Inter Professional Collaboration In Practice
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Inter-professional Education (IPE) occurs when "two or more professions learn together with the object of cultivating collaborative practice" (CAIPE 2002). The benefits, as purported by (Barr 2002) are to have mutual understanding and respect, broadminded attitudes and perceptions and minimised stereotypical thinking. This thinking is informed by the legislative policy requirements of health and social care agencies to work closely and collaboratively together with service user along with professional guidelines (DH 2006, GSCC 2008, and QAA 2008). Communicating with other health and social care professionals, understanding contrasting perspectives, being involved in the seminars, groupwork trigger exercises, and IPE literature has enhanced my learning at the conference and has informed my practice for the future.
The module began with introductions and the team members each described their professional roles. (Dombeck 1997) refers to the importance of knowing your own professional identity and that of others before you are able to be able to form useful IP relationships. As students there was an initial understanding of each of our own professional roles and this was enhanced by discussion. Through this social process of learning we were able to correct each others bias and assumptions. The multidisciplinary group was not universal in its wish to achieve as much from the course as possible; this became understandable later, when it was clarified that the course did not form part of the medical degree qualification. A sense of inequality developed, which led the group to question the value placed on IPE within the medical profession. (Stapleton 1998) refers to open and honest and equal participation being conducive to collaborative relationships between professions. Despite this perceived inequality the group functioned well together. Open and honest discussions ensued although any interactions were superficial given the duration of the conference. Contact was sparse following the conference and there was little use of the IT systems placed on blackboard to assist or cement further learning.
Professor Means (2010) presentation resonated with me, as he spoke of championing one's own values and ethics, whilst seeing different perspectives and challenging boundaries of roles. He viewed this to be achievable with positive interactions and collaborations and engendering mutual trust and support. This led me to reflect on the nature of this discussion and contribute to the completion of one of our sentences. "Challenging professional boundaries creatively, whilst advocating ones own professions values and ethics." Pecukonis et al (2008) state that ethics relate to the pursuit of human betterment but these can be viewed and interpreted by different professions and refers to the term profession-centrism.This was underpinned by discussion within the group of the crossover in roles occurring within health and social care for example occupational therapist carrying out some of the duties of nurses and vice versa, whilst also being the 'eyes and ears' for social workers. This caused me to consider that social work is done by many professionals and its boundaries are not clear. This, whilst confusing, can lead to more professional fulfilment within roles and lead to a stronger skill mix which, with the service user at the centre, will lead to a better service and resource savings. Social, political and economic elements would welcome this cross over of skills however there is a possibility of a devaluing the value of each profession. (Barr 2004) supports this view and discusses the new flexible worker giving patients a holistic approach but also advocates respect for specialism's within teams.
The upgrading of responsibility and specialisation of medical tasks to nurses previously in the Doctors domain was discussed and there was a consensus within the group that this was a positive experience as it valued knowledge and not hierarchical structures of power. (Baker et al 2006) discusses the modernisation of healthcare and the move towards a team based model of healthcare delivery. Power has traditionally been sanctioned through authority and has in general been located within the medical profession (Colyer 2004) advises that the last fifteen years have seen a sea change in the medical professions organisation, structure and agency and this has improved the quality of intervention to service users.
The seminar on Intermediate Care by Williams and Drake (2010) increased my knowledge of how the multidisciplinary teams within the Community Health Team and Bristol City Council work together to provide holistic, flexible and client centred services with a single point of access. This occurs despite different IT, communication and reward systems and the challenges for the future viewed as aligning the organisational aims and objectives, recording systems, and professional views to transform consistency, capacity and efficiency. This enabled me to understand the daily pressures of working between organisations and the further challenges that present themselves with the current political and financial changes currently affecting the NHS and how the stereotyping of roles and their responsibilities are changing as are service user involvement.
The terms service user, patient and client were debated by the group and the subtle ways that language inform the discourse. Service user as a term was decided upon as it was the least discriminatory although consensus was not possible and the problematic nature of labels was explored both for service users and carers (Thomas 2010 p.172-3). The National Occupational Standards of Social Work (2006) set out the values and ethics of service users and carers and the importance of inclusion. The carer in the "patients voices" video who expressed her lack of recognition of being an 'expert by experience' demonstrated the gaps that as (Payne 2000) defines as the difference between professionals in collaborative working detracting from the empowerment and involvement of people who use services. Service users and carers should have a place in the decision making process.
I was able to appreciate the seminar provide by Adams (2010) which challenged my perception of being different but being compatible with others. Analogies were used of 'chalk and cheese' and 'peas in a pod'; the same components but different .This challenged my own conscious and unconscious views of my own profession and that of others, and the stereotypes that I hold and internalise. In order to combat these feelings I felt a need to have a clear sense of my own identity, confidence, role boundaries, values and ethics and practice and knowledge standards. I questioned my own perceived identity and that of my profession and recognised my own attempts to try to overcome perceived stereotypes and how issues of power and oppression require consideration before action, (Dalrymple and Burke 2006). A discussion ensued regarding conflicts of interest between professionals and I was able to make the links between theory and practice. (White and Featherstone 2005 p.210) explores the idea of story telling about different professions or professional groups and how 'atrocity' stories allows one profession to scapegoat another but how stories can also 'strengthen and confirm identity', by questioning other professions and thereby strengthening one's own. (Barnes et al., 2000) state that by developing ones own knowledge base and 'othering' of different professions whether rooted in the medical or social models allows different perspectives to be heard and recognised. (Lukes 1974) discusses these views of power and the subtle way that power is exercised and how people can remain powerless and this how service users are viewed within IP practice.
The Childrens Act 1989 and Every Child Matters 2006 are all resulting from the failures within public services to protect children. In reality IPW continues to fail. The Bristol Royal Infirmary (2001) Victoria Climbie Inquiry Lord Laming(2003) and more recent news on the serious case review of Baby P (2009) and the ongoing Mid Staffordshire NHS Trust Inquiry (2010) have highlighted serious breakdowns in multi-agency working and communication. The subsequent media reports have shown increased public mistrust and increased accountability for professionals Davies et al (1999) states that trust is an asset and that its reduction may hamper institutions ability to function.
Discuss how you would take what you have learnt about IP working into practice?
Effective IP working (IPW) involves performing within practice situations of cohesion and disparity. Working collaboratively with other social and health care professionals has experientially helped me to reaffirm and develop my practice. I have gained experience in communicating effectively, understanding teamwork, exploring stereotypes and professional identity and how social, economic and political factors will affect my future practice.
As a social work (SW) student working within an education and child protection setting, I understand the need to ensure a holistic and safe care provision in order to protect vulnerable children and adults. The Victoria Climbie Inquiry (Laming, 2003) pointed to the failure of various professions in their ability to work together in a competent and unified way. The Laming report led to the change in social workers National Occupational Standards and focussed on the need to develop clear documented communication, sharing all aspects with all relevant professionals to avoid any ambiguity and uncertainty within teams. (Laming, 2009. p. 61) emphasises that: 'there is a clear need for a determined focus on improvement of practice in child protection across all the agencies . . .' I will describe a child protection team meeting and its wider lessons for my practice.
Whilst on placement I met a young girl, who's younger brother was subject to a child protection investigation. Her mother had limited English and her father was the alleged abuser. The investigation involved a child protection meeting involving a plethora of health and social care professions to jointly assess the risk to both children. The meeting was effectively chaired by a social worker and all were invited to contribute their specific knowledge and evidence on the family, opinion was sought on actions and timeframes.(Molyneux 2001) debates the issue of good teamwork as being dependant on the qualities of the staff and the need for there to be no one dominant force. By communication being inclusive, creative and regular, issues can be debated and resolved. Concluding that teams were successful when members were confident, motivated and flexible and communication channels were clear, frequent and in the same base. (Petrie 1976) discusses a cognitive map where two opposing disciplinarians can look at the same thing but not see the same thing. My experience of working within this multi-disciplinary team was positive with all professionals having a voice. However on reflection and through IPW I am now more aware of the perspectives of others and the need to define and develop my professional identity. (Bell & Allain 2010 p.10) in their pedagogic study allude to SW students being reverential to medical expertise and giving low ratings on their own abilities of leadership. I feel a dichotomy exists between SW railing against the medical model and promoting the social model whilst deferring to the stereotypes of professionalism within health and social care. For the future I need to be aware of stereotypes and continue to develop my critical reflection of both my personal and professional self whilst developing my abilities to be heard within multiprofessional teams.
As a SW student, I am aware that there exists a blurring of edges of what the SW role entails and how the identity of the role may change in the future. (Payne2006) refers to a social worker working within a mental health practitioners' team which included working alongside nurses and psychologists including high levels of therapy based work, which would not usually sit within social work practice and therefore one's professional identity could be lost. (Lymbury & Butler 2004) state that whilst it is important to share knowledge with other professionals that are allied to social work it is imperative that the identity of one's own profession is preserved. (Laidler 1991) further addresses the issues of crossing professional boundaries describing them as 'professional adulthood'. That IP jealousy and conflicts will arise to the detriment of the team members and more importantly to the service user. Power as exercised may cause some to struggle as power is shared and fluctuates in accordance with whose knowledge and expertise best suits the service user. Envy as discussed by (Schein 2004) identifies ways in which it can stand in the way of good IP learning by creating a collective unconscious resulting in; an attack on colleagues, an attack on learning and failing to learn from each other and or authority figures, and issues of who takes responsibility. Within the Child Protection meeting the chair was a senior SW who co-ordinated the professionals and this caused me to reflect on my abilities, as SWs must deliver safe high quality care but given limited resources , different professional groups will have different priorities and see issues differently. Sellman (2010) concludes that you need to be willing , have trust in others and have effective leadership either acting with your inclinations or action that affords the best outcome however, personal , professional and structural influences can encourage or discourage practitioners. I recognised that for the future I needed to increase my ability to create a dialogue across difference whilst holding on to the dignity and responsibility of every person. (Skaerbaek 2010) purports that by listening to the minority one is able to see the practices that underlie the agenda of the majority.
However the future blurring of health and welfare provision is changing across all sectors. The role of the private sector in the provision of health and welfare practice can provide competitive market forces to drive up the standards and offer greater choice to individuals through direct payments. This in turn can create greater service user autonomy and much more creative solutions. However this can also lead to inequality and a perception that the services are driven by profit bringing the ethical motivation of private sector into question and a blurring of the duties of the state to the service user. (Field and Peck 2003) conclude that the culture of the private and public sector will need to merge and this will result in challenges within roles and organisations. The voluntary sector is one of the fastest growing with voluntary organisations, who, when commissioned, are more accessible to service users and people are more likely to engage with them. They have more freedom acting as advocates and campaigners and are less regulated through targets (Pollard et al 2010). However given the current economic climate and the recently announced budget cuts (Rickets 2010) suggests that the pressure on the voluntary sector to provide more services will continue and if the state retreats from providing services, the voluntary and community sector will fill the gap. Personalisation in which services are tailored to the needs and preferences of citizens is the overall government vision: that the state should empower citizens to shape their own lives and the services they receive. Liberating the NHS 2010 (p3 & 4) states that "We will put patients at the heart of the NHS, through an information revolution and greater choice and control: a. Shared decision making will become the norm: no decision about me without me" and "The Government will devolve power and responsibility for commissioning services to the healthcare professionals closest to patients: GP's and their practice teams working in consortia."(Foreman 2008) sees the need to involve IT in helping to improve and reduce the barriers to IPW. The structures of IPW will continue to evolve and change with complexity and ideological thinking however I need to engage with other professionals and service users in a person centred way.
In conclusion, the IPW conference, literature and subsequent research have clarified my future need to be flexible in both my role and that of others and the primacy of the service user at the centre of my practice. Teams and service users are diverse, comprised of people of different ages, from different social and cultural backgrounds with different expectations. (Carnwell et al 2005 p.56) relates collaboration to embracing diversity and moving away from the comfortable assumption that there is only one way to see the world , providing strategies : learn from each other, embrace IP working, and adopt a value position where anti discriminatory practice is central. By critically reflecting on practice I must embrace a degree of uncertainty and unpredictability as a necessary part of the complex micro and macro systems of IPW.
SECTION 3 - REFERENCES
Adams, K. (2010) What is Interprofessional Education? UWE Bristol, IPE Level 2 Conference.
Baker, D. Day, R. Salas, E. (2006) Teamwork as an essential component of high reliability organizations. Health Services Research 41(4) pp 1576-98.
Barnes, D., Carpenter, J. & Dickinson, C. (2000) 'Inter-professional education for community mental health: attitudes to community care and professional stereotypes', Social Work Education. Vol 19 (6), pp. 565-583.
Haringey Safeguarding Children Board Serious Case Review: Baby Peter Executive Summary (2009).[online] Available from:
http://www.haringeylscb.org/executive_summary_peter_final.pdf [Accessed 22 November 2010]
Barr ,H. (2002) Interprofessional Education Today, Yesterday and Tomorrow: A Review. LTSN HS & P: London.
Barr, H., Freeth, D., Hammick, M., Koppel, I. & Reeves, S. (2000) Evaluations of Interprofessional Education: A United Kingdom Review for Health and Social Care. CAIPE/BERA: London.
Bell, L. and Allain, L. (2010) Exploring Professional Stereotypes and Learning for Interprofessional Practice: An Example from UK Qualifying Level. Social Work Education. Vol 1 pp1 -15
Bristol Royal Infirmary Inquiry HM Government (2001) Learning from Bristol: the report of the public inquiry into children's heart surgery at the Bristol Royal Infirmary 1984 -1995. London: HMSO [online] Available from:
http://www.bristol-inquiry.org.uk/final_report/report/index.htm [Accessed 16 November 2010]
Carnwell, R. Buchanan, J. (2005) Effective Practice in Health & Social Care: A partnership Approach. Berkshire: Open University Press
CAIPE (2002) [online] Available from : http://www.caipe.org.uk/about-us/defining-ipe/ [Accessed 8 November 2010]
Childrens Act (1989) [online] Available from: http://www.legislation.gov.uk/ukpga/1989/41/contents [Accessed 10 November 2010]
Colyer, H. (2004) The construction and development of health professions: where will it end? Journal of Advanced Nursing Vol 48, (4), pp. 408-412
Dalrymple, J. and Burke, B. (2006) Anti-oppressive Practice, Social Care and the Law (2nd edition). Maidenhead: Open University Press
Davies, H. & Shields, A. (1999) Public trust and accountability for clinical performance; lessons from the national press reportage of the Bristol hearing. Journal of Evaluation in Clinical practice. Vol 5,(3) pp. 335-342.
Department of Health (DH) (2006) Options for Excellence- Building the Social care Workforce of the future TSO: London
Dombeck, M. (1997) Professional personhood:training, territoriality and tolerance. Journal of Interprofessional Care, 11 pp. 9-21.
Field, J & Peck, E. (2003) Public-private partnerships in healthcare: the managers' perspective. Health and Social Care in the Community. Vol 11 pp.494-501
Foreman, D. (2008) Using technology to overcome some traditional barriers to effective clinical interprofessional learning. Journal of Interprofessional Care, Vol 22(2) pp.209-211.
General Social Care Council (2008) Social Work at its Best: A Statement of Social Work Roles and Tasks for the 21st Century [online]. Available at http://www.gscc.org.uk [Accessed 18 November 2010]
HM Government (2004) Every Child Matters: Change for Children 2004. London: HMSO [online] Available from:
http://www.opsi.gov.uk/Acts/acts2004/ukpga_20040031_en_1 [Accessed 19 November 2010]
HM Government (2010) Equity and excellence: Liberating the NHS. London: HMSO [online] Available from: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_117794.pdf [Accessed 19 November 2010]
Haringey Safeguarding Children Board Serious Case Review: Baby Peter Executive Summary (2009).[online] Available from:
http://www.haringeylscb.org/executive_summary_peter_final.pdf [Accessed 22 November 2010]
Keeping, C. & Barratt, G. 2009 Interprofessional Practice cited in Glasby, J & Dickenson H (2009) International Perspectives on Health and Social Care Oxford Wiley- Blackwell.
Laidler, P. (1991) Adults, and how to become one. Therapy Weekly. Vol 17 (35) p4.
Laming, Lord (2003) The Victoria Climbie Inquiry. Stationery Office, London
Laming, Lord (2009) The Protection of Children in England: A Progress Report. Stationery Office: London
Lukes, S. (1974) Power: A Radical View Basingstoke: Macmillan
Lymbury, M. and Butler, S. (2004) Social work ideals and practice realities. Basingstoke: Palgrave Macmillan
Means, R. (2010) Why Inter-professional Working Matters: From Theory To Practice UWE Bristol, IPE Level 2 Conference.
Mid Staffordshire NHS Foundation Trust Public Inquiry (2010) [online] Available from: http://www.midstaffspublicinquiry.com/ [Accessed 22 November 2010]
Molyneux J (2001) Interprofessional teamworking: what makes teams work well? Journal of Interprofessional Care. 15,(1), pp.338-346
Payne, M. (2006) What is professional social work? Bristol: Polity Press
Pecukonis E, Doyle O, Bliss DL (2008) Reducing barriers to interprofessional training: promoting interprofessional cultural competence. Journal of Interprofessional Care Vol 22 pp.417-28
Petrie, H . G. (1976) Do you see what I see? The epistemology of interdisciplinary inquiry. Journal of Aesthetic Education, 10, 29 - 43.
Pollard, K. Thomas, J. and Miers, M. (2010) Understanding Interprofessional Working in Health and Social Care. Basingstoke: Palgrave Macmillan
Quality Assurance Agency (QAA) (2008) Social Work Benchmark Statements [online]. Available at:
[Accessed 15 November 2010]
Rickets, A. (2010) Budget will place major burden on charities. Third Sector [online] Available at: http://www.thirdsector.co.uk/News/DailyBulletin/1011592/Budget-will-place-major-burden-charities-umbrella-bodies- [Accessed 20 November 2010]
Schein, E. (2004) Organizational Culture and Leadership. San Francisco: Jossey-Bass.
Sellman D. (2010) Values and Ethics in Interprofessional Working In Pollard K. Thomas J, Miers, M.(eds) (2010) Understanding Interprofessional Working in Health and Social Care Basingstoke: Palgrave MacMillan
Skaerbaek, E. (2010) Undressing the Emperor? On the ethical dilemmas of heirarchical knowledge Journal of Interprofessional Care, September2010; 24(5) : 579-586
Skills for Care (2006) National Occupational Standards for Social Work. [online]. Available at: http://www.skillsforcare.org.uk (Accessed 19 November 2010).
Stapleton, S. (1998) Team-building: making collaborative practice work. Journal of Nurse-Midwifery 43(1), pp12-18
Thomas, J (2010) Service Users, Carers and Issues for Collaborative Practice cited in Pollard, K, Thomas, J and Miers, M. Understanding Interprofessional Working in Health and Social Car Basingstoke: Palgrave Macmillan.
White, S. & Featherstone, B. (2005) 'Communicating misunderstandings: multi-agency work as social practice', Child and Family Social Work, Vol. 10, pp. 207-216
Williams, V. and Drake, S. (2010) Intermediate Care (IMCS) Bridging the Gap Facilitated Discharge. UWE Bristol, IPE Level 2 Conference.
APPENDIX- 6 AGREED GROUP SENTENCES
Theme 1: Communication issues between Health and Social Care professionals
Clear and concise communication is key to a well co-ordinated transfer within health and social care services.
Health and Social care professionals need to recognise the importance of maintaining privacy, dignity and respect when communicating in the presence of service users.
Theme 2: Contrasting professional perspectives/ values within teams.
Recognise the importance of valuing each health and social care professions perspective.
Challenging professional boundaries creatively whilst advocating ones own professions values and ethics.
Theme 3: Stereotyping, power imbalances and team processes
Positive attitudes to working with other health and social care professionals in a real world environment with the patient/service user at the centre of planning and documenting is necessary to reduce power imbalances.
Recognise and embrace differences to minimise stereotypical views within health and social care.
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