tisdag 24 maj 2011

Samarbete mellan många professioner inom sjukvården

Roy Liff har studerat samarbetet inom tre BUP enheter i västra Sverige. Liff (2011:paper 4) skriver i sin avhandling Professionals and the New Public Management - Multi professional teamwork in psychiatric care:
Multiprofessional teamwork in health care is a well-researched area that focuses on organisation members' difficulties in understanding different professional cultures (Lister, 1982; Davidson, 1990, Evers et al., 1994; Ferrer and Navarra, 1994; Pietroni, 1994; Hanily, 1995; Hilton, 1995). Payne (2000:186, i Liff, 2011:paper 4) asserts:

The different professional groups need to invest time in becoming clear about their own professional role and its contribution to the multiprofessional team.

Vad kan förklaringen vara till mindre bra samarbete och koordinering:
  • Är det "social and cultural factors, both outside and inside the organisation" (Martin-Rodriquez et al., 2005), eller
  • (grupp)ledarskap och motivation (Ödegård, 2006), eller
  • betydelsen av väletablerade rutiner (Bradley Eilertsen et al., 2009), eller
  • aktörernas relationer till normer (Oliver, 1992; Diermeier and Krehbiel, 2003; Peters, 2005; Scott, 2008)?

Ovanstående förklaringsfaktorer är exempel på kulturella förklaringsvariabler. Men dessa kan inte förklara varför det kan fungera på en avdelning ("ward") men inte på en annan (Liff, 2011:paper 4).

Exempel på "samarbete" (Liff, 2011:paper 4):
A psychologist presents a new patient case with her comments.
Unit Manager: I give you Gaff [a diagnosis method], I give you z-diagnosis, I give you 5-1 talk therapy session [therapy method].
Psychologist: But the girl started to cut herself when she was 10. A 5-1 talk therapy session cannot be relevant.
Unit manager: Take the next patient.


Ett annat exempel på samarbete i Liffs (2011) avhandling:

Psychologist 1: J has anorexia and a difficult family situation. The girl both wants and doesn't want treatment. We would like to discuss how we should go on.
Unit manager: This is nothing to discuss. Family therapy!
(Silence)
Psychologist 1: But they [family members] do not want to talk to each other.
Unit manager:  That is just why you should use family therapy.
Psychologist 2: Then we must give this patient high priority because she is anorexic.
Psychologist 1: She has lost 10 kilo during the last four months. I do not think we can just give hem family therapy. We must offer them individual talk therapy as well.
(Silence)
Unit manager: I feel for we should treat the case as family therapy.
Social welfare worker: Yourself?
Unit manager: Yes, I feel for it
(Silence)

Liff (2011) vill föra fram "rationalism", "underinstitutionalisation", som ett kompletterande perspektiv till det kulturella, "overinstitutionalisation" som förklaring till varför samarbete och koordinering inte fungerar fullt ut. Det kan vara för få och för svaga normer, "institutioner" (inte för starka och för många), som förhindrar aktörerna att handla i egen sak.

Liff skriver även om medledarskap inom vård och omsorg.

From Liff, Roy (2011) Professionals and the New Public Management Multi professional teamwork in psychiatric care