This essay seeks to examine the drivers and initiatives influencing the change in the service provision to improve the quality of the organisation. As these changes are advocated alongside the need for multi-agency and interprofessional collaborative working their impact on interprofessional working would be discussed. Furthermore a reflective account of the impact of Interprofessional learning on my future practice would be provided.
The project was about medical coding. Medical coding is the process by which numerical codes are assigned to medical data following the completion of a consultant episode. The codes serve as a universal medical language and are used to collect medical statistical information within a trust and determine financial reimbursement. This is known as payment by results (PbR) (Spinello, 2009).The skills or quality used will be communication and documentation of patient's records. According to the health science journal (2007), documentation is the written and legal recording of the interventions that concern the patient and it includes a progression of processes. Documentation is recognized with the personal record of the patient, which constitutes a foundation of information on the circumstance of his health. The value of nursing documentation is neuralgic, provided that without it, there cannot be a comprehensive qualitative nursing intervention and not even successful care for the patient. In the purposes of nursing documentation are integrated the research on a more valuable care of the already detected problems, the programming of care throughout the organization and modification of the plan on patient's care and the more straight communication between the professionals of the health system, who collaborate on the patient's care. The methods of
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documentation are numerous and among the most fundamental ones are the method focussed towards the source or the problem, the system problem-intervention-evaluation, the persistent registration, the focusing diagram, the registration by exception, the electronic files and the home documentation, Health science journalÂ (HEALTH SCI J), 2007 Oct-Dec; 1(4). (7p) (23 refs)
ORGANISATION DRIVERS AND OBJECTIVES
In June 2008, Lord Darzi set out in a report titled 'High Quality Care for all' visions of improvement to healthcare within the NHS, at local and national level. Within the report one highlighted area talks about fostering leadership for quality, enhancing excellent leadership by identifying core element and this is communication, (DOH 2008). Communication is crucial in all aspects of health care, but has particular characteristics in the context of multi-professional working in acute care settings (Miller et al 2001). It is argued that the fundamental feature of effective interprofessional team is to have a high-quality considerate of each other's roles, professional language and cope confidently with role differences and role overlap (Hilton 1995, Miller et al 2001). Effective communication hence becomes essential component to improve victorious collaboration between professionals (Barr et al 2005). This can be fostered by excellent quality of communication which can relieve relationships which need "in detail discussion and intervention" in order to develop a team perceptive (Miller et al 2001). If team members are unwilling to work jointly and distribute knowledge then the interprofessional team will be unproductive in practice (Bailey 2004). There is evidence that failure of health and social care professionals to work jointly and communicate with each other can have terrible consequences (Quinney, 2006 p13; Laming Inquiry 2003). Government strategies contain powerfully advocated for approaches that could keep away from the barriers of communication (Forth and Fowler 2009). Freeman et al (2000) identifies that an amplified level of communication is compulsory in order to assist superior team communications. . High-profile child-abuse cases, the key messages from this report were that there needed to be better collaboration across organisational boundaries and improved communication between professionals, e.g. Baby P (2009), Victoria Climbee (2003), Laming lnquiry.
There are a number of supporting and operational backdrops which are important to the implementation of the medical coding. The top drivers include government policy. Firstly, Making A Difference (DOH 1999) advocates for better integration to provide effective care for service users. This concept is further endorsed by NHS Plan a Ten Year programme of reform of practice which focused on service redesigned around the needs of the patient and the need for interprofessional collaboration between health and social care to promote interprofessional working (DOH, 2000). Other targets set out in the NHS plan included reduced waiting times and high quality of care (DOH, 2000). Drivers of interprofessional working in professional practice do not occur in isolation, they are always located in a social, economic and political context. In Our NHS, Our Future (2007), the Department of Health describes the essence of clinical leadership as: To motivate, inspire, to promote the values of the NHS, empower and to create a consistent focus on the needs of the patients being served. Essence of care 2010 identifies best practice and highlights and how this can be achieved. The changing health, social and care environment, patients are now empowered to make informed decisions about their wellbeing, health and social care. Professional developments, these developments will mean that the professional boundaries will be challenged as professionals across the boundaries to deliver care to patients, using a team approach. Factors affecting team working are technological developments, as members of primary health care teams are not usually geographically close to one another, advances in information technology will mean that the information can be transferred more easily between members of the health care team. This will provide better opportunities for consultation between primary health care professionals, reduce professional isolation and should ultimately result in enhanced patient care.
INFLUENCE OF DRIVER/OBJECTIVE ON INTER- PROFESSIONAL PRACTICE
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The stipulation of "seamless care" has motivated the policy makers into developing and promoting successful interprofessional collaboration to boost patient centred practice (Pollard et al 2005). The government recognises that many health care troubles that cannot be addressed efficiently by any organisation acting in isolation from others (Wilson et al 2008). "The delivery of the NHS' modernisation agenda requires strong and integrated working by way of fine established inter-professional practice, (DOH 2001). Jooste (2004) defined three things that are fundamental to leadership, authority, power, and influence.Â Effective leaders of today ought to use more influence and less authority and power, it is supplementary essential to be able to motivate, persuade, appreciate, and discuss than to merely exercise power Jooste (2004). Effective management leadership in nursing is not a profession that is suitable for every person or for each nurse, (DOH 2008). Therefore effective management leadership in nursing does not signify just barely surviving the job, it actually means captivating it full force and making it flourish, NHS with outstanding leadership and leadership development at every level to guarantee high quality care for Leadership qualities and Management skills are especially important (DOH 2008).
Smith et al (2000) argues that traditional assumptions about professional roles and structures are being challenged in the modernising NHS resulting in 'role blurring' hence requiring new accepting of professional roles (Higgs and Jones 2000 cited in Baxter 2008). Rushmer (2005) argue that professionals are informally being expectant to blur the boundaries in order to "decrease protectionist, rigid demarcations" adversely affecting service provision. The customary demarcations between staff and barriers in services have been cited as partly to blame for failures within the system of health care provision (DOH, 2000). However it is recognised that when care provision crosses over the traditional boundaries there are often difficulties in establishing new systems (Martin, 2004). Martin (2004) suggests that there is often a fear that interprofessional working will demand significant blurring of boundaries to the point where the expertise that a professional has developed may be less valued. Those who were discouraged by the importance of coding in the project were mainly concerned about the impact of the change on their professional identity.
Professional identity and area acts as a barrier to effective interprofessional collaboration (Hudson, 2002). This emphasises the need to endorse skills and knowledge of interprofessional practice (Barr 1998). Miller recognized that the different perceptions of role can lead to professional defensiveness and might in other instances overrule patient focus (Miller et al 2001). It is essential to be well-known with that the suppleness in professional roles enables "continuity and consistency of care through the exchange of skills and knowledge" (Miller, et al 2001 p92). Dom beck argues that it is difficult for professionals to generate collaborative ties when one is unsure of their professional identity and hences asserts that "articulating corrective and professional identity is vital before interprofessional relationships can be flourishing."(Dombeck 1997 cited in Mouyleax 2001). A conflict in role prospect result in professional defensiveness...overruling patient focus' (Miller et al 2001).
APPLICATION OF LEARNING TO MY OWN PROFESSIONAL PRACTICE
Once I become a qualified Registered Mental Health Nurse (RMN) in working practice I will use this reflection when placed in comparable situations accepting that I am part of a team and as such will be grateful for all members input. Therefore, personal clinical effectiveness in its purest form relies on the acquirement of core competencies such as the capability to work and have high opinion for patients, interprofessional collaboration and fellow professionals. In totalling, to be capable to supervise and reflect on ones practice during the process of guided reflection of clinical supervision. Effective work relationships among teams consisting of staff and front-line leaders contributed to successful outcomes, but team-operations leader relationships made the biggest difference. Formal access to power through leadership is critical for building and sustaining processes that promote and sustain nurses' control over practice. Journal of nursing management (J NURS MANAGE), 2010 Nov; 18(8): 1016-26 (48 ref). Considering the benefits of changing nursing attitudes and developing professionalism through reflective practice, many authors have emphasized the need to use reflective practice as a training method within nursing education. Chabeli and Muller (2004) use a qualitative contextual and exploratory descriptive design for theory generation that was used to develop model facilitating reflective thing in clinical nursing education. The authors cited Wilson (1963 and Gift (1997) who provided a theoretical framework for a concept analysis of reflective thinking in nursing education.
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Our behaviour and the worth of our care are improved by "reflection-on-action and in achievement" (Schon 1983), by making wisdom of what we have practised, and thinking about how we may act differently in the future. Through this experience I have developed an improved understanding of how the new development and interprofessional practice can bring an better experience for service users and carers in the course of providing a more effective service (Mc Cray 2007).I have also gained a better knowledge and perceptive of the significance of role understanding, communication and its involvement to effective inter professional practice. This is mostly important in my future practice as a mental health nurse, since nurses commonly work in interprofessional settings within health and social care. Acknowledging role overlaps and my involvement to the team would improve any anxieties and allow me to face up to any stereotypes created against other professionals. Incorporating the impression of reflexivity in my practice whereby I would keep in reflection on the nature of collaborative process probing the role of power and the dilemmas ensuing from interprofessional perspective would facilitate an open, honest and important discussion between me and other professionals (Carrier 1995). I will identify that in order to work together and develop interpersonal and team working skills I need to value the variety of other's belief and knowledge experiences.
I will be acquainted with the process of reflection in inter-professional practice as recognized by Driscoll (2000) must involve a notion of discussion within teams and professions. This could be improved through partaking a general language as a means of overcoming cultural words difference that Wenger (2002) describes as alive between groups. Atkins (1993) also recommends that crucial reflection is important in making intellect of power relations within organisational structures. In the course of this process I will make an effort to take into account issues of power and discrimination (Ghaye 2005) that are perceived to be threatening in interprofessional collaboration and in our communications with our clients. Reflection is seen as a necessary establishment of professional development, important for the combination of theory and practice and in producing successful education and practice (Barr et al, 2005, Pirrie et al 1998. Reflection may be triggered by an awareness of a gap between theory and practice, a difference between what 'should be' and 'what is' (Sullivan & Decker 2005).
As illustrated above interprofessional practice is instrumental in the delivery of better quality of care and in implementing the innovative change in the service provision. Interprofessional working can bring many benefits, but there are also hurdles that need to be considered and overcome to ensure high quality of service is provided. It is apparent that although different ways are adopted in to reduce the obstacles through educating future workforce, there is need for better understanding of professional roles and the acknowledgement of role overlap. Reflecting on these differences in practice could foster better knowledge and collaborative practice. The success of the service change depends on the staff demonstrating commitment and cohesion within the team. Communication is crucial in all aspects of health care, but has particular characteristics in the context of multi-professional working in acute care settings (Miller et al 2001). The recommendations made to the project will help the organisation to enhance better quality of care through offering timely assessments, discharges and continuity of care. This illustrates that through collaborative practice service change could be highly beneficial to the staff, patients and the organisation as a whole.