As a member of the inactive class of the Ontario College of Social Workers and Social Service Workers (OCSWSSW), my interprofessional experiences lie more in observation than in practice. However, I have been fortunate to observe and support multiple health professionals in their roles as Home and Community Care Support Services (HCCSS) Care Coordinators (case management) and/or hospital discharge planners. These observations have helped to inform my understanding of the benefits of interprofessional collaboration and the opportunities it provides in the provision of optimal patient care.
As guided by the Registered Health Professionals Act, 1991, HCCSS Care Coordinators encompass professionals from a variety of different backgrounds. Primarily nurses, occupational, physio, and speech therapists are also included, as well as social workers (generally with a graduate-level education and credentials, however not regulated under the RHPA). These individuals work on multidisciplinary teams to support patients in home, retirement, school, and community settings. Collaboration between professions occurs within the walls of the organization (using the expertise of team members and peers to supplement one’s own knowledge), with community-based service providers (sharing information through reports as dictated by best practices and government mandates), in formal team meetings (with patients and their families, or for specialty programs such as stroke rehabilitation), or through informal conversations (e-mail, phone).
In a hospital setting HCCSS Care Coordinators serve in the role of discharge planner for patients whose discharge requires (as examples) home care services, in-patient rehabilitation, or the initiation of a long-term care application. Again, disciplines vary, but, in this setting more than in community, it is important that coordinators “know their role” and maintain professional boundaries. A HCCSS hospital coordinator needs to be knowledgeable, but not wear multiple hats. Hospital care coordination offers the advantage of being able to defer to in-house experts (doctors, nurses, hospital allied health professionals) and use their knowledge, skill, and documented interventions to facilitate a safe discharge that is in the best interest and meets the identified needs of the patient and their support system. Well-executed interprofessional teamwork assists to prevent recurrent hospitalization for the same or similar health concerns.
In a hospital setting where HCCSS is not involved in patient discharge, it is typically a registered hospital social worker who assumes the role of discharge planner. Like HCCSS care coordinators, the hospital discharge planner must consult with other health professionals within the hospital to coordinate services and enact a discharge plan that ensures a patient feels fully supported (medically, mentally, emotionally, socially, financially), and where suggested or required interventions, treatments and follow-ups do not present obvious barriers. Where these may exist (expressed by patient or family, or evident based on the development of a patient-practitioner relationship) the social worker/discharge planner will troubleshoot and coordinate alternatives with the support of interprofessional team members.
In my brief search for interprofessional practice resources, I came across an article (admittedly a bit dated, but I feel still relevant) exploring the benefits and potential pitfalls of interprofessional team membership as it pertains to social work practice. In Practice Notes: The Inter-professional Team – Asset or Encumbrance, author Pamela Blake (2010) shares her thoughts as a Registered Social Worker (RSW) on collaborative practice, and how social workers may function on interprofessional teams. Of interest was Blake’s point that “the educational background and skill set of social workers…position them uniquely to play a critical role in identifying key issues and resolving team conflicts” given their background and skill in assessment, evaluation, and conflict resolution (Blake, 2010). Additionally, the College’s Code of Ethics and Standards of Practice provides guidance of a member’s conduct as it relates to confidentiality, patient self-determination, and advocacy (as a few examples) which may be useful and offer differing perspectives in the context of interprofessional teamwork (Blake, 2010; Ontario College of Social Workers and Social Service Workers, 2008). As a developing leader, I look forward to putting Blake’s observations in to practice in my own experience on future interprofessional teams.
Regardless of setting, the interprofessional interactions discussed above are necessary in providing optimal patient care, that is in the interest of patient goals, and supports a return to independence, where possible. Discussion with my Master of Health Studies peers further cements this observation. Daily, Nurses, social workers, allied staff, and technologists collaborate to provide seamless intervention. Especially in, but not limited to, hospital settings, even seemingly disconnected roles such as a Registered Dietician and Registered Respiratory Therapist cross paths. There exists an obvious mutual respect between professionals, not just of boundaries, but of values, knowledge, and skill. Where leadership is involved, leaders tend to consult with their interprofessional staff to understand professional obligations and individual workflow, and how these intersect with operational mandates and objectives. Together, plans are enacted that meet the needs of most, while encouraging collaboration, communication, and an appropriate level of transparency.
Successful interprofessional collaboration requires an ongoing commitment from individuals across disciplines. While this may, at times, present stress and strain, or pose challenges to care planning, it also provides opportunities to learn and grow. As professionals we must persist, together, connecting with patient success in mind.
References
Blake, P (2010, October). Practice notes: The inter-professional team – asset or encumbrance? [Editorial]. Perspective. https://www.ocswssw.org/wp-content/uploads/Practice-Notes-The-Inter-Professional-Team-revised-20180629.pdf
Ontario College of Social Workers and Social Service Workers (2008). Code of ethics and standards of practice handbook (2nd ed.). https://www.ocswssw.org/ocswssw-resources/code-of-ethics-and-standards-of-practice/
Some additional resources for review …
Reeves, S., Pelone, F., Harrison, R., Goldman, J., & Zwarenstein, M. (2017). Interprofessional collaboration to improve professional practice and healthcare outcomes. Cochrane Database of Systematic Reviews, 2018(8). https://doi.org/10.1002/14651858.cd000072.pub3
A review of existing research which explores the strength of connection between selected interprofessional collaboration activities (of social workers and other health professionals) and improved professional practice as well as (patient-reported) improvement in health and overall care provided., While the review suggests there currently exists little evidence in support of strong connections, it concludes that the current body of research is encouraging and suggests interest in further study of interprofessional collaboration and its use in improving health care delivery and patient outcomes.
Adamson, K., Ashcroft, R., Langlois, S., & Lising, D. (2020). Integrating social work into interprofessional education. Advances in Social Work, 20(2), 454–472. https://doi.org/10.18060/23602
A paper reviewing the need for, as well as current gap in interprofessional education with social work students. Specifically exploring the University of Toronto’s interprofessional education curriculum, the paper makes a strong case for the inclusion of interprofessional education activities in the social work curriculum (at all levels) in support of enhancing professional knowledge and collaborative practice (in health care settings). The authors task social work educators to improve interprofessional opportunities and provide examples of ways this can be achieved.
National Association of Social Workers (2016, April). Challenges faced by social workers as members of interprofessional collaborative health care teams. http://www.socialworkblog.org/nasw-publications/2016/04/challenges-face-by-social-workers-as-members-of-interprofessional-collaborative-health-care-teams/
A review of a 2016 study which explored the benefits of and barriers to interprofessional collaboration as communicated by Canadian social work professionals and students. The study describes six key themes in participant responses: professional culture, role clarification, professional identity, decision making, communication and power dynamics and explains how each can contribute either positively or negatively to interprofessional teamwork in the social work profession.
Note – Given barriers to accessing the original article, I made use of the NASW review. However, the reference for the original study is as follows:
Ambrose-Miller, W., & Ashcroft, R. (2016). Challenges faced by social workers as members of interprofessional collaborative health care teams. Health & Social Work, 41(2), 101–109. https://doi.org/10.1093/hsw/hlw006
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