Knotworking: CHHS Collaborations

Last November, when I participated in a public forum as part of my job interview at WKU, nurturing collaboration was a key focal point of the presentation. A quick online search of writings related to collaboration finds thousands of works. Kouzes and Posner[1] defined collaboration as working “jointly with others or together especially in an intellectual endeavor.” All higher education institutions are trying to do more with less; therefore, competitive strategies lose to approaches that promote collaboration and teamwork. Strategically fostering collaboration on pedagogical, research, and service-related activities both within CHHS and with other units at WKU will need to be a key activity for our continued success.

Drs. Neale Chumbler (CHHS) and Jeff Katz (GFCB)
Drs. Neale Chumbler (CHHS) and Jeff Katz (GFCB)

Gordon Ford College of Business Dean, Jeffrey Katz, and I are working on a few collaborative projects that aim to pay dividends for both units as we move forward. As you can see below, Dean Katz and I happened to show up at an event together randomly dressed exactly alike. Two or more individuals do not have to dress alike to develop and foster collaborative ventures, but it certainly shows our similarities!

While CHHS continues to build collaborations across and outside of campus, we have the great opportunity to facilitate novel interprofessional healthcare work to meet the unmet health care needs of Southern Kentuckians. It is imperative more than ever that the large array of allied health professionals collaborate to deliver timely and accessible care. Interprofessional healthcare initiatives can be complex and require clear communication and efficient processes. Even though “working in teams” has been a key shift in how healthcare work is more effectively delivered is necessary to better explain the complexity of how practitioners deliver their care and services. A new theoretically informed approach is necessary to better understand how interprofessional health care clinicians can work through the complexities to deliver high quality of care.

One such development is the theory of Knotworking, which describes collaborative work among several different situations involving constantly changing combinations of individuals distributed over time and space. According to this theory, healthcare teamwork consists of collaborations through the profession’s unique activity system. Each professional comes to the interprofessional collaboration through his or her unique talents and contributes a unique thread of activity to resolve the patient’s complex case.[2] Knotworking is best described as a “strategic alliance” between different professionals in a healthcare system.[3]

One very recent program that I want to highlight that will integrate several health professions into a consolidated curriculum and analogous to the perspective of knotworking is the Interdisciplinary Undergraduate Patient Navigator Certificate in CHHS. This new academic program will prepare students in the health care professions to effectively assist diverse clients to locate appropriate healthcare services, participate in healthcare decision-making, and understand medical vernacular and processes in the healthcare system. It prepares students in the healthcare professions by increasing understanding of both the complexity of the US healthcare system and the diverse barriers and strengths of rural healthcare clients. Students completing this certificate will be prepared to work with patients in healthcare or community settings at all stages of the healthcare process including preventative care, maintaining a healthy lifestyle; diagnosis, treatment, and disease management; and adjustment to chronic illness or sometimes end of life. This certification program was derived from an interdisciplinary group of scholars in CHHS from several disciplines: Dr. Trish Desrosiers (Social Work), Dr. Gregory Ellis-Griffith (Public Health), Ms. Jan Hunt-Shepherd (Health Information Management), Ms. Lee Brown (Paramedicine), Dr. Tonya Bragg-Underwood (Nursing), Dr. William Mkanta (Public Health), Ms. Andrea Brooks (Nursing), Ms. Wendi Hulsey (Allied Health), and Dr. Gayle Mallinger (Social Work). The coordinator of the program is Associate Dean, Dr. Danita Kelley. This group in CHHS are working together synergistically and effectively to deliver a novel academic program.

As an interdisciplinary group charged with exploring the possible options for new program creation, the committee relied on a literature review, a public roundtable event, and current programming at CHHS to guide them. The committee determined that the proposed interdisciplinary patient navigator certificate met the needs of the citizens of Kentucky, the healthcare industry, and WKU health professions students, as well as the mission of the CHHS. Students completing this certificate will be prepared to work with patients in healthcare or community settings at all stages of the healthcare process including preventative care, maintaining a healthy lifestyle, diagnosis, treatment, disease management, and adjustment to chronic illness or, sometimes, end of life.

Teams that “knotwork” together efficiently produce new knowledge and novel practice strategies because they tolerate high levels of ambiguity and work at maximum complexity due to the members being adaptable.3 CHHS will continue to work with WKU stakeholders to develop and implement pedagogical, research, and service related programs to meet the needs of our students and South Central Kentuckians.

[1] Kouzes JM and Posner BZ. 2002. The Leadership Challenge (3rd ed.). Jossey-Bass: San Francisco. (Page 412).

[2] Varpio L, Hall P, Lingard L, Schryer CF. 2008. Interprofessional communication and medical error: A reframing of research questions and approaches. Academic Medicine, 83, S76-S81. See also, Engestrom Y, Engestrom R, Vahaaho T. When the center does not hold: The importance of knotworking. In: Chaiklin S, Hedegaard M, Jensen UJ, eds. Activity theory and social practice; 1999:345-374.

[3] Bleakley A. 2013. Working in “teams” in an era of “liquid” healthcare: What is the use of theory? Journal of Interprofessional Care, 2013, 27:18-26.

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