It is well recognized that people in organizations typically spend over 75% of their time in an interpersonal situation; thus it is no surprise to find that at the root of a large number of interprofessional problems is poor communications. Effective communication is an essential component of interprofessional work success. Besides, the issue of interprofessional working is currently one of key importance in the field of health and social care.
Much of the literature on interprofessional working focuses on the potential difficulties in achieving effective working relationships between practitioners from different professions, and the ways in which these problems might be avoided or resolved (Davidson, 1990; Evers et al., 1994; Ferrer & Navarra 1994; Pietroni, 1994; Hanily, 1995; Hilton, 1995). In United Kingdom, the legislative and policy requirements over the past decade have required health and social care agencies to work closely and collaboratively together in partnership with service users (Pearson & Spencer, 1995; DoH, 1999).
Thus, it is important to identify and evaluate the positive characteristics of good interprofessional working. The aim of this paper is to cover the role of the basic process of effective communication related to interprofessional work and the conflict problems generated from the interprofessional practice. Further, we will discuss some studies carried out on the era (mainly in the health care sector), followed by conclusion and recommendations.
The communication that can be defined by a process of transmitting information from an individual (or group) to another is a very complex process with many sources of potential error. In other words, the meaning of any communication is a simple transmission of a message from the sender to the receiver. In many situations a lot of the true message is lost because the significant difference that exists between the message that is heard and the one intended.
Further, the effectiveness of the communication process still difficult, because at each step, there is a multitude of potential source of errors. Thus, the social psychologists estimate of a usual 40-60% loss of meaning in the transmission of messages from sender to receiver still justified.
However, in order to increase the effectiveness of the communication process, it is critical to make sure that there is a minimal loss of information. Hence, it is required to understand well this process, understand and control constantly the potential sources of errors. Further, it is important to point out that the communication process appears more complex when it is accomplished between to persons or groups with different knowledge’s and professional activities.
In the following, we will see that conflict within teamworking takes many forms. We will give the definition of a team and which are the problems rising from the lost of effective communication in an interprofessional teamworking process. Finally, we will see a checklist of criteria that healthy teams do well and dysfunctional teams do poorly.
The team can be defined as a group of individuals who must work interdependently in order to attain individual and organizational objectives. The key word here is interdependently. However, within an interprofessional work, interdependence means that all the teams must depend on each other and if any one team drops the ball, the whole teams suffer. Different divisions within a company may need to share information but they are not really a team. Why the shift to teams? The answer is simple. There is less management, less direction, more autonomy and accountability, the need for specialists, and a greater expectation to work independently without management direction. Also, senior managers know peer pressure to support team goals and each other is a very powerful motivator and productivity is much greater with a team than with individual workers. Most companies will take advantage of this. In contrast, the lost of an effective communication lead to a set of problems that are:
• conflicting personalities and egos;
• difficulty of collaboration and decisions;
• lack of definition of members’ roles;
• hidden agendas or win/lose struggles;
• necessity of time-consuming meetings;
• unclear goals or conflicting goals within the team;
• lack of awareness of how the work fits into the bigger picture;
• unwillingness to share or to ask for help
• geographic remoteness;
• cultural clashes;
It is rarely the technical challenges that cause problems, but rather the people issues that are mostly often the source. Further, healthy interprofessional work will always do the following six criteria well and, conversely, dysfunctional one will not do these well.
i. Clear Communication
Usually the first sign of a dysfunctional team is communication breakdown. Healthy teams have a communication plan that is agreed to by all members. The frequency, format, and type of communication are pre-negotiated and meet the unique needs of the team or situation. Team members also know what to do when they feel that communication is breaking down or if they feel out of the loop.
ii. Clear Goals, Roles, and Responsibilities
This is a major source of frustration on most teams and must be clearly defined early. This is the role of the Team Leader’s.
iii. A Conflict Resolution Process
Conflict within any teams is inevitable and healthy if managed properly. Healthy teams have pre-set rules of conduct in times of conflict.
iv. Clear Decision-Making Process
Depending on the situation, there could be many ways to make a decision: depending on the short or long strategic project, the Project Leader decides and tells the team, a team vote, majority rules, minority rules, an expert decides, or a consensus. The key is that there should be a primary and backup decision-making method that everyone agrees to.
v. Fair Work Distribution
The problems with fair work distribution are usually caused by slackers. If the teams cannot address their performance and contribution, then, the leader may have to get involved by giving clear feedback and setting expectations.
vi. Appropriate Leadership
This is usually the most difficult one to get right. This is never an easy choice.
Due to the complexity of health care domain, which generally includes problems with features of both familiar and complex problems, internist decision-making frequently includes a mix of both data-driven and hypothesis-driven diagnostic strategies.
Recent investigations into decision making have included the study of group decision making in real health care environments, with different limitations and situational variables (Orasanu, 1993). A special type of coordinated group activity is the collaboration, in which individuals with different areas of knowledge and skill work together to perform tasks and carry out activities necessary for achieving a shared goal. In the medical context, collaborative planning and activity involve interactions between team members in order to manage the complexity of clinical practice.
The health care literature abounds with examples of successful multidisciplinary teams with praise for this type of delivery system in many different domains, including primary care, geriatric, diabetes, cardiovascular medicine, head and neck surgical oncology, endovascular surgery, anaesthesiology and psychiatry. In each of these domains, physicians, nurses, dieticians, physiotherapists, social workers, and other health care support staff each bring different domain knowledge and coordinated activity to health care decision making (though unfortunately usually excluding the patient who is the focus of the interaction). How this does coordinated activity work, given that the team members have very specific knowledge and skills?
Patel et al. (1996) examined team interactions within an Intensive Care Unit team, where they identified individuals possessing different types of expertise with roles that are clearly and formally defined. This led to the identification of properties that emerged in the collaborative setting. The attending expert then generated appropriate plans based on consideration of the patient as a whole. The complexity of medical analysis increased at each level in the hierarchy while information management tasks decreased in intensity. Multiple streams of information were processed in a hierarchical manner using two types of strategies. Under conditions of high urgency, reasoning was data-driven toward action, rather than based on consideration of underlying justifications and a high degree of knowledge organization. Under less urgent conditions, causally directed reasoning was used to explain relevant patient information. In both cases, the overall goal of individual and collective reasoning was to find a reasonable explanation for a particular aspect of a patient’s condition so that appropriate actions could be taken.
For each type of conditions described above, the communication still very important for bridging differences, leading to shared products and understanding. The preferred mode of communication will found to vary with the purpose of the interaction, planning tended to take place during conference calls and face-to-face meetings, while technical issues were emphasized in email communication. As tasks will be clarified and a shared commitment developed over time, the pattern of communication became more focused, showing greater degrees of integration. At the same time, the development of communication depends on each individual’s contributions (in terms of expertise) to the team effort.
Another important point that would be outlined here, in the same context of health care, is the health human resources (HHR) planning, present as well in private as public sectors. HHR is a complex issue and the management of human resources includes monitoring and evaluation, planning, and policy research. It takes into account the supply, distribution, quality, deployment, organization and utilization of health human resources. It has further been described as seeking to establish optimal numbers for each of the health care provider groups, given the most cost-effective and appropriate mix of required personnel based on varying services needs. A Key feature that is important and need to be considered in this HHR planning is the physiotherapy profession.
Physiotherapists play a large role in promoting health. They understand the determinants of health and see this as a fundamental requirement for responsible decision-making that is conducive to promoting health. In this capacity; physiotherapists often work as consultants to private and public organizations. They work with corporations, professional and amateur sports teams, and with governments and their agencies. Their consultative work also includes prevention awareness and the focus of this work is to prevent injury and to promote health, which is so required for the good functioning of each private or public structure. Hence, and regarding the above considerations assigned in section 2, the physiotherapists are therefore essential providers of the health care support and information useful for each professional structure, and which is crucial for a successful, interprofessional teamworking.
The present paper examines the concept of the role of communication in interprofessional work and its relationship to efficient and effective delivery of decisions and services, regarding the example of the health care issue. It state that the collaboration between workers from professions and of various institutions necessitates time, clarification of the intention and expectations of each, as well as the placement of definite procedures of collective work. Not to respect these conditions at the beginning of the procedure risk to fail the project or to delay it considerably, because of the conflicts that inevitably will appear.
In the health care teamworking exposed above, communication as well as redundancy assures that omissions will be discovered and corrected. The mode of communication is directly related to the purpose of the interaction. This timely communication among individual members assured the co-ordination of activities, reducing redundancies and unnecessary interactions. Face-to-face and telephone interactions were the most frequently used modes of communication, offering an immediacy of response and the opportunity for exchange of information and ideas.
Further, in recognition of the importance of communication skills, pressure has been placed on the medical education system to acknowledge their significance and to devote resources to teaching them. While the results emphasize the prominence of communication in team functioning, they also highlight the conceptual basis of communication related to the development of individual expertise, making team communication an added value to already existing conceptual competence in this domain. We observed that expert providers in each situation determined the most effective methods for communicating with each other based on the purpose of the interaction being sought. It has been suggested that it is the very nature of the practice itself that promotes acquisition of tacit knowledge and skills.
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