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School of Social Professions
Inter-Professional Practice. (SH7007)
Topic
Inter- Professional Practice in Contemporary Health &
Social Care Setting: Inter-Professional Practice and
Working
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Inter- Professional Practice Reflective Explanatory Report.
Reflective Explanation.
The reflective explanation carefully looked at what emerged at the case conference,
what are my experience and understanding I made in it in my own constraints. My
reflective will be on the performance of team in using of Tuckman Model which
underpin my reflection on forming, storming, norming performing and adjourning
(Tuckman, 1965). In my comment the team followed these stages. The intending
group was form by the individuals who are present, that same day decision to form
the group was accepted by all present. Forming period was taken place twice at the
initial stage; we introduced ourselves and discussed individual abilities and
experience to apportion nominated roles.
Underpinning storming stage diverse group member had altered view which was
primary to clash with concerns of the scenario. I have persuaded the group to
change their knowledge and come to a treaty of the case scenario. Nobody in the
group is willing to take on the role of a service user the parents and children, I
accepted to take the role. A brief case scenario is formed but was accepted as a
group that we need to come up with ideas when next we meet. Contact details were
exchanged and a WhatsApp group was created, to enable us to communicate ideas,
group meeting venue and time.
The norming stage I witnessed team members were having an in-depth
understanding and were getting to grasps with the dialogue around the case
scenario and the group becoming more organised. Collaboration of team work was
effective than individuals. I also realised that individuals have confident of their roles
with clearer understanding of anticipation. At the stage of performing each team
member are indebted of their tasks, clear instruction and the time limit was
communicated well in progress. The enablement to support, inspire each other all
through the progress. The adjourning stage the team break up as the case
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conference ended, members of the team gave feedback I was very satisfied with the
general result.
As stated by Belbin (2004) group members can take on multiple roles. I consider my
role in the group was very clear has the mother of the service users, I was
representing myself and my children, adjusted my level of communication approach
by expressing myself clearly according to the case scenario. I made my points
clearly with conviction in regards to the case scenario. The group agreed to
communicate through WhatsApp, although it takes some individual awhile before
they reply or not to reply which was quite irritating. The knowledge I cultured from the
teamwork is reciprocated reverence, self-restraint and trust are factors very vital to
attaining a communal goal. Analysing my own performance critically through the
team meetings I felt that any form of communication either verbal or nonverbal are
very significant. In future it is crucial for me to keep up a good eye contact as I
accepted as true effective medium of communication. In future if I were involved in
any team task, I will be more proactive and self-assured at performing
nonprofessional or professional.
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Contents
Introduction………………………………………………………………………………………………… 5
Central Concepts of Inter-Professional Practice and Working …………………………….. 5
Impact of Policies, Codes, Organisational Frameworks and Approaches on InterProfessional Practice …………………………………………………………………………………… 6
Factors that Promote and Hinder Inter-Professional Practice……………………………… 8
Personal and Professional Awareness, Practice and Assumptions ……………………. 10
Conclusion……………………………………………………………………………………………….. 11
References ………………………………………………………………………………………………. 12
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Introduction
This report examines the topic of inter-professional working. In the first instance it
considers what the central concepts of inter-professional practice and working are,
before moving on to look at how policy, codes, organisational frameworks and
approaches can have an impact on this way of working. Subsequently to this, interprofessional working promoting factors and hindrances are examined, showing how
when managed well a factor can be beneficial but when this is not the case, the
factor can become an obstacle to effective working. Finally, the report reflects on my
personal practice and how certain factors may impact on my own effectiveness in
this regard. As Littlechild and Smith (2013, p. 35) state, the “policy agenda is
overwhelmingly in favour of closer collaboration between professionals irrespective
of their parent discipline.” This means that understanding how to make interprofessional working more effective is beneficial from the perspective of delivering
better outcomes for service users.
Central Concepts of Inter-Professional Practice and Working
Inter-professional practice and working has several central tenants that need to be
considered, in order to understand the concept. As Weeks (2012) reports, one of the
important concepts that underlie inter-professional practice is collaboration between
people of different professional backgrounds within the health and social care
system. An important component within this is argued by Reeves et al. (2011) to be
team working by people of different types of practice. While Reeves et al. (2011)
explain that there is no one template that is to be used for collaboration and
teamwork, these are required to ensure that inter-professional practice and working
can be effective. With this in mind, leadership is considered to be important for
integration and effectiveness with regard to multi-agency working (Gray and Birrell,
2013). There are various other factors as well that are thought to be necessary for
good inter-professional working, and these include roles and responsibilities that are
clear, having common goals, being willing to get involved, sharing information when
it is needed for the joint solution, and a commitment to working together, as indicated
by Linsley et al. (2011). These factors all present opportunities that arguably enable
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people to work more effectively together despite the challenges faced from coming
from different professional agencies.
User participation is also considered to be an important factor in inter-professional
practice, with the concept of putting the user central to the care being a key theme
(Gray and Birrell, 2013). Increasing complexity of health and social care needs, in
addition to high profile failings led to an understanding of a need for better
collaboration placing the user centrally within the whole process to achieve better
outcomes and to avoid problems from falling through the gaps between agencies.
This is particularly important given that Gray and Birrell (2013, p. 2) indicate the
issues that can come about as a result of the “silo mentality” that can occur in
different agencies.
Linsley et al. (2011) also argue that an important concept that is part of interprofessional practice and working is the training and education that is needed at the
outset so that practitioners understand what is needed and are able to work
effectively in this way. They describe that one of the key pre-requisites for this, and a
concept that should underlie training and education for inter-professional practice is
that of each profession recognising and respecting the others (Linsley et al., 2011).
This makes sense, since if professionals need to be able to work together more
commonly than in the past, continuing to train people for different professions as was
carried out in the past is likely to be problematic, so training is a fundamental
concept in inter-professional practice.
Impact of Policies, Codes, Organisational Frameworks and Approaches on
Inter-Professional Practice
Policies, codes, organisational frameworks and approaches impact inter-professional
practice. Regular policy change impacts on the way in which inter-professional
practice works and means that professionals need to be ready to adjust accordingly.
A key set of policies that has an impact on inter-professional practice are those
relating to data and its sharing. For example, as Hammick et al. (2009) argue, the
Human Rights Act 1988 does put in place limits on the sharing of information. This
can lead to some information being kept confidential, because the Act tends to be
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misunderstood (Hammick et al., 2009). The unnecessary holding back of some types
of data can sometimes result from misunderstandings of this Act, which can damage
inter-professional working through limiting information sharing and keeping some
information confidential when this perhaps is not necessary in the inter-professional
team (Hammick et al., 2009). There is an opportunity to be more effective in this
regard, arguably.
As opined by Dunhill et al. (2009) policy has an impact on the environment within
which people practice professionally, and importantly, political ideology does have an
impact upon this. This may arguably be seen with the political policy of the
Conservative party which has been in power since 2010 (including the coalition
between 2010 and 2015). Specifically, policy within this period has involved
constraints on funding (The King’s Fund, 2019) which may in theory encourage the
pooled budgets that inter-professional working supposedly encourages. However, as
Hill et al (2013) point out, there may be insufficient experience of joint commissioning
that can lead to challenges here. While on the subject of commissioning, it can be
noted that the Health and Social Care Act 2012 also had an impact on interprofessional working. As Gray and Birrell (2013) indicate, and as argued above, the
silo mentality was seen as being problematic with regard to the effective provisioning
of health and social care services, and the Act with its new concepts around
commissioning sought to adapt this. This has created a new opportunity with regard
to collaboration in inter-professional working, arguably.
Codes and organisational frameworks also influence inter-professional working.
Leathard (2004) explains that codes may differ between professions, and what is
meant by ethics across different agencies may also conflict. Leathard (2004) outlines
how common principles include justice, beneficence, non-maleficence and autonomy
and how these are important to ethical codes in health and social care. However,
what might be considered not doing harm by one agency could feasibly perhaps be
thought of as damaging from another perspective, meaning that challenges can
arise. As Leathard (2004) presents, governance can help to ensure that the team
acts ethically, because simply saying that they are working as a team is insufficient.
However, this is still challenging, since as argued, “It is difficult to establish without
doubt what is good and what is bad practice,” (Leathard, 2004, p. 73). Additionally,
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arguably this could change over time as new cases come to light or new failings
discovered. Therefore agreeing what is meant by good practice as a group at the
start can be helpful where possible for more effective working between different
organisational frameworks and codes (Leathard, 2004). These are key challenges
that need to be overcome when working as an inter-professional group.
Factors that Promote and Hinder Inter-Professional Practice
There are numerous factors that can either promote or hinder inter-professional
practice, and these are now considered. From the perspective of communication,
this can be a factor that can promote inter-professional working more effectively,
when this is committed to. Indeed, Thomas et al. (2014) present this as being a very
important competency to aid with dealing with differences and listening to one
another to fully understand the issues, to find joint solutions (Thomas et al., 2014).
However, sometimes those participating in an inter-professional team may not
communicate as well as they might otherwise, for various reasons. Thomas et al.
(2014) indicate that professionals can find their roles feeling threatened in such
teams which may lead to them not sharing so much information as may be needed
to work effectively together in an inter-professional team. Moreover, as Hammick et
al. (2009) outline, there may be different processes and guidelines pertaining to the
way in which information is shared and what is shared, and this may be built into
organisational culture.
Since there may not be an agreed way of working between the different agencies,
this can lead to information not necessarily being shared, which can hinder interprofessional practice (Hammick et al., 2009). However, Hammick et al., 2009) do
also argue that the converse is true and that when there is a common set of agreed
ways of working, inter-professional practice is supported, and it can be more
collaborative – which in this case promotes effective working of this nature.
Confidentiality is an important aspect of this, as highlighted by Littlechild and Smith
(2013), but there can be issues with this. For example, Littlechild and Smith (2013)
outline the importance of confidentiality to the medical profession as a core value,
and this can make it difficult for information sharing to occur.
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Accountability should also be analysed, and in 1994, Leathard argued that this was
important in terms of getting inter-professional teams to work effectively together.
Matters to consider were seen to include personal versus group accountability and to
what extent groups of inter-professional teams can be accountable (Leathard et al.,
1994). Littlechild and Smith (2013) describe how accountability can be defined such
that it does support joint working from an inter-professional perspective. They opine
that for this to be effective, objectives of the inter-professional team should be set up
and should be SMART, and when the right framework is in place in this way then
partnership working can lead to high performance. However, as Standing (2010)
indicates there may be differences in understanding of accountability between
different professions, which could hamper inter-professional working.
Culture is another important factor, and this is rather complicated. As argued by
Swisher and Royeen (2019) different groups in the health and social care system
have different cultures and professional codes of ethics, which hold them
accountable in different ways for how they go about their professional activities. As
Geva et al. (2000) explain, culture includes a range of different attributes such as
beliefs and values, structures, behaviour and institutions, among others, and in
organisations is not the same as ethnic culture. With a range of different beliefs,
values and codes of ethics, this factor is likely to be somewhat of a hindrance to
inter-professional practice. Vision and different concepts of this can be a difficult area
within this. Another is that of risk taking, which can differ between different types of
practice, and which can lead to conflict between the group members (Drinka and
Clark, 2016). Drinka and Clark (2016) expand on this indicating that even within a
profession some groups may be more averse to risk taking that others.
Equality and diversity is another factor that can arise in inter-professional working
that could sometimes hinder its effectiveness as presented by Thomas et al. (2014).
As indicated, social differences are “inevitably replicated in professional practice and
can affect dynamics in teams,” (Thomas et al., 2014). This has the potential to
impact the group not just from the perspective of different types of practice but also
from the individual perspective, further complicating matters for inter-professional
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working, potentially. When valued, diversity can be a promoting factor in interprofessional working due to the range of different ideas and solutions that can
potentially be generated, but diversity can also be a hindrance when not appreciated
(Drinka and Clark, 2016).
Personal and Professional Awareness, Practice and Assumptions
Moving forward in my career, it seems that inter-professional working is likely to
continue to be the policy for health and social care practice, and as such, as
Crawford (2011) opines, there is a need to be ready to work in these types of
environments, and to understand that they are continually changing. An issue to be
aware of in my own practice is negative stereotyping that, with hindsight may have
clouded my judgement in the past. As Eisler and Potter (2014) explain, there can be
different stereotypes associated with different roles such as doctors, nurses and
social workers. For example, Eisler and Potter (2014) argue that doctors might not
expect nurses or others in inter-professional teams to stand up to them due to
stereotypes, and the dominance of the medical model. While I may not always
necessarily believe a particular individual is right in their opinion, it will be important
for me to not pre-judge or pre-determine situations based on stereotypes, as this
could negatively impact on service user outcomes through leading to ineffective
working between myself and others.
From a personal perspective, one assumption that I have always made in my
practice is that working in inter-professional teams is cost saving. Sayer (2008)
opines that this is one of the commonest cited benefits of inter-professional working,
so on reflection it is likely that the reason that I have tended to believe this is that it is
simply said and assumed a lot. I can see however, that the reality of interprofessional working is that new layers of bureaucracy can be introduced that can be
detrimental to the process, and increase costs. Crawford (2011) highlights some of
the problems in this regard, particularly as different organisations and types of
practice have different ways of working that can lead to duplication, where in reality
bureaucracy should be cut down.
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Another aspect to be aware of is that there is a group development process and that
this can lead to conflict. In the past I have experienced conflict in inter-professional
teams, and with the benefit of hindsight, I believe that this has been as a result of the
so-called storming phase of the Tuckman group development model (Egolf, 2013).
As Egolf (2013) defines there are various stages of this model, including forming,
storming, norming and performing, and Crawford (2011) also adds adjourning.
Crawford (2011) highlights how storming can be constructive and beneficial for interprofessional group working effectiveness through helping to ensure teams can be
flexible, innovative and creative. However, from my own perspective I have also
seen how when conflict is not managed well in these situations, how it can lead to a
lack of transparency and information sharing between individuals in interprofessional work groups, so I believe great care is needed in leadership in this
sense to encourage constructive conflict.
Conclusion
As has been demonstrated within this report, inter-professional practice involves the
collaboration of different types of professionals from different agencies within the
health and social care field, and beyond, in order to bring about better outcomes for
service users. It has been illustrated how policy and other factors can impact on the
way in which inter-professional practice and working is done. It has also been shown
how certain factors can either be of benefit to or a hindrance to inter-professional
working – for example, good communication and information sharing promotes this,
while not doing so becomes a barrier to effective working. It has been indicated
through undertaking reflection the ways in which my own professional and personal
practice could be improved with regard to inter-professional working, so I am better
prepared for the career ahead of me.
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References
Crawford, K. (2011) Interprofessional Collaboration in Social Work Practice, London:
SAGE
Drinka, T.J.K. and Clark, P.G. (2016) Healthcare Teamwork, Wallingford: ABC-CLIO
Dunhill, A., Elliott, B. and Shaw, A. (2009) Effective Communication and
Engagement with Children and Young People, their Families and Carers, Exeter:
Learning Matters
Egolf, D.B. (2013) Forming Storming Norming Performing, Bloomington: iUniverse
Eisler, R. and Potter, T.M. (2014) Transforming Interprofessional Partnerships, USA:
Sigma Theta Tau
Geva, E., Barsky, A.E. and Westernoff, F. (2000) Interprofessional Practice with
Diverse Populations, Westport: Greenwood Publishing Group
Gray, A.M. and Birrell, D. (2013) Transforming Adult Social Care, Bristol: Policy
Press
Hammick, M., Freeth, D.S., Copperman, J. and Goodsman, D. (2009) Being
Interprofessional, Malden: Polity
Hill, M., Head, G., Lockyer, A., Reid, B. and Taylor, R. (2013) Children’s Services:
Working Together, Oxford: Routledge
Leathard, A. (1994) Going Inter-Professional, London: Psychology Press
Leathard, A. (2004) Interprofessional Collaboration, Oxford: Routledge
Linsley, P., Kane, R. and Owen, S. (2011) Nursing for Public Health, Oxford: OUP
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Littlechild, B. and Smith, R. (2013) A Handbook for Interprofessional Practice in the
Human Services, Oxford: Routledge
Reeves, S., Lewin, S., Espin, S. and Zwarenstein, M. (2011) Interprofessional
Teamwork for Health and Social Care, London: John Wiley & Sons
Sayer, T. (2008) Critical Practice in Working with Children, Maidenhead: Macmillan
International Higher Education
Standing, M. (2010) Clinical Judgement and Decision-Making in Nursing and InterProfessional Healthcare, Maidenhead: McGraw Hill Education
Swisher, L.L. and Royeen, C.B. (2019) Rehabilitation Ethics for Interprofessional
Practice, London: Jones and Bartlett Learning
The King’s Fund (2019) Closing the Gap, London: The King’s Fund
Thomas, J., Pollard, K. and Sellman, D. (2014) Interprofessional Working in Health
and Social Care, Maidenhead: Macmillan International Higher Education
Weeks, S.M. (2012) Critical Care of Patients with Mental Health Issues, Oxford:
Elsevier Health Sciences