Values-Based Interprofessional Collaborative Practice: Working Together in Health Care

192 Pages·2012·1.18 MB·English

by  Jill E. Thistlethwaite

Values-Based
Interprofessional
Collaborative Practice
Working Together in Health Care
VALUES-BASEDPRACTICEisaseriesfromCambridgeUniversityPressonvaluesand
values-basedpracticeinmedicine.EditedbyBillFulfordandEdPeile,volumesintheseries
willspeaktoclinicians,policymakers,managers,patientsandcarers.
Othervolumesinthisnewseriesinclude
EssentialValues-BasedPractice:Fulford,PeileandCarroll
ISBN:9780521530255
Values-BasedCommissioningofHealthandSocialCare:Heginbotham
ISBN:9781107603356
Values-Based
Interprofessional
Collaborative Practice
Working Together in Health Care
JillE.Thistlethwaite
ProfessorofMedicalEducationandDirector,
CentreforMedicalEducationResearchandScholarship,
SchoolofMedicine,UniversityofQueensland,
Australia
CAMBRIDGEUNIVERSITYPRESS
Cambridge,NewYork,Melbourne,Madrid,CapeTown,
Singapore,Sa˜oPaulo,Delhi,MexicoCity
CambridgeUniversityPress
TheEdinburghBuilding,CambridgeCB28RU,UK
PublishedintheUnitedStatesofAmericabyCambridgeUniversity
Press,NewYork
www.cambridge.org
Informationonthistitle:www.cambridge.org/9781107636163
(cid:2)c JillE.Thistlethwaite2012
Thispublicationisincopyright.Subjecttostatutoryexception
andtotheprovisionsofrelevantcollectivelicensingagreements,
noreproductionofanypartmaytakeplacewithoutthewritten
permissionofCambridgeUniversityPress.
Firstpublished2012
PrintedandboundintheUnitedKingdombytheMPG
BooksGroup
Acataloguerecordforthispublicationisavailablefromthe
BritishLibrary
LibraryofCongressCataloguinginPublicationdata
Thistlethwaite,Jill.
Values-basedinterprofessionalcollaborativepractice:working
togetherinhealthcare/JillE.Thistlethwaite.
p.;cm.
Includesbibliographicalreferencesandindex.
ISBN978-1-107-63616-3(pbk.)
I.Title.
[DNLM:1.PatientCareTeam. 2.CommunityNetworks.
3.InterprofessionalRelations. 4.PatientCare–ethics.
5.ProfessionalPractice–ethics. W84.8]
610.73–dc23 2012021825
ISBN978-1-107-63616-3Paperback
CambridgeUniversityPresshasnoresponsibilityforthe
persistenceoraccuracyofURLsforexternalorthird-party
internetwebsitesreferredtointhispublication,anddoes
notguaranteethatanycontentonsuchwebsitesis,orwill
remain,accurateorappropriate.
Everyefforthasbeenmadeinpreparingthisbooktoprovide
accurateandup-to-dateinformationwhichisinaccordwith
acceptedstandardsandpracticeatthetimeofpublication.
Althoughcasehistoriesaredrawnfromactualcases,everyeffort
hasbeenmadetodisguisetheidentitiesoftheindividualsinvolved.
Nevertheless,theauthors,editorsandpublisherscanmakeno
warrantiesthattheinformationcontainedhereinistotallyfree
fromerror,notleastbecauseclinicalstandardsareconstantly
changingthroughresearchandregulation.Theauthors,editorsand
publishersthereforedisclaimallliabilityfordirectorconsequential
damagesresultingfromtheuseofmaterialcontainedinthisbook.
Readersarestronglyadvisedtopaycarefulattentiontoinformation
providedbythemanufacturerofanydrugsorequipmentthatthey
plantouse.
Contents
Preface pagevii
Forewords xii
Part1–Introductionand 7 Arequestforstronganalgesia:
honestyandtruth 74
theory
8 Asylumseekersandrefugees:
1 Values-basedpracticeinhealth workingacrosscultures 84
care:settingthescene 1
9 Arequestforahomebirthand
2 Teamworkandcollaborative otherpregnancy-related
practiceinmodernhealthcare 14 consultations 95
3 Communicationwithinteamsand 10 Community-basedcareandthe
betweenprofessionals 28 widerhealthcareteam 107
ProfessorDawnForman,Curtin
Part2–Primarycareandthe University,Australia
primaryhealthcareteam 11 Ageingandendoflife
decisions 118
4 Apatientcomplaint:team
12 Referralsandtheinterfacebetween
meetings,policyandpractice
primaryandsecondarycare:
values–raisingawarenessinthe
lookingafter‘our’patients 128
team 40
13 Livingwithvisibledifferenceand
5 Awellpersonhealthcheck,health
valuingappearance 139
promotionanddiseaseprevention:
differentlifestyles,different 14 Collaborationwithother
values 52 professionals:inandoutsidehealth
care 149
6 Apatientwithmedically
unexplainedsymptoms:applying 15 Learninginandaboutteams 158
evidenceandvaluesforshared
decision-making,self-careand
co-productionofhealth 63
Afterword 170
Index 171
v

Preface
Thisbookisoneofaseriesonvalues-basedpractice(VBP).Ithasaspecificfocusonteam-
workandcollaborativehealthcarepracticeparticularly,butnotexclusively,inprimarycare.
Thehealthcareteamsconsideredincludenurses(practiceandadvancepractitioners),mid-
wives, general practitioners (GPs) and hospital doctors, physiotherapists and other allied
healthprofessionalsaswellasreceptionistsandpracticemanagers.Thebookconsidersthe
interactions between health care professionals and the way that these may be affected by
differences in professional and personal values, amongst other factors. The scenarios are
informedbymyexperienceingeneralpracticeinboththeUKandAustralia,buttheycanbe
adaptedtofamilymedicinesituationsinothercountries.
Thisbookisthusforallhealthcareprofessionalswhoworkinteamsoraspiretocollab-
orativepractice,andforeducatorswhofacilitatelearnersinteamwork.Healthprofessional
students should also find it useful and hopefully stimulating, while the scenarios may be
helpfulforlearningactivities.
Thetextcontributestotheliteratureonconsultationandcommunicationskillsbyadding
the dimension of values-based practice, which is rarely mentioned in other work of this
nature.Itisapracticalguide,underpinnedbytheory,tohealthcareinteractions.Theunder-
lying philosophy of values-based practice, as described and discussed by my colleagues,
Professors Bill Fulford and Ed Peile, in their own work, will be the starting point for
the text. However I also consider and reflect on working in teams and the importance of
communication.
HealthandsocialcarewithintheNHSintheUKisnowlargelyteambased;fromthepri-
marycareteamofcommunitysettingstothemultidisciplinaryteamsofsecondarycare,as
particularlyexemplifiedbycanceranddiabetesmanagement.Theageingpopulationandthe
riseintheincidenceoflongtermchronicandcomplexconditionsmeanthatonehealthcare
professionalisunlikelytohavetheknowledgeandskillstoprovidecompletecare.Thegrow-
ingteamworkliteraturehighlightsthedifficultiesofdiverseprofessionalscomingtogether
toworktogetherwiththeiruniqueprofessionalidentities,theirchangingrolesandresponsi-
bilitiesand,formany,theirlackoftraininginteamworkatprequalificationlevel.Addtothis
bothpersonalandprofessionalvaluesbases,andwecanseethatcommunicationisfraught
withdifficulty.Poorcommunicationisimplicatedasamajorcauseofadverseeventsinhealth
careandleadstopoorpatientsafety.Lackofcommunicationbetweenprofessionalsanddys-
functionalteamwork havebeenrepeatedlyshowntocontributeto poorpatient andclient
outcomes.
Whyavalues-basedapproach?
Health care practitioners from different professional backgrounds may work together in
definedco-locatedteamsorcollaborateacrosssitestoachievespecificgoalsoveralimited
timeframe.Notallprofessionalsinteractingwiththesamepatientaremembersofthesame
team–someprovidealimitedamountofinputinhighlyspecialisedareas.Toprovidesuch
collaborationand,whererelevant,team-basedcare,thereisanecessitynotonlytolearnthe
vii
viii Preface
appropriate skillsbutalsotoexploreandunderstandeachother’svalues,andthoseofthe
peoplewecareforandtreat.
If health professionals have competing values, arising from their professional identity
and/orcultural background and/orpersonal experiences,thereis likelyto bemiscommu-
nication.Inmyexperiencehealthprofessionalsrarelyputasidetimetodiscusstheirvalues
withtheircolleagues,thoughsomemayadoptavalues-basedapproachwithpatients/clients.
Stereotypingofprofessionalsbyprofessionalsoccursfrequently,e.g.,thearrogantdoctor,the
caringnurse,theefficientpharmacist.InthisbookIconsiderhowprofessionalsmaydiscuss
theirvalues–throughlearningtogetherandworkingtogether.
Myexperience
Ibringtothisvolumemyownexperienceofinterprofessionaleducation(IPE)andcollab-
orativepractice,my26yearsasapractisinggeneralpractitioner(GP)andmy22yearsasa
clinicaleducator.AsayoungGPprincipalinWestYorkshireIwasfortunatetobeamember
ofahighlydevelopedprimarycareteamandvaluedtheinteractionswithotherhealthprofes-
sionalsfromwhichIlearntagreatdeal.Theteamincludedpracticeanddistrictnurses,health
visitors,psychologistsandphysiotherapists,andcommunitymidwiveswhoworkedwiththe
doctorstoprovidehighqualityantenatalandpost-natalcare,plushomeandhospitalbirths.
Aswellasthehealthprofessionals,thereceptionistsandsecretarieswereindispensible.We
hadtheusualproblemsofargumentsaboutworkloadandpay,butwereunitedinaimingto
providethebestcareforourpatients.InmyearlycareerItendedtobepaternalistictowards
patients,aconsequenceofmyhospitaltraining,butIdiscoveredtheconceptsofshareddeci-
sionmakingandmovedtowardsamorepatientpartnershipmodel.
Idon’trememberanexplicitdiscussionaboutpracticevaluesbutwehada‘missionstate-
ment’ and regular team meetings for both business and education. This teamwork aspect
ofmyworkwaswhatImissedmostwhenImovedtoAustraliaandworkedasasessional
GPwhilepursuingmycareerasanacademicmedicaleducator.Myexperienceisthatteam-
workandcollaborativepracticeareveryvariableintheirqualitydependingonthepeople
involved,theirvaluesandcommitmenttohealthcaredelivery.Myinvolvementintheteach-
ingofcommunicationandconsultationskillsovertheyearshasshownmethatperformance
maybeimprovedbutthatitisimportanttoinvolvearangeofhealthprofessionalsinlearn-
ingtogethertobreakdownexistingstereotypingandthehierarchicalnatureofsomeclinical
environments.
ImustemphasisethatasamedicaldoctorIhaveacertainviewofhealthcarepractice.
Ihavetriedtothinkfromtheperspectiveofotherprofessionalsandpatientsinthiswork
andhavehadbothfeedbackonthetextandinputtosomechaptersascommentariesfrom
colleagues and service users. However if it feels too medical I do apologise. Mostly I use
thewordpatient,butIacknowledgethatothersmayreferinsteadtoclient,serviceuseror
consumer.
Overallstructureofthebook
Theopeningchaptersincludeanoverviewofvalues-basedpractice,teamworkandcollabo-
rativepracticetosetthesceneforthesubsequentcasehistories.Aftertheintroductorychap-
ters,subsequentchapterspresentcasehistoriesandscenariosbasedonauthenticprofessional
experienceswithdetailschangedtopreserveconfidentiality.Thescenariogeneratesreflection
pointsandreadersareencouragedtostopandreflectwhereindicated.Selectedchaptershave