Multidisciplinary team working: Collaboration and conflict

Abstract

The aim of this paper is to report on findings identifying some of the difficulties encountered by the multidisciplinary team in the development and implementation of a care pathway for patients diagnosed with schizophrenia. Policy direction has shifted towards greater team working and blurring of professional boundaries. Moreover, there is greater need to deliver care according to set standards and for patients to reach particular outcomes of care. Care pathways are relatively new for psychiatry and will potentially uncover tensions within the team. Data were collected by participant observation and semistructured interviews over a period of 12 months on an acute psychiatric unit. The care team developed the care pathway and the process of development and implementation was observed through action research. Cross-sectional indexing was used to analyse the data, and themes were developed using interview and observational data collection methods. Clinicians argued strongly for clear role boundaries but also defended their perceived control over health care from other professions. The findings indicate that designing a care pathway for people with schizophrenia may produce conflicting perceptions from the team. Conflict may arise through professions being unwilling to accept plurality over roles, which may hinder progress in meeting the needs of patients. The findings also counter the impression that care pathways can be implemented with little impact on the team.

Nursing handover within mental health rehabilitation: An exploratory study of practice and perception

“…However, the nurses in this study underestimated the value their unique care activities would have to nursing handover. Perhaps their activities were not clearly acknowledged within the broader domain of mental health rehabilitation practices or the voice of nurses as a singular group had been 'displaced' by others (Jones 2006).…”

“…Mental health rehabilitation services utilize a multidisciplinary team approach with collaborative coordination of patient care (Jones 2006;NSW Health Department 2002;Pratt et al 2007). Each professional group contributes their own knowledge and experience, with none seen as being superior over another (Stanton & Tooth 2005).…”

Evidence of collaboration, pooling of resources, learning and role blurring in interprofessional healthcare teams: a realist synthesis

“…However, one study found that a lack of role clarity could also trigger role blurring, as when a new, poorly defined role was introduced into a team, the post-holder undertook a variety of tasks falling outside of their remit in order to gain acceptance from their colleagues (Willard & Luker, 2007). Role blurring was also strongly influenced by the individual attitudes of team members (Booth & Hewison, 2002;Clarke, 2010;Jones, 2006;Long et al, 2003;Nancarrow, 2004;Proctor-Childs et al, 1998;Smith & Roberts, 2005). For example, those who felt insecure or less confident in their role were more protective of it and less willing to blur role boundaries than those with professional confidence.…”

Taking advantage of dissonance: a CPD framework

“…It is a complex social phenomenon and is recognised in the academic fields of politics, psychology, management and international relations.. Although conflict has been greatly researched in psychology and management it can be argued that it is still in its infancy in the academic field of health and social care (see Elston and Holloway, 2001;Reese and Sontag, 2001;Jones, 2006 andGraboury et al, 2011). Moreover, it has not been extensively used to consider the organisational dynamics that exist within a children's integrated service.…”

“…The work of Baxter and Brumfitt (2008) and Jones (2006) denotes the fact that health and social care professionals have their own value base which dictates how they carry out and also accomplish tasks (Carpenter, 2002). As stated earlier, Frost and Robinson (2007 p.191) found that professionals made use of different explanatory frameworks in order to decide upon the task and the nature of the intervention; for example social work practitioners made use of the developmental risk and protection model, health service practitioners the medical model and educationalist an attainment model.…”