Collaborative or interdisciplinary approach require different individuals or groups come together to share their knowledge and ideas on particular task. Each component of the collaborative team needs to take ownership and work towards identifying areas of improvement. In most of the public and social health organisations, care is being provided independently by respective service providers. There is lack of collaborative work in these organisations. Most of the service providers are being providing services independently because they seek to prove independent capabilities. However, it is evident that health and safety of service users being affected due to independent service provision. Since, independence is impacting health and safety of service users; it would be difficult to promote independent services in health social care setting. Hence, it is necessary maintain independence of the service providers and maintain optimum health and safety of the service users. It can be effectively achieved by promoting interdisciplinary health and social services (Estape et al., 2011).
Four cases were identified where it is necessary to provide interdisciplinary care to these service users. These include case of Mr. A with dementia, case of Mrs. B with hip fracture due to fall, case of Mr. C with multiple organ dysfunction and case of Mrs. D with problem of breastfeeding.
Mr. A, age 74 yrs was admitted to psychiatric ward two days ago. I reached the ward at morning 8 a.m. and I was asking the patients to complete their daily activities. Suddenly, Mr. A became aggressive and started shouting at me and he was not willing to complete his morning daily activities. I was freighted with this behaviour because previously I never experienced such behaviour. I was thinking whether, I did anything wrong with him. In this strange incidence also, I could manage to calm down Mr. A and made him to complete all the activities. I was not happy with the atmosphere of the ward during this incidence because total atmosphere of the ward gets disturbed. I took help of the other senior patients of the ward to assist me in handling the situation. I could have called the senior members of the team and handle the situation. Mr. A need not only medical intervention but also psychiatric and social. Psychiatrist is necessary because it is obligatory to understand reason behind the aggressive behaviour of Mr. A. Role of social health worker is important in case of Mr. A because he was staying alone. His wife expired three years back and his son was separated from him. As a result of dementia, he forgotten that his wife is not alive. He was thinking hospital people are not allowing to meet him to his wife. Hence, he was behaving aggressively with most of the healthcare providers. I would integrate interdisciplinary team comprising of physician, nurse, psychiatrist and social worker for his care (Bulman and Schutz, 2016).
Mrs. B, 82 yrs old was admitted to the orthopaedic department with hip fracture and she was in severe pain. I went on the round with senior physician and I came across Mrs. B. During round, I came to know that her neighbour brought her to the hospital yesterday and since that time nobody was there to take care of her. I was feeling sorry for her and during that visit my sympathy was with her. I observed good thing that ward boy was frequently visiting her and enquiring about her condition. Though, he was not on duty during this time. I observed bad thing that she was experiencing severe pain and she was willing to express her feelings to her son. However, her son was not there. Considering, the situation I requested ward boy to accompany her. I could have called community workers to accompany her and take care of her. If situation occurs in future, I would have incorporated diverse professionals like physician, social worker and pharmacist. Since, her pain was not getting relived, I could have brought it to the notice of physician and pharmacist to alter dose of the medicine. I could have asked social worker to convince his son to accompany her in this difficult situation. His son was in confusion to come to the hospital because he was thinking he would not be able take care of his wife and 2 yrs daughter; if he would go to the hospital. Moreover, I would have asked social worker to arrange community members to take care of her. Hence, interdisciplinary care comprising of physician, nurse, pharmacist and social worker is necessary to provide medical, emotional and social intervention to Mrs. B (Bulman and Schutz, 2016).
Mr C, age 62 yrs was admitted to hospital with multiple complications. I visited the ward in the morning session and observed that his family members were in deep grief due to his health condition. During this visit, I was thinking that I need to give emotional support to his family members. I observed that his health condition was improving since last two days. It was evident from her medical records. However, his family members were not giving moral and emotional support to him. I suggested his family members to shift him to the special room. Hence, he would not feel the burden of grief of his family members. I could have taken social worker with me to provide counselling to Mr. C and his family members. I would incorporate different professionals like general physician gastroenterologist, psychiatrist, cardiologist, pulmonology specialist, diagnostic personal and pharmacist to assess his actual health condition and to provide immediate care (Bulman and Schutz, 2016).
Mrs. D, age 30 yrs was in obstetrics unit and she delivered baby boy three days before. When I entered her room, I observed that she was stressed and she was forcibly trying to breastfeed her baby because her baby was not taking breastfeeding. During this incidence, I felt that she was not doing right thing by forcible breastfeeding her. It was good that she was able to produce milk because in few of the unsuccessful breastfeeding cases it was observed that milk production from mother was not adequate. Her baby was crying continuously due to her unsuccessful efforts for breastfeeding. During this incidence, I tried to help her to feed her child. I could have asked to take initiative by the senior female member of the family to assist her in breastfeeding. I incorporated lactation consultant, psychiatrist and social worker for initiating effective breastfeeding in her. Lactation consultant would give her training about breastfeeding, psychiatrist would provide her counselling because she was feeling depressed and social worker would give her and her family members counselling for moral support (Bulman and Schutz, 2016).
Practitioner need to have certain qualities for effective management of collaborative team work. These qualities include effective communication, respecting or understanding roles, appropriate skill mix, quality and outcomes of care, clear vision, flexibility, leadership and management, team culture, consideration of personal attributes, provision of individual rewards and training and development opportunities. In all the above-mentioned cases different professionals like physician, nurses, pharmacist, social worker and diagnostic personal need to be worked. It is necessary to bring effective communication among all these professionals because activity of each of these professionals should support each other. This communication should be two-way; otherwise health and safety of A, B, C and D patients would be affected. Practitioner managing collaborative team need to respect role of each member of team. It would be helpful in maintaining dignity of health and social care professionals. It would also be beneficial in understanding capabilities of the team member; hence, practitioner can assign relevant work to the respective professional (Nancarrow et al., 2013).
Professionals from different disciplines are necessary to provide care to patients like A, B, C and D. Practitioner need to value the diversity in the team and take input from each members of the team to bring complementary experience to provide effective care to the patients. Practitioner need to ensure quality and outcomes of team through reflective mechanisms of the team members. Practitioner need to ensure team members to accept criticism, define their outcome, follow-up patients, maintain timeline, keep up to date skills and information and provide feedback. Practitioner need to ensure that each member of the team have sufficient resources and optimum workload for completion of the task (Andreatta and Marzano, 2012).
In case of B and D; additional manpower is required other than the collaborative team. In case of patient B, social worker needs to arrange community person to take care of her in absence of her son. In case of patient D, it necessary to have a woman who can teach breastfeeding technique to Mrs. D. Practitioner should ensure that he and his team members should have clear vision about the role and purpose. Practitioner need to ensure that each member should get opportunity to express their views within their own boundaries (West and Lyubovnikova, 2013). Practitioner need to be good leader and manager. Practitioner need to bring team culture which would be helpful in bringing informal relationship, friendship, trust, mutual respect, reliability and commitment. Practitioner need to provide training to all the team members and give them opportunity to share knowledge and provide education to other team members. Personal attributes are the important aspects for bringing excellence in team members. Practitioner need to provide rewards and opportunity for team members to receive financial rewards and career development (O’Connor and Fisher, 2011).
Multi-agency team work is associated with limitations or boundaries for knowledge distribution. With the change in the roles and responsibilities, professional identity gets affected. It is difficult for the professionals to accept the disintegration of one identity prior to building new identity. In the care of these four patients, multi-agency care is not applicable because there should not be knowledge boundary while providing care to these four patients. On the other hand, there would not be knowledge boundary in the multi-disciplinary working. Multi-disciplinary care needs to be provided to patients A, B, C and D. Multi-disciplinary team is necessary in providing care to these patients because professionals from different disciplines like medical, social, nursing, diagnostic and pharmacy need to work in coordination with one another for providing care to these patients (Kate, 2008).
Individuals working in multi-agency environment would not get time to adjust to the changing environment. These individuals would have less time between the strategic planning to operational implementation. Professionals working in the multi-disciplinary team would be mostly aware of the work setting and they can provide service on the immediate basis. Immediate care needs to be provided to all these A, B, C and D patients. Meetings and discussions would be on regular basis in case of interdisciplinary team. It would be helpful for exchange of knowledge and information among the team members. Discussions among team members would also be helpful in effective planning of care for A, B, C and D patients. Collaboration of agencies occur at the organisational level; however, in case of multi-disciplinary work, collaboration occur at different professionals’ level (Kate, 2008).
In multi-agencies collaboration certain health related national and international organisations; also, certain Government and non-Government organisations can be involved. In multi-disciplinary collaboration certain professionals like health care workers, social care workers, allied healthcare workers, education professionals and voluntary care workers can be involved. In most of the case, multi-agency collaboration needs to work towards providing public health and long-term planning (Maidment et al., 2017). Multi-disciplinary collaboration work towards providing holistic care to the patient. Patients A, B, C and D are associated with multiple problems; hence, multi-disciplinary collaboration comprising of different healthcare professionals need to be incorporated in the care of these patients. Multi-agency collaboration mainly focusses on the planning, funding and delivery of care for the patients at the health care centre of multi-disciplinary professionals. Multi-agency collaboration work together with local authorities to provide community-based healthcare services and promote heath and wellbeing through evidence, local information, skills and resources. Multi-disciplinary team work as the local authorities for multi-agency collaboration and ensure adequate availability of resources (Maidment et al., 2017).
Multi-agency collaboration would be helpful in facilitating shared vision, development and implementation of novel healthcare and social service models. It would also be responsible for improving awareness and communication among different team members and organisations. Multiple organisations need to work together to develop and adopt protocols for implementation of health services. All the staff members need to be engaged continuously and at all levels for the service users to provide integrated services (Kate, 2008). Different organisations and staff members communicate effectively to perform all the activities in the effective manner. Members of the multi-agency and multi-disciplinary team need to communicate about barriers encountered in the implementation of the programme. These members also should discuss progress of the programme. These members should use personal relationships to eliminate barriers for working together. Team members should enlighten each other for working together by educating about value of working together. Members of the multi-agency team need to consider the impact of organisational change and need to work towards achieving common goal and establishing professional roles (DeSisto et al., 2017; Maidment et al., 2017).
Health and social care agencies need to span and disrupt boundaries of diverse aspects like geography, socioeconomic status and epidemiological burden for providing effective care. Cross-country learning networks and community practice services would be helpful in providing effective care in the low- and middle-income countries. Mindset for boundary-spanning practices should be inclusiveness, with awareness of and respect for all the member countries (Meerkerk and Edelenbos, 2018). Boundary-spanning would be helpful in implementing and building institutions for achieving global health goals. Boundary spanning is the capability of leadership which create direction, alignment and commitment across different organisations to achieve common goals. Boundary spanning would be helpful in building positive personal relationship among members of different healthcare and social organisations (De Regge et al., 2018).
There should be positive relationship among physician, nurse, health administrators and social workers. It would reflect respect for each other to achieve goals and to work together to achieve the common goals. It would be feasible to maintain positive relationship in multi-disciplinary work; however, it would be difficult to maintain positive relationship in multi-agency work. Healthcare administrators and physicians need to solve practical difficulties of nurse. Moreover, they should ensure that all the resources are available with nurses to solve practical difficulties. Consideration of nurses would be helpful in building positive relationship among the team members which would result in improving quality of the work. Positive relationship among the team members would also be helpful in sharing knowledge and providing effective care to the patients. Positive relationship among nurse and physician would also be helpful in positive reporting of errors by the nurses (McIntosh-Scott, 2013). Hence, physician can provide immediate solution. Not only people at the higher authority but also at bottom can also provide recommendations and initiatives for improving quality of healthcare services in the organisation. Positive relationship would give opportunity for nurses to give recommendations and initiatives. Moreover, positive relationship would enhance chances of acceptance of recommendations and initiatives. Clinical and managerial cultures are important aspects of effective healthcare service. Positive relationship would be helpful in integrating both clinical and managerial cultures for providing effective healthcare services (Gupta et al., 2016; Fox and Cooper, 2013).
References:
Andreatta, P. and Marzano, D. (2012) Healthcare management strategies: interdisciplinary team factors. Current Opinion in Obstetrics and Gynecology, 24(6), pp. 445-52.
Bulman, C., and Schutz, S. (2016). Reflective Practice in Nursing. John Wiley & Sons. New Jersey, United States.
DeSisto, C.L., Estrich, C., Kroelinger, C.D., et al., (2017). Goodman DA, Pliska E, Mackie CN, Waddell LF, Rankin KM. Using a multi-state Learning Community as an implementation strategy for immediate postpartum long-acting reversible contraception. Implementation Science, 12(1):138. doi: 10.1186/s13012-017-0674-9.
De Regge, M., Van Baelen, F., Aerens, S., Deweer, T., and Trybou, J. (2018). The boundary-spanning behavior of nurses: The role of support and affective organizational commitment. Health Care Management Review, doi: 10.1097/HMR.0000000000000210.
Estape, E., Laurido, L.E., Shaheen, M., et al. (2011) Quarshie A, Frontera W, Mays MH, Harrigan R, White R. A multiinstitutional, multidisciplinary model for developing and teaching translational research in health disparities. Clinical and Translational Science, 4(6), pp. 434-8.
Fox, J. L., and Cooper, C. (2013). Boundary-Spanning in Organizations: Network, Influence and Conflict. Routledge. Abingdon, United Kingdom.
Gupta, V., Agarwal, U.A. and Khatri, N. (2016). The relationships between perceived organizational support, affective commitment, psychological contract breach, organizational citizenship behaviour and work engagement. Journal of Advanced Nursing, 72(11), 2806-2817.
Kate, M. (2008). Social Work and Multi-agency Working: Making a Difference. Policy Press. Bristol, United Kingdom.
Maidment, I., Booth, A., Mullan, J., et al. (2017). Developing a framework for a novel multi-disciplinary, multi-agency intervention(s), to improve medication management in community-dwelling older people on complex medication regimens (MEMORABLE)–a realist synthesis. Systematic Reviews, 6(1):125. doi: 10.1186/s13643-017-0528-1.
McIntosh-Scott, A., Mason, T., Mason-Whitehead, E., and Coyle, D. (2013). Key Concepts in Nursing and Healthcare Research. SAGE Publications. California, United States.
Meerkerk, I., and Edelenbos, J. (2018). Boundary Spanners in Public Management and Governance: An Interdisciplinary and Governance. Edward Elgar Publishing. Cheltenham, United Kingdom.
Nancarrow, S.A., Booth, A., Ariss, S., et al. (2013) Ten principles of good interdisciplinary team work. Human Resources for Health, 11(19). doi: 10.1186/1478-4491-11-19.
O’Connor, M. and Fisher, C. (2011) Exploring the dynamics of interdisciplinary palliative care teams in providing psychosocial care: “Everybody thinks that everybody can do it and they can’t”. Journal of Palliative Medicine, 14(2), pp. 191-6.
West, M.A. and Lyubovnikova, J. (2013) Illusions of team working in health care. Journal of Health Organization and Management, 27(1), pp. 134-42.
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