Effective Interprofessional Collaboration is key to providing good quality patient centred care
This essay will discuss the principles of patient centred care and their relationship to multi-disciplinary team working and identify and explain key concepts of individual and team communication within the practice setting. Reference will also be made to experiences in practice and the effect of these experiences on the patient. My personal experiences of multi-disciplinary team working will be reflected upon, as will my strengths and weaknesses in relation to my skills as a collaborative team member. Patient confidentiality will be protected at all times when reflecting on personal experiences in placement in accordance with the NMC code of professional conduct (NMC 2004).
The term patient-centred care refers to the participation and involvement of the patient in the decisions taken concerning their care and treating the person as an individual, recognising the differing needs amongst individual patients (Barrett, Sellman and Thomas 2005). The importance of involving the patient in their own care has become increasingly important over the last half of the 20th century, with more people living into older age than ever before, and with this increase of life expectancy has come an increase of those living with chronic or long-term illness (Department of Health 2001). This has led to a heightened number of people becoming, in many instances, more knowledgeable of their condition than the healthcare professionals that are involved in their care and treatment, and therefore, rather than being merely recipients of this care they are increasingly taking responsibility for the management of their illness by making informed decisions concerning their treatment, alongside those of healthcare professionals (Department of Health 2001). As the significance of patient centred care has been identified it also important to understand the relationship between patient centred care and multi-disciplinary team work, which is that to enable the provision of patient-centred care a number of different professions will need to be involved, as it is not possible for one profession to have all the knowledge required to provide effective care, therefore the multi-disciplinary team must work collaboratively to be effective, with effective communication between professions making this collaboration possible (Barrett, Sellman and Thomas 2005).
Furthermore, as healthcare teams are not comprised solely as a solitary department a patient may need to attend clinics in many of the different hospital departments in order to gain the desired treatment. In order to provide the patient with the best quality treatment and care, it is essential that there is high level of effective Interprofessional collaboration between all members of the healthcare team. Ensuring efficient communication between healthcare professionals will not only increase the quality of the service, but it could also help reduce hospital waiting lists for treatments and ultimately, increase patient satisfaction. For example, when considering a department such as radiology it is becomes clear why effective communication between all members if the team is essential. A radiology team is composed of many different interdisciplinary professionals not only doctors, radiologists and nurses working within the radiology department, but it also comprises the individuals with whom these members of staff interact within their different, complementary departments. For example, a patient will have been referred to a radiologist from a different department e.g. gynaecology. The patient will also go to meet the staff at the admissions desk, outpatients staff, perhaps ward staff if they are to be admitted. Thus, the coordination of this team of practitioners is vital in order to ensure that the patient is treat efficiently and that their care needs are met.
When there is a lack of communication between professions the quality of care will inevitably suffer. There are many examples, and consequences, of good and poor communication and one example is that of a scenario my colleagues and I were asked to consider as part of our online learning for the Collaboration in Professional Practice (CIPP) module, which was of a student nurse attending a ward round with a doctor. In the scenario the student nurse had concerns as to the patient having little opportunity to ask the doctor any questions or allay any concerns that he had, which the student nurse perceived to be due to a number of reasons, including the lack of privacy on the ward and the doctor making it apparent that he was short of time. When she reflected on this incident she felt that she had not communicated with the doctor efficiently and acted as advocate for her patient, therefore, the consequences are that he was possibly left with many unanswered concerns. There were many opinions relating to this scenario put forward on the group discussion board (see appendix 1) and many of us felt that this emphasised the importance of having a mixed number of professions on ward rounds, including a nurse whose responsibility it is to act as advocate for the patient. The student nurse in the scenario pointed out that she felt she had let her patient down in favour of showing the doctor that she was efficient and good at her job and it could be argued that this need to impress the doctor was due to the hierarchical structure within which hospitals tend to operate, with doctors being at the top of this structure, which could affect communication between doctors and nursing staff.
One of the objectives of a study which was carried out by Kinley et al (2001) was the investigation of ‘the quality of communication between senior medical staff and ATNs’ (Kinley et al 2001: 2) (The ATN’s are appropriately trained nurses) and the study was conducted in retrospect of the plans to implement nurse-run clinics and to give nurses some duties which were previously considered to be that of a doctor. This is of importance and relevance to the provision of patient centred care, as the ability of members of a healthcare team to effectively communicate and articulate any problems, concerns or even advice which one may have in order to help another member of the healthcare team to treat a patient is one of the keys to effective collaboration within the multidisciplinary environment of a hospital (Barrett, Sellman and Thomas 2005). The conclusion made by the research team was that there is ‘no reason to inhibit the development of fully trained nurse-led pre-operative assessment, provided that the nurses are appropriately trained and maintain sufficient workload to retain skills’ (Kinley et al, 2001: 3). However, the qualitative counterpart of the study indicated that the use of ATN’s for pre-operative assessment was agreeable to patients but there was no indication that there was any improvement in the ‘communication between senior medical staff and those carrying out the pre-operative assessments’ (Kinley et al 2001: 3). Hence, this study could be viewed to be indicative of the fact that if interdisciplinary communication and collaboration was to be improved within the healthcare team and hospital settings, perhaps the abilities of nursing staff to fulfil roles and complete duties previously associated with a doctor, such as completing pre-operative assessments and taking medical histories would be enhanced.
I myself have witnessed examples of both good and poor interprofessional collaboration and communication whilst out in practice. For example, whilst caring for an elderly lady in hospital who was recovering from surgery it became apparent that she was suffering from acute constipation. Numerous healthcare professionals worked collaboratively to eliminate her constipation, including doctors, nurses, a dietician and physiotherapist and in the end a satisfactory result was achieved. On reflection of this incident I felt that although there was clearly excellent communication and collaboration between professions, once they were working together in the treatment of this problem, there was also an unnecessary delay in the nurses involving these other professions in her treatment for this particular problem, which led to unnecessary suffering and pain for the patient. I referred to this incident on the CIPP group discussion board (see appendix 2) and found that this concern as to the length of time it can sometimes take to involve other professions was shared. Therefore, it is worth noting that even when communication is good between professions the quality of patient care will still suffer if there are delays in bringing about their collaboration.
The ability to reflect on incidents such as these is an essential component of nursing as it enables us to analyse what we did, if we did it well or if it we could have done it better, and then how we can develop our skills further to do better in the future (Brooker and Nicol 2003). When considering that nurses are expected to make certain decisions as to the care of a patient the benefits of reflective practice become apparent, reflecting on past mistakes can help greatly when deciding what action should be taken in the care of patient, particularly when it is a situation that one has previously experienced and thus gained knowledge from (Brooker and Nicol 2003). I feel that although I have made significant progress in my ability to reflect over the last year there is still much room for improvement, something which I have referred to in my action plan for the formative assignment (see appendix 3). I listed the priority of this ‘action point’ as being medium to high as although it is to be achieved throughout my career, as part of my lifelong learning, I feel that it is also an essential skill whilst being a student as it will my greatly aide my learning at present as well as in the future when qualified.
Being self-aware is vital to the reflective process as it is through our knowledge of ourselves that we are able to recognise our strengths and weaknesses and identify areas where more learning is required (Burns and Bulman 2000). Self-awareness is to be conscious of who we are, to be aware of our own values, beliefs and strengths and weaknesses (Burns and Bulman 2000). Being self-aware is essential to nursing as not only does it form the basis upon which reflection is built but it also contributes to how we communicate with others and aides our interpersonal development with our colleagues, as well as enabling us to build and maintain positive relationships with our patients (Bulman and Schutz 2004).
When reflecting upon my own strengths and weaknesses, in relation to my collaborative skills, I feel that whilst I am beginning to acquire an in depth understanding of the role of the nurse in the care of the patient I feel that I lack substantial knowledge of the roles of the other healthcare professionals that I work alongside in the care of these same patients. This point is also referred to in my action plan for the formative assessment (see appendix 3) and I listed the priority of this as being medium to high as I feel that it is not possible to become an effective collaborative healthcare professional without having an understanding of the roles of others with whom you are working alongside. If there is a lack of understanding of the roles of others I feel that it would be difficult to see why they are involved in the care of my patient, or even when it is appropriate to involve other healthcare professionals, inevitably leading to the quality of the care for the patient to suffer.
As we have identified the importance of Interprofessional collaboration in the provision of effective patient centred care and satisfaction within the hospital environment it is important to look at methodologies which can be utilised in order to improve the interactions and communication between members of each multidisciplinary team within the healthcare setting. Buchan and O’May (2007) describe how the process of ‘skill mix’ can be used to as a method of organisational change within a healthcare team and it has a role to play in improving the effectiveness of the organisation and quality of care. The four stages of a skill mix cycle are ‘the evaluation of the need for change, the identification of opportunities and barriers for change, the planning for change and finally making the change happen’ (Buchanan and O’May 2007: 1) Therefore, we can see that the methodology of skill mix is one option available to healthcare managers when they are aiming to improve the Interprofessional collaboration between members of their healthcare teams, the method does however require careful planning. Furthermore, it is important to realise that skill mix is more than just a technical exercise, as it is also ‘a method of achieving organisational change which requires careful planning, communication, implementation and evaluation if it is to achieve its main objectives’ (Buchanan and O’May 2007: 1).
Sibbald, Shen and McBride (2004) value the strategy of changing the skill mix of the healthcare workforce and highlight that factors promoting success in the improvement of the patient care service and the interactions and collaborations of members of the healthcare interdisciplinary teams include: ‘introducing ‘treatments’ of proven efficacy, appropriate staff education and training; removal of unhelpful boundary demarcations between staff or service sectors; appropriate pay and reward systems; and good strategic planning and human resource management’ (Sibbald, Shen and McBride, 2004 : 28). It is important to identify the areas which can help to improve staff communication because this will help with the planning and implementation of change and improvements within the healthcare setting. Education and training opportunities appear to be beneficial in two ways, firstly they provide a method for improving the staff morale and self-respect as they feel more satisfied and qualified to help others and thus communicate with other members of the healthcare team and additionally the training will provide opportunities for members of staff to become acquainted with other employees and to interact (Sibbald, Shen and McBride 2004). This may then help in the collaboration in the work place. Education and training strategies which could train doctors and nurses simultaneously would be beneficial in reducing the hierarchical boundaries between these disciplines (Freeth, 2005 and Dominelli, 2002).
The subject of this essay is increasingly significant at present due to the recent changes observed within the structure and function of the National Health Service (NHS) and the demands placed upon it to reduce the waiting times of patients and increase patient centred care, whilst at the same time cutting the costs and expenditure within the NHS (The Department of Health 2000). This puts pressure on medical staff, not only to increase their efficiency of treatment, but also to cope with and adapt to changes which are being made within their departments (The department of Health 2000). One of these changes which may be difficult for medical staff to adapt to in particular is the replacement of doctors with nursing staff in the carrying out of some of the duties and roles which were previously associated solely with the doctor. As the primary aim of the NHS is to provide the best healthcare possible for each patient, it is important that the staff employed to take over some of the duties and responsibilities previously associated with the doctors we must ensure that the nursing staff are fully trained and able to perform the tasks to the required standard and in order to do this it is important that there is an effective level of collaboration between the doctors and nursing staff and that the doctors provide a support network, to which members of the nursing team can turn to and ask advice when and wherever appropriate. However, as there may be negative feelings towards this change, perhaps felt more so by the doctors, this may prove to be difficult. Hence, it is necessary to enhance the levels of cooperation and team spirit in order to work more efficiently and make the most of the skills of all the professionals in the NHS workforce (The Department of Health 2000).
In conclusion, it is clearly apparent that the effective collaboration and consequentially the communication between members of a healthcare team is of vital importance when considering the accuracy and efficiency in which care can be provided to patients in a patient focused manner, and as this is an important aim of the NHS plan to reform, plans must be put into action to ensure that the levels of communication between members of the healthcare team are achieved to enable the goals made by government bodies to be reached and to aid staff moral in the workplace.
Barrett, G, Sellman, D and Thomas, J (2005) Interprofessional working in health and social care. Basingstoke, Palgrave Macmillan
Brooker, C., Nicol, M (2003) Nursing Adults, the Practice of Caring. London, Mosby
Buchan. J, O’May. F (2007) Determining Skill Mix: Practical Guidelines for
Managers and Health Professionals [online] last accessed on 16th December 2007 at: http://www.who.int/hrh/en/HRDJ_4_2_07.pdf
Bulman, C., Schutz, S (2004) Reflective Practice in Nursing. Oxford, Blackwell Publishing
Burns, S and Bulman, C (2000) Reflective practice in nursing: the growth of the reflective practitioner (2nd Edition) Oxford, Blackwell Science
Department of Health (2000) The NHS Plan: a plan for investment, a plan for reform [online] last accessed 16th December 2007 at: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4002960
Department of Health (2001) The expert patient: a new approach to chronic disease management for the 21st century [online] last accessed on 15 December 2007 at http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4006801
Dominelli, L (2002) Anti-oppressive social work theory and practice. Basingstoke, Palgrave Macmillan
Freeth, D (2005) Effective interprofessional education: development, delivery and evaluation. Oxford, Blackwell Publishing
Kinley et al (2001) Extended scope of nursing practice: a multicentre randomised controlled trial of appropriately trained nurses and pre-registration house officers in pre-operative assessment in elective general surgery Health Technology Assessment. Vol 5: No 20
Nursing and Midwifery Council (2004) The NMC code of professional conduct: standards for conduct, performance and ethics, London, Nursing and Midwifery Council
Sibbald,B, Shen, J and McBride, A (2004). Changing the skill-mix of the health care workforce. Journal of Health Service Research and Policy 9(1), 28-38.