
You're missing more. And so this demand just keeps kind of growing and pushing into that resource space.

437
00:54:44.080 --> 00:54:52.989
People are waiting longer. because they they're getting spat out again by this Gp triage model. So actually, because if you if you like, the

438
00:54:53.210 --> 00:55:01.950
the health literacy and the the ability to articulate what exactly your health needs are to communicate effectively over the phone

439
00:55:02.410 --> 00:55:16.450
what it is that you truly need. If you're not able to do that, you you risk being just set out the other side because I've you know tech. I've I've met that person's needs. But actually, their needs were far more complex and interwoven. And yeah, things are missed.

440
00:55:16.900 --> 00:55:18.969
So that demand just keeps on growing.

441
00:55:19.660 --> 00:55:21.660
and I suppose

442
00:55:22.800 --> 00:55:30.060
this brings me here. I kept going all the way up to new public management. and I'm puzzling as to why

443
00:55:30.110 --> 00:55:44.060
newer public management's not been mentioned more over the the discussions that we've had, and in this conference, because I keep seeing it, I keep seeing it and everything that we're talking about this need for more efficiency, for value, for money, for doing more with less.

444
00:55:44.240 --> 00:55:49.400
And I'm wondering is new public management taboo in an ie. Now I

445
00:55:50.660 --> 00:55:59.100
I'm troubling this idea, thinking, have I gone wrong? But but really what I saw from starting from that conversation

446
00:55:59.420 --> 00:56:05.890
of what for? Starting from this, this survey, this unmet need we want to see.

447
00:56:06.110 --> 00:56:14.709
how do you pay my Gp. All the way up to? Well, now, you have a phone call. You have a 5 min phone call with Gp. And and that's great. And we've done

448
00:56:14.750 --> 00:56:19.339
really good care for you. And we're telling you this is really good. Here we are telling you that this is great.

449
00:56:19.500 --> 00:56:22.880
This is great, that you can talk on the phone to your Gp.

450
00:56:24.610 --> 00:56:27.620
And it's not value for money for the patient

451
00:56:27.700 --> 00:56:34.280
they are still paying. They pay the full fever service for that 5 min phone call if their needs are resolved.

452
00:56:34.560 --> 00:56:43.939
So if it turns into a full consultation, as in with an outcome and a diagnosis in a prescription or goodness knows what that's considered needs met full charge.

453
00:56:44.390 --> 00:56:46.970
The needs aren't made at all. That's not what they're wanting

454
00:56:48.320 --> 00:56:49.410
beautiful.

455
00:56:49.720 --> 00:56:55.170
 So this was. This was something. As I say, this was introduced to respond to.

456
00:56:56.760 --> 00:57:02.749
reportedly introduced to respond to those patient needs. But instead, what it's doing

457
00:57:02.910 --> 00:57:16.380
is providing efficiency and value for money for the business model that sits over top of primary care.  so whose interests are being served? It's the business, the business of

458
00:57:16.400 --> 00:57:22.379
primary care. So they are now making money from primary gear for

459
00:57:22.690 --> 00:57:25.560
doing less, more care, less time.

460
00:57:26.170 --> 00:57:35.180
And oh, I I didn't. I wasn't looking for that. I didn't expect to find that of all things, and it just I couldn't.

461
00:57:35.390 --> 00:57:41.960
you know you open that door, and I couldn't shut that door to the social. I had to keep going because it was so intriguing and so. Oh, my goodness!

462
00:57:42.440 --> 00:57:45.350
And how captured the the layers of

463
00:57:45.420 --> 00:57:57.860
clinicians were! I mean, Rhonda is really beautifully unpacked. How easy we can be captured by thinking that we are using tools to improve. And I found here this, the nurse saying, the right people get seen.

464
00:57:58.120 --> 00:57:59.410
So let's kind of

465
00:57:59.560 --> 00:58:06.790
where I'm finishing up this discussion, and where I would really like to open a conversation about

466
00:58:07.440 --> 00:58:18.809
I suppose that connection in ie. To to talking about those those big, ugly things, and not shying away from from drawing that line all the way up and saying, Hey.

467
00:58:19.050 --> 00:58:28.330
this is this is new public management. So thank you, Nami and and I really look forward to conversations and and questions afterwards, because this has been a great panel.

468
00:58:28.680 --> 00:58:29.529
Thank you

469
00:58:35.220 --> 00:58:37.970
this, and then we should

470
00:58:38.130 --> 00:58:40.489
perhaps open it up for

471
00:58:42.620 --> 00:58:44.230
stop share.

472
00:58:44.280 --> 00:59:01.190
so we can see you all too great. before we do that is, there, are we? I I assume we just move on we per Danny? I just some sorry, but I presume that we just have to keep going at this point and assume that that she's not going to join. Is that a

473
00:59:02.340 --> 00:59:06.580
Grainne Kearney: I don't think there's anything we can do, really. So it's a yeah. Okay.

474
00:59:07.180 --> 00:59:10.070
I think there must have been some sort of

475
00:59:10.830 --> 00:59:11.920
Grainne Kearney: something.

476
00:59:12.250 --> 00:59:15.340
Grainne Kearney: no problem, nothing. Okay?

477
00:59:15.790 --> 00:59:33.740
Grainne Kearney: And thank you all for a really exciting and diverse range of interesting topics. I think so. Certainly I feel that ie. In health and health care is a really exciting area and growing all the time, and I think they sort of

478
00:59:33.890 --> 00:59:58.580
Grainne Kearney: diverse nature all the into professional professions that we represent and chat about today really represents that so well and yet so many similar tensions have come up in some of the topics. I'm conscious that I I think I can see you all in the audience, and I'm not sure what the whether the speakers want to come up to the microphone or want to do a roaming mic. I whatever is easiest for you folks, because I'm conscious I'm the

479
00:59:58.750 --> 01:00:14.880
Grainne Kearney: person not in the room. So whatever works obviously for you all but and there's a few, very, you know, clear thoughts that I have around and discussion. But I'll maybe let if if anybody else wanted to open that up first. Is there anything anybody particularly wants to

480
01:00:14.900 --> 01:00:16.350
Grainne Kearney: start a sulfate?

481
01:00:20.730 --> 01:00:23.579
I'm happy to rotate with the money to the people

482
01:00:24.200 --> 01:00:25.909
points or questions.

483
01:00:29.120 --> 01:00:29.990
Okay.

484
01:00:34.150 --> 01:00:40.930
my question is for Sally. Thank you very much for your presentation. It's really nice to see

485
01:00:41.320 --> 01:00:57.729
more disability studies arising out of like non-western contexts. My question is through your institutional ethnography. How did you see disability being constructed or perceived

486
01:00:57.770 --> 01:01:01.430
within these institutions?

487
01:01:01.600 --> 01:01:04.630
Do you relate it to. You know the various models of

488
01:01:04.840 --> 01:01:07.709
how we understand disability?

489
01:01:12.160 --> 01:01:15.119
like so through

490
01:01:15.300 --> 01:01:17.579
Your few work.

491
01:01:17.990 --> 01:01:25.570
How do you see this disability as being understood by the different stakeholders.

492
01:01:29.700 --> 01:01:35.279
I try to. I try to say something that

493
01:01:35.590 --> 01:01:38.349
because in in our work

494
01:01:38.490 --> 01:02:01.780
all the writing is done by the worker, like professional, like occupational therapist and social worker. And the case manager is a role to test the as the form to everyone, and and then collect laws from together, and then to carry out on the clients. So the clients

495
01:02:01.800 --> 01:02:07.809
we need to answer the question from those professionals.

496
01:02:07.970 --> 01:02:19.159
and then the case, the case murder will tell them. Oh, you need to do that. You need to do that. So I think that is the disadvantage of the clients in the field.

497
01:02:19.400 --> 01:02:24.160
I don't know this. This is your question.

498
01:02:25.330 --> 01:02:47.090
Something like that. I think it's more about how they view disability like better. It is a medical problem, although they view but sense of disabilities, as say, people with agency, people who can make their own decisions. Yeah. But I think that was kind of like underlying in your response in your presentation.

499
01:02:48.530 --> 01:02:50.680
because I think.

500
01:02:50.810 --> 01:02:59.470
like in the recovery model, it is emphasized the autonomy of Lakhian. So in the regulation

501
01:03:00.280 --> 01:03:14.549
it tells the workers to need to care about the client, and also the because this is a kind of relay station. So it is the difference in the in the hospital.

502
01:03:14.790 --> 01:03:18.300
This clients in the center

503
01:03:18.920 --> 01:03:27.749
 Players who are in the center may have their own thoughts, like the Mr. W.

504
01:03:28.010 --> 01:03:37.760
He wants to go to work, so he think he can come here, and he can come here and have some service to help him to

505
01:03:38.350 --> 01:03:41.340
 connect to work

506
01:03:41.460 --> 01:03:47.769
faster. So I think in this field the clients can say something

507
01:03:47.910 --> 01:03:49.520
they want, but

508
01:03:49.930 --> 01:03:59.140
in a service they need to follow the advice from the professional, so the autonomy cannot be shown in a relationship

509
01:04:03.400 --> 01:04:04.940
I

510
01:04:05.760 --> 01:04:10.590
Grainne Kearney: did. I pick up on something around that with Sally, is that okay?

511
01:04:12.800 --> 01:04:13.980
Yes, please.

512
01:04:14.650 --> 01:04:20.650
Grainne Kearney: Sally, you talked about their participation as being very superficial.

513
01:04:21.230 --> 01:04:27.430
Grainne Kearney: I was hoping you might say a little bit more about that idea of the very superficial participation.

514
01:04:29.420 --> 01:04:33.719
because those laws.

515
01:04:33.950 --> 01:04:42.769
supplies and demands, translate into words on the form. So in the form, we cannot

516
01:04:42.910 --> 01:04:49.250
write down whole picture and whole story about the client, so we only

517
01:04:49.280 --> 01:04:55.720
write down like he need to exercise 30 min needs every day.

518
01:04:55.870 --> 01:05:09.810
but we cannot see how and why he need the exercise. So maybe the SSI is what the professional things you need. But the clients do not think exercise is important.

519
01:05:10.140 --> 01:05:11.600
Yeah. So

520
01:05:11.950 --> 01:05:18.469
so I think the participant is superficial, because those documents are writing

521
01:05:19.180 --> 01:05:22.980
are right by professionals and case manager and

522
01:05:23.010 --> 01:05:26.349
clients only sign on the paper.

523
01:05:26.790 --> 01:05:34.580
and then follow what the case merger taught to them. So they they are even

524
01:05:34.660 --> 01:05:49.420
they cannot understand the professional writing, because maybe we write down is aerobic dance, but they don't know why. Aerobic, then, is related to himself

525
01:05:50.070 --> 01:05:50.939
too soon.

526
01:05:52.630 --> 01:05:54.600
and all that he had.

527
01:05:57.260 --> 01:06:01.479
Yeah, thank you. This is super interesting. I was wondering, like.

528
01:06:01.600 --> 01:06:25.060
whether all of you or any of you see, like are the metrics translated into sort of like a discourse to explain to the frontline workers why it makes sense. I was just. It made me think, especially Rachel's presentation. I feel like I worked at a disability service where they changed. Essentially, we were always working one to one, and they had definitely taken on. People could not be unsupervised by various reasons.

529
01:06:25.060 --> 01:06:31.779
and even for a day and hour both, but definitely. There would be issues within one day.

530
01:06:31.780 --> 01:06:55.759
if that if they were left unsupervised for some time. And they but they told us, Oh, look, guys, we've always been actually one one staff for 0 point 75 students. so this, you know. But it wouldn't be so sad if we didn't take more students on, because imagine what they would be doing, you know, if they did couldn't come here. We don't have the resources. They would be sitting home watching TV. So they I really feel like

531
01:06:55.930 --> 01:07:13.810
when you were talking. I was thinking about this like discourse of like something is better than nothing. Where actually go to the point where it was so ridiculous that I was like actually TV watching my piece a lot safer, a lot better, you know, because if you bring 3 people per one step and staff member. Then it's just so unsafe. That's

532
01:07:13.920 --> 01:07:26.610
And I don't know. Yeah, just a terrible situation. So I was wondering if those metrics also get translated or put into terms that they yeah think that maybe frontline workers will respond to

533
01:07:26.770 --> 01:07:30.950
better kind of emotional. They didn't, perhaps. But I don't know if that's

534
01:07:35.560 --> 01:07:42.319
yeah, right to here. Quick response. And I can hear. Feel Rhonda's brain churning on it

535
01:07:42.370 --> 01:07:56.520
in the primary care setting in New Zealand. because of the business model. And then, as you saw the the pitch about the stupid triage was sitting at a medical conference, so the capture, I suppose the

536
01:07:56.880 --> 01:07:58.720
brainwashing

537
01:07:58.780 --> 01:08:06.569
starts from that business model. So once they see the dollars fit, then they just have to convince the the mixed layer. The

538
01:08:06.660 --> 01:08:09.130
GPS hold a lot of power

539
01:08:09.200 --> 01:08:17.180
brightly or wrongly, in New Zealand, in lobbying in general. And so actually.

540
01:08:17.280 --> 01:08:23.870
once you've got them captured and and and brought into the agenda. It will just trickle down

541
01:08:24.330 --> 01:08:26.649
who wasn't told was the patients.

542
01:08:26.800 --> 01:08:44.580
So you know, business came on. GPS got brought into this idea. Nurses? Obviously, I, my, the nurses, particular nurse, and that court were saying, you know this is quite patient, and the right patients get seen. So they've received that training and risk being told that this is good.

543
01:08:45.310 --> 01:08:51.380
But the patients that I spoke to that then had to learn to use this navigate this new process

544
01:08:51.710 --> 01:09:01.889
had no idea why they didn't. They were not told why, but they knew about this discourse of short staffing, and they knew about limited resources. And so they went off it.

545
01:09:02.060 --> 01:09:02.810
Yeah.

546
01:09:05.190 --> 01:09:10.069
in and in relation to mine and the

547
01:09:10.480 --> 01:09:12.439
marketing this has done.

548
01:09:12.600 --> 01:09:17.740
Nurses were systematically indoctrinated with their

549
01:09:19.520 --> 01:09:26.339
and that's often the case with any kind of health that ultimately gets pushed down to the frontline workers, and they do the work of them.

550
01:09:27.290 --> 01:09:35.919
So it got to the point where, because it was a partnership between a collaboration between the Unions and the Dhbs

551
01:09:36.020 --> 01:09:37.350
nurses were being

552
01:09:38.220 --> 01:09:41.099
colonize. Their thinking has been colonized from 2 directions.

553
01:09:41.280 --> 01:09:46.520
Employee, what if you do this, your union wants you to do this. This is the solution you used to it. This is a job

554
01:09:46.690 --> 01:09:50.499
got to the point where any resistance was, was

555
01:09:50.660 --> 01:09:56.010
pretty quickly counter-narrative with a poster on the wall that said, If you don't do your

556
01:09:56.090 --> 01:10:01.009
patient acuity information data entry, you won't get more if you

557
01:10:01.420 --> 01:10:05.480
you know, there's a real kind of pushing the work

558
01:10:05.600 --> 01:10:10.770
and a moral conflict, one to the frontline workers with Piv and a doctor and

559
01:10:18.530 --> 01:10:26.520
 other

560
01:10:26.720 --> 01:10:30.149
questions and try and feel free to.

561
01:10:34.220 --> 01:10:42.610
Can you even hear me? Yes, okay. So are there questions in the room or other people want to make.

562
01:10:42.760 --> 01:10:43.960
Yeah, please.

563
01:10:46.730 --> 01:10:56.799
Ronda's last point. seem to be. If it's quite nicely to what Frank was saying the other day about having done some. I work

564
01:10:56.930 --> 01:10:59.350
in terms of the social focus.

565
01:10:59.410 --> 01:11:07.219
and then take it back to this ideology in which you're saying this to.

566
01:11:07.330 --> 01:11:09.450
And you know it's an education

567
01:11:09.940 --> 01:11:17.470
they come to you for me that the one to one which for many of us at the end of the screen is a special part of that.

568
01:11:18.070 --> 01:11:22.839
It's a South African project at the moment where Phd is by a bunch.

569
01:11:23.100 --> 01:11:29.160
So again, a meeting crystal.

570
01:11:29.490 --> 01:11:34.360
Just so, there's a last yeah.

571
01:11:35.920 --> 01:11:43.690
it's spelled broad. And yeah. And as we come on Dive, I'm not wonder one of which is difference.

572
01:11:49.030 --> 01:11:50.110
You know

573
01:11:52.300 --> 01:11:53.280
anybody else.

574
01:11:55.110 --> 01:11:57.040
You

575
01:11:57.570 --> 01:12:07.380
I'm interested in the discussion on that question that you read with Rachel about new public management. I think that's a really good one for a discussion.

576
01:12:07.880 --> 01:12:12.309
I don't have anything to say about them.

577
01:12:14.210 --> 01:12:16.220
I do have some stick on that. But I

578
01:12:16.400 --> 01:12:24.280
and I don't want to say a lot about it, because I would quickly move into a territory that

579
01:12:24.800 --> 01:12:25.890
would just be

580
01:12:26.150 --> 01:12:35.419
not saying anything that I have anything to face it on. So my understanding is that it was an attempt

581
01:12:35.780 --> 01:12:47.060
to specify things that people were talking about as ruling relations.  so is it taboo? I would say, no, absolutely not

582
01:12:47.640 --> 01:12:54.159
But so, for example, when I talk about neoliberalism or the global economy or those kinds of things.

583
01:12:54.180 --> 01:13:03.100
I think that those are the ways that I have of tapping into that. But I think that the new public management. It operates

584
01:13:03.600 --> 01:13:17.320
so for people who do institutional ethnography within institutions that are clearly managed under neoliberal principles, for the purposes of whether it's education or social work or healthcare, you know.

585
01:13:17.430 --> 01:13:19.980
Then new public management really works.

586
01:13:19.990 --> 01:13:22.409
I think that some of us are doing

587
01:13:23.200 --> 01:13:26.239
work where it's it is more.

588
01:13:26.820 --> 01:13:35.969
it's more nebulous. And in the whole discourse of ruling relations with a little better, or neoliberalism, or a global economy or something.

589
01:13:36.180 --> 01:13:37.899
But yeah, I mean, I think it.

590
01:13:38.250 --> 01:13:44.859
That's totally just my take on it, and I could be very wrong.

591
01:13:47.000 --> 01:13:58.489
So my, I suppose response to the the I. E collective here is when we are sitting here watching presentations and seeing it. Is it something?

592
01:13:58.510 --> 01:14:04.760
Because I suppose I probably didn't see it without a strong means coming from from? So it's supervisor going. Oh.

593
01:14:05.110 --> 01:14:08.630
okay, so your public management. It's it

594
01:14:08.640 --> 01:14:20.050
a little bit further and go, yeah, yeah. So is it useful to be having those in the feedback moments to go, or did you? Did you see that there? Did you recognize that? Because that.

595
01:14:20.260 --> 01:14:34.999
I said, and I perhaps New Zealand discourse, I mean New Zealand took a very big bang approach to to new public management, and we went all in. So it is a very common, I suppose, finding across all the all the institutions.

596
01:14:35.330 --> 01:14:36.409
all the bigs.

597
01:14:36.630 --> 01:14:46.369
so not unexpected for us now to be seeing it. But perhaps it is slightly more unexpected, and and not so visible to others. And do you want that

598
01:14:47.290 --> 01:14:48.570
this

599
01:14:50.370 --> 01:14:51.470
hours?

600
01:14:52.050 --> 01:14:54.609
Yeah, well, I'll say that

601
01:14:54.870 --> 01:15:07.730
beating you, I think, because I think we've been there for long, at least in education. And some of the latest research on education is that one of the real dangers is that

602
01:15:08.320 --> 01:15:12.880
new teachers coming in now? Actually, it's normalized for them.

603
01:15:13.030 --> 01:15:18.119
Older teachers have kind of given up some of the the fight a little bit. So

604
01:15:18.290 --> 01:15:25.329
I suppose maybe there's value in institutional ethnography that people like yourself who

605
01:15:25.410 --> 01:15:30.209
are able to show participants. I guess how this works.

606
01:15:30.310 --> 01:15:37.550
because it's been so normalized in education. Everything that you were saying resonated where you've got

607
01:15:37.830 --> 01:15:52.850
kendi and early childhood teachers. For instance, someone was telling me just recently that they have to take a a photo every day of every child and and put it on and up to to communicate with parents. There's so much expectation to document.

608
01:15:52.880 --> 01:15:55.140
that's where we're

609
01:15:55.230 --> 01:16:03.899
spending their time. So it's yeah, it's It resonates a lot, I think, with education, at least in Australia. And

610
01:16:04.050 --> 01:16:06.020
if you want to talk about health care.

611
01:16:07.030 --> 01:16:09.160
I

612
01:16:09.460 --> 01:16:10.929
practice with me.

613
01:16:11.820 --> 01:16:31.219
I want to echo on the importance of a new public managerialism. It's certainly it's very important. I I keep hearing from my workers saying that now the Kvi replace the needs of my crime. I just want to hit the Api. So I have 2 questions for 1 1.

614
01:16:31.240 --> 01:16:32.540
This is high.

615
01:16:32.600 --> 01:16:41.890
that physicians appear and disappear. Whether I I highly suspect it's about

616
01:16:42.330 --> 01:16:47.199
how they calculate the usage of physicians time to make money.

617
01:16:47.360 --> 01:17:09.419
so they decide to appear, and they decide to disappear because it doesn't make enough money. So I think So the problem is not appear or disappear is how they measure the Cp. The the money they make for. So I so I think,

618
01:17:10.050 --> 01:17:17.290
how the physician evaluate to do a discharge plan, I know physician think, is

619
01:17:17.560 --> 01:17:19.220
he paid too low.

620
01:17:19.280 --> 01:17:24.810
so they leave it to the nurse. They just put the stand.

621
01:17:24.870 --> 01:17:35.649
So that's one question. Well, the role of money play in your topic, and the second is as an educator.

622
01:17:36.140 --> 01:17:41.360
You want to make sure our physician. they being

623
01:17:41.550 --> 01:17:47.919
humane, and day 3, patient like a human being, but in an environment

624
01:17:48.090 --> 01:17:51.499
that all emphasize on money.

625
01:17:51.590 --> 01:17:56.439
All your time is money for the hospital.

626
01:17:56.480 --> 01:17:58.749
How do you do your education

627
01:17:58.880 --> 01:18:03.579
in that, neo? My material is a environment.

628
01:18:03.650 --> 01:18:04.710
I don't know

629
01:18:04.740 --> 01:18:06.390
how your education

630
01:18:06.410 --> 01:18:07.719
deal with that.

631
01:18:11.720 --> 01:18:23.899
Thank you for your question. In fact, I'm a kind of a student of institutional, ethnically

632
01:18:23.960 --> 01:18:27.159
so. maybe my answer is not to

633
01:18:27.510 --> 01:18:30.240
much corresponding to

634
01:18:30.520 --> 01:18:32.470
institutional ethnography.

635
01:18:32.690 --> 01:18:39.220
For now I can just reply, the very realistic problem just about money. So

636
01:18:39.420 --> 01:18:46.299
in Taiwan physician, as I told you before. We don't have gypsy institution.

637
01:18:46.340 --> 01:18:49.639
so a family physician

638
01:18:49.970 --> 01:18:54.730
they can lack the patient when the patient

639
01:18:54.900 --> 01:19:03.290
charged out of a hospital. but the other specialty, they will not so look to transfer

640
01:19:03.630 --> 01:19:09.820
location to memory for medicine. Physician. Let me say why

641
01:19:10.200 --> 01:19:16.689
I make you earn more money. If, just before one or 2 week they go out hospitals.

642
01:19:17.810 --> 01:19:23.059
So that is very difficult, since to implement the dose.

643
01:19:23.660 --> 01:19:29.040
even the policy try to set a lot of incentive.

644
01:19:30.060 --> 01:19:33.510
So on the one hand, the incentive is not strong enough.

645
01:19:33.780 --> 01:19:37.479
maybe for 2,005 empty dollars.

646
01:19:37.540 --> 01:19:43.269
It's around 100 Australia dollar for 3 tops.

647
01:19:43.700 --> 01:19:57.890
So incentive is not so strong, but the difficult difficulties is too strong. but that would not prevent those to disappear, because

648
01:19:57.990 --> 01:19:59.520
the physician real.

649
01:20:00.480 --> 01:20:04.590
push the work to other

650
01:20:04.770 --> 01:20:06.800
go to our nurse's death.

651
01:20:07.050 --> 01:20:11.870
So that's still a kind of way to make money.

652
01:20:12.050 --> 01:20:19.690
but not to use our physician's time to make money when the hospitals still want to make money even that there is more money.

653
01:20:20.320 --> 01:20:26.879
So this is the first question. The second question, I think, is a very big question.

654
01:20:27.110 --> 01:20:38.019
because the For as a educator in university in Taiwan we are a little awkward, because

655
01:20:38.030 --> 01:20:40.180
the medical student I teach

656
01:20:40.530 --> 01:20:43.999
when they become a Pgi physician.

657
01:20:44.050 --> 01:20:47.040
may earn more than a a system of facil.

658
01:20:47.210 --> 01:20:52.599
so they always told me. Oh, you are very high commitment to

659
01:20:52.770 --> 01:20:53.680
any.

660
01:20:54.230 --> 01:20:55.740
because you

661
01:20:55.750 --> 01:21:00.419
you get a lower salaries at me when I was a

662
01:21:00.630 --> 01:21:09.489
an year of 1,828, but that higher, still higher than your salary when you are 35, or 38.

663
01:21:09.850 --> 01:21:11.820
So they interpret this

664
01:21:12.370 --> 01:21:15.870
this situation as a kind of loyalty

665
01:21:16.020 --> 01:21:17.440
to your profession.

666
01:21:17.770 --> 01:21:18.530
So

667
01:21:18.720 --> 01:21:23.230
if you would like to get low salary.

668
01:21:23.340 --> 01:21:25.499
not because you love your profession.

669
01:21:25.830 --> 01:21:28.720
but I think this is a very wrong logic.

670
01:21:29.040 --> 01:21:30.410
Money.

671
01:21:30.790 --> 01:21:33.970
does it? The upstate? 2.

672
01:21:34.090 --> 01:21:44.809
Look just that care is not the upside down of money, why do we get care? And also getting deep in time?

673
01:21:45.960 --> 01:21:57.640
So for the education, I think that is a very difficult things for for physician in Taiwan, because they have already get a very high salary.

674
01:21:57.830 --> 01:22:10.600
So once a survey in Taiwan physician have too high humanity concern. First of all, when they were student.

675
01:22:11.000 --> 01:22:21.190
so they saw the patient they feel like, Oh, it's a very difficult task. and the next time it, around the year of 15 or 16.

676
01:22:21.810 --> 01:22:23.429
When they get very old

677
01:22:23.860 --> 01:22:25.859
they feel like, Oh, I

678
01:22:26.190 --> 01:22:29.580
respected to view my life as

679
01:22:29.690 --> 01:22:36.850
there are so many things I highly valued. but during the middle age.

680
01:22:37.380 --> 01:22:39.310
I was there for an office

681
01:22:39.490 --> 01:22:43.240
to earn money, or to do with all the medical

682
01:22:43.280 --> 01:22:45.430
tradition apprentice.

683
01:22:45.470 --> 01:22:50.509
So that will, for example, we do a questionnaire, the empathy

684
01:22:50.550 --> 01:22:54.419
of you just Jefferson's justice you.

685
01:22:54.610 --> 01:22:58.249
So they are very low when they are young.

686
01:22:58.540 --> 01:23:05.649
I don't know when they are strong age, but they are very high when they are young, and they are all. It's very real things for the educator

687
01:23:05.780 --> 01:23:11.869
in Taiwan. I'm not sure is that this similar situation in Australia or New Zealand.

688
01:23:12.960 --> 01:23:14.290
Thank you.

689
01:23:14.670 --> 01:23:17.070
Granny, you're on.

690
01:23:17.120 --> 01:23:39.950
Grainne Kearney: Thank you. So I'm really enjoying this. I mean, I I really have an interest in the new public management, my side myself, and I was going to make a really per joke about how efficiently you're stuck to your 15 min at the start, but I I to it was not too, but so actually just to pick up Lauren something I think, that you'd said about new public management about it being an ie. Perhaps it is quite

691
01:23:39.950 --> 01:23:53.989
Grainne Kearney: visible, as we may be described in the very managed profession, such as health, and then I suppose my perspective on it is, I work half my time as a family doctor, and then half in university, and through my learning about, i. E.

692
01:23:53.990 --> 01:24:12.300
Grainne Kearney: I have certainly become really aware of new public management and health. I mean, as Rhonda and Rachel have described so beautifully. It's it's I can't believe I couldn't see it before. It just is so obvious. So, but in the, in, the, in my my medical education, which is a bit different, perhaps, in other types of education or health professionals, education in general

693
01:24:12.300 --> 01:24:31.789
Grainne Kearney: it it wasn't so obvious, and and perhaps I started to look a little more deeply, and people didn't really talk about efficiency, effectiveness, all those terms so much. But what I find in my work, which is into a type of assessment and medical education was. They talked about fairness and defensibility, which really, when you sort of

694
01:24:31.870 --> 01:24:50.859
Grainne Kearney: drilled into or distilled it down, was about accountability of the institution, really. And and I perhaps that's where I see the new public management in areas where it's not so obvious as it might be in health. So. But I'm certainly interested in that in an ongoing discussion about new public management, I just I think it's fascinating.

695
01:24:51.380 --> 01:25:15.979
I agree. And I I I sort of flippantly said, you know, we should get the Nordics to talk about it, because I'm just wondering if there is a different orientation to that in places that have a more more of a commitment to the welfare state like my experience of living in the United States just to see how it permeates society. Not that I'm saying it's, you know.

696
01:25:16.030 --> 01:25:18.349
Obviously, the welfare state is

697
01:25:18.530 --> 01:25:30.290
is being eroded all over the world. And that's kind of what this conference is about in terms of research and authoritarianisms and that kind of thing. But yeah, I just think it's interesting to.

698
01:25:30.340 --> 01:25:33.529
And I'm glad that this was raised as a question.

699
01:25:33.760 --> 01:25:36.200
I think it's a very interesting topic and important

700
01:25:39.650 --> 01:25:44.319
the advantage of being at the end of the ie. Sessions we've been having.

701
01:25:44.620 --> 01:25:47.770
there's so many flavors that have been

702
01:25:47.860 --> 01:25:51.649
emerging from the sessions that have been delivered.

703
01:25:51.660 --> 01:26:03.900
And although we had come to this ourselves, what's really happened? The 4 of us are all out staying together, and we here in a little more, or our hours afterwards, and then tell each other

704
01:26:06.680 --> 01:26:13.130
Our discoveries, which parallel our colleagues, discoveries, and the very small number of

705
01:26:13.730 --> 01:26:18.840
it is very dominated by new product management, and, as I just said, it was a Blitz great in New Zealand.

706
01:26:18.860 --> 01:26:24.209
It was hideously dumb and catastrophic, and they were all still

707
01:26:24.580 --> 01:26:26.590
by that.

708
01:26:27.060 --> 01:26:37.589
But we have the compounding aspect of our treaty and our commitment to our partners in agriculturalism.

709
01:26:37.660 --> 01:26:39.990
and the recognition. So.

710
01:26:40.160 --> 01:26:42.720
and at the end of my basis.

711
01:26:42.780 --> 01:26:46.500
 you become a subject matter expert

712
01:26:46.850 --> 01:26:48.689
when you finished a Ph. D.

713
01:26:49.510 --> 01:27:02.480
It's doubly challenging when you've discovered something that nobody wants to know. So that that was a bit of a challenge I did get asked by the Minister of Health to join a group of subject matter experts and to talk about the program and to critique it.

714
01:27:03.050 --> 01:27:13.579
And one of the major discoveries really from that process was how we have designed something built on that 30 years of research I talked about, which is mostly abroad.

715
01:27:13.930 --> 01:27:21.929
but we designed something over several years in-house, and it never once occurred to us to consider what patient's safety looks like.

716
01:27:21.960 --> 01:27:25.770
or what patient safety looks like for morning and users.

717
01:27:26.580 --> 01:27:29.939
And of course it will be different, because the world of you is doing.

718
01:27:30.520 --> 01:27:33.360
And so now we have this thing

719
01:27:35.020 --> 01:27:40.539
aligned itself to colonial thinking that it's the Western way.

720
01:27:40.950 --> 01:27:49.830
And so we have this kind of additional flaw in our in our approach, which is that we haven't

721
01:27:49.880 --> 01:27:53.410
designed and developed fantastic and

722
01:27:53.480 --> 01:27:57.840
conjunction with their I used to.

723
01:27:58.340 --> 01:27:59.320
And

724
01:27:59.640 --> 01:28:05.900
so, yeah, that's something else we need to think about, because new product management has also had an impact on all of the

725
01:28:06.200 --> 01:28:14.109
to all of the people, not through, but particularly for our

726
01:28:16.850 --> 01:28:17.780
okay.

727
01:28:18.060 --> 01:28:40.399
this is so for hooky at the end of a really long day. And this is the strain, the the the thought train that I was thinking when Nerd asked me whether I wanted to talk about Neil rules in Australia. I was just like I'm too tired. But The infamous paper that I wrote that hopefully one day we'll see the light of day.

728
01:28:40.700 --> 01:28:47.090
It was about the intertwining of new public management, neoliberalism and the client, willing relations.

729
01:28:47.200 --> 01:28:49.320
And and it was really

730
01:28:49.580 --> 01:28:58.150
it was really how this they are so intricately intertwined, and the Colonial like to kind of really long story short.

731
01:28:58.280 --> 01:29:02.689
the colonial ruling relations. What? Just?

732
01:29:02.730 --> 01:29:19.420
It's just happening, but through different disposals with new public management. It was the the vehicle from which the old ideologies were still being happening. And the way that I did that was a very strategic choice of a problematic

733
01:29:20.270 --> 01:29:33.960
which I just wish I could just give you the reference. But it was something that didn't require. Money didn't require much work that could be effectively, you know, implemented at the click of a button.

734
01:29:35.320 --> 01:29:38.929
Everyone said they wanted to do it, like, you know.

735
01:29:39.280 --> 01:29:43.499
tick, tick as far as easy to for man.

736
01:29:43.600 --> 01:29:45.160
cost-effective.

737
01:29:45.930 --> 01:29:49.100
but symbolically, that I can.

738
01:29:49.160 --> 01:29:57.580
Acknowledging country was a step too political and too far to do in an institutional framework in, you know.

739
01:29:57.760 --> 01:29:59.999
this day and age in Australia.

740
01:30:00.160 --> 01:30:08.120
and so, yeah, so that paper was kind of looking at. Why is it so fucking difficult for an institution to actually do acknowledgments?

741
01:30:08.310 --> 01:30:15.580
so yes, I think that that's a really exciting space is actually looking at the

742
01:30:16.000 --> 01:30:18.180
the intertwining.

743
01:30:18.420 --> 01:30:29.559
I don't know if ruling relations is the right way, but these big concepty things that it's not just one. It's not just the other, but actually it can get all messed up.

744
01:30:33.330 --> 01:30:34.740
so I,

745
01:30:34.810 --> 01:30:39.220
and very new to I like have not done it. I'm not really reading it. I'm just

746
01:30:39.270 --> 01:30:58.839
so sort of thing. And I watched some of the sessions yesterday, and sorry to bring up a session that occurred yesterday, but the one that was about environment yesterday evening. So I found that throughout that there was a common theme of like the UN was involved, or like development and whiteness could have been something that was brought up and similar to you, saying, like.

747
01:30:58.840 --> 01:31:23.840
I think it was like sort of spoken about slightly, but similar to how you said, like, we're not talking about new public management. And so I was wondering if any of the panelists could so speak to that. Sophie has already sort of started like, is there a space in, i. E. For these broader, like ideas that sort of cut across our whole lives that aren't necessarily done by institutions in institutions, but are part of like. If you could call the world in institutional, western.

748
01:31:24.090 --> 01:31:34.369
colonial ways of knowing an institution. I don't know if any of the panelists can speak to that, because probably outside. But I think it ties into the new public management as well.

749
01:31:37.290 --> 01:31:37.950
okay.

750
01:31:38.840 --> 01:31:44.590
If you all happen to be here tomorrow, you can hear Rachel and I talk about a little bit about this to my

751
01:31:44.740 --> 01:31:48.070
in terms of the

752
01:31:48.200 --> 01:32:03.950
the mapping that we did to find those ruling relations. So, for example, obviously, what I focused on tonight was very much what happened in hospitals, what nurses at the bedside were doing But when I was tracing the building relations you can just keep going up.

753
01:32:04.150 --> 01:32:06.750
And so new public management

754
01:32:09.270 --> 01:32:12.000
behind that you've got the medical

755
01:32:12.090 --> 01:32:19.350
profession in the medical associations which are global, you've got patient safety. The world health organization is global.

756
01:32:19.430 --> 01:32:23.020
So, but still the ideas of the quality, efficiency.

757
01:32:23.030 --> 01:32:41.050
safety. All of those ideas are at that very ideological, conceptual little, and they sound great. You know you wear a T-shirt. You buy the poster, you believe. But when it starts to get translated down into, how does that actually get operated by people on the ground?

758
01:32:41.300 --> 01:32:45.679
Let me in. The priorities come into

759
01:32:46.030 --> 01:32:51.680
Janet Rankin's brilliant book from her Phd. Around managing to news. She talks about the

760
01:32:51.720 --> 01:32:59.939
the cognitive dissonance, the moral distress that occurs for a registered news, who's trying to look after the special who's obviously sick.

761
01:32:59.960 --> 01:33:04.820
but also trying to discharge that patient because the next obviously set as you.

762
01:33:05.410 --> 01:33:09.799
So that's how it presents on the ground. But you can trace that.

763
01:33:09.980 --> 01:33:10.969
What was that?

764
01:33:11.730 --> 01:33:22.020
Endlessly? Why, we haven't left the planet. It's not quite. But you know, like these ideas about the way health care should be done in

765
01:33:22.510 --> 01:33:32.330
is global. So one of the troubling things well, both of us had done at all. That was to my our sort of personal journeys through our Phds around the schools.

766
01:33:32.730 --> 01:33:44.850
our our own personal senses of cultural and and involvement in this. But then, as soon as you start to get to that really satellite view of the world, everybody is operating in the same way.

767
01:33:45.010 --> 01:33:46.980
So it's not as if

768
01:33:46.990 --> 01:33:52.839
people are deliberately thinking, and they did it in the morning. Right? I'm getting a new public. Manage my way through life today.

769
01:33:52.990 --> 01:34:04.889
They don't even that's not conscious, you know, we don't know that until we start to get this satellite view. And I really love what drive this is about mapping. No one person can see the whole terrain.

770
01:34:05.370 --> 01:34:12.809
It's not really until you can see much more of the terrain. And you get this much. I agree with you. The it's really.

771
01:34:13.600 --> 01:34:18.570
and then you can step back from personal popularity and blame it on this, because

772
01:34:18.690 --> 01:34:20.760
actually there was no one away the rest of it.

773
01:34:21.960 --> 01:34:37.569
So part of that was. I was interested in all this kind of just burn it all down, you know. I'm not sure that the capitalism is going to happen anytime. So so what we have to figure out is, how do we operate on within what isn't global

774
01:34:37.650 --> 01:34:42.429
in a way that we still feel like we're going through to I, do we? The vision of our machine?

775
01:34:44.350 --> 01:34:50.010
 They're here.

776
01:34:50.680 --> 01:34:55.560
There are comments, or we're not wearing Hi

777
01:34:57.610 --> 01:34:59.060
and frankness

778
01:35:01.040 --> 01:35:02.390
in Buddhism

779
01:35:03.170 --> 01:35:10.140
meditation. They have this word that you can see a world through watching a scent

780
01:35:10.580 --> 01:35:12.709
from small thing you can see over

781
01:35:12.850 --> 01:35:14.309
nothing. I

782
01:35:14.390 --> 01:35:18.439
do something like that. If you have a good case.

783
01:35:18.620 --> 01:35:28.919
and actually the others will be able to see how the power, the pattern, so they will be able to understand how power operate in their life.

784
01:35:29.590 --> 01:35:49.190
I'll give you one example, like Marie Campbell, write about Canadian hospital restriction 20 years ago, and I use it as a reading text in my teaching and one of my nursing background students

785
01:35:49.290 --> 01:35:53.660
read the text and say that I hear the same

786
01:35:53.690 --> 01:35:57.529
word from my interview, E. Saying the same thing.

787
01:35:57.700 --> 01:35:58.600
that

788
01:35:58.730 --> 01:36:03.499
how the nurse are asked to be financial, sensitive.

789
01:36:04.370 --> 01:36:23.479
like 20 years difference. And it's in Canada, in in Taiwan. But how the hospital, being restructured is the same logic. So so so I think to see the world, we need to start from the local.

790
01:36:23.640 --> 01:36:29.570
So if we did not do the local well, the globalization would just be

791
01:36:29.900 --> 01:36:31.120
kind of

792
01:36:31.160 --> 01:36:33.420
did not tell much about it.

793
01:36:33.800 --> 01:36:38.130
So I really like the metaphor that we

794
01:36:38.230 --> 01:36:41.520
can see the world through watching ascent.

795
01:36:41.540 --> 01:36:43.949
I think that's the power of I

796
01:36:49.380 --> 01:36:51.280
comments or

797
01:36:53.070 --> 01:36:57.140
questions. We technically have 12 min, but we did. Also.

798
01:36:57.970 --> 01:37:03.950
He's a panelist, and I was trying to keep.

799
01:37:06.210 --> 01:37:11.559
You know I'm exhausted, but I'm kind of sad that tomorrow's the last day.

800
01:37:16.750 --> 01:37:41.269
Grainne Kearney: Yes, and I'm conscious that I've unlike most of you, I've had a sleep in between the panels earlier in this panel. So so you're probably all ready to call this bring this together. So is that okay, Lauren, you happy for me to do that. Yeah. So first of all, thank you, Lauren, because not only could I hear I could see most of that, and that was just lovely. So thank you for moving the laptop.

801
01:37:41.270 --> 01:38:04.530
Grainne Kearney: Did you get seasick? I was like, no, no, no, thank you, that was so fine, because I'm conscious that I'm like not the person not in the room, and thank you for involving me, because I've really enjoyed it, and I'm so sorry not to be in the room. It would be absolutely lovely to have met some of you in person, and to see some of you again in person. So But as I thought it would be. I think that was a really great discussion for great presentations, and

802
01:38:04.530 --> 01:38:23.399
Grainne Kearney: very different, but lots of similarities as well and actually stuff we could have talked on for ours, but I'm also conscious that everybody's probably ready for that next meal, but I even know what your next meal might be, but whether that's dinner time. But so yes, thank you all so much. and thank you, Lauren, and and yes, have a lovely evening. Everybody.

803
01:38:23.600 --> 01:38:25.479
Thank you for organizing.

804
01:38:27.770 --> 01:38:31.970
Thank you. To all the presenters I learned a lot.