The field of study is adult nursing. The chosen case study is Winterbourne View. Winterbourne was a private hospital owned and operated by Castlebeck Care Limited. The hospital was for people with learning disabilities and autism who also had challenging behavior or other mental health issues. This case study is relevant to adult nursing because it indicates how inter-professional and interagency working broke down and seriously affected adult hospital residents. It indicates the adverse effects of poor and ineffective inter-professional and interagency working in health care and adult nursing. This essay discusses the key principles of, barriers to, and enablers of inter-professional and interagency working in the context of the selected case study.
Principles of inter-professional and interagency working and why they are important in the context of the selected case study
The inter-professional practice has been identified as critical for improved health and social care. Inter-professional working (IPW) or inter-agency working (IAW) involves two or more entities working together to achieve a desired and shred outcome (Green & Johnson, 2015). The first principle of IPW is communication. This principle requires inter-professional and inter-agency teams to achieve a common understanding when communicating across roles and professions. This principle requires inter-professional team members to actively provide and seek information from other team members to ensure an adequate understanding of their functions (McLaney et al., 2022). This principle was not observed in the case study. There was a communication breakdown between the health professionals in Winterbourne View Hospital. An example of communication problems in the case study was the hospital failing to report injuries adequately by not informing the patient’s family, the NHS, and Care Quality Commission (CQC).
Another principle of IPW is teamwork. Teamwork involves members of different professionals having efficient coordination and delivery of care to community members. Teamwork requires members of the inter-professional teams to relinquish their perceptions and adopt the collective reward spirit (Information Resources Management Association, 2021). Teamwork enhances shared decision-making, with team members coming together to determine appropriate actions. This principle was not observed in the Winterbourne View case study. Learning disability nursing and psychiatry were the two disciplines deployed at the hospital. However, members of the two disciplines did not adopt a multi-agency working approach. This poor teamwork significantly contributed to the abuse against patients.
Another guiding principle for IPW is observing inter-professional ethics. According to Swisher and Royeen (2019), inter-professional ethics should be relevant across all professionals, patient/family-centered, relationship-focused, and formulated in a common language meaningful across all professionals. The inter-professional teams in the Winterbourne View case study did not observe inter-professional ethics. Instead of supporting the patients at the hospital, the staff mocked and tortured them. The fundamental principles of healthcare ethics, such as justice, autonomy, and beneficence, were absent at the Winterbourne View Hospital.
Inter-professional working is important as it would protect the patients from abuse. For instance, multiple agencies involved with the hospital failed to identify key warning signs. For instance, police attendance at the hospital, safeguarding concerns reported to the local council, management failure, and punitive culture contributed to the abuse. Different organizations failed in their mandate. NHS did not follow whether the patients it had placed there were being cared for properly, and CQC did not assess whether the hospital managers and staff were following rules․ Other agencies that did not work together to prevent the abuse are the local council and safeguarding adults board‚ and CQC․
Barriers to inter-professional working
In this case study, a significant barrier to IPW is the lack of communication. Lack of or poor communication is a barrier to IPW because it weakens relationships between professionals and hinders shared decision-making (Rawlinson et al., 2021). Due to poor communication, there was no timely exchange of information, agreement on role definition, and sharing of decision-making. For instance, the different agencies involved in the case study did not meet regularly to assess the kind of services provided at the hospital and whether the hospital managers and staff were following the relevant roles. This poor communication led to the hospital management not reporting the abuse happening at the hospital to the relevant stakeholders such as the NHS and CQC. The manager did not report injuries to the two agencies. There was also a communication breakdown among the staff at the GP surgery in charge of prescribing, which contributed to failures in medicines management.
The second barrier to IPW in this care is poor training of the hospital staff. Etherington et al. (2021) indicate that lack of training or knowledge regarding teamwork and inter-professional practice is a barrier to teamwork. The hospital staff did not receive adequate training, which led to failure to effectively collaborate with other health and social care professionals and fulfill their duty of care. Due to lack of training, the learning disability nursing and psychiatry professionals did not understand each other roles. They failed to collaborate in providing safe and effective care to the hospital patients. The staff also failed report to report the abuses. For instance, though some staff did not engage in abusing the patients, they did not take action to stop the abuse. If the staff had received training, they would have identified and stopped the abuse by working with other staff on providing safe and patient-centered care.
Enablers to inter-professional working
A key enabler to IPW is establishing procedures for inter-professional meetings and documentation and handling of patient data. Sørensen et al. (2018) indicate that introducing standard procedures for documentation and handling of patient data and knowledge sharing facilitates inter-professional collaboration. The hospital did not have guidelines for establishing inter-professional meetings and documentation. For instance, the hospital managers did not record the injuries suffered at the hospital. The lack of meetings led to several missed opportunities for taking action to rectify the issue. For instance, regular meetings would have assessed the hospital’s quality of care provided to the patients, identified the abuses and stopped the practice. Due to a lack of sufficient procedures, Castlebeck Ltd.’s managers did not deal with the unprofessional practices at the hospital.
Another enabler to IPW is having departmental and organizational leaders who promote or act as inter-professional collaboration agents. Leaders play a critical role in fostering inter-professional working by addressing essential questions, concerns and critiques. Strong leadership would plan multi-disciplinary meetings to facilitate improvements based on staff observations and experiences during their daily care functions (Michalec et al., 2015). The Winterbourne View Hospital did not have a registered manager for six months or more. The manager also ignored the patients’ reports of abuse. The management allowed that culture of abuse to flourish by ignoring whistle-blowers’ and patients’ reports about the problem. Effective management would have stopped the issue at the earliest opportunity and prevented the several incidences of patient abuse that adversely affect patient safety. Effective management would have also ensured effective inter-professional working, improving patient outcomes.
Recommendations emerging from the case study
Based on this case study, the paper recommends that inter-professional working in adult nursing can be enhanced by selecting leaders with adequate knowledge and skills to enhance IPW and training nurses and other professionals involved in adult care. Adult nursing units should have nurse leaders with sufficient knowledge and skills to promote IPW, such as effective communication, conflict-resolution, teamwork, coordination, and giving all professionals from different teams equal opportunities in decision-making in multidisciplinary teams. Evidence indicates that solid and consistent leadership and a leader’s ability to support staff contribute to interdisciplinary team collaboration, foster a better understanding of commonality in professional settings, and develop new collaborative strategies (Folkman et al., 2019). The selected leader should understand the specific roles and responsibilities of the different healthcare professional groups. This understanding will enable the leader to addres IPW problems such as role conflicts and cultural and behavioral differences.
Health care organizations can enhance IPW in adult care settings by training nursing professionals and other healthcare professionals working in the unit. The rationale for this recommendation is that inter-professional learning enables professionals to acquire an improved knowledge of others’ roles and responsibilities (Carney et al., 2019). For instance, adult nurses can understand the roles and responsibilities of physicians, dieticians, psychologists, psychotherapists, pharmacists, and other professionals and identify ways of working with them in providing adult care. The training will enhance staff development of IPW skills.
Conclusion
The field of study is adult nursing. The chosen case study is Winterbourne View Hospital. The hospital was for people with learning disabilities and autism who also had challenging behavior or other mental health issues. This case study is relevant to adult nursing because it indicates how inter-professional and interagency working broke down and had severe implications for the adult hospital residents. The principles of IPW important in this case are effective communication, teamwork, and inter-professional ethics. These principles were not observed in the cases study contributing to patients’ abuse and other failures. The significant barriers to IPW are lack of communication and inadequate staff training. Enablers of IPW identified from the case study are establishing procedures for inter-professional meetings, documentation, and handling of patient data, and having leaders with effective inter-professional collaboration skills. Recommendations for enhancing IPW among adult nurses and other professionals working in adult care settings are having leaders with adequate knowledge and skills to enhance IPW and training nurses and other professionals involved in adult care.
