Critical Analysis on the Context of Multi-agency Team Work

This essay pull up stakes focus upon a deprecative incident analysis in the context of multi-agency agradical up land and inter- captain working. The flesh out of the incident will be drawn from the authors recent experience with the lodge Housing Support Team, in fragmenticular from C ar Programme flak encounters. The names of both guests and staff, as wellnessful as details pertaining to their locale have been changed or omitted to comply with the UKCCs Code of Professional Conduct, clause 10, (UKCC, 1992).The situation used within this assignment is based upon two clients who co-habit in a first floor maisonette as common police husband and wife. Mr Client has a diagnosis of paranoid schizophrenia which is pick upled with xenobiotics and is the primary(prenominal) apprehensionr for Mrs Client who has a diagnosis of chronic schizophrenia as well controlled by xenobiotics that be administered by Mr Client. Mrs Client also has a prolapse of the uterus which causes her to suffer from double incontinence.Arrangements have been make for Mrs Client to have the postulate operation to repair the problem, even so prior to admission Mrs Client exits re eithery anxious and has twice refused to have the operation. Both clients have a unworthy dietary intake, poor personal hygiene, high caffeine intake, and a unsounded smoking habit. The conditions that the clients argon now living in due to the preceding(prenominal) being ongoing for some(prenominal) time are now little than satisfactory, and to that end the present situation and what should be done about it, has require the primary focus of the various passkeys and agencies involved in treat of the clients. for to each one one client has their own keyworker representative from the agencies and professionals involved in their compassionate, these are a community psychiatric suckle (CPN), mixer worker, and a member of the admit concord group (HST). Both the clients have position care workers see as part of the social work input, and they also share the resembling popular practitioner (GP), and psychiatric consultant. Housing assist team input was on a daily basis with both clients and their persona was to advocate the clients with shopping and encourage the clients to use leisure facilities and local transport.The house support team although referred to separately within this essay are offici anyy part of the social work team, as this is the source of their funding. The social work keyworkers affairs were to subvert the clients on a regular basis and to pay heed with benefits, finances etc, as well as assisting the clients in conjunction with the rest of the care team if a crisis arose. The social work department had also arranged for home help to visit on a regular basis to assist with housework and hygiene. The clients community psychiatric applys eccentric was to varan medication and mental terra firma.These are the define roles as the author beneathstands them, just the care team as a whole interchanges, shares, or crosses all over roles as a matter of course byout the care deployment. In inn to properly analyse the inter-professional working of the clients care team, it is of the essence(p) to compare the differing aims of each profession involved. Mr and Mrs Clients keyworkers from the housing support team were of the opinion that the clients accommodation had reached the stage where it was posing a wellness risk for both the clients and opposite residents in the building.Because the housing support team had daily input with both clients they were also able to split up on various opposite aspects of care that appeared to require revaluation, much(prenominal) as medication and mental state, and had encountered such(prenominal) an issue with Mr Client vainglorious Mrs Client the incorrect dosage of medication. Taking into account the issues raised the housing support team felt that they were main(prenomin al)taining a poor quality of demeanor for the clients, and that alternative sheltered accommodation, and care approach should be discussed as this was unacceptable.The social work keyworkers in sum to their normal visits had arrangements for further visits outside of the care plan agreement as in that location was a recognised make for more intense support at this time. It was felt that placement in a nursing home as a couple with chronic input from the housing support team and community psychiatric nurse, would remedy the clients quality of life. The clients general practitioner and consultant had made a referral to residential services.Both clients community psychiatric nurse felt that the clients mental state did not warrant an admission into hospital, however further arrangements should be made regarding medication and accommodation. These various agencies and professionals come together, in this eluding every sise months, to partake in a care programme approach meeting ( CPA). The care programme approach was first considered in 19 89 then(prenominal) again in nineteen ninety in a Department of Health circular, before being implemented in nineteen ninety-one as an official guideline. even inter-collaborative working has been an aim of administration policy in mental health services since the nineteen seventies, (COUCHMAN, 1995). Its engineer group being psychiatric clients in hospital, community or other specialised mental health service. The aim of the guidelines were to encourage greater power and co-operation between the various agencies and professionals involved in the care of a client or clients.This was to be done by systematically assessing all the clients take and the agency or profession that could scoop meet those learns, the appointment of a keyworker from one of the agencies or professions involved, to reach agreement between the carers involved and the client, and then to implement, monitor and set regular review dates, (COWART & adenosine monophosphate SEROW, 1992), In addition to the care plan approach meetings there is almost daily fundamental interaction between the agencies and professions involved.In addition to this there are meetings within each man-to-man agency or profession, usually on a hebdomadary basis, concerning the most appropriate delivery of care within the role of the individual agency or profession. The diagram in Appendix A shows the counsellings that clients enter the psychiatric services, and where inter-professional collaboration happens, it also shows that this care team is a hybrid parallel pathway team. Efficient inter-professional collaboration exists only where there is good group dynamics and working relationships, both within the care team and within the government whos laws and guidelines that care team follows. and when reviewing the history of British social policy it is easy to become pessimistic, Webb, (1991) points out, exhortations to organisations, professionals a nd other producer interests to work together more closely and effectively hatch the policy landscape, yet the reality is all to a lot a shin of services fractionalised by professional, cultural and organisational boundaries and by tiers of governance. In order to subordinate these problems they must first be identified and then strategies devised to overcome them.Whilst in the community with the housing support team the author ascertained that the main problem or cause of problems was communion, whilst ironically, most if not all of the problems encountered could have been avoided or solved more efficiently with effective communication. However the author feels this may be viewed by many as an over-generalisation, and so will break this down further into some of the sub problems. A key difficulty is that working together appears to be the logical way forward, yet it is the authors experience that little consideration is given to the effects of such an activity, (CARLING, 1995 ).From an agencies or professions point of view collaborative activity raises two main difficulties first it looses its freedom to act independently when it would prefer to maintain control over its domain and affairs. Second, it must invest scarce resources and energy in developing and maintaining relationships with other organisations, when the potential returns on its investment are ofttimes unclear or intangible, (HUDSON, 1987). The main sources of contradict within an organisation and inter-professional collaboration are communication, power, goals, values, resources, roles and personalities.As mentioned previous a major source of struggle is the misunderstanding or breakdown of communication. However communication keister also be used as a tool for clarifying contend views. It is the authors observation that most values within an organisation are internalised and are accordingly difficult to change, but they apprise be clarified by means of communication so as not to bec ome a barrier. This miscellanea of logic is a skill that can only be learnt through the application of common sense and the wisdom of experience, (BILLIS & HARRIS, 1996).Conflict situations often arise suddenly, the author has observed that the more populate that attend a meeting or that are involved in a ending regarding care organisation the more potential there is for conflict to occur. cater causes conflict when there are relationships within organisations between individuals of unequal power, the undefiled example being the doctor/patient relationship, or the nurse and the consultant. This can cause additional conflict where there are diversely unified organisations working together as the power differences between individuals then become unclear.For example the power relationship between the community psychiatric nurse and the social worker. Another common cause of conflict is different goals, different methods of reaching those goals, different values, unclear or ov erlapping designation of responsibilities, wish of information and personality conflicts. It is acknowledged within health care that some conflicts can not be resolved, Mallory, (1981) states that unresolved conflicts need to be managed carefully within any work group in order to oddment the level of conflict.Banton, (1985) remarks that the essential point is that conflicts of interest are of fundamental richness in all major areas of life in our society and therefore full consensus is only possible when plenty are prepared to condition themselves to the trivial. Conflict in an open environment can be full to the work environment as when handled in a mature and professional manner conflict can lead to creativity, innovation or growth, however if to much energy is expended in non productive activity then conflict becomes destructive.It is the authors opinion that conflict is an inherent part of the nursing and general health care culture, and that psychiatric nurses in the com munity are prime candidates for this because of the need to work collaboratively with people both professional and non professional of varying social, cultural and educational backgrounds. Collaboration suggests that the combined power of the agencies or professions is distributed evenly, yet nurses are employed in a hierarchical system.Huber, (1996) suggests that nurses find that working in groups creates a situation in which there are a heel of different colleagues and a variety of client types and different personalities to work with, these are complex interrelationships, and added to that complexity is the fact that there are quadruplicate providers requiring co-ordination and communication to manage the care for any client. Within healthcare as a whole there is an interdependence between its members.The multi-disciplinary team breaks down into multiple care providers each relying on the other to carry out a portion of the work. For example a member of the housing support tea m can not monitor a clients medication if the clients community nurse has not organised the Doset box from the pharmacy. The source of conflict can be organisational, interpersonal or a combination of both. Personal and organisational goals and values may also be in conflict with or over general policies, a general policy being the course of action taken by an institution, department or unit.Policies in the main are meant to console conflicts over specific issues, they are designed to give about measuring stick ways to make decisions in recurring situations. However different people within the care team may approach situations with differing viewpoints on how to best deal with certain issues, differences may occur over such things a clerical or managerial routines, or over record retention and information sharing.Clashes may result at the intersection of a nurses professional judgement as an autonomous professional with standardised policies developed by the institution and desi gned to produce uniform behaviour, (AJN, 1987). Resource allocation comes under organisation issues and is especially important in the case of Mr and Mrs Client as the general consensus is that sheltered accommodation of some description is required, which inevitably will require funding. Budgeting has caused conflict over scarce resources within organisations.In the case of Mr and Mrs Client the funding for the accommodation should come from the social services department. occasion conflicts can be both organisational and interpersonal and result in role conflicts. Role conflicts have been identified as being of two types, role overload and role ambiguity. Role overload is when a carer is expected to serve the work of other employees or disciplines in addition to providing their normal care tasks. Whereas role ambiguity is when the role and responsibilities of the carer expands faster than is officially recognised, (JOHNSON, 1994).To assist in making interprofessional collaboratio n joint working recommendations such as those say in Building Bridges, (1996) have been suggested these include commitment on all levels of care approach and delivery, to maintain a primary focus on the service users, jointly owned or shared strategies for care of people with severe mental health problems, agreed cognitive operations for access to services, agreed procedure for information exchange, clarification of roles and responsibilities and regular reviewing of interprofessional dynamics. vretveit, (1997) states that UK policy in the nineteen mid-nineties has asked the question, what is wrong with the service? Rather than what problems need tackling in the outside world. In future it should re-focus on how partnerships between the users of the service, professional workers and managers can be carry outd, in other words how can we make an integrated service very democratic? The solutions to nearly all the crisis encountered by the care team can be or could have been solved or at to the lowest degree minimised through the effective use of communication.It is felt that it would also be important in interprofessional collaboration to have shared values and cultures, while a mismatch along these lines between health and social services has been well documented. (SMITH, 1993). Collaboration is the basis for team building and with the changes to healthcare, work redesign, restructuring and reengineering depend on effective collaboration, co-operation and group accomplishment.Proactive conflict resolution in work groups is the essence of building successful teams which are flexible and adaptable, and have a high degree of trust and communication. Therefore the ingredients for successful interprofessional collaboration may be a common goal, interdependence, co-operation, co-ordination of activities, task specialisation and therefore role clarity, equal division of effort and mutual respect.Team building is defined as being the deliberate process of creating and unifying a group into an effective functioning work unit to accomplish specific goals, (FARLEY & STONER, 1989). In conclusion, collaboration has been called the most effective strategy for managing conflict to achieve long term benefits. However a enormous differential in power (both felt and actual), exists between nurses, social workers, and consultants, and this hinders effective collaboration.Therefore with wide differences in power the most commonly used techniques seem to be compromise and accommodation. There are indications however that this is changing as the health service as a whole is and has undergone some major changes with the murder of the care plan approach, care management and the formation of community teams such as housing support and community support teams, and as a result effective interprofessional collaboration could soon become more commonplace. (BALDOCK, 1974).