Here are some examples of completed worksheets from students. These examples indicate poor, better and best responses. Excellent examples provide evidence of critical reflection, insight and future application of what was learnt.
Briefly describe the team event you observed, its purpose and the professions involved.
Physiotherapy, Medical, Social Work, Occupational Therapy, Enrolled Nursing, Certificate IV Mental Health. Quarterly Care Review Meeting – Review of community care services including Occupational Therapy home assessment for modifications for recently discharged patient
Discuss and analyse aspects of team collaboration observed using the following prompts:
A. Were any particular communication protocols followed? B. Was communication respectful? C. Was communication effective? Why or why not? D. What about use of profession specific terms/jargon? E. Were all members heard?
Prior to the meeting, the nurse provided us with a list of clients/patients. At the meeting the doctor & nurse just talked about what the patient needed at home. Then the OT, PT, SP, SW and Mental Health Support Worker had their say. I was a bit confused at times as I didn’t know many of the terms used.
Prior to the meeting, the nurse provided us with a checklist of what will be discussed for each patient that is on their list. Prior to the meeting each team member is to write their summary so the Community Nurse and Medical officer know the patient progress. During the meeting, each team member further explained their summary. At the end an overall goal was set for action by the team members until the next meeting. Everyone had a chance to speak and give their opinion. I was a bit confused at times as I didn’t know many of the terms used.
Prior to the meeting, the nurse provided us with a checklist of what will be discussed for each patient that is on their list. Prior to the meeting each team member is to write their summary so the Community Nurse and Medical officer know the patient progress. The Medical Officer and nurse lead the meeting, but tended to rush through the patients during the meeting, not really allowing each team member to further explain their summary. I realize that there is a time limit to the meeting but it seemed that the meeting was more information giving than actual discussion. I was disturbed at some of the comments made about the patient – there was a lack of empathy for some of the patients who were not progressing. Following the discussion of each patient an overall goal was set for action by the team members until the next meeting. Although each team member had a chance to speak and give their opinion, they were cut off at times. Some didn’t even speak up. I was a bit confused at times and the conversation was difficult to follow as I didn’t know many of the terms used.
How were differences of opinion managed?
I noticed conflict over discharge arrangements for a few of the patients. Some allied health staff had differing opinions as to whether the patient should be discharged This was usually worked through by them raising their concerns at the meeting.
Although the medical officer and nurse seemed to want to move quickly through the meeting, there were a few allied health professionals who spoke up and really advocated for the patient, for example over discharge arrangements. They did this in a very professional way by always bringing the conversation back to the needs and wishes of the patient and their family.
Patient/client focused care:
How were the patient/client’s goals, preferences, needs or wishes expressed or accounted for within the event? Were any particular protocols followed?
The nurse would identify the general goals and the medical officer would agree. Sometimes the allied health professionals would say something.
The nurse outlined the patient goals & medical officer and allied health professionals were very clear in outlining how the goal would be attained. The protocol was per the checklist they provided us. Criteria included falls risk, support at home. The patient wasn’t present at the meeting.
What leadership behaviours were observed?
The meeting was led by the medical officer and nurse. They had different roles in the meeting – the nurse was the person who encouraged input from the allied health team members. This was important as there were some new team members who seemed reluctant to speak up.
The meeting was led by the medical officer and nurse together, however, the nurse ensured each profession had time to report and say what they had to say. He tended to focus on the relationship building aspect of leadership, whereas the doctor was more task focused – which is important if we are to get through the huge list of patients to be discussed. The nurse made sure that the meeting was inclusive to all and encouraged advocacy for the patient.
Were the team members seated in a way or standing in a way that influenced power dynamics in the team? Were all team members heard?
We were seated at a long table. The MO was at the head of the table with the nurse. The medical officer did not look up from his paperwork often to see if anyone wanted to say anything. It was the nurse who took on this role. The Doctor and nurse at head of table represented power but this didn’t mean others could not speak up.
We were seated at a long table. People seemed to sit where they felt comfortable and, on this occasion the doctor sat next to the Social Worker (I think because community care arrangements were a focus of the meeting?). The nurse ensured all participants said what they needed to and doctor ensured we moved through the list. At times there seemed to be a power play between the nurse and the doctor – the doctor had the final say. Maybe because he is pressured by hospital performance indicators such as freeing-up beds and has overall responsibility for the patient, this is appropriate. However, team members need to feel their contribution is valued and still speak up.
Considering the above analysis:
Do you think that genuine collaborative practice was observed in this interprofessional forum? Why or why not?
I am sure they were trying to be collaborative. But at times I felt that each profession had different goals for the patient and they were not listening to each other.
For the most part they were collaborative. When clients with complex and diverse health and social problems were discussed, I noticed that team members made less effort to establish a new plan or set new goals, leaving the person to 1-2 disciplines to ‘sort out’.
How did this impact on patient/client care?
When staff don’t work together, clients/patients are more likely to re-admit soon after being discharged. We need to educate clients/patients and their family/carers about this also. IP needs to include the client and their family/carer, wherever practicable and as appropriate.
What constraints or challenges may be present inhibiting the effectiveness of this interprofessional forum?
All staff are busy and have heavy workloads. They don’t often see patients together during the home visits and do most things in isolation.
I noted that some professionals had not recently reviewed the client/patient and thus could not contribute to the discussion. I realize that all staff have heavy workloads. In most instances, the Mental Health Support Worker would usually be present when the nurse, OT or PT would see the person. This enabled the IP team to contribute to a more collaborative approach to meet client’s community living goals and decide whether the person was being adequately supported at home. This collaborative approach came through at meetings and they were able to ask other professions for their input to review the patient.
How would you improve this particular interprofessional forum if given the opportunity?
Ensure all professions know the client being discussed and have reviewed the person’s needs and situation prior to the meeting. This way the team could set goals together – based on goals discussed with the patient. Have goals to attain with patient each week and bring to next meeting the progress or challenges faced. Important that everyone is given an opportunity to speak at the meeting. However, there is limited time – team members need to be succinct in how they get their message across.
What behaviours could you build into your practice to improve your interprofessional communication and collaboration in the future?
Get to know my interprofessional team …. Ask questions, invite them to assess/review with me and discuss client/patient goals and plan intervention strategies together to achieve optimal patient outcomes. Be more involved in care planning or discharge planning. Attend and/or be aware of the outcomes of all ward rounds and case conferences related to clients/patients I work with. Read progress notes and reports from other profession.