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Section 1
Collaborative practice aims to deliver high quality, patient centred, safe and
effective care. This involves multiple professionals with different knowledge,
skills and experience working together to meet the patients, families and
carers needs and preferences (Elsevier, 2013). In this essay, I will be
discussing my experience with collaborative practice whilst I was on
placement and will be relating it to the knowledge, skills and values behind
collaborative working which are taught elements of the module. My
placement was with a Community Mental Health Team (CMHT) and I had
plenty of opportunity to see collaborative practice as the team was
integrated with different health and social care professionals. Furthermore, I
will be utilising Rolfe et al.’s (2001) reflective model throughout the second
part my essay and I will be justifying my chosen model.
Furthermore, the Code of Ethics (College of Occupational Therapists, COT,
2015) state the importance of multi-professional collaboration to ensure a
well-coordinated and effective service. For example, if the Occupational
Therapist (OT) feels that a task is beyond their expertise, they a have a duty
to refer to another professional or service for additional knowledge and
support (COT,2015). Complex case meetings with the whole team is an
example of collaborative practice that I have experienced on placement. This
meeting would occur once every three weeks and involves everyone in the
team coming together to discuss patients who’s needs have become more
complex and allows other members of the multidisciplinary team (MDT) to
share their professional opinion and identify options and solutions to best
tackle the situation. For example, a nurse has observed that her patients
home environment may not be safe and suitable so she liased with the OT to
carry out an environmental assessment. The OT adapted stair rails and a
toilet frame which has made the patient feel safer and independent at home.
This demonstrates effective teamwork as the team functions
interdependently towards a common objective and have a shared
understanding which results in better coordinated care and productivity
(Babiker et al., 2014; Stewart, Manz and Sims 1999).
The role of the OT within the team is to enable patients to actively
participate in areas of self-care, productivity and leisure as mental illness
can affect the individual’s occupations due to loss of confidence and skills
(COT, 2017). I have found that the OT’s role was clear to other members of
the team which resulted in effective teamwork, efficiency and better patient
outcomes as the OT received the appropriate referrals and duplications of
interventions are prevented (Youssef and Kadami, 2017). Furthermore, role
ambiguity is a barrier that affects the teams performance, leads to unclear
priorities and lack of accountability and tribalism (Brault et al., 2014).
Tribalism is defined as having a loyalty to a group with strong negative
feelings for individuals outside the group (Merriam-Webster, 2018).
The CMHT managed conflict and tribalism from occurring in the workplace
through a variety of ways. Firstly, by having a common objective which is
addressed weekly during MDT meetings. For example, the team would
discuss and review a detailed team action plan which allocated different
members of the MDT to a task (i.e. design and complete audit for care plans
to establish current practice was allocated to two practitioners with differing
professional backgrounds). Secondly, the team has an Equality and Diversity
Champion to promote all aspects of Equality and Diversity. It is their
responsibility to attend quarterly Diversity Champion meetings in the trust to
feedback information to their team on current, equality and diversity
guidance and to raise concerns regarding this issue (Equality and Diversity
Steering Group, 2012). This allows the team to meet their duties under the
Equality Act (2010) which protects individuals from discrimination in the
workplace and community. Thirdly, the team maintained a rapport with one
another which was strengthened by interprofessional education. This
involved members of the team continuously exchanging knowledge that
would be beneficial to the care of the patient (Li, 2007). For example, the OT
conducted a workshop for her team which clarified the role of the OT and
explained what interventions she can provide. I have observed that these
elements built stronger team relationships, encouraged shared decision
making and nurtured a learning culture. Furthermore, NICE guidelines
(2018) state that shared decision-making puts patients at the centre of
decisions about their own treatment as care and treatment options,
alongside risks and benefits, are fully explored and practitioners can tailor
the treatment to the needs of the individual.
On the other hand, tribalism can occur in some places which can negatively
impact on collaborative practice as it leads to professionals within the team
having different professional priorities, unclarified assumptions and
expectations and loss of professional identity (Hakanen, Hakkinen and
Soundunsaari, 2015). For example, group members may make false
assumptions about another group member which breaks trust within the
team and impedes the progress of the group (Milward, 2009).
A case study of how tribalism affects patient care is the Winterbourne View
case. This case involved 11 members of staff harming and neglecting
patients with severe learning disabilities. A Care Quality Commission (CQC)
report found that the managers did not report major incidents, did not
appropriately respond to allegations of abuse and failed to provide
appropriate training and supervision to staff (CQC, 2011). This case study
relates to the problem of conformity to group norms, values and perceptions
as the members of staff conformed to the group norms which was abusing
the patients (Buchanan and Huczyynski, 2004). Additionally, a study of
conformity by Milgram’s experiment (1974) found that 65% volunteers
administered electrical shocks to subjects as they complied to an
authoritative figure (Buchanan and Huczyynski, 2004).
Moreover, Nancarrow et al. (2013) state that an effective interdisciplinary
team must meet competencies such as utilising communication strategies
that promote collaborative decision making and team processes, promote
role interdependence and respect for everyone’s role and facilitate personal
professional development. Tuckman’s theory (1965) indicate that there are 5
stages of team formation: Forming, Storming, Norming and Performing. As
the team develops, there is a progression through the stages. Utilizing this
theory can help understand the teams behaviour and maximise productivity
(Stein, n.d). To get from the Forming to Storming stage, the team must
identify and communication goals, role identity/responsibility, establish trust
and have an effective leader (Stein, n.d.). A limitation of Tuckmans theory
is that it is simplistic as it lacks rich detail about group development and
assumes that team building is linear (Buchanan and Huczynski, 2010).
Collaborative practice can influence client-centred practice as Sumsion and
Lencucha (2009) found that team cohesion and consultation with the
patient, their family and members of the MDT contribute to a successful
client-centred approach. This is because effective team work provided more
opportunity to share background information about the clients, appropriately
share referral information and widened the scope of expertise when dealing
with specific patient needs (Sumison and Lencucha, 2009). On the other
hand, a reduction of patient safety can happen when practitioners have
different goals, lack of communication and empowerment. An analysis of
malpractice found that poor teamwork and communication caused 52-70%
harmful events (Royal College of Physicians, 2017). There is a need for
improvement in communication and coordination between hospital and
community staff to prevent poor discharges. A survey from the Queens
Nursing Institute found that 83% of community nurses reported that
coordination and communication with hospital staff were inadequate
(Turnbull,2016).
A high profile example of poor practice by health and social care
professionals is the case of Baby P. Baby P was a 17 month old boy who died
after a series of injuries and had been visited over 60 times by authorities
months prior to his death. Health and social care professionals in this case
failed to identify abuse despite the boy having broken bones and regular
visits to the hospital (Moore, 2009). In this case, social workers,
pediatricians and other professionals who were involved failed to comply
with child protection plans, failed to recognise neglect and abuse, take quick
and appropriate actions and failed to communicate with each other
(McGregor, 2010). Since then, there have been changes and additions to
legislation and policy documents in relation to safeguarding children and
young adults. For example, child protection procedures were reviewed and
the official government child protection guidance ‘Working Together to
Safeguard Children’ was strengthened (Community Care, 2005). This
guidance is derived from the Children’s Act 1989 and Children Act 2004 and
sets out responsibilities and duties for individuals and organisations to work
together effectively to safeguard and promote the welfare of children and
young people, guidance for managing cases where the child’s safety and
welfare are at risk and more (HM Government, 2010).
Ensuring that patients are at the centre of their care is a high priority to
developing high quality healthcare (Ashby and Dowding, 2001). This means
seeing patients and their families as experts to their care to achieve the best
outcomes. Person centred care improves the quality of services, allows
patients to be more active in looking after themselves and reduces some
pressure on health and social services, including multi-agency teams. It
reduces pressure from other services as it encourages people to lead
healthier lifestyles as they learn more about their conditions and breaks
away from older traditions where practitioners ‘do things for’ people (Health
Innovation Network, n.d.). For example, a carers forum took place in my
placement which allowed different members of the CMHT (i.e. manager, OT,
nurses) to meet with the patients carers to identify and discuss whether
there are any improvements or recommendations that needs to be achieved
for the team to be successful in meeting the patient’s and families needs. An
example of a recommendation concluded by the meeting was, ensuring that
care plans/action plans are understandable to the public.
Moreover, National policies in England have identified strengthening
individual and collective involvement in care as a key goal. For example, the
NHS Outcomes Framework ensures that individuals have a positive
experience of care and there are legislations such as the Health and Social
Care Act (2008) that focus on increasing patients to play a more active role
in their own care (CQC, 2018). A National Patient Survey Programme looked
at how patients rate their access to care, high quality and coordinate care,
better information and choice and building closer relationships found that
between 2005-2011, the overall results were above 75% (Health and Social
Care Information Centre, 2015).
Section 2
As stated earlier, I will be utilising Rolfe et al.’s (2001) model which consists
of three headings; What? So What? and Now What? These headings will be
used in this essay to make the structure clearer. This model will act as a
guide to reflect on my strengths and areas of development as a future
professional in collaborative practice. Also, I will justify my chosen model
towards the end of my essay.
What?
At the beginning of the module, we were allocated to smaller
interdisciplinary groups. I have found that my team got along well from the
start as some of us knew each other from working together previously. We
all introduced ourselves and were able to build a rapport with each other
swiftly. This made me feel comfortable sharing my thoughts and opinions
with the team as I felt that I was being listened to. We had a diverse
profession of students in my team which comprised of: occupational
therapists, a mental health nurse, a learning disability nurse and adult
nurses. This enabled us to gain a better understanding of each others roles
and further discuss how our profession would contribute to the scenarios or
activities that were presented each week. For example, we got to discuss in
an activity what problems we experienced during placement, identify areas
of improvement within service and how our professions would tackle a
problem. By doing this, I was able to explore different ways of thinking
about the same problem which developed my critical thinking skills
(Gruenwald, 2014).
Also, we established our roles in the team by using Belbins teamwork
questionnaire (Appendix 1). I have found that my role was the Expert which
states that my strengths are highly task-oriented, a dedicated professional
and have specialised knowledge. A stated weakness of an Expert is that they
tend to become isolated and can dwell on technicalities. In my group, we
found that we all had varied roles thus there was a good balance of
characteristics and contributions from each member (Moga, 2017). When we
were allocated the topic of discussion for the presentation, we all agreed on
who was doing each section and how we were going to structure the
PowerPoint. This made me feel assured that our team would effectively work
together to finish this PowerPoint within the short time frame we were given
which was 6 days. However, conflict arose when bringing the content of the
PowerPoint together. This is because some team members lived outside
Lancaster and nursing students were on placement during this time. This led
to a lack of coordination when we started creating our presentation as we
were not able to meet outside seminar times and thus we were not able to
discuss how everyone was getting on with their work and help those who
were struggling with their section.
So What?
Since the module focused on interdisciplinary teamwork, we were
encouraged to share our own viewpoints, recognise and value other
professionals approach to care. By sharing views from an OT perspective and
listen to other students way of thinking, I was able to think beyond
traditional OT practice and improve interdisciplinary relationships (Ross, King
and Firth ,2005). This has made me feel more confident on my knowledge of
my own profession as I felt that I was able to contribute towards weekly
topics. Furthermore, receiving the role of the Expert from Belbin’s
questionnaire has made me reflect on how I have performed in previous
groupwork activities as I feel that this has accurately presented how I work
with other people. I like to focus on a task, work on it alone then feedback
what I have done and researched about to the group when we come
together. Also, by identifying other people’s team roles, I was able to have
some understanding on how individuals behave in a group. The issues that
arrived from not being able to meet outside seminar times was that some
team members were not able to update the team on their work as they were
busy and stressed with placement. I understood that placement can be
stressful so I did not want to pressure the other team members on getting
their work done promptly. This may have stalled the progress of our work.
However, I trusted my team members to deliver their completed work when
they said they would as everyone attended every seminar and proactively
contributed to discussions. We all discussed and agreed upon the team
contract in the beginning which looked at team procedures, team
expectations, participations, personal accountability and consequences for
failing to follow and fulfil procedures and expectations. We had also set up a
group chat on Facebook so we could communicate and send each other work
more efficiently. This allowed us to overcome the barrier of not being able to
meet outside seminar times as we were able to send each other work in our
own time. The chairman was responsible for putting the PowerPoint together
and we were all able to complete our own sections a day before the
presentation as we sent our work via university email and we communicated
when we were going to meet and practice through Facebook. As we were
going through and practicing the presentation, I stuttered with some words
as I always feel nervous before and during presenting in front of an
audience. However, my team members were very encouraging and made me
feel less nervous.
Now What?
I have found that working in an interdisciplinary group has enhanced my
knowledge about other professions, improved my interpersonal skills and as
a group we were able to demonstrate shared decision making and problem
solving. As the results of Belbin’s questionnaire also stated my weakness,
this gave me a deeper insight on what I can do to improve myself in future
group work and I was more conscious on not dwelling on technicalities and
not overloading my section with too much information. I feel that this
experience will benefit me in future practice as effective teamwork has a
positive impact on patient safety, boosts staff morale and is associated with
reduced medical errors (Baker,2005; Risser, 1999). Furthermore, working in
an interdisciplinary group where we got to discuss how we would problem
solve case studies has made me become an effective team player which has
made me feel more confident in contributing towards multidisciplinary
meetings in the future. For future presentations and practice I will adapt
breathing techniques and keep practicing speaking in front of an audience to
boost my confidence when speaking. Shapira (2015) state that taking
controlled breathes between sentences calms presentation or speech nerves.
I have tried this technique during the presentation and I was able to present
my section without stuttering and my team members mentioned that I
sounded confident as I was not rushing on my points. However, my hands
were shaking from nerves as I was reading from my book. I will overcome
this in the future practice by using hand gestures when explaining my
points.
I have chosen Rolfe et al.’s (2001) reflective model as it only comprised of
three straight forward questions; What? So What? and Now what?. This
format made it easier to write reflectively as I was able to consciously
discuss what happened in the situation, feelings associated with it, how it
has benefitted me, analyse my performance, link theory into the situation
and how my situation relates to future practice. Furthermore, this model is
suitable among novice reflectors thus it is appropriate for my level of
reflective writing (University of Exeter, n.d).
On the other hand, Gibbs’ reflection model (1988) has 6 stages of reflection:
Description, Feelings, Evaluation, Conclusion and Action. This model is useful
for individuals wanting to learn from a situation that they experience
regularly, particularly when it is a negative experience so they can think
about an action plan to improve themselves (Mind Tools, 2018). This model
acknowledges how feelings and thoughts influence situations and allows the
individual to descriptively evaluate events. However, it can be argued that
this model can result in superficial reflection as it does not refer to critical
thinking (Open University, 2018). I have used Gibbs’ model in previous
reflections and I found that I have written too much and had to cut down on
words as the 6 stages required descriptive writing and explanations.
Whereas, using Rolfe’s model made it easier for me to write and reflect on
my situation, thoughts and makes sense of it using theory as it was focused
on 3 simple questions.
In conclusion, the importance of collaborative practice and team working
between professionals has been emphasised and observed in practice as it
enhances the quality of care patients receive. However, it has been
highlighted that there are barriers to collaborative practice such as lack of
communication, tribalism or lack of knowledge of other professions which
leads to harmful situations such as the Baby P case. National policies
highlight the importance of patient centred care to enable individuals to play
an active role in managing their care. Rolfe et al.’s model (2001) has been
used for my reflective piece to explain and analyse my experience in working
within a group setting with other students from different professional
backgrounds. Overall, I have found that this module has been valuable as I
was able to work effectively in a team, share my knowledge of OT, build
relationships and I was able to think more holistically by listening to other
people’s perspective on how they would implement care.
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Appendix
1. Belbin’s Team role questionnaire results: