Case Study Solutions of Achieve Patient Centered Care: MGMT8003

Case Study Solutions of Achieve Patient Centered Care: MGMT8003

Case Study:

Failure of the multidisciplinary team in providing person-centred care to patient resulting in readmission of patient and other sufferings:

Introduction:

Present day healthcare systems are striving to achieve new goals that have come up from the researches in the evidence based care approach. Person centred care is an effective way by which healthcare professionals include patients and their family members as equal partners in planning, developing and also monitoring care (Kogan et al. 2016). These are mainly done to make sure that the services provided to patients and family members not only meet their needs but also put them in the centre of decision making and also see them as experts. Researchers have clearly depicted that such an approach is not only about providing what the patients want or just giving them information which they want to know (Wildevuur and Simonse 2015). The healthcare professionals need to consider the desire, values, family situations, lifestyles, social circumstances and work with the patient as an individual to find out effective solution. It might seem that the entire concept is about activities entirely but in reality, it involves more about how healthcare professionals and patient think about their care and how their relationships develop during the time of admissions (Edvardsson, Sandman and Borell 2014). Present day researchers are of the opinion that person-centred care has a number of advantages than that traditional form of care which was applied in earlier decades. This approach helps in improving the quality of the services available (Herlitz 2017). They also help the patients to get the care that they need. They help patients and family members to be more active in looking after themselves and also help in reduction of pressure on health and social services. Researchers say that this approach helps in empowering the patients and their family members. Therefore they do not develop anxiety and stress which otherwise have negative outcomes on their health (Li and Parock 2014).

The Bloomsvalley Nursing home had been one of the most trusted nursing home in the locality of Samandra Jones who is a 68 year old lady. She has been suffering from chronic disorders like obesity and osteoarthritis. Her blood glucose level was also found to be quite high above 140 HG/mm and was also suffering from diabetes mellitus. Due to loss of mobility because of chronic pain in her knees, she has reduced walking. However, while walking in the garden in the evening, she had a fall due to which she had suffered a minor stroke. Several cuts were also found on her knees and arms and also on her faces which resulted in moderate bleeding. She was immediately admitted to the emergency ward and after staying there for four days, she was transferred to the rehab for further transition of care. She had a family of a son and daughter in law who had two toddlers. Her daughter in law was the main carer and had not completed her school. Her son used to own a departmental store in the local market. Both of them were quite nervous and at the same time quite scared. Their financial condition was stable.

An effective teamwork was needed among the multidisciplinary team members so that Samandra could have achieved higher satisfaction and effective health outcomes. There had been lots of areas where her dignity was hampered due to the ineffective teamwork of the healthcare professionals. Moreover, the family members were not treated properly and they were not involves in the care plan for the patient. Person centred care entirely failed and the team could not work together properly resulting in failure of meeting the objective of providing person centred-care.

After thoroughly interviewing the team members, it was found that the team coordinator was highly autocratic in nature and never behaved well with the nursing professionals. The junior professionals were continuously embarrassed in front of other members which resulted in affecting their morale. When confidentiality was promised to be maintained, one of the junior stated:

“As we are new to the organisation and also to our profession, we need guidance in many scenarios. However, it often becomes difficult for us to handle any serious situation effectively when we cannot get guidance from the team leader or the senior members. They are rude and we never know how they will behave. They make fun of us when we go with our queries. Many of our colleagues become highly demoralised and suffer emotionally”

There was lack of communication among the team members. Once it was seen that Ms. Sonia, a senior nurse professional had provided a medicine to the Samandra following which she needed sleep. She asked the patient to sleep and left her sleep. Within half an hour, the patient was attended by physiotherapist and asked her to prepare herself for the physiotherapy session. She was startled by this approach of the physiotherapy as he did not even ask for consent. This was immediately followed by the arrival of the speech therapist who instead of communicating with the physiotherapist asked the patient to prepare herself for her speech practices. Samandra had stated:

“ I was highly disappointed by the healthcare teams, firstly, they did not inform me what they are doing with me. I was not involved in the care plan and not also my family members. Secondly, none of the professionals acted professionally and there was clear picture of miscommunication among them. Soon they started arguing in front of me and I was feeling disgusting”

Another issue that was also noticed in the team was that there was lack of motivation among the team members. None of the workers were motivated and they were also not aware of the advantages of effective teamwork. Both extrinsic and intrinsic motivators were found to be absent which thereby resulted in development of boredom. The team members were not properly motivated and they were stated saying:

“After few days of joining the place, I realised that no one is interested in talking with each other. There is nothing to learn forward and there are very few people who look on this profession as their passion. There are no emotional attachments with the team members and therefore looking forward to learn new things is rare. Besides, there is very little scope of gratitude from the seniors and also there is no incentives, rewards and other. Therefore burning down is common”.

Another event which was also noticed is the trust issue. This trust issue mainly acted as barriers in providing patient-centred care. Samandra had stated that at the time, when she asked the immediate registered nurse with her about the food she would be getting that day, the registered nurse seemed clueless. She then called an immediate dietician on the floor who advised the nurse to provide her food free from sugar as she checked her blood sugar level to be high. The senior nurse came on the floor and she was furious to see that the patient was given food without her advice. Although the junior nurse confirmed that she had done so with the permission of the dietician, the senior nurse did not trust her. She talked to her rudely stating that she does not trust her and she might be telling a lie to escape penalties. Hence a power struggle and trust issues were also noticed that hampered person centred care. The diet should have been decided by the professionals through a meeting as it is an essential part of the treatment plan. Lack of trust and confidence among teams were clearly reflected in their activities. Samandra was heard saying:

“I saw one member took my blood glucose level test and again after few minutes another senior member took blood glucose level test as she was not sure about the previous test. I was not getting what was happening here. I started to feel scared about my health. I felt that something was wrong with my health for which they were doing the same task twice. When I wanted to know form the, they just said it needs to be done”.

This approach was totally against patient centred care. Preferences of the patient on her diet were not asked. Moreover they also did not care to make the patient understand the situation in details about why the test needs to be conducted. All these affected the principles of person centred care.

Blame games also were found among the team members. On one of the occasion, it was seen that medication for Samandra was missed and none of the professionals was ready to take on the blame. They were constantly blaming each other which not only resulted in development of conflicts but was resulting a stressful situations that affected smooth flow of work. Conflict resolution skills were also not present among them and therefore negative behaviours were noticed among the different healthcare staffs. Once, conflicts rose to a high level between the dietician and the health educator in Samandra’s case. The healthcare educator not only withdrew herself from the case but also left working in the hospital also. All these resulted in inappropriate care delivery by the multidisciplinary team which resulted her in readmissions, longer stays in hospitals and greater suffering which are against the benefits of person centred care. Her family members were suffering from depression and anxiety and were upset with the healthcare team. A complaint was lodged against them in the complaint cell.

Questions:

What are the main reasons for the failure of the effective teamwork by the healthcare professionals in providing a person centred care?

The first issue that was observed among the team members was that they lacked proper organising and planning skills. It helps in the completion of tasks in a smooth way without creating issues in the future. Researchers suggest that teams which conduct proper planning, time management, project management, action planning and similar activities achieve success at a faster pace (Weller, Boyd and Cumin 2014). In the case study, it is seen that a large number of issues mainly rose as there was no prior planning and organising sessions among the healthcare professionals. The speech therapist, the nursing professional and the physiotherapist faced issues because they had not organised their meeting prior visiting the patient on the ward. Moreover, decision making is also another skill that should have been properly be inculcated in the professionals. Researchers are of the opinion that team members should be able to make decisions in a coordinated manner to make things move forward (Hastie, Boyd and Cumin 2014). In order to make the professionals get the scope of decision making, managers or leaders need to be careful and provide them with effective feedback so that they can develop the skills of proper decision making and critical reasoning. If the healthcare professionals would have got proper support from the care coordinator, they would have developed the expertise of proper decision making. This would have prevented sufferings of Samandra. Instead of being autocratic, he should have been transformational and should have provided them with scope of learning. Besides, problem solving and conflict resolution skills were also absent among the team members. Researchers are of the opinion that proper innovative ideas and positive attitude and outlook can help in effective conflict resolution (Mesmer et al. 2017). If the members attending Samandra could have effective problem solving skills and conflict resolution skills, the feud between the dietician and the healthcare educator would not have taken place. They could have used proper ideas and skills so that they could resolve the differences between them and develop a positive behaviour towards each other for the betterment of the patients. Besides, trust is one of the most important factors that should be developed in the team for preparing a better working environment. Trust was completely absent among the senior and junior members and power struggles took place as a result of this. When team members are able to trust each other, they are able to release a lot of stress from themselves and can be stable emotionally (Kozlowski et al. 2015). This prevents development of burnout feeling and also makes them feel motivated to work for each other (Casimiro et al. 2015).

How does effective communication act as important part of effective teamwork preventing failures?

The team leader holds the responsibility of training all the team members about the importance of communication. The training should have been conducted not only with juniors but also with seniors. Proper communication skills like feedback giving and receiving in con structure ways by all team members help others to develop the skills and knowledge and help one to recognise the mistakes he or she had conducted (Weller, Boyd and Cumin 2014). Not only does it help in skill and knowledge development but it also helps in building of rapport. Effective communication skills help in developing trust among the team members. This in turn helps in developing a positive working climate where everyone trusts each other and shares their physical and mental issues among themselves (Shockley-Zalabak 2014). This reduces stress and anxiety among the members. If effective communication would have been present, there would have been no trust issues and effective feedback giving and receiving would have taken place (Arora et al. 2015). The team members should also ensure that they develop skills in chairing meetings. In healthcare chairing meetings are extremely important so that all experts can sit together and decide a care plan which is appropriate for the patient (Carter et al. 2016). From the entire case study, it becomes quite clear that no formal meetings were conducted among the specialists of the multidisciplinary team. Therefore, conflicts were found among the physiotherapist, speech therapist, dietician, health educator and nursing professionals. They should have sat together and communicated their concerns in meetings so that patient care was not affected. Effective communication is also helpful in efficient action, encouraging input, encouraging dynamic change and creating understanding of different situations (Gluyas 2015). If the team members had proper communication skills, they could have provided proper patient centred care by communication with the patient and their family members about their needs and preferences which would have helped in meeting the objectives.

References:

Arora, S., Hull, L., Fitzpatrick, M., Sevdalis, N. and Birnbach, D.J., 2015. Crisis management on surgical wards: a simulation-based approach to enhancing technical, teamwork, and patient interaction skills. Annals of surgery, 261(5), pp.888-893.

Carter, D.F., Ro, H.K., Alcott, B. and Lattuca, L.R., 2016. Co-curricular connections: The role of undergraduate research experiences in promoting engineering students’ communication, teamwork, and leadership skills. Research in Higher Education, 57(3), pp.363-393.

Casimiro, L.M., Hall, P., Kuziemsky, C., O’Connor, M. and Varpio, L., 2015. Enhancing patient-engaged teamwork in healthcare: An observational case study. Journal of interprofessional care, 29(1), pp.55-61.

Edvardsson, D., Sandman, P.O. and Borell, L., 2014. Implementing national guidelines for person-centered care of people with dementia in residential aged care: effects on perceived person-centeredness, staff strain, and stress of conscience. International Psychogeriatrics, 26(7), pp.1171-1179.

Gluyas, H., 2015. Effective communication and teamwork promotes patient safety. Nursing Standard, 29(49), pp.50-57.

Hastie, C., Fahy, K. and Parratt, J., 2014. The development of a rubric for peer assessment of individual teamwork skills in undergraduate midwifery students. Women and Birth, 27(3), pp.220-226.

Herlitz, A., 2017. Comparativism and the Grounds for Person-Centered Care and Shared Decision Making. The Journal of clinical ethics, 28(4), pp.269-278.

Kogan, A.C., Wilber, K. and Mosqueda, L., 2016. Person‐Centered Care for Older Adults with Chronic Conditions and Functional Impairment: A Systematic Literature Review. Journal of the American Geriatrics Society, 64(1).

Kozlowski, S.W., Grand, J.A., Baard, S.K. and Pearce, M., 2015. Teams, teamwork, and team effectiveness: Implications for human systems integration. The handbook of human systems integration, pp.535-552.

Li, J. and Porock, D., 2014. Resident outcomes of person-centered care in long-term care: A narrative review of interventional research. International journal of nursing studies, 51(10), pp.1395-1415.

Mesmer-Magnus, J., Niler, A.A., Plummer, G., Larson, L.E. and DeChurch, L.A., 2017. The cognitive underpinnings of effective teamwork: a continuation. Career Development International, 22(5), pp.507-519.

Shockley-Zalabak, P., 2014. Fundamentals of organizational communication. Pearson.

Weller, J., Boyd, M. and Cumin, D., 2014. Teams, tribes and patient safety: overcoming barriers to effective teamwork in healthcare. Postgraduate medical journal, 90(1061), pp.149-154.

Weller, J., Boyd, M. and Cumin, D., 2014. Teams, tribes and patient safety: overcoming barriers to effective teamwork in healthcare. Postgraduate medical journal, 90(1061), pp.149-154.

Wildevuur, S.E. and Simonse, L.W., 2015. Information and communication technology–enabled person-centered care for the “big five” chronic conditions: scoping review. Journal of medical Internet research, 17(3).

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