Research Topics: Collaborative Practice

Collaborative Practice within the Organization

Introduction   As pediatric nurse practitioners, our task is to provide health care to infants and children. This is a big responsibility with difficult tasks that come with it. However, in a certain situation at work, this has not been the big problem that confronts us. Rather, the problem lies with a person and how she works with us. There is a registered nurse in my pediatric ward inside the private hospital where I work. This nurse always works for her own interest and seems to think that all she does is right and thus she puts the blame on the other colleagues. Even though she is the In-Charge nurse, she only likes to stay with the medicine trolley and distribute medicine to the patients but all the ward responsibility and problems will lay on the junior RN, EN and HCA, so she could stay in a complain free situation all the time. Most of the staffs feel very frustrated and do not like to work with her, but since the hospital lacks ‘experienced’ RN for IC, we, the staff needs to bear with her working attitude   What Is Collaborative Practice?               Collaborative practice is the application of interventions and therapies that require the knowledge, skill, and expertise of multiple health professionals (Potter & Perry, 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 (Lumby & Piccone, 2000). Shared leadership is a collaborative team process in which team members share key leadership roles (Storey, 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 (George, et al, 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.   What Is Happening Now?               According to Mullins (2002), customer satisfaction, workforce quality, and of course, the rickety economic conditions are the areas that need to be improved. It is believed that Mullins’ (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. According to Mullins (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, Mullins’ (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 (Spohn, 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) (Marshall, 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 (Pfeffer, 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 (Handy 1986, cited in Adeyoyin 2006).   Barriers to Collaboration: 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 (Fisher, 2004). From such a hierarchy alone, it is inevitable that there might be a clash of views that might cause conflicts within a team. Rahim (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 (p. 7).  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 (Copeland & Wida, 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.   Barriers to Collaboration: Ineffective Communication             Communication is a lifelong learning process for the nurse (Potter & Perry, 2004. p. 424). 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 (Potter & Perry, 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 (Clark & Drinka, 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.   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 (Clark & Drinka, 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 (Lumby & Piccone, 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 (Clark & Drinka, 2000).             The table below outlines how problems can be solved through collaborative practice: src=”template%20for%20ivytypepad_files/image001.gif” v:shapes=”_x0000_s1025 _x0000_s1026 _x0000_s1027″> ê src=”template%20for%20ivytypepad_files/image002.gif” v:shapes=”_x0000_s1028 _x0000_s1029 _x0000_s1030″> ê                                                                                                                                         ê 
200%"> Yes                                                                 No 
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200%">                                                             Yes                 No 
200%">ê                                                         ê                     ê         src=”template%20for%20ivytypepad_files/image004.gif” v:shapes=”_x0000_s1035 _x0000_s1036 _x0000_s1037 _x0000_s1038 _x0000_s1039″>   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.    References Clark, P.G. & Drinka, T.J.K. 2000. Health Care Teamwork: Interdisciplinary Practice and Teaching. Auburn House. Copeland, B.W. & Wida, K. 1996. Resolving Team Conflict. The Journal of Physical Education, Recreation & Dance. Fisher, E.A. 2004. The Art Of Managing Everyday Conflict: Understanding Emotions and Power Struggles. Praeger Publishers. George, V., Burke, L.J., Rodgers, B. & Duthie, N. 2002. Developing Staff Nurse Shared Leadership Behavior in Professional Nursing Practice. Nursing Administration Quarterly. Hospital Authority. 2003. ‘Annual Report of Hospital Authority (2002-2003)’,             Hong Kong Hospital Authority. 2004. ‘Annual Report of Hospital Authority (2003-2004)’,             Hong Kong Kozier, B, Erb, G, Berman, A, & Snyder, S. 2004. Fundamentals of Nursing:             Concepts, Processes, & Practice, 7th ed., Pearson, Singapore.  Lumby, J. & Piccone, D. 2000. Clinical Challenges: Focus on Nursing. Allen & Unwin. Marshall, G. 1998. Organization Theory, A Dictionary of Sociology, Oxford University Press. Mullins, L.J. 1991. Management and Organization Behaviour, 2nd ed. Pitman             Publishing, London Mullins, L.J. 2002. Management and Organizational Behaviour, 6th ed., Financial Times Pitman Publishing, Harlow. Mullins, L.J. 2005. Management and Organizational Behaviour, 7th ed., Financial Times Pitman Publishing, Harlow. Potter, P. and Perry, A. 2004. Fundamentals of Nursing. Mosby, Singapore. Rahim, MA 2001. Managing Conflict in Organizations, Quorum Books, Westport, CT. Spohn, M. 2005. Organization and Leadership Theory: An Evolutionary Psychology Perspective. Journal of Evolutionary Psychology. Storey, J. 2004. Leadership in Organizations: Current Issues and Key Trends. Routledge. Credit:ivythesis.typepad.com

Collaborative Practice within the Organization

Introduction As pediatric nurse practitioners, our task is to provide health care to infants and children. This is a big responsibili...

Health Promotion

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.                                                                       Credit:ivythesis.typepad.com

Health Promotion

Collaborative Practice within the Organization Introduction In 1992, The American Nurses Association has set the work...

Collaborative Practice with Public/Private Sector Organizations

Module     Title Small Storm in my Unit CONTENTS Introduction………………………………………………………………………………………….2 Description……………………………………………………………………3-4 Feelings……………………………………………………………………….4-5 Evaluation……………………………………………………………………………………………5-6 Situational Analysis……………………………………………………………………………….7-10 Conclusion…………………………………………………………………………………………….10-11 Action Plan…………………………………………………………………….11-13 References………………………………………………………………………14     Introduction Collaborative means a team of people work together as well cooperating with each other for the target. ( 2000) As (2002), comment teamwork is delegation and empowerment gives people a sense of being valued, feeling that their efforts are being acceptable. It seems an ideal picture, instead there are many barrier in command good collaboration among a team such as role and culture different, knowledge base and training are different, decrease of manpower , value of view are different or communication breakdown in the organization. (2002) All these reason might cause conflict between the team therefore; we need a strong leader as a head of the ship to guide the team cooperation. ( 1985) In organization, there is no individual work; especially in health care worker, we must work together as a team to provide safety services to our patients. Therefore, in the assignment I will use an issue as an example apply on Reflection cycle (1988) to explorer why we have conflict in the team and cause of working inefficiency in my working area (medical unit). Nurse are the largest group of professional in health services, team work between nurse to provide appropriate care and avoid harming to patient are the main concern. Thus, I will analyse my unit situation and find out if we have room to improve in team building and reduce cause of conflict, so that we have smooth shift work closely with patients 24 hours a day   Description In the past, our unit cares the patient by use of team nursing system (functional nurse). It means one Registered Nurse (RN) in-charge the ward, one RN /one enrolled nurse (EN) as a partner to deliver medication for all patients in the unit and the rest of the nurse will care of the patient as a team. Most of the time, each nurse have to takes care about 8 to 9 case and we have one to two health care assistant in each shift. Usually we have seven nurses in morning shift, six nurses in evening shift and three nurses in night shift on 37-bed unit. The ratio of staff depended on the high-risk case ratio in the ward. Few month ago, follow the change of the nursing administer we change the team nursing system to total patient care system. Which was one nurse (RN or EN) take care about 8-9 case from admission to offer medication, set up the infusion drip, dressing, make round with doctor, answering the call bell… One day, my colleagues was crying after duty and complains of too busy without support as she need to take care of two high dependency case. On top of that, she have another six case need to care, she just cannot manage and even do not have time for lunch. It make her feeling of lonely in the unit without support, she comment on that incident was that if condition no change than she will plan for resign. In this issue, I have the same feeling about that new system, it seems working in the factory without team spirit; each staff was busy to complete their own work without other support; after a long period, it becomes a routine and monotonous job without any challenge. Hence, I will explorer our unit situation and the poor team working among the staffs. Feelings On this issue, health care providers should maintain the level of competence and deliver safe quality care to our patients. Therefore, a good team work in the unit must well establish by collaboration between staff and manager so as the top leader. According to (1985), change cannot be too rapid and must be well inform to the staff about the new system because staff need time to adjust. At the beginning of the system start, everything seems out of control and feeling of mess. Such as we only have one medication trolley and 4-5 nurses get the medicine from one trolley. Even we have feedback to the manager and the answer was you just not familiar to the new system. The other point that I concern which is RN and EN role seems not clear and I feel not comfort and it is not fair to EN. Just (2002) pointed out that team members should understand each other’s role and specialize for the task in the organization.  (1999) suggests that leader should try to co-exist in harmony with two groups of people. About team nursing and total patient care system, each system has their weakness and strength part. After a new system start, manager should ask for feed back and have adjustment to help team work smooth, this way can show administer were concern their staffs. As (2000) ask for feedback should have active listening and being open in encouragement but not criticism to staff, the last was argue to convince and not to win . I have an experience was some nurse are very busy but some of the nurse seems always busy in her job without help each other. The result will be fatigue and frustrated among the team members and feeling of unfair in job allocation, the outcome will be conflict among team can easily arise. Evaluation The system itself might create different kinds of problem, I am try to evaluate their strength and weakness parts between team nursing system and total patient care system. Strength in team nursing can have good task orientate with arrangement that is more flexible such as when staff got sick, manager could easy to delegate job to other team members. As (2002) suggests teams working encourage flexibility, involvement and efficiency. Teamwork usually has good team spirit as a group of people working as well as a cooperating with each other in the task. In addition, teamwork can achieve cost-effectiveness especially in the private-health sectors. (2004) also mention consumers want the latest technology and highest- quality care at the lowest possible cost from their caregivers. Weakness in team nursing were the responsibilities sometime may be not clear, as I mention above (RN/EN) role are not clear. For example, the new experience RN cannot manage some of the job than the old experience EN need to take over the job. Team nurse play a functional role in a group might have a limited understanding of patients’ needs. Furthermore, team nursing might limitation in staff development in management aspect as decision-making usually put on few nurse (2004) share decision making, empowerment is an essential element of the work. Strength in total nursing care, patient will have good nursing care as nurse are full understanding of the patient’s needs therefore nurse can provide prompt service as patient required. This system also can establish a good relationship between nursing staff and patient so as their family. It contributes the communication skill and decision-making skill while caring of the patient. According (1999), job satisfaction is one of the intrinsic factor. As nurse understand patient‘s condition thus can give a clear handover report to the next shift in provide an effective continuity care. Weakness in total patient care were time consuming if inadequate staff might leading to burnout, therefore my colleague crying after shift for the heavy workload. This system benefit on train the nurse about technique in solves problem independency. On the other hand, this system will limit in development of the relationship between colleagues because nurse handle patient all by her own. As a result, staff will lose the team spirit in the organization. Furthermore, nurse unresponsive to other patient’s needs might influence our customer services. For example, while that patient seeks for help, nurse might not handle what patient ask for, as she does not know the whole picture.    Situational Analysis analysis (1999) Political-In Hong Kong nurse training before 1997were base on academic and practical in few hospital with recognized by nursing broad for (RN and EN). After 1997, all EN training was suspended and RN training is back to University. Thus different nursing work together with different levels of knowledge or skills and the clinical experience background might have different value/view, as the result, it become a barrier in collaboration. Economic- hospital was try to cut budget that staffs salary expend not over 47% therefore the shortage staff and over workload brings nurses are stress and fatigue. As (1999) economic is one of the 12 human needs, its will influence staff moral and lost the enthusiasm so as the sense of belonging. According to (2004), point out that health budget cuts will result in lower standard of service and poorer patient outcomes thus a threat to patient safety. Social- personal differences when engaged in interacting with others require having different skill and talents indifferent situations. Usually, nurse has different cultural background, training, age, religions and educational background; hence influence the team working performance (2000) mention different culture might speak different ‘languages’ and it find hard to understand each other. Technical-Due to our hospital expand its services in the procurement of new equipments in our unit and computerization system. Nurse should collaborate with other in operate the new equipments such as use the hoist to lift the over weight patient from one place to the other place. On nurse cannot manage some of the job and we should work with other to achieve that target. According (2004), mention consumers want the last technology and highest-quality care at the lowest possible need kindness and compassion from their caregivers. Ethical- Each person have their value and point of view; once they work together, conflict might arise. We should respect other decision even I am not agree with other, therefore, collaboration might have barrier. There is no single formula for health care worker in caring of the patient; both patient and nurse have their right but respect each other can reduce conflict.     Legal- as a health organization, patient safety must put in first priority. Hong Kong is a city under legislation; hospital and health care worker have responsibility to ensure all actions have taken to prevent or minimize harm to patient. (2004) In the collaboration issue, legal aspect seems cannot total apply on it, only if under the reason of patient safety. According to the (1981) nine types of personality, which include people with plant, resource investigator, coordinator, shapers, monitor-evaluator, team worker, implementer, completer, . As I know my colleague was a typical team worker, she need support and power but cannot take too much responsibility. Therefore, she was crying under stress in taking care of heavy workload. Each type of personality has its strengths and weaknesses, thus different situations will have different outcomes. In team nursing system and total patient care system, if manger knows the staffs strengths and weaknesses than delegate different task that leads to satisfactory outcomes. It was because both system cases was delegates by unit manager, the problem is manager assign case to staff sometime was not even and do not follow the team role, once the staffs have error occur our manager will blame the staff for any of the incident happen. Just like (2000), mention people want the praise for success, but not the blame for the failure. In my unit, experience EN take care of high dependency case and new experience RN take care simple case were always happen. As the result, experience staff will be felling of exhaust to deal with heavy workload and new experience nurse will lost of chance in learning without job satisfactory thus destroy the relationship between staff (RN/EN). According to the (2005) mention four main type of barrier that include distrust to staff, unfamiliarity with staff’s contributions, aversion and attraction to staying busy. However, (2000) mention that delegating task to the staff must include delegate with authority, identify skill, evaluate and recognize the achievement, set up the objectives, ensure it is really necessary, monitor set the time frame and communicate with the colleagues……….. My manager did not empower the staff and not trust the staff might decrease team spirit so as the morale in the unit In  (1965) who identified the four main successive stages of group development and relationships, which are forming, storming, norming and performing . My suggestion was that good orientation program is an important step on develops team building as new staff would able to adapt to the new environment, have sense of belonging and feel familiar with staffs. Just like  (2000) mention we must aware different languages and different interpretations and emphases in similar languages. Therefore, manager should help the new staff in go through each step until created structure and cohesiveness to work effectively as a team.  Conclusion As one of the team member in the unit, I would like to work in the pleasure environment with my colleagues in well co-operated with other. Health care worker always work under stress, as we have to face live and death every days. To reduce stress among staff, nurse manger can play an important role in helping frontline staff by provide effective learning environment, establish the strategy of two-way communication between team members and the rest of organization, promote an open and fair culture, listen for the staff’s feedback and empower the staff in create job satisfaction. Each human need to and to be respect, manager knowing the staff strengths and weaknesses and able to empower the staff wound gain support and raise motivation in work. Just like my colleagues, once she make error than she will lost the chance to improve as my manager not delegate job to her; this way will contribute lost of self-esteem and sense of belong to the team.  (2002) comment on success team, require empowerment, providing, autonomy in decision-making, establishing opportunities for training, resourcing the team, support and respect. On the other hand, team members should establish social relationship hence to keep humorous working environment.  (2000) suggests five areas should improve in organization that includes affiliation, security, competence, achievement and power. These can help staff to build up the enthusiasm through success and create work that is more efficient. The aim of collaboration between health care worker was benefit to the patient and their family in provide the safety and efficiency service.      Action Plan As we know that, no system is perfect and we can try to modify these two-system in helping staffs collaboration. My suggestion was that, if we have seven nurse on duty that include one unit manager to over see the unit situation; three nurse in each team that include one RN, one EN and one nurse assistant. Each nurse can still take care of their patient but they can help each other such as checking medication, answer the call bell while her partner was busy in other job. On the other hand, old experience nurse can assist or teach the new experience nurse to reduce the role delegate not fair in duty. Increase equipments as staffs request for user know what they needs and convenient to both staff and the patient.   Moreover, our organization needs to support the staffs by provide chance of training and continued education. According to  (2000), providing staff education can achieve valuable benefits in improving staffs insight and ensure individuals value in their professional.  (2005) pointes out that lack of professional development and training opportunities will lead staffs sense of job dissatisfaction and frustration, thus influencing the quality care to patient. In other author (2005) mention, that knowledge will provide varying goals for the professional’s value and the foundation in role of change. Continue education can improve our knowledge base while apply on our nursing practice we can gain experience thus increase our confidence in work so as self-esteem and job satisfaction.  (2000) mention about shortage of nursing staff and increase of workload could cause miscommunication among team working. Both  (2002) and  (2000) have mention about effective communication mechanisms is an essential for team building.  (2000) suggests four communication skills including encouragement and criticism, active listening, being open and argue to convince, not to win. Using the issue of my colleague, if she cannot manage the heavy workload, she should inform the manager to make better arrangement and the manager should listen to the staff and give support hence to collaboration each other in run the smooth teamwork. Therefore, no matter formal or informal communication between team members and manager so as the organization should well establish. The last,  (2000), points out that people are able to feel proud of belonging to the team; the most important principle of all in successful team is through respect. We can support by team empowerment, providing autonomy in decision-making, establishing opportunities for training, listen for the staff feedback, and try to make change if possible to gain a win-win outcome.  (2000) also mention trust and respect will make the team grow. Just like the change of team nursing to total patient care system, manager should listen to the staffs’ feedback regularly to make plan in adjust the system so that we could work together in harmony environment.    .         Credit:ivythesis.typepad.com

Collaborative Practice with Public/Private Sector Organizations

Module Title Small Storm in my Unit CONTENTS Introduction………………………………………………………………………………………….2 Description………………………………………………………………...