Discuss how communication within an inter-professional team could affect collaborative working.
WORD COUNTS: 1650
Introduction
The aim of this essay is to discuss the concept of communication within Interprofessional team, critically analysing how this could affect collaborative working and with meticulous attention given to two key points; effective communication in terms of verbal, non-verbal and active listening and the development of mutual trust and respect. It will endeavour to critically examine the impact these key points and the impact they have on the dynamics of collaborative working. It will also seek to explore strategies that may be used to facilitate effective communication and collaboration between professionals.

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Modern healthcare is becoming ever complex due to the aging population, diverse range of co-morbidities and increasing expectations of health service quality and safety (World Health Organisation, 2011). Hence, there is exerting growing pressure on health and social care providers to deliver care that is effective thus to meet these demands. Pollard, Thomas and Miers (2010) advocates that in order for health and social care professionals to be able to cope with these demand, they have to work together as a team. For instance, during the hospital stay of a patient , they may encounter numerous professionals from diverse disciplines such as doctors, nurses, pharmacists, dieticians, physiotherapists, social workers and many more depending on the patient’s needs, therefore, professionals will need to collaborate together efficiently as a team.
Collaboration requires professionals from different disciplines in health and social care to work together as a team by sharing of knowledge, ideas, expertise, resources and responsibility in order to tackle the most difficult health and social care issues and make effective clinical decisions regarding a patient’s care (ref). In turn, collaboration also ensures consistency in quality care for their patients, subsequently, improves services and outcomes (Social Care Institute for Excellence, 2015). However, for this to occur, effective communication is needed for a successful collaboration to be achieved (Brock et al., 2013) which is in line with the 6 C’s of care as highlighted in the Department of Health (2015) guideline. . In agreement, O’Daniel & Rosenstein (2008) insist that communication forms the backbone of collaborative working and when lacking or incompetent compromises a cohesive collaborative team.
Wood (2004) defines communication as “a systemic process in which individuals interact with and through symbols to create and interpret meanings” (p.9). Nemeth (2008) affirms that for communication to transpire between individuals it has to be effective and not the mere fact of interaction, as effective communication entails the transmission of information uninterrupted that results to understanding. Effective communication is argued, the key ingredient for the successfulness of interprofessional collaborative working within health and social care (NHS Commissioning Board, 2013). Hargestam, Lindkvist, Brulin, Jacobsson and Hultin (2013) further emphasised that communication is the key factor for the prerequisite for the team’s structure, collaboration and task performance. Alfredsottir and Bjornsdottir (2008) put forth the notion that where there is effective communication within a team, there is also good clinical outcomes. Kenny (2002) also suggests that positive collaboration alongside effective communication ensures sufficient sharing of valuable experience and expertise, thus, enhances levels of job satisfaction. In support, Almost et al. (2015) review of positive and negative behaviours in workplace relationships among healthcare members found that improved communication and teamwork reduces stress, increases job satisfaction and work performance in turn enhances communication between team members.
Jerry (2011) ascertains that there are two major components of communication used within health and social care; verbal and non-verbal communication. Verbal communication involves professionals meeting face-to-face in the form of meetings or over the telephone which are one of the most common and preferred way of communication. This allows sharing of knowledge and skills, generating common narrative that draws team together. Jerry (2011) further illustrates that during this phase of communication, members should speak clearly and directly in a succinct manner while drawing from their own knowledge, warranting free flowing and efficient information thus avoiding errors of miscommunication and confusion. On reflection during MDT meetings in clinical placement, each member was given the opportunity to make critical points that endorsed other members to bring in ideas and make sound decisions. Browning and Waite (2010) however acknowledge that active listening plays a major role in verbal communication as it is the pedigree for a successful interaction, hence sustaining collaborative working among healthcare professional.
Burnard and Gill (2013) further declares that how well professionals communicate is also dependent on non-verbal communication such as written notes, care plans, letters, maintaining of eye contact during meetings as they are key factors that enhances or detracts from the way professionals communicate. Fiske (2011) stresses that where there is lack of listening skills or clarity of information being transmitted, this often leads to potential conflicts and confusion to arise as a result of ambiguity or reception of message not being fully understood or misinterpreted. (ref) supports this stating that, when there is breakdown in communication, it hinders the efficiency and leads to insufficient information, ambiguous and unclear information being exchanged between professionals, consequently jeopardising the dynamics of collaboration. In their qualitative study of multidisciplinary communication at ward board rounds, Hellier et al. (2015) found that ineffective communication amongst healthcare professionals correlates with lack of appropriate information being available, conclusions often not reached and decisions of patients often deferred. A study by Wu et al (2012) suggests that, where discrepancies in the flow of information between professional were found to lead to misunderstandings and frustrations among healthcare teams which meant communication and cohesion barriers were formed (Burnard & Gill, 2013).
O’Daniel and Rosenstein (2008) further accentuate that barriers to effective communication may be due to members from different profession having varied behaviour and language affiliation part due to training, therefore, sets up the potential for miscommunication. Hence, Lingard (2012) advocates that poor communication shapes events that impact on professional working and patients downstream. Nonetheless, Wu et al. (2012) stated that when there is strong communication within a team, professionals are adequately informed as all members of a team are kept updated as they are in the loop of the information they need, hence a standardised common inter-professional language is established (Reeves, Lewin, Espin & Zwarenstein, 2010).
All the same, there is an array of literatures and cases that shows that communication and collaboration does not always occur in clinical practice. The Joint Commission (2010) found that an estimated 80% of serious preventable adverse events stems from miscommunication between caregivers. The detrimental effects of communication deficiency between professionals were evident in the Mid Staffordshire NHS Trust report (Francis, 2013). Central to the analysis of the Francis (2013) report was the evidence of egregious failings of communication between health professionals and organisations. The report showed that the quality of information exchange was often poor or failed to be passed on between hospitals, thereby affecting the way professionals interacted, delivery of services and patient care (Zwarenstein, Goldman & Reeves, 2009). Devastating cases such as this illustrates the necessity of optimising communication among Interprofessional teams.
Kenny (2002) illustrates that effective communication is the platform that creates transparency, encouraging professionals to develop trust, respect and form good working relationships where communication becomes more open and effective (Burnard & Gill, 2013). This is in conjunction with McDonald, Jayasuriya and Harris (2012) qualitative findings of the influence of power dynamics and trust on multidisciplinary collaboration of diverse health professionals. Findings suggest that when effective communication is established especially through shared experience, technical skills and competence, opportunities for professional to rapport, gain mutual respect and trust is developed, thereby, forming alliance among professionals that facilitate cooperation.
Result of the thematic analysis correlates with the author’s own experience observed in the classroom during Interprofessional education (IPE), as the author was able to work efficiently and show mutual respects to other students from other health educational sector such as pharmacy, child nursing and mental health nursing once effective communication had been established (Keller, Eggenberger ,Belkowitz, Sarsekeyeva & Zito, 2013). This ensured that task sets out by the lecturer were achieved as everyone took turn to contribute and allowed ideas and decisions to be rigorously debated. Dixon-Woods et al. (2013) qualitative findings of culture and behaviour in the English National Health Service (NHS) among physicians, nurses and administrators accentuated that where there was lack of trust and mutual respect this led to lack of support, appreciation of individual professional expertise. Findings also showed that some professionals were not being consulted or listened to which created conflicts, disagreement and miscommunication (Leonard, Graham & Bonacum, 2004). The trustworthiness and reliability of the findings within the study is questionable as the researchers failed to provide full details of the methods used to collect data. However, findings was consistent with that of Ferlie and Shortell (2001) study which showed that where there was lack of trust and mutual respect between health professionals, there was deterrent to quality improvement work and on how well they communicated.
O’Daniel and Rosenstein (2008) maintain that barriers to communication that affects collaboration between health professionals can be bridged by the use of a standardised communication stool. NHS Institute for Innovation and Improvement (2012) recommended that healthcare professionals implement a standardised approach to communicate such as the use of SBAR to make certain that information shared is structured by being concise and focused to maintain consistency of high quality of care. Randmaa, Mårtensson, Swenne and Engström (2013) prospective intervention study identified that SBAR improves communication between healthcare professionals, a proportion of incidents report due to communication errors decreasing from 31% to 11%. The study also highlighted that the tool sets out expectations between health professionals of how they should communicate. In terms of the limitation of this study, participants were not chosen at random which questions the study’s reliability.
Conclusion
Evidence gathered suggests that effective communication and collaboration is imperative and should be used in correlation impetuously by professionals, thus to foster high quality care and promote practice to the highest calibre.
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