Collaborative Practice within the Organization or the Health Care Institution

Collaborative Practice within the Organization

 

Introduction

 

            In 1992, The American Nurses Association has set the working definition of collaboration as “a collegial working relationship with another health care provider in the provision of (to supply) patient care” (2004).  This essay is going to tackle the significance of collaborative practice within the organization or the health care institution, among its health care professionals. The succeeding discussions provide its resolution by utilizing the concepts of organizational culture, team building, organizational conflict and its management, and effective communication. 

 

What Is Collaborative Practice?

 

            Collaborative practice is the application of interventions and therapies that require the knowledge, skill, and expertise of multiple health professionals (2004). Collaborative practice and its interventions require critical thinking and decision making. When encountering collaborative interventions, the nurse does not automatically implement the therapy but determine whether it is appropriate for the patient. Every nurse faces an inappropriate or incorrect order at some time. The nurse with a strong knowledge base recognizes the errors and seeks to correct it.

 

            Through collaborative practice, the nurse along with other health care professionals taps the best resources to individualize nursing interventions. During collaboration, the nurse includes the patient, family, and members of the health care team. In addition, the nurse also reviews previous clinical experiences and priorities to select nursing interventions that have the best potential for achieving the expected outcomes. With the contributed experience of every member in collaborative practice, health care interventions and processes become more efficient and experience based.

 

In order that patients become beneficiaries of optimum health care interventions there is therefore a need for multi-disciplinary collaboration between clinicians and other health care providers. The foundation of this collaboration is education. Clinicians, patients, administrators and politicians need access to the new concepts of pain and its management in order to start realizing this goal (2000).

 

Shared leadership is a collaborative team process in which team members share key leadership roles (2004). Shared leadership is empowering employees to act autonomously, be decisive at the point-of-service, and create a shared vision aligned with organizational goals. Shared leadership development and autonomously practicing nurses appear to be the equation for success in delivering quality patient outcomes in today’s organized health care delivery systems. Employees must develop or refine new behaviors and skills in empowerment, facilitation, negotiation, systems thinking, and accountability on behalf of patients (2002).

 

Shared leadership is a way to strengthen continuous learning and enhance relationships between leaders/managers, health care staff and patients, which are the foundation upon which the nurses can develop a new type of relationship with management and with each other. This in turn could significantly improve the work environment. There is an emphasis on ‘relationships’ since these relationships can be tenuous at times as both managers and staff members adopt attitudes of contention and competition with each other.

 

It is clearly recognized that collaboration between health professionals is fundamental to the provision of quality health services, whether the collaboration and consultation may take place via telephone, radio, facsimile or the internet, or in a high level intensive care unit in a tertiary referral centre (2000). This is central to the facilitation of partnerships in health care.

 

What Is Happening Now?

 

            According to  (2002), customer satisfaction, workforce quality, and of course, the rickety economic conditions are the areas that need to be improved. It is believed that  (2002) account has a bearing on the nursing profession in direct or indirect ways. It may resonate clinical governance, but it is related with collaborative practice. The subsequent paragraphs are about to extract the main point of the essay – the need for a collaborative practice within health institutions.

           

Hospital Authority (2003) has reported that the Hong Kong Special Administrative Region (HKSAR) government aimed for a budget cut on Hospital Authority. The Hospital Authority (HA) has suffered a tremendous pressure from the government to minimize health care burdens. HA has responded by changing its nursing personnel as a means to cut costs or reduce budgets. Teams that were working productively have been changed overnight. It has been natural to see well-trained and experienced staff resigning or retiring early and has been replaced by technical or unskilled staff with little or no experience at all. Frontline staffs have been stretched to their limits both in terms of numbers and in terms of psychological stress (2004).

 

According to  (2002), the reason behind is the inability to handle stress and an unsupportive management. To illustrate further, a very experienced Registered Nurse (RN) is being replaced by a health care assistant, who had a minimal nursing training. Unfortunately, HA has not required technical experience to replace operation room nurse. As a result, there is fewer and fewer experienced, trained and skilled staff in a team. This leads to many difficulties in a team working together.

           

When all team members are relatively inexperienced, it is believed that they are prone to errors. In effect,  (2002) findings can be considered accurate. Being prone to errors further implicates that the hospital is not delivering quality health care services. Aside from that, among the health care providers themselves, low morale and stress emerge as a consequence of work overload especially to existing staff. The existing staff is burdened with heightened responsibilities, cannot communicate pleasantly, and collaborate with fellow colleagues. Adding up all these things, it only becomes a losing situation for everyone.

 

Organizational Change

 

            Organizations are shaped by their culture, which include assumptions, values, norms, organization members, and their behaviors. They are also shaped by characteristics, which include strategies, technologies, structures, and processes. Where there are people and technologies, there are organizations. There are four key elements that define organization: (a) people and their roles within the organization; (b) the purpose of the organization; (c) the work activities; and (d) a person’s working relationship with the organization (2005). Everyday our lives are touched by some element of an organization, whether it is a visit to the doctor, a board meeting, or forming alliances on an uninhabited island.

Organizations as structures of action have approaches which focus on the circumstances determining the actions of individuals in organizations. A great deal of organization theory has been criticized for its normative (in this case pro-managerial) bias; for its individualistic analysis of the members of organizations (that is, for being more informed by psychological, than by sociological perspectives); and for embodying an inadequate analysis of how wider relations of power and control in society affect and are affected by organizations (in other words for concentrating mainly on the internal exercise of managerial authority and attempts to subvert it) (1998).

           

The world that organization theory seeks to analyze and describe has changed in some important ways. Four of the more significant changes are (a) the increasing externalization of the employment relation and the development of the “new employment contract,” (b) a change in the size distribution of organizations, with a comparative growth in the proportion of smaller organizations, (c) the increasing influence of external capital markets on organizational governance and decision making, and (d) increasing salary inequality within organizations in the United States, compared both to the past and to other industrialized nations (1997).

 

When a health care organization is not practicing collaboration, an organizational change is needed. Collaborative practice needs to be the norm within the health care institution. It is suggested that health care institutions have to be one of a task culture and role culture too. The former contemplates on completing the job instead of looking at the ways to do it, which refers to the latter. Task cultures require “speed of reaction”, flexibility, creativity and teamwork, while role culture places a premium on the rules, hierarchy, authority, etc. of the organization (1986, 2006).

 

The rationale behind undertaking both concepts is because both of which fits in what this essay is proposing – collaborative practice within the health care institution. Health care professionals in collaboration need to recognize each other’s roles (e.g. dietician, physical therapist, surgeon, etc.) because they are armed with specific specialties. They need each other to resolve public health concerns through a group performance, i.e. teamwork, which will be further discussed under the subheading – Team building. Health care professionals should follow the procedure of collaborative practice and focus on achieving their desired end-goals. 

 

Team building

 

            Collaboration requires the efforts of a health care team. A health care team usually consists of a nurse, physician, nurse practitioner, and social worker. Such teams usually operate in a primary care clinic in the inner core of a large city. Like most primary care clinics, its patients are a mix of relatively healthy individuals and the walking wounded ( 2000).

 

Features of effective teams are cooperative management and mentoring of all members of the care team. Multi-disciplinary health care organizations provide a rich environment for collaborative research, teaching and clinical practice (2000).

 

Similarly, continuing education opportunities can be provided in support of currently practicing professionals wanting more training in teamwork and collaborative skills. This could take the form of general workshops on the knowledge and skills necessary for effective team-building, as well as more individualized team development and process consultation. In most cases, currently practicing professionals have little background or training in teamwork, yet they are often thrust into situations where they are expected to work as part of a collaborative health care team ( 2000).

 

Conflict within Team

 

            We cannot expect people to leave their evolved behavior at the door when they enter any environment; gossip, dominance, harassment, and status seeking behaviors permeate organizations and create conflict, intimidation, and jealousy. These behaviors cannot be eliminated, but they can be understood and considered when creating organizational policy. When considering one’s position in an organization, it is advantageous to be socially intelligent, which can be thought of as being skilled at social networking, knowing whom to trust, and being able to form powerful relationships. Such can be an element in a health care organization or team.

           

Consider the differences in the power structure of a health care organization, even in health care teams. In any given health care system, there is a pecking order wherein everyone has a clear place. Each person has a position that may give him or her authority over others, but they must be accountable to those higher in the power structure. In a group therapy environment, all participants are equal. They all have thoughts and experiences to relate, and the intent is to have a situation wherein everyone benefits mutually from the sharing of thoughts and experiences offered by each member (2004). From such a hierarchy alone, it is inevitable that there might be a clash of views that might cause conflicts within a team.

 

 (2001) recognizes a duality of outcome behind conflict wherein, it is either functional or dysfunctional. In essence, that of which brings positive feedbacks such as innovations within the organization in various aspects or improvement of decision-making, and individual or group performances fall under the functional outcome of conflict. On the other end, job stress and dissatisfaction, decreased exchange of verbal/non-verbal interaction, poor job performances, a pronounced opposition to change, organizational members in distrust, and low commitment to the organization are the manifestations of conflict’s dysfunctional outcome ().  This only leads us to the significant idea that conflict is not a concept to be feared, for it is not negative at all times.  It actually contributes to the good of the organization too. 

           

If conflicts occur within teams, it is important that the group resolve it. Managing teams begins with creating a positive team environment in which team members envision and understand what proper conduct includes. Establishing clear, realistic expectations of acceptable behavior provides purpose and direction for instilling and maintaining discipline. If the members of the health care team are involved in making these decisions, they will be even more likely to conform to team standards ( 1996).

 

Effective communication is the foundation for managing most team problems and conflicts. Negative attitudes related to jealousy, resentment, or distrust may be avoided or minimized through the establishing an effective communication system, which shall be discussed in the next part.

 

Communication

            Communication is a lifelong learning process for the nurse (2004). Nurses make the intimate journey with patients and their families from the miracle of birth to the mystery of death. It is necessary to build therapeutic communications for this journey.

           

Nurses communicate with other people even under stress: patients, families, and colleagues. Nurses function as patient advocates and as members of interdisciplinary teams in a collaborative practice. They may have different ideas about priorities for care, but they would still collaborate to make the best intervention for a patient.

           

In addition, within a collaborative practice, nurses must be assertive to ask the right questions and make their voices heard. Being assertive to communicate one’s own needs endures balance in a nurse’s life. Without such balance and communication, the high-stress environment may contribute to burnout and diminish the nurse’s effectiveness.

           

Despite the complexity of technology and the multiple demands on nurses’ time, it is the intimate moment of connection that is happening in communication that makes all the difference in the quality of care and meaning for the patient and the nurse. Here we see that communication is essential not only between nurses and other health care professionals but also between nurses and their patients.

           

Nurses interact with many individuals in the course of their profession. Competency in communication helps the nurse maintain effective relationships within the entire sphere of professional practice and helps meet legal, ethical, and clinical standards of care. Failure to effectively communicate causes serious difficulty, increases liability, and threatens professional credibility ( 2004).

           

In collaborative health care teams, the dimensions of communication most often discussed relate to issues involving personality clashes, role overlap and conflict, and the effective use and sharing of clinically important information. Absent is an examination of underlying problems with communication based on the professional differences among health care providers, including how they acquired particular values over the course of their education and subsequent clinical work experience. These values are related to their orientations both to the patient and toward each other ( 2000).

 

To summarize, effective teamwork requires good communication. Frustrated team members often express concerns about its quality and extent. As in any relationship between people, the ability to “keep the lines of communication open” in a collaborative health care team is an important indicator of effective teamwork skills.

 

Conclusion

 

A collaborative practice among health care providers or professionals should be the institution’s guiding framework.  Health care providers, e.g. physicians, therapists, etc. and health care assistants alike should deliver health care service to their clients hand in hand among each other.  They have to work together as a united team.  Conflicts are inevitable, but these can be fixed through recognition of each other’s status/identities, and of course, effective communication.  Apart from effective communication, there has to be mutuality among them, and eventually trust.  When health care providers trust and consult each other’s views in making decisions to a certain problem, then they are said to be in a collaborative practice. 

 

 

 

 

 

 

 

 

 

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