Interprofessional team working in healthcare delivery - Essay Example

?Interprofessional Teamwork Introduction The idea of patient-centred is the core of health care plan and interprofessional teamwork in health care services (Reeves, Macmillan & Van Soeren 2010). For this research, the case that will be analysed is the Case of Tom. This case has been chosen because of the following reasons. First, it puts into question the concept of patient–centeredness. In concrete experiences of patients, what does patient-centeredness means? Is it simply a mantra that we continuously repeat, but do not act upon or is it a reality for some patients and not for all? Second, because of the vagueness of the idea of patient-centeredness, the case highlights the wide divide between health policy and health care plan and that no matter hard policy makers think of coming up with ways that may theoretically realise patient centeredness of health care if it is not implemented in real cases, it is worth nothing. Third, it brings to the fore the issue of decision-making in cases of patients that are incapacitated in making the decisions for themselves. Fourth, it emphasises the unclear position of parents in decision-making when it comes to their child who is vulnerated by multiple learning disabilities. Fifth, it presents a stark contradiction to the ideal of interprofessional teamwork to achieve the best quality health care that can be provided to the patients. Finally, sixth, it brings us back to the basics of humanity – rights, dignity, respect, and human integrity. With these reasons, as the study presents the ethical and legal responsibilities that have been neglected by the health care providers of Tom prior to his moving to a social services residential home, it will focus on the concept of interprofessional teamwork as this research will attempt to clarify what does interprofessional teamwork in the health care services means. The researcher is using ‘health care services’ and not ‘health policies’ in order to stress the point that is glaringly presented by the case of Tom – health care services which is supposed to respond to the actual health care needs of actual patients do not ‘necessarily’ mirror the policies that established it. Ethical and Legal Issues In the case of Tom, there are several ethical issues observed. These are 1. The issues pertinent to the autonomy, integrity, and dignity of Tom. 2. The ethical concern regarding decision-making in cases where in the patient is incapacitated to make an autonomous decision. 3. The issue of double standards in care vis-a-vis neglect in providing care. 4. The ethical issue of duty of people who are primarily responsible in providing the necessary care for Tom’s condition and 5. The ethical issue of malfeasance as a result of the negligence of the primary health care providers of Tom. All of these ethical issues are manifested by the failure of the health care team to assess, address and treat the expressions of pain by Tom, which is repeatedly re-affirmed by his parents. In this failure, the entire team failed to recognise and respect the dignity and integrity of Tom as a patient (Gaskell & Nightingale 2010). Tom is in a vulnerated condition of profound and multiple learning disabilities, which places him in a constant situation wherein his dignity and integrity as a person is injured. In this context, treatment should be made available and accessible indiscriminately (Kottow 2010). In his condition, dignity in disease should not be equated with ‘dignity in uprightness’, but it is a differing dignity where “it is not so important whether we are sick or healthy; what matters is to be sick in a healthy way, and not healthy in a sick manner. In the question of autonomy, it is apparent that Tom is incapable of making an autonomous decision. As such, in his behalf, his parents have consistently shown that they are advocating for their child. Beauchamp and Childress (2009) have explained that the norm in disregarding parental decision in terms of treatment is when the decision is refusal of treatment that is detrimental to the well-being of the child or when the decision constitutes child abuse, child neglect and disregard of child’s rights. However, in the case of Tom, his parents are his advocates. They were consistently informing all the key primary health care providers of Tom – the social workers, the care providers who neglected the instruction of the doctor to have Tom examined because of his suspicion that the cause of Tom’s pain is his digestive system, the GP who did not provide the PEG tubing and the psychiatric unit did not take the time to assess Tom’s needs and concerns. Another issue that is glaring in this case is the violation of Tom’s rights as a patient. The question of justice and discrimination is glaring in this case. Alborz, Mcnally and Glendinning (2007) claim that there is a high level of unmet needs of patients who have learning disabilities. This means that care providers have difficulty of identifying what is needed by the patients. However, this is not an excuse not to provide the appropriate care that Tom needed in order to alleviate his pain. In fact, it has been ascertained that health care providers and institutions that are insensitive in respecting and upholding their human dignity have failed people with learning disabilities (Kmietowicz 2007). This discrimination manifests the issue of personhood in dealing with patients who have learning disabilities. In their vulnerated condition, are they less of a person? Of course, this question should not be asked, since, there is no more or less of a person. everybody is equal in our being human. Nonetheless, this is asked because the neglect of the key health care providers of Tom shows that they do not give him the appropriate treatment that respects his dignity, integrity, and rights as a person. Their actions disempowered Tom and his family as try seek the right health care (Bracken & Thomas 2005; Wallcraft 2010). Aside from ethical issues, there are also legal issues involve in the case of Tom. The people involved in Tom’s care violated the Section 21 of Disability Discrimination Act of 1999 which places a significant responsibility to NHS “identify the key physical barriers which made it impossible or unreasonably difficult for disabled people to effectively access health care provision; identify the barriers which disabled people themselves consider to be most in need of addressing; recommend strategies for compliance at different levels throughout the NHS; and provide an estimate of the likely cost of compliance”. In addition, to solidify further the intention of providing quality care to all health care service users, the Health and Social Bill of 2011 is now being lobbied and discussed. It offers reforms to NHS that will democratise the institution, make it more transparent and allocate a wider space for public voice. In the case of Tom, the health care providers and the institutions where he was placed did not adopt any measures that would assists Tom in his pain and a s such, they contributed to Tom’s being ‘doubly disabled’ instead of being treated as equally as a person. Moreover, they have violated the Health Act of 2009 which stipulates that quality care will be provided to patients and patients’ rights and responsibilities will be upheld at all times. At the same time, they have failed to implement the tenets of Mental Health Act of 2007 which states that appropriate treatment is given to the patient “ if the treatment is appropriate in his case, taking into account the degree and nature of his mental disorder of which he is suffering, taking into account the nature and degree of mental disorder form which he is suffering and all other circumstances of his case.” (Part 4, Sec 64 Subsection 4). All these laws and bill show the intention of policy makers to protect the patient, create the condition wherein service users will have the opportunity to have access and availability of health care service and that they will have an equal chance to avail of health care services regardless of one’s stature in life. In this regard, it can be claimed that within the tenets of the law, various safeguards are in place that will protect people like Tom from abuses, maltreatment, and neglect. Although the system is not perfect, but it can maintained there is a conscious effort in protecting the rights of both the service users and the health care providers while health policies are made more responsive to the challenges of contemporary health issues and developments. As such, the primary health care providers of Tom, both the health care providers and institutions, are ethically and legally liable for what had happened to him. However, more than that, their non-action on Tom’s pain condition fortifies the distrust that service users have towards the system and establishes the gap between health policies and the health care plan. Interprofessional Working Interprofessional teamwork is referred to as the coming together of different health professionals from different fields to provide health care to an individual patient (Day 2006; Retchin 2008). Co-management of care is necessitated in interprofessional working. The rationale behind the interprofessional teamwork is the idea that diverse expertise, skills, training and aptitude provides a more robust ground in which health care may be delivered (Clark, Cott & Drinka 2007). For instance, in the case of Tom, the interprofessional team who manages his care plan involves the social worker, the nurse, the doctor, and the therapists. In order to provide the holistic care plan for the patient, the multidisciplinary approach to health service has been advocated (Atwal & Smith 2010; Goodman & Clemow 2010). Under the holistic health care, the patient’s social, medical, psychological, cognitive, environmental and rehabilitative needs are given equal weight and consideration. To respond effectively to the challenges of holistic health care, teams are perceived to be more efficient in managing the care plan. Some of the advantages of teamwork include “improved planning, more clinically effective services, a more responsive and patient-focused service, avoidance of duplication and fragmentation and more satisfying roles for healthcare professionals” (Atwal & Smith 2010, p. 1). In this sense, it can be claimed the ethos behind interprofessional teamwork is the position that inter and multidisciplinary approach to health care provides the venue for a delivery of a better health care service to an individual patient. This is achieved through the collaborative effort that team has as they addressed the holistic condition of the patient (Pollard, Sellman & Senior 2005). Care becomes a concerted effort with the patient at the centre. However, in a study conducted by Reeves et al (2009), claim studies show that there is inconclusive evidence regarding the claimed advantages of interprofessional teamwork to health care. They have analysed studies conducted on the subject matter and the variegated results of the various studies have led to the conclusion that there is insufficient data to affirm or negate the claimed advantages of interprofessional teamwork. In the same way, Brown et al (2010) claim there is urgency in coming up health care plans and parameters for patients with learning disabilities as there is an increasing evidence of shortfalls and failings in cases wherein premature and needless death occurs. The case of Tom is one instance wherein interprofessional working failed. The neglect of the social service, the GP, and psychiatric unit in assessing and treating Tom’s pain is irrational and inhumane. This is claim on the premise that these people/institution are supposed to be the primary health care providers of Tom and that they are tasked to work together and come up with the appropriate care plan that are authentically responsive to Tom’s needs (Health Act 2009; Day 2006; Mental Health act 2007; Pollard et al 2005). They are mandated to provide equal access to health care to patients like Tom (Disability Discrimination Act 1999). However, Tom’s case provides the failure interprofessional working. Indeed, they are working as a team because they are able to move Tom from one institution to another, but it does not necessarily mean that their team efforts were for the good of Tom. This is critical because interprofessional working is collaborative work with the patient at the centre. This means that care measures undertaken should benefit the patient and not cause the patient’s death. This needless death of Tom could have been avoided if measures to encourage genuine interprofessional working have been adopted by the health care team of Tom. Communication is integral, but the communication necessary in interprofessional care is a two way process that is built on respect (Reeves et al. 2007). Reeves et al (2007) identified the complexity of the current health care system as one of the factors contributing to the difficulty of achieving authentic communication. However, this is not s deterrent to communicate, but it acts as an ethos driving the search for means in attaining interprofessional communication and collaboration (Bleakly 2006). Since, it is only in fostering communication that field differences are crossed and individual uniqueness are bridged (Clark et al., 2007; Hermsem & Ten Have 2005; Zwarenstein & reeves 2006). Moreover, through enhanced communication, patient’s safety is secured (Fernandez, Tran, Johnson & Jones 2010). Various models of communication have been shown to be effective in interprofessional communication. Communication need not be difficult. Technology provides ample ways of communicating among the professionals involve. Leaving notes or messages on the phone, text messages, emails, Skype meeting, yahoo messengers and other ways of reaching other members of the team are available. This is effective keeping communication and information flowing within the team as experience. In fact, the real difficulty is whether the members of the team are honestly willing to enter into a respectful collaborative teamwork for the patient. Nonetheless, the hope brought by communication starts to shatter the walls dividing the various fields involve (Reader, Flin, Mearns & Cuthberson, 2007). Working Partnership In the case of Tom, inclusion of the informal carers is necessary in order to know the real status of the condition of Tom. Family members, in this case Tom’s parents, provide the vital information from which the health care providers may start looking in to what really is concern of Tom. In trying to identify what is best for Tom parental involvement is necessary. In fact, it is surprising that Tom’s parents are ignored as important source of information regarding Tom and as part of the decision-makers in the case of Tom. it is a surprise because Great Britain is one of the countries where there is high prevalence of parental decision-making in end of life cases of children (Cuttini et al, 2006). A significant contribution was repeatedly given by the parents of Tom, “He is in pain.” and the team’s exclusion of the parents as co-carers and member of the team resulted into the senseless demise of Tom. Conclusion Interprofessional teamwork rests on a noble ideal – to provide holistic care to the patient. Various fields, with different expertise, skills, aptitudes and knowledge, come together and draw the appropriate care plan for the patient. Interprofessional work empowers the patient, as it becomes the arena wherein quality care is given a reality and the vision of being sick in a healthy way is turned into a reality. However, despite the ideals that support interprofessional working, if the actual carers will be deaf and blind to the actual needs of patients, especially patients with learning disabilities, then the incidence of needless death will continue. As such, there is an urgency to come up with parameters and paradigms that will foster collaborative efforts among the various fields involve in health care services. Although the significance of communication is undeniable in collaborative effort, but the attitude and the perspective of people engage collaborative effort should be further given attention. In this study, what I have learned is the truism that the complex reality of the current health care system require for interprofessional working. This requires being open and accepting of the fact that several heads are better than one. This becomes more pressing because we are dealing with people who are vulnerated. As workers in the health sciences, we have the responsibility to affirm life and not to destroy it (Mckie 2004). As such, honest communication is critical not only in providing care to the patient, but also in keeping authentic teamwork, collaborative effort with other health care providers for the good of the patient in an honest and genuine way (Tuckett 2005). Finally, I have come to realise there is a call for becoming more compassionate, more technically skilled and able in the performance of our duty within our profession, more humane and more respectful as we perform our task in giving care to our patients. 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