Coping with complexity: educating for capability

doi:10.1136/bmj.323.7316.799

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Sarah W Fraser, visiting professor, Middlesex University (sfraser881@aol.com)a,
Trisha Greenhalgh, professor of primary health careb

^a 5 Cuddington Road, Dinton, Aylesbury, Buckinghamshire HP18 0AB
^b University College London, London N19 3UA

Correspondence to: S W Fraser

This is the last in a series of four articles

Recent high profile scandals in the United Kingdom have highlighted the changing values by which the National Health Service is judged.1 The public expects, and the government has promised to deliver, a health service that is ever safer, constantly up to date, and focused on patients' changing needs. Successful health services in the 21st century must aim not merely for change, improvement, and response, but for changeability, improvability, and responsiveness.

Educators are therefore challenged to enable not just competence, but also capability (box). Capability ensures that the delivery of health care keeps up with its ever changing context. Education providers must offer an environment and process that enables individuals to develop sustainable abilities appropriate for a continuously evolving organisation. Recent announcements in the United Kingdom of a “university for the NHS,”2 a “national leadership programme,”3 and “workforce confederations”4 raise the question of what kind of education and training will help the NHS to deliver its goals

Capability is more than competence

Competence—what individuals know or are able to do in terms of knowledge, skills, attitude

Capability—extent to which individuals can adapt to change, generate new knowledge, and continue to improve their performance

Summary points

Traditional education and training largely focuses on enhancing competence (knowledge, skills, and attitudes)

In today's complex world, we must educate not merely for competence, but for capability (the ability to adapt to change, generate new knowledge, and continuously improve performance)

Capability is enhanced through feedback on performance, the challenge of unfamiliar contexts, and the use of non-linear methods such as story telling and small group, problem based learning

Education for capability must focus on process (supporting learners to construct their own learning goals, receive feedback, reflect, and consolidate) and avoid goals with rigid and prescriptive content

The …