Interprofessional collaboration in the healthcare industry. The benefits of getting it right and the dangers of getting it wrong.

Interprofessional Module 3 – Briefing Paper 1

Trigger

“When registered I will be working to achieve interprofessional partnerships. How will I manage accountability to different bosses and to the consumer/user/patient?” (Anon, 2006).

The following briefing paper aims to discuss and explore the issues raised by the above trigger and my subsequent reading around the issue of ‘accountability’; personal thoughts and feelings will be cited in order to clarify and individualise the opinions and arguments provoked. First it may be beneficial to examine the meaning of the term ‘accountability’. It is reported by Kupperschmidt (2004) that this pertains to “being responsible” to oneself and others for “behaviours and outcomes” included in the “professional role” of an individual; Brinkerhoff (2003) elaborates, highlighting that accountability also carries an “obligation of individuals or agencies to provide information about” and also “justification” for their actions.

Professionals are accountable “in many areas” or their work (Bothamley, 2006) and all staff members are personally accountable for their own practice, including any “casual mistakes or deliberate abuse” (Martin, 2001). Importantly, it is acknowledged by Brinkerhoff (2003) that with accountability there coexists an inherent risk for potential consequences for individual professionals in terms of “answerability” and “legal procedures”; adding that such risks to the individual practitioner are “at the core of enforcing accountability”.

Obviously the need for accountability is unquestionable within the healthcare system, where mistakes can have the potential to cause “wrongful death or injury” to patients (Reid, 2004); however, as a student nurse I find the anticipation and prospect of handling such responsibility post-registration can be massively daunting and the source of much anxiety. According to Bothamley (2006) I am not alone; she suggests that many student healthcare professionals do not feel or appear to be fully prepared “for professional practice and the responsibility that this involves”. This highlights personal doubts regarding my own professional abilities and also a lack of confidence. In addition, it is interesting to note that Reid (2004) states that some professional titles “may infer duties and standards” that the title-holder is unaware of or unable to fulfil; this emphasises a real need for professionals to understand exactly what they are “accountable for” and “to whom” (Martin, 2001). Consequently, Cohen (2004) reports that individual professionals must be clear about what is expected of them; adding that such a lack of clarity regarding accountability presents a “common obstacle” to successful interprofessional collaboration.

During clinical practice I will endeavour to seek complete comprehension of my accountabilities to ensure that I am able to successfully meet the expectations of my role; there are probably few, if any, healthcare professionals who have not at one time or another failed to rise to their accountabilities (Reid, 2004) and I feel that a personal recognition of the potential for being held accountable for tragedy and lawsuits will serve to motivate my practice.

Despite this, Martin (2001) reports that whilst professionals must possess sufficient confidence to perform effectively, they must also acknowledge the limitations of their abilities and personal resources, in order to ensure that “they seek support when necessary”. This approach to practice is currently inherent in my role as a student healthcare professional, where I am required to be supervised in my learning and practice; however, I feel that continuing to seek support and input from fellow professionals, across different disciplines will be beneficial to the management of my personal accountabilities.

Reference List

Brinkerhoff, D. (2003) Accountability and Health Systems: Overview, Framework, and Strategies. Bethesda, Maryland: Partners for Health Reform plus. – [online] Available from: http://www.phrplus.org/pubs/tech018_fin.pdf.

Bothamley, J. (2006) Face up to responsibility. Nursing Standard 20(45) p.77.

Cohen, S. (2004) The push and pull of staff accountability. Nursing Management 35(6) p.10.

Kupperschmidt, B. (2004) Making a Case for Shared Accountability. Journal of Nursing Administration 34(3) p.114-116.

Martin, V. (2001) Service planning and governance: Part Two: Managing accountability and risk. Nursing Management 8(3) p.33-37.

Reid, W. (2004) Organization Liability: Beyond Respondeat Superior. Journal of Psychiatric Practice 10(4) p.258-262.

Interprofessional Module 3 – Briefing Paper 2

This briefing paper is aimed at the members of my interprofessional module group, and intends to extend the discussion of the preceding briefing paper by further exploring issues surrounding the management of professional accountability within the healthcare system; opening the debate to include the subjects of clinical governance, patient-centred care, and collaborative practice. Personal experience will be used in order to highlight and reinforce significant aspects of the discussion.

As mentioned previously, the term ‘accountability’ refers to the complex responsibilities of individual professionals, to various parties, which are inherently attached to their professional identity (Brinkerhoff, 2003; and Kupperschmidt, 2004). It is reported by Bothamley (2006) that making the transition from a student to a qualified healthcare professional can be, for many, a daunting prospect due to the challenges presented by an increase in professional accountability; this view is reiterated by Nancarrow and Mackey (2005) who highlight that although the working practices of student healthcare professionals may be no different to those of their qualified counterparts, there are significant increases in accountability post-registration. As a student nurse my accountabilities after qualifying will be legally enforced by a professional code of conduct (NMC, 2004).

A recent influx of government policies and initiatives detail ‘clinical governance’ as a key milestone on the road to improved care delivery; this concept places responsibility on all individual professionals for the continued and sustained development and improvement of service provision (Checkland et al, 2004; DOH, 1998; and Wilkinson et al, 2004). Clinical governance serves as a measure to prevent mistakes, abuse and misconduct (Martin, 2001; and Onion, 2000).

Despite this, it is interesting to note that the demand on the health services to meet government guidelines can cause difficulties to arise whereby practitioners are torn between their accountability to their organisation and the achieving of targets, and their accountability to the patient (Cranwell and Buchanan, 2005; and Halligan and Donaldson, 2001); consequently, there may be occasions when accountability to patients is overlooked, as organisational accountability is prioritised (Onion, 2000). I have witnessed an example of this during clinical practice, where a detained patient in a psychiatric intensive care unit was prescribed only escorted leave from the hospital grounds, meaning that they could not leave the ward or go outdoors unless accompanied by staff; the patient wished to go outside for some fresh air and a change of scenery, and had waited patiently for several hours, yet ward staff were not able to facilitate the request in a timely fashion. The ward staff were not only accountable to the inpatients on their ward, but were also accountable to the rest of the hospital for carrying medical emergency response equipment, and did not have the necessary staff numbers to both escort the patient and cover the hospital for the event of a medical emergency.

According to the DOH (2006) if healthcare professionals are to deliver effective and holistic care then a patient-centred approach must be adopted. Although, this notion is widely recognised and is reiterated throughout numerous recent government publications and professional journals, it is not always achieved with consistency in practice (Fulford et al, 1996). There are many factors, which can obstruct the successful implementation of a patient-centred approach; however, Hogston et al (2002) suggest that there is a need for the development of comprehensive policies which place the patient at the focus of clinical practice and raise accountability to patients to the top of the workplace agenda.

It is reported by both Headrick et al (1998) and Hornby and Atkins (2000) that with increasingly complex patient needs, the delivery of effective holistic care is rarely the province of only one professional group; this emphasises the unquestionable need for professionals to collaborate in the delivery of care to meet the growing diverse and involved needs of patients. One may assume that a need to collaborate across professional disciplines and agencies is also implicit of a need for professionals to actively develop and sustain interprofessional relationships with their colleagues and fellow team members in order to ensure the success of this process.

Significantly, Hewison and Sim (1998) state that professional codes of conduct for all healthcare disciplines dictate that interprofessional collaboration must form the backbone of practice, asserting that qualified practitioners possess a legal and ethical requirement to adopt an interprofessional approach to practice. However, as discussed this is not a clean-cut process, and in order to facilitate smooth and successful collaboration professionals must be clear about their accountabilities (Martin, 2001) and seek guidance with them when necessary (Reid, 2004; and Wilkinson et al, 2004). I feel that writing this briefing paper has allowed me to acquire a useful knowledge and understanding of the intricacies of professional accountability and how it will effect my future practice as a qualified professional.

Reference List

Brinkerhoff, D. (2003) Accountability and Health Systems: Overview, Framework, and Strategies. Bethesda, Maryland: Partners for Health Reform plus. – [online] Available from: http://www.phrplus.org/pubs/tech018_fin.pdf.

Bothamley, J. (2006) Face up to responsibility. Nursing Standard 20(45) p.77.

Carnwell, R. and Buchanan, J. (2005) Effective Practice in Health and Social Care: A Partnership Approach. Maidenhead: Open University Press.

Checkland, K., Marshall, M. and Harrison, S. (2004) Re-thinking accountability: trust versus confidence in medical practice. Quality & Safety in Health Care 13 p.130-135.

DOH (1998) A First Class Service, Quality in the NHS. London: Stationary Office.

DOH (2006) Essence of Care: Benchmarks for Promoting Health. London: Department of Health.

Fulford, K., Ersser, S. and Hope, T. (1996) Essential Practice in Patient-Centred Care. London: Blackwell Science.

Halligan, A. and Donaldson, L. (2001) Implementing clinical governance: turning vision into reality. British Medical Journal 322 p.1413-1417.

Headrick, L., Wilcock, P. and Batalden, P. (1998) Continuing medical education: Interprofessional working and continuing medical education. British Medical Journal 316(7133) p.771-774.

Hewison, A. and Sim, J. (1998) Managing interprofessional working: using codes of ethics as a foundation. Journal of Interprofessional Care 12(3) p.309-321.

Hogston, R. and Simpson, P. (2002 ) Foundations of Nursing Practice. Making the Difference. 2nd ed. Hampshire: Palgrave Macmillan.

Hornby, S. and Atkins, J. (2000) Collaborative Care: Interprofessional, Interagency and Interpersonal. 2nd ed, Oxford: Blackwell Science.

Kupperschmidt, B. (2004) Making a Case for Shared Accountability. Journal of Nursing Administration 34(3) p.114-116.

Martin, V. (2001) Service planning and governance: Part Two: Managing accountability and risk. Nursing Management 8(3) p.33-37.

Nancarrow, S. and Mackey, H. (2005) The introduction and evaluation of an occupational therapy assistant practitioner. Australian Occupational Therapy Journal 52 p.293-301.

NMC (2004) The NMC code of professional conduct: standards for conduct, performance and ethics.

Onion, C. (2000) Principles to Govern Clinical Governance. Journal of Evaluation in Clinical Practice 6(4) p.405-412.

Reid, W. (2004) Organization Liability: Beyond Respondeat Superior. Journal of Psychiatric Practice 10(4) p.258-262.

Wilkinson, J., Rushmore, R. and Davies, H. (2004) Clinical governance and the learning organisation. Journal of Nursing Management 12 p.105-113 .

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