In the next session we developed a shared understanding of these three main elements but we failed to explore it further due to a lack of research, so the discussion returned again to the key points. However, I feel I have learned a lot from this experience. I have learned how a good discussion relies on the active participation and a sense of shared responsibility among its members, qualities that we lacked in my group. I also feel that working in small groups with different heath care students has improved my communication skills. Interprofessional education is very important, it creates positive attitudes and students acquire skills for future professional roles (Soothill , 1995). Interprofessional working is the desired result, where professionals from all Heath and Social Services agencies work together seamlessly. The way to achieve this is through effective education of all the staff working in these agencies. EBL is the tool that takes the student from Interprofessional education to Interprofessional working.
Part 3
The aim of this essay is mainly to explain my understanding and experience of interprofessional working. I will explore the different aspects related to this concept, the reason for interprofessional working and the policies behind it, the notion of user centred practice and its relationship to interprofessional working. I will consider what knowledge, skills and attitudes are required, and discuss barriers for interprofessional working. Finally, I will discuss organisational factors that influence it.
Interdisciplinary refers to professionals working together. According to Goorman (1998) inter-disciplinary indicates that all members and disciplines of the team recognise the
abilities, skills and critical contributions of each of the others. There is a number of ideological, practical and political explanations that can be identified to explain the emergence of interprofessional care. The idealogical explanation is related with the re-discovery of the “ whole patient” during the 1970s. It was recognised that patients/clients often present with multi-factorial problems, that can be defined as both “medical” and “ social”, that a few agencies alone are/were unable to address. The political explanations came from the reform of the government’s role in delivery of health care that has placed a demand on service providers to use resources efficiently and get value for money. Multidisciplinary practice was viewed as a panacea for: the inefficiency in health service delivery; for communication failures within and between disciplines and for professional separatism (Irvine, 1985). The last element that explains the emergence of interprofessional care refers to the specialisation that has occurred during the twentieth century where generalist workers have been replaced by a diversified range of occupations and specialists focused on particular fields of work (Abbott,1988). The result of this professional and functional specialisation, fragmented knowledge, is that it is no longer possible for any one profession to have all the knowledge and skills necessary to address a particular need, issue, or problem. Every profession, then, overlaps by necessity other professions. Also, the reform of health care systems and the emergence of evaluative systems contributed to the multiplication in the number of social agents involved in the delivery of services to the public. Against this situation, the belief emerged that progress in heath care delivery could only be made by professionals who were able to ignore disciplinary boundaries, and who could work in a new interdisciplinary way. This approach was viewed as a possible solution to the problems which emerged from traditional hierarchical relationships in the division of labour.
In health and social care, there was an early recognition that the boundary between these two public services was a key issue for service users and for the notion of user centred practice that the government wanted to achieve (Glasby, 2003). It was with the publication of it’s White Paper on the NHS (department of Health, 1997), that the government announced its intention to bring down what it described as the “Berlin Wall” that had grown up between heath and social services (House of Commons Debates, 1997). Following this, the government introduced a number of policy initiatives to promote effective partnerships between health and social care. The first one, The Parnership in Action (1998) proposed new legislation to remove existing barriers to joint working and facilitated inter-agency collaboration but this proposals however did not tackle the root cause of the problem. The second one, The Royal Commission on Long Term Care (1999) focused on the shortcomings of the current system for organizing and funding long-term care, the inequitable distinction between health care (free) and means-tested social care, but the Commission’s failed to resolve the inconsistency inherent in the current system. Finally the third one was The NHS Plan (Department of Health, 2000a), which was intended to be a long-term strategy to re-built the NHS , where the government, among other things, promised financial incentives for joint working but it also threatened decisive action against the ones who failed to work collaboratively. According to Gasby ( 2003) creating halfway houses somewhere in between was not an answer to the longstanding issues that the social care divide raises, and would only postpone the inevitable. During the past years the importance of IPW, as well as Interprofessional education, has been growing and they are now seen as process that are essentials for the effective running of Heath & Social Services agencies to deliver a patient-centred approach.
As we have seen, Interprofessional team working has become one of the main issues in the field of social care. The article called " Interprofessional Teamworking: what makes teams work well" showed the results of a research project in the North- east of England which aimed to identify and evaluate the positive characteristic that make good interprofessional working. The research showed that there are three main themes that help to develop good team working. One of these characteristics was the motivation and commitment of staff. Another characteristic was good communication within the team, small numbers of staff and the members of the group working from the same base seemed to ease the communication. The last characteristic was the lack of guidelines and methods of working, which seemed to have facilitated the flexibility and adaptability of each member of the team which helped to develop creative working methods. It helped to work across boundaries and created good working relationships and good working practices, a multi-professional model of working in a patient centred way.
Communication and reflection are two key issues for IPW, they facilitate positive working relationships. In order to have good relationships within the team all the staff need to feel confident in their own role to be able to share their knowledge with others. If the level of confidence is not achieved jealousy and conflicts may appear in the team. The team members then are unable to work in a positive environment and, as a result, the patient care delivery could be damaged (Molyneux, 2001). Professional attitudes are important also for IPW. IPW, and IPE, required mutual understanding and respect between professionals, minimised stereotypical thinking, more open-minded attitudes and views, more inter-professional empathy and more adaptability to change (Barr, 2000). As a result of this, there are behavioural changes within professional practice, students and staff. They can see different approaches in the delivery of care and, as I did in my IPW sessions run at the UWE, understand, value and learn from other people’s point of view. Changes in the organisation, like joint training, will bring improvement in health for the patient as a result of a more efficient staff. Poor communication has been the root of many catastrophic failures in care in the last twenty years, one example is the Victoria Climbie case where the lack of communication between the services resulted in a fatal consequences for a patient (Barret, 2005).
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Some of the difficulties that may inhibit interprofessional working can arise from struggles for power that can emerge from professional’s traditional and social difference. Also conflict can emerge from a combination of social and professional differences too. Another problems that can inhibit IPW is lack of support at a senior level, professional culture (which encompasses a particular set of beliefs, values and norms) and envy and defences against anxiety. Some of the strategies that may be effective to prevent some of these difficulties are reflection and supervision, which can enable individuals to recognise their strengths and limitations in relation to knowledge, skills and attitudes required for effective interprofessional working. Another strategy that can be used is evaluation, in order to analyse the nature and impact of the interprofessional working relationships. And finally education and training which will support professionals to understand each other’s role, managerial support and realistic expectation.
That an holistic approach and an Interprofessional working is essential and positive for a user/patient centred practice has been show in many studies and research projects eg Squires, A; Hastings, M (2002), Journal of Interprofessional Care, March 2005 and David Abbott, Ruth Townsley and Debby Watson, University of Bristol (2004). All these studies show how a multi-agency working has not just improved the quality and benefits for the user/patient but as also that the interdisciplinary team work did have a positive impact on the lives of professionals “ Professionals said they enjoyed working this way and importantly, felt able to provide families with better quality coordination and relationships.” University of Bristol (2004).
The notion of user centred practice and interprofessional working are closely linked together. The government want the patients to believe that they are centrally involved in their health care. Clinical government is about quality. According to that every Trust has been told that they are responsible for delivering standard quality care. The essential meaning of interprofessional working taken to its limit is user/ patients themselves. As we have seen, the government has put policies in place to regulate interprofessional working but just those policies alone has been proved inadequate to achieved the desirable outcome. Every individual requires knowledge, skills and attitudes to enable them to participate in collaborative working relationships. The interprofessional education is trying to provide the conditions and skills to enable future professionals to work collaboratively as: respect for each other, knowing others professional’s roles etc.. They aim also to make them recognise some of the difficulties that may inhibit interprofessional working as the problem of the power, the little tribes within professionals, attitude problems, the treats to professional identity etc. All these difficulties can be a really big barrier to achieved positive interprofessional working.
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