Multidisciplinary Team Relationships in Healthcare - Essay Example

Literature Review on Multidisciplinary Team Relationships in Healthcare Introduction: A multidisciplinary team comprises professionals from different specialities who work as a group towards care to the patient. The main reason for such a care strategy is diversity and complexity of healthcare, rapid advancement of medical specialities in terms of knowledge, technical dexterity of members of the team, enhanced client concerns about health and care, and many other intricate issues in present-day healthcare where no profession has superiority over another across the contexts of healthcare delivery plan to a patient (NOLAN, M. 1995). This can point to the complex issue of interprofessional relationships or professional interrelationships and are likely to have impact on the working interface between different individuals participating in a multidisciplinary healthcare team. The disturbances in interrelationship would certainly (ADAMSON, B.J., KENNY, D.T., AND WILSON-BARNETT, J., 1995) affect the outcome in patient care. There have been legislations on equality and diversity in professional practice that have been incorporated in the training needs and personal development plans created by most providers (WAGNER, E.H., 2000). Consequently, there is a huge volume of literature on this area where different view points on multidisciplinary healthcare team have been critically examined in order to reach viable model of implementation in quality healthcare and to find out some heuristic device to solve the problems of interrelationships in a team. (Good emphasise) (ROYAL COLLEGE OF PHYSICIANS. 1994.) ''This author intends to have a critical review of literature on multidisciplinary team relationships in healthcare mainly focusing on nursing and other members of the team with examples from occupational therapy, physiotherapy, and other care disciplines'' Reasoning is sufficient. To be able to do this, a thorough literature search was undertaken from Blackwell Press, Medline, Ingenta, British Medical Journal, High Wire Press, and Sage Journals online with the keywords 'multidisciplinary team' and 'health care'. A total of 6432 journal articles were identified. To narrow down our search, a further search on these articles with keywords, 'relationship', 'interdisciplinary relations' and 'interrelationship' yielded only 232 articles. To further focus in our interest area and to reduce the articles to the specific area of the review, a search with key words 'occupational therapy', 'physiotherapy', 'community mental health' at different search incidences led to 15, 4, and 20 articles respectively. The keyword 'nursing' further narrowed it down to 12 results in total. This reviewer selected 6 literatures to study the question of professional interrelationships in a multidisciplinary care team from the perspective of nurses included in the team as applied to healthcare and its impact on delivery of healthcare in the areas of occupational therapy, physiotherapy, and mental health. The multidisciplinary care in the area of occupational therapy demands a change in the approach towards the definition of the responsibilities of each participant in the team with an emphasis on chronic illnesses and sufferings from it. There are always ambiguous areas of roles or responsibilities in terms of ownership of healthcare, and there would be evident and consequent power struggles to lay claim on ownerships in a team. This leads to heightened tension within the group and resultant shift of focus from patient-centred care to hassles related to assumption of authority in a team. To obviate this, terms like collaboration and participation have proliferated with growing concern and stress on active involvement of patient and caregivers that invokes predominance of informed choices of the patients at least in selected areas (COPNELL, B.,JOHNSTON, L., HARRISON, D. ET AL. 2004). (Reference would be of benefit). When applies to actual interventions, this policy would not hold good because individuals with conditions needing occupational therapy still depend on hospital care delivered by health professional for interventions (BADLEY, E.M. AND TENNANT, A., 1997) (says who ). To turn this into a successful model, the necessity of the hour is that of comprehension of the concept of rehabilitation and respective roles of various groups (ENABLING, S. 1995). The very idea of a satisfactory healthcare service is the resultant of the recognition that the perceived aims of outcome of healthcare involves satisfaction with life and health of the care recipients (EGGER E., 2000). (Reference would be of benefit). In reality, involved professions in a team often demonstrate a tendency to restrict the legitimate focus of attention necessary for action in this area into professional paradigm almost reaching the extent of professional reductionism. This has a very detrimental effect on innovation of service strategies due to lack, mainly, of collaboration within the team. Where the team lacks interrelationships, particularly in the healthcare setting, the phrase 'multidisciplinary care team' sounds mostly ornamental and rhetoric. When healthcare is delivered by a team, each member of team with different professional training and skills would deliver their skills with a common goal of patient benefit. If there is a sharp demarcation of professional boundaries, there would be perceived deficiencies in trust, tolerance to each other, and willingness to share responsibilities (Reference would be of benefit) (HAY, R., 1994). Notwithstanding the fact that personal skills are necessary in the ultimate disposition of care delivery, despite superb skills of the participants, the whole purpose may fail due to lack of co-ordination of the team effort (Reference would be of benefit) (OVRETVEIT, J., 1993). A coordination of care through team approach will blur the professional demarcations within a team, will establish a bond of relationship within the team members, and will effectively dismantle the barriers to collaborative working (Reference would be of benefit) (GUIRDHAM, M., 1996). The harsh fact is that the professional relationships in healthcare have undergone drastic changes from the past. Agreed definitions of purpose and intent may facilitate constructive debate and dialogue in the interprofessional levels to smoothen the way to a perfect interdisciplinary care. The well-educated, articulate, and assertive nurse practitioners are important part of this system because the final common pathway for care delivery is dependent on them for the most part in the care setting, and there must be a balance between the ingredients of skills, feelings, and analysis in nursing practice. Like the boundaries between the different professions involved in the team, the ideal format should be a harmony and balance between these ingredients, enough flexibility, and provisions for shifts of focus in response to the healthcare environment (LASCHINGER, H.K.S.,WONG, C., MCMAHON, L., AND KAUFINANN, C. 1999). There is no difference of opinion between the authors about the method of delivery of healthcare in complex clinical situations, such as, those involving people with chronic diseases, and that method is a comprehensive therapeutic approach best delivered through a multidisciplinary care team since it is pertinent to fully address the special and complicated health care needs that arise with a chronic disease in such settings (MANT, J., CARTER, J., WADE, D.T., AND WINNER, S., 1998). (Reference would be of benefit). This obviously is an integrated method of care that needs exchange of experiences, perceptions, and information among all people involved in the team, and the therapeutic process will only then surpass boundaries of different professions and will start acting as a single instrument of delivery of care after harmonising and synthesising the difference in perspectives. Shift of goals of treatment and grossly differing points of view regarding the specific health need often result in chaos that can be translated into inappropriate treatment strategies irrelevant to specific needs and disorders. This often results from deficiency of communications which is directly a derivative of relationships within the team. A close interdisciplinary relationship would ensure clarification of goals before planning of interventions sets in. This system of relationship may be compared to that of a machine that has well-oiled parts that function with the goal of production or function. (reference ) (LANE, D. AND MAXFIELD, R., 1996). Optimised performance can happen only when the discrete actions of individual parts or distinct operating system play their roles as per specifications and in time harmonious with those of one another (OWEN, A.V., 1995). In this way, the components of a multidisciplinary team should best function in an environment of productive, generative, and innovative relationship that demands interactions among the parts, and it could be promising in the way that it might produce valuable, novel, surprising, and unpredictable capabilities to enrich the care delivered. In contrast, the parts acting alone just cannot deliver this. The healthcare operating system largely depends on interactions that are productive, and legislations have significant roles in preventing this interdependence. For example by legislations, healthcare sector in United Kingdom is divided into separate sectors, such as, primary care, secondary care, social services. Due mainly to allocations of separate budgets and performance targets for each of these systems, these hardly, if ever, focus on good functioning of the system as a whole. (FOOTE, C. AND PLSEK, P.E., 2001). (Reference would be of benefit) Another obstacle towards a creative and progressive goal is rigorous specifications with frameworks and very detailed guidelines for any procedure or action. This stunts the proactive thinking in the way that it fails to take advantage of creative trained thinking of the participants, and in case of inevitable unpredictability of events that are rife in the clinical setting, the partners in the team those are in immediate vicinity of the patients fail to react. Strict and detailed specifications in a team may as well result in negative impacts on generation of future relationships in a team. If one member of the team always waits for permissions and resources and always is afraid of crossing the delineated boundaries, it will, as expected, work towards closing the space for personal contributions to the team's efforts and discouraging shared action (MINSKY, B.D., 1998). A system can be in place where the team will be able to identify specific and relevant target problems, for example, in the area of occupational medicine multidisciplinary care, and through dialogue within the team, the team can discern the contributing factors to those problems, and the team can reach a decision for the most appropriate intervention. In reaching this decision, the leaders should take utmost care to ensure that even the professionally least significant member has his or her part in the decision making process keeping aside the sense that "nobody asked me a question". This instrumental system can facilitate both intraprofessional and interprofessional communication, boost the interrelationship and depending on the output will serve as a medium of communication between the healthcare professionals and the patient. (reference ) (GOLDSTEIN, J., 1994). The goal of occupational medicine and physiotherapy is rehabilitation, and the ultimate focus of the team is to improve the patient's health status and functioning, to reduce the disability, to develop the quality of life as per the client needs by minimising the consequence and effects of disease (CHAMBERLAIN, M., GOODWILL. C., AND EVANS, C., 1997). (Reference would be of benefit). A team that is responsible for achieving such goals would work together to identify the problem and needs of the patient, to discover the relevant factors in both the subject and the environment that might have been causative in the problem, to define the goal of the therapy, and to continuously assess and modify the interventions depending on the results (TURNER-STOKES, L. AND FRANK, A., 1990). (reference )The factor that is often neglected in this approach is the patient, his needs and preferences, valuing his input as an individual in the process of therapy planning. A consolidated team approach where the interrelationships of the participants are in question must focus on the patient as an active member of the team, and this calls for courage to cross the idiosyncratic boundaries of unprofessional professionalism in a multidisciplinary team, and the leaders are supposed to show some courage in building this extremely necessary relationship. If all the members bonded together starts understanding what disease means to the patient, this inevitably will generate an acceptable and fruitful care for the patient (MASTERSON, A., 2002). (Reference would be of benefit). A series of interviews involving the physician, psychologist, physiotherapist, occupational therapist, social worker, and nurse is ideal for identification of the problems of a particular patient (DUNCAN, E.A.S., ed., 2006). In this way, a complete and detailed account of the patient's main problems, impairment of functions and incapacity, ability to regulate emotions, the level of general physical endurance and muscle power, pattern of handling stress and other psychological demands, analysis of environmental factors, and analysis of coping strategies can be obtained (CREEK, J., 2002). It is important that the findings should be discussed with the patient, and all the participants of the team will separately record these data but will interpret the findings together on a common platform. An examination of the patient following that would ensure that the team try to relate these problems to impairments, limitation of activity, restrictions in participation, and factors inherent in personal and environmental domain. Even if all team members are required separate hypotheses for this incapacity and nonperformance, it is a huge task that can be accomplished by a single individual. This needs a team, and that team needs interrelations (STEINER, W.A., RYSER, L., HUBER, E., UEBELHART, D., AESCHLIMANN, A., AND STUCKI, G., 2002). Is this the conclusion Could you underline the fact that it is Conclusion The most interesting fact is that most of the clinicians and senior nursing staff have clear ideas about what is wrong in the multidisciplinary interrelationships, and the junior staff has much difficulty in making a point and in getting their voices heard. Added to this, there is fear about hierarchy in a team in relation to adverse reference and being referred to as a troublemaker. The consulting professionals are more concerned about the retention of their professional autonomy and superiority over others in the team; nurses prefer not to disturb the directorial hierarchy as long as things are not too disorganized. Things that raise hope against the depressive interrelationship pattern in a multidisciplinary team is newer generation who are ready to increasingly participate in the crucial decision making process within the team and question others and themselves in the team, within the workplace disregarding the nonsensical demarcation lines, almost forcing a relation where no relationship exists. References NOLAN, M. 1995. Towards An Ethos Of Interdisciplinary Practice. British Medical Journal;311:305-307. ADAMSON, B.J., KENNY, D.T., AND WILSON-BARNETT, J., 1995. The Impact Of Perceived Medical Dominance On The Workplace Satisfaction Of Australian And British Nurses. Journal of Advanced Nursing;21: 172-83. [Medline]. BADLEY, E.M. AND TENNANT, A., 1997. Epidemiology. In: Goodwill CJ, Chamberlain MA, Evans C, eds. Rehabilitation of the physically disabled adult. 2nd ed. Cheltenham: Stanley Thornes. CHAMBERLAIN, M., GOODWILL. C., AND EVANS, C., 1997. Rehabilitation Of The Physically Disabled Adult. Cheltenham: Stanley Thomas. COPNELL, B.,JOHNSTON, L., HARRISON, D. ET AL., 2004. Doctors' And Nurses' Perceptions Of Interdisciplinary Collaboration In The NICU, And The Impact Of A Neonatal Nurse Practitioner Model Of Practice. Journal of Clinical Nursing, 13(1): 105-13 EGGER E., 2000. Like Herding Cats, Herd Physicians By Making Them Want To Come. Health Care Strategic Management;18(7):1819. ENABLING, S. 1995. Exploring Multidisciplinary Teamwork. British Journal Of Therapy And Rehabilitation, 2(3): 1 4 2. FOOTE, C. AND PLSEK, P.E., 2001. NHS Plan: Thinking Out Of The Box. Health Services Journal;111:3233. GOLDSTEIN, J., 1994. The Unshackled Organization: Facing The Challenge Of Unpredictability Through Spontaneous Reorganization. Portland, OR: Productivity Press, 1994. GUIRDHAM, M., 1996. Interpersonal Skills at Work. 2nd edn. Prentice and Hall, Europe. HAY, R., 1994. A Nurse's Place Is At The Bedside. Nursing Standard;8(27):42-43. LANE, D. AND MAXFIELD, R., 1996. Strategy Under Complexity: Fostering Generative Relationships. Long Range Planning; 29:21531. LASCHINGER, H.K.S.,WONG, C., MCMAHON, L., AND KAUFINANN, C. 1999. Leader Behaviour: Impact On Staff Nurse Empowerment, Job Tension, And Effectiveness. Journal of Nursing Administration 29(5): 28-39. MANT, J., CARTER, J., WADE, D.T., AND WINNER, S., 1998. The Impact Of An Information Pack On Patients With Stroke And Their Carers: A Randomised Controlled Trial. Clinical Rehabilitation; 12: 465-476 MASTERSON, A., 2002 Cross-Boundary Working: A Macro-Political Analysis Of The Impact On Professional Roles.. Journal of Clinical Nursing 1(3): 331-339 MINSKY, B.D., 1998. Multidisciplinary Case Teams: An Approach To The Future Management Of Advanced Colorectal Cancer. British Journal of Cancer;77 (supplement 2):1-4. OWEN, A.V., 1995. Management For Doctors: Getting The Best From People. British Medical Journal, 310:650-652. OVRETVEIT, J., 1993. Coordinating Community Care: Multidisciplinary Teams And Care Management. Buckingham: Open University Press. ROYAL COLLEGE OF PHYSICIANS. 1994. Ensuring equity and quality of care for elderly people. London: RCP. STEINER, W.A., RYSER, L., HUBER, E., UEBELHART, D., AESCHLIMANN, A., AND STUCKI, G., 2002. Use of the ICF Model as a Clinical Problem-Solving Tool in Physical Therapy and Rehabilitation Medicine. Physical Therapy, Vol. 82 , No. 11, pp 1098-2008 . TURNER-STOKES, L. AND FRANK, A., 1990. Emerging Specialties - Disability Medicine. British Journal of Hospital Medicine;44:190-193. WAGNER, E.H., 2000. The Role Of Patient Care Teams In Chronic Disease Management. British Medical Journal; 320:569-572. General References DUNCAN, E.A.S., ed., 2006. Foundations for Practice in Occupational Therapy 4th ed. Edinburgh: Elsevier Churchill Livingstone. CREEK, J., 2002. Occupational Therapy and Mental Health.3rd Ed., London: Churchill Livingstone. HANSEN, R. A., ATCHISON, B., 1999. Conditions in Occupational Therapy : Effect on Occupational Performance. 2nd Ed. USA: Lippincott Williams & Wilkins Further Reading (Not Used in the Essay) CASTLEDINE, G., 1994. The Role Of The Nurse In The Twenty First Century. British Journal of Nursing; 3:621-2. [Medline] DENNER, S., 1995. Extending Professional Practice: Benefits And Pitfalls. Nursing Times;91(14):27-9. DEPARTMENT OF HEALTH., 1994. The Challenge For Nursing And Midwifery In The Twenty First Century: The Heathrow Debate. London: HMSO. KANTER, R.M., 1993. Men and Women of the Cooperation. 2nd edn. Basic Books, New York. KATZENBACH, J.R., SMITH, D.K., 1993. The Wisdom of Teams: Creating the High- Performance Organization. Harvard Business School Press, Boston KING, P.M., 1994. Health Promotion: The Emerging Frontier In Nursing. Journal of Advanced Nursing; 20:209-18. [Medline]. MARIANO, G., 1992. Inter-Disciplinary Collaboration. A Practice Imperative. Healthc Trends Transit 3(5): 10-5,24,25 Marriner-Tomey AM (2000) Guide to Nursing Management. 6th edn. Mosby, London. MASLOW, A., 1954. Motivation and Personality. Harper and Row, London. MORGAN, G., 1997. Images of organization.2nd ed. Thousand Oaks, CA: Sage. PARKIN, P.A.C., 1995. Nursing The Future: A Re-Examination Of The Professionalization Thesis In The Light Of Some Recent Developments. Journal of Advanced Nursing;21: 561-7. PETZINGER, T., 1999. The New Pioneers: The Men And Women Who Are Transforming The Workplace And The Marketplace. New York: Simon & Schuster. Read More