Collaboration & communication

Communication and collaboration are key to a successful rehabilitation plan. It is also imperative to minimize health care costs, duplicated efforts and testing, and maximize efficiencies in the health care system.

Collaboration in health care is defined as working together to improve patient outcomes [1]. There are two facets of collaboration: collaboration between the clinicians; and collaboration with the patient and families/stakeholders. Both are equally important and serve to better the patient’s health outcome.

Communication & collaboration with patients & families

Communication styles develop based on various factors, including culture; ethnicity; and socioeconomic background. However, survivors of brain injury are faced with additional barriers Most individuals with brain injury face challenges with “language functioning, cognition and executive skills” which effect their ability to communicate their needs and goals [2].

Collaboration involves health care providers working with the individuals closest to the patient, such as their caregivers, families and friends to provide them with strategies for effective communication. The communication is bilateral, as these individuals can provide the health care team with valuable information about the patient. “The partnership between providers, patients and their families in shared decision making, coordination, and cooperation has been defined as interprofessional collaborative practice” [3]. Collectively, this partnership will drive the rehabilitation process and promote more efficient and patient centered goals.

Collaborative communication emphasizes strategies of “positive” and “rewarding” communication skills [4]. It promotes an atmosphere of respectfulness and transparency while allowing each team member to feel valued.

There are many ways collaboration with the patient and their respective family members/stakeholders. This can be accomplished through team meetings scheduled to include the patient, family, stakeholders, as well as ongoing therapeutic representatives. It can also be accomplished through group emails or online virtual meetings.

Patients and their families should be made to feel comfortable enough to ask questions and discuss alternative treatments without judgement. It is a team effort, and “team diversity should be viewed as a strength; it can bring about different viewpoints, facilitate innovation and problem solving and have the potential to result in amazing outcomes” [6].

Mitchell at all, from the The Institute of Medicine, in their discussion paper Core Principles & Values of Effective Team-Based Health Care [7] outlined what they found, through research, to be the Principles of Team-Based Health Care. They are as follows:

  • Shared goals: The team – including the patient and, where appropriate, family members or other support person – works to establish shared goals that reflect patient and family priorities, and can be clearly articulated, understood, and supported by all team members.
  • Clear roles: There are clear expectations for each team member’s functions, responsibilities, and accountabilities, which optimize the team’s efficiency and often make it possible for the team to take advantage of division of labor, thereby accomplishing more than the sum of its parts.
  • Mutual trust: Team members earn each others’ trust, creating strong norms of reciprocity and greater opportunities for shared achievement.
  • Effective communication: The team prioritizes and continuously refines its communication skills. It has consistent channels for candid and complete communication, which are accessed and used by all team members across all settings.
  • Measurable processes and outcomes: The team agrees on and implements reliable and timely feedback on successes and failures in both the functioning of the team and achievement of the team’s goals. These are used to track and improve performance immediately and over time.

 Interdisciplinary collaboration

It is beneficial for an individual to be “treated as a whole patient rather than just chief complaints,” [8]. This statement is especially true when dealing with individuals with multiple comorbidities, such as in brain injury. Interdisciplinary collaboration occurs between health care providers and the interdisciplinary team has a “common goal of optimizing patient care” [9].

Through various studies, The Government of Canada has identified several factors as important in collaboration. These include [10]:

  • Co-location and amount of time spent at a site;
  • Understanding of roles and responsibilities;
  • Trust and respect of each professional;
  • Ability to share patients/clients;
  • Sharing information about structures and procedures;
  • Regular face-to-face contact;
  • Joint work on local projects or specific topics; and
  • Support from senior management

The incorporation of various communication tools for collaboration is determined by the organization and/or the health authority. Interdisciplinary collaboration requires each participant to understand their role and responsibilities in way of communicating and attaining the patient’s goals.
Unfortunately, we are still faced with numerous challenges in working collaboratively in the health care system. Staff shortages and an increasing number of health care disciplines may contribute to more fragmented health care plans [11]. This therefore emphasizes the need for an increase in collaboration and collaborative tools and systems to be put in place.

Interprofessional and interdisciplinary collaboration are important elements for “Improved healthcare outcomes, […] the transfer of knowledge, sharing of information and enhanced decision making” [12]. It has been acknowledged that through this collaboration, the patient and their families will have better knowledge and communication which increases engagement and positive health outcomes. This collaboration is known for its “reduced length of hospital stays, improved compliance with standards of drug prescription, improved symptom and psychosocial management” [13]. Many organizations have embraced interdisciplinary collaboration for the patient’s best outcome. “It must be the duty of health care professionals, physicians, nurses, pharmacists, social workers and researchers to collaborate in order to reduce the health disparities and better the overall health among people” in our communities [14].

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