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Effective communication its role on inter professional work | Health

It is well recognized that people in organizations typically spend over 75% of their time in an interpersonal situation; thus it is no surprise to find that at the root of a large number of interprofessional problems is poor communications. Effective communication is an essential component of interprofessional work success. Besides, the issue of interprofessional working is currently one of key importance in the field of health and social care.

Much of the literature on interprofessional working focuseson the potential difficulties in achieving effective workingrelationships between practitioners from different professions, and theways in which these problems might be avoided or resolved (Davidson,1990; Evers et al., 1994; Ferrer & Navarra 1994; Pietroni, 1994;Hanily, 1995; Hilton, 1995). In United Kingdom, the legislative andpolicy requirements over the past decade have required health andsocial care agencies to work closely and collaboratively together inpartnership with service users (Pearson & Spencer, 1995; DoH,1999). Thus, it is important to identify and evaluate the positivecharacteristics of good interprofessional working. The aim of thispaper is to cover the role of the basic process of effectivecommunication related to interprofessional work and the conflictproblems generated from the interprofessional practice. Further, wewill discuss some studies carried out on the era (mainly in the healthcare sector), followed by conclusion and recommendations.

The communication that can be defined by a process of transmittinginformation from an individual (or group) to another is a very complexprocess with many sources of potential error. In other words, themeaning of any communication is a simple transmission of a message fromthe sender to the receiver. In many situations a lot of the truemessage is lost because the significant difference that exists betweenthe message that is heard and the one intended.

Further, the effectiveness of the communication process stilldifficult, because at each step, there is a multitude of potentialsource of errors. Thus, the social psychologists estimate of a usual40-60% loss of meaning in the transmission of messages from sender toreceiver still justified.

However, in order to increase the effectiveness of the communicationprocess, it is critical to make sure that there is a minimal loss ofinformation. Hence, it is required to understand well this process,understand and control constantly the potential sources of errors.Further, it is important to point out that the communication processappears more complex when it is accomplished between to persons orgroups with different knowledge's and professional activities.

In the following, we will see that conflict within teamworking takesmany forms. We will give the definition of a team and which are theproblems rising from the lost of effective communication in aninterprofessional teamworking process. Finally, we will see a checklistof criteria that healthy teams do well and dysfunctional teams dopoorly.

The team can be defined as a group of individuals who must workinterdependently in order to attain individual and organizationalobjectives. The key word here is interdependently. However, within aninterprofessional work, interdependence means that all the teams mustdepend on each other and if any one team drops the ball, the wholeteams suffer. Different divisions within a company may need to shareinformation but they are not really a team. Why the shift to teams? Theanswer is simple. There is less management, less direction, moreautonomy and accountability, the need for specialists, and a greaterexpectation to work independently without management direction. Also,senior managers know peer pressure to support team goals and each otheris a very powerful motivator and productivity is much greater with ateam than with individual workers. Most companies will take advantageof this. In contrast, the lost of an effective communication lead to aset of problems that are:
• conflicting personalities and egos;
• difficulty of collaboration and decisions;
• lack of definition of members' roles;
• hidden agendas or win/lose struggles;
• necessity of time-consuming meetings;
• unclear goals or conflicting goals within the team;
• lack of awareness of how the work fits into the bigger picture;
• unwillingness to share or to ask for help
• geographic remoteness;
• cultural clashes;
 • etc.

It is rarely the technical challenges that cause problems, but ratherthe people issues that are mostly often the source. Further, healthyinterprofessional work will always do the following six criteria welland, conversely, dysfunctional one will not do these well.

i. Clear Communication
Usually the first sign of adysfunctional team is communication breakdown. Healthy teams have acommunication plan that is agreed to by all members. The frequency,format, and type of communication are pre-negotiated and meet theunique needs of the team or situation. Team members also know what todo when they feel that communication is breaking down or if they feelout of the loop.
ii. Clear Goals, Roles, and Responsibilities
This is a major source of frustration on most teams and must be clearly defined early. This is the role of the Team Leader's.
iii. A Conflict Resolution Process
Conflict within any teams is inevitable and healthy if managedproperly. Healthy teams have pre-set rules of conduct in times ofconflict.
iv. Clear Decision-Making Process
Depending on the situation, there could be many ways to make adecision: depending on the short or long strategic project, the ProjectLeader decides and tells the team, a team vote, majority rules,minority rules, an expert decides, or a consensus. The key is thatthere should be a primary and backup decision-making method thateveryone agrees to.
v. Fair Work Distribution
The problems with fair work distribution are usually caused byslackers. If the teams cannot address their performance andcontribution, then, the leader may have to get involved by giving clearfeedback and setting expectations.
vi. Appropriate Leadership
This is usually the most difficult one to get right. This is never an easy choice.

Due to the complexity of health care domain, which generally includesproblems with features of both familiar and complex problems, internistdecision-making frequently includes a mix of both data-driven andhypothesis-driven diagnostic strategies.

Recent investigations into decision making have included the studyof group decision making in real health care environments, withdifferent limitations and situational variables (Orasanu, 1993).  Aspecial type of coordinated group activity is the collaboration, inwhich individuals with different areas of knowledge and skill worktogether to perform tasks and carry out activities necessary forachieving a shared goal. In the medical context, collaborative planningand activity involve interactions between team members in order tomanage the complexity of clinical practice. The health care literatureabounds with examples of successful multidisciplinary teams with praisefor this type of delivery system in many different domains, includingprimary care, geriatric, diabetes, cardiovascular medicine, head andneck surgical oncology, endovascular surgery, anaesthesiology andpsychiatry. In each of these domains, physicians, nurses, dieticians,physiotherapists, social workers, and other health care support staffeach bring different domain knowledge and coordinated activity tohealth care decision making (though unfortunately usually excluding thepatient who is the focus of the interaction). How this does coordinatedactivity work, given that the team members have very specific knowledgeand skills?

Patel et al. (1996) examined team interactions within an IntensiveCare Unit team, where they identified individuals possessing differenttypes of expertise with roles that are clearly and formally defined.This led to the identification of properties that emerged in thecollaborative setting. The attending expert then generated appropriateplans based on consideration of the patient as a whole. The complexityof medical analysis increased at each level in the hierarchy whileinformation management tasks decreased in intensity. Multiple streamsof information were processed in a hierarchical manner using two typesof strategies. Under conditions of high urgency, reasoning wasdata-driven toward action, rather than based on consideration ofunderlying justifications and a high degree of knowledge organization.Under less urgent conditions, causally directed reasoning was used toexplain relevant patient information. In both cases, the overall goalof individual and collective reasoning was to find a reasonableexplanation for a particular aspect of a patient's condition so thatappropriate actions could be taken.

For each type of conditions described above, the communication stillvery important for bridging differences, leading to shared products andunderstanding. The preferred mode of communication will found to varywith the purpose of the interaction, planning tended to take placeduring conference calls and face-to-face meetings, while technicalissues were emphasized in email communication. As tasks will beclarified and a shared commitment developed over time, the pattern ofcommunication became more focused, showing greater degrees ofintegration. At the same time, the development of communication dependson each individual's contributions (in terms of expertise) to the teameffort.

Another important point that would be outlined here, in the samecontext of health care, is the health human resources (HHR) planning,present as well in private as public sectors. HHR is a complex issueand the management of human resources includes monitoring andevaluation, planning, and policy research. It takes into account thesupply, distribution, quality, deployment, organization and utilizationof health human resources. It has further been described as seeking toestablish optimal numbers for each of the health care provider groups,given the most cost-effective and appropriate mix of required personnelbased on varying services needs. A Key feature that is important andneed to be considered in this HHR planning is the physiotherapyprofession.

Physiotherapists play a large role in promoting health. Theyunderstand the determinants of health and see this as a fundamentalrequirement for responsible decision-making that is conducive topromoting health. In this capacity; physiotherapists often work asconsultants to private and public organizations. They work withcorporations, professional and amateur sports teams, and withgovernments and their agencies. Their consultative work also includesprevention awareness and the focus of this work is to prevent injuryand to promote health, which is so required for the good functioning ofeach private or public structure. Hence, and regarding the aboveconsiderations assigned in section 2, the physiotherapists aretherefore essential providers of the health care support andinformation useful for each professional structure, and which iscrucial for a successful, interprofessional teamworking.

The present paper examines the concept of the role of communicationin interprofessional work and its relationship to efficient andeffective delivery of decisions and services, regarding the example ofthe health care issue. It state that the collaboration between workersfrom professions and of various institutions necessitates time,clarification of the intention and expectations of each, as well as theplacement of definite procedures of collective work.  Not to respectthese conditions at the beginning of the procedure risk to fail theproject or to delay it considerably, because of the conflicts thatinevitably will appear. 

In the health care teamworking exposed above, communication as well asredundancy assures that omissions will be discovered and corrected. Themode of communication is directly related to the purpose of theinteraction. This timely communication among individual members assuredthe co-ordination of activities, reducing redundancies and unnecessaryinteractions. Face-to-face and telephone interactions were the mostfrequently used modes of communication, offering an immediacy ofresponse and the opportunity for exchange of information and ideas.Further, in recognition of the importance of communication skills,pressure has been placed on the medical education system to acknowledgetheir significance and to devote resources to teaching them. While theresults emphasize the prominence of communication in team functioning,they also highlight the conceptual basis of communication related tothe development of individual expertise, making team communication anadded value to already existing conceptual competence in this domain.We observed that expert providers in each situation determined the mosteffective methods for communicating with each other based on thepurpose of the interaction being sought. It has been suggested that itis the very nature of the practice itself that promotes acquisition oftacit knowledge and skills.

DAVIDSON, K.W. (1990) Role blurring and the hospital social worker'ssearch for a clear domain. Health and Social Work, 15, 228-234.DEPARTMENT OF HEALTH.

DEPARTMENT OF HEALTH (1999). National Service Framework for Mental Health: Modern Standards & Service Models.

EVERS, H. CAMERON, E. & BADGER, F. (1994) Interprofessional workwith old and disabled people. In A. LEATHARD (Ed.), Goinginterprofessional: working together for health and welfare. London:Routledge.

FERRER, M. & NAVARRA, T. (1994) Professional boundaries: clarifying roles and goals. Cancer Practice, 2, 311-312.

HANILY, F. (1995) Mental health teams in the community. Nursing Standard, 10, 35-37.

HILTON, R.W. (1995). Fragmentation within interprofessional work. Aresult of isolationism in health care professional education programmesand the preparation of students to function only in the cofines oftheir own disciplines. Journal of Interprofessional Care, 9, 33-40.

ORASANU, J. & SALAS, E.  (1993) Team decision making in complexenvironments. In: Klein GA, Orasanu J, Calderwood R, Zsambok CE, eds.Decision Making in Action: Models and Methods. Norwood, NJ: Ablex;327-345.

PATEL, V.L. KAUFMAN, D.R.  & MAGDER, SA. (1996) The acquisitionof medical expertise in complex dynamic environments. In: Ericsson KA,ed. The Road to Expert Performance: Empirical Evidence from the Arts& Sciences, Sports and Games. Hillsdale, NJ: Lawrence Erlbaum:127-165.

PEARSON, P. & SPENCER, J. (1995). Pointers to effectiveteamwork: exploring primary care. Journal of Interprofessional Care, 9,131-138.

PIETRONI, P.C. (1994). Interprofessional teamwork. Its history anddevelopment in hospitals, general practice and community care (UK). In:A. LEATHARD (Ed.), Going interprofessional: working together for healthand welfare. London: Routledge.

Much of the literature on interprofessional working focuseson the potential difficulties in achieving effective workingrelationships between practitioners from different professions, and theways in which these problems might be avoided or resolved (Davidson,1990; Evers et al., 1994; Ferrer & Navarra 1994; Pietroni, 1994;Hanily, 1995; Hilton, 1995). In United Kingdom, the legislative andpolicy requirements over the past decade have required health andsocial care agencies to work closely and collaboratively together inpartnership with service users (Pearson & Spencer, 1995; DoH,1999). Thus, it is important to identify and evaluate the positivecharacteristics of good interprofessional working. The aim of thispaper is to cover the role of the basic process of effectivecommunication related to interprofessional work and the conflictproblems generated from the interprofessional practice. Further, wewill discuss some studies carried out on the era (mainly in the healthcare sector), followed by conclusion and recommendations.

The communication that can be defined by a process of transmittinginformation from an individual (or group) to another is a very complexprocess with many sources of potential error. In other words, themeaning of any communication is a simple transmission of a message fromthe sender to the receiver. In many situations a lot of the truemessage is lost because the significant difference that exists betweenthe message that is heard and the one intended.

Further, the effectiveness of the communication process stilldifficult, because at each step, there is a multitude of potentialsource of errors. Thus, the social psychologists estimate of a usual40-60% loss of meaning in the transmission of messages from sender toreceiver still justified.

However, in order to increase the effectiveness of the communicationprocess, it is critical to make sure that there is a minimal loss ofinformation. Hence, it is required to understand well this process,understand and control constantly the potential sources of errors.Further, it is important to point out that the communication processappears more complex when it is accomplished between to persons orgroups with different knowledge's and professional activities.

In the following, we will see that conflict within teamworking takesmany forms. We will give the definition of a team and which are theproblems rising from the lost of effective communication in aninterprofessional teamworking process. Finally, we will see a checklistof criteria that healthy teams do well and dysfunctional teams dopoorly.

The team can be defined as a group of individuals who must workinterdependently in order to attain individual and organizationalobjectives. The key word here is interdependently. However, within aninterprofessional work, interdependence means that all the teams mustdepend on each other and if any one team drops the ball, the wholeteams suffer. Different divisions within a company may need to shareinformation but they are not really a team. Why the shift to teams? Theanswer is simple. There is less management, less direction, moreautonomy and accountability, the need for specialists, and a greaterexpectation to work independently without management direction. Also,senior managers know peer pressure to support team goals and each otheris a very powerful motivator and productivity is much greater with ateam than with individual workers. Most companies will take advantageof this. In contrast, the lost of an effective communication lead to aset of problems that are:
• conflicting personalities and egos;
• difficulty of collaboration and decisions;
• lack of definition of members' roles;
• hidden agendas or win/lose struggles;
• necessity of time-consuming meetings;
• unclear goals or conflicting goals within the team;
• lack of awareness of how the work fits into the bigger picture;
• unwillingness to share or to ask for help
• geographic remoteness;
• cultural clashes;
 • etc.

It is rarely the technical challenges that cause problems, but ratherthe people issues that are mostly often the source. Further, healthyinterprofessional work will always do the following six criteria welland, conversely, dysfunctional one will not do these well.

i. Clear Communication
Usually the first sign of adysfunctional team is communication breakdown. Healthy teams have acommunication plan that is agreed to by all members. The frequency,format, and type of communication are pre-negotiated and meet theunique needs of the team or situation. Team members also know what todo when they feel that communication is breaking down or if they feelout of the loop.
ii. Clear Goals, Roles, and Responsibilities
This is a major source of frustration on most teams and must be clearly defined early. This is the role of the Team Leader's.
iii. A Conflict Resolution Process
Conflict within any teams is inevitable and healthy if managedproperly. Healthy teams have pre-set rules of conduct in times ofconflict.
iv. Clear Decision-Making Process
Depending on the situation, there could be many ways to make adecision: depending on the short or long strategic project, the ProjectLeader decides and tells the team, a team vote, majority rules,minority rules, an expert decides, or a consensus. The key is thatthere should be a primary and backup decision-making method thateveryone agrees to.
v. Fair Work Distribution
The problems with fair work distribution are usually caused byslackers. If the teams cannot address their performance andcontribution, then, the leader may have to get involved by giving clearfeedback and setting expectations.
vi. Appropriate Leadership
This is usually the most difficult one to get right. This is never an easy choice.

Due to the complexity of health care domain, which generally includesproblems with features of both familiar and complex problems, internistdecision-making frequently includes a mix of both data-driven andhypothesis-driven diagnostic strategies.

Recent investigations into decision making have included the studyof group decision making in real health care environments, withdifferent limitations and situational variables (Orasanu, 1993).  Aspecial type of coordinated group activity is the collaboration, inwhich individuals with different areas of knowledge and skill worktogether to perform tasks and carry out activities necessary forachieving a shared goal. In the medical context, collaborative planningand activity involve interactions between team members in order tomanage the complexity of clinical practice. The health care literatureabounds with examples of successful multidisciplinary teams with praisefor this type of delivery system in many different domains, includingprimary care, geriatric, diabetes, cardiovascular medicine, head andneck surgical oncology, endovascular surgery, anaesthesiology andpsychiatry. In each of these domains, physicians, nurses, dieticians,physiotherapists, social workers, and other health care support staffeach bring different domain knowledge and coordinated activity tohealth care decision making (though unfortunately usually excluding thepatient who is the focus of the interaction). How this does coordinatedactivity work, given that the team members have very specific knowledgeand skills?

Patel et al. (1996) examined team interactions within an IntensiveCare Unit team, where they identified individuals possessing differenttypes of expertise with roles that are clearly and formally defined.This led to the identification of properties that emerged in thecollaborative setting. The attending expert then generated appropriateplans based on consideration of the patient as a whole. The complexityof medical analysis increased at each level in the hierarchy whileinformation management tasks decreased in intensity. Multiple streamsof information were processed in a hierarchical manner using two typesof strategies. Under conditions of high urgency, reasoning wasdata-driven toward action, rather than based on consideration ofunderlying justifications and a high degree of knowledge organization.Under less urgent conditions, causally directed reasoning was used toexplain relevant patient information. In both cases, the overall goalof individual and collective reasoning was to find a reasonableexplanation for a particular aspect of a patient's condition so thatappropriate actions could be taken.

For each type of conditions described above, the communication stillvery important for bridging differences, leading to shared products andunderstanding. The preferred mode of communication will found to varywith the purpose of the interaction, planning tended to take placeduring conference calls and face-to-face meetings, while technicalissues were emphasized in email communication. As tasks will beclarified and a shared commitment developed over time, the pattern ofcommunication became more focused, showing greater degrees ofintegration. At the same time, the development of communication dependson each individual's contributions (in terms of expertise) to the teameffort.

Another important point that would be outlined here, in the samecontext of health care, is the health human resources (HHR) planning,present as well in private as public sectors. HHR is a complex issueand the management of human resources includes monitoring andevaluation, planning, and policy research. It takes into account thesupply, distribution, quality, deployment, organization and utilizationof health human resources. It has further been described as seeking toestablish optimal numbers for each of the health care provider groups,given the most cost-effective and appropriate mix of required personnelbased on varying services needs. A Key feature that is important andneed to be considered in this HHR planning is the physiotherapyprofession.

Physiotherapists play a large role in promoting health. Theyunderstand the determinants of health and see this as a fundamentalrequirement for responsible decision-making that is conducive topromoting health. In this capacity; physiotherapists often work asconsultants to private and public organizations. They work withcorporations, professional and amateur sports teams, and withgovernments and their agencies. Their consultative work also includesprevention awareness and the focus of this work is to prevent injuryand to promote health, which is so required for the good functioning ofeach private or public structure. Hence, and regarding the aboveconsiderations assigned in section 2, the physiotherapists aretherefore essential providers of the health care support andinformation useful for each professional structure, and which iscrucial for a successful, interprofessional teamworking.

The present paper examines the concept of the role of communicationin interprofessional work and its relationship to efficient andeffective delivery of decisions and services, regarding the example ofthe health care issue. It state that the collaboration between workersfrom professions and of various institutions necessitates time,clarification of the intention and expectations of each, as well as theplacement of definite procedures of collective work.  Not to respectthese conditions at the beginning of the procedure risk to fail theproject or to delay it considerably, because of the conflicts thatinevitably will appear. 

In the health care teamworking exposed above, communication as well asredundancy assures that omissions will be discovered and corrected. Themode of communication is directly related to the purpose of theinteraction. This timely communication among individual members assuredthe co-ordination of activities, reducing redundancies and unnecessaryinteractions. Face-to-face and telephone interactions were the mostfrequently used modes of communication, offering an immediacy ofresponse and the opportunity for exchange of information and ideas.Further, in recognition of the importance of communication skills,pressure has been placed on the medical education system to acknowledgetheir significance and to devote resources to teaching them. While theresults emphasize the prominence of communication in team functioning,they also highlight the conceptual basis of communication related tothe development of individual expertise, making team communication anadded value to already existing conceptual competence in this domain.We observed that expert providers in each situation determined the mosteffective methods for communicating with each other based on thepurpose of the interaction being sought. It has been suggested that itis the very nature of the practice itself that promotes acquisition oftacit knowledge and skills.

DAVIDSON, K.W. (1990) Role blurring and the hospital social worker'ssearch for a clear domain. Health and Social Work, 15, 228-234.DEPARTMENT OF HEALTH.

DEPARTMENT OF HEALTH (1999). National Service Framework for Mental Health: Modern Standards & Service Models.

EVERS, H. CAMERON, E. & BADGER, F. (1994) Interprofessional workwith old and disabled people. In A. LEATHARD (Ed.), Goinginterprofessional: working together for health and welfare. London:Routledge.

FERRER, M. & NAVARRA, T. (1994) Professional boundaries: clarifying roles and goals. Cancer Practice, 2, 311-312.

HANILY, F. (1995) Mental health teams in the community. Nursing Standard, 10, 35-37.

HILTON, R.W. (1995). Fragmentation within interprofessional work. Aresult of isolationism in health care professional education programmesand the preparation of students to function only in the cofines oftheir own disciplines. Journal of Interprofessional Care, 9, 33-40.

ORASANU, J. & SALAS, E.  (1993) Team decision making in complexenvironments. In: Klein GA, Orasanu J, Calderwood R, Zsambok CE, eds.Decision Making in Action: Models and Methods. Norwood, NJ: Ablex;327-345.

PATEL, V.L. KAUFMAN, D.R.  & MAGDER, SA. (1996) The acquisitionof medical expertise in complex dynamic environments. In: Ericsson KA,ed. The Road to Expert Performance: Empirical Evidence from the Arts& Sciences, Sports and Games. Hillsdale, NJ: Lawrence Erlbaum:127-165.

PEARSON, P. & SPENCER, J. (1995). Pointers to effectiveteamwork: exploring primary care. Journal of Interprofessional Care, 9,131-138.

PIETRONI, P.C. (1994). Interprofessional teamwork. Its history anddevelopment in hospitals, general practice and community care (UK). In:A. LEATHARD (Ed.), Going interprofessional: working together for healthand welfare. London: Routledge.

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