INTERPROFESSIONAL WORKING, ITS CHALLENGES AND APPLICATIONS IN GYNECOLOGY
Hospital and healthcare delivery is a multistep process involving many stages. From to surgical care, to post-operative monitoring and follow-up, each area brings with it a different set of health personnel who take up the responsibility of caring for the patient. Coordination in all of these departments and health providers is essential; otherwise treatments may be carried out improperly, or may fail miserably, or even worsen the health of the patient. Teams must have clear aims, clear processes and flexible structures which support such coordination (McPherson, Headrick and Moss, 2001, pp ii46). The value of communication cannot be overestimated.
The dynamic environment of the healthcare system involves the contribution of many individuals and professional groups. It is through this contact that learning with others can take place (Hammick et al, 2009, pp 10). In this manner, they come together as a team with a unified intention and aim, in order to serve the patient and ensure positive health outcomes. Thus, it is important that these team members should be on the same footing to ensure quality of service. This interprofessional teamwork is the key to the success or failure of any healthcare service (McPherson, Headrick and Moss, 2001, pp ii46). The results are already showing in the form of decreasing infant mortality rates, mortality and morbidity rates for stroke and traumatic injury patients, and improved levels of functions for patients after heart related surgeries (McPherson, Headrick and Moss, 2001, pp ii46).
Creating an interactive environment in health care delivery is important for multifarious reasons. Firstly, it allows the various contributors to the health of the patient to come together. It allows for better communication between the parties, and creates better organization. It helps in improving the quality of care through integrated distribution of responsibility, leaving fewer margins for error in care provision. It can help improve the speed of care, as more coordinated work can help improve efficiency as well. It is, therefore, one of the uppermost priorities of health policies in the UK. The NHS and government has been actively working in doing research, creating data bases and different learning methods, to help introduce and implement interprofessional working methodology in the British healthcare system (Goodman and Clemow, 2010, pp 87).
Through collaboration, interprofessional working can help in the process of communication between different members of the team. It can help draw out the individual knowledge and expertise of the group members, and apply them according to their validity in the treatment of patients and treatment plans (Illiadi, 2010, pp 130).
The study aims to highlight the benefits of interpersonal working in the department of gynaecology and obstetrics and its current applications in this area. It aims to highlight those researches that show positive outcomes through the implementation of this methodology. The study also aims to look into the challenges that are presenting themselves in interprofessional working. Alongside, it aims to look at the future trends in interprofessional working related to gynaecological practice and what can be done to improve the outcomes.
Researches and evidences now leave no room for doubt that interprofessional working and team play are one of the key factors in the success of care provision (McPherson, Headrick and Moss, 2001, pp ii46). The achievement of the goals put forward to the team, whether it is patient education, or preventing mortality in emergency departments, are the key indicators to the success of team work. Interprofessional team work helps in providing care to patients with continuity, even when the patient is going through various stages of treatment and recovery. It allows for better communication, with no ambiguity, conflict or errors in directions to the patients (Hean, 2010, pp 4). Patients are able to have a coordinated and well planned referral system, which prevents confusion during follow-ups and investigation processes.
With professionals from multiple specialties working together, it allows for a more holistic approach to the treatment, providing challenge to the thinking patterns of care, and thereby allowing innovations in health care treatments and continual improvement. The problem solving capacity of staff is put to test, and the theories are put to practical implementations respectively (Hean, 2010, pp 4).
These are some of the benefits that patients receive. Teams and professionals also stand to gain benefit from such practice; at best, there are no down sides. For example, through interprofessional team work, there is a decrease in the team member turnover, a positive team climate, reduction in the overall costs of health care, improved confidence among the professionals for their contribution in the cases, a positive method to criticize and improve the level of care, and ability to get more done with lesser time (Hean, 2010, pp 4; McPherson, Headrick and Moss, 2001, pp ii47) – in theory, at least.
Knowing these processes can be an advantage to professionals, even when there is no need to apply them (McPherson, Headrick and Moss, 2001, pp ii47). It is important to understand that interprofessional working is intended to exist alongside interprofessional learning. Different professionals, by coming together, are not only able to provide their own input in any given situation, but are also able to learn from their colleagues, thereby allowing the symbiotic transfer of information. This in turn can help them reach towards a better clinical decision and allow for a more holistic treatment planning.
Becoming an interprofessional worker does require some attributes. Being willing to engage in discussions and being flexible about communication with others is the first requirement and is essential. A team can only work when it knows the strengths and weakness of its team members. Therefore, identifying the knowledge and skills of the team is another important prerequisite for learning interprofessionalism (Hammick et al, 2009, pp 17).
There are, however many challenges that remain. A key challenge in the complete integration of such technique in health care system is the difference in the philosophical approach towards team work within team members (Hean, 2010, pp 7). While some members may believe in a hierarchal system of decision making, others may be seeking an integrated version of team play, while still others may be the silent contributors, who only perform or come to light when needed (The Impact and Effectiveness of Inter-professional Education in Primary Care: An RCN Literature Review, 2006, pp 8; Goodman and Clemow, 2010, pp 87). This may change the way each professional handles their responsibly and their approach in communication with other members of the team. Therefore, perhaps the main challenge that needs addressing in educating interprofessionalism among healthcare professionals is to understand these philosophies and how to overcome these differences in approach (Hean, 2010, pp 7).
Again, the philosophical approach towards a member’s role in a team depends on the stereotyping that may be already present among different people of the team (Goodman and Clemow, 2010, pp 87). This may lead to over, under or false expectations towards a contributor in a team (Goodman and Clemow, 2010, pp 96). An open and outright disagreement towards decision making, which is the most important part of the clinical care process, should be avoided (Goodman and Clemow, 2010, pp 94). Therefore, training and teamwork should ensure that such stereotypical thinking is addressed properly, with each member of the team knowing exactly what is expected from them and from other members of the team (Hean, 2010, pp 8).
These initial aspects of coordinated working are important, for they pave the way for more complex health care management systems such as interagency systems or health care systems in different regions (Hean, 2010, pp 11 and 12). The importance of realizing the role of each and every individual, no matter how small, is the key to best healthcare delivery. Without proper coordination of a team, it may be impossible for them to work at regional levels (Hean, 2010, pp 11 and 12).
Alongside, the current need is to make it a part of the clinical curriculum. So far, it is applied as a learning approach in various clinical and health based settings, with no formal teaching or learning style (McPherson, Headrick and Moss, 2001, pp ii47). In order to make it more effective and make new students accustomed to the concept, it should be applied as part of the regular curriculum. Furthermore, practicing these methods during clinical learning will provide the opportunity for practice among students, thereby integrating these concepts (McPherson, Headrick and Moss, 2001, ii 47).
Other issues that present themselves in the implementation of interprofessional working and learning include:
“time consuming consultations, administrative and communication costs, differing leadership styles, language and values between professional groups, separate training backgrounds, inequalities in status and pays, conflicting professional and organizational boundaries and loyalties, lack of clarity about roles and negative mutual perceptions and latent prejudices” (Illiadi, 2010, pp 130).
APPLICATION OF INTERPERSONAL LEARNING IN GYNAE
The different steps in gynaecological practice warrant the need for different health professionals. Each of these professional people has a significant need to address at different times of patient care (The Impact and Effectiveness of Inter-professional Education in Primary Care: An RCN Literature Review, 2006, pp 9). The care of one professional translates into a challenge for another professional, meaning that the care of one person is what is handled by the next professional, and so on. This series of care events is an essential part of gynaecological (and perhaps all) practice, and thus there is need to educate each professional in managing interprofessional skills. A multidisciplinary practice model must be taught to students and members of the staff to help them better understand these integrated practices (The Impact and Effectiveness of Inter-professional Education in Primary Care: An RCN Literature Review, 2006, pp 9). The NSF practices for maternity services require the same form of interpersonal integration as all other components of primary care. In this regard, staff should be well versed in managing multi-agency and multidisciplinary situations and locations. Initiatives in the past such as working together-learning together have been involved in teaching core skills to all professionals, so as to provide a common ground for each member of the team (The Impact and Effectiveness of Inter-p professional Education in Primary Care: An RCN Literature Review, 2006, pp 10).
Gynae and the related medical fields are perhaps more challenging in nature due to the emphasis on accountability in the midwifery practice. The role of all the health care staff, and arguably especially midwifery staff, is essential in caring for women in all phases of pregnancy, delivery and post partum care of the mother and infant. It is essentially the midwives that are involved in communicating the needs of the patient to other members of the healthcare profession. Therefore, a midwife is an essential part of the team of gynae healthcare, and other members of the group must ensure that the comments of the midwife are taken seriously and decisions be made based on her insight (Illiadi, 2010, pp 130 and 131).
The ethical issues pertaining to midwifery and nursing practice related to gynae practice is a highly important component of the work. These should be kept in mind when making decisions, carrying out researches, treating patients and providing accountability for the various actions (Illiadi, 2010, pp 131).
Interprofessional education remains the first step towards the integration of this system in actual health care systems. The five objectives included in interprofessional education include “team work, partnership and collaborative working, skill mix and flexible working, opportunities for flexible career pathways and new types of workers” (The Impact and Effectiveness of Inter-professional Education in Primary Care: An RCN Literature Review, 2006, pp 11).
In this regard, the use of IPE (interprofessional education) can help overcome the many barriers that are involved in care of patients with gynaecological health problems and needs. Certain steps have been highly effective in bringing together forces. The merger of the Academic Division of Midwifery with Academic Divisions of Child Health, Obstetrics and Gynaecology at the University of Nottingham is one such example. In this shared learning strategy, midwifery and medical students share some modules, courses and learning materials with other student groups (Cullen, Fraser and Symonds,2003, pp 428). The method not only brought together the different approaches in treatment planning, but also increased an understanding of each person’s role within a team (Cullen, Fraser and Symonds, 2003, pp 428).
The implications of interprofessional working are not only limited to the health management aspects. With more accountability in health care, the current systems require people who are able to handle many types of responsibilities at the same time. Since this may not be possible, the second best option is working as a unit and a team to achieve goals (Illiadi, 2010, pp 129). The economic outcomes of such efforts are already documented. Study results show that interprofessional working leads to “more efficient use of staff, more effective service provision and a more satisfying work environment” (Illiadi, 2010, pp 130).
Based on the many challenges that face the midwifery and nursing areas pertaining to gynae practice, there are certain steps that can help overcome barriers. Firstly, a neutral basis of operation, with good administrative support during the entire care process of the patient is the first requirement. There should also be a shared interest and credit, with the help of shared resources (Illiadi, 2010, pp 133). As well as this, a partnership with the community is an essential part of interprofessional working, with training of staff in collaborative skills too, which will allow for better communication between members of different professions and roles. Application of these methods can help better outcomes in the health sector.
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