This core module aims to enable students to:
To provide an opportunity for students of health & social care, public health & associated disciplines to explore key theory, policy and practice elements of inter-professional practice within a user centred approach.
To enable students to experience in a highly interactive way and within a safe environment, approaches to inter-professional practice and organisational management to inform present and future practice.
To develop students’ capability to reflect upon their own experiences of inter-professional practice and explore both factors that influence this, including resource constraints and the ethical bases across the different professional groups and to see how common values may underpin effective practice.
To locate the changing nature of organisations and evaluate the implications for effective inter-professional working within a theoretical framework.
Module learning outcomes
On successful completion of this module students will be able to:
1.Identify and rehearse skills necessary for inter-professional practice including inter-professional communication, networking, team working and ethical decision making.
2.Discuss the central concepts of inter-professional practice and be able to apply them to their own practice context.
3.Evaluate how different policies, professional codes, organisational frameworks and approaches impact on inter-professional practice with stakeholders, users and carers within a context of policy change.
4.Discuss critically the factors that promote or hinder inter-professional practice, including vision, culture, equality and diversity, joint solutions, accountability, risk management, information sharing and confidentiality.
5.Reflect on personal and professional self-awareness and critically analyse their practice and assumptions
6.Discuss the central concepts of inter-professional practice and be able to apply them to their own practice context.
7.Evaluate how different policies, professional codes, organisational frameworks and approaches impact on inter-professional practice with stakeholders, users and carers within a context of policy change.
8.Discuss critically the factors that promote or hinder inter-professional practice, including vision, culture, equality and diversity, joint solutions, accountability, risk management, information sharing and confidentiality.
9.Reflect on personal and professional self-awareness and critically analyse their practice and assumptions.
At this point, the team was not predetermined as there were no prior relationships between the members to participate in the case conference. The group had to be chosen basing on abilities which were complementary to individuals. I was worried at first of being part of a team with people I had not formally sat down to talk to. I feared the possible conflicts which would have possibly come up. I managed to bring together a team whose individual members had similar objectives, hence conforming to Tuckman’s theory of forming, which suggests that people need to conform to what they deem as acceptable behaviour and be able to provide responses to allocated tasks to the group for approval and acceptance. (Kumar, K 2011, P. 290).
During the storming session of the team, I still had the nervous feeling of what the team would feel about my contribution. I was sad about what the rest of the team felt about the significance or quality of my contributions. However, I tried as much as possible to listen to the concerns raised about the case assigned and offer relevant recommendations on what had to be done. At such instances, the importance of listening skills to a mental health nurse becomes evident (Hamilton 2010)
In order to communicate effectively with the rest of the team at this stage, I focused on ensuring I use the right tone of voice, which was not only clear but effective. This was first due to the fact that the members kept talking over each other during this storming stages. It is crucial for a performing team to build capacities of tolerating differences and developing an agreement which will be able to honour all voices of the group. This is what I tried to emphasize and lead by example during the inter-professional meeting (Vangen & Huxham 2010, p. 15).
In the norming stages of the discussion, I felt at ease as we now understood each other quite well. However, I noted that there was a barrier in message delivery as a number of the members brought in their thoughts and emotions about the topic of the case conference. It is always important to consider the receiver's point of view and determine whether they will understand the message we are passing across. Health care practitioners need to understand this because they face a great challenge in delivering information about diseases which may be complex (Darrell 2005 p. 1099). In the implementation stages, I felt empathy for the case-patient, believing that the decisions made will be effective for their recovery. I believe that empathy creates a connection and relationship with the client and is important in ensuring that positive outcomes are achieved (Whitehead 2010, p. 25).
At this point, I felt at ease as everything seemed to be going according to plan. I felt that we were now performing as a team with clear goals in mind. With this in mind, I was confident that the outcome of the conference would be valuable.
Identifying Skills for Inter-Professional Practice
Inter-professional Practice in Contemporary Health and Social Care/Public health settings: What are the opportunities and Challenges?
At this point in time, it is possible for each and every one of our peers to have participated in a team or group work. This is basically what it means by working in collaboration. You might not be physically present but as long as you have the chance to share your thoughts and ideas in order to help a group achieve its course, it means that you have worked in collaboration (Silver & Leslie 2010, p. 34). Hence, Inter-professional communication referrers to a situation when two or more professions, come together in different settings in order to achieve common set goals which often are finding relevant and most effective solutions to a problem which is persistent and complex (Powell 2010 p. 120). There are a variety of benefits which come up due to collaboration but the most important one of all and probably the most common is that through IPC, it is possible to achieve what could not be achieved when a person was working as an individual. It will be possible to serve a larger group of people and in the long term, it will promote growth at both a personal and organizational level (Resnick 2011, p. 20). This study shall provide an analysis of inter-professional collaboration especially in the areas of clinical practice, research as well as in education. In addition, it shall offer a discussion on the benefits of inter-professional collaboration as well as discuss the potential barriers and how they might be overcome.
Inter-professional collaboration is commonly exercised in the fields of medical/scientific research, clinical practices as well as during the education of health professionals. They refer to teamwork in the different aspects of health which include but not limited to advocacy of the patient, collaborative of health care, learning collaboration as well as inter-professional collaboration in practice. In modern society, this practice is becoming common as and possibly even over long distances due to the advancements of technology. Computerized communication, smart mobile devices and social media are of high significance to the increased effectiveness and ease of inter-professional communication (Vangen & Huxham, 2010 p. 10).
In an organizational setting, it is possible for collaboration to occur at any level of the structure setting. It may happen within the organization, between two or more organizations and also between differed professional disciplines. In the business world, IPC is commonly referred to as inter-organizational collaboration. Despite the different name, both these practices utilize the same principles. Some important concepts to collaboration include partnership, sharing, interdependence as well as power. According to Mattessich and Monsey, the essence of collaboration can be summarized as first, a mutually beneficial relationship, which has been well defined and implemented by two or more organizations for the purpose of achieving certain set goals. Secondly, according to the two, a relationship in this context has to include commitment to mutually defined objectives and goals and in a structure that has been jointly developed in order to ensure there is a shared responsibility, authority, and accountability for the success or failure, and sharing of the possible resultant rewards of the relationship (Didegah & Thelwall 2013, p. 866).
Central Concepts of Inter-Professional Practice
It is a common belief that creating a successful collaboration is hard, this is not true. There are a number collaborations which were developed in the medical field and came out successful. These include the Cochrane Collaboration which is a global network of health practitioners, advocates of patients, medical researchers and other professionals. The network is independent and is meant to respond to the challenges of creating evidence in order to make informed decisions about health issues. The second is the US Preventative Service Task Force, an independent national expert's volunteer panel purposed with prevention and practising medicine which is evidence-based. Others include the Bone and Joint Decade, The National Clinical Guidance Center, the Canadian Inter-professional Health Collaborative (CIHC), and the Best Evidence Medical Education Collaboration.
Through collaboration, organizations or individual professionals are provided with a means to achieve which would otherwise not have been met if they worked on an individual basis. In the traditional business environments, collaborations have mainly been used in order to share resultant costs and benefits, spread the potential risks and minimize them on one entity, and form alliances which are strategic for the reduction of the uncertainties of the supply chain. The relationships serve as fertile ground onto which innovation, as well as leaning, can develop. In the health care sector, is believed that through inter-professional collaboration, it is possible for the practitioners to come up with care delivery services that would yield better outcomes for the served patients (Bozeman & Corley 2010, p. 600).
According to Littlechild and Smith, IPC has often led to significant improvements in efficiency, skill mix, responsive levels, innovation as well as a practice that is more holistic and user-centred. According to the world health organization, IPCs have been liked to improved outcomes on otherwise persistent problems in family health, humanitarian efforts, epidemics response, and in the infectious and communicable diseases (Charles & McGuire 2011 p. 270). In addition to this, several studies have shown that that through IPC, the public health sector has been able to make improvements on the access to care and service coordination. It also helped in the appropriate usage of specialty care, improve outcomes of chronic illnesses, and improve the safety of medical practice (Frenken 2005 p. 12). Some common safety indicator in medical care includes rates of error, the length of stay in the hospital, mortality rates, and situations of conflicts among the care providers. All these issues have shown a significant reduction in environments of collaborative care (Littlechild & Smith 2013).
There are a number of policies and legislations created for the purpose of managing as well as promoting the practice of inter-professional collaboration among the healthcare professionals. The most legislations have been created through parliamentary acts. Policies are also formulated by the associations to which the practitioners are registered to. The most recent, for example, are the changes made to the regulatory systems of Ontario’s health professions. These were initiated through legislative amendments. They obligated the health professional colleges to support IPC among the students and practicing professionals. In the legislation, it is needed that they share controlled acts as well as incorporate IPC into their programs of quality assurance. Other pieces of legislations formulated to promote IPC include the Mental Health Act, 2007 which stresses on the use of IPC in the assessment after treatment care planning for patients; the Mental Capacity Act, 2005 which encourages consultation; the Children Act, 2004 which required the local authorities to appoint a director of children’s services who would ensure cooperation among agencies to safeguard the welfare of children (Charles & McGuire 2011, p. 298).
Evaluation of Impact of Policies on Inter-Professional Practice
IPC has been used in health care provision for decades and the trend seems to increase as the years go by. Example, in the past 15 years, inter-professional collaborative practice (IPCP) has reaped a lot of support as an effective and efficient way to address errors in the medical field. This acceptance has also been motivated by the advent of medical homes which are patient centred. This needed the development of family home teams. However, due to the shortage of primary caregivers in areas majorly affected by health disparity issues, IPCP became a preferred model through which better health care could be provided to these users (Powell 2010 p. 126).
In IPCP, different providers of health care manage a patient through the application of their unique skill and knowledge. This, however, is possible to occur only when the involved individuals mutually respect each other on a personal and professional level and are willing to relate in an atmosphere which is collaborative (Nomaler & Frenken 2013, p. 970). In the past, it was assumed that a single health care provider working in their own office was able to meet the needs of patients who visited them. Today, however, chronic and complex illness have become common, a factor that required the specialty care providers to shift towards team-based care provision (Nagarajan 2010 p. 42). According to studies and evidence from different situations of health care provision, medical practices which only focus on a single health care provider's charisma and skill set are not only inefficient but also costly. It is evident that organizing numerous services of chronic disease management becomes harder when small practices are used. This is according to a report by the Institute of Medicine named The Future of the Public's Health (MacKenzie et al. 2014, p. 122).
Fragmentation of health care systems in many countries in the world has made it difficult for them to meet the healthcare needs of their own populations. The shortage of care providers being experienced on a global level is a major driving force to the use of IPC models. The siloed models of care administration which are only centred on the fixes that are temporary are unable to sufficiently relieve the overall disease burden, especially in the developing countries.
Various research studies by WHO have reported that team play in health care provision has succeeded in alleviating complex situations in the medical care (WHO 2010). IPC is highly reliant on integration, and despite the perspective being common in public health, it is not so in environments of patient care. At this level, the collaborating professionals have to be open minded and value each other as team members. Collaboration is evident in an inter-professional oath proposed by Brown which states that caregivers will work together to deliver care through recognizing each other's unique skills, and they will seek to effectively collaborate on the team of healthcare (Lee et al. 2010, p. 12).
Challenges to Collaboration
The collaboration involved a group of people coming together to accomplish a task, and in such situations, problems are likely to arise. First, conflicts are common barriers as different professionals have different cultures, history, values, beliefs, and attitudes (Kumar 2011 p. 282). It is challenging for these nuances to be understood and appreciated by every member of the team. Other barriers occur due to issues of status, disputes on boundaries, orientations of customer service, and language and communication barriers. Lack of appropriate physical space to work, inadequate work design that leads to confusion and role overlap and the presence of territorial ideologies and also additional constraints to IPC (CIPHC 2010).
Reflecting on Personal and Professional Self-Awareness
The conceptual framework of an effective inter-professional team includes three important elements. Principles are the first elements and these provide the guidelines on the general behaviours of the participants basing on ethical concepts which are considered to be essential in maintenance of relationships between humans as well as communities. These principles are very important when it comes to finding solutions to ethical dilemmas which are likely to occur in IPCs. Another element is the structures. Through these, it is possible to establish the thought and behaviour patterns in a particular organization for the practices of teamwork on an individual and collective level (Buring et al. 2010, p. 100).
Through research, attention has been drawn to contexts of the society which lead to situations of moral dilemma as well as those that lead to the application of the stated principles. Structures may be formal since they are based on developed codes of practice and behaviour that make up the rules and regulations. In some situations, however, exist out of the boundaries set in meetings, memos, or medical records. The final element is the processes. These emphasize on the ethics of the procedures which create fairness in definition of the problematic situations and the solutions sought after and implemented. The most important aspects in this process is the quality of communication and the measure of conflict identification and solution. The processes can however be conceptualized as activities which occur in structures. In summary, the structures make up the framework while the actual actions are the processes and they occur within the structures (D'Amour 2010 p. 124).
In order to effectively put the theory if inter-professional collaboration discussed in this study into practice, the following issues have to be addressed. It is vital to first identify the appropriate situations to use the approach. It has to be noted that collaboration is meant to achieve an outcome that is desirable and not to be used every time. Collaboration also works in diverse groups where the participants are able to authoritatively make decisions and come up with innovative and creative ideas whenever required (D'Amour 2010 p. 128). Also, because the collaborating partners have to benefit from the collaboration as well as cater for the costs, some efforts need to be expended before the collaboration in order to determine whether the end value outweighs the costs.
It is also important to be well aware of the driving factors of a collaboration's effectiveness (Rijnsoever & Hessels 2010, p. 467). These include an alignment to the mission and values, connections on a personal level, the improvement on outcomes as well as the ability to generate value for each of the collaborating professionals (Buring et al. 2010, p. 99). Being aware of the factors such as attitudes, environmental factors, motivation and commitment are also important for successful IPC implementation into practice as they strongly influence the decisions of people (Hansen 2010).
On a personal level, I have always believed in the power of collaboration in order to arrive at a solution to issues which are problematic. It has been a custom for me to seek assistance on issues impacting my life as well as my profession. I however did not put much thought on a major factor of a successful collaboration which is, creating mutual benefits among the participants, or the idea of sharing the costs and rewards of the outcomes. From this study, I am now aware that what I was practising was not a proper collaboration, simply an act of seeking assistance to solve a task.
On a professional level, I believe that I have been able to implement a lot of aspects of inter-professional collaboration. This however was motivated by the fact that the in the nursing education, a lot of motivation is put on the learners to brainstorm with other professionals in the relevant field in order to offer the most appropriate care to the patient. To me, it is not just a way of conducting activity but is a rule of the profession. One of the overriding ethical values of nurses is to ensure the best care is provided to the patient at hand. As a nurse, I believe that inter-professional collaboration is one of the most important models of health care delivery especially in the current society where access to quality medication is a challenge despite the levels of chronic illnesses among population being on a high.
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