Interprofessional Working In Health and Social Care - Essay Example

Interprofessional Working In Health and Social Care Interprofessional working entails the inter-relationship, working together, understanding roles and responsibilities among different professionals to achieve a better quality of care for the patient/client involved. In practical terms, Interprofessional working may be described as a process that places the patient/service user at the centre of the activity, where individual contributions of the care team are collaborative in nature and where roles and functions may overlap in order to provide the best possible care for the individual and his/her carers (Gordon and Ward, 2005). Thus, the client/service user is at the centre, the main focus of such a healthcare delivery approach. According to D’Amour and Oandasan (2004), collaborative or Interprofessional, patient centred practice is an approach to health care provision where health and social care professionals work together with their patients/clients. This involves a continuous interaction between the different professions or discipline organized into a common effort to solve or explore common issues with the best possible participation of the patient to achieve care and well being for the patient, although, the patient’s willingness to cooperate and participate is at the centre of the success of such an approach. Interprofessional practice achieved several feat when put in the right perspectives. First and foremost, the working together of different professionals change reciprocal attitudes or the perception between the different professions, resulting in the breakdown of the negative and stereotyped impression or ideas about the other profession, while, at the same time, leading to positive reaffirmation of each professional’s positive beliefs and roles of his/her profession, especially, in a team (Smyth, 2004). In line with this, Interprofessional practice therefore changes each professional’s attitudes towards the value and/or use of team approach to caring for a specific client group. At the root of these, is the cross breeding of ides and smooth working relationship between professionals and between professional and client, generating a wider and far reaching changes in the organisation and delivery of care and improvement in health or well being of patient/client, thus a greater likelihood of positive client/patient outcomes (Smyth, 2004). The necessity for Interprofessional practice and approaches to health care provision has become paramount considering the recent modernisations in health and social care delivery, in response to several factors. The enquiry reports that have always followed crises in health and/or social care provision in the mental health care provision have highlighted the need for strengthening Interprofessional working among health and social workers. The integration of several health and social care organisations (through Primary Care Trust, Partnership Trust for Mental Health and Learning disability) (What is Interprofessional ) the increasing complexities in patient care and requirements (Zwarenstein et al, 2000), the realisation by the professional and regulatory bodies that health and social professionals in the mental health area must demonstrate the ability to act effectively as members of a multidisciplinary team to achieve better and positive patient/client outcome, the necessity of putting in place a system to promote sharing and cross breeding of ideas between health and social care professionals (Smyth, 2004), are all factors that make Interprofessional approach to mental health care very important. Even the guidance documents from the Department of Health (DoH) have increasingly specified and elaborated the importance of Interprofessional practice and approach to the success of health and social care tasks and responsibilities in mental health services. Also, the QAA Subject benchmarks for health professionals titled ‘An emerging Health Profession Framework (QAA, 2001) as indicated by Smyth in his report, emphasised shared learning across professional boundaries in the mental health service and also optimising shared learning in practice in fostering an interdependency that is required for effective Interprofessional working in health and social care provision and for patient/client satisfaction (Smyth, 2004). It is noteworthy that professionals who work in a collaborative and Interprofessional settings to achieve better patient outcome have also been found to build and demonstrate a couple of subtle, but far reaching skills that improves their performance as a professionals and also as team members. Some of these skills include: i. In-depth knowledge of health and social care roles, of themselves and fellow team member, and a deeper appreciation of interdependency. ii. Better communication skills between the team members iii. Reflections related to one’s role and impact in a team and as a team member, towards a collective or shared goal iv. Changes in perception and attitudes leading to mutual respect and understanding v. Willingness to cooperate and collaborate and the openness to trust and believe in other team member (D’Amour and Oandasan, 2004) Interprofessional approach to mental health care delivery places the patient/service user at its centre; it is therefore, value based, espousing reciprocity and mutuality, collaboration and improvements of services. It enhances improvement in patient/client care and in some cases, cost effective (Smyth, 2004). Putting these together, it becomes clear that the collaboration of mental health and social care workers would exert a far reaching impact. The effects, with respect to service user would be seen as an increase in client well being and in the quality of care (accessibility and continuity) and in client satisfaction. While for the service providers, it would be seen as better job satisfaction and professional growth. The health organisations are also likely to benefit from Interprofessional approach to mental health care delivery, since professionals would work more efficiently, perhaps, as a result of reduced duplication in services, greater latitude for creativity and better understanding, cooperation and trust among professionals providing services to a specific user group, in this case, mental health (D’Amour and Oandasan, 2004; Smyth, 2004). Moreover, the key element of collaboration in Interprofessional approach to mental health care, understandably, will vary with respect to the goal or mission of a team, for instance, a permanent team or a team made up to meet the specific needs of a patient/client. The make up of each team will thus, depend largely, on the complexities of the patient’s needs that it is to address. Patients are therefore, again, found at the centre of Interprofessional services, since they are, in the first place, the reason for the interdependency of the professionals. Therefore, though, patients are the recipients of the collaborative care and attention, they become elevated from the ordinary label of the ‘sick’, empowered and become an active member of the team, both in planning and execution, however, this privileged position in the team would depend on the patient’s willingness and/or ability to participate in the planning and execution of health care and services. (D’Amour and Oandasan, 2004). It is imperative to state, here, that though focusing on client’s need is necessary and vital, it is not sufficient for Interprofessional practice. Human interactions and other organisational factors are some other dimensions to collaboration in Interprofessional working. From the interactional perspective, for instance, the sharing of common goals and vision is very vital. Shared patient’s oriented goals unfold when patients are seen as the focus of the health care team. Though, we must also realise that shared patient goals and treatment goals is likely to suffer the diversity of interests of the different professionals who have to be negotiated among them. Another factor with interaction is the bonding within a team and the willingness to work together which is bound to contribute towards building a sense of mutual trust among the professionals who happen to be working together towards a shared goal. In this regards, professionals need to know each other personally and professionally to establish the trust, understanding and cooperation that seems to be the pre requisite for creating a strong team spirit (D’Amour and Oandasan, 2004). However, to know each other professionally, professionals must know the conceptual models, roles and responsibilities of one another and as a team. Without these basic requirements, collaboration in Interprofessional settings will be virtually impossible. But when these factors are present, professionals would learn and be willing to grow beyond their inclinations towards exclusive professional ‘turfs’ and to contribute towards sharing common professional territories and goals (D’Amour and Oandasan, 2004). In as much as teamwork is central to Interprofessional working, it is important to recognise that collaborative Interprofessional working cannot exist only within teams, but also within the context of larger organisation settings that influence its success and operation in a significant manner. The two major organisational dimensions to Interprofessional working have to do with governance (policies, guidelines, framework etc) and formalization. The formalisation dimension refers to structuring clinical care in a more systematised approach. The efforts to formalise comprise the development of protocols, procedures, and agreements. This constitutes a key element since it permits clarification of the expectations (Feeley, 2004). I will elaborate on the governance dimension later in this write up. All these factors, when put together, sets the stage for Interprofessional collaboration in providing patient centred, efficient mental health care, drawing on the knowledge, skills and concepts of each professional in the team for a more positive patient outcome and better job satisfaction for the professionals. Evidences Underpinning Interprofessional Practice. What can be described as factors strengthening the necessity for a patient centred Interprofessional health and social care services, in the first place, is what appears to be a profound shift away from the perceptions of scientific paradigm of (medical) knowledge and predictability, to the realisation that mental health is more of a contested area with differing understanding of mental illness and distress. The language of the medical model that sees mental illness as a result of biological or genetic anomaly is becoming less dominant in mental health care, while the perspectives, concerns and expertise of service users and carers tend to be taking a more central place (Tew and Anderson, 2004; Phil, 2001). For this arrangement to work, it becomes explicitly clear that the context of multi disciplinary, collaborative and Interprofessional working is essential. This alternative to the biological constructions of mental illness suggests the possibilities for more holistic forms of psychosocial intervention to mental health care (Phil, 2001), since mental distress is portrayed as part of a mainstream life experience and therefore located within context of growing up, ageing, family and community life (Tew and Anderson, 2004). From this perspective, evidence abound of some sort of erosion of the ‘us’ and ‘them’ distinctions between professionals and people suffering mental illness, perhaps from the acknowledgement that mental health issues impact on workers as well as those who use the services. With this approach and understanding comes the increasing confidence that professionals involved with mental heath care should be able to see and work with the bigger picture and not just being involved managing individual professional role, as it concerns the distress feelings and behaviours of the service user and also be able to overlap roles and respond to client’s experience within a wider context of shared outcome or goals (Tew and Anderson, 2004). In addition, according to Phil (2001), conceiving mental problems as consequence of the difficulties and life experiences the service user and those close to him/her have encountered is a pragmatic and respectful approach to addressing the lived-experience of the client that seeks to empower the client, making him/her a central theme in the care team of different professionals, sharing a common goal, as clearly opposed to the biological or genetic understanding that had to describe mental problem as an unusual or mysterious condition the patient has developed. In most cases, the latter relegates the service user to an ordinary label; ‘sick’ and making him/her completely irrelevant in the scheme of care provision (Phil 2001). The provision of person centred, collaborative Interprofessional health and social care to patients with mental problems has been further emphasised due to the enormous and extra ordinary needs of the mentally distressed. Mental distress in patients calls for unusual and special attention, due to the uncertainty and unpredictability of the needs of the mentally distressed. Such cross professional needs of the service user, requires professionals to further collaborate and work as team for better patient outcome. The following points further buttress the necessity for Interprofessional collaboration in the arena of mental health and social care provision: Professionals need to understand mental health holistically, above and beyond their professional limitations or barriers, and to consider mental health factors in relation to all situations, needs and even problems encountered in a collective manner. There is the need to identify how stigma and social exclusion and opportunities on the basis of race, gender, sexual orientation, age and several other factors, impact on people’s mental health and on the efficiency of the care and treatment they receive and perhaps, implement strategies, cross-professionally, to reduce this factors. Professionals need to see how they can contribute to the promotion of mental health and the prevention of breakdown in mental health The complete awareness of the impact of mental health problems on individuals, throughout their life cycle, on families and on the wider community, goes beyond the scope or limitation of each single professional involved with mental health services The ability to recognise when an individual’s mental health is on the downward slide, or is under threat due to external pressures or circumstances, or due to internal factors, require more than the skills of a single professional. Access to different and numerous models and framework for better understanding mental distress, including service user and carer’s perspective; social models, biological models and the differing cultural understanding, would surely require the coming together and collaboration of different professionals responsible for mental health care provision. To work with the complete awareness of the impact of mental health issues on oneself and the confidence to be clear about what one does not know as well as what one does, as a professional, requires mutual understanding, interaction and respect among the professionals working together towards the same patient outcome. Applying the knowledge of mental health policies and legislations, and of the nature and impact of mental health problems, in order to know when and how to consult with others, including service users, carers and other professionals, would better employed in an Interprofessional settings, where the service user is at the centre of the team of professionals and where mutual trust, respect and understanding has been established, towards achieving a shared goal. Also, acknowledging the contested nature of mental health, tolerating the accompanying uncertainties and the ability to make good judgement in complex situations or seek further information where appropriate are all factors that have reinforced Interprofessional practice in mental health and social care provision (Tew and Anderson, 2004). It therefore, goes without saying, that these factors, together with the numerous other needs of the mentally distressed have made collaboration in service provision across professional lines, a welcomed approach. Regulation of Interprofessional Practice. According to the NSF (Raising The Standards; Adult Mental Health Services, 2005), The standards and factors regulating mental health care services are based on a four fold set of principles that underpins the standards for mental health care delivery. These principles: Equity: The standards of mental health is based on the fact that service should be available to all, and personalised with respect to the needs of each service user, irrespective of factors like race, geographic location, gender, culture, religion, sexuality or any physical disability. Access to mental health services should not be restricted because of existing health problems and the unacceptable geographical variations in standard of mental health services should be discontinued. Empowerment: The standards for mental health care delivery seek to empower mentally distressed patients. The principle is based on the belief that service users and their carers need to be integrally involved in the planning and provision of mental health services, thus empowering them to be part of the care team. This empowerment should be established at all levels, from encouraging self-management to formal involvement in planning and execution of care. However, informed choice for all service users is central to this principle This principle also seek to reduce stigma surrounding mental illness, both within health services and the wider community. Thus, people detained under mental health legislation could be encouraged to participate actively and willingly in their own care. Effectiveness: Mental health services should provide effective interventions that improve quality of life by treating symptoms and their causes, preventing deterioration, reducing harm and assisting rehabilitation (Raising The Standards, 2005). Clinical guidance within NHS thus provides the mechanism to ensure that issues of effectiveness and quality of care are central. Efficiency: To ensure that mental health service providers use resources efficiently and accountably. Improving efficient inter-agency and Interprofessional working between health and social service providers and other partners in the care team (Raising The Standards, 2005). The first NSF standard for mental health service is: social inclusion, health promotion and fighting stigma. The aim here is to promote good mental health for everyone, to fight stigmatising as it relates people with mental illness and to encourage and promote social inclusion of people with mental problems. In this regards, health and social workers are to help people develop the skills to stay free of, or minimise the effects of mental health problems at trying times in life and to survive mental health problems. To achieve this feat, mental health service providers are: To promote the understanding of mental heath issues in the society in order to reduce stigma associated with mental illness Ensure that formulation, delivery and revision of other social economic policies and programmes take into account the potential impacts on mental health. And to create a society that embraces and welcomes diversity and facilitates people with mental health problems to participate as fully as they may wish. To achieve these goals, authorities and professionals are encouraged to strengthen inter authority and Interprofessional arrangements to adopt a coherent approach to mental health promotion and to foster the development of life skills which help to promote good mental health. The second standard for mental health services, as set by the NSF, is to encourage the complete, active and willing participation of service users and carers in all aspect of mental health services, including planning and commission. This is to be accomplished by establishing clear and timely service users and carers’ access to comprehensive, clear, appropriate and helpful information in different formats and languages to encourage informed choice on the part of the service user. The NSF fifth standard for mental health service envisages commissioning effective, comprehensive and responsive services. The services are to be jointly planned across professional lines, commissioned and delivered in an efficient coordinated manner in order to provide collaborative, responsive and seamless care for the service user (Raising The Standards, 2005). These standards should are seen as the guidelines for Interprofessional mental health service, centred on the service user, irrespective of race, age, gender or geographical location. These guidelines have set the stage for the improved collaboration between different professional groups and agencies, which has resulted in the provision of better and higher quality of care for people with mental health problems. However, a number of things are still missing, which are which are vital for effective Interprofessional practice. Some of the barriers sitting on the path to efficient and effective Interprofessional collaboration include: The difference in the structures and operational philosophies of the various organisations involved with health and social services The rivalries and competition that exist between the various professions and The fact that professional groups are still, largely, educated and trained in isolation (Fowler et al, 2000). And as started earlier in this write up, a sense of communication, bonding and the willingness to work with one another and a team member, which is very crucial to team still seems to be missing within Interprofessional practice settings. This is where Interprofessional learning and shared learning comes to play, to foster the skills of communication, team work, interaction and sharing of ideas among professionals with different roles and responsibilities is believed to prepare students for what they are to expect in an Interprofessional work settings (Zwarenstein et al 2000). The prospects of Interprofessional approach to health and social care provision looks very good for all concerned. The service user would be seen as an active member of the care team, seeking a common outcome. This empowerment of the service user would result in better and higher quality of care for the patient/client leading to better patient outcome. This too will foster job satisfaction and growth in the professional. And most importantly, mutual understanding, respect and communication would be established across professions saddled with common responsibilities and finally, blurring of the individual lines of limitations, which in most cases only generate the sense of rivalry and competition among professionals. In addition, students should look forward to a team approach to service delivery with shared goals, cross professional understanding of functions, roles and responsibilities and thus be made acquire core competencies, such as communication skills, reflections of personal roles in a team, willingness to cooperate and work towards a common goal and mutual respect – which are vital for efficient performance within an Interprofessional setting. References. Borrill, C., West, M.A., Dawson, J., Shapiro, D., Rees, A., Richards, A 2002, Team working and effectiveness in health care. Findings from the health care team. Effectiveness project. Aston Centre for Health Service Organization Research. D'Amour, Danielle and Oandasan Ivy, 2004, Interprofessional Education for Collaborative Patient-Centred Practice: An Evolving Framework, Viewed 11th Feb. 2006, < http://www.hc-sc.gc.ca/hcs-sss/hhr-rhs/strateg/interprof/chap-10_e.html> Feeley, N., & Gottlieb, L 2004, Collaborative-partnership: A delicate balance. Toronto: C.V. Mosby. Fowler P.; Hannigan B.; Northway R 2000, Community nurses and social workers learning together: a report of an interprofessional education initiative in South Wales, Health & Social Care in the Community, Volume 8, Number 3, pp. 186-191(6) Gordon, Frances and Ward Katie, 2005, Making it Real: Interprofessional Teaching Strategies in Practice, Journal of Integrated Care. Phil, Barker 2001, Tidal Model: Developing a person-centered approach to psychiatric and mental health nursing, Perspectives in Psychiatric Care, Updated: 2004-10-01, Viewed 11th Feb. 2006, < http://findarticles.com/p/articles/mi_qa3804/is_200107/ai_n8956210/print > Raising The Standard; Adult Mental Health Services 2005, The Revised Adult Mental Health National Service Framework and an Action Plan for Wales Terry Smyth, 2004, For the Common Good: Developing An Interprofessional Learning Strategy for Pre-registration Programmes, Interim Report for Anglia Polytechnic University. Tew, Jerry and Jill Anderson, 2004, Ideas in Action The Mental Health Dimension in the New Social Work Degree: Starting a Debate, Social Work Education, Vol. 23, No. 2, pp. 231–240. What is Interprofessional Education (IPE)? Viewed 11th Feb. 2006, < http://www.swap.ac.uk/learning/ipe1.asp?version=printversion> Zwarenstein M, Reeves S, Barr H, Hammick M, Koppel I, Atkins J. Interprofessional education: effects on professional practice and health care outcomes. The Cochrane Database of Systematic Reviews 2000, Issue 3. Art. No.: CD002213. DOI: 10.1002/14651858.CD002213. Read More