Interprofessional Collaboration between Physicians & Nurses - Group Project

Insufficient man power, Physician/Nurse/Patient CRY together

In early time, the relationship of physician and nurse is absolute superior-subordinate relationship where physician did all the diagnosis and treatment, medication and prescription while nurse was only to carry out physician’s instruction without any analysis required, nor any participation in decision making.  Physician orders while nurse conducts, single way of communication only. 

Advanced technology increased the population worldwide so as the demand in healthcare.  The number of physician is insufficient to cater the increasing need and the more complicated way of treatment.  Fostering a physician is way longer than fostering a nurse.  So gradually, some preliminary diagnostic work of a physician has delegated to nurse.  As nurses are more and more well educated, they are capable of taking up the simple work of physician.  Nowadays, nurse has shifted to a more advisory role doing the early diagnosis work, participated in analysis and research, and then to provide plans to the physician.  The physician will then, according to the information and advice given, evaluate, decide the course of cure, and continuously cooperate with nurses during the course of cure.  The social gap between physician and nurse is gradually decreasing.  Nurse has greater responsibility today.  Communication is more two ways as physician today is more willing to listen and discuss with nurses for the benefit of the patient.  They have become partner rather than the former leader and follower relationship.  A doctor is unable to cure a patient by themselves today.  In the earlier doctor-centric approach, the doctor design and decide everything rigidly without considering the unique needs of different patient.  Insufficient and inexperienced man power have led to many medical blunders[1].  With the raise of curing complexity, doctors were unable to perform all task by themselves.  Some jobs had to be delegated to nurses unavoidably.  The psychodynamic function[2] hence became more ‘adult to adult’ rather than the earlier ‘adult to child’.  Doctor and nurse now form a HPT team[3], created synergy that improve

1) production to cure more patients,

2) quality and responsiveness to shorten the hospitalization, and

3) creativity to tackle the newly found illness and virus.

Shortage of physician has led to the raise of nurse’s profession.  At individual level, physician and nurse works fine as a team[4] that improve retention and morale, and as well allowed greater flexibility in back up and job rotation.  At organizational level physician was not quite willing to share their task to nurse.  But with the scarcity[5] of available physicians they compromised.  Training a physician requires at least 5 years while a nurse require about 2 years only.  Historically, nurse was a low end job that didn’t require much education.  Highly educated people would not choose to become a nurse.  They either chose to become a doctor or outside healthcare industry (exp. financial sector).  However, through decades of economic fluctuation, people realized that healthcare industry is more stable and it has attracted more educated people to enter the industry that eventually enhanced the individual nursing quality which later allowed them to share the doctor’s work.  Education therefore played an important role in fostering such inter-professional collaboration.  Looking ahead, more and more professional task will be assigned to nurse to improve the healthcare outcome which will further deepen the interdependence, as well as the conflict in the organizational level.  The social distance between physician and nurse will one day vanish for sake of better healthcare quality.

Analyze the Global Forces and International Context

The global forces and international contexts that influenced the history are concluded in three major contexts. 

(I)  The demographics of Ageing

The ageing population has emerged as a major demographic trend worldwide. According to the UN Population Division in 2009, 1 in 5 people are expected to be 65 or older by 2035. The trend caused an increasing of life expectancy and pressure on health care cost.  Together with the advanced technology, the health care system became more complex. Health system and policy are continuously reforming due to the ageing phenomenon globally.  In the modern health care environment, we have discovered 4,000 medical and surgical procedures. There are 6,000 drugs that doctors now licensed to prescribe. Doctors can't know it all and can't do it all by themselves. A new interprofessional collaboration is emerged in the health care industry.

Source : http://www.transgenerational.org/aging/demographics.htm#ixzz2ykX0GdMj

(II) The specialisation of the medical system

The 21st century medical care involves numerous fields of science. All health care workers are specialist and responsible for a piece of care.They were trained up as independence, self-sufficient. It might be the main cause about the medical error.  80% of medical error was due to the mis-communication between health workers. We need the health care team work like a pit crew through a inter-professional collaboration.  This is to provide an integrated and seamless patient care so as to enhance the patient and health outcomes.  Such practise can help to reduce service duplication/mistake and health care costs.

(III) Irreversible accountability on health care professionals

The health care reform pushes a greater accountability to health care professionals on the patient safety issue.  The working relationship between physicians and nurses were tension and hierarchy before due to power and gender issues. (Sirota 2007) They are subject to a “Task Conflict” “Process Conflict” and “Relationship Conflict” and the sources of conflict are major due to the differences in power, status and culture.  It is dangerous when nurses would refrain from communicating concerns to those higher in the decision-making structure. A new interprofessional collaboration is necessary to make sure the team is effective functions. This is so called a “Participation-based” approach to manage the conflict with the aims to empower stakeholders and improve the relationship by expressing, exploring, co-creating and reframing the working relationship. (Mcallum, 2003)

Source : Healing the Hospital Hierarchy

(IV) The new form of communication

The new form of communications caused the breakdown of traditional health care silos. Nowadays, consumers can communicate and reach the public in the form of Facebook and digital forms of social media. Their “Expertise Trust” on the health care professionals is shocked by the “Third opinion” from the social media.  According to B.Japsen (2012), the changes are fuelling a trend of patients and consumers “self-treating and self-medicating” leaving leaders in public health and health care with the challenge of coordinating their efforts to make sure consumers understand what they get is accurate and effective. According to Frank Capek (nGenera Thought Leader), the customer experience is the essential point of value creation today, and collaboration is a critical element of the customer experience. The interprofessional collaborative patient-centred practise is increasingly advocated as a means for improving patient outcomes and the cost effectiveness of care in variety settings from primary health care to acute care to rehabilitation. (Aaron K. Chan, B Pharm, Victoria Wood)

Project & Predict

The patient-centred care transformed the interprofessional collaboration practise. Such practise is extending towards patient and physician relationship. All of the collaboration is built on the values of trust, empathy, respect and honesty, which are all the elements of a performing team.  In order to sustain the collaborative practise, the interprofessional education is redesigned as to foster a common ethical value and new partnership working culture between physicians and nurses.  The industry is also subject to the knowledge management drives like technology infrastructure, globalisation, demographics and quality. The advanced technology advocate the self caring.  Hospital might no longer be the only place for medical care.  In the foreseeable future, the rapid advancement of technology will transform the medical care in anywhere and focused on networking.  The interprofessional collaboration could transform to a virtual team with specialist from all over the world  to take care a patient.

Eric Dishman: Health care should be a team sport

Ted Talk - Eric Dishman

Reference:
[1] http://hkhclib.wordpress.com/en/

[2] Peter G Northouse, Leadership – Theories and Practices, sixth edition, chapter 13 Psychodynamic Approach, p319 to 347

[3] Frank Yu, MGT 6209, Building High Performing Teams, slide no. 4

[4] Frank Yu, MGT 6209, Building High Performing Teams, slide no. 3

[5] Robert B. Cialdini, Harnessing the Science of Persuasion, The principle of Scarcity, page 78

(6) Don Tapscott, Tammy Erickson, Lynda Gratton, Rob Cross and Frank Capek, “Building the Collaborative Enterprise – Ten Questions to Ask about Business Opportunities through Collaboration”, nGenera, 2009 Boardrook Imperative

(7) B.Japsen, “Leaders In Public Health & Health Care Urged To Move Beyond Silos”, Robert Wood Johnson Foundation Blog, http://www.rwjf.org/en/blogs/new-public-health/2012/10/leaders_in_publiche.html

(8)  Diane W.Shannon, MD, MPH; and Leigh Ann Myers, RN, Sept/Oct 2012, “Nurse-to-Physician Communications: Connecting for Safety” (PSQH) http://www.psqh.com/september-october-2012/1405-nurse-to-physician-communications-connecting-for-safety.html

(9) Transgenerational Design Matters, Website: 
http://www.transgenerational.org/aging/demographics.htm#ixzz2ykX0GdMj

(10) Hazelj. Schattschneider, RN,SC,  “POWER RELATIONSHIPS BETWEEN PHYSICIAN AND NURSE” Vol 6, No. 3 Human Medicine Health Care, http://www.humanehealthcare.com/Article.asp?art_id=275

(11) Hazelj. Schattschneider, RN,SC,  “POWER RELATIONSHIPS BETWEEN PHYSICIAN AND NURSE” Vol 6, No. 3 Human Medicine Health Care, http://www.humanehealthcare.com/Article.asp?art_id=275

(12) Hazelj. Schattschneider, RN,SC,  “POWER RELATIONSHIPS BETWEEN PHYSICIAN AND NURSE” Vol 6, No. 3 Human Medicine Health Care, http://www.humanehealthcare.com/Article.asp?art_id=275

Group Blog Assignment : Responding to the Audience Comments on the Group Video

Be Friend of the Sea or the Murderer of the Future?
 

First of all, thank you for your comments. I do admit that there is still a lot to improve in our video. Your idea and comment is valuable to us, especially criticism is always a positive motivator for people to improve. And yes, we believe we should also include some sea bed, boats and fishing pictures so that the video would be more coherent to the missions of FOS. Perhaps pictures of those ban trawling that harms the sea bed. Bascially FOS promoted the idea of 'NOT over digging from the ocean'. As we were targeting the Hongkonger who might not be familiar with WHAT is over digging. Hong Kong is now a very developed city. Fishing industry seem to be too far from the generatin X so we adopted a more popular topic in Hong Kong which is shark killing. Eating shark fin is good to your body, especially to your skin. They are valuable and expensive. Chinese people or let's focus onto the Hongkonger therefore love shark fin soup for dinner so much to exhabit their wealth as well. So because of its demand, finshers kill sharks heavily to obtain their valuable fin for selling to the Chinese market. And if we keep killing and killing endlessly, they will extinct one day such as all other kinds of species. Understood from your comment that you don't like shark at all because they are such a dangerous sea creature. However, isn't that's just their instinct to kill for survival as all other kinds of creatures (including human being). You may agree or disagree, but we do believe that all animals in this planet deserve some rooms to live. If we keep hunting and hunting greedyily without leting them reproduce, people will not have enough fish to eat one day. The message is if we wish to sustain our future, we start saying, telling yourself and other people doing what we need to do today. Pass the message out, role modelling yourself to spread the idea across HK, as well as to the world.

After reviewed all the comments, the most issue that people addressed is the bloody fish pictures and the shark fin images.  Although comments were subject to different perspectives, they shared a common characteristic.  Audience tend to pay more attention to those images in relation to the "Pathos" clusters (Aristotle's Rhetoric), talking about the persuasion tactics that inspire the audience emotions.  In our video, we intentionally putting lots of bloody fish and shark fin images to make the audience think guilty.  This is our purpose to persuade audience using their affective emotions for appealing.  And it proves its a right approach. Audience tend to remember those things that can arose their emotions rather than cognitive thinking.  Not only the pictures, so as the background music can impress audience. There are few comments specify that our video song made them patience to stay focus on our lengthy video.  It gave me an insight that the human 5-senses are important in persuasive efficacy of video.

Another insights about persuasive efficacy that we learnt from the comments is about the tactics to "Frame for common ground".  We are not only trying to frame the common benefit in saving the sea, we frame the common culture of Chinese about the custom eating the shark fin in wedding party.  That common culture made us be part of the murderer of the extinguish fishes.  The photos provide evidence that able to persuade audience to re-think our consequences of the common behaviour.  Few comments agreed that only few pictures that can arouse their guilty feeling.  This is another way to connect the audience by framing a common ground of our argument. This is based on a solid understanding of our audience background that make their positions come alive.

Be 'Friend of the Sea' ??? or the murderer of the future???

Common Sense

This is common sense, every resource in the earth has a limit.  Harvesting it too heavily without letting it rest and reproduce, you will empty it one day.  Overfishing is definitely a PROBLEM[1].

Friend of the Sea (FOS) is a NGO based in Italy promoting and certifying the sustainable fisheries and sustainable aquaculture (both the wild and farmed seafood).  Rather than building barriers and impacting with fisheries directly, FOS helped to protect the sea from heavy exploiting in a more curvy way.  For companies that satisfy the strict compliance and criterion after the audit will be certified the 'Friend of the Sea' logo in their products.  The audit is run by an independent ISO accredited certification auditor.  Measurements are different among species.  You pass?  Congret!!!  You get the logo in your product and the world knows that you are friend of the sea, friend of the earth indeed.  You help save the sea?  People will reciprocally purchase your product as a repay to your kindness.  As what the other ecolable does, FOS arrange events as well as created a comic/cartoon character – Friend of the Sea Hero to promote ‘saving the sea’.

http://www.friendofthesea.org/index.asp

Basically the key to 'Friend of the Sea' is sustainable by not over exploited - the less you exploit and better the way you consume, the more are preserved for the future.  The ecolabel is mainly funded by the annual royalties paid by the certified companies.  50 out of the 75 aquaculture producers worldwide who requested the audit have been successfully certified.  Around 86 fisheries and fleets are being certified around the world as well.  You may not be familiar with the fishery and aquacultural names but some of the major retail participants are Carrefour Italy, Coop Italia, Eroski, Manor and Finiper.

Is it that difficult to satisfy the below criteria?

Brief aquaculture criteria as follow quoted from http://www.friendofthesea.org

• no impact critical habitat (eg: mangroves, wetlands, etc)
• compliance with waste water parameters
• reduction of escapes and bycatches to a negligible level
• no use of harmful antifoulants, GMOs and growth hormones
• compliance with Social Accountability
• gradual reduction of carbon footprint

Brief criteria for fisheries are as follow quoted from http://en.wikipedia.org/wiki/Friend_of_the_Sea

• the product should not originate from over exploited (nor depleted, data deficient or recovering) stocks
• the fishing method should not impact the seabed
• the fishing method should be selective (below the world average for discards, which in 2005 was about 8%).
• the fishery should respect all legal requirements.

Now, lets watch the video

So how does the above video persuade other people to become friend of the sea?

Stream fresh fish, especially the rare deep water fish is one of the favorite main dish in Chinese culture.  Shark fin soup is a must for wedding banquet in Hong Kong society as well.  In general, Hongkonger are seemed as materialized and Consumerism[2].  They value quantity of life rather than quality[3].  They like to compare themselves with others and wanted to look good in front of the others.  So when inviting other people out for dinner, Hongkonger would always order rare and expensive seafood to reflect their wealth and as well as to emphasize the importance of the invitees.  This is the culture and it is like some sort of endless chain reaction that will never stop (if we don’t stop it now), and this cannot be changed easily.  However, nowadays most of the generation X are well educated in terms of environmental protection.  Consumerism though seems the dominate value in the city. However there is a Hong Kong City-State Autonomy Movement recently[4].  The city is evolving.  They all know that this is a right and ethical thing to do as a human being.  But wait, someone else will do it, why me?  Let me ask you a question here.  Have you ever been in a crowd transportation hesitating whether or not to give your seat to an elderly.  As soon as someone gave their seat faster, you regret and blame yourself about your shyness and hesitation.  And as soon as another elderly comes, you give them your seat right away to repay the debt.  Hongkonger are just sometimes to shy and to slow to the right behavior.  If someone can lead their way, they will follow right away.  (For more details about this phenomenon, check this video out on youtube - http://www.youtube.com/watch?v=fW8amMCVAJQ&hd=1)

Local people advocate the protection of our own place/own value/own language. This is the foundation of our video that we want to save the ocean in order to save our home. Everyone can work on it by just simply purchase the accredited seafood product. Consumption is the key activity in our place. Instead of reduce the consumption, we are promoting a good consumption habit. Gen X is the biggest spenders in HK and they are the key decision maker for dining out. They are our target group of the video. With considered they want to eat the high quality of food like shark fine and Salmon. That's why we put those pictures in the video so as to make them feel guilty and hope they will return the society by new consumption habit.  So in the above video, we are trying to arose the hidden sympathy of the video reader by adopting the ethos, logos and pathos of persuasion as well as by the six persuasion techniques learnt from the article 'Harnessing the Science of Persuasion' by Rober B. Cialdini.

In the video, we have quoted some findings from some professors to enhance the creditability of the video/speaker (Ethos).  We then shown the audience some cruel pictures to make them feel guilty (Pathos).  We also included some real pictures, statistic and solid facts about what the reality is like (logos) in the video.  We tried to convince them by facts.  And we also adopted the Liking, Reciprocity, Social Proof, Consistency, Authority and Scarcity as follow.

1         Liking – we praise/appreciate the people in Hong Kong about their effort spent in pervious environmental protection.  For example, Hongkonger helped pick up plastic bits leaked from a sinking ship on the beach.  This is to uncover real similarities and offer genuine praise[5].  This is to establish a positive relationship between the video and the audience.

2         Reciprocity – we tried to express that sea/fish has given us the nutrition for our growth and survival and we should therefore in return treat them well.  The hidden message here is that if the fishes are all gone, will human being be gone too?  We should therefore repay in kind.  Give what you want to receive[6].

3         Social Proof – logos of famous retail participant and famous artist in Hong Kong are also supporting this mission as people follow the lead of similar others[7].

4         Consistency – at the end of the video we asked the audience to like and share it out to others as people align with their clear commitments.  By liking the video and sharing it out to friends, their commitment becomes active, public, firm and more importantly people are more committed to what they voluntarily admitted[8].  In this case, buying the FOS labelled food.

5         Authority – names and titles of famous professors in the video acts as the authority as people are more deferred to words of experts[9].

6         Scarcity - People want more of what they can have less of. We are trying to highlight the possible loss of the valuable food source instead of what people stand to gain[10].

Summary – this isn’t the end

To summarize, We were trying to engage the reader's emotions by means of arose their sympathy -->guilty --> frame our goals by establish the common ground ---> vivid examp[ole --> connect emotionally with emotions.  Working along in this assignment, we also realized how important for us to save the sea so to save our future.  We do hope that the video we made in youtube can be some of our minor contribution to persuade the Hongkonger to start purchasing the FOC certified product in order to sustain our future.

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[1] Dr. Daniel Pauly, Professor and Director of the University of British Columbia's Fisheries Centre, 2006, why is over fishing a problem from http://overfishing.org/pages/why_is_overfishing_a_problem.php

[2] Lifestyles And Consumption Habits Of Four Generations Of Hong Kong Consumers Revealed By Synovate, 2010 from http://www.marketresearchworld.net/content/view/3069/77/

[3] Muster, Maxine, A critical analysis of Hong Kong political culture: Apathy and activism, 2011 from http://lbms03.cityu.edu.hk/oaps/ais2011-4012-mma760.pdf

[4] Stuart Lau and Dennis Chong, Beijing's Global Times labels HK autonomy group 'pro-independence, 2012 fromhttp://www.scmp.com/news/hong-kong/article/1073582/beijings-global-times-labels-hk-autonomy-group-pro-independence

[5] Robert B. Cialdini, Harnessing the Science of Persuasion, The principle of Liking, page 74

[6] Robert B. Cialdini, Harnessing the Science of Persuasion, The principle of Reciprocity, page 75

[7] Robert B. Cialdini, Harnessing the Science of Persuasion, The principle of Social Proof, page 75

[8] Robert B. Cialdini, Harnessing the Science of Persuasion, The principle of Consistency, page 76

[9] Robert B. Cialdini, Harnessing the Science of Persuasion, The principle of Authority, page 77

[10] Robert B. Cialdini, Harnessing the Science of Persuasion, The principle of Scarcity, page 78