|CHAPTER 5: PHYSICAL AND REHABILITATION MEDICINE IN HEALTH CARE SYSTEMS
|Year : 2019 | Volume
| Issue : 2 | Page : 98-101
5.6 Physical and rehabilitation medicine in health-care systems: Collaboration with other health-care professionals
Katharina Stibrant Sunnerhagen
Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Rehabilitation Medicine, University of Gothenburg, Gothenburg, Sweden
|Date of Web Publication||11-Jun-2019|
Prof. Katharina Stibrant Sunnerhagen
Institute of Neuroscience and Physiology, Rehabilitation Medicine, University of Gothenburg, Gothenburg
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Sunnerhagen KS. 5.6 Physical and rehabilitation medicine in health-care systems: Collaboration with other health-care professionals. J Int Soc Phys Rehabil Med 2019;2, Suppl S1:98-101
|How to cite this URL:|
Sunnerhagen KS. 5.6 Physical and rehabilitation medicine in health-care systems: Collaboration with other health-care professionals. J Int Soc Phys Rehabil Med [serial online] 2019 [cited 2019 Aug 20];2, Suppl S1:98-101. Available from: http://www.jisprm.org/text.asp?2019/2/2/98/259348
| Introduction|| |
“Collaboration can be defined as where two or more people or organization work together to achieve something (1). Collaboration is similar to cooperation but more closely aligned. Collaboration requires some form of leadership, but this collaboration can also be performed within a decentralized and egalitarian group. Collaboration is an efficient way to obtain resources, recognition and reward when facing competition for finite resources.”
Modern medical care requires that we work together as well-functioning teams to ensure good patient safety. To have effective teams, knowledge and understanding of each other's roles and knowledge about the importance of clear communication is needed.
Interprofessional can be defined as a group of individuals from different disciplines working and communicating with each other individuals. In the interprofessional learning environment, each member provides his/her knowledge, skills, and attitudes to augment and support the contributions of others. Thereby, interprofessional teamwork requires training.
The United States Institute of Medicine's (IOM) Report, Health Professions Education: A Bridge to Quality (2003), define an interdisciplinary team as “composed of members from different professions and occupations with varied and specialized knowledge, skills, and methods.” (p. 54). Members of the team communicate and work together, as colleagues, to provide quality, individualized care for patients. Interprofessional teamwork is defined by IOM as a collaborative interaction among interprofessional team members to provide quality and individualized care for patients.
Being trained as a health-care professional means that one adapts to a culture, which includes values, beliefs, attitudes, customs, and behaviors. The development of the professions reflects historic factors, as well as social class and gender issues. Educational experiences and the socialization process that occur during the training of each health professional reinforce the common values, problem-solving approaches, and language/jargon of each profession. In their health care, increasing specialization has led to even further immersion of the learners into the knowledge and culture of their own professional group. These professional cultures contribute to the challenges of effective interprofessional teamwork. Therefore, today in many professional schools, the students train together in realistic situations at simulator training centers as well as running real wards. This can also be accomplished through video recording, for instance, a meeting and then later analyze the process. Modern medical care requires that we work together as well-functioning teams to ensure good patient safety. In order to have effective teams, knowledge and understanding of each other's roles and knowledge about the importance of clear communication is needed. Teamwork, just like technical skills, needs training.
Assessment of interprofessional collaboration practice in rehabilitation identified four categories, all of which included both positive and negative descriptions of collaboration: (i) Crossing professional and organizational boundaries; (ii) Awareness of own professional identity; (iii) Information and knowledge transfer; and (iv) Balancing between patient, system, and process. These findings indicate the importance of leadership and organizational structures for stimulating communication and promoting collaboration between team members.
| Disciplines and Professions|| |
There are a number of terms used to describe team and teamwork. Two commonly used concepts are discipline and profession. Often these are used as interchangeable; however, they too have different meanings.
A discipline can be seen as a scientific knowledge area. A discipline is an area where through research, new knowledge is generated. As example of disciplines: the research on diseases in the nervous system (discipline neurology), treatment of neurological motor impairments (physiotherapy) and assessment of cognitive problems (neuropsychology) and their consequences in daily life (occupational therapy). Disciplines can be equal to scientific areas, and there are levels in scientific areas such as medicine, with subareas, and social science.
Professions are vocational categories, but with the add on that, a profession needs specialized knowledge within an area. There is sociological research that shows that different professions within the health-care sector often define themselves by defining boundaries toward others and thereby strengthening the professional role, the group affiliation, and status. This is called professionalization (care as profession or care about the profession). Part of this is seen in the growth of professional organizations. This process usually leads to a license where only those that have the right training, right knowledge, etc., is granted this privilege. In health care, professional licenses are connected to ethical codes. In the case of unethical, unskillful, or illegal behavior, the license can be revoked.
Multidisciplinary is based on the different knowledge areas that rehabilitation emanates from and is thereby a knowledge theory-based aspect. Rehabilitation can be seen as a multidisciplinary type of health care since it is based on knowledge generated in many different scientific disciplines.
Multiprofessional, on the other hand, is grounded in the different professionals that are involved in the rehabilitative work and thereby describes an organizational aspect. Rehabilitation can be described as a multiprofessional type of health care since often different professionals are working together.
| Crowd, Flock, Groups, and Team|| |
A crowd is a number of persons that by chance happens to be at the same place at the same time, i.e., in a waiting room. A flock is a number of individuals that are at the same place. However, a flock follows a leader, i.e., students following a teacher. This is dependent on time and room. A group is often used regarding a number of persons that share something, such as a group of nurses that share the same type of education. During university studies, the students sometimes are asked to go a group project by the teacher. There are groups described as people working together to solve a problem. A group is independent of time and place. Identity is often connected to a group belonging. Groups usually are at least three people and larger. Groups containing more than eight persons usually tend to form subgroups. Groups can be formal or informal, steady or transient in time.
So what is the differences between a team and a group?
Jon Katzenbach and Douglas Smith define a team as: “a small group of people with complementary skills who are committed to a common purpose, performance goals and approach for which they are mutually accountable.” This simple definition brings together team role models such as (complementary skills) with management (common purpose and performance goals) and models of leadership (mutually accountable). Different types of team performance can be seen as part of the maturation of the team.
| Working Group|| |
The individual members come together to share information but have no common purpose or performance goals that require mutual accountability. Team members are only accountable for the work that the group has delegated to them [Figure 1].
|Figure 1: An illustration of how group functioning (x-axis) influences performance|
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| Pseudo Team|| |
Members may believe they are part of a team but not acting like one. This may be because they do not want to take the risk of committing to a common purpose and the mutual accountability that this entails. This team is not performing at all [Figure 1].
| Potential Team|| |
At this level, the team members are moving toward a common goal and approach to achieving it. They are working toward a higher level of performance and must agree on mutual accountability [Figure 1].
| Real Team|| |
Here, a small group of people shares a common purpose and approach. They have complementary skills and share accountability for results and start to trust each other [Figure 1].
| High-Performing Team “dream Team”|| |
Here, the relationships between the team members are mutual trust. High performance results from the members being committed to one another's personal growth and development. The achievement of the shared objectives requires team members to share multiple sources of information, systematic communication, coordination, and cooperation.
With efficient teamwork,, everyone in the team collaborates against a well-defined common goal. In addition, everyone involved communicates effectively while creating trust in each other. Everyone in the team should feel so confident that they dared say if they see something that could be a safety hazard to the patient or wrong procedure/treatment.
It is important to create a trustworthy and thus safe atmosphere within teamwork to allow for flexibility and acceptance for each other's skills. Security is also a prerequisite for the courage to try new, all to offer the patient the best to achieve their goals. A culture for continuous improvement and team requires personal development and against acknowledging mistakes. It is important to have fun, which facilitates learning in teamwork. It has to be acknowledged that it must take time to develop well-functioning teamwork [Table 1].
|Table 1: The work structure, advantages, and disadvantages of two common team models|
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Different types of teamwork:
- Multidisciplinary model
- Team arranged according to the medical model (different specialists)
- Interdisciplinary model
- Transdisciplinary model
The different types of team all have their advantages and disadvantages., The work culture usually influences the organization of the team. However, in the best of worlds, the organization of the team should depend on the complexity of the task. There is some research that indicates that teamwork and team effectiveness are higher in teams working with the interdisciplinary team approach. Therefore, the interdisciplinary approach can be recommended, particularly for clinics in the somatic indication field. Team development can help to move from the multidisciplinary to the interdisciplinary approach.
| Leadership in a Team|| |
Leadership in a team is a complex task [Figure 2]. It involves not only attention to the completion of the task but also to the productivity of the people. Team leadership is a reflection of you as a whole person, intellect, personality, emotion, skills, and behavior. To lead, you need to use communication skills, problem-solving, have certain technical and organizational skills, awareness of the needs of the team as well as the external demands and expectations and you need to have a vision. To become a leader, you need to develop and practice your leadership skills. The organization of the team requires different types of leadership.
|Figure 2: Illustration of two types of teams and leadership. The expert team/leader works mainly top-down. The shared model has a more bottom up structure where the input is from the members|
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When do you need a team?
- When the task is ambiguous, complex task
- In a situation where different roles are required (different people need to do different things)
- When you need multiple perspectives (each professional view the task through different glasses).
Why is there need for teamwork in rehabilitation?
One reason is that the world of knowledge in areas that are central for rehabilitation are expanding fast. The other reason is the increased awareness of the patient's problems in a wider psychosocial perspective.
The medical research is expanding as well as other areas that are of relevance for rehabilitation (such as basic research, psychology, sociology, pedagogy as well as technology). As an example, we can look at the testing of a patient's skill in different areas or the increased awareness of the economical and psychosocial factors that will possible complicate what at first looks a purely medical problem. The requirements for a successful rehabilitation process are complexed as well are the interventions. These increased demands for deep and broad medical knowledge in conjunction individual designed treatments and a process thinking put the health-care workers before situations that in most cases will be more easily handled by a multi-professional team.
In parallel, the demands for a cohesive patient reception become stronger from both patient organizations as well as those steering the health-care system. This has to do with the awareness that highly qualified care requires collaboration not only within that unit (the team) but also with other health-care providers, the patient, and the next of kin.
Does the quality of teamwork matter?
A recent Cochrane review showed that externally facilitated interprofessional activities may slightly improve patient functional status and health-care professionals' adherence to recommended practices, and may slightly improve the use of health-care resources. It was not clear whether externally facilitated interprofessional activities improve patient-assessed quality of care, continuity of care, or collaborative working behaviors. The use of interprofessional rounds and interprofessional checklists may slightly improve the use of health-care resources. Interprofessional meetings may slightly improve adherence to recommended practices, and may slightly improve the use of health-care resources.
| Summary|| |
Not all rehabilitation situations require a team. A team does not form itself but requires engagement from the members. Teams can be organized in different ways, and the best model depends on the demands from the situation. To be a team leader often requires leadership training. You do not become a leader by profession or by appointment. A good teamwork results in a better outcome for the patients and often is cost-efficient.
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Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]