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Topic: How do human factors impact on interprofessional collaboration and service user safety

The current health care system, including delivery processes, is essential but characterized by several crossing points and hand patient handoffs among numerous health care experts with different levels of educational and professional training. Therefore, the understanding of interactions between humans and other elements of the healthcare system, and the profession that utilizes theoretical approaches, data and principles to ensure optimum service delivery for patients’ well-being and overall healthcare performance (Trodd & Chivers, 2011). Human factors are scientific disciplines concerned with improving clinical performance through an understanding of the influences of teamwork, workspace, tasks, culture and organization on social behaviours and capabilities and application of that knowledge in healthcare settings. Meads et al. (2008) point out three core domains of system design that human factors consider in a health care system. These include cognitive, physical and organizational domains. Primary care would benefit from implementing human factor approaches because of the complexity of primary care, the coordinating role that primary care play and the multiple elements in the system.
Human factors can be essentially used to develop a healthcare system that supports health care professionals in service as well as minimalizing injuries and medical errors to patients. Generally, it is necessary to consider the positive impacts in terms of patients’ safety and health care professionals providing the services (Howard, 2008). Considering human factor approaches in enhancing service delivery and safety of patients, therefore, involves establishing systems which reduce potential risks while preventing future errors, and establishing system defences which promote patient safety. Since patients present to health care practitioners with diverse clinical needs, there is a need to explore and execute some of the aspects of human factors to improve patient safety. This is because primary care requires effective coordination of activities and information in serving patients. As a result, there is increased concern about maximizing patient outcomes by enhancing communication, collaboration and resilience among healthcare professionals (Orchard, King, Khalili & Bezzina, 2012). Therefore, this paper will explore communication and resilience as human factor approaches in health care system and their impacts on interprofessional collaboration and service user safety.
Collaboration among healthcare professionals is essential in providing quality care to patients. The term “interprofessional collaboration” frequently appears in healthcare literature. Therefore, understanding the concept and putting into practice in the mental health care system is fundamental. According to Orchard et al. (2012), interprofessional collaboration is “a partnership between a client and team of health professionals in a collaborative, participatory and coordinated manner to achieve shared decision-making concerning health and social issues.” Interprofessional collaboration, according to Boyle and Kochinda (2004), is the process of collective decision-making by independent parties, involving collective ownership and joint responsibility for the outcomes. Although there is a varying definition of interprofessional collaboration, the underlying features include partnership, communication, cooperation, shared decision-making and coordination (Orchard, King, Khalili & Bezzina, 2012).
Non-invasive ventilation is a technique used in the provision of ventilatory support to patients through upper airways using a mask or related device. Ram, Picot, Lightowler and Wedzicha (2004) highlights that this technique is unique from the ones used to bypass the upper airway with a tracheal tube which is why it is considered invasive. The use of non-invasive ventilation using nasal masks to treat hypoventilation in patients with neuromuscular illness has been successful making it be widely used method in health care systems (Knebel, Allen, McNemar & Feigenbaum, 1997). This has led to its use in acute hypercapnic respiratory failure to help patients who often experience respiratory failure. This being complex health care, patients need to be guaranteed of their safety (Brochard et al., 1995). Similarly, there is a need for sound communication among health care professionals so that they can save the lives of patients.
Achieving effective clinical practices involves relaying and communicating critical information accurately and promptly. Therefore, the collaboration of healthcare professionals is essential. Ineffective communication among health care professionals automatically puts the life of patients at risks. Firstly, the lack of proper communication present situations which can cause medical errors among health care practitioners (Leathard, 2004). Communication is defined as “the interchange or imparting of information, thoughts, or opinions through writing, speech or signs” (Jacobs et al., 2014). It is essential to note that communication is not just verbal expression. A study conducted by Fredheim et al. (2011) reports that about ninety-three per cent of communication is more influenced by tone, attitude, body language, leaving only seven per cent for verbal communication. Although verbal communication contains critical content, the meaning and effectiveness can be affected by the delivery style. However, essential information which is often conveyed through writings, messages, or e-mails can lead to adverse consequences in case miscommunication occur.
Healthcare professionals such as nurses, psychiatrists, pharmacists, and other practitioners play an integral roles in the delivery of health care services. A research conducted by Britain (2009) concluded that there was a diminished rate of readmission and improved quality of health when interprofessional collaboration is used. Nonetheless, studies reveal that productive interprofessional collaboration and communication among health care practitioners is essential for enhanced patient care and reduced medical errors (Ahmedzai et al., 2011). In another study conducted by Boyle and Kochinda (2004) to advance communication and collaboration between healthcare professionals in a medical background revealed that interprofessional collaboration through effective communication was enhanced among the participants. The study also reported the positive involvement of nurse practitioners in facilitating communication and collaboration. Their findings are consistent with the results from the Institute of Medicine (IOM), which reported the positive communication could have on interprofessional collaboration and organizational effectiveness at large (IOM, 2010).
An extensive review of the existing literature indicates that communication, interprofessional collaboration and teamwork rarely exist in healthcare settings. For instance, a study by Bosch and Mansell (2015) shows that social, organizational and relational structures potentially cause communication failures which in turn lead to failure in the health care system. Jones and Delaney (2014) conducted another study showing that patients have different priorities from health care professionals, and the verbal communication between health care professionals is often inconsistent. Meanwhile, Grant and Kinman (2012) reported that many patients in the United States health care system experienced issues, including the provision of conflicting information by the staff. Recent research has attempted to establish the effects of physician – nurse unruly behaviours and its impacts on the relationships of staff, the patient outcome of care and staff satisfaction and turnover (Bott et al., 1993). It further explores issues such as medical errors, poor quality care, adverse events and connections to avoidable patient mortality. Most of these consequences can be linked to poor communication and interprofessional collaboration.
Unfortunately, our health care system is run and managed by practitioners who are used to poor communication rooting from the culture of underperformance. Through the culture, health care practitioners anticipate for faulty and distorted exchange of information, which would cause more harm (Trodd & Chivers, 2011). This is because even professional workers tend to assume potential risks and healthcare inconsistencies. Although poor communication is often associated with adverse consequences, studies indicate that effective communication has positive impacts on the health care system. Some of the positive effects include increased patient satisfaction, improved employee morale, improved flow of information, enhanced interventions, and enhanced safety. Darzi and Johnson (2008) support this claim by showing that system implementation is essential in facilitating communication and improved quality delivery. Furthermore, effective communication among professionals promotes teamwork and transparency in the patient care system. It also inspires interprofessional collaboration and service user safety.
Despite the need and importance of effective communication in the healthcare system, there still exist barriers which compromise the quality of information. Although health professionals argue that they are part of a team, they tend to work separately. Communication and interprofessional collaboration barriers often jeopardize efforts to enhance health care quality and safety. Even though some health professionals tend to interact more often, they have divergent perceptions of what tasks they should perform pertaining to patient needs. The core communication barrier to effective interprofessional collaboration across the world is the fact that most of the health professionals are culturally diverse and have different cultural backgrounds. Cultural diversity, at any point of interaction, can only worsen communication issues. Cultural barriers can also hamper nonverbal communication. This is because different cultures ascribe to different nonverbal communication signs which have different meanings.
Often, interprofessional collaboration and communication have received minimal or no attention from healthcare professionals. As seen earlier, healthcare professionals are used to working independently. Sometimes, they may or may not share patient health information, making follow-up very difficult and high chances of compromised patient outcome. Lack of interprofessional collective practices has often caused delays in the provision of care services to patients. Meads et al. (2008) conducted a study which demonstrated the importance of employing interprofessional collaboration and communication to patient-care programs. They concluded that improved safety and outcome require a focus on collaboration and shared responsibilities. A ninety-hour interview conducted by Leathard (2004) generated a piece of detailed information on interprofessional collaboration and relationships. The study evaluated interventions to enhance interprofessional collaboration and communications. Their finding concluded that interprofessional collaboration was an essential determinant of patient outcome, but not the priority to patients due to interprofessional authorities and work pace.
On the other hand, the United Kingdom care system fortified by teamwork and collaborative work is perceived to be one of the models which can benefit service users. Maintenance of a user-focused team of professionals in complex care delivery circumstances is one of the core factors which health and social care, who need resilient employees, should adopt. Resilience is “the ability to persevere and thrive in the face of exposure to adverse situations.” Resilience is vital in protecting workers from the effects of stress-related to work (Howard, 2008). A report on the state of social work practice in the UK recognizes the existence of stress among social workers and suggests the need for the development of organizational, professional resilience as a means of addressing the problems (Munro, 2011). According to Grant and Kinman (2012), resilience is a complex and multi-dimensional aspect increasingly perceived as appropriate to countering occupations which are emotionally challenging and under-explored in social care practices.
According to Fisk and Dionisi (2010), resilience is a concept which incorporates psychological, behavioural features such as emotional intelligence, self-monitoring, self-evaluation and self-efficacy. Even though the situations and contexts in which resilience is required are significant considerations, and often challenges the determination of possibility of a person’s resilience (Pangallo et al., 2014). Workforce development is an essential aspect of achieving organizational efficiency and effectiveness. A focus on workforce resilience is a concept which has rapidly gained popularity as organizations utilize it for workforce development solutions. However, there is scant literature on how resilience functions and the strategies to transfer it to professionals and organizations (Zellars et al., 2012). Although some researchers support deploying individuals with resilience features who can create psychological capitals and assets, others suggest instilling resilience in individuals through tailor-made training programs.
Organizations undergoing the challenges of external pressures, complicated work conditions and additional targets may develop stress-creating conditions for their workforce (Jacobs et al., 2014). This may turn out as a weak communication system in an organization which is due to additional demands in deliveries from limited resources. Employees develop stress which causes emotional exhaustion and dissatisfaction of service users. Ultimately, it would lead to poor interprofessional collaboration and service delivery system. Although the development of resilience in the whole team, which is sometimes difficult, is essential, individual resilience has been necessary for the overall performance in the health and social care workplace.
Modern healthcare professionals have the most challenging roles, and therefore, resilience is increasingly becoming a requirement to perform in these roles. However, there exist various cultural and contextual factors in community-based healthcare systems which can affect the resilience of healthcare professionals. The ability of an individual or healthcare professional to successfully demonstrate resilience, they have to face harsh conditions at work. In the context of being the primary care professional, resilience is the ability to overcome or recover from adverse impacts of stresses and other challenges, to remain optimistic at the glance of adversity (McCray, Palmer & Chmiel, 2016). There have been studies on resilience in health professionals, although to a shallow extent because health care provision can be stressful due to the challenges and context of practice.
Review of literature about nursing resilience and coping strategies in the workplace reveals that resilience can be developed and strengthened, and should be necessarily incorporated in nursing training programs. Also, resilience has been found to be a combination of personal experience and traits, which are the primary contributors to positive adaptation. However, there are two critical challenges which affect primary care; working in remote and rural areas and working in areas of manifold deprivation (Laming, 2009). Either way, they determine one’s level of resilience. Poor resilience is associated with high employee turnover, which affects services for deprived and rural dwellers. Regardless of the challenges of resilience adaptation, some health care professionals still have the ability to endure the harsh conditions to deliver their services to patients. As a result, it would be helpful to explore the resilient features of such practitioners to know what enables them to survive in such conditions. Also, as suggested by Bowden et al. (2014), there is an increased need to incorporate effective strategies to nurture resilience to prevent challenges. This would deduce whether resilience in health professionals can be developed to enhance workforce sustainability.
In conclusion, interprofessional collaboration is an essential phenomenon in the health care system. Collaboration among health professionals is vital in providing quality care to patients and the achievement of a healthy society. Although health professionals may seem to exist in the same environmental context and have a smooth flow of information, they do not enjoy the privilege of organized work practice. The poor communication that exists among them translates to an adverse effect on patients and other service users. For this reason, there are increasing needs to incorporate adequate communication channels or systems whereby information can flow from the highest authority to the lowest without any distortion. Studies have shown that effective communication has positive impacts on interprofessional collaboration and service user’s satisfaction. Often, lack of a proper information channel has led to non-follow-up of patient prescriptions as well as treatment requirements. On the other hand, resilience plays a notable role in interprofessional collaboration and service users’ safety. Because it makes health professionals persevere and thrive exposure to adversities, it also offers protection against stress-related works. It is essential in overcoming occupations which are emotionally challenging in the health care system. However, poor resilience is one of the significant causes of employee turnover, which affect service delivery to patients. Therefore, effective communication and resilience, as seen in this study, have positive impacts on interprofessional collaboration and service user safety.

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