The potential benefits and difficulties associated with interprofessional collaborative working

Discuss the potential benefits and difficulties associated with interprofessional collaborative working, drawing examples from your own experience of the collaborative group work that forms an integral aspect of the module. (2908 words)

The following essay aims to explore different aspects of interprofessional collaboration across healthcare professions, and highlights the benefits and potential difficulties associated with interprofessional working. These topics were discussed extensively within my interprofessional group, and were investigated through enquiry-based learning. The British Medical Association (2004) states that:

“Enquiry based learning (EBL) refers to forms of learning driven by a process of enquiry: this usually involves a deep engagement with a complex problem. (…) It can take several forms including analysis, problem solving and research.”

The issues that were raised and discussed within my interprofessional group during our enquiry-based learning sessions will form the basis of this assignment. Russell and Hymans (1999) define the term ‘interprofessional collaboration’ as:

“Interaction between or among the members of two or more disciplines involving professionals who work together, with intention, mutual respect and commitment for the sake of a more adequate response to a human problem.”

Whilst the concept of interprofessional teamwork has been present since the early 1900s (National League for Nursing, 1998), interprofessional education schemes for healthcare professionals only came into existence in the 1960s (Page and Meerabeau, 2004), and it was only in the 1970s that this approach to working was beginning to be incorporated into the field of healthcare (Madge and Khair, 2000). Therefore, one can assume that traditionally, healthcare professionals did not receive much or any interprofessional education or training, and this could explain the difficulties in implementing such methods of working. However, increasingly, over recent years interprofessional working has been considered a crucial aspect of providing efficient and effective holistic healthcare; today it is widely argued that successful interprofessional collaboration increases the “achievement of positive outcomes for service users” (Gair and Hartery, 2001). Headrick et al (1998) highlight the importance of consistency and continuity in utilising an interprofessional approach to healthcare delivery, by stating that virtually everyone receiving healthcare “interacts with more than one health professional”; this reiterates the need for healthcare workers to possess good interprofessional skills. Lax and Galvin (2002) suggest that changes to health and social care policy and the needs of service users have fuelled the increased demand on healthcare professionals to work collaboratively. As patient and client care needs become increasingly complex, successful teamwork between healthcare professionals is needed (Zwarenstein et al, 2005).

The NHS (2002) reports that there is a history of healthcare systems working against one another, and stresses the importance of collaboration across different professions and trusts. This is just one of many new government health policies which stress the importance of interprofessional collaboration “to ensure more integrated health and social care services” (Rolls et al, 2002). The NHS Modernisation Agency (2003) reinforce this by stating that successful teamwork is to be a “key component” of reform within the NHS. In addition to this, Coombs and Dillon (2002) report that in the United Kingdom the government is encouraging widespread modernisation of the working methods and roles of healthcare professionals, with the intention of developing a more effective, patient-centred approach to the delivery of care through teamwork and collaboration between professionals.

There are clearly many benefits of implementing successful interprofessional collaboration, which explains the reasoning behind an increase in government policy advocating interprofessional working and education in the United Kingdom. However, these advantages are not limited to only effecting the patients and clients receiving healthcare, but also benefit the healthcare professionals themselves. Adamson et al (1995) suggest that job satisfaction is linked to interprofessional collaboration; AbuAlRub (2004) reports that effective collaboration and support between colleagues reduces the perception of work-related stress, and this has the potential to improve the quality of treatment for patients through more efficient teamwork and better staff performance. Interprofessional teamwork facilitates bonding and can improve relationships between team members, by allowing the team to learn about one another (Abbott et al, 2005). I was able to experience this for myself during the first enquiry-based learning session for this module. The students that formed the group were a combination of ‘adult’ student nurses and ‘mental health’ student nurses; these students had not met one another before. The group was divided into two teams and both teams were immediately set the task of constructing a tower from paper and cardboard, as tall as they possibly could, within a given time. This seemed rather trivial at the time, however it clearly illustrates how interprofessional collaboration helps team members to bond, because although we were all strangers to one another, the teams were able to work together towards a common goal. When the task was completed the groups began mixing and socialising within themselves, suggesting that the teamwork orientated task had facilitated group bonding in both of the two groups. This suggests that good interprofessional practice is advantageous to all parties involved.

It can be argued that interprofessional collaboration is of great support to the individual receiving the healthcare, their carer and also their family, as it can include them all in the decision making processes surrounding the delivery of holistic healthcare, and “focuses” on the entire personal needs of the individual (Headrick et al, 1998). Toop (1998) supports this by suggesting that the shared responsibility over the provision of healthcare in interprofessional teams leads to an improvement in patient-centred care. Therefore, an important step in achieving better patient-centred healthcare is to utilise superior interprofessional teamwork (Kremitske and West, 1997). Mandy et al (2004) reinforce the advantages of interprofessional collaboration, stating that interprofessional teamwork is fundamental in order to provide “optimum healthcare delivery”, and according to Roberts and Priest (1997) interprofessional collaboration is essential for “good practice”. The quality of healthcare that clients and patients receive is, therefore dependent on the teamwork of the healthcare professionals, which are providing that care (Kaas et al, 2000); this is backed up by Browne and Odell (2004), who state that “skill-mixing” within teams is an essential aspect of good “workforce planning”. CAIPE (1996) suggest that this is because “the complexities of care cannot be met by the expertise of any one profession in isolation”. When creating a team it is imperative that the individuals within that team possess “personalities and skills” which “compliment” one another, this ensures the presence of “the necessary talent and skill sets to accomplish set goals” (Hill and Ingala, 2001). Therefore good communication among team members is crucial, in order to guarantee that the assortment of “talent and skills” possessed by different members across an interprofessional team are co-ordinated and used effectively to their potential, “so that every patient gets the right care” (NHS, 2000)

Whilst there are clearly numerous advantages to utilising successful interprofessional collaboration, there are also many significant problems in adopting such an approach. There are numerous factors, which have the ability to reduce the success of interprofessional working. Rolls et al (2002) identify three significant inhibitory factors as; “poor communication, conflicting power relations and role confusion”. The term ‘interprofessional collaboration’ and the methods of applying this to clinical practice continue to be areas of poor understanding for healthcare professionals (Kenny, 2002). The confusion and potential problems surrounding working collaboratively are clearly demonstrated in the case of Victoria Climbié; where a “lack of communication and co-ordination” among a range of professional groups failed to prevent an appalling case of child abuse, which eventually led to murder (Royal College of General Practitioners, 2003). The Victoria Climbié case was raised as a topic of discussion during an enquiry-based learning session, and was researched heavily by the group. It became clear through our research and reading surrounding this case that good communication is crucial in order to guarantee effective interprofessional collaboration. Daly (2004) supports this, stating that clear communication between interprofessional team members is an essential “linchpin of successful collaboration”. Poor communication between the professionals involved in the Victoria Climbié case was an immense factor in allowing her child abuse to continue unnoticed (The Victoria Climbié Inquiry, 2003), even though there was an abundance of evidence detailing frequent suspicious injuries and incidents, which were not investigated or followed up. The BBC (2003) state that at the public inquiry twelve separate occasions were highlighted where authorities had the opportunity to intervene and prevent further abuse from occurring, but failed to do so.

The sharing of information and communication between members of the interprofessional team was consistently poor in every aspect of this case; for example, the BBC (2003) report that on one occasion social services had been contacted anonymously and informed that Victoria Climbié was “in danger”; the senior social worker involved denied that he or any of his colleagues received information detailing a “potentially serious child protection case”. This indicates that a serious communication error took place, which meant that this information was not shared or investigated. Communication difficulties are a significant problem when implementing interprofessional collaboration, and quite obviously these difficulties can have disastrous consequences.

Todd et al (1998) highlight that communication difficulties within teams can lead to “poor group dynamics” and detract from job performance and satisfaction. Roberts and Priest (1997) acknowledge this, and suggest that one cause of communication misunderstanding in an interprofessional setting is the difference in “knowledge base and terminology” used by various professionals. This is supported by Headrick et al (1998) who draw attention to the language variations and “jargon” used by different professional groups, however they also indicate that this is caused by differing educational preparation between professions. Therefore, one possible method for overcoming these differences may be to adopt interprofessional education schemes across healthcare professions “at both pre- and post-qualification levels” (Roberts and Priest, 1997). This would allow the barriers and boundaries between professional groups to be crossed, and enable healthcare workers to develop an understanding of the roles and working practices of other professionals.

Confusion and lack of knowledge regarding the roles and responsibilities of each member within an interprofessional team is another factor, which leads to difficulties in implementing successful interprofessional collaboration, and detracts from the ability of the team to provide good holistic healthcare. Pearson (2003) emphasises the severity of this, stating that both “role confusion and role conflict” are now widespread problems in the field of healthcare. It is, therefore, increasingly necessary for healthcare professionals to have an awareness and knowledge of the roles of other professionals within an interprofessional team; the reasons for this are clearly demonstrated in the Victoria Climbié case. The Victoria Climbié Inquiry (2003) details that after one of her numerous admissions to hospital, although she was deemed medically fit enough to be discharged, the doctor involved felt that “she had yet to provide a satisfactory account of what had happened to her”. The doctor then identified that a “proper history” should be obtained, but failed to take any further action, as he wrongly assumed that the nursing staff would do this. Evidently, both the doctor and the nursing staff failed to acquire an account of what had happened to Victoria Climbié, and she was subsequently discharged back into the care of her abusers. This indicates that a gross lack of knowledge regarding the roles of other professional groups led to essential work being omitted, where professionals incorrectly assumed that others would follow up and further investigate the case. T oop (1998) offers one possible explanation for the reason that this crucial work was omitted, claiming that interprofessional teamwork can “blur” the roles and responsibilities of team members, and this can potentially cause a decline in the quality of personal care as this can lead to the duplication or omission of work. Pearson (2003) agrees, stating that the role of the nurse within an interprofessional team has become an area of increasing “ambiguity and debate”. Therefore, in order to minimise and prevent “dysfunction” within interprofessional teams, it is an essential requirement that team members have a shared and mutual understanding of the roles of other professionals working within that team (Rowe, 1996). The lack of awareness and knowledge regarding the roles of other professionals, which was demonstrated in the Victoria Climbié case, is again indicative that an increase in interprofessional education is required among healthcare professionals (Department of Health, 2003).

[...]