1. Collaboration and teamwork .. Peter Milburn Nov 2008

2. Questions and issues for discussion…….. • Is the consideration of collaborative practice necessary at all?? • Could you recognise effective collaboration if you met it!! • Is ‘it’ a learnt skill? • Are there factors that might hinder or facilitate effective collaborative practice within a healthcare team or organisation? A definition ………………….. ‘Effective collaboration in the modern health and social care sector is about everyone appreciating there position and being clear about where the ‘book stops’ (if things get ‘sticky’) and doing as they are told without question?

3. The n MRCGP…….. Curriculum Statements: • Coordinating care with other professionals in primary care and with other specialties • Understanding the importance of excellent communication with patients and staff and skill in effective teamwork ‘being a GP requires the ability to be an effective team player’ • Understand methods and models of brining about effective teamwork (n MRCGP 2007) Similar statements appear in the curriculum of every Health and Social Care Practitioner – the majority of H&SC practitioners are now taught on ‘interprofessional programmes’

4. Policy statements ……. • The NHS Plan (2000) “social services and the NHS will come together with new agreements to pool resources …. prevent patients/clients … falling in the cracks between ..” • Every Child Matters (2003) “addressing poor integration of services” • Modernising Medical Careers 2003 ‘Reform had been long overdue and was driven by the need for care based in more effective teamwork, a multi-disciplinary approach and more flexible training pathways tailored to meet service and personal development needs’. • Our Health, our Care, our Say (2006)“integrated approaches … innovative models of joined-up support within communities”

5. Secondly, UK society is changing …. - The breakdown of the post-war social democratic consensus - Increase in personal wealth and autonomy - Growth in the availability of material goods - Dissolution of social hierarchies – (elders and betters) - Society has become secular, materialistic, individualistic & rights focused

6. How has the NHS changed in response…

7. The NHS of today is …. • Market-led (payment by results) • Bureaucratic • Quality driven • Standardised (NICE, SCIE) • Accountable • Performance Managed (AfC) • Has (or attempting to) break down professional boundaries, barriers and restricted practices

8. The language of Health Care has Changed…… • Autonomy (not paternalism) • Individual need (not common good) • Choice (not sameness) • Partnership (not deference) • Empowerment (not authority) • Person-centred (not professionally-led) • Consumer (not patient)

9. Do you think ………………….. • the response appropriate?? • the response is evidence based??

10. How have the professions responded …

11. How have the professions responded… Positively by: • Creating pillars of society • Reflect rationality • Adopting practice concerned with core values selflessness / advocacy • Managing scares resources effectively • Applying rational knowledge efficiently and regardless of person • Having developed and work to written code of ethics Negatively by: • Creating closed occupational group • Establishing elitists training & selection programmes • Formed professional association to exclude others • Being political activity to establish recognition and protection of professional work • Put the interest of their profession before the needs of the public adapted from Wilensky (1964) (Schon 1988)

12. What is it the public want from professionals…. • Knowledge: accurate, up-to-date and evidence based • Skills: expert clinical and personal skills, open-minded team players • Attitudes: compassionate, respectful, enquiring, fostering independence, honest, focusing on possibility not risk Recognition that complex services can only be delivered with openness, transparency and COLLABORATION

13. What are the boundaries to effective collaborative practice in ‘General Practice’

14. Suggestions ………. • Organisational Barriers: • Organisations have different structures, cultures and financial arrangements – working across the health – social care divide • Professional Barriers: • Individuals working in Primary Care belong to and identify with different (professional) groups, each of which may have differences in knowledge and values • Personal Inability: • Differences in personality traits and preferences may make collaboration difficult

15. Models to investigate and facilitate collaborative practice …. • General systems theory • Models of power • Social Identity theory • Contact hypothesis • Psychodynamic theory • Functional transactional analysis (TA)

16. Questions ton ask that may help you collaborate more effectively ……. • Who do I need to work with and why? • What kinds of relationship do we want? • How do we expect the relationship to operate? • Is our experience of the relationship satisfactory? • How well do organizational factors support the relationship? • How well do people factors support the relationship? • Is the relationship delivering the desired outcomes? (Meads and Ashcroft 2005)

17. How do you know how well you collaborate: The ‘Taxonomy of collaboration’ …. In your association with others do you ….. • Work in isolation • Only have encounters other professionals • Communication effectively when necessary • Collaborate to make effective decisions • Lead a fully integrated team of professions each being equally responsible for their own effectiveness (adapted from Bond et al 1985)

18. The excuses……. • Conflicting pressures and constraints – I’m to busy to be bothered – (I can’t manage myself effectively how on earth can I manage others!) • Organisational and professional differences • If I collaborate ‘others’ will start to think they can do my job as well as me!! • Power relationships • Its natural and important for there to be a social order – how else would I justify being paid twice as much!! • Lack of clarity about purpose and outcomes • My role keeps changing and I am continually being to deliver a different set of outcomes (adapted from Charlesworth 2003)

19. A definition ………………….. ‘Effective collaboration in the modern health and social care sector is about everyone appreciating there position and being clear about where the ‘book stops’ (if things get ‘sticky’) and doing as they are told without question?

20. The outcome …….. “…When the social services came to see me, she said, “We didn’t realise your mother’s legs were that bad.” I said, “Well, I told you they were when she was in hospital.” When the district nurse comes, they say they don’t do legs any longer… they don’t wash legs, that’s the social services job. So they’re arguing in my mother’s house about who’s going to do what.” (Service user quoted by Charlesworth 2003)

21. “Health is not a product, but a process of interaction within and between individuals and the societies in which they live. The recognition of health and welfare within society as an interactive, adaptive process without an end becomes the only creative basis for strategies, policies and practices. In this interactive process, by definition, the ability to collaborate is essential.” (Loxley 1997 p.29)