Interprofessional Harmonisation In Healthcare System / Delivery is a precinct unit made up of different health professionals who work in inseparable and interdependent teams, in which each profession has defined roles that complement each other in delivering health services to individuals and communities.
The World Health Organization (WHO) defined Interprofessional Teamwork or Collaboration as a situation where multiple healthcare workers from different professional backgrounds work together with patients, caregivers, families, and host communities to deliver the highest quality of care.
This is essential in a situation where healthcare professionals assume complementary roles and cooperatively work together, sharing responsibilities for problem-solving and decisions to formulate and carry out plans for adequate patient care.
THE FOUR DIMENSIONS OF HARMONISATION IN HEALTHCARE DELIVERY AND PERFORMANCE INCLUDE:
Adequate availability of health facilities and human resources is needed in districts and rural areas, which are underperforming in terms of the availability and utilization of health services to improve utilization.
Competency is a cornerstone on which a successful healthcare organization is built. Defining and understanding competence and competency is the first step in managing it effectively.
Competence can be described as the combination of training, skills, experience, and knowledge that a person has and their ability to apply them to perform a task safely. Other factors, such as attitude and physical ability, can also affect someone’s competence. Competence lies at the heart of any talent management effort in healthcare.
Responsiveness is defined as “the outcome that can be achieved when institutions and institutional relationships are designed in such a way that they are cognisant of and respond appropriately to the universally legitimate expectations of individuals (WHO 2000)”.
In the healthcare sector, the traditional measures of productivity are the labor output per health worker and the cost of the goods/services. Here, the two key metrics are time and financials, which directly focus on the bottom line of your operations, rather than the quality of services you provide.
Greater employee productivity in healthcare can benefit the quality of healthcare services and, as a result, boost customer satisfaction with the company’s medical services. Furthermore, in the healthcare industry, employee productivity is closely related to employee commitment and, ultimately, the turnover rate. Note; Patients are the center of every medical team and there is a need to include them as team members in any team function.
MANACLE OF TEAMWORK IN THE HEALTHCARE SECTOR IN NIGERIA.
Teamwork has been advocated across the globe. Nigerian healthcare shows interest in teamwork across healthcare institutions, however, some mitigating factors hinder the teamwork spirit and the expected positive outcomes.
- Hierarchy and health leadership. Supremacy/leadership challenge especially in health institutions leadership has developed an ugly trend that limits the effect of teamwork. Currently, it is difficult to have a health team where the team’s decision would be accepted if the team leader is not a medical doctor. This handed the competency in administration and management in Nigerian healthcare to the hands of Doctors, who may or may not have adequate knowledge in the practice of administration and management. Therefore, there is a need to give further attention, because the agreement with the concept of shared team decision-making is fundamental to effective interdisciplinary work of any kind.
- Personal values and expectations. Teamwork requires collaboration and understanding within the healthcare sector, therefore personal values and interests which is depending on the exposure have to be well maintained in other to understand each other.
- Generational differences Having a varied generation representing a team will create a barrier to inter-professional teamwork, some health workers have a particular age range; and might have some ideas, attitudes, or values.
The generation gap puts the freshly graduated health professionals who may be doing Internships and are fully Information Communication Technology (ICT) savvy to have different approaches to case management, in comparison to the older generation. If mutual understanding cannot be maintained, it creates so many differences.
- 4. Culture and Ethnicity In the Nigerian healthcare sector; culture and ethnicity serve as a gap in teamwork. When a client and a health professional are from different backgrounds; difficulty in language, communication, and understanding occurs. Some cultures or practices may be due to religion. This may pose a challenge, especially where women abhor medical attention from men or vice versa. Sometimes it might be hard to get a translator and this, therefore, ends the means of achieving a goal.
- 5. Gender
Gender In Nigeria, women are more among nurses and men are more among other professionals though there is a serious improvement towards mixing the gender unconsciously. Gender sensitivity is very important in the formation of good teams. In cases where professional members are dominated by men or women, such gender differences pose some challenges to team performance.
- 6. Personality and professional differences.
In Nigeria, some see the practice of medicine as an autonomous one-on-one relationship between the clinician and the patient while others see it as teamwork towards a better patient outcome. The challenge emerges when a particular profession in a healthcare setting takes ownership of a patient and assumes that other healthcare professionals that come in contact with the patient are not important. This serves as a barrier to interprofessional teamwork where one behavior or attitude differs from the other and sometimes, the attitudes can be traced to professional differences.
Differences in accountability, payment, and rewards. Dispute over accountability, salaries, rewards and allowances, poor remuneration, and welfare has also been identified in the Nigerian healthcare sector with cases of partiality depending on the professionals involved which have continued to emerge day in and day out among other factors. In Nigeria, various payment and salary structures exist. We have:
– Consolidated Medical Salary Structure (CONMESS), salary scale for medical doctors.
– Consolidated Health Salary Structure (CONHESS), for other healthcare professionals. The challenge is that CONMESS puts medical doctors more important in healthcare as other professionals lament frequently over the review of CONMESS and not the same for CONHESS. The argument is that the Chief Executives who are all medical doctors prefer to favor their colleagues to the detriment of other professionals.
This are are the major factor affecting the team spirit as it is evident that a team comprising of a Doctor, Pharmacist, Medical Laboratory Scientist, Nurse, Radiographer, and Physiotherapist who are in the same grade level shall go home with different amounts wages and emolument even though they are in the same team. Let us also remind ourselves of what was described as “Tribalism of the professions i.e. the tendency of the various professions to act in isolation from or even competition with each other by the “Lancet Commission on Health Professional for a New Century”.
THE CHALLENGES FACED AS A RESULT OF HINDRANCES OF TEAMWORK IN HEALTHCARE DELIVERY IN NIGERIA INCLUDE:
- Poor Quality Healthcare Delivery/Service
- Lack Of Good Resources Management.
- Weak Training And Education Of Health Care Workers.
- Weak Healthcare System.
- Lack Of Access To Healthcare.
- Healthcare System Corruption.
- Poor Leadership And Administration.
- Non-Used of Evidence_Based Intervention
- Hight Disease Burden. The Psychosocial factors of team members should not be allowed to affect team interactions. However, the impact of change on team members should be recognized.
SO, HOW DO WE AS A HEALTHCARE TEAM COMBAT THE TRENDS AND CHALLENGES IN NIGERIA HEALTHCARE?
All efforts should be put in place in Nigerian healthcare institutions to respect everyone’s values and assumptions that affect interactions with team members who are other professionals. No matter the strengths and weaknesses of different team members, good teamwork helps to deliver quality and safe care.
- Increase real-time care team communications and collaboration to improve capacity and increase patient throughput.
- Promote provider education to stay current with advancements in medicine and meet continuing. medical education requirements.
- Eliminate communication silos to accelerate decision-making.
- Improve team communication and performance
- Improve team productivity and expertise.
- Extend the care experience.
All are enhanced ‘Only’ when there is teamwork, harmony, and cohesion within and between the health professions in health service planning and delivery as a HealthCare Team. Based on my perspective/view, building a sound and effective “HEALTH CARE DELIVERY IN NIGERIA” strongly depends on the above certain factors together with the quality of leadership and management exhibited by health workers playing leadership roles at all levels. Remember; Our priority must be to focus our efforts on detribalizing the health professions and promoting intra and trans-professional harmony to serve the people and not the professions or individuals.
GEMALIURA EMMANUEL OBADIAH.
University Of Maiduguri, Unimaid.