Enhancing Healthcare System Through Multidisciplinary Collaboration: A COPD Patient Case Study

Introduction

The improvement is a continuous process to maintain a sustainable healthcare system with most effective outcome. In this regard collaboration of different types of sectors lead to improvement of the whole system. Brandrud et al. have discussed the role of multidisciplinary team (MDT) in continuous development of healthcare sectors using different success factors (Brandrud, et al, 2011). In this essay the self-review action plan will be discussed within a case study scenario, where the patient has chronic disease here COPD and readmitted to hospitals under emergency condition (See appendix). COPD is a special condition where inflammation in the airway of lungs causes severe obstructions in air flow. Agusti et al. have discussed on heterogeneity of COPD using a cohort study (Agusti, et al, 2010). Moreover, it also has genetic origin as explained by Regan et al. (Regan, et al, 2011). The interventions for such chronic diseases need involvement of multiple team members from different disciplines. Therefore, formation of this collaborative framework is necessary with discussion of leadership and management theories. Moreover, inter relationship among team members should be good enough and should be inclusive in nature. In this essay the importance of the above stated theoretical framework shall be discussed in the light of a case study model to provide a more practical understanding of healthcare development in a critical way.

Skills and behaviour required for carer progression

Self-improvement using reflective model:Reflection about own effectiveness is necessary for the self-development. Dimitriadou-Panteka et al. have discussed the role of personality growth on effective improvement of professional efficiency of nurses (Dimitriadou-Panteka, et al, 2014). In a cyclic process of reflectiveness one can get the positive and negative sides of own behaviour and this in turn contribute to the development process in a most useful methodical way. In this regard, it is important to note that, Driscoll’s reflective model has deep rooted implications in evidence based practice for self-improvement. The outline of the model is made up of three question, ‘WHAT?’ ‘SO WHAT?’ and ‘NOW WHAT?’. This kind of segmented view simplifies a problem by resolving the components of the key problem. In ‘what’, a description of event is given and this process stress on key experiences during the study. Then comes ‘so what’, this analyse the situation and assess what lead to such a good or bad situation, then comes ‘now what’, to chart down the actions and plans that will be followed to get best outcome. Driscoll et al. have discussed the role of constant improvement in quality of nursing in-spite of the huge workload and busy schedule of the nurses (Driscoll, et al, 2019). For COPD patient the frequent follow up process, which is a continuous process, needs intervention of several persons involved with the patient’s care. Here ‘What?’ deals with the critical sides of the problem, ‘So What?’ deals with the analysis, which according to the case study is, the emergency condition of the patient due to negligence of some key self-awareness criteria. Therefore, ‘Now What?’ that is, the future plan should emphasise on more stress on the self-awareness which can be done by involvement of a multi-disciplinary team. The outcome of the reflective model stress on the delegation of duty among several competent parsons and improvement of self-managerial quality to get most effective outcome. Moreover, it allows to resolve and segregate the thought processes necessary to define the action plan which in case of COPD deals with development of personal managerial qualities and leadership aptitudes. Sims et al. have discussed the role of critical reflectiveness in inter-professional team working (Sims, et al, 2015). Reflection imparts positive instructions for team training and management (Stocker, et al, 2014). Kennedy et al. have discussed the positive role of reflective practice for the caring of COPD patients (Kennedy, et al, 2011).

Management and leadership skills:Organization and management of work force is inevitable in integrated care delivery job. This process is not simple if the nursing practice devoid management and leadership skills. Management deals with creative ideas for solving problems in an organization. Sometimes it becomes synonymous with administration skills. (Kelly, 2011) Moreover, during the practice of nursing several critical problems and risk may arise which need proper managerial interventions to get resolved. Slemon et al. discussed the role of nurse in critical risk management (Slemon, et al, 2017). The management theories are useful to understand and grow, the key managerial skills necessary for patient management. In case of chronic COPD patients integrated healthcare has long standing effect in wellbeing and management and leadership skills are very much necessary to run an integrated collaborative care delivery process. McDonald et al. have discussed the role of clinical management in case of COPD patients (McDonald, et al, 2011).

The classical management theories that are useful for nursing practice are:

Scientific management theory, focusing on goals and productivity. In this theory an organisation is considered as a machine needed to be run most efficiently and effectively to get maximum output. The duty of the managing person is to look after the working standard and they should regularly take care about the clinical tours and equipment. Training and education is also necessary in this regard to properly carry out the quality work. (Bell, et al, 2012)

Bureaucratic management theory, however, focus on the communication transmittances from top to bottom of a hierarchical chain of workers. Here the work is done using the ordered way of technical competence and transformative regulation. The team members are constantly appraised and promoted on the basis of work quality. (Sturdy, et al, 2016)

Administrative management theory focuses on scientific management and principles of a particular organisation and applies the most suitable way they fit. It focuses on planning, organization, staffing, direction, coordination, reporting and budgeting, in short ‘POSDCORB’. (Hill, et al, 2014)

Another important theory which deals with human relation called human relation management theory is worth to mention here. It focuses on the wellbeing of individual workers in a team by a microscopic management to increase productivity. (Bratton, et al, 2017) Hawthorne effect is part of this theory which believes the relation between the team members and the managers as well as among the team members is the sole determinant of organizational efficacy. In short the theory deals with workers anatomy and participatory decision making as the key determinant of effective nursing practice. (Sedgwick, et al, 2015)

Along with management skill it is necessary to be a good leader to effectively run a team in order to achieve the management model in a most effective way (Sullivan, et al, 2010). Leadership can have different faces, however, theoretically they can be described as,

Autocratic leadership in which the nurse is at the top position of management and using his/her managerial skills the team gets the proper direction. However, this is a bit straightforward way of strict legal or medical interventions and lacks the scope of question or dissent. (Giltinane, 2013)

Laissez-Faire model is opposite in nature with respect to the autocratic model. Here the team members work in a self-directed manner however, this is applicable only when the team members are experienced enough to do their job. (Aboshaiqah, et al, 2014)

emocratic leadership is another variation of nursing leadership in which the leader gets input from the subordinates to run the system. (Giltinane, 2013)

Transformational leadership is a skill based leadership where, the manager looks upon the big picture of patient care improvement and betterment of the system. The manager in this process transforms his/her key skills to the team members and inculcates changes in the system for improvement.

For a COPD patient as stated earlier a holistic care is necessary and therefore the managerial action plans should include a evidence-based proper practicing by using the most appropriate management and leadership model. It is worth to mention that multidisciplinary approach towards holistic care needs proper management of human resource and human relation management is necessary to make the collaboration more effective. Valentijn et al. have discussed the role of workable relationship among the team members in success of multidisciplinary care (Valentijn, et al, 2013). This management also deals with empowerment of the team members and according to the theoretical background of multidisciplinary treatment, each member in the integrated network should have proper toolkit to run their job in most effective way (Lundell, et al, 2017). The management skills in my opinion will be most effective for self-development as it deals with positive interaction with experts from multiple discipline. Moreover, this will also involve the family members of the patient which will also be useful to fulfil the ethical sides regarding consent seeking and discussion process. Leal et al, have discussed the role of clinical management skill in maintaining ethical values in nursing practice. COPD patients are treated in the best way of self-management process. The older patient like Mr. H due to lower cognitive efficiency, old age needs rigorous management process to aware the team members about the good health behaviour. Which needs effective transformation of self-management knowledge. Tyson has stressed on the role of transformational leadership in inculcating the changes in a team (Tyson, 2016). This is another important issue for COPD patient where sometimes change is necessary to solve emergency conditions, like in case of current scenario.

Importance of collaboration, multi-disciplinary team and interprofessional working

Collaboration in nursing is an inevitable pathway for effective care delivery. The collaboration among patient, family members and different health sector members needs proper communicational, managerial and leadership skills. In current scenario of an old age person with lower cognitive abilities need collaborative effect from nurses, carers, doctors, family members and social workers. Rivas et al. have also stressed on collaboration in the care giving of the COPD patient (Rivas, et al, 2010). Interprofessional working is another part of collaborative care delivery is necessary to address in current scenario. This enhances the strength of collaboration by most efficient way of data sharing and communication between the nurses and clinical experts. This is an interactive pathway where the team members constantly engaged in interaction with the patients as well as with the team members.

Collaboration gives good result when a multidisciplinary team (MDT) gives a comprehensive care to the patient. In general a multidisciplinary team is composed of general practitioner, practicing nurses, community nurses, medical specialist, physiotherapist, health psychologist, social workers and many other experts according to requirements. In COPD multi-disciplinary model provides a complete treatment by pulmonary rehabilitation, self-management, nutritional as well as psychological interventions. Fromer has argued on inevitability of collaborative multidisciplinary care teams for emergency COPD management, going beyond primary care practice (Fromer, 2011). In a patient centred care for old age people with lower cognitive abilities, multidisciplinary teams can also help the patient by providing the nitty gritty of COPD education. This process also help in decision making (Aboumatar, et al, 2017).

As a future assistant practitioner self-awareness in a collaborative team is necessary to explore. Moreover, the proper reflectiveness can be helpful in this way to enhance the self-efficacy and to play a commendable role in clinical practice. In career development socialization with the working environment is very important. Interpersonal collaboration have played always a positive role in this regard (Price, et al, 2014).

Importance of effectiveness to create positive relationships

In a collaborative environment relationship among the team member is very important to obtain fruitful outcome in the whole process. Positive relationship by proper coordination in a rational way is necessary which in current scenario was done within clinical board meetings. Inclusiveness of the team members is a key of achieving best results from multidisciplinary team work. This process allow to reduce the bottlenecks of caregiving by exposing skills, knowledge and collective intelligence (Grossman, 2012). For growing self-awareness positive relationship is very important within a collaborative work model. The positive inclusiveness can become helpful in work-based educational development, a key self-awareness process in nursing (McDonald, et al, 2012). As stated earlier in current case study a plan of clinical practice was made on the basis of transformational leadership model, of which empowerment of each member is a key positive relationship trait. In a multilevel model, empowerment significantly enhances the performance of the individual in a team. At a team level empowering incorporate professionalism in team performance (Hill, et al, 2016). Negative relationship like conflict, should be always eradicated to avoid any kind of denomination of team performance. Self-awareness as self-development should be effective enough so that using managerial tricks such conflicts can be avoided (Giltinane, 2013).

Conclusion

Enhancing self-effectiveness should be practiced each and every time in case of clinicians to nurture and harness skills, efficacy, knowledge and administrative abilities. The attitude of improvement should be reflective in nature in which self-questioning can improve the quality of understanding. For a multidisciplinary team management this self-awareness plays a crucial role which comes out in a best way by grassroot management and transformational leadership. However, within a team the manager should perfectly be aware of his/her own qualities. Collaborative work can also be a good source of gathering interdisciplinary knowledge which in turn becomes another source of self-development.

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Appendix

Case Study: Mr. H who is 74 years, a chronic obstructive pulmonary disorder (COPD) patient readmitted under emergency in the hospital for treatment. The case history shows Mr. H was admitted few months ago with the same medical conditions. He had congested throat with high tendency of bronchial pneumonia. Medical team checked him along with proper care from the nurses and the carer and after seven days he was released. However, this time a series of additive follow ups were suggested with consultation among multidisciplinary team (MDT) to avoid the risk of readmission, unlike the previous interventions.