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Collaboration and teamwork ..

Peter MilburnNov 2008

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Questions and issues for

discussion.. Is the consideration of collaborative practice necessary at all??

Could you recognise effective collaboration if you met it!!

Is it a learnt skill?

Are there factors that might hinder or facilitate effective collaborativepractice within a healthcare team or organisation?

A definition ..

Effective collaboration in the modern health and social care sector isabout everyone appreciating there position and being clear about

where the book stops (if things get sticky) and doing as they are toldwithout question?

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The n MRCGP..

Curriculum Statements:

Coordinating care with other professionals in primary care and withother specialties

Understanding the importance of excellent communication with patients

and staff and skill in effective teamworkbeing a GP requires the ability to be an effective team player

Understand methods and models of brining about effective teamwork

(n MRCGP 2007)

Similar statements appear in the curriculum of every Health and SocialCare Practitioner

the majority of H&SC practitioners are now taught oninterprofessional programmes

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Policy statements .

The NHS Plan (2000)social services and the NHS will cometogether with new agreements to pool resources . preventpatients/clients falling in the cracks between ..

Every Child Matters (2003) addressing poor integration of

services Modernising Medical Careers 2003Reform had been long

overdue and was driven by the need for care based in moreeffective teamwork, a multi-disciplinary approach and moreflexible training pathways tailored to meet service andpersonal development needs.

Our Health, our Care, our Say (2006)integratedapproaches innovative models of joined-up support withincommunities

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Secondly, UK society is changing .

- The breakdown of the post-war social democraticconsensus

- Increase in personal wealth and autonomy

- Growth in the availability of material goods

- Dissolution of social hierarchies (elders and betters)- Society has become secular, materialistic,

individualistic & rights focused

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How has the NHS changed in response

http://images.google.co.uk/imgres?imgurl=http://www.nhscampaign.org/uploads/images/KONP%2520jpeg.jpg&imgrefurl=http://nhscampaign.org/&h=654&w=1417&sz=448&hl=en&start=4&usg=__lTjdts8nxjR9vVFkj6qj5TF_9JE=&tbnid=C0eGFGaxuX5TnM:&tbnh=69&tbnw=150&prev=/images%3Fq%3Dthe%2Bnhs%26gbv%3D2%26hl%3Den

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The NHS of today is .

Market-led (payment by results)

Bureaucratic Quality driven

Standardised (NICE, SCIE)

Accountable

Performance Managed (AfC) Has (or attempting to) break down professional

boundaries, barriers and restricted practices

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The language of Health Care has

Changed

Autonomy (not paternalism)

Individual need (not common good)

Choice (not sameness) Partnership (not deference)

Empowerment (not authority)

Person-centred (not professionally-led)

Consumer(not patient)

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Do you think ..

the response appropriate??

the response is evidence based??

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How have the professions responded

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How have the professions responded

Positively by:

Creating pillars of society

Reflect rationality

Adopting practice concerned with core values selflessness / advocacy

Managing scares resources effectively

Applying rational knowledge efficiently and regardless of person

Having developed and work to written code of ethics

Negatively by:

Creating closed occupational group

Establishing elitists training & selection programmes

Formed professional association to exclude others Being political activity to establish recognition and protection of professional

work

Put the interest of their profession before the needs of the public

adapted from Wilensky (1964) (Schon 1988)

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What is it the public want from

professionals.

Knowledge: accurate, up-to-date and evidencebased

Skills: expert clinical and personal skills, open-minded team players

Attitudes: compassionate, respectful,enquiring, fostering independence, honest,focusing on possibility not risk

Recognition that complex services can only bedelivered with openness, transparency and

COLLABORATION

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What are the boundaries to effective

collaborative practice in General Practice

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Suggestions .

Organisational Barriers: Organisations have different structures, cultures

and financial arrangements working across thehealth social care divide

Professional Barriers: Individuals working in Primary Care belong to and

identify with different (professional) groups, each ofwhich may have differences in knowledge andvalues

Personal Inability: Differences in personality traits and preferences

may make collaboration difficult

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Models to investigate and facilitate

collaborative practice .

General systems theory

Models of power

Social Identity theory

Contact hypothesis

Psychodynamic theory

Functional transactional analysis (TA)

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Questions ton ask that may help you

collaborate more effectively .

Who do I need to work with and why?

What kinds of relationship do we want?

How do we expect the relationship to operate?

Is our experience of the relationship satisfactory? How well do organizational factors support the

relationship?

How well do people factors support the relationship?

Is the relationship delivering the desired outcomes?

(Meads and Ashcroft 2005)

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How do you know how well you collaborate: The

Taxonomy of collaboration .

In your association with others do you ..

Work in isolation

Only have encounters other professionals Communication effectively when necessary

Collaborate to make effective decisions

Lead a fully integrated team of professions each

being equally responsible for their owneffectiveness(adapted from Bond et al 1985)

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The excuses.

Conflicting pressures and constraints

Im to busy to be bothered (I cant manage myselfeffectively how on earth can I manage others!)

Organisational and professional differences

If I collaborate others will start to think they can do myjob as well as me!!

Power relationships

Its natural and important for there to be a social order

how else would I justify being paid twice as much!!

Lack of clarity about purpose and outcomes

My role keeps changing and I am continually being todeliver a different set of outcomes

(adapted from Charlesworth 2003)

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A definition ..

Effective collaboration in the modern healthand social care sector is about everyone

appreciating there position and being clear

about where the book stops (if things get

sticky) and doing as they are told without

question?

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The outcome ..

When the social services came to see me, she

said, We didnt realise your mothers legs werethat bad. I said, Well, I told you they were whenshe was in hospital. When the district nursecomes, they say they dont do legs any longerthey dont wash legs, thats the social services job.

So theyre arguing in my mothers house aboutwhos going to do what.(Service user quoted by Charlesworth 2003)

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Health is not a product, but a process of interaction withinand between individuals and the societies in which theylive.

The recognition of health and welfare within society as aninteractive, adaptive process without an end becomes theonly creative basis for strategies, policies and practices.

In this interactive process, by definition, the ability tocollaborate is essential.

(Loxley 1997 p.29)