Proving professional interdisciplinary teamwork.
University of New England Armidale
HLTH102: Interprofessional Practice in Health and Social Care
Due Date 03/02/2021
The Definition of Leader
The Health 102: Interprofessional Practice in Health and Social Care course, provided at the University of New England, Armidale, provides a case study by which students may become familiar with relevant legal, ethical and professional requirements in context. The Case Study describes a malfunctioning pair of teams beset with poor communication, leading our care staff protagonist to flounder between two hospitals, government support agencies, the patients and their family members. The Case Study highlights analysis of professional practice for multidisciplinary teams, and the need for self-responsibility in future employ in the healthcare industry. The end of the Case Study has our protagonist appearing incompetent and ignorant to the mother of the car accident victim due to repeated lapses in communication, which would otherwise define a multidisciplinary team.
Leadership and Collaboration
Effective communication is a skill which requires appropriate training, which has a history of positive outcomes for a wide variety of professionals (Donesky et al., 2016) and especially when it includes practical metacognition for effectiveness (Berkhof et al., 2011). The Department of Health (2017) indicates that a functioning recall system with a case manager to coordinate patient, professionals and the care plan yields the most effective and efficient provision of service, all of which is based on clear staff duties and communication: The Genaurie and Tabletop Community Case Study repeatedly exemplifies a severe lack of both. This indicates upper-level management may need to open lines of feedback to foster a naturally communicative team (Brown, 2020).
As Forsyth and Mason indicate (2017), where specialists feel their professional identity is under threat, perhaps due to unclear duties and responsibilities, leadership is unlikely to emerge in practice. This may be the actual source of poor communication in this Case Study, and line managers would be responsible for creating team identification and membership, with the latest evidence reiterating group membership and collaboration: multidisciplinary teams are a group of leaders contributing collectively (McAuliffe et al., 2019).
Protocol and Professionalism
Each and every professional in healthcare is overseen by a society, association, organisation and/or governmental department which provides standards of care and conduct, all of which are readily accessible online. For this Case Study, the patient transfer depended upon a multidisciplinary team. I have listed below key staff and their standards in context of the Case Study, including some reflections on each position.
Doctors
The Australian Health Practitioner Regulatory Agency provides a comprehensive Code of Conduct for Doctors (October, 2020), as does the Australian Medical Association (Rev. 2016), which specifically states, ‘2.1.9 Facilitate coordination and continuity of care’, and ‘3.4.3 Work collaboratively with other members of the patient’s health care team’. The doctor was negligent through not ensuring all staff were informed of Jason’s needs. If I were the doctor, I would have briefed the head nurse, receiving hospital staff, the social worker and the accompanying medical transport staff in a pre-transfer meeting. This would demonstrate facilitation of care and would be working collaboratively, with the result of maximising patient safety.
Nurses
Nursing is subject a variety of peak bodies such as AHPRA and ICN with detailed policy related to standards of practice and ethics. The Nursing and Midwifery Board of Australia has a Code of Conduct for Nurses (March, 2018) and states ‘3.3 Effective Communication d. clearly and accurately communicate relevant and timely information about the person to colleagues, within the bounds of relevant privacy requirements’. The Case Study nurses are negligent through a series of lapses in this code at both Glenaurie and Tabletop Hospitals. The protagonist of the Case Study is repeatedly left uninformed despite repeated requests for information. Were I in either nursing positions, I would have informed the protagonist the reason for not sharing the information, or the reason I was unable to obtain it. I personally cannot think of a professional reason that a healthcare team member would not be kept immediately informed, barring actionable behaviour.
Line Manager
Although I am not sure as to the actual professional identity of the ‘line manager’ as referred to in the Case Study (I tried confirming on JobSeeker, Internet searches, and UNE Library journal searches), as a healthcare professional, the NSW Health Code of Conduct (2015) would seem to apply with ‘4.1.2 Treat all other members of staff… in a way that promotes harmonious and productive working relationships, and a collaborative teamwork approach’. The Case Study line manager was repeatedly negligent through failure to convey relevant information timely to the protagonist, resulting in a very unprofessional working environment. If I were the line manager, I would – bare minimum – send updates via emails or messages to relevant staff.
Social Worker
The Case Study seemed to indicate a great need for an informed social worker to function as part of Jason’s (critically injured patient) healthcare team. The protagonist is repeatedly left uninformed, especially by the line manager. With Maureen (patient’s mother and main carer post-release) updating the social worker of Jason’s situation, a great deal of doubt is naturally cast by the whole team on this person. This situation is extremely unprofessional. Were I in this situation, I would address the line manager pursuant to improving lines of communication. Were there no professional reason for this situation, I may need to follow up with the supervising doctor or head registered nurse, or the hospital general manager. Based on the evidence, I can only conclude the executives at both hospitals engender an unsafe work culture.
Organisational Management: As above, so below
Suitable Change
It is unlikely that a grass-roots movement led by the protagonist in this Case Study would result in any positive change in attitudes, such as lodging official complaints with the Medical Board of Australia, or going live with the Australian Broadcasting Commission. Rather, a suitable evaluation and management training system would need to be implemented. Evidence indicates the workplace environment actually extends from the executive team’s management style (Kalim & Ingelsson, 2019). Implementing new management practices here would not a simple process, as healthcare is not analogous to other industries, so the choice of change must be appropriate (Stanton et al., 2014; Alsalem et al., 2018). The multidisciplinary nature of healthcare indicates not an hierarchical, time- and resource-demanding approach to training such as with Lead, but one more in line with the principles of social work, which to my mind, aim for the fulcrum of respect and honesty (International Federation of Social Workers, 2 July, 2018).
Climate Change
For any implementation of training to be effective, evidence indicates all levels of management must lead in creating an organisational climate of learning (Conner et al., 2020; Lyman et al., 2020). In opposition to the Case Study, where the protagonist is framed as a new staff member and is repeatedly ignored and left uninformed, a necessary change in the work climate is clearly indicated. One training method with proven success is Crew Resource Management (CRM). This approach is focussed on the identification of human error, and where content terms are clarified, has proven to reduce errors and increase patient safety (Gross et al., 2019; Chan et al., 2016; Kuy & Romero, 2017). If I were involved in staff management at either hospital, I would propose a CRM-based training program aimed at multidisciplinary cooperation and patient safety.
Critical Care Reflection
Analysis of this Case Study and exploring the evidence available, at some points, reinforced my assumptions, and at others, deleted them. The process of analysing and assimilating dozens of articles related to patient safety and a safe working climate has certainly broadened my awareness of healthcare. The standards and policies provided by a variety of organisations seem to reiterate the same values of respect and honesty for others, which the Case Study targets the protagonist as receiving little to none of both.
The literature reviewed, not all of which made it into the reference section, covers a huge range of issues and solutions of varying effectiveness, yet the Case Study effectively highlights how poor leadership results in communication breakdowns, increasing patient danger and generating a very negative reputation of healthcare with staff and the public alike. Were complications to arise with Jason post-transfer, an inquiry would seemingly place almost every key healthcare staff member as culpable.
If I were the protagonist in this Case Study, I would need a great deal of patience, silence, resilience and determination to simply leave the front door in the morning. Interacting with unresponsive key staff would be a continual, high-level stressor. If no solutions or changes were available, I would eventually remove them from my professional focus and centre on assisting Maureen and Jason with rebuilding their lives – in isolation from the hospital staff.
The Case Study has reinforced my prior knowledge and skills relating to the importance of education, of communication, and of personal integrity. Training, learning and skills development, transposed from teaching English in Japan to the Australian healthcare system, all seem to be just as relevant if we are to improve the quality of life of the people around us.
References
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Australian Health Practitioner Regulatory Agency. (2020). Code of Conduct for Doctors. https://www.wslhd.health.nsw.gov.au/ArticleDocuments/1650/Medical-Board—Code—Good-medical-practice-a-code-of-conduct-for-doctors-in-Australia—1-October-2020.pdf.aspx
Australian Medical Association. (2016). Code of Ethics. https://ama.com.au/sites/default/files/documents/AMA_Code_of_Ethics_2004._Editorially_Revised_2006._Revised_2016_0.pdf
Berkhof, M., van Rijssen, H. J., Schellart, A. J.M, Anema, J. R, & van der Beek, A. J. (2011). Effective training strategies for teaching communication skills to physicians: An overview of systematic reviews. Patient Education and Counseling, 84(2), pp 152–162. https://doi.org/10.1016/j.pec.2010.06.010
Brown, A. (2020). Communication and leadership in healthcare quality governance. Journal of Health Organization and Management, 34(2), 144–161. https://doi.org/10.1108/JHOM-07-2019-0194
Chan, C.K.W., So, E.H.K., Ng, G.W.Y., Ma, T.W.L., Chan, K.K.L., & Ho, L.Y. (2016). Participant evaluation of simulation training using crew resource management in a hospital setting in Hong Kong. Hong Kong Medical Journal = Xianggang Yi Xue Za Zhi, 22(2), 131–137. https://doi.org/10.12809/hkmj154595
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Department of Health. (2017). Health Care Homes. Best-practice examples of chronic disease management in Australia. https://www1.health.gov.au/internet/main/publishing.nsf/Content/DC81DBD295AA217BCA2580F70015FF57/$File/Providers_practice%20case%20studies_coordinated%20carev.3.pdf
Donesky, D., Reid, T., Joseph, D., & Anderson, W. (2016). TeamTalk: Interprofessional Team Development and Communication Skills Training (FR482B). Journal of Pain and Symptom Management, Volume 51, (Issue 2),pp 382-383.https://doi.org/10.1016/j.jpainsymman.2015.12.255
Forsyth, C., & Mason, B. (2017). Shared leadership and group identification in healthcare: The leadership beliefs of clinicians working in interprofessional teams. Journal of Interprofessional Care, 31(3), 291–299. https://doi.org/10.1080/13561820.2017.1280005
Gross, B., Rusin, L., Kiesewetter, J., Zottmann, J.M., Fishcer, M.R., Prukner, S., & Zech, A. (2019). Crew resource management training in healthcare: A systematic review of intervention design, training conditions and evaluation. BJM Open, 9(2), doi:http://dx.doi.org.ezproxy.une.edu.au/10.1136/bmjopen-2018-025247
International Federation of Social Workers. (2 July, 2018). Global Social Work Statement of Ethical Principles. https://www.ifsw.org/global-social-work-statement-of-ethical-principles/
Kahm, T., & Ingelsson, P. (2019). Creating a development force in Swedish healthcare. International Journal of Health Care Quality Assurance, 32(8), 1132–1144. https://doi.org/10.1108/IJHCQA-01-2019-0017
Kuy, S-R., & Romero, R. (2016). Improving staff perception of a safety climate with crew resource management training. The Journal of Surgical Research, 213, 177–183. https://doi.org/10.1016/j.jss.2016.04.013
Lyman, B., Biddulph, M.E., Hopper, V.G., & Brogan, J.L. (2020). Nurses’ experiences of Organisational learning: A qualitative descriptive study. Journal of Nursing Management, 28(6), 1241–1249. https://doi.org/10.1111/jonm.13070
McAuliffe, E., DeBrun, A., & Cunningham, U. (2019). Collective Leadership and Safety Cultures: Developing an alternative model of leadership for healthcare teams. International Journal of Integrated Care, 19(4), 55. https://doi.org/10.5334/ijic.s3055
Nursing and Midwifery Board of Australia. (2018). Codes of Conduct for Nurses. http://www.nursingmidwiferyboard.gov.au/documents/default.aspx?record=WD17%2f23850&dbid=AP&chksum=L8j874hp3DTlC1Sj4klHag%3d%3d
Policy Directive NSW Health. (2015). Code of Conduct. https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2015_049.pdf#page10
Stanton, P., Gough, R., Ballardie, R., Bartram, T., Bamber, G. J, & Sohal, A. (2014). Implementing lean management/Six Sigma in hospitals: beyond empowerment or work intensification? International Journal of Human Resource Management, 25(21), 2926–2940. https://doi.org/10.1080/09585192.2014.963138