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