Going Interprofessional

Working Together for Health and Welfare

Audrey Leathard

• Publisher: Routledge
• Year: 2002
• Print ISBN: 9780415092852
• eBook ISBN: 9781134871889
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

Health and welfare professionals increasingly have to collaborate and co-ordinate their practice in order to provide a more integrated service for the consumer. Going Inter-Professional brings together academics, professionals and researchers to assess the implications for all the professions involved and the practical developments in hospitals, general practice and community care. Individual contributors look at:
* the theoretical background to inter-professional work
* education and management issues
* inter-professional practice issues in work with children, disabled, elderly and mentally ill people
* the implications for carers
* developments in Australia, Western Europe and the USA

Part I
Background

Concepts – models and theoretical implications

Chapter 1
Inter-professional developments in Britain

An overview

Audrey Leathard

The idea that inter-professional education and practice should be encouraged has been almost universally supported but invariably not achieved. The picture is now changing rapidly. The lack of achievement could be attributed to the tensions and conflicts posed by the collaboration of different professionals. However, health and welfare professionals have come under increasing pressure to learn and work together. This publication therefore sets out to explore some of the key issues raised by inter-professional approaches.

Introduction and summary

This overview starts by looking at the purpose of the book overall. As the word inter-professional quickly leads into a minefield of terminology and the place of the professional is ambiguous, both issues are then considered as well as a brief analysis of the case for going inter-professional. In order to set subsequent chapters within a wider context, relevant government health and welfare policies are identified to see the impact on inter-professional developments in practice. The two main outcomes point to an increased emphasis on teamwork and inter-agency collaboration. The rise of organizations seeking to further inter-professional work and the response of educational initiatives are reviewed. By the 1990s, the two favoured educational methods of embracing multi-professional education have been the shared learning model and the inter-professionally centred approach. The opening chapter concludes by introducing the authors and presenting a plan of the book.

THE PURPOSE OF THE BOOK

This publication sets out to provide a bench mark in time; to outline and analyse some of the key developments; and, above all, to encourage a wider debate about health and welfare professionals learning and working together.

As various trends are recent and emerging, the discussion presented does not seek to be prescriptive but attempts to assess the significant features by those who have been closely involved with particular aspects of health, welfare and caring. This is where the emphasis of the book lies as it is in these arenas where most debate and activity have taken place within an inter-professional context. The authors have therefore sought to analyse the main issues in health and social care which have a bearing on inter-professional developments in theory (Part I); in practice in Britain (Part II); and abroad (Part III). The book has attempted to present a balance of inter-professional considerations between theoretical possibilities; educational developments; and practice outcomes for groups in the community (such as old and disabled people and their carers, among others).

However, although not debated in detail here, the context is changing and expanding to the extent that related fields, such as marriage guidance, pastoral and hospice care, and issues surrounding housing and homelessness, among emerging elements, are becoming increasingly relevant to collaborative working with health and welfare professionals. The idea behind this book is, therefore, to open up an awareness of the potential of interprofessional activities as well as the drawbacks, so that as wide an audience as possible can participate in the debate and developments.

This book is therefore relevant for all who have an interest in matters of health, welfare and caring whether as policy makers or politicians, educators, purchasers or providers, as doctors, nurses, members of the professions allied to medicine (for example, physiotherapists, speech therapists, radiographers, occupational therapists, osteopaths), as well as general practitioners, practice nurses, community nurses (health visitors, district nurses, psychiatric nurses), pharmacists, health educators, dental carers, informal carers, social workers, care managers, clergy, probation officers, police officers, housing officers, teachers, staff of voluntary organizations and from the private hospital and nursing home sectors and, among others, Directors of Social Services, Family Health Service Authorities and hospital managers. In various ways, all these groups are involved in working together with others in health, welfare and educational provision.

With this range of participants in mind, the present group of authors have therefore set out to bring together certain key issues, at this time, at the frontiers of inter-professional knowledge, pressures and developments. As this is one of the first books which seeks to address a wide-ranging review of inter-professional work in Britain and abroad, it is by nature an exploratory exercise. The authors themselves are seeking to map out relatively new territory. It is hoped that the book will thus present a springboard for future activity, participation, debate and involvement as well as provide a past and present record of how the inter-professional picture looked by 1993.

THE MEANING OF THE WORD

Several terms have already been used to denote going inter-professional. As developments move apace so an ever-expanding range of professionals, carers and ‘cared for’ have become involved in inter-professional work as well as a variety of organizations and sectors. This has led to a terminological quagmire. In an attempt to clarify the arena, Table 1.1 sets out some of the terms used to denote learning and working together.

Table 1.1 Alternative terms used variously for inter-professional work denotinglearning together and working together

Any grouping of terms is debatable and alternatives may be considered more appropriate. In the next chapter, Don Rawson presents an interesting variant with a similar approach. Redefining and clarifying terminology is precisely one purpose of this publication: to further the debate on inter-professional issues.

Meanwhile, one undeniable fact is the complexity of defining the meaning and even the spelling of the word. Hyphens are variable in use. In this volume, we simply aim to be consistent within each chapter; although titles of courses and organizations remain in their original format. However, not only does ‘inter-professional’ mean different things to different groups of people but professionals themselves speak different languages which influence both their mode of thought and identity (Pietroni 1992).

In health care, the terms ‘inter-disciplinary’ or ‘multi-disciplinary’ are often used to refer to a team of individuals, with different training backgrounds (e.g. nursing, medicine, occupational therapy, health visiting, social work) who share common objectives but who make a different but complementary contribution (thus differing from inter-agency collaboration or ad hoc collaboration between professionals) (Marshall et al. 1979: 12).

The snag here is that there are those who feel that ‘inter’ means between two groups only – so for them ‘multi-disciplinary’ or ‘multi-professional’ are preferable terms to denote a wider team of professionals. For others, ‘inter-professional’ is the key term as it indicates that the professionals involved have the same joint goals and are likely to be working in the same building. From a psychiatrist’s perspective, Derek Steinberg (1989) has identified interprofessional consultation as collaborative work between one person (the consultant) helping another (the consultee).

In academic parlance, multi-disciplinary work usually refers to the coming together and contribution of different academic disciplines. Meanwhile, multi-professional and interprofessional courses are often both used to express the coming together of a wide range of health and welfare professionals to further their studies in a shared context. However, as Hugh Barr discusses later, the crucial distinction is that inter-professional work relies on interactive learning. Within the wide spectrum of choice available and the varying interpretations, organizations and groups tend to favour particular forms: as does the World Health Organization with the preferred use of ‘inter-sectoral’. Latinists can help to simplify the arena by translating ‘inter’ as between; ‘multi’ as many; and ‘trans’ as across. What everyone is really talking about is simply learning together and working together.

WHO ARE THE PROFESSIONALS?

A further difficulty can arise over the use of the word ‘professional’. For some, the implication is to marginalize non-professionals within an inter-professional context. Traditionally, a professional person is associated with control of entry to a particular profession: the requirement to undergo a recognized length of training, accredited and, in some cases licensed, by an acknowledged professional body. At the end of training, the professional is recognized as having a certain expertise which legitimates practitioner action, Inter-professional developments in Britain 7 usually bound by a code of ethics. However, as Paul Wilding (1982) has shown, certain of the professionals’ claims are both questionable and problematical. Within an inter-professional context, where the work of professionals, carers, cared-for and voluntary input can all be relevant, the term inter-professional may begin to lack credibility. Helen Evers and her colleagues, in their chapter on elderly and disabled people, move the perspective usefully forward by describing all the workers involved, including service users and carers, as ‘experts’.

SO WHY GO INTER-PROFESSIONAL?

The need to bring together separate but interlinked professional skills has increasingly arisen in response to the growth in the complexity of health and welfare services; the expansion of knowledge and the subsequent increase in specialization (Marshall et al. 1979: 12); as well as the perceived need for rationalization of resources, for lessening duplication and to provide a more effective, integrated and supportive service for both users and professionals. As Michael Casto discusses later, similar factors have led to the rise in inter-professional developments in the United States.

One striking feature about inter-professional work in Britain is that there has been a generally held belief that collaboration is a good thing and inter-professional teams have increasingly gained favour in recent years (Westrin 1987; Gregson et al. 1991). However, there has been little evidence to substantiate the view that collaboration leads to an increase in the quality of care which has furthered the well-being of patients and service users. Again, although coordination is generally accepted as a valuable goal, how to assess its outcome remains effectively somewhat intangible (McGrath 1991). Nevertheless, ‘multidisciplinary’ teams between health and social services have even been described as taking on the aura of a ‘social movement’ (Lonsdale et al. 1980). Charles Engel, in his chapter ‘A Functional Anatomy of Teamwork ’, looks in greater depth at the wider concept of teamwork.

SOME ADVANTAGES AND DISADVANTAGES OF INTERPROFESSIONAL WORK IN PRACTICE

Meanwhile, McGrath’s (1991) study valuably assesses the advantages and disadvantages of inter-professional teams working in the field of community mental handicap. The three main advantages are listed as:

• more efficient use of staff (e.g. enabling specialist staff to concentrate on specialist skills and maximizing the potential of unqualified staff);
• effective service provision (through encouraging overall service planning and goal orientation);
• a more satisfying work environment (through promoting a more relevant and supportive service);
• as well as, in the view of the Pritchards’ (1992) study on teamwork in primary health care, enabling professional and lay people to achieve their objectives more fully and economically.

The interesting study on the Rhymney Valley Joint Project for pre-school children, which involved a wide range of workers from education, health authorities and a voluntary child care agency, showed that, through exchange and sharing of resources, there emerged a sense of the needs of the client, child and family, superseding any one organization’s need to predominate or protect its identity, although resources were not necessarily maximized through cooperation (White 1989).

Inter-professional pitfalls, on the other hand, have included: time-consuming consultation; administrative and communication costs; differing leadership styles, language and values between professional groups; separate training backgrounds; inequalities in status and pay; conflicting professional and organizational boundaries and loyalties; practitioners being isolated with little management support; lack of clarity about roles; negative mutual perceptions and latent prejudices (Marshall et al. 1979; Brunning and Huffington 1985; Jones 1986; White 1989; Ovretveit 1990; McGrath 1991). From a study on inter-professional collaboration in marriage guidance, Woodhouse and Pengelly (1991) further identified institutionalized defences and an inescapable attendant anxiety among the individuals involved, despite the generally positive attitudes that social workers and health visitors had one to another. Meanwhile Ovretveit’s (1990) report, Cooperation in Primary Health Care, concluded that, although the primary health care team was a much used term (everyone said they were in one) to represent a wish to work more closely together, in reality everyone was organized in professional groupings which were pulled back into this structure whenever any significant moves to true inter-professional working were made.

On balance, despite the drawbacks inherent in inter-professional work, McGrath (1991: 193) concludes from her community mental handicap study that the advantages outweighed the disadvantages in multi-disciplinary teamwork: as a result, coordination in services had improved.

AN INTEGRATED CARE SYSTEM

Stepping centrally and positively into inter-professional work, the Helen Hamlyn Foundation starts out from an integrated perspective. The Foundation has set up a number of EPICS (Elderly People’s Integrated Care System) Centres (in North Kensington, Derby and Shropshire) which set out to offer comprehensive, centrebased, integrated health, social and personal care support for frail elderly people living at home (Hollingbery 1990). Based on the principles of integrated working, adequate resources and the total needs of elderly people, sought through the elements of holistic assessment, individual care programmes, generic care staff and a joint management board, the programme was favourably reviewed by a Nuffield Institute study (Hunter and Wistow 1990). An entirely identifiable trans-disciplinary perspective was located to support a people-centred rather than an organizationally structured system in which the needs and views of elderly individuals were held to be paramount (Henwood 1992).

At the positive end of the inter-professional spectrum, the themes of holistic care, a commitment to integration and an overriding philosophy of working together for the good of the ‘cared for’, as in hospice care, seem to play a significant part in bringing together user needs and views as a whole, enhanced by professionals sharing and supporting each other.

BACKGROUND DEVELOPMENTS 1970s–1990s

Meanwhile, the pressure to go inter-professional has speeded up under the impact of government policy, since the mid-1980s, and noticeably in the 1990s. Such is the extent of the impact that, arguably, government policy has seemingly spearheaded recent interprofessional developments in practice. What remains to be seen is whether the pressure on health and welfare professionals to work together will have a positive outcome on the effectiveness of service provision. As a result, 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 inter-professional resolve.

THE IMPACT OF GOVERNMENT POLICY: SOME INTER-PROFESSIONAL OUTCOMES

Among the various health and welfare arenas where the impact of recent government policy developments has increasingly put pressure on going inter-professional, six elements stand out. They include: teamwork in hospitals; healthy alliances seeking to work together on health prevention strategies; the place of child protection; and, in the light of the National Health Service and Community Care Act 1990, a renewed focus on primary health care teams; on the collaboration between health and community care provision; and an emphasis on inter-agency approaches.

1 Teamwork in hospitals: collaborative care planning

As Patrick Pietroni’s chapter on inter-professional teamwork identifies later, doctors, nurses, ancillary health workers and social workers have, over the years, been separately trained and held to their independence and autonomy. Nevertheless, surgical teams in hospitals have had a trad...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Illustrations
• Contributors
• Foreword
• Abbreviations
• Part I: Background
• Part II: Inter-professional education and practice in Britain
• Part III: Learning together and working together abroad