Collaboration In Health Care

Collaboration in health Care 1

COLLABORATION IN HEALTH CARE.

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Collaboration in health Care 2

SECTION 1.

1.1 Purpose Statement.

The purpose of this study is to evaluate the necessity of collaboration at work more so

in the health care industry as suggested by Dickinson (2008) where team work is termed as a

central ingredient to success. To accomplish this objective, the essay will rely on the case of

Sarah (not real name), as an illustration of how collaboration would enable women to have

better births (Peck & Dickinson, 2008). Here, the real names of all actors have been

concealed because the nursing and midwifery council argues for the privacy of delivering

mothers especially those with special needs. According to Kilpatrick & Berg (2016), better

births a term used to describe an improvement in the outcome of maternity services as it may

apply to women and children.

To clarify, Sarah required to attend a case conference so as to decide whether her

unborn child would be placed under a child procreation plan. To complete the study

successfully, this essay will run in two key sections- part 1 and part 2. In the first part, the

main aim is to link the case to fundamental theories of collaborative practice. They include

Gaventa’s theory of power, the theory of conflict resolution and the communication theory.

Moreover, the section will also define the concept of collaboration as it applies to health care

as well as outline the benefits of collaboration. Finally, the section will summarize the case as

an appendix.

1.2 The concept of Collaboration.

According to Vincent & Masters (2015), collaboration is a special approach to work

where team members synchronize their efforts with the aim of attaining an objective that

would be otherwise difficult to accomplish. Today, the best practice in nursing is rooted in

person-centered care, multidisciplinary teamwork and shared decision making (Sullivan &

Collaboration in health Care 3

Skelcher, 2002). To say the least, the concept of shared decision making is a subject of debate

and whose success varies from one situation to another (Vincent & Masters, 2015). The

problem is even more pronounced in the case of patients especially when limits are imposed

by factors like adverse previous experiences, the level of education and general exposure.

Often, not all stakeholders are able or willing to engage in the processes of decision making

as it applies to the health sector (Hebert, 2014). In practice, shared decision making is a

challenging endeavor. Mostly, stakeholders require to engage in creative discussions

especially on treatment and care options. In the past, literature has listed a count of factors

that bar effective collaboration in the health care sector (McComb et al., 2017 & Raparla et

al. 2017). They include heavy workloads, poor leadership, cultural factors, organizational

factors such as culture, work place animosity and lack of adequate training. Despite the

existence of these barriers, health care providers must actively seek to collaborate with

colleagues (Underhill et al., 2015 & Jelphs & Dickinson, 2008).

To evaluate the need for collaboration, McComb et al., 2017 & Raparla et al. (2017)

argue that to ensure quality services and patients’ comfort, collaboration is a mandatory

requirement. Mostly, inter-professional collaboration guarantees swift provision of services

and easy communication processes (Glasby & Dickinson, 2008). Better still, collaboration

fosters respect and mutual trust which then translate to quality services. Finally, it creates an

atmosphere where both parties work towards the achievement of common goals. In this

study, one of those goals is to stabilize Sarah from anxieties.

1.3 Theories of Collaboration.

Gaventa’s theory of power.

In minimal terms, power is the ability to influence the behavior of others regardless of

whether such influence is justified or unjustified (Goodridge, Isinger & Rotter, 2018). On the

Collaboration in health Care 4

other hand, authority is the legitimacy of power or in simpler terms, the right to the use of

power. According to Gaventa’s theory of power, power is measurable by the extent to which

the behavior of the subject is changed. For instance, if person A is travelling to direction 1

and person B is travelling to direction B, both A and B may interact with the hope that one of

them will abandon their direction and join the other alternative. If after the interaction person

B begins to follow direction a as followed by person A, A has power over B to the extent of

changing directions. Usually, there are 3 dimensions of power namely 1-dimensional

approach, 2-dimensional and 3-dimensional approach. In 1-dimensional approach, person A

would use power to influence person B to perform something that they would not have dome.

For example, abandoning their direction (direction 2) in favor of direction 2. Moreover, 2-

dimensional power escalates from influencing person B to preventing them from making a

decision at all.

Therefore, only person A would decide the direction to be followed. Finally, 3-

dimensional approach to power requires that person A to control B’s will and preferences. At

this point, the subject (person B) would follow A’s command even without an explicit

request. Regardless of the method of governance in question, one fact is apparent-

collaboration is key to leadership. Of note, this condition also applies to the case of Sarah and

all scenarios where health care services are provided.

In the case of Sarah, and compared to the social worker, I sustained the higher

authority as the mid-wife although I was still subordinate to my supervisor. On the other

hand, the social worker Mr. Johnson (not real name) shared a lesser scope of authority than

my supervisor and I. Speaking from a theoretical point of view, the supervisor would set the

courses of action, the mid-wife would implement them with the assistance of the social

worker.

Collaboration in health Care 5

The Theory of Conflict Resolution.

According to Cheng (2015), practitioners have different points of view and given the

right circumstances, conflicts may arise. In the events of conflict, practitioners are advised to

address the underlying issue as opposed to pointless complaining, shifting the blame,

ignoring the problem or giving up (Day, 2006). Furthermore, conflicts must be addressed in a

creative manner as the risk of escalation is always high. Minimally, the process of conflict

resolution must begin with acknowledging the existence of the problem (Greenfield et al.,

2015). Considering Sarah’s case, the team acknowledged the existence of the problem by

accepting that the service user’s condition was improving but at an exceedingly slow rate

(Dickinson, 2008). Sometimes, additional adverse behaviors would surface, for example

inability to control anger and screaming more often. Secondly, the conflict resolution method

requires teams to discuss the effects of the problem. Notably, the conflicts in question were

not addressed in an effective manner. First, the social worker was unwilling to disclose the

source of his unexplained irritation. In some instances, he would switch off his mobile phone

and refuse to return any emails.

The theory of Communication.

The theory of communication featured in the year 1980 after its foundation by

Scudder (Blais et al., 2015). According to this author, all human beings, just like plants and

animals exist to communicate although the modes of communication may differ. For

instance, plants communicate their need for water by dis-coloring their leaves. Likewise,

animals make specific sounds or movements to indicate hunger or the need for veterinary

attention. Moreover, Scudder proposed a universal law of communication which states that

all people, animals and plants pass messages through sound, speech, gestures, body

Collaboration in health Care 6

movements or any other method that sufficiently conveys information. In another illustration,

a parent may let a week to pass without speaking to their children who performed poorly in

school. That way, the child in question would understand that poor performance is

undesirable hence strive to improve thereafter.

In the case of Sarah, the role of communication in promoting quality health care was

apparent (Smith & Liehr, 2018 & Gibb, 2016). To begin with, as the mid-wife, my initial idea

was to persistently pose questions until Sarah would give up answers. On the other hand, Mr.

Johnson thought that Sarah required time to adjust before she would begin to reveal the

underlying problems. During the first three weeks, I persistently posed questions while Mr.

Johnson only met Sarah between 11:00 Hours and 13:00 hours every day. During this time,

he did not pose any questions relating to Sarah’s past experiences. At the start of the week, I

noted that Sarah was becoming more comfortable to stay with Mr. Johnson and more

disturbed in my presence. Quickly, I approached the social worker who advised that to help

service users suffering from anxieties, it is needful to win their trust. Sadly, the Mr. Johnson

refused to show concern over the issue and the patient’s trust remained unattained. Indeed,

this problem required an immediate solution because according to Lindegård et al. (2015)

Vollmer et al. (2016), unless patients trust the practitioners, most of the problems will remain

undiscovered.

Collaboration in health Care 7

Appendix.

To set the context, the exercise occurred in The Royal College of Obstetricians and

Gynecologists (RCOG) located in London. For the sake of the patient’s anonymity, which is

in line with Machanavajjhala, Gehrke, Kifer & Venkitasubramaniam (2006, p. 24), details

regarding the Wing, floor and room number at which the service user was treated have been

withheld. Also, the exercise entailed a total of 8 persons (both natural and artificial) 5 of

whom were health care providers. To point out, the care givers included the supervisor, the

social workers, the mid-wife, the Nursing and Midwifery Council (artificial person) and the

RCOG (artificial person). The other stakeholders included the services user, husband to

service user and the brother to the husband. Mostly, the supervisor allowed the spouse and his

brother to offer psychological support especially because the social worker was unavailable.

In particular, technical interventions like cleaning would be performed by the mid-wife.

As mentioned in earlier sections, this assignment details the case of a woman who

required to attend a case conference so as to decide whether her unborn child would be placed

under a child procreation plan. Due to the condition, the lady, who for the purpose of this

study is given the name Sarah (not real name) experienced three important disorders-

nervousness, fear and unexplained worries. To be specific, Sarah believed that she was the

mother of 2 precious children (a boy and a girl) whom she gave away to a friend in the past

because she could not provide for them. Due to her condition and other unidentified reasons,

Sarah was unwilling to give further information. However, she would constantly complain

that she was anxious, worried and fearful. According to medical records, Sarah’s conditioned

had been identified as generalized anxiety disorder (GAD) which according to specialists is

not only common but also long lasting. To understand why health care providers require to

engage in collaborative efforts, scholars only need to evaluate Sarah’s case. To be clear, the

social worker practicing at the hospital from which Sarah was undergoing treatment, refused

Collaboration in health Care 8

to collaborate with the team hence the escalation of the patient’s problem. Moreover, they

also refused to return the team’s messages or calls. According to the case’s evaluation, Sarah

was determined to retain her child this time. Most of the times, the patient was accompanied

to the hospital by her partner and partner’s brother.

PART 2: GIBB’s REFLECTIVE MODELS.

2.1 The Concept of Better Birth.

The aim of this exercise was to stabilize the patient’s condition and have a normal or

better birth. According to the World Health organization (WHO), better births entail six

conditions (1) labor should begin naturally (2) patients have freedom of movement during

labor (3) there is continuous support for labor (4) no routine interventions (5) non-supine

positions for birth and (6) the baby and mother must not be separated immediately after birth.

To evaluate the effectiveness of the exercise, my supervisor had developed these

conditions in a list which would be filled through the delivery process. Of note, the social

worker was expected to assist in all of these roles. Precisely, the supervisor would be absent

from time to time and the mid-wife (myself) would leave the institution from time to time.

Therefore, the social worker would stay with the patient during these times. However, their

absence had disorganized the entire schedule.

2.2 The kirkup Report.

Furthermore, the case of Sarah required the integration of the Kirkup’s report

especially considering that she experienced anxieties. In this report, among the challenges

confronting delivering mothers are (1) dysfunctional maternity unity, (2) delayed recognition

of problems and (3) failure of external bodies to assist the process (Dr. Bill Kirkup., 2018).

Collaboration in health Care 9

In our case, the most disturbing problem was the 2

, delayed recognition of problems.

Specifically, this issue was important because social workers assist in the discovery of

problems while in our case, such a person was absent. Secondly, Sarah was suffering from

anxieties and was therefore secretive and showed signs of withdrawal.

Reflecting from the Gibb’s model.

Figure 1: Gibb’s Reflective Cycle.

Source: (Gibb, Edwards, & Gardner, 2015).

Application of Gibbs Reflective Model.

Stage 1: Description

To describe, the case involved a collaborator effort between my supervisor, the social

worker and myself. Therefore, only 1 group was involved with one member from the hospital

in question (the social worker), 1 member posted from another hospital (the supervisor) and 1

member from a learning institution (the mid-wife).

Collaboration in health Care 10

To understand the team roles of these persons, I used the Belbin theory of team roles

as reflected by (Day, 2006). The first team role was that of a resource investigator. According

to the theory, this player gathers information from outside sources and brings back to the

team for assimilation. In this case, this role was played by the supervisor especially because

he was posted from another health institution. On several occasions, the supervisor would

carry a list of questions to be filled by his colleagues from the other hospital. Also, the

supervisor assumed the role of a team worker by enabling the team to gel. To reinforce this

role, the supervisor would sometimes complete tasks that were meant for other team

members. Moreover, the supervisor assumed the coordinator’s role. Here, the identifying

characteristics included maturity, confidence and talent identification. At the same time, the

supervisor was plant because he was active in anticipating problems and resolving them as

they arose. Finally, the supervisor assumed the roles of monitor evaluator (making impartial

judgments, weigh the team’s options), specialists (introduce in-depth knowledge of key

areas), shaper (provide team’s drive) and implementer (provided a workable strategy).

Reflecting at a personal point of view, I performed well as a team worker (helping in

identifying the tasks in question), plant (closely followed on problem solving skills) and

shaper keeping the team’s enthusiasm. Of note, I did not perform well in reference to roles

like resource investigator, coordinator, motivator, specialists’ and implementer. To explain, I

was a mid-wife in placement, with little experience and just fair training. Considering that the

patient was in dire need of speedy attendance, most of the problems had to be solved by the

supervisor because I would not be allowed to experiment with the service user. On the side of

the social worker, the performance was below standard in regard to all of the 9 roles.

Collaboration in health Care 11

Stage 2: Feelings

Reflecting on feelings, it emerges that I was overwhelmed by change of feelings. As a

mid-wife, I felt that I should have assumed leading roles in the exercise. Precisely, my

training had focused on pregnancy education, childbirth, reproductive health and women’s

sexual health. Therefore, I deserved to guide a significant portion of the exercise. On the

contrary, my supervisor denied this opportunity by giving instructions in regard to all issues.

For instance, the supervisor was attending to patients from two hospitals. Therefore, the

social worker and the mid-wife were expected to spend more time with the patient. During

his absence, the supervisor would leave written instructions and checklist them upon arrival.

Furthermore, the supervisor also placed a series of phones calls to inquire on the progress.

In my view, the supervisor was underscoring my skills. Considering that I was

trained, I would have been left to attend to the patient without excessive oversight. Also, I felt

that the supervisor was excessively lenient with the social worker. To elaborate, he played

their roles when absent and even delegated a list of those roles to me. In my opinion, there

was need to confront the social worker and condemn the misbehavior.

However, my feelings changed with time. Precisely, it occurred to me that some team

players are just unwilling to collaborate or feel the need for segregating from the group

(Dickinson, 2008). Nevertheless, the best approach is to allow such members time to adjust to

the presence of other group members as opposed to judging or condemning them.

Stage 3 and 4: Evaluation and Analysis.

Usually, the aim of this step is to evaluate what might have hindered or helped the

whole event. Also, experience gained through the exercise can be compared to the related

literature at this stage. To start with, the exercise was successful because Sarah recovered

from the condition and gave birth to a healthy child.

Collaboration in health Care 12

However, there was a list of hiccups that would not have been experienced in the first

place. To evaluate the team with effectiveness, this essay will rely on Tuckman’s theory of

group development. Minimally, the theory suggests that for a team to be successful, it must

undergo four key stages- forming, storming, norming and performing. Also, the theory argues

that to be classified as successful, a team must grow, overcome challenges, tackle problems,

have a work plan as well as deliver results. The diagram below illustrates the stages of the

Tuckman’s theory of group development.

Figure 4: Tuckman’s theory of group development.

Stage 1: Forming.

Usually, this is the initial stage and is mostly dominated by the group leader. Also, the

members are new and some do not understand their roles with entirety. In the case of Sarah,

this stage was effective especially because members were collaborative.

Stage 2: Storming.

This stage comes closely after the first stage, forming. Here, most members are already aware

of the group, its roles as well as the roles of colleagues. In the case of Sarah, this stage

marked the begging of challenges. Mostly, the social workers reduced the rates of

collaboration, sometimes forcing the patient to speak about her past without the supervisor’s

guidance, an intervention that breaks trust between health providers and users (Sarvestani et

al., 2017).

Stage 1:

Forming

Stage 2:

Storming

Stage 3:

Norming

Stage 4:

Perfoming

Collaboration in health Care 13

Stage 3: Norming.

According to literature, norming is the stage where members begin to act normally.

Also, they give up the roles belonging to colleagues and which may have be taken in stage 2.

In our case, this did not happen. To clarify, the social worker refused to collaborate, a

situation that may devastate health provision efforts (Price et al., 2014). Sometimes, he would

ignore the supervisor’s direction on how questions could be posed. Also, he missed important

sessions even without apologies.

Stage 4: Preforming.

According to Forsyth (2018), this is the final stage and it entails the accomplishment

of group objectives. At this stage, performance should be speedy because most of the

members are already active. In the case of Sarah, and just like stage 3, this stage was

challenging. Pointedly, the social worker was mostly absent and even when present, he was

mostly withdrawn. Therefore, the supervisor and I had to handle most of his roles especially

comforting the patient and relatives.

Stage 5: Conclusion.

Following the Gibb’s model, this is the final stage and its main aim is to answer the

questions- what did I learn from the experience and what could have been done differently in

the situation? In the case of Sarah, the necessity for this step cannot be overlooked. In this

case, conclusion has made it easy to highlight the issues that affect collaboration.

First, collaboration is affected by the team’s ability to foster effective communication

(Sullivan & Skelcher, 2002 & Matziou et al., 2014). For example, the social worker was

unable to illustrate to the team when they would not participate. As a result, my supervisor

ended up with unaccomplished objectives some of which would be later distributed between

himself and the mid-wife.

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Secondly, effective collaboration is also affected by mutual trust. In some cases, I

failed to participate because the supervisor failed to trust that I would handle complex issues

and emergencies. Finally, effective collaboration is also affected by the ability of team

members to replace beliefs with reality. In our case, I failed to disengage from the belief that

I deserved to control the exercise.

Stage 6: Action Plan.

According to the designer of the Gibb’s model, the action plan sums up what should

be noted in the whole document and how the same can be improved in the future. The

recommendations can include the need to attend a seminar or to learn something that could

ensure proper preparation. The stage might include the help one might seek from a tutor or

the advice needed. The steps to undertake to be better prepared for similar instances are

highlighted at this stage. In practice, practitioners may improve collaboration with the help of

a list of tactics. First, team work may be enhanced through team building activities, for

instance field work. Also, team spirit can be encouraged by encouraging interdependence and

trust. For instance, by ensuring fair representation in terms of racial, gender and nationality of

origin.

In a reflection, the exercise taught me (as a mid-wife) that I must appreciate

collaboration as a key determiner to success. In the first place, I thought that my supervisor

and I required to disengage the social worker with entirety. Also, I thought that in the absence

of my supervisor, I was supposed to take over the situation. Today, the reflection has revealed

that in future, there is need to shun the mentality of non-collaboration.

Collaboration in health Care 15

According to experience, I have learned that collaboration reduces the number of

days that patients remain in hospital and consequently, the cost of services. For example,

Sarah lasted in the facility for 6 weeks. Under normal circumstances, a service user in her

conditions would only have lasted for 3.5-4 weeks.

Furthermore, the experience has enlightened me on the need for self-awareness

especially in terms of emotions. Indeed, recent studies have encouraged health care providers

(including mid-wives) to embrace self-awareness for the sake of career success and personal

happiness. Also, I realize that by being more self-aware, I would have secured a higher

degree of self-confidence. Usually, this confidence emanates from the realization that as a

professional mid-wife, my judgment would be based on logical thinking as opposed to

feelings.

Change in Behavior.

` Following the occurrences recorded above, I have resolved to adopt a new set of

behaviors. To start with, I will never assume that all team members are willing to collaborate.

Equally, I will never assume that I have control the actions other team members even when I

am the team leader. This realization follows from the fact that my supervisor was unable to

control the actions of the social worker despite being theoretically superior to them.

Furthermore, as a team leader or a committed tem player, I will never compromise on

the welfare of service users. Indeed, the Kirkuk report confirms that for mothers to receive

effective maternity care, there should be collaboration between all stakeholders, for instance,

the Commissioning Groups, monitor and even the care quality commission (Dr. Bill Kirkup.,

2018, p. 188).

Collaboration in health Care 16

Moreover, the experience also enabled me to identify specific personal behaviors that

are potentially detrimental not only to the team but also the service user. For instance, the

feeling of self-importance where I viewed the case as a chance to show off my skills is an

unwarranted approach. To be sure, this attitude would easily hurt my colleagues, demotivate

them and consequently reduce the effectiveness of treatment.

To add, I have learnt that it is always safe to reflect before acting. For example, I

would be sometimes tempted to confront the social workers or encourage the supervisor to

confront them. However, I later realized that the step would raise unnecessary conflict at the

expense of the patient. Also, there are times I felt that I required to confront the supervisor for

micromanaging my input. Although I did not take this step, I am convinced that it would have

devastated our working relationship, an outcome that would also worked to the detriment of

the patient.

Equipped with all of these lessons, I am now confident that my future experiences

will be better. Summarily, I will not over expect from other team members, I will not assume

to have control over their behavior, I will uphold the interest of service users at all costs, I

will not start confrontations unless all other options are exhausted and most of all, I will not

embrace feelings of “self-importance.”

Collaboration in health Care 17

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