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 health care institution, among its health care professionals. The subsequent section briefly explicates through PESTLE analysis the concept of collaborative practice. After which comes the issue that this essay seeks to bring into light. 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?
The term collaborative practice (CP) speaks for itself. It can be simply construed as enacting or making use of the concept of collaboration, as stated in the aforementioned paragraph, in a specific setting. Let’s expound CP further. It can be conceived as a matter of interprofessional operations. To collaborate is to act hand in hand with another in resolving a certain concern. Two or more entities are working together to deliver health care at its best. Therefore, CP is the lumping of two or more entities for a certain cause. It has been found out that, in the CP process, the growth of collaborative behavior among the professionals involved may be unequally distributed among them ( 1987). Simply put, some may excel in this kind of practice, while some may not. The way out then, according to (1998), is for the participating organizations to parallel their CP Programs in their contest, i.e. organizational goals, structure, etc. This is a remarkable finding to note. It goes to show that not every participant of CP develops similarly with the rest.
When do we say that CP is effective? Researchers Seashore (1995) suggest that it is when both the individual and the group find meaning and productivity from the CP. It is only right that every participant benefits from the practice, instead of just a few individuals. A CP is a group performance. Since there are more hands and/or heads that resolve a specific problem, most likely it means that there are greater chances of its resolution and efficiency.
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.
What Is Happening Now?
According to (2002), customer satisfaction, workforce quality, and of course, the unstable 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 be associated with clinical governance, but it is more 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 since 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.
Analysis of the Issue
There are actually several interdependent issues that are present in the situation. In the aforementioned paragraph, it has been said that HKSAR has reduced the financial resources allotted for the Health Department of the country. Other than that, situations like customer satisfaction, workforce quality, the unstable economic conditions, inability to handle stress by health care professionals, and an unsupportive management. All of these point to the need for collaborative practice within organizations.
In 2003, recall the Severe Acute Respiratory Syndrome (SARS) that has triggered the country. The consequence proves further devastating especially for the economic conditions of the country. At the present however, the virus is no longer such a public concern as it once was before. HKSAR is currently on the road to a better than ever economic progress. Budget allocations for Health Department needs to be cut in order to make way for more economic endeavors.
Budget cut means a lot. It implies a change for HA in meeting public health. Aside from the fact that RNs have been replaced by HCAs, HA has embarked on applied clinical training especially in urgent conditions, at the expense of less urgent conditions such as my department, the operation room. HA has continued to reform the system of de-nursing to save money. HCAs replaced RN’s jobs in my department. Investment in HA has traditionally been focused on the provision of services and facilities to those who require immediate medical care and support (2004). This means that everyone can be free for primary treatment whether he has money or not. Government funding to HA is in constant reduction annually. Costs continue to be raised. Pressure to reduce costs further. Thus, the quality of health care service delivery is at risk brought about by budget cut.
The downside of having cheap medical care is also the low quality of health care that will be offered. Low quality health care would cost more money still. From medical errors and unnecessary treatments to misused drugs and bureaucratic waste, new research suggests such problems compromise quality medical care and each year cost private employers between ,700 and ,000 per insured worker ( 2002).
Although efforts have been made to control the costs of health care, these costs continue to increase. Employers, legislators, insurers, and health care providers continue to collaborate in efforts to resolve the issues surrounding how to best finance health care costs.
Employers and the government should be doing something about their high medical costs. Public insurers and private employers can be smarter purchasers by demanding better quality medical service and information from doctors, hospitals and health insurance companies. The nation has searched for an organizational structure that would add the missing elements of planning, coordination, and control to the health care system to improve efficiency and limit the total expenditures.
Customer satisfaction is determined largely by customer expectations. Today’s health care consumers have greater knowledge about their health than in the previous years and they are increasingly influencing health care delivery. Formerly, people expected a physician to make decisions about their care; today, however, consumers expect to be involved in making any decisions regarding their health.
Almost all healthcare consumers would want to go to the “best” hospital in town, see their own doctor, and have access to the same new medicines. When one falls ill, gets a certain level of medical care, and tells the neighbor about it, the other’s expectations are raised accordingly ( 2001). Each individual consumer shares a common need for health and a desire for the absence of illness through the demand for health care services and products. This in return affects the aforementioned rising healthcare costs.
Since consumers expect so much of healthcare, the healthcare providers are pushed to offering consumers a range of choices. Consumer expectations are fueling demand for health information that they can understand and services that they want. Consumers would want to know what their care options are and what health plans are available to them. By offering consumers a choice of healthcare services and plans, various healthcare organizations encourage the development of price competition among competitors. Price competition among healthcare providers could generate in a cost reduction of a range of healthcare services.
The workforce quality is also affected, creating deterioration of work and work environments. The deterioration of healthcare work environments is a major problem of concern to the healthcare leaders or managers. A healthy work environment is necessary to bring about quality healthcare service to the population. An unhealthy work environment would create a devastating impact not only to the healthcare professionals and the clients but most importantly on the effectiveness of the entire healthcare system.
The possible root causes for this apparent deterioration of healthcare work environments are outlined in the succeeding sentences. (1) Healthcare professionals are placed in leadership positions even if they are not adequately prepared and without adequate support for their roles. (2) Healthcare professionals, especially in the case of nurses are assigned to handle many clients than they can handle. (3) Decision-making within the work environment is done only by one department, without consultation of all the other parties that are involved.
The resulting environment created by these situations brings about many negative results in the working environment. When inadequate leaders are placed in positions, there will be dissatisfaction and high turnover for healthcare leaders and the staff as well. For example, when each nurse is assigned to handle many clients, this would result in confusion and the clients are placed at risk for errors and injury. The nurses are also frustrated, angry and stressed out. Decisions that are made without consulting all the parties involved places everyone involved – doctors, clients, nurses, managers and other staff – at risk. The overall quality of care offered by the healthcare service would be diminished.
Skill acquisition should therefore be a responsibility of the worker, although for healthcare professionals it is generally their professional body that determines the appropriateness of education and training. There is a growing acknowledgement of the importance of continuing professional development (CPD) in order that the individual can continue to refine skills and keep up to date with current evidence for practice. CPD must encompass, among many other things, technical skills and attitudes towards patients, staff and the general population ( 2001).
Ongoing development and educational support for health care professionals require recognition of the reaming needs in the transformed workplace. Professional role development initially implies an ongoing personal commitment to education. Health care professionals are expected and accountable to participate as active reamers. To enable this, resources for reaming such as professional journals and continuing education programs must be available and affordable with minimal financial and time constraints (1996).
Unsupportive management is another issue interdependent on the bigger issue. It should be noted that in any kind of organization, management is necessary to make labor and capital productive and requires converting economic principles into rules of behavior that can be clearly communicated to employees, bosses, clients, and other partners. True, management is not simple. In management it is people, not things, which have to be managed, and because decisions must be made under uncertainty, based on expectations, without ever really knowing the entire facts one would like to have, it makes it all the more complicated.
In the case before us, the whole healthcare organization should recognize that its approach of no support for its health care staff — thinking that its approach is best in health care and serving the community—is its downfall in its attempts at successful healthcare management.
Since this kind of strategy did not lend itself very well to issues of empowerment for the health care employees or the community, a new strategy should be developed. This new strategy has to embrace empowerment of all in decision making, organizational and performance structure, service delivery modeling, and people behavior if the model is to meet the communal needs of the client base to be served. Also, this new strategy needs to embrace the thought issue of collaboration and the behavioral issues embedded in reciprocity—the give and take.
Last, medical care and management needed to be a representation of all affected by the healthcare. This would mean that an experts approach might not be as successful as a case conference approach which would involve physicians, mental health professionals (clinical and organizational psychologists, specialty and organizational psychiatrists), social workers, church leaders, family members, and family support system members. Although the process might seem unwieldy, the reality was that differing ways of knowing and differing world views would expand the options and capacities needed to craft strategies that fostered harmony, bonding, trusting, and honoring of the client and the healthcare system (2002).
Organizational Change
(1991) assert that organizational goals are attained upon the discharge of individual and collective efforts, and need to be common among them. The purpose of CP is to succeed, with the help of different entities of different specialties. (2003) state that that the valuable assets include the following: culture, skill and competence, motivation and social interaction between people, teams and business units are valuable assets. Increasing these assets can fortify the organization and combine people and process together for its own good. Organizational change has to take place. Because CP is believed to be the key framework within the health care institution, CP therefore will come alive if it is at the heart of its organizational culture.
Organizational culture, as said by (1985), is related with the “observed behavioral regularities, norms, values, philosophies or policies, the “rules of the game”, and the “feeling or climate” obtained by the individual as a member of the organization (p.6,9). It is in no way dissimilar with culture in the society. Only that, culture is specifically identified in the organization like the workplace. CP 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). Role culture relates to those roles played by members of an organization, meaning the individual looks for ways to do it.
The rationale behind undertaking both concepts is because both of which fits in what this essay is proposing – CP 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 CP and focus on achieving their desired end-goals.
Vision
The Dictionary defines vision as the means ability to identify a subject, a problem foresight and wisdom in planning. According to (2004), its corporate vision goes
“The Hospital Authority will collaborate with other healthcare providers and carers in the community to create a seamless healthcare environment which will maximize health care benefits and meet community expectations”
This essay is going to hold on to this vision. However, the only point of deviation is that, this essay suggests that CP has to be realized first within the health care institution per se before working together with other entities outside of it.
Team building
(1989) defines team building as the deliberate process of unifying a group of individuals into a functional working unit, accomplishing specific goals. In a CP, definitely, team building is involved. A team is made up of 2 or more individuals who are fused together because of a common goal; and in this process, they are said to be “mutually accountable” (1993). How are we to build the team within the health care institution? It would be necessary then to make use of the 3 key concepts behind a collaborative intrusion – (1) communication, (2) mutual respect and trust, and (3) decision-making. Communication is going to be discussed further in the latter section of the essay.
According to (2004), mutual respect and trust are another key element of CP, which is supposed to be articulated in words, actions, etc. . Mutual respect and trust are quite synonymous and actually build on each other. Whilst mutual respect exists, trust likewise exists between or among individuals or groups of individuals. This concept can be seen in too, as mentioned above. Mutuality is in the air when a team is or teams are at work. Despite the fact that HCAs may be regarded as not highly competent, based on the fact that they lack the necessary skills, knowledge, and experiences, their counterparts, the experienced and knowledgeable RNs, physicians, etc. should still respect them being HCAs. The collaborating nurse is one who discloses proficiency with fellow nurses at the same time draws out from fellow nurses’ proficiencies (). It is believed that this statement from . is not only limited to the nurse, but to every health care professional. This is one of the ways to build a fortified team.
Collaboration is at the heart of successful decision-making. Decision-making, essentially, is a matter of shared responsibility and shared goals, and utilizing decision-making processes (2004). Collaboration among team members leverages skills time, and resources for their own benefit and that of the organization. In health care, the new rule is quality care and service-oriented teams, which is essential in care delivery outcomes and cost-control. Different health care professionals (physical therapists, dietician, physician, etc.) participate in this process, in accordance with its decision-making methods, in order to provide a holistic decision or resolution to a certain health problem.
Conflict within Team
“That which does not kill us makes us stronger.”
(1993) defines conflict as “the clash of perceptions, goals, or values in an arena where people care about the outcome” (). It is but natural for teams to be, at a certain point of time, in conflict. Futile conflict management disrupts the entire group process. The quote on top could be the underlying framework to develop in conflict management. Conflict management within the organization, or health care institution for that matter, can further be elucidated by the subsequent parcels of information accordingly.
(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.
In line with the quote on top, it is worthy to look more on the functional side of conflict, rather than the dysfunctional one. The functional outcomes of conflict serve as the rooms for improvement in an organization in conflict. The perceived conflict between an experienced and inexperienced health care provider may be related with their roles. The former seeks ways to deliver the finest quality care while the latter, is there to assist them. The latter therefore, has to ensure that he or she truly collaborates with the former. Otherwise, it will only open to more serious problems. Conflict in teams can and does occur. Divided loyalties between professional groups and a multidisciplinary team, and territorial disputes between professional groups, can be possible sources of friction. Conflict can occur when there is a lack of understanding of the conceptual framework used by various disciplines and/or a lack of clarity in terms of role expectations and definition.
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).
Conflict can be resolved initially, through an effective communication. 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 an imperative concept because an effective communication among health care professionals leads to the attainment of their goal, which is responding to the clients’ needs (2004). There is good teamwork (or collaboration) when there is good communication among the health care professionals. Likewise, there is a lesser room for conflict and a bigger one for team building and quality health care services delivery. If we are going to illustrate it, if physicians effectively communicate with the HCAs, then it is more likely that health care services are delivered properly and customers are satisfied.
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.
(2001) identifies 2 significant elements in communication: 1) the message being delivered to the receiver; and, 2) its “emotional impact” or the feedback of the recipient (). And, there are three things to consider in order to regard communication to be truly effective. First, one must distinguish precisely the message and/or information they want to convey to the recipients. Second, one must identify your audience. Briefly consider who the receiver is and what he/she does. Lastly, one must think about the style or the ways by which the message is sent to the receiving party (). This essay suggest that this should be the underlying communication process among the health care professionals within the health care institution in whatever activity they venture in, e.g decision-making, team building, etc. It is likewise necessary that they talks among themselves and disclose their feelings so as to somehow minimize the so-called stress they receive from their work.
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. This essay would like to end with (1990) idea that we live in an interdependent society and success depends on the cooperation of all members of an organization.
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