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It is well recognized that people in organizations typically spend over 75% of their time in an interpersonal situation; thus it is no surprise to find that at the root of a large number of interprofessional problems is poor communications. Effective communication is an essential component of interprofessional work success. Besides, the issue of interprofessional working is currently one of key importance in the field of health and social care.
Much of the literature on interprofessional working focuses
on the potential difficulties in achieving effective working
relationships between practitioners from different professions, and the
ways in which these problems might be avoided or resolved (Davidson,
1990; Evers et al., 1994; Ferrer & Navarra 1994; Pietroni, 1994;
Hanily, 1995; Hilton, 1995). In United Kingdom, the legislative and
policy requirements over the past decade have required health and
social care agencies to work closely and collaboratively together in
partnership with service users (Pearson & Spencer, 1995; DoH,
1999). Thus, it is important to identify and evaluate the positive
characteristics of good interprofessional working. The aim of this
paper is to cover the role of the basic process of effective
communication related to interprofessional work and the conflict
problems generated from the interprofessional practice. Further, we
will discuss some studies carried out on the era (mainly in the health
care sector), followed by conclusion and recommendations.
2. Interprofessional teamworking: communication breakdown and conflict
The communication that can be defined by a process of transmitting
information from an individual (or group) to another is a very complex
process with many sources of potential error. In other words, the
meaning of any communication is a simple transmission of a message from
the sender to the receiver. In many situations a lot of the true
message is lost because the significant difference that exists between
the message that is heard and the one intended.
Further, the effectiveness of the communication process still
difficult, because at each step, there is a multitude of potential
source of errors. Thus, the social psychologists estimate of a usual
40-60% loss of meaning in the transmission of messages from sender to
receiver still justified.
However, in order to increase the effectiveness of the communication
process, it is critical to make sure that there is a minimal loss of
information. Hence, it is required to understand well this process,
understand and control constantly the potential sources of errors.
Further, it is important to point out that the communication process
appears more complex when it is accomplished between to persons or
groups with different knowledge’s and professional activities.
In the following, we will see that conflict within teamworking takes
many forms. We will give the definition of a team and which are the
problems rising from the lost of effective communication in an
interprofessional teamworking process. Finally, we will see a checklist
of criteria that healthy teams do well and dysfunctional teams do
poorly.
The team can be defined as a group of individuals who must work
interdependently in order to attain individual and organizational
objectives. The key word here is interdependently. However, within an
interprofessional work, interdependence means that all the teams must
depend on each other and if any one team drops the ball, the whole
teams suffer. Different divisions within a company may need to share
information but they are not really a team. Why the shift to teams? The
answer is simple. There is less management, less direction, more
autonomy and accountability, the need for specialists, and a greater
expectation to work independently without management direction. Also,
senior managers know peer pressure to support team goals and each other
is a very powerful motivator and productivity is much greater with a
team than with individual workers. Most companies will take advantage
of this. In contrast, the lost of an effective communication lead to a
set of problems that are:
• conflicting personalities and egos;
• difficulty of collaboration and decisions;
• lack of definition of members’ roles;
• hidden agendas or win/lose struggles;
• necessity of time-consuming meetings;
• unclear goals or conflicting goals within the team;
• lack of awareness of how the work fits into the bigger picture;
• unwillingness to share or to ask for help
• geographic remoteness;
• cultural clashes;
• etc.
It is rarely the technical challenges that cause problems, but rather
the people issues that are mostly often the source. Further, healthy
interprofessional work will always do the following six criteria well
and, conversely, dysfunctional one will not do these well.
i. Clear Communication
Usually the first sign of a
dysfunctional team is communication breakdown. Healthy teams have a
communication plan that is agreed to by all members. The frequency,
format, and type of communication are pre-negotiated and meet the
unique needs of the team or situation. Team members also know what to
do when they feel that communication is breaking down or if they feel
out of the loop.
ii. Clear Goals, Roles, and Responsibilities
This is a major source of frustration on most teams and must be clearly defined early. This is the role of the Team Leader’s.
iii. A Conflict Resolution Process
Conflict within any teams is inevitable and healthy if managed
properly. Healthy teams have pre-set rules of conduct in times of
conflict.
iv. Clear Decision-Making Process
Depending on the situation, there could be many ways to make a
decision: depending on the short or long strategic project, the Project
Leader decides and tells the team, a team vote, majority rules,
minority rules, an expert decides, or a consensus. The key is that
there should be a primary and backup decision-making method that
everyone agrees to.
v. Fair Work Distribution
The problems with fair work distribution are usually caused by
slackers. If the teams cannot address their performance and
contribution, then, the leader may have to get involved by giving clear
feedback and setting expectations.
vi. Appropriate Leadership
This is usually the most difficult one to get right. This is never an easy choice.
3. Health care teamworking: Interaction and collaboration
Due to the complexity of health care domain, which generally includes
problems with features of both familiar and complex problems, internist
decision-making frequently includes a mix of both data-driven and
hypothesis-driven diagnostic strategies.
Recent investigations into decision making have included the study
of group decision making in real health care environments, with
different limitations and situational variables (Orasanu, 1993). A
special type of coordinated group activity is the collaboration, in
which individuals with different areas of knowledge and skill work
together to perform tasks and carry out activities necessary for
achieving a shared goal. In the medical context, collaborative planning
and activity involve interactions between team members in order to
manage the complexity of clinical practice. The health care literature
abounds with examples of successful multidisciplinary teams with praise
for this type of delivery system in many different domains, including
primary care, geriatric, diabetes, cardiovascular medicine, head and
neck surgical oncology, endovascular surgery, anaesthesiology and
psychiatry. In each of these domains, physicians, nurses, dieticians,
physiotherapists, social workers, and other health care support staff
each bring different domain knowledge and coordinated activity to
health care decision making (though unfortunately usually excluding the
patient who is the focus of the interaction). How this does coordinated
activity work, given that the team members have very specific knowledge
and skills?
Patel et al. (1996) examined team interactions within an Intensive
Care Unit team, where they identified individuals possessing different
types of expertise with roles that are clearly and formally defined.
This led to the identification of properties that emerged in the
collaborative setting. The attending expert then generated appropriate
plans based on consideration of the patient as a whole. The complexity
of medical analysis increased at each level in the hierarchy while
information management tasks decreased in intensity. Multiple streams
of information were processed in a hierarchical manner using two types
of strategies. Under conditions of high urgency, reasoning was
data-driven toward action, rather than based on consideration of
underlying justifications and a high degree of knowledge organization.
Under less urgent conditions, causally directed reasoning was used to
explain relevant patient information. In both cases, the overall goal
of individual and collective reasoning was to find a reasonable
explanation for a particular aspect of a patient’s condition so that
appropriate actions could be taken.
For each type of conditions described above, the communication still
very important for bridging differences, leading to shared products and
understanding. The preferred mode of communication will found to vary
with the purpose of the interaction, planning tended to take place
during conference calls and face-to-face meetings, while technical
issues were emphasized in email communication. As tasks will be
clarified and a shared commitment developed over time, the pattern of
communication became more focused, showing greater degrees of
integration. At the same time, the development of communication depends
on each individual’s contributions (in terms of expertise) to the team
effort.
Another important point that would be outlined here, in the same
context of health care, is the health human resources (HHR) planning,
present as well in private as public sectors. HHR is a complex issue
and the management of human resources includes monitoring and
evaluation, planning, and policy research. It takes into account the
supply, distribution, quality, deployment, organization and utilization
of health human resources. It has further been described as seeking to
establish optimal numbers for each of the health care provider groups,
given the most cost-effective and appropriate mix of required personnel
based on varying services needs. A Key feature that is important and
need to be considered in this HHR planning is the physiotherapy
profession.
Physiotherapists play a large role in promoting health. They
understand the determinants of health and see this as a fundamental
requirement for responsible decision-making that is conducive to
promoting health. In this capacity; physiotherapists often work as
consultants to private and public organizations. They work with
corporations, professional and amateur sports teams, and with
governments and their agencies. Their consultative work also includes
prevention awareness and the focus of this work is to prevent injury
and to promote health, which is so required for the good functioning of
each private or public structure. Hence, and regarding the above
considerations assigned in section 2, the physiotherapists are
therefore essential providers of the health care support and
information useful for each professional structure, and which is
crucial for a successful, interprofessional teamworking.
4. Conclusion
The present paper examines the concept of the role of communication
in interprofessional work and its relationship to efficient and
effective delivery of decisions and services, regarding the example of
the health care issue. It state that the collaboration between workers
from professions and of various institutions necessitates time,
clarification of the intention and expectations of each, as well as the
placement of definite procedures of collective work. Not to respect
these conditions at the beginning of the procedure risk to fail the
project or to delay it considerably, because of the conflicts that
inevitably will appear.
In the health care teamworking exposed above, communication as well as
redundancy assures that omissions will be discovered and corrected. The
mode of communication is directly related to the purpose of the
interaction. This timely communication among individual members assured
the co-ordination of activities, reducing redundancies and unnecessary
interactions. Face-to-face and telephone interactions were the most
frequently used modes of communication, offering an immediacy of
response and the opportunity for exchange of information and ideas.
Further, in recognition of the importance of communication skills,
pressure has been placed on the medical education system to acknowledge
their significance and to devote resources to teaching them. While the
results emphasize the prominence of communication in team functioning,
they also highlight the conceptual basis of communication related to
the development of individual expertise, making team communication an
added value to already existing conceptual competence in this domain.
We observed that expert providers in each situation determined the most
effective methods for communicating with each other based on the
purpose of the interaction being sought. It has been suggested that it
is the very nature of the practice itself that promotes acquisition of
tacit knowledge and skills.
References
DAVIDSON, K.W. (1990) Role blurring and the hospital social worker’s
search for a clear domain. Health and Social Work, 15, 228–234.
DEPARTMENT OF HEALTH.
DEPARTMENT OF HEALTH (1999). National Service Framework for Mental Health: Modern Standards & Service Models.
EVERS, H. CAMERON, E. & BADGER, F. (1994) Interprofessional work
with old and disabled people. In A. LEATHARD (Ed.), Going
interprofessional: working together for health and welfare. London:
Routledge.
FERRER, M. & NAVARRA, T. (1994) Professional boundaries: clarifying roles and goals. Cancer Practice, 2, 311–312.
HANILY, F. (1995) Mental health teams in the community. Nursing Standard, 10, 35–37.
HILTON, R.W. (1995). Fragmentation within interprofessional work. A
result of isolationism in health care professional education programmes
and the preparation of students to function only in the cofines of
their own disciplines. Journal of Interprofessional Care, 9, 33–40.
ORASANU, J. & SALAS, E. (1993) Team decision making in complex
environments. In: Klein GA, Orasanu J, Calderwood R, Zsambok CE, eds.
Decision Making in Action: Models and Methods. Norwood, NJ: Ablex;
327-345.
PATEL, V.L. KAUFMAN, D.R. & MAGDER, SA. (1996) The acquisition
of medical expertise in complex dynamic environments. In: Ericsson KA,
ed. The Road to Expert Performance: Empirical Evidence from the Arts
& Sciences, Sports and Games. Hillsdale, NJ: Lawrence Erlbaum:
127-165.
PEARSON, P. & SPENCER, J. (1995). Pointers to effective
teamwork: exploring primary care. Journal of Interprofessional Care, 9,
131–138.
PIETRONI, P.C. (1994). Interprofessional teamwork. Its history and
development in hospitals, general practice and community care (UK). In:
A. LEATHARD (Ed.), Going interprofessional: working together for health
and welfare. London: Routledge.
Much of the literature on interprofessional working focuses
on the potential difficulties in achieving effective working
relationships between practitioners from different professions, and the
ways in which these problems might be avoided or resolved (Davidson,
1990; Evers et al., 1994; Ferrer & Navarra 1994; Pietroni, 1994;
Hanily, 1995; Hilton, 1995). In United Kingdom, the legislative and
policy requirements over the past decade have required health and
social care agencies to work closely and collaboratively together in
partnership with service users (Pearson & Spencer, 1995; DoH,
1999). Thus, it is important to identify and evaluate the positive
characteristics of good interprofessional working. The aim of this
paper is to cover the role of the basic process of effective
communication related to interprofessional work and the conflict
problems generated from the interprofessional practice. Further, we
will discuss some studies carried out on the era (mainly in the health
care sector), followed by conclusion and recommendations.
2. Interprofessional teamworking: communication breakdown and conflict
The communication that can be defined by a process of transmitting
information from an individual (or group) to another is a very complex
process with many sources of potential error. In other words, the
meaning of any communication is a simple transmission of a message from
the sender to the receiver. In many situations a lot of the true
message is lost because the significant difference that exists between
the message that is heard and the one intended.
Further, the effectiveness of the communication process still
difficult, because at each step, there is a multitude of potential
source of errors. Thus, the social psychologists estimate of a usual
40-60% loss of meaning in the transmission of messages from sender to
receiver still justified.
However, in order to increase the effectiveness of the communication
process, it is critical to make sure that there is a minimal loss of
information. Hence, it is required to understand well this process,
understand and control constantly the potential sources of errors.
Further, it is important to point out that the communication process
appears more complex when it is accomplished between to persons or
groups with different knowledge’s and professional activities.
In the following, we will see that conflict within teamworking takes
many forms. We will give the definition of a team and which are the
problems rising from the lost of effective communication in an
interprofessional teamworking process. Finally, we will see a checklist
of criteria that healthy teams do well and dysfunctional teams do
poorly.
The team can be defined as a group of individuals who must work
interdependently in order to attain individual and organizational
objectives. The key word here is interdependently. However, within an
interprofessional work, interdependence means that all the teams must
depend on each other and if any one team drops the ball, the whole
teams suffer. Different divisions within a company may need to share
information but they are not really a team. Why the shift to teams? The
answer is simple. There is less management, less direction, more
autonomy and accountability, the need for specialists, and a greater
expectation to work independently without management direction. Also,
senior managers know peer pressure to support team goals and each other
is a very powerful motivator and productivity is much greater with a
team than with individual workers. Most companies will take advantage
of this. In contrast, the lost of an effective communication lead to a
set of problems that are:
• conflicting personalities and egos;
• difficulty of collaboration and decisions;
• lack of definition of members’ roles;
• hidden agendas or win/lose struggles;
• necessity of time-consuming meetings;
• unclear goals or conflicting goals within the team;
• lack of awareness of how the work fits into the bigger picture;
• unwillingness to share or to ask for help
• geographic remoteness;
• cultural clashes;
• etc.
It is rarely the technical challenges that cause problems, but rather
the people issues that are mostly often the source. Further, healthy
interprofessional work will always do the following six criteria well
and, conversely, dysfunctional one will not do these well.
i. Clear Communication
Usually the first sign of a
dysfunctional team is communication breakdown. Healthy teams have a
communication plan that is agreed to by all members. The frequency,
format, and type of communication are pre-negotiated and meet the
unique needs of the team or situation. Team members also know what to
do when they feel that communication is breaking down or if they feel
out of the loop.
ii. Clear Goals, Roles, and Responsibilities
This is a major source of frustration on most teams and must be clearly defined early. This is the role of the Team Leader’s.
iii. A Conflict Resolution Process
Conflict within any teams is inevitable and healthy if managed
properly. Healthy teams have pre-set rules of conduct in times of
conflict.
iv. Clear Decision-Making Process
Depending on the situation, there could be many ways to make a
decision: depending on the short or long strategic project, the Project
Leader decides and tells the team, a team vote, majority rules,
minority rules, an expert decides, or a consensus. The key is that
there should be a primary and backup decision-making method that
everyone agrees to.
v. Fair Work Distribution
The problems with fair work distribution are usually caused by
slackers. If the teams cannot address their performance and
contribution, then, the leader may have to get involved by giving clear
feedback and setting expectations.
vi. Appropriate Leadership
This is usually the most difficult one to get right. This is never an easy choice.
3. Health care teamworking: Interaction and collaboration
Due to the complexity of health care domain, which generally includes
problems with features of both familiar and complex problems, internist
decision-making frequently includes a mix of both data-driven and
hypothesis-driven diagnostic strategies.
Recent investigations into decision making have included the study
of group decision making in real health care environments, with
different limitations and situational variables (Orasanu, 1993). A
special type of coordinated group activity is the collaboration, in
which individuals with different areas of knowledge and skill work
together to perform tasks and carry out activities necessary for
achieving a shared goal. In the medical context, collaborative planning
and activity involve interactions between team members in order to
manage the complexity of clinical practice. The health care literature
abounds with examples of successful multidisciplinary teams with praise
for this type of delivery system in many different domains, including
primary care, geriatric, diabetes, cardiovascular medicine, head and
neck surgical oncology, endovascular surgery, anaesthesiology and
psychiatry. In each of these domains, physicians, nurses, dieticians,
physiotherapists, social workers, and other health care support staff
each bring different domain knowledge and coordinated activity to
health care decision making (though unfortunately usually excluding the
patient who is the focus of the interaction). How this does coordinated
activity work, given that the team members have very specific knowledge
and skills?
Patel et al. (1996) examined team interactions within an Intensive
Care Unit team, where they identified individuals possessing different
types of expertise with roles that are clearly and formally defined.
This led to the identification of properties that emerged in the
collaborative setting. The attending expert then generated appropriate
plans based on consideration of the patient as a whole. The complexity
of medical analysis increased at each level in the hierarchy while
information management tasks decreased in intensity. Multiple streams
of information were processed in a hierarchical manner using two types
of strategies. Under conditions of high urgency, reasoning was
data-driven toward action, rather than based on consideration of
underlying justifications and a high degree of knowledge organization.
Under less urgent conditions, causally directed reasoning was used to
explain relevant patient information. In both cases, the overall goal
of individual and collective reasoning was to find a reasonable
explanation for a particular aspect of a patient’s condition so that
appropriate actions could be taken.
For each type of conditions described above, the communication still
very important for bridging differences, leading to shared products and
understanding. The preferred mode of communication will found to vary
with the purpose of the interaction, planning tended to take place
during conference calls and face-to-face meetings, while technical
issues were emphasized in email communication. As tasks will be
clarified and a shared commitment developed over time, the pattern of
communication became more focused, showing greater degrees of
integration. At the same time, the development of communication depends
on each individual’s contributions (in terms of expertise) to the team
effort.
Another important point that would be outlined here, in the same
context of health care, is the health human resources (HHR) planning,
present as well in private as public sectors. HHR is a complex issue
and the management of human resources includes monitoring and
evaluation, planning, and policy research. It takes into account the
supply, distribution, quality, deployment, organization and utilization
of health human resources. It has further been described as seeking to
establish optimal numbers for each of the health care provider groups,
given the most cost-effective and appropriate mix of required personnel
based on varying services needs. A Key feature that is important and
need to be considered in this HHR planning is the physiotherapy
profession.
Physiotherapists play a large role in promoting health. They
understand the determinants of health and see this as a fundamental
requirement for responsible decision-making that is conducive to
promoting health. In this capacity; physiotherapists often work as
consultants to private and public organizations. They work with
corporations, professional and amateur sports teams, and with
governments and their agencies. Their consultative work also includes
prevention awareness and the focus of this work is to prevent injury
and to promote health, which is so required for the good functioning of
each private or public structure. Hence, and regarding the above
considerations assigned in section 2, the physiotherapists are
therefore essential providers of the health care support and
information useful for each professional structure, and which is
crucial for a successful, interprofessional teamworking.
4. Conclusion
The present paper examines the concept of the role of communication
in interprofessional work and its relationship to efficient and
effective delivery of decisions and services, regarding the example of
the health care issue. It state that the collaboration between workers
from professions and of various institutions necessitates time,
clarification of the intention and expectations of each, as well as the
placement of definite procedures of collective work. Not to respect
these conditions at the beginning of the procedure risk to fail the
project or to delay it considerably, because of the conflicts that
inevitably will appear.
In the health care teamworking exposed above, communication as well as
redundancy assures that omissions will be discovered and corrected. The
mode of communication is directly related to the purpose of the
interaction. This timely communication among individual members assured
the co-ordination of activities, reducing redundancies and unnecessary
interactions. Face-to-face and telephone interactions were the most
frequently used modes of communication, offering an immediacy of
response and the opportunity for exchange of information and ideas.
Further, in recognition of the importance of communication skills,
pressure has been placed on the medical education system to acknowledge
their significance and to devote resources to teaching them. While the
results emphasize the prominence of communication in team functioning,
they also highlight the conceptual basis of communication related to
the development of individual expertise, making team communication an
added value to already existing conceptual competence in this domain.
We observed that expert providers in each situation determined the most
effective methods for communicating with each other based on the
purpose of the interaction being sought. It has been suggested that it
is the very nature of the practice itself that promotes acquisition of
tacit knowledge and skills.
References
DAVIDSON, K.W. (1990) Role blurring and the hospital social worker’s
search for a clear domain. Health and Social Work, 15, 228–234.
DEPARTMENT OF HEALTH.
DEPARTMENT OF HEALTH (1999). National Service Framework for Mental Health: Modern Standards & Service Models.
EVERS, H. CAMERON, E. & BADGER, F. (1994) Interprofessional work
with old and disabled people. In A. LEATHARD (Ed.), Going
interprofessional: working together for health and welfare. London:
Routledge.
FERRER, M. & NAVARRA, T. (1994) Professional boundaries: clarifying roles and goals. Cancer Practice, 2, 311–312.
HANILY, F. (1995) Mental health teams in the community. Nursing Standard, 10, 35–37.
HILTON, R.W. (1995). Fragmentation within interprofessional work. A
result of isolationism in health care professional education programmes
and the preparation of students to function only in the cofines of
their own disciplines. Journal of Interprofessional Care, 9, 33–40.
ORASANU, J. & SALAS, E. (1993) Team decision making in complex
environments. In: Klein GA, Orasanu J, Calderwood R, Zsambok CE, eds.
Decision Making in Action: Models and Methods. Norwood, NJ: Ablex;
327-345.
PATEL, V.L. KAUFMAN, D.R. & MAGDER, SA. (1996) The acquisition
of medical expertise in complex dynamic environments. In: Ericsson KA,
ed. The Road to Expert Performance: Empirical Evidence from the Arts
& Sciences, Sports and Games. Hillsdale, NJ: Lawrence Erlbaum:
127-165.
PEARSON, P. & SPENCER, J. (1995). Pointers to effective
teamwork: exploring primary care. Journal of Interprofessional Care, 9,
131–138.
PIETRONI, P.C. (1994). Interprofessional teamwork. Its history and
development in hospitals, general practice and community care (UK). In:
A. LEATHARD (Ed.), Going interprofessional: working together for health
and welfare. London: Routledge.
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