Collaborative Working Reflective Essay

Throughout this whole assignment I am going to critically appraise others and my own practice as a collaborative worker via personal reflections and experiences of collaborative working, through experience in professional practice. I aim to link service user improvement and collaboration defining the importance of them both. Furthermore, explaining the various leadership models clarifying why they are important and needed throughout a health care team. I will plan to explain and critically evaluate an experience with the intention to promote positive outcomes for the service environment. Additionally then identifying a service improvement plan, in this case designing a 15minute time management nutritional chart for patients with dementia.
Service improvement
The BW Quality & Safety (2007) defines service improvement, stating it is a combined and constant effort from everyone, including healthcare professionals, patients and their families, researchers, payers, etc. The changes need to lead to better patient outcomes, better quality care and better professional development (see appendix 2). The aim of all health care systems strive to provide safe and good quality health care, improve patient experiences, tackle effectiveness and update practice in the light of evidence from research (RCN 2015).

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Critical analysis of own performance from the Interprofessional capability framework (2009) section OC3/L2, I identified myself as level 2 (see appendix 1). During my district nursing placement, collaborative working is a key when being a nurse in the community. During my placement I interacted with various health professionals across various organisations. I ensured I was knowledgeable about the information I was passing over and I always opted in to interacting with the other professionals to build my confidence.
Collaborative working
The King Fund (2014) recently released a new policy document about “time for change’ bringing ideas together from all sectors to help change the health care and improve collaborative working. The Royal College of Nursing (2004) states collaboration is diverse, ranging from intra-disciplinary teams on an individual setting to multi-agency working practices. Collaboration covers the process of researching, assessing, planning, implementing and evaluation (Thomas 2014).
Critical analysis of my own performance from the Interprofessional Capability Framework (2009) section R2/L2, I identified myself as level 2 (see appendix 1). In multi-disciplinary meetings (MDT), I was co-operative, keen and knowledgeable about the patients. I was eager and asked questions throughout the MDT. I asked question when not understanding and I felt as though the health care professionals valued me as a student because I showed an interested instead of doubting my own knowledge. Weaknesses showed as I felt more nervous to question a doctor if I didn’t feel the statement was correct. Nevertheless, opportunities to share and discuss actions with area for improvements are valued within the health care system (RCN 1995). Additionally, critically analysing another Interprofessional Capability (2009) section CAEP1/L2. I identified myself as level 2 (see appendix 1). Through collaborative working I was able to achieve this capability by engaging myself in discussions about cultural beliefs and awareness, during MDT meetings and general discussion between different sectors, therefore enabling to gain knowledge about the issues within communities of practice.
Service user and collaboration
The Journal of Nursing Management (2010) cited by Francis (2010, p400) dedication, compassion and effective teamwork contribute to the welfare of patients and should be valued. Both nursing and medical staff are entitled to effective collaboration, one of the core values of Interprofessional working should be about respecting the individuals within the team (Barnes 2012). Collaborative practice between disciplines, patients and family result in the highest quality of care and strengthens health care systems, proposing that Interprofessional education is the way forward to producing a “collaborative-practice” ready workforce (Goodman 2010). Reflecting on my first placement, collaborative practice was shown poorly within the team and there was little discussion made throughout the team. This made it difficult for crucial information to be passed on effectively.
Critically analysing my own performance from the Interprofessional Capability Framework (2009) section CW/L2, I identified myself as level 2 (see appendix 1). Effective communication is one of the primary barriers when working to ensure safe, consistent and excellent patient care (Baird 2012). An area of weakness when I communicate with patients is posture, from self-analysis I have noticed that on some occasions I become awkward and am unsure where to stand or how to sit in front of a patient. Hopefully, through self-realisation I will be able to improve in this area on my future placement.
Leadership
The NHS health care system is subject to a pressure of change, throughout these changes the health care industrial requires nursing leaders with special attributes, therefore identifying leaders who are able to guide the profession into a positive future (Sofarelli 1998).
The frameworks that will be critically analysed are The NHS Leadership framework (2011) and NHS Change Model (2013). The NHS Leadership framework (2011) to bring together leadership principles and best practice guidance. The framework delivers a reliable approach to leadership development for staff in health and care throughout the NHS. The NHS Leadership framework is made up of nine leadership styles (see appendix 3). The leadership behaviours are shown on a four-part scale which range from “essential” through “proficient’ and “strong” to “exemplary’.
The NHS Change Model (2013) has a similar aspect about leadership with slight differences as it has been released more recently (see appendix 4). The leadership framework also encourages staff members at all levels across the NHS to become a leader and the main aim for this framework is to encourage everyone working in the NHS to become a leader of change, pushing for everyone’s opinions to gather a general scope of the main issues in the healthcare. So how do leaders inspire staff to participate? Staff members need to be able to be independent, ensuring they can widen their choice of skills (West & Dawson 2012). This will allow greater job satisfaction.
Leadership is important when influencing a group of individuals to achieve a specific and obtainable goal. The style of the leader is essential when influencing change and aiming to achieve a high quality of care. Within leadership there are various types of leadership styles which, depending on your personality, determine which style you will obtain. Collective leadership is known as the most popular leadership style used within NHS healthcare. This style is based upon building relationships with the other health service users, the individual is strong and has passion to support and grow the team (Jackson 2007). This type of style influences and motivates other members, facilitating the development of robust, vibrant and reproductive research cultures (Russell & Stone 2004).The decisions are made within the whole team based on the organisations values and ideals. Additionally, authoritarian leadership is where all the decisions are made without consenting any of the other staff members, negative reinforcement and punishment is often used to enforce rules. This type of style is used when the individual feels power and generally withdraws from the team. The positive aspect about this style is that in an emergency situation little discussion is made and this then enables tasks to be completed promptly. I felt that during first placement authoritarian leadership style was used mainly. This was due to a lack of staff and high demand from the patients. This style seers to be the best for this kind of situation but it also entails negative points.
Critically analysing my own performance throughout placement, I personally feel that I am heading towards becoming a transformational leader, which is very similar to the collective leader. During my first third year placement, I had the chance to lead a small group of team members that were caring for the patients I was in charge of. I needed to make sure I had charisma and confidence, ensuring I motivated the other staff members and allowing me to build relationships with the team. At first I felt embarrassed and unconfident because of my experience compared to others, although after getting to know the team and showing commitment and knowledge, it allowed taking charge easier because I had more respect from the team.
SECOND SECTION
During placement periods as student nurses, we all experience different experiences and various routines dependant on the ward allocated to us. Throughout this section of the assignment, I am going to discuss a placement ward in which I felt there should be an area of change. The reflective model I have chosen to use is Bortons model (Barton 1970). Bortons model simply puts three simple questions to be asked of the experience to be reflected on; What?, So what?, Now what? The model will be incorporated into the reflection to facilitate critical thoughts, relating theory to practice.
In my first year of becoming a nursing student, I was placed on a care of the elderly ward for dementia specialising in Parkinson’s, with around roughly 26 medical beds. This ward was very fast paced and constantly hectic. Throughout the placement, I noticed the patients suffering from severe dementia had various nutritional needs. Weight loss is common in individuals suffering from dementia, caused by poor appetite. This could be due to a variety of problems including communication, depression and pain (Alzheimer’s society, 2013). I noticed that occasionally some patients would not have eaten throughout the whole day or even barely drank fluids due to refusing at meal times; this therefore becomes the patient’s routine because food isn’t incorporated into their daily activity. The main issue with this ward was time management due to the high demand of patients and care needed. This sometimes showed to have a damaging effect on various patients that needed more care and time. PDSA cycle plan is to design a time chart which specifies that a minimum of 15 minutes one-to-one time, needs to be spent with a particular patient. This will then hopefully enable the patient to become familiar with you as the care giver during their meal time.
It occurred to me when on a dementia ward that the patients often go by familiarity despite their memory. For example, some patients would only consume diet and fluids when their relative was around despite not knowing who they are. Therefore, hopefully with my change of plan being put in place, if a member of staff is allocated specific patients for the day and every meal time the care-giver spends 15 minutes with the patient during the period, the likelihood of the patient consuming even a small amount of food is higher than when the patient was not receiving enough quality time.
Additionally to help implement the service improvement, structures known as process mapping and the PDSA cycle (plan, so, study, act) are used. Process mapping enables health professionals to capture the certainty of the patient experiences, following their whole journey to help identify the main problem areas for change. An example of a process map performed is shown in (appendix 5), designing a process map helps to identify the specific problem, which provides clear evidence that a service improvement plan is needed. In this case, a process map was not needed for this service improvement plan. On the other hand the PDSA cycle is used to provisionally trail a change in practice, allowing the team members and patients to assess the impact of the change before implementing it into practice.
Plan
To firstly initiate my plan of change I introduced it into the multi-disciplinary team meeting. This allowed me to help steer and co-ordinate the intervention as well as review my process with the team. Therefore bringing all of the health care professionals together can then be given a stake in the outcome and we can all work to achieve the goal. Clarke (2008) believes that teams without nurses are guaranteed to fail. Additionally tears led by nurses and therapists, however successful, often lack control; therefore doctors must also be a part of the team. This change of plan has been designed purely through observation during my first year placement. Speaking to various service users and family members I gathered together a concern for the patient’s nutritional needs. As well as noticing a strain on the staff I thought assembling a change of plan will relieve the team and prevent stress, hopefully bringing collaborative practice together.
Additionally when implementing a plan of change there will be controversy. Lewin (1951) designed a force field analysis, a strategic tool used to understand what is needed for change in both corporate and personal environments. For example Kurt Lewin (1951) states directly ” An issue is health in balance by the interaction of two opposing sets of forces – those seeking to promote change, known as the driving forces and those attempting to maintain the status quo (restraining forces). Throughout change there will always be individuals willing to contribute to make a change happen, nevertheless there will be restraining forces that resist.
To help with the leadership section for my plan of change, the approach I will use is the transformational style. This will allow me to bring everyone together creating a discussion on everyone’s thoughts and feelings about the plan. It is crucial that the idea set out is agreed by the majority of the individuals, because the plan of change will cost a small amount from the NHS budget, therefore the change needs to be beneficial to the NHS. The Institute for Innovation and Improvement (2013) states currently in the NHS we are facing an unpredictable challenge to improve quality and reduce the cost. Collecting the correct data both quantitative and qualitative at frequent intervals over extended periods allows the health professionals to make an uniformed decision about whether the change is moving the NHS in the correct direction. To enable my plan of change to happen/work I am going to need to ensure I have the involvement of various team members. Therefore allowing the patients to get the specified 15minutes one-to-one time, obviously nurses and health care assistants are going to be my main priority.
Do
To test whether this change of plan is a good idea I am going to perform a pilot study. A pilot study is a methodological introduction, the aim is to develop, adapt and check the possibility of the methods functioning for my service improvement plan (Foster 2013). To test this idea firstly, I discussed the service improvement with members of staff from other wards and family members to gain a general scope of ideas about plan. I performed this because the ward used for my service improvement plan, staff did not work collaboratively therefore I didn’t feel as though I would gain a positive outcome. Nevertheless I decided to use questionnaires with the whole team on the ward. This allowed me to collect the positives and negatives together and analyse whether I have achieved the service improvement. Additionally collecting the information will allow me to predict how long the process will take due to the amount of staff members that are ‘for” my service improvement. Main source of data has come from surveys and questionnaires using a qualitative research approach. Qualitative research is performed in a realistic setting, generally used from research that is collected through interviews and observation (Cleary 2014). Reflecting on this I am able to look back at the data collected and weigh out the pros and cons of my service improvement. I gained feedback from the patient’s family members as well as staff on the ward and on other wards. I feel that I have used a variety of sources to gain an accurate and reliable result.
Study
Merging all of my information/evidence together my main priority was to achieve a summary of the results. I used a matrix framework to bring themes together from the data I collected. This way I could set out the data in various categories to make the research basic. Furthermore with the information, I shared this verbally during multi-disciplinary meetings to put the service improvement plan across a variety of health professionals, gaining a professional feedback. Also discussing the service improvement with family relatives, gaining more of an outside view from individuals that don’t work in the health care. This type of study allowed me to gain precision and feedback from different sectors.
Act
Unfortunately as I am unable to actually perform this service improvement, therefore I need to look at this service improvement plan hypothetically. Reviewing changes of my service improvement plan I am fully aware that this service improvement plan will only work if the ward works collaboratively. Consequently the ward chosen for this, need to aim to improve their leadership skills and their collaboration between the other sectors. To help implement this plan effectively I am going to firstly introduce this plan into breakfast meal times, allowing me to improve small areas more effectively and then eventually open this plan out to all meals. Overall I believe that allowing 15 minutes one-to-one time, whether that is during all meal times or just breakfast will improve patient’s nutritional needs, especially for dementia patients it allows time for familiarity for the patients.
Conclusion
Concluding the whole assignment together prioritising the main issues in this assignment, I feel collaborative practice needs to be used as daily activities within the health care system. It has been clearly shown how essential it is to collaborate in a team and ensure leadership is prioritised. Designing a service improvement plan was a great experience and I now feel confident critiquing services and planning a change, it has helped me realise how much you actually notice during practice placement and the improvements that I, as an individual, can actually make. Overall, l I now hold a greater knowledge about team dynamics, areas of good and bad practice and service user involvement.
 

Effect of Communication on Collaborative Working

Discuss how communication within an inter-professional team could affect collaborative working.
Inter-professional learning and collaborative working in healthcare are two significant practices that must be understood as health care practitioners and trainee health professionals, to deliver high quality of patient-centred care in National Health Service (NHS) through effective communication. Thus, the aim of this essay is to critical discuss and analyse how communication within an interprofessional team could affect collaborative working to reduce medical errors, decrease workloads, reduce mortality rate, conflict and lack of trust. Two specific key points will be addressed throughout this essay; collaboration with staff and students, effective communication such as verbal and non verbal which entails active listening. In accordance to the Nursing and Midwifery Council (NMC) (2015) codes of conduct on confidentiality, personal information and trust identifiers will be anonymous in the essay and service users (SU) will signify patients.

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Buring et al (2009) explained Inter-professional teamwork as the extent of which an array of several healthcare professionals such as doctors, nurses, pharmacists and many more work together successfully to influence the quality of care being provided, improve collaboration, enhance quality of patient care, lower costs, decrease patient length of stay and overall reduction in medical errors in health care setting. Negatively, poor communication within a team of health professionals might lead to conflict, lack of trust and may impact on patient care and safety (Vincent, 2011). Collaborative working in healthcare is the process whereby professionals from different disciplines work and support each other as a team cohesively, whilst balancing their roles, sharing responsibility towards making difficult clinical evidence based decisions appropriate enough for the best interest of the SU (McCabe & Timmins, 2013).
The NMC (2015) stated that to promote a dynamic collaboration among health and social care professionals, effective communication must be established and demonstrated within respective teams, at the same time respecting individual professional’s knowledge, skills and contribution.
Flin (2009) defines communication as ‘the transfer of information, ideas or feelings’ (p. 16). However, Emmitt and Gorse (2009) articulate that the transmission of information from sender to receiver may be distorted, therefore, in order for communication to be successful within collaboration, professionals have to utilise this skill effectively. Daly (2004) affirms that effective communication between healthcare professionals is the cornerstone to successful collaboration. Furthermore, Stukenberg (2010) states that once effective communication has been implemented within collaborative working, improved knowledge, work interactions, and positive environment for professionals to work cohesively is established, subsequently, improving the delivery of patient care (Chatman, 2008).
The two method of communication that has been commonly cited by numerous literatures are, verbal and non-verbal communications which are widely used by health and social care practitioners in various settings. A study of Purtilo and Haddad (2009) highlighted that verbal communication is vital to health professionals in forming professional relationship through the form of team meetings. The study further emphasised that regular meetings of interprofessional team linked by a common care pathway help to enforce verbal communication and activate effective team collaboration. An example of this was during the author’s placement in a hospice (palliative care), a multidisciplinary meeting was held regularly every week consisting of an array of professionals from different department such as nurse specialists, consultants, social workers, student nurses, doctors, occupational therapist, spiritual and psychological specialist to discuss and up-date members of the team regarding patients care. As observed, effective communication was utilised and initiated throughout the course of the meeting as ideas from this group of professionals were put forward in an orderly manner as each professionals took it in turn to contribute towards the decision-making process.
Communication observed was clear and concise among the health professionals. Bach and Grant (2012) concurs that clarity of conservation among professionals will aid the process of information being transmitted accordingly thus leading to understanding, as it ensure vital information are not misheard in turn reduces the risk for confusion among individuals within the team. Burnard and Gill (2014) further explained that communication is the art and process of creating and sharing ideas from different individuals, therefore, when this is demonstrated within a group of professionals, they are able to contribute ideas drawing from their own knowledge, experience and expertise as suggested by Baatrup (2014). Tindall, Sedrak and Boltri (2013)also articulated that effective communication will warrant that each members of the team are kept up-to-date which is vital when key decisions are made regarding a patient’s care. They further elaborate that communication forms relationship where trust and respect are instilledthereby enhancing job satisfaction and wiliness of health professionals to join forces with one another as a team in order to deliver a care that is of high quality. Rost and Wilson (2013) maintains that active listening should also be incorporated within communication as it an invaluable tool that sustains collaborative working among healthcare professionals.
However, communication failures among health care professionals have been highlighted as the leading cause of unintentional patients harm with many leading to permanent injuries and even deaths (The Joint commission, 2006). An example will be the devastating case of Victoria Climbie (UK Department of Health (DoH), 2003) which demonstrated the effects of ineffective team work and poor communication among health professionals. The recommendation from Lord Laming’s report on the Victoria Climbie inquiry stress the need for health care professionals to improve interprofessional communication and collaboration. As emphasised by UK DoH (2013), effective communication is crucial among health professionals to enhance care delivery, develop therapeutic relationships and it is known to be one of the 6C’s approved by government and NHS to support the values and ethics in health care delivery.
Ineffective collaborative working can be as a result of lack of understanding, poorly defined roles and responsibilities, poor communication challenges among health care professionals, which evidently has a negative impact on clinical outcomes. As seen in the Francis report (2013) of the Mid Staffordshire hospital where SU were left to suffer as a result of poor communication and collaboration among interprofessional team. For this reason, the DoH (2013) emphasise the need for all health care professionals to work together collaboratively, communication effectively among each other and have an increased knowledge of the role of each member of the team.
Interprofessional team must possess active listening skills which is an important tool in improving discussion and help building trusting relationships between health care professionals (Stainton et al, 2011). Aitken (2013) recognised good listening skills as an important tool for effective communication that can consolidate collaborative working among health professional especially for student analysis and learning. In terms of collaboration between staffs and students, this allows students to be able to gain insights into the varieties of language used such as terminologies commonly used within health and social care, in turn enhances understanding as students are aware of how best to communicate with other professionals within clinical practice building up their interprofessional skills paving away for effective collaboration (ref). REF) put fort the notion that where there is effective communication between staff and students, a strong relationship is formed where there is mutual respect and trust, even though there is differing competence between this specific group of individuals (Hamilton, 2010). Morgan, (2013) also states that effective communication will improve staff and students experiences.
Collaborative working through effective communication facilitates professionals from a diverse range of other expertise to help achieve single aim, decrease work load, share ideas on how to deliver highest quality of care through understanding of information communicated. In addition, NMC (2015) recommends that professionals should have the necessary skills to communicate effectively with colleagues and other professionals in order to improve patient care. Hence, working collaboratively has been widely stimulated as the best approach in improving health outcomes (UK DoH, 2010). Furthermore, to support collaborative practice individuals need to utilise interpersonal skills to promote effective teamwork and communication. Therefore, Combined Universities Inter-professional Unit (CUILU) (2010) recommended a guideline designed to help students and different professionals understand how the development of a collaborative worker is evaluated by applying the inter-professional capability framework. This consists of four domains which are Collaborative working (CW), Reflection (R), the Cultural Awareness and Ethical Practice (CAEP) and the Organisational Competence.
In conclusion, effective communication and collaboration has a huge impact on the lives of SU and health professionals either positively or negatively. It is the role of health professionals to address this and collaboratively maintain continuity of care where there is high quality patient centred care, promote good working relationship with members of a team, thereby enhancing job satisfaction for professionals and quality of life for patients. A good listening skills, mutual respect and value for team members irrespective of their discipline will also facilitate an effective collaboration and patient safety.
REFERENCES
Aitken, J.E. (2013). Cases on Communication Technology for Second Language Acquisition and Cultural Learning. United States: IGI Global.
Baatrup, G. (2014). Multidisciplinary Treatment of Colorectal Cancer:Staging – Treatment – Pathology – Palliation. United Kingdom: Springer.
Bach, S. & A. Grant, (2012). Communication and Interpersonal skills in nursing. Exeter: Learning Matters Ltd.
Buring, S.M., Bhushan, A., Broeseker, A., Conway, S., Duncan-Hewitt, W., Hansen, L. & Westberg, S. (2009). Interprofessional Education: Definitions, Student Compentencies, and Guidelines for Implementation. American journal of pharmaceutical education, 73 (4), 1-8.
Burnard, P. &Gill, P. (2014). Culture, Communication and Nursing. United States: Routledge.
Chatman, I.J. (2008). Medical Team Training:Strategies for Improving Patient Care and Communication. United States: Joint Commission Resources.
CUILU (2010) Interprofessional Capability Framework: a framework containing capabilities and learning levels learning to Interprofessional capability. The Combined Universities Interprofessional Unit. Sheffield Hallam University and The University of Sheffield.
Daly, G. (2004). Understanding the barriers to multiprofessional collaboration. Nursing Times, 1(9), 78 -79.
Emmitt, S. &Gorse, C.A. (2009). Construction Communication. United Kingdom: John Wiley & Sons.
Flin, R. et al (2009) Human factors in patient safety: review of topic and tools. Report for Methods and Measures Working Group of WHO Patient Safety. Geneva: World Health Organization. Retrieve April 7th 2015, from http://www.who.int/patientsafety/research/methods_measures/human_factors/hu man_factors_review.pdf
Francis, R. (2013). Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. The Mid Staffordshire NHS Foundation Trust Public Inquiry. London: TSO
Hamilton, C. (2010). Communicating for Results: A Guide for Business and the Professions. (9th ed.). United States: Wadsworth Cengage Learning.
McCabe, C. &Timmins, F. (2013). Communication Skills for Nursing Practice. (2nd ed.). United Kingdom: Palgrave Macmillan.
Morgan, M. (2013). Improving the Student Experience:A Practical Guide for Universities and Colleges. United Kingdom: Routledge.
Nursing & Midwifery Council. (2015). The code professional standards of practice and behaviour for nurses and midwives. London: NMC
Purtilo, R. & Haddard, A. (2009). Health professional and patient interaction. (7th ed.). United States:
Rost, M. & Wilson, J. (2013). Active Listening. United States: Routledge.
Stainton, K., Hughson, J., Funnell, R., Koutoukidis, G. & Lawrence, K. (2011). Tabbner’s Nursing Care:Theory and Practice. Elsevier Health Sciences.
Stukenberg, C.M. (2010). Successful Collaboration in Healthcare:A Guide for Physicians, Nurses and Clinical Documentation Specialists. United States: CRC Press.
The Joint Commission (2006). Root causes of sentinel events, all categories. Oakbrook, IL Retrieved April 4th , from http://www.jointcommission.org/NR/rdonlyres/FA465646-5F5F-4543-AC8F-E8AF6571E372/0/root_cause_se.jpg
Tindall, W.N.,Sedrak,M., & Boltri, J. (2013). Patient-Centered Pharmacology:Learning System for the Conscientious Prescribe. Philadelphia: F.A. Davis.
United Kingdom. Department of Health (2010). Modernising Scientific Careers: The England action plan. Retrieved April 10th, 2015 from https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/139529/dh_115144.pdf
United Kingdom. Department of Health and NHS Commissioning Board (2013). Compassion in practice. Nursing, midwifery and care staff: our vision and strategy Redditch: NHS Commissioning Board.
United Kingdom. Department of Health. (2003). Laming Report. The Victoria Climbié Inquiry-Report of an inquiry by Lord Laming. Retrieved April 4th , 2015 from https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/273183/5730.pdf
Vincent, C. (2011). Patient Safety.(2nd ed.). United Kingdom: Wiley Blackwell.
 

Effect of Inter-professional Team on Collaborative Working

How Communication within an Inter-professional Team Can Affect Collaborative Working Strategies
Introduction
Schwartz, Lowe & Sinclair (2010) have stated that effective communication is very important for a health care professional and service user to interaction with each other successful and also between the health care professionals. according to Weiss &Tappen (2014),P98 Communication is considered to be a core competency in promoting inter-professional collaborative practice.
This assignment will identify and discuss the differences within the inter-professional and collaborative working strategies, which can help health care professionals overcome any boundaries within different professions. The assignment will also looked at the knowledge and skills which are vital in order to show autonomy in practice this help nurses to improved their level of interaction with different professionals within the an inter-professional team.

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Anderson(2013), have stated that communication is vital in nursing profession this is due to the nursing practice on a daily basis is build on collaborating or working with different professionals. (Garwood, Lingard et al, 2005) reported that when medical errors take place, the reasons for the error are often traced back to breakdowns in communication between members of the healthcare team. It has been stated by Goodman and clemow(2010) nursing profession is not a solitary profession.
Nurses should therefore be able communicate effectively with different professionals in order to work as a part of the team and interact successfully. If nurses can maintain this positive attitude of working in inter-professional collaborative working strategies and communicate effective, this will not only benefit the patient centre care but it will also reduce the conflict within different professions.
Anderson (1990) stated that active listening is a process that requires energy and concentration to avoid one missing major points which would in turn compromise delivering quality care to the service users. This has been evidenced in both Victoria Climbie baby P cases and Mid Staffordshire(Francis report 2013) where there was a lack of communication and collaboration among the inter-professional group which led to fatal incidents in both cases. According to (Hall and Weaver,2001) in order to improved the quality of the service user there has to be a good communication, collaboration and congruence among the health care provides. To be an effective collaborative worker.
The Nursing & Midwifery Council (NMC,2008) have state in the code of conduct that nurses must able to work effectively as a part of a team and this can only be achieved through if nurses are willing to sharing their knowledge, skills and experience with their colleagues. making consultations, taking advice when appropriate, and making referrals to other practitioners. cooperate with others in the team; maintain your professional knowledge and competence; be trustworthy and to act to identify and minimise risk to service users This strategy naturally entails communication with other professionals. Communication in this case can be verbal or non-verbal.when communicating with different professional it is vital that the language which is used during the communication is understood by all those whom are involved in the care of the service user.
(Kourkouta & Papathanasiou, 2014).What that means is that during inter-professional communication the language which is use should be formal and consistent. This is another way which help to improve inter-professional communication and enhance collaborative practice. Schwartz et al.(2010) have identify that one related problem which prevent effective development of inter-professional communication, which is development of a language that is different for every profession. Having a language which is only unique to one profession or discipline can seriously cause communication barrier within personnel from different professions or discipline(Schwartz et al.2010).
Miscommunication could be due that health care professionals are unable to understand the information which been given , now this could be due to lack of shared understanding of commonly used acronyms , terms and concepts.( Schwartz et al.2010).This can have great impact of the quality of collaboration within professionals this could be due that they are unable to understand each other on easy way. In order to deal with this problem it is important to avoided use of medical jargon, especially when inter-professional team involved non-healthcare personnel.
This issue of using medical jargon when communicating with non-healthcare personnel has been a hot topic during the lecture of Cares of Hertfordshire, they have stated that they wish that healthcare professional will communicate with them with the language that they understood not so many medical jargon that they do not understand and has not been explained to them in way that they could understand it. which is why it vital to recognize our own use of jargon and asked colleagues clarified unclear terminology and use jargon free language whenever is possible. Campbell(2006) Have reported that poor communication has frequently been cited as one of the biggest criticisms in health care settings.
Another importance of collaboration is that it ensure the transfer of accurate information necessary to deliver appropriate care . Nurses have also been advice to adopt a structured format of verbal and non-verbal communication skill which is acceptable to all members of the inter-professional team. One structured which is common within the hospital known as SBAR,(Situation, Background, Assessment and Recommendation) this method make inter-professional communication more effective and easy to understand and reduced any confusion . Narayan(2013,p504).
According to Kourkouta & Papathanasiou, (2014,p65) have stated that communication can happened even without words been said, which is it is important to recognise that non-verbal communication is quail important as verbal communication. Non-verbal communication is through body language and facial expression (Kourkouta & Papathanasiou,2014 ) .
This is why it is vital that nurses learn within early stage of their practice learn how read and understand other professionals non-verbal communication, which usually should use with spoken words, in order to fully understand the information communicate and eventually improve collaborative practice.
It is important to have a clear and structured form of communication in order to prevent stereotyping and judgmental attitudes and unprofessional behaviours towards other members of staff. with this knowledge in hand it is important to make sure ones future professional judgement or decision are based on accurate information sharing, making sure that non-judgemental avoided misunderstanding and misconception when making decision.
This is one of the reason why The NMC (2008,p5) states that nurses should be able to work cooperatively within teams and respect the skills, expertise and contribution of the others. another strategy of collaborative working is that always make sure that patients or service users are involved at any decision making regarding their acre. According to Beauchamp & Childress (2001) the autonomy of services users should be respected and their decision-making capacity of independent person which enabling them as an individual’s to make reasoned informed choices about their treatment.
It is clear that nursing profession is like any other profession which requires a certain of independence from other professions even if the practice of nursing required ones to work collaborating with other professions. Dave (2009) have state that the role and responsibilities needs to be defined, challenged and task to be shared within health care profession this will enable both nurses and different other health care professions whom are also involved in service user care. Independent practice points to the concept of autonomy. Dewar (2010) states to be able to practice professional autonomy means that one is already in the advance practice of one’s profession. Nurses should be able make clinical decision directly relating to their patients care in order to practice autonomy.
It is important to know yourself and your capabilities, to understand what makes us do the things we do and why we do them. also to be self-aware. Self-awareness is a vital aspect of professional development. People are born into different backgrounds and are different in their ways, motivations, thoughts and beliefs; however as a professional, it is important to recognise how these affect others to be able to establish and maintain therapeutic relationships with patients.
(Swapna ,2007) Knowing our own thoughts and feelings, strengths and weaknesses gives us the ability to guide us in our decision making, and also helps us to become more self-confident in our approaches
The main priority of service improvement is to improve access for patients by engaging clinical teams to reduce waits and delays at all stages across a patient pathway. Service Improvement is achieved by looking for opportunities to redesign as well as ensuring that effective waiting list management practice is implemented.
 
Conclusion
Inter-professional communication gravely affects collaborative working strategies which use within an inter-professional team. It is core effect which is inefficient collaborative practice which enable to make sure high quality of care is deliver to the patients at all time. poor inter-professional communication can hinder collaboration within professionals and which in turned can have a greater impact on the quality of care which delivered to the patient. It is important to have good inter-professional communication and collaborative working practice in place to prevent any miscommunication happening within the health care. SBAR is one good example of using a formal structured language. It is also very important as a health care profession to remind ourselves to avoided using medical jargon .
References
Anderson, L. (2013). Why communication in the nursing profession is important? Retrieved May 10, 2015, fromhttp://www.nursetogether.com/why-communication-in-the-nursing-profession-is-important
Anderson, C. (1990) Patient Teaching & Communication in an Information Age. New York. Delmar Publishers Inc.
Beauchamp T & Childress J (2001) Principles of Biomedical Ethics. Oxford. Oxford University Press
Dewar, K. (2010). Advanced practitioners and advanced practice. In: M. Standing (Ed.).Clinical judgement and decision-making in nursing and inter-professional.(pp. 28-53). Maidenhead: Open University Press.
David Hutton (2009)Professional Advisor Revalidation, Nursing and Midwifery Council Preceptorship Framework for Newly Registered Nurses, Midwives and Allied Health Professionals Department of Health (2009)
Goodman, B. & and Clemow, R. (2010).Nursing and collaborative practice: A guide to interprofessional learning.London: SAGE.
Francis (2013) Report on Mid Staffordshire Hospital.
Retrieved from https://www.gov.uk/government.
Hall, P., & Weaver, L. (2001). Interdisciplinary education and teamwork: A long and winding road. Medical Education, 35, 867 – 875.
Joshi Swapna Ranade Sujata (2007)Model Answers in Obstetrics Nursing
Published byJaypee Brothers Medical Publishers (P) Ltd.
The Nursing & Midwifery Council (2008) Code of professional conduct: Standards for Conduct, Performance and Ethics. London. NMC
Kourkouta, L. & Papathanasiou, I. (2014). Communication in nursing practice.Mater Sociomed,26(1), 65-67.
Narayan, M. (2013). Using SBAR communications in efforts to prevent patient rehospitalizations.Home Healthcare Nurse,31(9), 504-515.

Schwartz, F., Lowe, M. & Sinclair, L. (2010).Communication in health care: Considerations and strategies for successful consumer and team dialogue.Retrieved December 20, 2014, fromhttp://www.hypothesisjournal.com/?p=885
Thurgood, G. (2011). Teamwork: Working with other people. In: R. Burton & G. Ormrod (Eds.).Nursing: Transition to professional practice.(pp.118-157). Oxford: Oxford University Press.
Verhovsek, E., Byington, R. & Deshkulkarni, S. (2013). Perceptions of interprofessional communication: Impact on patient care, occupational stress and job satisfaction.The Internet Journal of Radiology.12(2) Retrieved December 20, 2014,https://ispub.com/IJRA/12/2/4895
Weiss, S. & Tappen, R. (2014).Essentials of nursing leadership and management.Philadelphia: F.A. Davis Company.
 
 
 
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Effect of Communication in on Collaborative Working

Discuss how communication within an inter-professional team could affect collaborative working
Introduction
This assignment will discuss how communication within an inter-professional team could affect collaborative working. It will focus on effective communication and understanding other professional roles. It will also examine collaborative working in a team and the barriers that can affect inter- professional team.
According to Curtis, Tzannes and Rudge (2011) communication is the art of imparting a message, idea or information between two or more people and is a two way process of transferring information from a source (sender) to a destination (receiver) without the information becoming scrambled on its way so that the exact meaning is understood (Clemow, 2010).
A failure to ensure effective communication may adversely affect clinical practice due to increased staff frustration causing undue anxiety and apprehension to patients. (Pincock, 2004) maintains that poor communication by health service staff is a significant cause of complaints brought against the National Health Services (NHS) and clearly shows the importance of achieving effective communication at all times. The Morecambe Bay Report (2015), reported poor working relationships between midwives, obstetricians and paediatricians, which caused major organisational failures and substandard care.

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(Cheung et al, 2010) stressed inter-professional communication failures are known to be the root cause of adverse events. The increase of effective communication will support government policies such as The Quality and Outcomes Framework (QOF, 2013) and the NHS Outcomes 2013/14, which have been produced to improve patient care through meeting the outcomes of the five key domains, which is a legal requirement of the Care Quality Commission (CQC, 2011).
Collaboration between healthcare providers is necessary in any healthcare setting, since there is no single profession which can meet all patient’s needs. Consequently, good quality care depends upon professionals working collaboratively in inter-professional teams. In order to improve the quality of patient care and ensure that the goals of care are being achieved, many settings are using the collaborative care delivery model. The collaborative approach involves teams of health professionals working together to provide more coordinated and comprehensive care to clients (Kearney, 2008).
According to Day (2006) collaboration in health care settings involves professionals assuming complementary roles and co-operatively working together, sharing responsibility for problem-solving and making-decisions. Collaboration between health care professionals can increase team member’s awareness of different types of knowledge and skills. Berry (2007) affirms that inter-professional education is a collaborative approach to develop students as future inter-professional team members. The IPE module has given individual students an insight into other students chosen professions and the importance of communication between them.
Bronstein (2003) discovered the diverse cultures, norms and languages of each profession make the process of interdisciplinary collaboration resemble the bringing together of inhabitants from different backgrounds. The Morecambe Bay Report (2015) also emphasised the cultural differences between the inter-professional team which led to dysfunctional and serious failures of clinical care.
According to Kerridge (2002) culture influences all aspects of our lives, it therefore influences our unconscious perception of others. These cultural differences brings with it many challenges to inter-professional working. MacDonald et al (2010) recognised the ability of a professional to learn about other professional roles leads to a broadening and an enrichment of the knowledge required to collaborate with other team members in providing effective healthcare. Inter-professional team work allows healthcare professionals to identify unique differences and to understand the roles and contributions of other members (Lee, 2011).
As members of an inter-professional healthcare team, it is imperative that the basis of our different knowledge and skills set be acknowledged and understood. As an inter-professional we must understand what other healthcare professional do, how to access their services and understand the teams goals and needs from their perspective. For instance, in collaborative partners working to achieve quality care we must find ways for healthcare professionals to become good collaborators and competent team members (MacDonald et al, 2010).
Working with different professionals however can be very challenging because each inter-professional has a particular approach to patients care for example, a doctor might decide to treat a cancer patient by using chemotherapy even though, there is a small chance of success and the treatment has significant side effects. The nurse on the other hand might feel like the level of pain from the side effect is too much that treatment should not continue. These different in views should be recognised and inter professionals must share their views, justify treatment approaches, and most importantly involve the patient. The success of collaborative working relies on sharing patient concerns as well as professional perspectives, values and beliefs (Cook, Gerrish & Clerk, 2007).
McWilliams et al (2010) suggest that inter-professional working is very challenging in the workplace, and it is not an easy concept for healthcare professionals to adopt. He argued that inter-professional working is not being delivered to patients, due to communication misunderstanding of information regarding collaborative working. It has been suggested that this is due to the lack of support and training from managers and that managers should involve staff in changes within practice (Dunsford, 2009).
However, challenges in inter-professional collaboration such as professional hierarchy can prevent an inter-professional work system from achieving it goals in improving quality of care (Reeves et al, 2009).Traumacentrum (2009) also considered the design of the care system to be responsible for communication issues. Understanding the design of the care system can therefore be a first step towards gaining insight into the root causes of communication failures (Clemow, 2010).
A common barrier to effective communication and collaboration is hierarchy between professionals (Berry, 2007). Deutschlander (2009) concur that communication failures in an inter-professional setting arise from vertical hierarchical differences, concerns with upward influence, role and power conflict, and ambiguity. Communication is likely to be distorted or withheld in situations where there are hierarchical differences between communicators (Hornby & Atkins, 2000).
Nursing and Midwifery Council’s Code of Professional Practice (NMC, 2015) stated that nurses must engage and communicate with a wide range of professionals to ensure that the patient receives quality care. (Gerard,2002) states that communication is an essential part of health care planning and delivery, no matter which area or discipline one happens to work in, as healthcare delivery involves working with people.
Verbal communication is used to convey feelings, ideas and emotions and integral within verbal communication is the process of effective or active listening (Barret, Sellman & Thomas 2005). Non-verbal communication conveys how we communicate both unconsciously and consciously which includes body language, facial expressions, posture, eye contact and touch (Leathard, 2003). Written communication can take various forms such as documents, patient care plans, prescription charts, letters and emails (Drake, 2007).
In regard to verbal communication, a clear explanation of procedures should be given to the patient in terms that they can understand taking into account age, ethnicity and level of understanding. (Adler & Rodman, 2009) suggests that professionals can often be poor listeners, as they are too busy to listen properly and jump ahead to reach their own conclusions and appear impatient and high handed as they already have a fixed idea of what they intend to do.
The use of active listening techniques such as open posture and questions enhance a practitioner’s ability to accurately assess the information needs of a patient, by creating and encouraging an atmosphere in which the patient feels free to express their needs (Leathard, 2003).
Day (2006) states that a vital method of communication between the inter-professional team is through the patient’s records. Good record keeping should be accurate and is essential for professional practice. Most patient records are handwritten and this sometimes presented barriers because some professionals used meaningless phrases, abbreviations and jargon which are difficult to comprehend. Booker (2005) acknowledges that the use of jargon is a way of making professional status known, however, Cheng et al (2011) points out that patients have a right to view their records and it should be written in a way that they can understand.
Inter- professional caregivers are supposed to be communicators, especially when documenting patient information. If what is documented does not communicate, then the healthcare giver has failed in his or her profession and legal duty (Hornby & Atkins, 2000). The Morecambe Bay Report (2015) stated that lack of openness and effective communication was a key contributor in the care received by patients, where a patient chart had gone missing, before it could be used as evidence in an investigation.
If previous documentation is not properly documented or incomplete, other members of the team would find it difficult making good decisions based on the information available (Tummey, 2005). There are situations where nurses and other professionals work effectively together. The multidisciplinary team work well in long term care situations, because it is virtually impossible to tease apart the ever- changing social and healthcare needs of dependent individual and their family. When it comes to recommending patients to the right support system for example referral to social workers, the doctors and nurses discuss the patient’s condition before deciding their next line of action (Warren, 2007).
A further barrier to effective verbal communication within an inter-professional team may be found within styles of speech. Speech that is heavily accented, containing technical and medical jargon or which is spoken too quickly may present communication barriers for the inter-professional team and patients, when caring for patients with hearing, learning, or language difficulties, when English may not be a person’s first language, effective communication is essential. (Yukl, 2010).
Communication is fundamental in providing good nursing care and collaborative working with the modern healthcare environment. The NHS England Strategy (2014) The NHS five years forward view require healthcare professionals to consider their possible future, the choices faced, and how the services need to change, for a more engaged relationship with patients and communities, so that wellbeing is promoted and ill-health prevented. In order that patient centred care is provided inter-professionals will need to utilise effective communication skills and build upon existing communication skills and knowledge, by increasing awareness of the many barriers to communication that exist within the inter-professional team ( Pogue,2007).
In conclusion, this assignment has discuss on how effective communication can hinder and impact on collaborative working. It also recognised how poor communication can lead to catastrophic result among inter-professional team. Effective communication can lead to positive outcomes, such as improving information flow, more effective involvement and improved safety, and improved collaborative working morale and service user’s experience (Day, 2006). Excellent communication and information given is essential to patient care. The more inter-professional team considers the significance of communication, the more their method towards team collaboration will be influenced positively and better would be the results.
REFERENCES LIST
Adler,B.R. & Rodman, G. (2009). Understanding Human Communication. Oxford:Oxford University Press.
Barrett. G. Sellman. D. Thomas. J. (2005). Interprofessional working in health and social care: Professional perspectives. Basingstoke: Palgrave Macmillan.
Berry, D. (2007). Health Communication. Theory and Practice. Maidenhead: Open University Press.
Bronstein, L. R. (2003). A Model for Interdisciplinary Collaboration. Social Work, 48(3), 297-306.
Brooker, C. Nicol, M. (2005). Nursing adults: The practice of caring. London: Elsevier.
Care Quality Commission. (2011). Promoting patient safety. Retrieved 18/3/2015from, http://www.cqc.org.uk/public/reports-surveys-and-reviews/reports/mental health- act-annual-report-2010/11/promoting-patient
Cheung, D.S., Kelly, J.J., Beach, C., Berkeley, R.P., Betterment, R.A., Broida, R.I., Dalsey, W.C., et al. (2010). Improving handoffs in the emergency department. Annals of Emergency Medicine, 55(1) 171–180.
Clemow, R. (2010) Nursing and Collaborative Practice, 2nd edition. Exeter: Learning Matters LTD.
Cook. G. Gerrish K. Clarke. C. (2001). Decision making in teams: issues arising from two UK evaluations. Journal of Interprofessional Care. Vol. 15(4), 141-51.
Curtis, K., Tzannes, A., & Rudge, T. (2011). How to talk to doctors –A guide for effective communication. International Nursing Review, 58(6), 13–20.
Day, J. (2006) Interprofessional Working. Cheltenham: Nelson Thornes.
Deutschlander, S. (2009). Role understanding and effective communication as core competencies for collaborative practice. Journal of Interprofessional Care, 23(3), 41–51.
Dunsford, J. (2009). Structured communication: Improving patient safety with SBAR. Nursing for Women’s Health, 13(4), 384–390
England, NHS, (2014) Five Year Forward View. Community Practitioner.
Ethics for Nurses and Midwives. London: NMC.
Gerard, K. (2002). Interprofessional working: opportunities and challenges. Nursing Standard. Vol. 17 (6). 33-35.
Headrick, L., A., Wilcock, P. M. & Batalden, P. B. (1998). Interprofessional Working and Continued medical Education. British Medical Journal, 316(7133), 771-774.
Hornby, S. and Atkins, J. (2000) Collaborative Care: Inter-professional, Interagency and Interpersonal, 2nd edition. Oxford: Blackwell Science.
Kearney, A. (2008). Facilitating interprofessional education and practice. The Canadian Nurse, 104(3), 22-6. Retrieved March 21, 2015, from ProQuest Health and Medical Complete.
Kerridge, J. (2012). Leading change 1: identifying the issue. Nursing Times, 4(108), 12-15
Leathard. A. (2003). Interprofessional collaboration: From policy to practice in health and social care. Hove: Brunner-Routledge.
Lee, V. S. (2012). What is inquiry‐guided learning? New directions for teaching andlearning, 2012(129), 5-14.
MacDonald, M., Bally, J., Ferguson, L., Murray, B., Fowler-Kerry, S., & Anonson, J. (2010). Knowledge of the professional role of others: a key interprofessional competency. Nurse Education in Practice, 10(4), 238-242.
Mc Williams, R., Holt, J., Coates, C., Cotterill, D., Eastburn, S., Laxton, J., Mistry, H., & Young, C. (2010). Identifying common competences in health and social care: An example of multi-institutional and inter-professional working. Nurse Education Today, 30(3), 264-270.
Nursing and Midwifery Council. (2015) The Code: Standards OF Conduct, performance and
Pincock, S. (2004). Poor Communication Lies at the heart of NHS complaints. [Electronic version], British Medical Journal 328 (430), 10.
Pogue, P. (2007). The nurse practitioner role: Into the future. Canadian Journal of Nursing Leadership, 20(2), 34–38.
The Care Quality Commission (CQC). (2015) University Hospital of Morecambe Bay NHS, Foundation Trust. London.
Traumacentrum Limburg. (2009). Failure mode and effects analysis CVA, Myocardia infarct, Heuptrauma, Obstetric, Psychiatric. Maastricht: Traumacentrum Limburg
Tummey, R. (Ed.) (2005) Planning Care in Mental Health Nursing. Hampshire: Palgrave Macmillan.
Warren, J. (2007) Service User and Carer Participation in Social Work. Exeter: Learning Matters LTD.
Yukl, G. (2010). Leadership in organizations (7th Ed.). New Jersey: Prentice Hall.

STUDENT NUMBER :12236309

1

 

Implementing a Cloud-based Collaborative Solution

As an organization grows, it’ll come to a point where it must contemplate whether or not a cloud-based solution will meet their needs and attain the required level of support needed to help the corporation continue to grow. For this assignment, I will be discussing the implementation of a cloud-based collaborative solution for businesses. By definition, a cloud collaboration permits staff to work along together on documents and different information that is kept off-site. This is often done employing a cloud-based collaboration platform used to share, edit and work on comes along (Rouse, 2015).

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For a business to contemplate cloud-based collaborative solution they must consider a number of things before move ahead to implementation. They have to be ready to firmly store and share the information within the cloud. They’re going to need to be able to set permissions and accessibility perimeters for restricted access based on job roles and need to understand data information to ensure security of potentially sensitive information and to guard their clients. It’s necessary to make certain that end users have a clear understanding of the goals of the platform and the way they will gain the foremost out of using the platform. There will need to be coaching given and constant support throughout the conversion. A business must have a backup arranged for just in case of an emergency or system failure, they’re going to need to have a thorough understanding of the disaster recovery aspects of the service that they choose to be able to recover any information from the cloud service that they use. Having the ability to possess confidence within the cloud service to maintain the safety of the data from potential attacks and outside intrusion into the system is one of the primary things an organization ought to consider once considering their choices.  

For most corporations looking into the cloud based collaborative, it’s invariably a priority as to how seamless the transition can go from their current system to a replacement one. “In a survey of 2,438 IT executives and technology decision makers in the United States, Canada, France, Germany, and also the UK, Forrester found that fifty six have moved  or plan to move a number of their enterprise collaboration systems to the cloud.” (C. 2017) The potential cloud solution will have to offer constant support throughout the modification for both the IT department handling the migration and supporting the users. This concern ought to be met with a rigorously planned infrastructure to facilitate modification management and control the variables that come in conjunction with migrating from the present system to a cloud-based one. 

Azendoo designed to help companies reduce the bulk of maintaining “to-do” lists and monitoring active projects. It is a characteristic corporate solution that highlights the importance of efficient team work synchronization, file sharing and project planning as well as communication. With Azendoo, you can share files from desktop, Gmail drive, DropBox and Evernote and also allows real time discussions. Without doubt, this cloud based collaboration solution organizes your work environment and makes optimizes team work activities.

 Monday.com is actually an app designed for smart business communication. It allows team members to work on projects and share information in a central place through streamlined discussions and contributions. Monday.com uses very efficient user navigation reminiscent of modern social media platforms where each team member creates a profile and shares project files and information with one another. Prominent clients include Uber and Universal like NBC.

Both iPhone and Android applications, platforms are appropriate for companies that range from small businesses to large enterprises. Both companies also offer support for online, training, phone and live support. Both of these platforms offer a large variety of features, there are a few that a business owner needs to be aware of before they subscribe to one or the other.

There are many cloud collaboration solutions in the market and finding one is as effortless as looking up businesses on your favorite browser. However, not all perform exceptionally well. Although no single solution can be identified as the best for every business, since each industry has its unique set of requirements, some offers have attributes that distinguish them from the rest.

References

 

Developing Capability for Effective Collaborative Services

Developing Capability for Effective Collaborative Services

This assignment will focus on the perspective of the patient and carer, regarding interprofessional working, considering the strengths and limitations of interprofessional working. The factors that contribute to collaborative working, the formation of safe environments and services for patients and carers will also be explained. This will be accomplished by reflecting and using examples of my own experiences which have been observed through clinical placements and study during Interprofessional Education week. This will show my personal involvement and therefore I will be able to evaluate my own strengths and weaknesses regarding working collaboratively with other professionals. The Interprofessional Capability framework will be used to evaluate, and I have developed an action plan, detailing goals for the year ahead. In adherence with the Nursing and Midwifery Council (NMC code of conduct, 2015) all reflections will be amended so to respect confidentiality.

Patient and Carer involvement

The services for healthcare are developing everyday just like the professional’s roles who work within the services.  This will in turn improve patient centred care and will be more cost effective for health care services (Cross, 2006). There have been various recommendations for what would be most effective in order to improve our services; it is suggested that the people using our services are the focus and not the professionals (McCutcheon & Gormley, 2014).

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The Francis report explained the findings of the public enquiry into the staff and services at the Mid- Staffordshire hospital trust. It showed what can happen when significant factors in providing patient centered care aren’t present. The Francis report displayed a list of recommendations in order to improve the services and ensure that patient experience was to a high standard, working interprofessional to collaborate with others and making sure professionals communicated effectively (Francis, 2013).

Collaborative working can be identified as the joint establishment of services that are available by different providers. It creates bonds between different professionals who have different values and views on how care should be given and how they achieve patient centered care. By working alongside other professionals, it adds new skills, knowledge, improves communication and beliefs in order to accomplish goals that are set (Dawson, 2007).

To work professionally in any health and social care setting, it is essential that professionals collaboratively work together. According to (Williams, 2017) he suggests that it is vital that professionals work collaboratively as it is an influential resource. This is because funding for the NHS does not compete with the increasing population which in turn means that the NHS will be reliant on collaborative working.

Communication can be a multifaceted, but it requires skills and knowledge to make sure its effective as it is a key competence for the best delivery of care for patients using the service. Through communication we can outline the discussion of information, feelings and thoughts amongst people using verbal and non- verbal communication. As nurses we need to be able to interact with patients, which is a two-way process (L. Kourkouta, et al 2014).  An important subject is that healthcare professionals are educated in healthcare services and inter- professional working. This ensures that professionals know how to interact with each other on placement or at university (K. McPherson et al 2001). There are numerous barriers to communication, one being when the message does not reach the person it was intended, thus creating error (K.E. Rosengren 2000).

The Francis report (2013) highlighted the poor communication between professionals, patients, carers and families. This has promoted change, underlining how important it is to have patient and carer involvement and for professionals to strive for patients to have a choice in their care. By having patient choice, it actively includes the patients in their journey, they can have a say in their treatment and care plan. By including families and carers in the patient’s journey it makes it more effective. Thomas, J (2017) contends that this is an imaginary theory rather than professionals applying it to practice in everyday life, however through my experiences on placement I disagree as I feel the patients feel as though they are being treated as a person rather than just another patient.

During placement I have witnessed how collaborative working and patient involvement has a massive impact on how services run. Consequently, potential barriers are removed through positive interactions. This year, I was placed on a Gynecology ward which collaborates with the Early Pregnancy unit. They provide ultra- sound scans for patients on the ward, also ensuring education, advice and support.

I have had the opportunity to witness scans and the challenges that arise when working with a specific patient group for the patient, their family and the nurses involved. For example, the patient could receive good news where everything with the pregnancy is progressing well but on the other hand a patient could receive bad news for example an ectopic pregnancy could have occurred where the pregnancy is growing in the wrong place. Subsequently, I have learnt that effective communication is the basis for a therapeutic relationship to be formed between the patient and nurse (L. Kourkouta et al 2014). Being told you don’t have a vital pregnancy can be a very difficult time for both the patient and their partner and I noticed that they require a lot of support and advice from the nurse.

Building a therapeutic relationship with patients and having exemplary communication skills plays a crucial part in this role. A couple of weeks into my placement I observed a patient who had come onto the ward for an operation. The patient’s first language was Lithuanian, and she had very poor English. She communicated through her daughter. By doing this, it overcame the communication barrier and it worked successfully. It became evident that it was harder to create a therapeutic relationship with this patient due to the language barrier.

Effective collaboration for safe and effective services

When working within a team of professionals it is vital that people communicate effectively, listen, work as part of a team, respect each other’s opinions and have a shared understanding of one another in order to have active collaborative practice. An important factor is that all professionals have goals, and everyone follows the same guidelines and protocols. To make the patient experience the best it can be, professionals need to ensure that when referring patients to other teams and services, for example; about the patient’s background to create a picture of what the problem is. Team work can only be achieved if every member understands their role and everyone else in the team’s role. For a team to achieve goals they need to certify that they have an objective they are aiming towards (Mosser and Begun, 2014).

On the other hand, effective collaboration cannot always be achieved. Greatrex (2001) states that the hierarchy of staff, for example: band 5 nurse to a band 6 sister can sometimes be a barrier to working collaboratively as people do not always want to work as part of a team. Dawson, S. (2007) suggests that the absence of collaboration affects the result of the patients experience and staff often segregate themselves from each other. When team members can’t communicate with one another it affects the way services are run and makes them less safe for the patients and staff. The Francis report (2013) stated that communication was one of the most important factors when communicating with patients and families in order to achieve a partnership.

I have seen the difference between poor collaboration and respectable collaboration. Poor collaboration can lead to problems arising such as miss- communication and information not being relayed from other interventions between professionals. The most reliable way to document patient records would be for all services to use the same system but this differs depending on what trust you work for. A ward may use Lorenzo, but the patients GP may use system one which means the nurse won’t be able to access any of the patient’s information from the contrasting system. This results in miscommunication between primary and secondary care.

The patient in question was referred after an appointment at their GP practise. When my mentor was reading the referral, it was evident that there wasn’t a lot of information about the patient’s problem or their medical history. The patient was 6 weeks pregnant, dehydrated and vomiting. The medical term for dehydration in pregnancy is hyperemesis. The patient was unsure of the cause or problem, subsequently my mentor explained. Hyperemesis is known to be caused by a sudden increase in the hormone called human chorionic gonadotropin (HCG).  Anti- emetics and IV fluids can be given to patients suffering with hyperemesis (MedLine Plus, 2018).

The patient was unaware she should be drinking on average 10 cups (2.3 litres) of water a day (Desjardins, E. 2016). My mentor relayed this to the patient and contacted the consultant to come and examine the patient. She admitted the patient providing 2 litres of fluid before allowing her to go home.

This observation was a good learning experience as I saw how working together with the patient and the multi- disciplinary team can support management in pregnancy and it shows how the theory of relationship centred care is used in practise. I also witnessed how uneducated people are and how a lack of confidence can affect how they participate fully in their care during pregnancy. In the future I will reflect on this observation, when referring patients to other professionals and teams and how essential patient and relationship centred care is for the professional, patient and their families regarding managing their symptoms or illness.

Service environment & policy drivers for collaborative practice

For services to work there needs to be some guidance, this is where policies come in. Policies allow professionals to work together safely and effectively. Policies set standards that professionals need to abide by, ensuring best patient centred care. The Department of Health aimed for the NHS to have a plan to ensure that practises across the UK were modernised by putting the patient first. (Department of Health, 2000). By having greater choice and more control over their care (no decisions being made without their consent) supports the concept of patient choice and involvement by giving them more options, which will result in a better outcome. Policy drivers are used to aid staff in healthcare so that all needs of the patient are met.

The environment in which we work has an impact on how professionals work collaboratively. For example, on a ward issues that can arise are, access to scans, the size of the ward, staffing levels and the services available. If issues are present it creates potential barriers to care (Renate, A. 2014). One thing I have picked up on in practise is the way the ward is laid out. There are a certain number of bays and single rooms to make sure staff and patients are protected from infection. By having fewer patients in bays and single rooms available it makes the patients stay more private.

A further observation is that staffing levels need to be maintained for the ward to be safe for both patients and staff. On numerous occasions, the ward has had no capacity for more patients as there hasn’t been enough staff present, this can also increase the work load of nurses on shift resulting in poor time management.

I have seen how professionals work depending on their environment and how the use of policies benefit or limits staff in certain situations regarding helping a patient’s experience be enhanced. As mentioned before the ward works closely with The Early Pregnancy unit. Often patients get admitted to the ward if they need further blood tests or they need to be seen by a doctor. I oversaw admitting this patient onto the ward, which an easy process as the ward is connected to the unit, so the patient was reviewed by a doctor and a plan was put in place. The patient was informed of everything that was being discussed throughout the process.

The care plan I have used is for patients on the gynaecology ward with cancer; e.g. ovarian cancer and cervical cancer. Patients come to the ward for either pain management or end of life care. All professionals contribute to the care plan for the patient ensuring collaboration. Challenges can arise for professionals when dealing with an end of life patient; however, it is essential for the patient and their family to know that the professionals caring for them understand each other’s role so that no mistakes can occur (Alsop, 2010).  A patient’s family member could inform one of the nurses that the patient is in pain and needs some analgesia. The nurse can then look in the care plan and see what regular medication the patient is on and how their pain is controlled. The care plan is there for guidance for each professional that deals with the patient. The environment is a big part regarding patient safety and comfort. All cancer patients that are admitted to the ward are given a single room, so they have privacy and it allows family members to stay over. They are also isolated from other patients which makes the patient less prone to infection. Patients during end of life care need as much support as they can get which is why having the opportunity for family to stay makes their journey more bearable. 

 

Personal development

Mosser and Begun (2014) suggest that it is a vital part of education that students have the correct interpersonal skills needed during their training. During my academic learning it has been highlighted that due to the separation between placement and university, student’s team work skills suffer. During IPE week we had seminars where we were able to find out about different professions and what their role entails. After these sessions our lecturer asked us to reflect on what we thought our strengths and weaknesses were when working in a team (linking it to placement and relating to the tasks in IPE week). The capability framework is a learning utensil where students can highlight weaknesses and strengths, they think they have regarding team work and their professional development. I have reflected on my IPE assignment from last year and found that I feel I have more knowledge this year secondary to a ward placement.

I was able to use the skills I have learnt on the ward and apply my knowledge when delivering care to patients. I can identify my strengths and weaknesses during placement, for example, I noticed that a patient had only passed 50mls of urine through her catheter in 4 hours. Following the correct protocols, I informed a senior as a patient should be passing 30mls per hour. I was nervous to bring this to their attention, but I had to think of the patient. Last year I wouldn’t have had the confidence or skill set to do this (Domains OC2 and CW3 from my action plan are related to this scenario).

During IPE week we were put into groups which were made up of students from different professions. The goal was to develop a presentation. I wasn’t looking forward to this as I don’t like talking in front of large groups. There were some strong characters within my group and one was allocated the team leader role. I didn’t know my place within the group as our roles were not discussed with each other which did aggravate me when trying to get my opinion across. As time went on, I still didn’t know what our finished product was going to be, so I continued to get on with my part (discussing a nurse’s role in a case study we’d been given). After we had presented, I felt there was areas I needed to improve, for example, talking louder. On the other hand, if there had of been a clear structure for me to follow, I would have felt more comfortable. From this experience I learnt that I need to have the confidence to speak up and be involved in making decisions. Domains R1 and R3 (see capability framework) can be applied to this experience.

For me to personally develop and continue to work collaboratively as part of a team I have created an action plan which reflects on my time on placement and in university (seminars and lectures). I have also used the inter-professional capability framework (CUILU, 2004).

Action Plan

Personal objective relating to Interprofessional capability

Priority

Target date

What specific actions/resources are needed?

Evidence of success

Review date

Collaborative working capability R3

To gain more confidence to contribute and voice my opinion in group tasks, IPE week and on placement.

High

On going

Practise speaking to small groups first to gain confidence, then enhance the size where I can. Speak up in front of a group of people I don’t know e.g. IPE group.

I will ensure that I will be confident in handing over patients to the next nurses on shift.

Ensure that I try to voice my opinion and management skills to other members of staff whilst on placement.

 Personal diary of the goals I have achieved throughout the year.

Testimonies from members of staff.

Contributing towards conversations with senior members of staff.

Beginning to hand over patients in second year to get ready for my third year.

Visits to different clinical areas to show my own initiative.

May 2019

Collaborative working capability CW3

When on placement ensure I have back ground knowledge and use the resources from members of staff i.e. books to enable me to speak confidently with patients and their families.

High 

On going

Arrange visits to gain more knowledge, e.g. visit gynaecology clinic so I have a range of knowledge surrounding my placement area.

Ensure I access all the relevant opportunities that arise for me to go on, i.e. training days whilst on placement.

Certificates of achievement.

Reflections from placement regarding thoughts and feelings towards experiences I have encountered.

Visit pages filled out to show attendance of different visits I planned.

Ensuring that I continue to read up to date research on my clinical area.

February 2019

Collaborative working capability CW2

To ensure I contribute when I can in giving other professionals information in regard to patients to enhance communication skills.

Medium

January 2019

 Ensure I go on ward rounds with the consultants and doctors.

Refer patients to other clinical areas.

Discharge patients where I can and explain what medication they are going home with and why.

I have gained feedback from other professionals e.g. when discharging patients.

Making notes of what I thought I’ve done well and what I could improve.

March 2019

Collaborative working capability OC2

To improve my teamwork skills and have a clear understanding of the roles of the members involved.

High- Medium

On going

Introduce myself to the team as I won’t have met them before.

Find out how different roles collaborate when working with the same patients.

Answer any questions the team may have.

Face to face feedback from mentor and other staff members from different professions.

Testimony on my progress from my hub mentor.

Testimonies from other staff members to go towards my portfolio.

February 2019

Collaborative working capability OC3

To develop my management, leadership and critical thinking skills to prepare for final year.

High

January 2019

Work alongside my mentor to delegate staff member’s tasks and teams to work with when required

Ask for help and advice when unsure.

Have

responsibility of

looking after my

own patients and

their care

pathway under

the supervision

of my mentor.

Testimony from mentor on how she thinks I’ve conducted myself.

Patient testimonies on how well I’ve worked with them.

January 2019

Action plan word count: 543

References

Alsop, A. (2010). Collaborative working in end-of-life care: developing a guide for health and social care professionals. International Journal of Palliative Nursing. 16, 3,120–125.

Communication in nursing practise L. Kourkouta et al 2014

Cross, S. (2006). Supporting an evolving nurse role. Practice Nursing. 17,9, 420–422.

CUILU. (2004). Interprofessional capability framework. Sheffield Hallam University

Dawson, S. (2007). Interprofessional working: communication, collaboration…perspiration! International Journal of Palliative Nursing.

Dawson, S. (2007). Interprofessional working: communication, collaboration…perspiration. International Journal of Palliative Nursing. 13,10,502–505.

Department of health (DH). (2000). The NHS plan. Retrieved from: http://navigator.health.org.uk/content/nhs-plan-plan-investment-plan-reform-2000

Francis, R. (2013). Francis Report. Retrieved from: http://webarchive.nationalarchives.gov.uk/20150407084003/http://www.midstaffspublicinquiry.com/sites/default/files/report/Executive%20summary.pdf

Greatrex, B. (2001). Infection surveillance scheme: collaborative working practices. British Journal of Nursing. 10 ,5, 306–311

How much water should you drink during pregnancy?BY ELLEN DESJARDINS, M.H.SC., RD, PUBLIC HEALTH NUTRITIONIST | AUG 11, 2016 https://www.todaysparent.com/pregnancy/how-much-water/

         How nurses and their work environment affect patient experiences of the quality of care: a qualitative study (2014)

Hyperemesis gravidarum – https://medlineplus.gov/ency/article/001499.htm

McCutcheon, K & Gormley, k. (2014). Service-user involvement in nurse education: partnership or tokenism? British Journal of Nursing. 23, 22, 1196–1199

Mosser. & Begun, J, W.(2014). Understanding teamwork in health care. McGraw-Hill Education. London, New York

NMC (2015). The code.   https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf

Renate AMM Kieft, Brigitte BJM de Brouwer, Anneke L Francke,and Diana MJ Delnoij

SHEFFIELD HALLAM UNIVERSITY (2014). Inter Professional Capability

Thomas, J. (2017). Setting up recovery clinics and promoting service user involvement. British Journal of Nursing. 26, 12, 671–676 

Williams, H. (2017). Collaborative working will enhance patient care. Journal of Kidney Care. 2, 3,132–132.

 

Challenges of Collaborative Leadership in the Government and Non-Profit Sector

The government and the non-profit sector are engaged in a wide array of relationships spanning from cooperative to adversarial. However, the connection is vital to the successful advancement of the public good. Many social welfare non-profits are dependent upon the public sector for funding; the government is dependent on the non-profit sector to provide services to its constituents. This mutually dependent and beneficial relationship has grown beyond “vendorship.” The public and non-profit sectors have an interdependent relationship whereby they rely on each other to provide services, and collaboratively address social problems, understanding the successful elements of a public-non-profit collaborative relationship is a high priority.

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Non-profit managers enter into collaborations to advance the mission of the organization, build organizational capacity, increase legitimacy within the community and advocate for policy changes (The Aspen Institute, 2002; Collins & Gerlack, 2019; Never & de Leon, 2014). Some non-profit leaders have expressed concerns with entering into collaborative relationships with the government sector due to lack of control or a loss of decision making (Collins & Gerlack, 2019). As non-profit agencies enter into collaborative processes, they must balance the risk of participation against the potential gains; with increased resource pressures on both sectors, cooperation and collaboration makes sense when goals are aligned (Collins & Gerlack, 2019). With the increased need to collaborate and pool resources across sectors, it is essential to evaluate the critical factors needed to ensure successful partnerships. Bryson et al. (2006) defines cross-sector collaboration as “the linking or sharing of information, resources, activities, and capabilities by organizations to achieve an outcome that could not be achieved by the organizations separately” (p.44).
Together, non-profit managers and government leaders can produce meaningful results and tackle complex social problems by leveraging a collaborative relationship built on leadership, trust, and accountability; as a result of collaborative processes, non-profit organizations create an opportunity to enhance organizational capacity and solve complex social problems. 
Collaborative leadership is responsible for ensuring that the structural design elements of the informal and formal processes build collaborative advantage, manage inequalities, and nurture stakeholder relationships.  Leadership is generally viewed as a critical factor in engaging stakeholders and guiding them through the challenges and benefits of the collaborative process (Ansell and Gash, 2007; Huxham and Vangen, 2000; Vangen and Huxham, 2003; Renade and Hudson, 2003).
Productive public-non-profit collaborations are dependent on dynamic leaders with a shared vision or a common agenda. As noted by Worth (2017), even high-performing non-profits are limited in their ability to influence change and address complex social problems without collective action across sectors. Public and non-profit leaders who utilize facilitated leadership in a network approach with stakeholders are in a position to influence change and advance towards the collaborative advantage. Huxham (2003) provides the argument, in order to gain advantage from the collaboration, “something has to be achieved that could not have been attained by any of the organizations acting alone” (p. 403). Effective leadership establishes the framework for which collaborative advantage can be achieved.
If we consider leadership as the process by which things happen (Huxham 2003, Vangen and Huxham, 2003), then the lack of leadership must be considered as an element when public-non-profit collaborative efforts fail to meet the intended outcomes. In order to not lose the collaborative advantage, non-profit leaders and collaborative partners will need to be mindful of hidden agendas (Huxham, 2000).
A collective approach to leadership where more than one agency or member holds the responsibility may help manage the collaborative inertia by balancing the individual or agency motivations and distributing available discretion across the members. Collaborative inertia is the process of slow output from collaborative efforts, or when successes are gained, it is done so through what might be described as a painful and challenging process (Huxham, 2003). A Cross-sector leadership model, whereby a public sector leader and non-profit leader, equally share responsibility may support advancing the collaborative effort and reducing inequalities and power imbalances. As agencies enter into a collaborative relationship, balancing and addressing inequalities through both formal and informal structures may support the advancement of the collaborative mission. Private-non-profit collaborations are more likely to succeed when resources and strategies are identified to address power differences (Bryson et al., 2006). Inequalities may surface when considering funding resources or in situations where programmatic or recipient knowledge is needed to identify a solution effectively. Inequalities can be a source of mistrust and disrupt productive collaborations (Bryson et al., 2006). Non-profit leaders may find that negotiating and balancing inequalities are best achieved through developing meaningful relationships.
Leaders need to put forth an effort to build and maintain relationships using social or relational mechanisms to manage their collaborations in addition to the formal structures and processes (Peng, Liao, & Lu., 2020).  As my former director would say, the real work happens outside of the formal meeting; it takes place over coffee, breakfast, and lunches (J. Drendel, personal communication, September 2019). These are the opportunities for managers to build trust, nurture relationships, and have honest communication. The nurturing process must be continual; the trust-building loop is fragile, partners will change, priorities shift, and these factors will disrupt the collaborative relationships (Huxham, 2003). Leadership is essential in the formation of an inclusive process where stakeholders are motivated to participate. Effective leadership sets the stage for trust-building among stakeholders.
Trust may be the most critical element of the public-non-profit collaboration, as a lack of trust among stakeholders can have the most significant impact on the outcome. Bryson et al. (2006) describes trust as both the lubricant and the glue; trust facilitates the work of the collaboration and holds the collaborative together. Trust levels among the stakeholders are influenced by the available discretion and commitment to the process.  Shared discretion is the defining element of successful public-non-profit collaborations; stakeholders must have a choice over defining the goals, methods for accomplishment, and innovation (Donahue and Zeckhauser, 2011). Shared purpose and trust-building require meaningful compromise and the ability to see the perspective of others (Huxham, 2000). Non-profit leaders need to balance perspective taking with the responsibility to remain focused on the activities and efforts aimed towards advancing the mission of the organization. The leadership of collaborative systems must demonstrate a sufficient balance of holding on to the knowledge and skills while simultaneously letting go, trusting in the stakeholders’ ability to discover and develop meaningful solutions (Bailey and Koney, 1996). Through the process of shared discretion, stakeholders build trust and develop a stronger commitment to the process.
Building an inclusive process where members are genuinely able to participate, builds toward stakeholder commitment (Ansell and Gash, 2007; Peng et al., 2020). “Trust is critical because why would you share responsibility with people you don’t trust?” (Ansell and Gash, p.560).  The establishment of a trusting partnership creates an environment for sharing knowledge, information, and resources as well as building organizational capacity. A commitment to the process is reliant on the presence of trust, stakeholders must hold a high level of confidence in the negotiation procedures and that individuals enter into the collaboration in good faith and transparency (Ansell and Gash, 2007).  Failure to achieve trust among the stakeholders stagnates the collaborative effort, whereas collaborations with high levels of trust may demonstrate higher levels of creativity and efficiency.  If the participants fail to establish trust, discretion will be held tighter, thereby reducing stakeholder commitment.  Environments with higher levels of trust, resulting in shared discretion, increases individual commitment to the process.  As such, these efforts have the highest potential for a positive impact on the problem at hand, although outcomes must be evaluated to determine if the intended goals have been achieved.
Collaborators have a responsibility to monitor and assess the effectiveness of progress and evaluate outcomes and recognize failures; doing so provides a layer of accountability to the collaborative partnerships, donors, and the public.  Public-non-profit collaborations are more likely to create public value when they are engaged in a system of accountability. Evaluation of outcomes and outputs provides an opportunity for stakeholders to revisit the overall purpose and sets forth criteria for assessing the collaboration ability to achieve its mission (Baily and Koney, 1996). As discussed by Longoria (2005), agencies must give the same volume of attention to data-informed evaluations to monitor outcomes as they do to the enthusiasm of the collaborative process itself.  The resilience of the collaboration may be rooted in the collaborative partner’s ability to identify failure and successes (Bryson et al., 2006). Cross-sector collaborations build legitimacy and generate public value through the data-driven decision making and evaluation methods.
The lasting impact of public-non-profit collaborations may be achieved through the use of strategic planning and strategic management processes. Additionally, non-profit leaders should examine internal strategic plans to ensure alignment with organizational missions, goals, and values. A collaborative strategic management framework must consider the specific context and environment; creating strategies is not a one size fits all approach. Leaders need to draw on their experiences, knowledge, and technical expertise in the approach to strategic management, planning, and implementation. Effective strategic planning is a collective achievement that leverages the expertise, skills, and abilities of teams, champions, sponsors, and task forces. This shared approach to planning must be accompanied by thoughtful reflection and deliberation and a willingness to change course or modify based on the needs of the collaborative partnerships. Implementing a data-informed strategic planning process within the collaborative relationship supports the development of shared accountability. 
Accountability is a complex issue for public-non-profit collaborations as there may not be a clear identification as to whom the collaborative is accountable to and for what.  The development of formal agreements provides structure to the collaboration and a framework for accountability. Peng et al. (2020) found that having formal agreements to govern collaborative relationships was positively associated with non-profit commitment.  Formal agreements also helped to support sustained collaborations as they serve as protection for participating agencies (Peng et al., 2020). Formal agreements provide an opportunity to outline the collaborative’s strategic plan, governance, shared outcomes, and commitment to data-driven decision making.
Strong leadership, trust, and use of data to inform decisions, contribute to long-term public-non-profit collaborative success. This essay established that together, non-profit managers and government leaders can produce meaningful results and tackle complex social problems by leveraging a collaborative relationship built on leadership, trust, and accountability. However, non-profit leaders should continuously assess the value of collaborative relationships and collaborative efforts.
Collaborations are not cost-free endeavors (Collins & Gerlack, 2019).  Collaborative relationships are particularly costly to non-profit organizations when considering employee time and the resources needed to maintain trusting relationships, to facilitate and coordinate collaborative efforts, and to evaluate outcomes and outputs.  There is also a need for sufficient time to evaluate design needs and a recognition of internal and external factors that continually influence the relationships. 
Each collaborative partner brings their own organizational culture, which may not align with the collaborative goals, “building a collaborative culture and identity takes time and requires a realistic appraisal of the current state of commitment and readiness to change of partnership members” (Ranade and Hudson, p.44).  Non-profit leaders must also recognize the limitations of replicating effective design across jurisdictions and groups, given the dependency on the relationships; each collaborative effort must consider the starting conditions to establish the initial design and governance processes effectively.  Collaborative partnerships require a continual cycle of analysis and management; the structure of collaboration must be revised as information is learned, priorities change, and events take place (Donahue and Zeckhauser, 2011).  As membership changes occur, collaborative structures must revisit the collective mission and commitment to the process.  The structure and design will evolve as collaborations seldom remain static (Huxham and Vangen, 2000).  A recognition that static structures invite opportunism, systems hold a responsibility to evaluate processes and modify the design as relationships change (Donahue and Zackhauser, 2011).  As Non-profit leaders continue to embrace collaborative relationships as a means to pooling resources and solving problems, they will continue to face ongoing challenges in managing the design evolution in response to stakeholder relationships.  However, the challenges must be met in order to address complex social problems effectively.  Private-non-profit collaborations provide an opportunity to build organizational capacity and produce meaningful results by leveraging a collaborative relationship built on leadership, trust, and accountability.
References
Ansell, C., & Gash, A. (2007). Collaborative Governance in Theory and Practice. Journal of Public Administration Research and Theory, 18(4), 543-571.
Bailey, D., & Koney, K. (1996). Interorganizational Community-Based Collaboratives: A Strategic Response to Shape the Social Work Agenda. Social Work, 602-611.
Bryson, J.M., Crosby, B.C., & Stone, M.M. (2006). The design and implementation of cross-sector collaborations: Propositions from the literature. Public Administration Review, 67(4), 702-717.
Collins, T., & Gerlack, J.D. (2019). Bridging the gaps: Local government and non-profit collaborations. Journal of Public and Nonprofit Affairs, 5(2), 118-133.
Donahue, J. D., & Zeckhauser, R. J. (2011). Collaborative governance: Private roles for public goals in turbulent times. Princeton, NJ: Princeton University Press.
Drendel, J. (2019, September). Personal interview.
Huxham, C. (2000). The Challenge Of Collaborative Governance. Public Management, 2(3), 337-357.
Huxham, C., & Vangen, S. (2000). Ambiguity, Complexity, and Dynamics in the Membership of Collaboration. Human Relations, 53(6), 771-806.
Longoria, R. A. (2005). Is Inter-Organizational Collaboration Always a Good Thing? Journal of Sociology and Social Welfare, 32(3), 123-138.
Peng, S., Liao, Y., & Lu, J. (2020). Stay or Exit: Why Do Non-profits Maintain Collaborations With Government? American Review of Public Administration, 50(1), 18–32.
Ranade, W., & Hudson, B. (2003). Conceptual issues in inter-agency collaboration. Local Government Studies: Volume 29; Autumn 2003; Number 3. Special Issue: Partnerships Between Health and Local Government. Frank Cass & Co. Ltd. London.
The Aspen Institute. (2002). The Nonprofit Sector and Government: Clarifying the Relationship. (01-030). Washington, DC: Nonprofit Sector Strategy Group.
Vangen, S., & Huxham, C. (2003). Enacting leadership for collaborative advantage: Dilemmas of ideology and pragmatism in the activities of partnership managers. British Journal of Management, Vol. 14, S61–S76 (2003). Glasgow, UK.
Worth, M. J. (2017). Nonprofit management: principles and practice (4th ed.). Thousand Oaks, CA: SAGE Publications, Inc.
 

Enhancing Quality of Services through Effective Collaborative Practice

Introduction
Throughout this piece of work, I will be considering and interspersing the 4 underpinning concepts and domains of collaborative practice using the Interprofessional Capability Framework. Using reflections and experiences I will consider the impact that these have on my role within the ambulance service.  I will be considering these concepts and domains in relation to my role as a future paramedic, student paramedic and also in my current role as an ambulance technician.

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In the period of August 2018 to August 2019, 86,095 or 10% of overall emergency calls received were related to falls with 68% (approximately 58,544) of these being over the age of 65 (YAS.NHS.uk, 2019). Previously, Darnell, G., Mason, S., & Snooks, H. (2012) had suggested that clinical and cost-effective service models were yet to be developed in relation to this widespread issue. In their study less than 50% of overall elderly patients who were attended by an ambulance crew were able to be left at home although reasons for this weren’t provided.
Working collaboratively and considering OC3, L2 (Shu 2014), we could begin to interact and co-operate with others within and across organisations in providing person focused services by sending the appropriate help first time every time. By sending an appropriate vehicle, be that a civilian vehicle, ambulance car or double crewed ambulance, crewed with, for example a medical professional, an occupational therapist and a district nurse, acting as a falls team and an after care team in one vehicle could reduce the time spent making referrals and the possibility of patients ‘falling through the cracks’. This initiative would provide for improved assessment tools on scene which Halter et al., (2005) believes would significantly reduce conveyance rates to hospital.
Gates et al., (2008) note that there have been few large scale and high quality trials on the effectiveness of assessment and intervention on falls in the community but that the trial by Snooks et al., (2010) allows for technology to work side by side with a new model of service delivery. Since these trials, numerous initiatives and trials have been completed with the London Ambulance Service (LAS) trialling a Falls Specialist Response Vehicle (FSRV) in 2017/18 with 768 bed days released and an approximate £173,760 saved on Emergency Department attendance. A fact that is queried by Darnell et al., (2012) who state that in their research only 5 years previous a crew of a paramedic and a social worker left between 7% and 65% of patients at home. Surely any percentage of patients left at home, safe and with a referral in place and not taken to hospital is a good thing.
I would like to believe that we can go further with a team such as the FSRV sent by LAS but with increased capabilities and personnel. In my experience referrals are made for a person who has fallen and once the patient is safe and seen to be mobile the crew leave scene without any follow up or information regarding the success or failure of their referral. Could a team with more capabilities and the ability to apply what the referral would’ve requested there and then on scene be a long-term cost saving idea and initiative that if successful could be rolled out nationwide.
Models of Leadership
Thistlethwaite, (2012), suggests that as a healthcare community we constantly value or devalue other professions using stereotypes and in the adjectives we use to describe them. My understanding and knowledge of other healthcare professions, even in my third year is sadly lacking and I have been guilty of the stereotyping of others. Working as part of the ambulance service already has both helped and hindered these thought processes by listening to the preconceptions of established ambulance workers and also highlighting the positives of other professions. I don’t believe that a leader who doesn’t believe in other healthcare professionals’ expertise is a leader I would like to follow.
At the core of the NHS leadership academy’s, Healthcare Leadership Model (NHS leadership academy, 2013), is ‘Inspiring Shared Purpose’ and ‘Connecting our service’, being curious about how to improve services and patient care and understanding where my team sits within a formal structure. In an ambulance service that is stretched and constantly busy it is difficult at times to find someone who has these beliefs or someone who will inspire me as a student/technician. With my idea for a service improvement the healthcare leadership model appears to have sections that encourage collaborative practice and encourages the working together of different sectors within the NHS, perfect for what I would be trying to achieve.
Within the NHS many different leadership models are used and these can change on a daily basis and even within the same team which confirms what Grimm, (2010) alludes to when saying that leadership is complex and has many definitions and qualities. The two leadership models that I believe best work for the ambulance service are Situational and Autocratic models. Situational due to the leader or the paramedic on the road knowing the skill set of the staff around them and being able to set realistic targets and know what they can expect from an individual. Autocratic would be used during a particular situation in which the leader or paramedic would give ‘top down’ instructions to their staff and is able to make immediate decisions with the final say. This model would work particularly well in a high-pressure situation such as a cardiac arrest where the model could go fluidly from situational to autocratic. Willis, (2015) notes though that although a leader may appear to be one style at one time, the leader would very rarely exhibit only one leadership style and it would be a mistake to label them as styles can be fluid as mentioned above. In my experience I tend to agree with Willis, (2015) in that paramedics I have been on the road with have, at times seemed to take control and barked orders as an autocratic leader but then for the next patient have changed completely.
A leader in an ambulance setting Gienapp (2008) and Parsons (2009) believe is integral to its success and should be someone who is willing to teach as Martin & Swinburn (2012) argue that pre-hospital is unplanned and complicated and that strong leadership in this environment needs to be greater than most other healthcare environments. Further to this, Sola et al., (2016) states that recent studies suggest that effective leadership promotes positive results and has a direct beneficial impact on patients. In relation to the idea of an interprofessional response vehicle, although an older article, Department for Health, (2005), ‘Taking Healthcare to the Patient’, notes that clinical leadership from a range of areas will be able to better utilise resources and will drive improvements and change in the healthcare environment and lends itself perfectly to OC3 L2 (SHU, 2014) by beginning the process of interaction and co-operation with others within and across organisations and enable them as a team to provide person focused services.
In one of my greatest experiences of collaborative practice the team work and collaboration between ambulance, a GP, end of life care and a hospice, the situational teamwork and leadership showed that day made an upsetting and seemingly impossible situation bearable. Autocratic leadership wouldn’t have worked on that day as an elderly gentleman was sadly in his final days, but the family were unaware and didn’t need anyone giving orders or taking control but understanding and appreciating the situation. Although an emotive situation I believe that the decision not to take the patient to the emergency department and instead look for alternative pathways collaborating with the family and external agencies was the best option. The paramedic on scene from the outset allowed those around him to express their feelings and to make decisions without pressure or especially in this situation, guilt. Feather, (2009) believes that the actions shown by the paramedic show an emotionally intelligent leader although Cavazotte, Moreno & Hickmann, (2012) argue that this trait is difficult to measure but Sterud et al., (2011) argue that attending terminally or chronically ill patients creates different emotional demands to those of a ‘regular’ emergency patient.
The opinion of the ambulance staff in this case were mirrored in the actions of the GP, end of life carer and the hospice in which the patient was taken to and most importantly the family were left to spend some time with the patient in his final days. Although argued as difficult to measure the leadership taken by all parties. A situation such as this one adds weight to the idea of a multi-faceted response team as although a positive outcome it meant the ambulance crew being on scene for around 3 hours.
Approaches to Service Delivery
Whilst out on the road it has become apparent that as the Shu 2014, Inter- Professional Capability Framework suggests, OC3 (Shu 2014, L2), healthcare professionals need to improve the communication between the members of the community of practice to enable change and improve person focused services.
For an elderly/geriatric SU their environment in many cases is all they know and can become a place of safety and Means, Richards & Smith, (2008) suggest that this is a key factor in the improvement of their personal health and wellbeing. Kelly, (2012) goes on to say that the environment in which these people live can make a healthy lifestyle easier to adhere to. Conversely to this advice I recently attended a geriatric patient who had become scared in their own home and also scared of his own son who lived with them. Due to this the patient had deteriorated from being self-sufficient and able to mobilise even to the shops 100 metres up the road to being almost bed bound, non-compliant with his medications and reliant on those around him. This enhances Kelly, (2012) argument that if this patient felt safer and more comfortable in his own home then this would translate to a healthier patient.
During previous inter collaborative weeks it became clear that not enough is done collaboratively and that the opportunities are there for us to work together as a wider healthcare workforce. With this thought process previous jobs that I have attended began to resonate and the impact this collaboration could have on our SU and how empowered we could make them to make their own decisions. In these jobs, allowing the SU to be part of his decision making and treatment plan would’ve been beneficial as quite often they do not want to go to hospital and in the policy document ‘No Decision about me, without me’, (Department of Health, 2010), SUs should be put at the heart of any decision and allowed to collaborate with healthcare professionals in decisions about their care.
As an autonomous practitioner it is going to be my responsibility to enable these SU’s to make their own decisions and using CAEP2 L1 (SHU, 2014) and along with Department of Health, (2010) policy, the SU should be able to recognise where it is appropriate for the SU to participate in a decision about their own treatment. NICE, (2015) states that the healthcare professional dealing with the SU has to power to decide the current mental state of the SU and decide if they are fit to participate in decisions regarding their own care.
It is also going to be a challenge when allowing this involvement to ensure that the decisions being made are in their own best interest and that the SU, by making these decisions, aren’t preventing an improvement in their own health and putting constraints on the improvement of healthcare services (Flottorp et al., 2013). McKeown, Malihi-Shoja & Downe, (2010) state that our job as a healthcare professional is to empower the service user (SU) to make their own decisions and empower them to decide their own welfare.
In my experience not enough is done on scene with a patient in terms of referrals and working collaboratively with other healthcare professionals to what I believe is the detriment of the patient. By making a ‘falls referral’ and making sure that the patient is mobile we as an ambulance service believe that we have done our job and that the detail is complete. I believe that there should be a collaborative effort for every patient in this situation and that access to all pathways and treatment plans should be available to confer and refer to. I have been to numerous patients where this isn’t the case and although patient care isn’t lacking, the aftercare for the patient left alone with the memories of a recent fall is.
I believe that as an ambulance service we should be striving to evolve and improve and that along with the Inter- Professional Capability Framework, R1 L2 (SHU, 2014) we should be reflecting on our performance in promoting person focused and integrated service provision whilst also self-reflecting. Improvements such as a collaborative response car would take a level of buy in from all sides but would eventually lead to an integrated service in which our soul focus was the patient. In terms of delivery and collaboration as Wankhade, (2017) states, emergency services and different areas of healthcare are moving at differing rates and speeds causing confusion as to the roles and responsibilities across organisations.
A study by Wankhade, (2016) points to the belief in the ambulance service that they are being inappropriately dispatched Wankhade believes doesn’t instill confidence in the staff responding and then that same clinician is under pressure when leaving the patient at home. Due to this, responsibility is growing with what Wankhade, (2016) describes as inconclusive evidence regarding the safety of patients not transported to hospital. This study is backed by significant evidence from McCann et al., (2013), Fisher et al., (2015), O’Hara et al., (2015), Newton and Harris, (2015) and Evans et al., (2014) who confirm that the service delivery currently being offered by the ambulance service, including that of paramedic decision making and patient safety in relation to this is sadly lacking.
For the delivery of the new collaborative response vehicle to work these barriers to successful service delivery would need to be overcome and clinicians from all areas of healthcare on scene should feel empowered to make safe and clinically backed decisions. In Wankhade’s, (2016) study the situations described are true to those of my personal experience where initial call coding has been incorrect, and the clinician is then on scene making a judgement regarding the correct pathway for the patient with minimal input. If this decision could be made collaboratively and with the input of leaders from other healthcare agencies on scene. Perceptions of the ambulance service being a transportation service to these other healthcare providers as described by McCann et al., (2013), Wankhade, (2011) and Heath and Wankhade, (2014). This is something that at times I have witnessed with patients calling an emergency response and waiting outside of a house with bag in hand knowing where they want to go and who they want to see there. Could this be made into a historic view with a future of collaboration, on scene decision making and care pathways that increase patient safety, reduce the individual stress on the clinician as described.
Conclusion
It is clear from the research and from my personal experiences that not enough is done on scene in my area to provide the elderly/geriatric patients, of which they are an increasing number, with a plan of action once an ambulance crew has been on scene. These patients are a prime example of CAEP2 L1, (SHU, 2014) in which they are, along with the clinicians on scene, able to collaborate and participate in the decisions made about them (if deemed to have capacity by the clinician) to improve their overall outcome. Within my idea for a new initiative in the ambulance service OC3 L2 and CW3 L3, (SHU, 2014) can be adjoined in the collaboration and co-operation of a multi-agency response to these particular details, leading to savings not only in the time of the ambulance service to be able to respond to the more life threatening calls but savings in A+E time, hospital bed costs and after care time that referrals create.
A collaborative picture is a picture in which one call from a patient to the ambulance service, triaged correctly at point of contact, leads to a quicker multi-agency response in which all aspects and areas of a patient’s treatment arrive in one vehicle. As mentioned in the main body of this piece of work the ambulance service is stretched and ambulance personnel are struggling with the weight put on them to keep the patient safe and also to make a decision of hospital or home. A collaborative approach to patient care would remove a lot of this individual stress and allow for interprofessional working and shared/joint decision making. The issues in service delivery stated above would therefore be alleviated and the issue of leadership would and could be shared. I have witnessed whilst on placement the stress of a clinician on scene trying to find an alternative pathway for a patient without knowing the full picture of what is available. Currently and from personal experience not enough is known about alternative pathways and therefore patients are incorrectly or inappropriately taken to hospital when they would be better served staying in their own homes. A joint approach to their care and treatment would allow a quicker time on scene and a more appropriate service delivery and journey for the patient.
I have however recognised the limitations in my role as a student paramedic and eventually a paramedic in that I would be asking for a significant change in process and initial investment, but I will endeavour to personally made a change as and when I deem possible on scene. When I am out on placement or in my regular role with the service I will constantly review jobs of this nature and lead my colleagues in making better referrals and considering all pathways available to me across the healthcare organisations thus developing as a clinician and creating a more integrated and patient focused environment (R1 L2, SHU, 2014).

Personal Objective

Priority

Target Date

Actions/resources are needed?

Evidence of success

Review date

 
CW3 L3

Medium

Completed by the end of placement 2020

On the back of this piece of work I intend to speak to the relevant people regarding the issues raised. I intend to have a meeting with my line manager to discuss how to move forward and any learning opportunities that could arise or I could be involved in where service delivery is at the forefront.
Forward thinking and planning to make sure that I am involved.
Confidence in my own knowledge and ideas so that I can be a part of a positive service delivery change.

This objective would be continuously monitored.
Being a part of any service delivery programmes, in which exchanging of knowledge is key.
A future goal would be for a team to be formed and for my idea to become a reality, that would be the real evidence of success.

Continuous discussion with the management team and monthly progress meetings.

 
CAEP2 L1
 

High

Continuous progression through the idea and implementation stage. Monitoring for any changes or participation opportunities throughout. Keeping up to date with any relevant policies within Yorkshire Ambulance Service.

Constant monitoring within my working environment with a discussion to be had in my monthly development meetings on how I am personally implementing this idea.
Keeping an awareness of the aging population and being aware of my own working practice when it comes to being non-judgmental and non-discriminatory.
Take any opportunities to educate both myself and the public in relation to these issues as and where I see them.

More awareness in my own practice and reading regarding frailty and the aging population to round myself as a practitioner.
Supporting and celebrating autonomy and independence not only in the workplace but In the environments in which we work.
Working together with other healthcare professionals and colleagues to develop more understanding.

Constant review of practice and continual monitoring

 
OC3 L2

Medium

Ongoing

Reflecting on my own practice in order to understand the ‘chain of command’ within my own workplace.
Understanding of team structures of wider healthcare teams and investigate ‘tiers’ of staff that are in other areas.
Understand that as a autonomous practitioner whom I would need to speak to to make a change in another area and what I would need to do to influence this change.

Having reflected upon experiences I have personally had and have a working understanding team structures that play a part in my working life.
Having completed a detail where team structures have been evident, I have to be confident to go away and reflect upon this and what measures I can take to enhance the service users experience and if necessary what I can do to make sure that my voice is heard next time.

Monthly discussion in development review with manager

 
R1 L2

Medium

Ongoing

I intend to complete reflection logs on pebblepad (SHU) to enhance my day to day practice.
SU feedback forms within pebblepad and continuing once in practice.
As an autonomous practitioner I should be constantly reflecting on my own practice and keeping up to date with any changes.

Being able to reflect subconsciously as an everyday part of my learning and development.
Any positive feedback gained.

Quarterly and ongoing within my own practice

References
Department of Health (2005) Taking Healthcare to the Patient. Department of Health, London
Department of Health. (2010). Equity and Excellence: Liberating the NHS. Retrieved from https://www.gov.uk/government/publications/liberating-the-nhs-white-paper
Healthcare Leadership Model, The nine dimensions of leadership behaviour, (2013), (www.leadershipacademy.nhs.uk) Accessed on 10th January 2020.
Heath, Geoffery and Paresh Wankhade. 2014. “A Balanced Judgement? Performance Indicators, Quality and the English Ambulance Service; Some Issues, Developments and a Research Agenda.” The Journal of Finance and Management in Public Services 13 (1): 1–17
NHS Improvement. (2018). Falls Specialist Response Vehicle. Retrieved from https://improvement.nhs.uk/resources/falls-specialist-response-vehicle/
Newton, A. and Harris, G. (2015), “Leadership and system thinking in the modern ambulance service”, in Wankhade, P. and Mackway-Jones, K. (Eds), Ambulance Services: Leadership and Management Perspectives, Springer, New York, NY, pp. 81-94.
O’Hara, Rachel; Johnson, Maxine; Siriwardena, A Niroshan; Weyman, Andrew; Turner, Janette; et al. (2015). A qualitative study of systemic influences on paramedic decision making: care transitions and patient safety, (2015), Journal of health services research and policy, Volume. 20, Issue 1
Parsons J (2009) Small ‘I’ in Leadership. Aust Fam Physician 38(5): 277
Yorkshire Ambulance Service Promotes Falls Awareness Week (2019), (https://www.yas.nhs.uk/news/media-releases/media-releases-2019/yorkshire-ambulance-service-promotes-falls-awareness-week/) Accessed on 10th January 2020.