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COIN members met on July 31st 2025 to discuss how to move forwards ideas generated at a recent COIN workshop. These points were raised: Education Needs of Citizens • We need ways to communicate, including repeated opportunities to be in the same ‘room’ as others, continuing conversations that matter • People need to see systems thinking & boundary spanning as building human relationships and not just about technology • As we become skilled at reflecting on, and challenging, our own assumptions we become more agile and resilient as humans as well as practitioners • People of all ages need to encounter difficult and complex, real-life, things to develop the skills to live life forwards in ways that are good and feel ‘safe-enough’ • Leadership as 'sensemaking' helps to facilitate collaboration • The goals of different people are different; they need to be valued and contribute to future policy • Local communities must lead the reduction of harm from ecological damage Practitioner Education Needs • Healthcare workers need to understand context, perspective and complexity to deal with everyday difficulties; and form trusted relationships across boundaries • Global environmental and climate issues need to be acted on locally, for example by planting trees & developing Green spaces • COIN has a focus on patient/public as equal partners with service providers. This is needed to avoid collapse of the NHS • Clinicians and other leaders need to recognise what isn't working, take responsibility for this and find the authority to make it work • Health & Social Care Practitioners need to learn to be boundary spanners who speak multiple 'languages', routinely moving from observation to true participation • Before students become practitioners they must be able to listen to people & families, see things from other perspectives, and build communities for health and care • Need a balance between treating the tests and developing the individuals/families • Need to teach people how to build relationships and navigate the system • Practitioners need to routinely challenge their own assumptions - this needs to be done in a way that feels safe-enough • People need to understand the dynamic, complex, co-evolving nature of the world. Students can learn this from real-life situations in community settings Learning from Other Places • Michigan University nurses learn about system-wide management quality, equity, perspective and complexity • Nurses everywhere learn about leadership and policy, but it goes un-noticed and un-used • Cuba appoints doctors for their personal as well as technical skills Implications for Healthcare Policy • Systems for health and care in the UK have been developed in a 'top down' way. This needs to change for a true partnership that uses everyone's skills well • In the UK, the NHS and local authorities are good at change, but not at listening to local communities • Community empowerment has created good things in Melbourne, where refugees from the Vietnam war were able to self-organise • Integrated care means developing local communities for health, routinely developing trusted relationships, taking responsibility and becoming leaders • ‘Digital’ provides opportunities - information helps people to challenge professionals • The system needs to support the flow of ideas everywhere • Building collaborations takes time, but it makes a huge, positive difference • Boundary-spanners who speak multiple languages are often viewed with suspicion • Everyone needs to talk about generalism with confidence • Ecological communities are those that are being organically developed rather than imagined to already exist in some mythical past • Leaders (and ourselves) often behave in unhelpful, controlling ways • Need a balance between using the community to support the individual and empowering individuals to support community development Implications for Children • Schools can help children to become skilled at dealing with complex situations, including when their friends are having a difficult time • Early education is essential, including health and environmental issues in intergenerational schools. Learning and trust take time, but it can, and must, be done • Body Talks Movement brings children together through creative movement. It helps to reduce anxiety in GP surgeries, end of life care, and school avoidance • Children, Carers, Teams and all human beings need to feel empowered - to be able to build healthy relationships & communities, and feel comfortable in their own skins • Children need to feel supported and listened to, and have an outlet to express themselves, when handling difficult things like death • Children often believe that whatever they are experiencing is normal; helping them to realise that what they feel is ‘normal’ considering their situation helps them to face difficulties positively - and become leaders of the future • Children and Elders are more natural systems thinkers than adults