Interprofessional Collaboration

From Policy to Practice in Health and Social Care

Audrey Leathard

• Publisher: Routledge
• Year: 2004
• ISBN:
  9781135480073
• Edition: 1
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

Interprofessional collaboration in the health and social care services has become a commanding force, spear-headed by the Government's modernisation programme to improve partnership.
Interprofessional Collaboration highlights the benefits and factors arising from working together for patients, service users and carers through a review of theoretical models illustrated by relevant examples. Discussion of topical problems being faced by practitioners, managers, and policy-makers in the health and social care sector covers:
*Policy issues from various interprofessional angles, including the place of management, ethical issues and technology
*The application of policy to practice in working together across professions, sectors and communities, giving an overview of teamwork, new primary care policies, interprofessional agendas for family support and mental health, and users' and carers' perspectives on collaboration in practice
*Policy and practice in learning together, including theoretical challenges and developments internationally.
Relevant for all those that have an interest in matters of health, social care, welfare and caring, Interprofessional Collaboration provides comprehensive coverage on interprofessional education and policy in the UK and abroad.

Part 1

---

Policy and interprofessional issues

---

Chapter 1

---

Introduction

Audrey Leathard

---

SUMMARY

The purpose of this book is outlined to acknowledge the professionals and people involved with interprofessional collaboration. An introduction to the authors and topic areas highlights the main theme from policy to practice in health and social care both in the UK and abroad. The background is set by considering the definition of terms alongside the negative then positive features of interprofessional working.

THE APPROACH TO THE PRESENT PUBLICATION

At the start of a new millennium, an updated review and new approaches to interprofessional collaboration are needed to perceive the twenty-first century with vision for the future. This book sets out to provide a balance between what can be gained from the past and present to enable future possibilities within the linked context of both policy and practice.

This book is therefore relevant for all who have an interest in matters of health (to include public health and health promotion), social care, welfare and caring, whether as policy-makers or politicians, educators, service users, commissioners or providers of care, as hospital doctors, nurses, members of the allied health professions (e.g., physiotherapists, speech therapists, radiographers, occupational therapists and osteopaths) as well as general practitioners, practice managers, practice nurses, community nurses (health visitors, district nurses and community psychiatric nurses), pharmacists, health educators, dental carers, informal carers, social workers, care managers, clergy, probation officers, police officers, housing officers and staff of voluntary organisations, private hospitals and nursing homes. Increasingly, the private sector has a significant part to play in partnership working with National Health Service (NHS) managers and chief executives in hospital trusts. Throughout, those involved with primary care trusts (PCTs), care trusts (from 2002) and local authority social services, all are variously involved in working together with others in health, social care and educational provision.

The first of three sections starts with a consideration of policy issues from various interprofessional angles. The sequence begins with a policy overview from the editor. Importantly, the place of management is next considered by Professor Charles Engel (from London) and Dr Elin Gursky (from the USA). In keeping with the international nature of the topic overall, Professor Richard Hugman then identifies the interprofessional dynamics in Australian health and welfare. Ethical issues have also become a key factor for interprofessional working that are addressed by Andrew Wall. At this point Scott Reeves and Dr Della Freeth introduce an innovative perspective, particularly relevant for the twenty-first century, in looking at new forms of technology for new forms of collaboration. This first section is then rounded up, by the editor, with the presentation of a range of models for interprofessional and interagency work in practice.

The second section seeks to apply policy to practice in working together across professions, sectors and communities. Professor Carolyn Miller and Dr Marnie Freeman provide an overview of teamwork, while Professor Geoffrey Meads looks at new primary care policies. Public health is next viewed through the relevance of metaphors for health alliances by Professor Alan Beattie. Moving then from the general to the particular, the sequence features specific groups across the policy and practice arenas, by addressing the interprofessional agenda for family support (from Lonica Vanclay); safeguarding children (by Sara Glennie); in developing services for older people (by Professor Caroline Glendinning and Kirstein Rummery); disability and user-led services (from Professor Colin Barnes); mental health within an interprofessional context (by Dr Tony Leiba); and an experimental interagency service for homeless single people (from Graham Park). Of central importance, Jill Manthorpe then highlights the users’ and carers’ perspectives on collaboration in practice. Jenny Weinstein completes this section with a questioning view on the place of the voluntary sector with respect to partnership.

The final section links policy to practice within the context of learning together. Professor Hugh Barr begins by ‘unpacking’ interprofessional education. The next three contributions all come from abroad with Dr John Gilbert and Lesley Bainbridge, from Canada, who consider theoretical challenges and practical solutions, while Professors Elisabeth Willumsen and Paal Breivik look at interprofessional education and practice for health and social care in Norway. In geographical contrast, Professor Diana Lee describes interprofessional work and education in Hong Kong. To complete the global perspective, Dr Rita Goble discusses various international developments with regard to multiprofessional education. The conclusion, from the editor, draws the perspectives together with a consideration of interprofessional issues overall for collaboration in policy and practice for the twenty-first century.

THE MEANING OF THE WORDS

Already various terms have been used to indicate the context of health and social care professionals working together. However, within an international arena, terminological variations become even more widespread. For example, lead writers from the USA have recently defined an interdisciplinary health care team as a group of colleagues from two or more disciplines who coordinate their expertise in providing care to patients (Farrell et al 2001). This perspective is shared by Marshall et al (1979) in the UK where both ‘interdisciplinary’ and ‘multidisciplinary’ are viewed as referring to a team of individuals, with different training backgrounds, who share common objectives but make a different but complementary contribution. While for some, ‘inter’ means working between two groups only, so for them ‘multidisciplinary’ or ‘multiprofessional’ are preferable forms to denote a wider team of professionals. For others, the term ‘interprofessional’ is the key term that refers to interaction between the professionals involved, albeit from different backgrounds, but who have the same joint goals in working together. In contrast, the term ‘intraprofessional’ normally refers to different specialist groups, but from one profession as with different nursing specialisms. However, as policy developments move apace, so an ever-expanding range of professionals, service users and carers have all become involved in interprofessional work as well as a variety of organisations and sectors. In academic parlance, multidisciplinary work usually refers to the coming together and contribution of different academic disciplines. 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 and working together. Multidisciplinary and interprofessional courses are often terms both used to express the coming together of a wider range of health and welfare professionals to further their studies in a context of shared learning. As Hugh Barr (1994) has pointed out, the crucial distinction is that interprofessional work relies on interactive learning.

From a terminological quagmire, Table 1.1 seeks to clarify the arena through a selection of key words used to express learning and working together but set out under three headings that distinguish different elements in the arena. Hyphens are another pitfall that are used on a variable basis but have become increasingly discarded.

Any grouping of terms is debatable; alternatives may be considered more appropriate according to the circumstances under view. Furthermore, interpretations can differ as ‘interprofessional’ can mean different things to different groups of people, even among the professionals themselves who speak different languages that influence both their mode of thought and identity (Pietroni 1992). However, the field is not entirely sublime, as Beattie (1994) has pointed out, when health alliances can become dangerous liaisons. The title of this book has therefore purposely included the word ‘collaboration’ as elements of danger and challenge form part of the overall fabric. Ian Shaw (1994: xi) has also indicated that collaboration can have two meanings: conspiring with the enemy or working in combination with others. By whichever route, three aspects underpin the issues on hand: interpersonal, interprofessional and interagency.

Table 1.1 A selection of key words used variously for interprofessional work to denote learning and working together

Concept-based	Process-based	Agency-based
Interdisciplinary	Teamwork	Interagency
Multidisciplinary	Partnership working	Multi-sectoral
Multiprofessional	Merger	Trans-sectoral
Trans-professional	Joint working/planning	Health alliances
Trans-disciplinary	Collaboration	Confederation
Holistic	Integration	Federation
Generic	Local planning	Consortium
	Coordination	Forum
	Unification	Interinstitutional
	Liaison Shared/joint learning	Locality groups

WHO ARE THE PROFESSIONALS?

The title of this book involves two central elements: the first is the place of professionals. Traditionally, a professional person is associated with control of entry to a particular profession; the requirement to undergo a recognised length of training, accredited and, in some cases, licensed, by an acknowledged professional body. At the end of training, the professional is recognised as having a certain expertise that legitimates practitioner action, usually bound by a code of ethics, although Paul Wilding (1982) has shown that certain professional claims may be problematical. However, increasingly within a context where managers, health and welfare professionals, administrative and reception staff, carers, cared-for and voluntary input are all involved, the term ‘interprofessional’ begins to lack clarity, other than ‘all who seek to work together for the good of the service user’. More recently, semi-professionals (such as health care assistants) further contribute to the many potentially engaged in joint working as well as the evermore significant part to be played by the private sector. By the twenty-first century, however, one point is quite clear: the emphasis has swung significantly behind the importance of upholding the patient/user/customer/client/carer at the centre of interprofessional working.

THE ADVANTAGES AND DISADVANTAGES OF INTERPROFESSIONAL WORK IN PRACTICE

The drawbacks

The second element contained in the book title is to recognise, as reflected in the word ‘collaboration’, that there can be potentially two sides to the case for working together. In starting with the more negative aspects, this section can then finish on a positive note. Hardy et al (1992) identified, early on, five categories of barrier in joint working and, more problematically, in joint planning across the health and social services:

• Structural issues between health and social services, such as service fragmentation, gaps in services and non-coterminosity of boundaries

• Procedural matters hindering joint planning through different budgetary and planning cycles and procedures

• Financial factors including different funding mechanisms and flows of financial resources as well as administrative and communication costs

• Status and legitimacy with differences in legitimacy between elected and appointed agencies wherein local authority responsibilities are firmly based within a democratically elected arena, in contrast to all services appointed and centrally run by the NHS (National Health Service)

• Professional issues including problems associated with competitive ideologies and values; professional self-interest; competition for domains; conflicting views about users; as well as differences between specialisms, expertise and skills.

Other commentators have drawn attention to further interprofessional pitfalls such as the different languages and values between professional groups (Pietroni 1992); separate training backgrounds; time-consuming consultation, conflicting professional and organisational boundaries and loyalties; practitioners isolated with little management support; inequalities in status and pay; differing leadership styles; lack of clarity about roles and latent ...

Table of contents

• Cover Page
• Half Title page
• Title Page
• Copyright Page
• Contents
• List of illustrations
• List of tables
• Contributors
• Foreword: John Horder
• Part I Policy and interprofessional issues
• Part II From policy to practice Working together across professions, sectors and communities
• Part III From policy to practice Learning together
• Index