A Handbook for Interprofessional Practice in the Human Services

Learning to Work Together

Brian Littlechild, Roger Smith, Brian Littlechild, Roger Smith

• Publisher: Routledge
• Year: 2013
• Print ISBN: 9781138132597
• eBook ISBN: 9781317862420
• Edition: 1
• Topic: Medicine
• Subtopic: Social Policy

A Handbook for Inter-professional Practice in the Human Services: Learning to Work Together is an essential text for all students of inter-professional education, and for practitioners looking to understand and develop better inter-agency working.

With an emphasis on working collaboratively with fellow professionals, service users and the community, and developing an holistic approach to working, this is an essential resource for anyone studying on courses in social work, nursing, education, health, medicine, social policy, physiotherapy, occupational therapy, physiotherapy and dentistry, and for all those with an interest in the human services.

Part One

KEY ISSUES IN INTERPROFESSIONAL AND INTERAGENCY WORKING IN HEALTH AND SOCIAL CARE

1 Working together: why it’s important and why it’s difficult

2 The drivers and dynamics of interprofessional working in policy and practice

3 Change and challenge in interprofessional education

4 Keeping interprofessional practice honest: fads and critical reflections

5 Working in partnership to develop local arrangements for interagency and interprofessional services: a case study

6 Information-sharing agreements between agencies and professionals: making use of law, policy and professional codes

Chapter 1
Working together: why it’s important and why it’s difficult

Roger Smith

Chapter summary

This chapter aims to introduce a number of key aspects of interprofessional or collaborative working, in order to focus specifically on the opportunities and challenges presented. It first identifies some of the benefits as well as potential disadvantages associated with working together. Building on this framework, the chapter proceeds to discuss the underlying preconditions and the practice requirements necessary to ensure that collaboration is effective, and of fundamental importance, and actually works to the benefit of people who use health and social care services. In setting out these elements of good practice, however, there is no attempt to hide or minimise the kind of interpersonal, professional and structural obstacles which stand in the way of successful cooperation.

Learning objectives

This chapter will cover:

the origins of interprofessional working

the potential advantages of collaboration

potential shortcomings in collaborative practice

the challenges and opportunities of joint working

key elements of effective collaboration

the value base for working together.

A closer look

Why should we work together?

Victoria Climbié died as a result of extreme abuse and neglect on 25 February 2000, aged 8. One of the witnesses to the subsequent inquiry into her death described it as ‘the worst [case] I have ever dealt with, and it is just about the worst I have ever heard of’.

(Laming, 2003, p. 2)

Writing about the lessons learnt from Victoria’s history of abuse and the inadequate responses of a range of agencies and professionals, the president of the Royal College of Paediatrics and Child Health wrote: ‘Prevention depends on collaboration … [I]t is not just organisations, committees and boards that must work together. Children like Victoria die when individual professionals do not work together.’

(Hall, 2003, p. 203)

Starting from the beginning

The impression is sometimes created that working in partnership has only become recognised as an important aspect of professional practice relatively recently. It is certainly the case that books such as this, and other publications on the subject, have only been produced in any quantity in the past decade or so. This does not mean, though, that the move towards better mutual understanding and cooperation in practice has no significant history. In fact, it is more likely that collaboration in some form or other has always been the norm as the modern welfare state has developed. This is certainly the view of some of those who have commented on the subject previously. Pietroni (1994, p. 77), for example, has suggested that ‘The development of “groups of workers” coming together to look after a patient began with the emergence of the hospital’. As health and social care provision began to be developed as a systematic form of activity, so there also emerged an increasing number of specialised roles and tasks. While at first the interface between different specialised functions may have been highly structured and regulated, the ‘militarisation’ of medical services meant that tasks and relationships between practitioners also came to be differentiated and closely specified. This also ensured that services tended to be organised in a hierarchical fashion, with little scope for mutual negotiation or exchange of professional opinion. But what it did mean was that even from this early stage the need for specialist skills, systematic allocation of tasks and effective communication and ‘transfer’ arrangements was recognised quite clearly. Ironically, in fact, the gradual development of very specific functions in health and welfare also led to a parallel requirement for those carrying out these functions to share responsibilities and develop effective ways of combining their inputs in the interests of service users/patients.

The process of specialisation has sometimes been equated to the equivalent developments in industrial production and other commercial spheres. The pioneer of this kind of approach is believed to be Frederick Taylor (Rastegar, 2004, p. 79), who was driven by the perceived need to improve the quality, productivity and efficiency of manufacturing processes. Taylor believed that complicated activities could be broken down into a series of relatively straightforward tasks, which could then be streamlined and integrated to maximise overall performance. Whether or not it has been motivated by exactly the same logic or demands, the same kind of trends have been identified in the welfare sector, with a similar increase in the number and range of specialised activities. However, it is also acknowledged that a simple transfer of lessons from industry to health and welfare may be to underestimate the inevitable complexities of human services:

While it is fairly straightforward to look at outcomes of a discrete condition or stage of care (situations where specialists tend to perform better), it is much harder to do so for patients with a variety of acute and chronic illnesses cared for in different settings for an extended period.

(Rastegar, 2004, p. 80)

There have been other drivers, too, that have created an increasing variety of professional identities, with responsibilities which may only be effectively discharged if they are linked with the work of others. Of course, this trend has partly been about the search for a distinctive rationale, value base and identity which has occupied the thoughts of many practitioner groupings, especially those which have been established as distinctive occupational roles relatively recently (the ‘new’ professions).

Exercise 1.1

Can you identify and distinguish separate lists of ‘old’ and ‘new’ professions in health and social care? Looking at these two lists, what are the features which differentiate them? Do you think these differences might lead to tensions and conflict?

This in turn itself sets up some interesting and challenging dynamics, given that becoming effective collaborators might mean giving up some aspects of your autonomous standing, which may have been hard won over a period of time.

At the same time, as Leathard (1994, p. 6) has wisely observed, difficulties ‘can arise over the use of the word “professional”’. If other practitioners, or non-professional interests and viewpoints are marginalised by this use of terminology, purely because they do not see themselves as ‘professionals’, genuinely collaborative working may also be made more problematic. This issue becomes more significant still when we reflect on the importance of keeping ‘carers’ and those ‘cared-for’ at the centre of the process, and seeing them as key members of the ‘team’.

So, two distinct trends of specialisation and professionalisation have been increasingly influential in shaping the working environment in health and social care. As tasks have become more discrete, and to some degree routinised, so have those responsible for carrying them out sought to articulate and maintain their own standing as professional experts with a degree of autonomy, authority and discretion. In light of this, it is perhaps not surprising that there has been an emerging recognition of the tensions and barriers inherent in these changes, and the need to address them. This has certainly been recognised as a significant challenge in the world of policy and practice guidance for some time (Pietroni, 1994), an awareness which has been compounded by the recurrent evidence from major inquiries that a failure to collaborate effectively may amount to risky and, indeed, harmful practice (Stevenson, 1994).

A closer look

Finding common ground

When I was asked to join a youth diversion team comprising a teacher, a police officer, a social worker, a youth worker and a probation officer, it quickly became clear that we had to find a balance between representing our own agency and its working principles and combining to deliver the specific collaborative task for which we were responsible. In order to do so, two essential preconditions had to be met. We all had to be prepared to give up some areas of practice for which we might previously have claimed exclusivity, and we all had to be ready to accept the validity of other disciplines’ distinctive skills and expertise.

Against this backdrop, then, there is a definite sense that the priority accorded to collaborative working has been enhanced in recent years, and that it has come to be seen as the starting point for effective practice in many areas across the service spectrum, rather than an optional extra. This impetus has been supported by many examples of ‘good practice’, such as the present author’s own experience of multiagency juvenile diversion (Smith, 2007), or the evidence from collaborative rehabilitative interventions for older people (Lymbery, 2003).

In parallel with these developments ‘on the ground’, we have also seen considerable behind-the-scenes activity on the part of government and other policymaking bodies (see Chapter 2). It has become almost a matter of faith that collaborative working is desirable and has the potential to resolve many of the difficulties encountered by people who feel that they are let down by health and social care agencies. But it is as well to begin with a cautionary note, as sounded by an earlier commentator:

What remains to be seen is whether the pressure on health and welfare professionals to work together will have a positive outcome … will clients, patients and users receive quality care and be enabled to make choices on a meaningful basis? Or will professional identities, under the cloak of rationalization and skill-mix realignment, become diluted and the standards of care undermined? Time will test the interprofessional resolve.

(Leathard, 1994, p. 9)

In light of this observation, it is worth stressing that in order to be able to work well with colleagues from other disciplines you will need to have and hold a clear and confident view of your own profession’s purposes and principles.

Gains and losses 1: possibilities

As in almost any sphere of activity, collaboration in health and social care presents both opportunities and risks, and has always done so. It has been relatively easy to make a case for partnership in recent times based on the observable consequences of fragmented services and poor communication, but it may be that pressure to find easy solutions and ‘quick fixes’ has led to an underestimation of some of the endemic difficulties involved. As suggested elsewhere (Smith, 2009), a number of both advantages and disadvantages are attributed to working collaboratively. On the positive side of the coin, we might expect improvements in the following areas:

Improved efficiency. There are a number of essentially practical ways in which sharing arrangements to work with service users should make provision more accessible and efficient. Thus, for instance, a number of discrete resources may be accessible to users from a single point of delivery. At the same time, practitioners may find that it is easier to communicate, and to share information and referrals...

Table of contents

• Cover Page
• Half-title Page
• Title Page
• Copyright Page
• Table Of Contents
• Contributors
• Acknowledgements
• Introduction
• Part One Key Issues in Interprofessional and Interagency Working in Health and Social Care
• Part Two Interprofessional and Interagency Working with Different Service-User Groups
• Part Three Interprofessional and Interagency Working: Service Users, Carers and Different Professional Groups
• Index