Managing Multi-Agency Working in Elderly Care

Managing Multi-Agency Working in Elderly flushManaging quislingism Multi-Agency Working for older peoples serve decision maker summary and introductioncollaboration in the field of both well-being and wellness plow, on one level, can be expedient, efficient and economical. On an other(a), much than pragmatic level, it can be a minefield of legislative, practical and interpersonal difficulties. (Arblaster. L. et al 1998)This report leave cut into these aspects in direct consideration of coaction of the various aspects of c argon related to the elderly.It has to be viewed as being indoors the spirit and the legislative restriction of the NHS Plan (DOH 2000) and therefore considers the methods of coactionism with the PCTs in some detail, and also in the spirit and legislative requirements of the National usefulness Frame get to for the elderly. (Rouse et al 2001)What is collaborationism between compositions?The transition from the concept conglomerate culture to the S eamless interface culture is effectively based on the concept of practical and effective collaboration. (Powell, J. Lovelock, R. 1996)The changes that were proposed in a number of late(a) pieces of welf are based legislation ( after(prenominal) the 1993 changes in the community care organisation and the National emolument Frameworks to quote just two), fork out solely espoused collaboration as their raison dtre. Clearly, in consideration of the elderly, there are many an(prenominal) organisations that can potentially collaborate (Appendix Two), and all afford their strengths, weaknesses and pit take places. Let us examine one important area as an illustration.If we consider the welfare/health servicing interface. Primary healthcare teams control access to junior-grade and community health run through unhurried referrals. mixer service equally manage funding for habitation care and residential services including nursing home facilities and control access through sound judgment and care precaution. (Glendenning C et al 1998).When it is the case that, in price of passe-part divulge organisations, one depends upon another for access to services, their ability to obtain their own organisational or headmaster objectives can be severely compromised. (Haralambos M et al 2000).In practical terms, the GP is dependent on the loving services to fund the attach facility whether it is a nursing home, domicillary enhancement services to keep a patient out of an acute medical hospital bed, or other forms of amic adequate to(p) support to facilitate the timely discharge of a patient from hospital. The arguments for collaboration are so overwhelmingly obvious that they hardly drive repeating here.In real terms, the consideration of collaboration between organisations more analytically hinges on the question, which organisations?. The example that we have given is a passably common collaboration and is therefore enshrined in both common workings practic e and also with legislative and regulatory boundaries. The advent of the National serve up Frameworks have helped promote usually recognised goals and objectives across the health/welfare spectrum of care, although a number of financial issues and problems with the organisational culture interface can commonly difficulty in everyday practice (Wierzbicki Reynolds 2001).Other organisations have to mediate and collaborate with the Social Services Dept. much(prenominal) as local and topic voluntary support classs and specialist interest support groups, (often disease work based,) and these mainly have much looser procedural issues and practices which may need assorted considerations. We shall discuss these in greater depth elsewhere in this essay.What are the problems?Taking a broad overview of the scope and possible nature of cooperative enterprises. Problems can arise from a number of organisational areas. Financial considerations, especially financial accountability, caus e problems when this eventuality has not specifically been legislated for. Appendix Three sets out many of the potential pitfalls in this area. We observe that the health based services are essentially free to the patient whereas Welfare is largely mode tested and thereby rendered vulnerable to changes of political direction and pressure. ( size up commission 2004) other major area of potential difficulty stems from the historical development of professional language, terminology and working practices that each collaboration can interface. Client, patient , in need, deserving, dependent all are terms frequently used by various healthcare professionals, but with antithetical interpretations and nuances of meaning. Collaboration will of necessity require a more exact and specific vocabulary to be evolved and agreed. (Garlick C 1996).Collaboration inevitably bureau information sharing. The Empire concepts and constructs adjudge a long time to die and be eradicated, but the circu lar-knit interface can only realistically be expected to work if all available information is shared. This raises serious problems of confidentiality if information is expected to be shared between healthcare professionals and collaborating agencies from the voluntary sector for example. (Cameron,A et al 2000).What are the solutions? trouble solutions can be both complex and difficult to sneak in or impose. By virtue of the potentially disparate nature of the collaborative partnerships that we are considering, there is clearly no one size fits all solution. It is for this reason that general principles are more useful than specific suggestions.The management of change (and therefore the solutions) is perhaps the most fundamental element in the discussion. Visions, ideas and directions are of little value if they cannot be translated into reality. (Bennis et al 1999).We can turn to the writings of Marinker (1997) who points to the fact that systems change, and indeed change managem ent itself, are antiphonal to the acceptance of a division between concordance and compliancy. People broadly speaking respond better to suggestion, reason and coercion rather than imposition of regulations and irresponsible change. The baffles that rely on human beingsation and dissemination of information are in general more likely to be well received and more fully implemented, particularly if it is peer driven. (Shortell SM et al 1998)This is perfectly illustrated by the Davidmann root (Davidmann 1988) on the debacle of the introduction of the Griffiths Reforms in the 80s.(Griffiths Report 1983). His major findings were that the Reforms failed because changes were oblige rather than managedCollaborative solutions should only realistically be made after a careful consideration of the evidence base underpinning that proposed change. (Berwick D 2005). current management theory calls for discriminate evaluation of the need for collaborative proposals by considering the ev idence base on which the situation could be improved, its instruction execution by making managers aware of the need for change and proactively encouraging them in the means of implementation, and then instituting a followup process to evaluate the effectiveness of the measures when they have been in place. (Berwick D. 1996) (Appendix five)Models of CollaborationThere are a great many models of professional collaboration cited in the literature. In order to make an illustrated analysis, we will return to the specific example of the Health/welfare interface to consider some of the models in that area. In general terms, all of the models follow the useable structure Plan, Implement and Review (expanded in Appendix Five).The Outreach (or Outposting) model appears to be a commonly adopted model (McNally D et al. 1996), whereby a social worker is attached to a radical healthcare team. In terms of our analytical assessment here we should note that such ar vomitments, if subjected to process evaluation, generally promote progression towards a seamless interface in areas such asThe sharing of information and in mutual understanding of the different professional roles, responsibilities, and organisational frameworks within which social and primary health services are delivered.It is also noted that such benefits are generally greater if the implementation of such models is preceded by exercises including team building or joint provision exercises. (Pithouse A et al 1996)Other models include the marijuana cigarette Needs Assessments model in which service commissioning between primary health and social services teams have a common assessment base (Wistow G et al. 1998). This does not appear to have been as prosperous as the outreach model, and has had a rather variable history (Booth T 1999).Collaboration here has baffling a variable number of agencies but not always the primary healthcare teams. The new primary care groups will have a strategic role in the com missioning of a broad range of health and welfare services. All NHS organisations have a clear obligate duty of collaboration and partnership with the local authorities (NHSE 1997)Collaboration in the form of joint commissioning models have also been tried. They tend to fall into one of three patterns includingArea or locality as tush for joint commissioningJoint commissioning at practice levelJoint commissioning at patient levelNone have been in place for long enough for a realistic assessment of their relative strengths and weaknesses to be evaluated yet. (Glendenning C et al 1998)Models- Interprofessional/teamsOne of the more successful models of collaboration is that of the multidisciplinary pre-discharge assessment team which, when it works well, can be considered a model of good collaborative working (Richards et al 1998). This requires all of the elements referred to above to be successfully implemented and to be in place if the best result for the client is to be obtaine d. Such a model calls for professional integration and collaboration of the highest order if National Service Framework ensample Two is to be fully realised. The framework calls for all concerned professionals to hold that older people are treated as individuals and that they receive appropriate and timely packages of care which meet their needs as individuals, regardless of health and social services boundaries.It is, in our estimation, the crossing of these boundaries that, perhaps, is the key to collaboration.ReviewCollaboration as a concept is comparatively easy to define. Any mental lexicon will give a reasonable definition. As a executable model of practice, it is far more nebulous and hard to achieve. In this review we have tried to consider the barriers and management problems that make it harder to achieve unitedly with the mechanisms which will militate towards successful implementation.We have identified financial and ethnical barriers, as well as structural and organi sational ones equally we have pointed towards models of collaboration which appear to be working well. It would appear to be the case that the autochthonic factor in the success or ultimate failure of a collaborative exercise, is the success and management skills with which it is initially introduced.ReferencesArblaster. L. et al (1998)Achieving the impossible interagency collaboration to address the housing, health and social care needs of people able to live in ordinary housingBristol Policy press and Joseph Rowntree. 1998Audit commission (2004)Older People Independence and well-being The challenge for public servicesLondon The Audit Commission 2004Bennis, Benne Chin (Eds.) 1999The think of Change (2nd Edition)..Holt, Rinehart and Winston, New York 1999.Berwick D. 1996A primer on the improvement of systems.BMJ 1996 312 619-622Berwick D 2005 Broadening the view of evidence-based medicine Qual. Saf. Health Care, Oct 2005 14 315 316.Booth T. 1999Collaboration between health and social services a case engage of joint care planning.Policy Polit 1999 19 23-49.Cameron,A. Brown H and Eby,M.A. (2000)Factors Promoting and Obstacles prevent Joint WorkingSchool for Policy Studies, Bristol. 2000Davidmann 1988Reorganising the National Health Service An Evaluation of the Griffiths ReportHMSO London 1988DOH 2000Department of Health (2000)The NHS Plan. A Plan for Investment. A Plan for Reform. Cm 4818.London The Stationery mappingGarlick C. 1996Social solution.Nurs Times 1996 92 28.Glendenning C. Rummery K, Clarke R 1998From collaboration to commissioning create relationships between primary health and social servicesBMJ 1998317122-125Griffiths Report 1983NHS Management Inquiry Report DHSS, 1983 Oct 25Haralambos M, M Holborn 2000Sociology themes and perspectives,Harper Collins 2000.Marinker M.1997From compliance to concordance achieving shared goalsBMJ 19973147478.McNally D Mercer N. 1996Social workers attached to practices. Project report. KnowsleyKnowsley metrop olitan Borough and St Helens and Knowsley Health , 1996.NHSE 1997National Health Service executive director. Health action zonesinvitation to bid.Leeds NHS Executive , 1997(EL(97)65.)Pithouse A, Butler I. 1994Social work attachment in a group practice a case study in success?reticuloendothelial system Policy Plann 1994 12 16-20.Powell, J. and Lovelock, R. (1996),Reason and commitment is communication possible in contested areas of social work theory and practice?, in Ford, P. and Hayes, P. (eds), Educating for Social Work Arguments for Optimism,Aldershot, Avebury, pp. 7694.Richards, Joanna Coast, David J Gunnell, Tim J Peters, John Pounsford, and Mary-Anne Darlow 1998 Randomised controlled struggle comparing effectiveness and acceptability of an early discharge, hospital at home scheme with acute hospital care BMJ, Jun 1998 316 1796 1801Rouse, Jolley, and Read 2001 National service frameworks BMJ, Dec 2001 323 1429.Shortell SM, Bennett CL, Byck GR. 1998Assessing the impact of con tinuous quality improvement on clinical practice what will it take to accelerate progress?Milbank Quarterly 1998 76 593-624Wierzbicki and Reynolds 2001 National service frameworks financial implications are huge BMJ, Sep 2001 321 705.Wistow G, Brookes T, eds.1998Joint planning and joint management. ,London Royal Institute for Public Affairs, 1998.25.1.06 PDG member count 2,290