Inter-professional Practice in Scotland - Term Paper Example

 «Inter-professional Practiсe in Scotland» Contents Introduction 1 The Impact of a Range of Professional Cultures on the Functioning of the Care Team 2 A Discussion about Processes that Influence Care Team Functioning 7 Conclusion 12 Bibliography/ References 14 Introduction As societies evolve and health conditions become more complicated those who live and suffer from illness in their complex environment demand attention at the social, psychological and biological levels (Gehlert, 2006, pp. xvii – xx). The care that is needed has to be provided by interdisciplinary teams which have to work in concert and social workers are now considered as being key members of such teams due to their ability to work across health systems and managed care settings (Gehlert, 2006, pp.18 - 25). The recommended approach for healthcare delivery today is biopsychosocial and this means that it is important to focus on the biological, social, environmental, psychological and behavioural aspects of illness. Thus, a number of professionals have to work together as a team to address medical problems in a variety of settings. The team members may include physicians, nurses, residents, physician assistants, dieticians, psychologists, patient care technicians, home health aides, administrators, chaplains, pharmacists, therapists of various kinds and social workers. It is important that team members are able to work together effectively and to deliver the best possible to those who are need and team members as well as healthcare managers are able to identify what makes teams work more effectively. This essay presents a discussion about factors that have an impact on the working of healthcare teams. The primary care medical office is often the first point of contact with those who have a problem and it is the team in this office that will collaborate further to facilitate a remedy for the client (Kessler, 2008, pp. 8 – 10). Thus, the essay focuses on the care team in the primary care setting. The Impact of a Range of Professional Cultures on the Functioning of the Care Team If teams that deliver healthcare are to function effectively, management policies must directly or indirectly foster collaboration and members must have the right attitudes (Leathard, 2003, pp. 125 – 126). It is important for everyone to understand about the workings of healthcare teams. Individual team members will not have the time, skills or the physical dexterity to manage all aspects of patient or client care. In addition, it is important that team members are able to communicate effectively, have positive attitudes and have the right motivation. Having a team identity, tolerance for stress, emotional awareness, an ability to resolve conflict and positive mood helps the team and the client. Thus, it is important that team members and healthcare managers are able to identify what makes teams work more effectively. The medical profession and those that are associated with healthcare have developed roles with established role boundaries that demarcate what they are willing and able to handle (Leathard, 2003, pp. 124 – 127). Researchers have compared those with specific responsibilities and tasks for healthcare with ‘tribes’ that find it difficult to mix (Leathard, 2003, pp. 54 – 66). In this context, healthcare team members that subscribe to the existing order can regard inter-professionalism as being highly dangerous because it introduces ambiguity and it is a threat for the existing order. Thus, those from the nursing staff are more inclined to focus on the biological aspects of a client’s illness under the supervision of doctors and the previously mentioned groups are likely to be less willing to focus on a client’s housing or financial problems. A tendency exists for regarding such problems as being the responsibility of social workers or their supervisors, including care managers. In addition, the nursing staff may feel more inclined towards having a one – to – one relationship with their patients and this means that they will be poorly motivated towards a team approach that required in-depth communication. Doctors assume responsibility for a biophysical care strategy for the patient but although they are considered as being senior team members, they are often less willing to leave their specialist professional duties to attend to the detailed non-medical needs of their patients or clients. Research studies indicate that team members in inter-professional teams, especially the younger members or the novices, have a tendency for oversimplifying and distorting the roles and motivations of others especially when they try to interpret tense communications within the team (Lingard, 2002, pp. 728 – 734). The previously mentioned reactions are suggestive of professional rivalries in a care team, but they may also be due to role simplification by inexperienced minds that have yet to fully come to grips with their professional identities. Within the UK and Scotland, the Audit Commission Report of 1992 identified several factors that contributed to a lack of effective teamwork in healthcare teams, including separate lines of control, different payment systems that led to suspicion over motives, diverse objectives, professional barriers and perceived inequalities in status (McLean, 2005, pp. 149 – 150). In Scotland, like elsewhere in the UK, a reconfiguration of services and the concept of joint working had made gains as early as 2000 when the Scottish Executive Joint Future Unit was established based on the report of the Joint Future Group (Hubbard, 2005, pp. 371). It is clear that healthcare team members subjected to differences in expectations, payments, control and differences in stature will expect to shoulder responsibilities accordingly. However, emphasising role awareness, cooperation, communication and common objectives enhances team performance, which is desirable from the healthcare delivery perspective. Any team established to deliver healthcare will pass through the stages of forming, storming, norming and performing prior to adjourning (Martin, 2004, pp. 140 – 144). It is in the storming phase that personality clashes and differences over professional and ethical issues can become significantly bothersome and leaders should make the effort to keep them in check. Leadership is important because the guidance provided and lessons learnt do become grounded in everyday practice. Health and social care professionals have to work together to learn how best to work in an inter-professional team and it is only logical to expect that nudging in the right direction will benefit team performance. Professional cultures, a lack of experience in collaboration, financial pressures and changing priorities are barriers that can be detrimental for inter-professional practice. Professions have traditionally identified with roles within the healthcare sector and new ways of working present new roles, difficulties associated with accessing new services and a break from habit (Hubbard, 2005, pp. 377 – 382). A new tradition for using new services must evolve because of professional thinking about the new inter-professional practice and new ways of thinking has to develop for the new system. Specialists and senior doctors have to redefine their roles when working in inter-professional teams, with a redefinition of roles impinging on the balance between skills and status (Robinson, 2005, pp. 553 – 559). Status clashes can cause distress because those from the high status groups, such as the medical specialists, may not want to compromise their status and their medical focus on the urging of other team members, including social workers, who may be seeking a more practical approach that will compromise the long-term aspirations and professional development of specialists. Issues related to status, power and professional boundaries might result in lack of communication, poor cooperation and a shifted focus from team goal of providing care. Ethical issues can arise in inter-professional teams especially when referrals are made to agencies that are outside of the inter-professional team have their own procedures and modus operandi (Robinson, 2005, pp. 555 – 557). Ethical considerations related to information sharing and confidentiality may prevent access of information about patients to all team members. Thus, social workers may not be able to access privileged medical information and details about medical information that may reflect on criminal behaviour, such as the taking of drugs, may not be available to all team members. Most team members are likely to be accustomed to working in free and open environments and strict confidentiality, control over exchange of information or procedural differences can make team members less than comfortable. Relations with external agencies can be particularly difficult because external agencies are likely to have their own rules and procedures for carrying on with their work. Thus, inter-professional teams often develop their own rules, procedures and ways of working with external agencies unless legal requirements force the team to act in a certain manner. However, ethics demand that effort to try to do everything that is for the best for a patient is undertaken and this means that the healthcare team professionals have an identical outlook within the team (Melia, 2004, pp. 116 – 140). The next section presents a discussion about the processes that affect the functioning of inter-professional healthcare teams. A Discussion about the Processes likely to Impact on Care Team Functioning Despite continued recommendations made by influential actors, including the government, about the desirability for having teams to deliver primary care practical evidence indicates that it is not easy to deliver a cohesive, well – performing healthcare team (Xyrichis, 2008, pp. 141). Thus, it makes sense to research what can create a high – performance team and what processes are likely to impact on the healthcare team’s performance. Team performance, which also includes its ability to innovate and do things better, is determined by a variety of factors that include the task that is required to be performed, team composition including size, skills, knowledge and diversity and resources that are available to the team (West, 2003, pp. 395). Team processes, the appropriateness and effectiveness of strategies used to accomplish tasks and the level of effort applied influence performance outcomes. Thus, it is appropriate that team leaders are aware of what influences team performance and how to improve team outcomes. Team processes for a primary healthcare team refers to clarity of objectives, levels of participation, commitment to excellence and support for innovation that exist within the team culture (West, 2003, pp. 395 – 408) and (Xyrichis, 2008, pp. 148 – 150). Team meetings, goals, objectives, audit of team performance, and the manner of conduct and approach towards tasks are important processes that influence team performance. Regular meetings and friendly exchange of ideas that are presented and accepted affirmatively lead to effective teamwork and enhanced levels of innovation for the team (Xyrichis, 2008, pp. 148 – 150). An effort made to try to schedule regular meetings even when time pressures and a tendency for informal discussions detract team members from such formal events can reward the team with improved performance. Meetings force participants to think about issues before the formal event and a tendency exists to overlook these thinking processes unless formal scheduled meetings force participants to prepare for the discussion. Meetings can break down professional barriers and help improve communications between members. Open – communications and trust are important ingredients in team performance but these take time to develop within teams. Working relationships correlate well with effective communications and meetings help reduce interprofessional conflict. Within the primary healthcare teams, doctors do find it difficult to let go of their power and to have a redistribution of power, but if other professionals are to assume responsibility for developing delivery of healthcare. It is important for a team to have its goals and function clearly defined because without such statements related to its mission, it will not be possible for a team to function effectively (Xyrichis, 2008, pp. 148 – 150). Clarity of leadership and conflict avoidance over leadership are important issues for newly formed teams (West, 2003, pp. 407). Leadership clarity results in the enhancement of team processes and these influence team innovation. Without clarity, a threat exists to the position of the leader because interpretations and clarifications result in a challenge for leadership. It is important to understand that new and improved ways of doing things, better treatments devised by teams and enhanced patient services can mean the difference between longer illness periods or even death and improved quality of life for patients or clients. Thus, innovation and being alert to what is required are important for healthcare teams. However, it is important to understand that innovation depends on effective communication of quality of ideas and this means that larger teams can be more innovative because of the number of ideas generated despite problems with the effective communication of such ideas within larger teams. Professional hierarchies and functional boundaries have impeded teamwork in the English and Scottish settings because these can impede free exchange of ideas (West, 2003, pp. 407). Audit processes within healthcare teams serve two important goals (Xyrichis, 2008, pp. 149). Firstly, it is possible to learn from the results of the audits and that, which transpired to bring about improvements for the future. Secondly, it is possible to assign responsibility and to reward the positive efforts of individual team members. Audits help decide about improving on faults for performance enhancement. Individual contributions are important for team members and everyone works to learn, win rewards and to be recognised. Without audit the skills, contribution and expertise of team members will remain undervalued and unrecognised resulting in a decline in team performance because of a lack of care for the effort presented by staff members. Thus, it is important to provide team members with encouragement for the hard work that they have rendered and a chance for improvement by conducting periodic audits. Recognition of a team is important for everyone. Organisational psychology supports the need for carrying out audits and recognising excellence because without reward the motivation for putting in the effort vanishes. However, it is important to ensure that competition does not become destructive and that the spirit of competition should encourage improvement without fear of dire consequences of failure. Evidence from hospitals in the UK suggests that audits may very well contribute to increasing healthcare team performance and patient mortality levels improved in direct proportion to the audit effort that was undertaken (Xyrichis, 2008, pp. 151). It is clear that healthcare team processes do have an impact on performance and that effort to try to promote an understanding of the ongoing processes within teams will improve team members. It is always better to try to explain and to make individuals understand than to make them obey instructions blindly. Thus, team leaders and senior members can play an effective role in educating members and improving healthcare team processes. Conclusion Improved patient care is the motivator for the popularity of inter-professional healthcare teams and it will appear that such teams will continue to deliver in the future because a need exists for efficient allocation of resources for healthcare. However, new ways of working and previous experience translated into practice will shape the manner in which these teams function in practice. Those attuned to the traditional practice will need to adjust and it is important that professional boundaries change to accommodate a diverse range of professionals. Social workers with an aptitude for observation, formulation of holistic solutions and interaction with a diverse range of professionals or agencies are very much a part of the inter-professional teams. 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