Good practice in integrated working, according to studies referenced below, is a result of a combination of different factors, which range from individual level, team level up to the organizational level supported by government policy. Below from section 2.6.4.1 – 2.6.4.5 I have described some of these important issues in good practice in integrated working.
2.6.4.1 Operational Policy
Over the years the mental health integration policies have developed in a way that suits the integrated work system in CMHTs. Larkin and Callaghan (2005) identify the
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“The recovery 'model' requires a change of approach on the part of both the professionals and the service users. Service users have to be prepared to step out of the 'sick role' and start to regard themselves as autonomous people with the capacity to come through a period of mental distress and develop their
individuality, self awareness and self acceptance. Professionals need also to look at people's potential, and to stop being managers and start being facilitators. They need to start looking first at people's potential for development rather than at how their mental distress may restrict their lives.” (MIND)
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importance of different professionals working from the same base following the same protocols and policies. Indeed, Onyett (1994) identifies that these common protocols and policies should be clearly identified within the operational policy. Thomassy and McShea (2001) cited by Larkin & Callaghan (2005:339) explain that „problems in effective planning of patient care are sometimes the result of poor collaboration between health care professionals, each of whom uses different priorities and protocols to assess and plan‟. This shows the importance of having a common operation policy within one team for different professionals.
2.6.4.2 Communication
Communication and decision-making processes are key issues for teams. Larkin & Callaghan (2005:339), quoting several writers, explain this issue as follows:
Hunt (1983) argues that teams that do not hold regular meetings of all members, which provide opportunity for policy making and resolution of difficulties, do not warrant the title of „team‟. The reason being, that the basic requirement of a team is that members engage in face-to-face interactions and engage in co-operative and co-ordinating activities. Lowe and O‟Hara (2000), in their study, found that regular team meetings held a distinct advantage in enabling the team to carry out its work. Molyneux (2001) reported that „communication was facilitated by weekly case conferences which gave an opportunity to plan the work of the whole team with patients‟. A study by Bennett-Emslie and McIntosh (1995) also found that team meetings were seen as key components in aiding communication and understanding between different professionals.
Larkin & Callaghan (2005) found that 60% of their research respondents from mental health teams had identified that meetings happened in their teams. However, these respondents demonstrated that meetings had not influenced their perceptions of interprofessional working.
2.6.4.3 Geographical Proximity
“Shared premises enable informal, frequent encounters between team members and provide opportunities for information sharing” (Larkin and Callaghan, 2005:339). Larkin & Callaghan (2005:343) further suggest that “when professionals share an office space they are pushed into identifying more structured means of organising themselves, communicating with each other and having clarity about how they are
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going to work together”. Shared location is also identified as a benefit for the service users, as they do not have to move from place to place in searching for different services when many professionals are working under the same roof.
2.6.4.4 Supervision and Appraisal
Supervision issues in integrated teams have always been controversial. Different professionals from different backgrounds emphasise the importance of getting supervision form their own discipline, to develop themselves in order to improve the service they provide. However, with the integrated teams this does not seem to work effectively, as most of the staff from social services had supervision from somebody from the medical background. Ovretveit et al (1997:26) suggest that “The subject of supervision is one of the most confused issues in team organisation and management. Different professionals have different interpretations and experiences of what supervision means to them within their profession”. Larkin & Callaghan (2005:344) observed professional supervision in integrated teams as a very sensitive issue and they believe that the „joint supervision policy may have caused the respondents to challenge their perceptions of inter-professional working within their teams‟.
2.6.4.5 Clarification of roles and responsibilities
In the integrated teams it is equally important to have a very good understanding of other professionals‟ roles as well as one‟s own. As Larkin & Callaghan (2005:340) explain, different individuals have their own duties within the teams, however it is necessary to have an understanding of each other‟s role form the onset. They further emphasise that lacking this clarification of each other‟s role might cause „confusion, tension and possibly rivalry‟ inside the team. Larkin & Callaghan (2005:340) further explain this by quoting some other research as follows:
Onyett (Onyett, 1995) identifies that lines of accountability must be clarified based on the identification of shared roles and responsibilities of team members, and separation of these from the specific and unique skills, which individuals and disciplines contribute to the team. Norman & Peck (1999) reinforce this and state that ambiguous roles may have negative consequences, and lead to unclear lines of responsibility and accountability. Hunt (1983) found that if team members‟ expectations of each other‟s roles
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are in accord few problems might occur. She stresses that if there are serious perceptual discrepancies considerable difficulties may arise within the team.
Larkin & Callaghan (2005:344) further report that on the whole, professionals in the mental health teams they researched identify their roles as well defined. However, they had found significant differences among different professionals about their perception of how well their role is recognised and understood within their teams. Based on those results, they suggest “there is some conflict between the fact that the professionals perceive that their role is clearly defined but that their role is not recognised and understood within their teams”. Larkin & Callaghan further emphasises that „whilst individuals are clear about their professional roles, the team as a whole is not clear about the roles and responsibilities of those within it and this may possibly lead to problems within the team‟. Larkin & Callaghan (2005:344), citing Norman & Peck (1999) and Hunt (1983), emphasise that „ambiguous roles and serious perceptual discrepancies may cause negative consequences and lead to unclear lines of responsibility, accountability and difficulty within the teams‟. Finally, Carpenter et al (2003:1100) confirm the “importance of enhancing role clarity and reducing role conflict in ensuring positive outcomes for community mental health staff”.