Unit 26: Supporting Team and Partnership Working Across Health and Social Care Services

Unit 26: Supporting Team and Partnership Working Across Health and Social Care Services

It’s me – Shoniea!

Introduction

LO3

My perspective of partnership working in health and social care is that it is the foundation of building great practice and the current reflection of the healthcare field shows many shortcomings in upholding partnership working theories in practice. Below is my observation on the outcomes of partnership working and the effects it has on different stakeholders. 

“Partnerships can achieve greater outcomes than individuals or organisations acting alone. Partnerships achieve increased benefits because they share expertise, skills and resources. These benefits can include: more effective service delivery.” (DHHS,2019). 

The outcome of partnership working across different healthcare fields can vary dependant on the stakeholder. The outcome of partnership working is also dependant on the culture, management and structure of an organisation. Different stakeholders in different settings strive for different factors when it comes to the quality of a service. And the outcome can be either positive or negative.

Positive outcomes:

Positive partnership working is very important in health and social care sector. In every walk of life, there is a balance to be struck between the expertise of the single practitioner and the need for cooperation, collaboration and coordination of other experts, especially in health care sector. Positive joint working prevents the consequences of getting it wrong. For partnership working to be positive and effective in health and social care, all partnership members and inter agency working teams must have joint working agreement.

Positive working outcomes for professionals and the service will mean a well organised service, encourage different establishments to work together to achieve a common goal. Effective partnership working means all professionals should have a clear and concise understanding of their work duties and more resources, support and enablement in fulfilling their job roles. Partnership working, effective communication and a coherent response to working can mean more efficient use of resources, effective safeguarding procedures and minimal errors due lack of communication amongst professionals, across services and better access to a wider range of services. This is why NHS work in partnership with organisations like NICE and CQC to have specific standards for achieving excellent practices. This can suggest that for example in areas such as Hospitals within a Partnership Trust the budget can be managed and retained more effectively and the establishment will have a good reputation and pass all audits. Effective partnership working allows for professionals to interact and communicate keeping all parties informed on the current status of establishment news and reduces job related stresses.

Positive outcomes for patients would revolve around what they value within a service. For primary healthcare services such as care homes this would involve things such as, having autonomy of their care, choice and to feel respected valued and taken care of and maintaining their independence. Having effective partnership working will allow for patients to reap the benefits of partnership working philosophies. And especially beneficial to older people who need home or primary care or support. In a agreement paper published by the department of health, NHS and the voluntary and community sector: Making Partnership Work for Patients, Carers and Service Users  stated “people said they wanted more real choices and services that were equitable and responsive to their diverse needs and preferences.” (DOH, 2004).

Looking specifically at Learning Disabilities: Good practice guidance around the commissioning of services for people with a learning disability and/or autism who display behaviour that challenges, including the 1993 and 2007 Mansell reports, describe the need to develop high quality local services that understand and support people, and reduce the reliance on out-of-area placements. They focus on ensuring the best outcomes for people by working in partnership with individuals and families/carers and through adopting person-centred approaches – vital to delivering independence and control for people and ensuring that the person’s wishes and aspirations for their own life are at the centre of their care and support arrangements. The benefits of positive outcomes for people using these partnerships is made much clearer since recently in the news there has been a spate of incidents where families have raised concerns about the out of area placements for their young relatives diagnosed with autism or mental health conditions.

When services work well in partnership with each other and families some positive outcomes can be gained:

Quality of life – people are treated with dignity and respect. Care and support given are personalised, enabling the person to achieve their hopes, goals and aspirations; while maximising the person’s quality of life regardless of the nature of their behaviours that challenge. Positive outcomes include a focus on supporting people to live in their own homes within the community, supported by local services.

Helen Sanderson, a specialist in making person-centred planning work for people with learning disabilities came up with a way how organisations and staff working in partnerships with families and service users can plan and cater for positive outcomes:

We have been exploring an 8-step approach to developing person-centred outcomes.

http://helensandersonassociates.co.uk/health-social-care/long-term-conditions/can-make-sure-person-centred-outcomes-people/

Step 1 - Checking that we know what matters to people

We need to make sure we know and have recorded what matters to the person. This means we can make sure that when we develop outcomes with the person, they will be meaningful to them. One way of capturing this is through a one-page profile.

Step 2 - Where are we now?

It is really important that we understand the person’s specific situation right now, comparing it with the life they have described in their one-page profile and truly understanding from their perspective what the issues are that they may want to address, rather than what we think they should address. One way of doing this is to use the person-centred thinking tool working/not working from different perspectives, including the health practitioner’s perspective. 

Step 3 - Prioritising

Having identified the issues that the person would like to address, they can be prioritised by mutual agreement.

Step 4 - What would success look like?

For each of the issues the person has prioritised, we can start developing outcomes by identifying what success would look like if each of the issues were addressed successfully. This gives us the basis of the outcome.

Step 5 - Test it

There are some simple questions you can ask to test the outcome. Sometimes, outcomes have solutions embedded in them, and asking questions like ‘What would it give you, do for you or make possible for you if you had that outcome?’ can help to uncover the true outcome. Exploring what is truly important to the person specifically regarding the issue can also be useful. This can help us to develop the outcome further to be more specific.

Step 6 - What is getting in the way?

Having identified what the person wants to achieve, we then need to identify the obstacles that may be getting in the way of achieving it.

Step 7 - Creating clear goals/steps and actions

Having identified what is getting in the way of achieving the outcomes, the person can then set goals or steps to address these obstacles and move forward with their outcomes. They will need to be SMART, and they may need resources to be assigned to ensure that they happen.

Step 8 - Record in the plan

The outcomes and the steps and support needed to achieve them can then be recorded in the plan. We should also record how the outcomes will be reviewed.

Partnership working is not only essential but also effective in reaching vulnerable adult within the community. Age UK are a charity that provide support and work in partnership with the local community, council and health services to help the elderly maintain their health, wellbeing and personal independence. Published on their website a touching story of how they worked in partnership to help an elderly gentleman back on his feet. This would not have been possible without the community and healthcare professional's coming together to support this individual. “Thanks to One Croydon - the partnership between local NHS services, GP practices, Croydon Council and Age UK in Croydon, 18 personal independence co-ordinators are helping to deliver co-ordinated support for older people living in the borough.”(Age UK, 2018). They concluded stating “‘through the formation of an inclusive partnership, harnessing the expertise and commitment from across the health and care system we are seeing the difference this is making to older people's lives across the country. One of the magical elements is the Age UK Personal Independence Coordinator – someone who is there for the older person when they most need that "extra arm" of encouragement and support.'” (Age UK, 2018).

  However, there are some common needs that services in any one local area need to ensure they have the capacity to address. There are also some common deficiencies in how services currently address those needs in the community, with the result that, too often, people may end up in hospital (including through diversion from the criminal justice system) at great human cost to themselves and

their families/carers, and when those circumstances could have been avoided. There are therefore, also some common changes that services will often need to make.

Assessing partnership working

Negative outcomes of lack of partnership working across organisations that would affect the clients are; miscommunication between client-carer and professionals -professionals and all other relevant personnel. In a hospital or primary care service this could result in the neglecting of an individual’s needs and the client having a lack of understanding regarding their illness and options. Lack of partnership working can leave clients feeling angry, frustrated and drained especially if; their needs are constantly under met, they have to constantly repeat themselves to different professionals, if there is a long waiting time for a particular service or they can see the disorganisation of a service. 

Importance of partnership working 

The importance of partnership working in social services is extremely vital as in some cases it is literally a difference between life and death. This was the case for Victoria Climbie and baby P. in these cases the outcome for the client as a result of ineffective partnership working was death. Both these children were under the care of social services and had attended multiple doctors’ visits for injuries sustained from abuse. When Victoria died in 2000 a report was initiated and the outcome of her devastating death lead to reforms being made in the children’s Act “Lord Laming report advises complete overhaul of child protection policies. Most of his 108 recommendations become law in 2004 Children Act.” (telegraph, 2010). In 2007 Baby P died “New report by Lord Laming concludes his Climbie reforms not widely implemented” (telegraph, 2010).

These were similar cases of child abuse and neglect. Both children were under social services observations, both attended numerous doctor’s appointments both had police called on their households and concerns raised by neighbour's yet none of these services were able to save these children from their deaths. As the event occurred 7 years apart and 3 years after a new law was passed another more horrific incident occurred. Reports state there was an appeared 60 missed opportunities to save Baby Ps life.

The Victoria Climbre inquiry report stated some factors that are similar in major child abuse cases in an attempt to shed some insight onto why professionals are failing to pick up on such cases. Those factors include, lack of interpersonal, staff and agency information. Lack of skill and competence of social workers, failings to follow procedures and inadequate resources to meet the service demands.

Such failures give a negative connotation to social services and the NHS as a whole as many failures, instances of abuse, harm, malpractice, accidents and deaths within NHS services that have catastrophic effects could be avoided with more effective partnership working. The same connotation can be applied to care and residential homes for the elderly and hospitals.

However some positives for stakeholders came out of the partnership working of government monitoring bodies, the legislative and other organisations and professionals. This was the Every Child Matters guidance under the Children Act of 2004.

Although LAs are at the forefront of the changes, schools and their governing bodies also have a key role in delivering the children’s agenda, for example, by supporting all children and young people in achieving the five ECM outcomes. Furthermore, the new supplementary guidance on the Children and Young People’s Plan (CYPP), issued in January 2007 to complement the existing guidance (HM Government, 2005), placed a duty on LAs to consult schools in the preparation of the CYPP. This duty was placed: to ensure schools and forums have sufficient opportunity to comment on the plan, fully understand local priorities and targets for improving outcomes for children and young people and understand how they are expected to contribute to delivery of those priorities and targets (DfES, 2007, p.12). Schools are also required to take account of the CYPP in their strategic planning to identify and demonstrate how they can deliver the five ECM outcomes. In this context, primary and secondary school respondents taking part in the Annual Survey of Trends were asked about how the ECM agenda was affecting their school and about their perceptions of, and views about, collaborating with other services. Collaboration has remained a key feature of current educational interest and policy development, exemplified by ongoing encouragement for schools to enter into collaborative relationships with each other and with outside organisations.

My findings from research  suggest that in areas such as curriculum development, that are typically the responsibility of schools, good progress had been made in implementing the ECM agenda. Similarly to the 2006 survey, in 2007, schools described improvements or positive developments covering standard aspects of school life, but the main challenge for schools remained the need to develop closer collaborative working with the services involved in supporting children and young people’s well-being.

The Francis report inquiry where hundreds of hospital patients died as a result of low standard of care delivery, and professional failings. These patients endured needless suffering as a result of the hospital being ineffectively managed, poor establishment culture, staff being discourages to speak out against malpractice and chronic staff shortages. All of which could be avoided with effective management and effective partnership working. The struggle in pushing for partnership working is reflected in the fact that in 2007, 3 years after the Children’s Act was refined another child died as a result of the same cause and many more have dies since.

Effects of the Francis report are varied. There has been a drive to ensure that the NHS is the most open and transparent system in the world on key measures of patient safety and patient experience. The Government has placed a new legal duty on all organisations to ensure that, when something goes wrong, patients and their relatives are told about it promptly. Known as the Duty of Candour, it is intended to counteract the legalistic and defensive culture that was found at Mid Staffordshire, fostering instead a culture in which mistakes are acknowledged and learned from. The professional regulators, such as the General Medical Council and the Nursing and Midwifery Council, are introducing consistent responsibilities on individual health professionals so that action can be taken when they are not candid about errors with their patients. This professional accountability is being reinforced through the introduction of the role of the ‘responsible clinician’. As a result, already two thirds of Trusts are now participating in the Name Above the Bed initiative, so that patients and their families now know who is in charge of their case, accountable for their care and responsible for ensuring continuity of care.

Ineffective partnership working

Outcomes of ineffective partnership working for professionals can lead to confusion in terms of roles and responsibilities, lack of communication between service professionals, funding allocation issues and conflict between professors of different professions and differing visions and strategies. All of these factors can lead to professionals feeling overwhelmed at work and add to the pressures of the job. It could also lead to a failing of auditing, disciplinary measures and tarnishing of the organisations reputation if continuous. In social services the effectiveness of partnership working can be the difference between life and death for some individuals.

However, when partnership working in healthcare services is effective and constructive it allows for services to run more seamlessly and has more positive outcomes for all service users. Positive outcomes for clients are; more empowerment and autonomy over their care, their individual needs are more likely to be met, their choices valued and independence encouraged and supported. They should be receiving high quality care and included in the process which will lead to more positive health and wellbeing outcomes. For example, allowing the elderly to live in retirement villages require professionals and councils across a range of disciplines to work together to meet the individual needs. Without integrated working regulations this would not be so frequently possible. 

LO4  My own contributions to working as part of a team

This post is a self reflection of my own contributions to working as part of a team in health care. Working as a healthcare assistant across various primary care settings, where my main duties revolved around supporting individuals in their day to day lives. I was able to observe how the different establishments were run and the level of quality care that service delivers vary.

My roles and responsibilities at work involved spending quality time with clients through meaningful activities, assisting with day to day needs of clients, providing help with personal care, assisting clients with their mobility, assisting with taking the blood pressure of clients, taking the temperatures of clients, monitoring clients progress and reporting back to team care members, taking clients pulse and respiration rate and performing a range of housekeeping duties.

Fulfilling my roles and responsibilities at work most of the time is relatively easy for me as I am caring by nature and take pride in doing my work to the best of my ability and encourage clients to be as independent as possible. Since the work is in shifts many staff sometimes have difficulties honouring their shifts. This can cause problems as the rota are usually made to serve the service users with different staff involved. For example having  at least one driver on shift with a qualified key holder to do medications and a first aider and you need to have other staff catering to the social needs of the clients. These staff are usually able to mix their abilities and swop around on shifts but as you may know many staff are fixed in their minds as to what they want to do on a shift and it may take some negotiations to shift them. Bad feelings can be caused as a result. Also when staff cannot come into do their shifts, you may need someone quickly to cover the shift as calling bank workers may take too much time and sometimes too costly.  Sometimes staff are down because they may have social problems in their lives and this can travel throughout the whole team and even to affect the service users.  I also observe that within my team some staff may not carry out all the tasks they are required to do and sometimes they work at substandard level just to finish the shift and leave.

Even though I was only an assistant my role was important and I took my job seriously and preformed to the best of my abilities so I would not let down the team by not finishing my workload, I was also always happy to help and very easy going. My co workers have often told me I raise the feel of the atmosphere in the establishment and impressed with my caring abilities. As my approach to care was very person centred and once I started working in healthcare I realised the huge gap between putting person centred theories into practice. I liked to think of myself as a role model modelling how people should be holistically cared for. Since  I do not want to embarrass my colleagues and keep repeating myself about ways of working I use the Social Learning Theory a lot to help my team members remember how to work in a person centred way: I become the model for trying to demonstrate good practice on my job so I do what Bandura says in his social learning theory for the  Modeling Process:

The Modeling Process developed by Bandura helps us understand that not all observed behaviors could be learned effectively, nor learning can necessarily result to behavioral changes. The modeling process includes the following steps in order for us to determine whether social learning is successful or not:

Step 1: Attention

Social Cognitive Theory implies that you must pay attention for you to learn. If you want to learn from the behavior of the model (the person that demonstrates the behavior), then you should eliminate anything that catches your attention other than what you need to pay attention to. Also, the more interesting the model is, the more likely you are to pay full attention learn.

I pay attention when in training so I learn as much as I can about how to do my job. I pay attention to the service users when they talk and when they around be to help keep them safe and included.

I make sure that my colleagues are paying attention when I work with them as I want them to see me modelling the correct behaviours. This can be difficult as I may need to be overt in my behaviours and this can look as if I am showing off or trying to upstage my colleagues. This is a challenge for me as I have to work harder at trying to be visible without being on show.

Step 2: Retention

According to Bandura- Retention of the newly learned behaviour is necessary. Without it, learning of the behaviour would not be established, and you might need to get back to observing the model again since you were not able to store information about the behaviour. I have notes in my files at work and on my phone about important things I need to remember with my job. I try to repeat instructions and procedures so I can become more familiar with them so I can carry them out accurately.

I help my colleagues by repeating certain instructions before we carry out certain activities. This is to make sure that we are on the same page and that the activity is carried out correctly and that there is good outcome for all partners involved. An example of this is when I am doing moving and handling activity with another staff to help a service user. It helps when one staff takes the lead, so I usually will cite what is to be done as per the policy and care plan of the individual. For example saying : “Oh I remember that Mary needs to use size medium sling for the hoist”. This usually signals that I am not going to unlawfully lift her like some of my colleagues but will use the equipment available as this is best practice.

Step 3: Reproduction

Bandura says that when you are successful in paying attention and retaining relevant information, this step requires you to demonstrate the behaviour. In this phase, practice of the behaviour by repeatedly doing it is important for improvement. I make sure that I reproduce the correct way of working and interacting with staff and service users repeatedly. They say that practice makes perfect and by doing things consistently I become better at doing it. This helps my team develop and become proficient and also helps eh reputation of my organisation and myself. The service uses are also pleased with the outcomes and their families.

Step 4: Motivation

Feeling motivated to repeat the behaviour is what you need in order to keep on performing it. This is where reinforcement and punishment come in. You can be rewarded by demonstrating the behaviour properly, and punished by displaying it inappropriately.

I try to make myself open for people to talk to when they are down and I try to keep a pleasant personality and be polite at all times. I sometimes am the one that does the whip-around for birthday cards, cakes and dos for people going through significant life events whether positive or negative.

As you can see the theory approach has many positives for partnership working and for individuals involved. One strength of this theory is that it has cognitive, cultural, and biological aspects involved in it. On a cultural level, this theory explains how cultural behaviour may be passed on by observations. On a biological level this shows how mirror neurons play a role in imitation. Mirror Neurons are Neurons that fire signals when behaviour is being imitated. Finally, another strength of this theory is that cognitions are involved in the process. Attention and retention are large parts of the process. Because you must attend to the behaviour of the model to learn that behaviour must then go through retention in the long term memory, so that it can later be retrieved and reproduced.

Limitations of the theory includes the fact that just as easy as it is to learn good behaviours through observations, it is just as easy to learn bad behaviours the same way. So staff can observe good behaviours from me and pick up bad behaviours from each other’s too.  So I cannot overestimate my value to the team on this basis although people say that by modelling good behaviour such memories does not leave the onlookers. The fact is at least the know how to act because it has been modelled so they have no excuse for not doing it.

One of the main barriers as mentioned previously I often experienced during my work experience was lack of staffing. I understand how if one member would slack in their duties it would affect the rest of the team especially if we were already short staffed. This made me work extra hard and fast. I shamefully admit that during times where there were too many tasks to fulfil and not enough time to complete them in I would sometimes rush the care of clients and not ‘waste time’ by allowing them to do some tasks themselves first or explaining what I was about to do. My standard of care had lowered as I was under time constraints and being new, young and ambitious to care I did not want to feel like I was a liability or let down to my co-workers or manager so I allowed the level of care I delivered to be compromised.

I need to try not to harbour feelings of superiority in myself as this is easy to do when you try to model behaviour for others. Many of the people who I work with have been working in care for much more years than I have and know so much better than myself so I need to be humble in my approach. If I do not do this I will put people off from observing and copying my lead.

Because I am so acutely aware of my role as a team member and that I need to be there for my colleagues, I sometimes behave in a super human way thinking that I can do many things and that I have to DO many things by myself or else it will not be done well. This can wear me out and a few times I have gone off sick but in reflection I realise that it is because I have trying too hard to do too much on my own. This stops me from asking for help sometimes.

 This sometimes creates tension within the team as it means someone else has to pick up the slack and an increased workload for others. This situation also makes me feel uncomfortable working with certain staff and reluctant to have any kind of conversation (or ask for help) with them which can sometimes lead to a communication issue that eventually affects the client’s needs being met. This situation means I am adding to the pressure of being understaffed and shows I am not competent or confident in my job role. So here are some things that I have learnt – I hope they will help you to be a better team worker :

 Speak to you soon!