The multi-professional Health Team making changes from the bottom up
The Health Team at LEAP in Lambeth assess better collaborative working between primary-care professionals in maternal and neonatal care.
This blog was originally published on the The National Lottery Community Fund website for the A Better Start programme.
Poor interprofessional communication is a recurrent theme in enquiries into maternal and neonatal mortality and morbidity. Multi-professional working has been identified and prioritised as a way to deliver safe care, and NHS plans state that: ‘Great quality care needs great leadership at all levels’.
Lambeth Early Action Partnership (LEAP) commissioned an innovative interprofessional Health Team to explore how primary care professionals could work better together. The Health Team is made up of four front-line clinicians: a local GP; Health Visitor (HV); and two midwives (MW) from the local Trusts, overseen by a public health specialist. Designed to have a flat hierarchy and to work autonomously, our aim is to identify barriers to seamless interprofessional working, and to develop low-cost solutions.
Released from our front-line jobs one day a week, we initially aimed to understand how each other provided care, and what the front-line challenges were. We observed each other at work, and met a wide range of people involved in families’ care. This included parents, but also people who commissioned children’s services, and a wide range of other health care professionals.
We produced a diagram of who was involved and how they communicated, marking areas where communication did and did not work well. Communication systems between primary care professionals were found to be extremely complex. We identified actions to improve interprofessional working and met with senior leaders to make them aware of issues and suggest changes.
The wide-ranging projects which emerged from our work include:
- GP Connect: GPs and HVs meet regularly to discuss vulnerable families and develop a joint plan of action if families need additional help.
- Local Care Record: working with IT managers, midwives can now access GP and HV notes at one hospital via a shared computer system through which different health specialities can see each other’s clinical notes.
- Contact List: A contact list of local practitioners will be hosted on Lambeth Council’s website to enable easy access (accessible to practitioner’s only). E.g. a midwife is able to find out which HV team is responsible for a particular family.
- Training sessions: e.g. communication and referrals session to midwives and practice nurses, perinatal mental health training to local HVs and GPs. Our midwives delivered Newborn Bloodspot (NBS) training to local HVs, aiming to reduce the number of tests that were inadequate and needed repeating.
- Conferences: We partnered with the Centre for the Advancement of Interprofessional Education (CAIPE) to host an event bringing together senior professionals working in early years in Lambeth to discuss inter-professional working.
- Maternity Vulnerability Assessment Tool (MatVAT): we developed a system to identify families in need of additional support before the baby is born. This work is ongoing and a research evaluation will be undertaken to understand the benefits for midwives of using such a tool.
The essential elements of the Health Team model which are different to previous multidisciplinary approaches are:
- The team is made of up front-line workers who are given paid, protected time away from clinical work.
- The team has a flat hierarchy: everybody’s contribution is honoured.
- The team have the autonomy to explore any issues they identify: light-touch management steered by the overarching priorities of the organisation.
- The team is supported to disseminate and implement solutions identified.
- Low cost - the Health Team had no implementation budget, so recommended actions involved using existing services only.
We feel empowered by seeing the positive results of our work breaking down barriers and dispelling personal bias about each other’s disciplines. We gained skills in negotiating systems change and have accessed opportunities for personal development including additional training, engaging in strategic meetings at senior level, teaching skills in training other health professionals, and gaining experience of public speaking. Adopting a similar approach could have a positive impact on retention of staff and reducing burnout.
An evaluation report from the GP Connect project shows the benefit of fostering the relationship between the GPs and the HVs, so the complexities of a child’s home environment could be understood. This, and linked computer systems, benefit families due to improved continuity of care, and less repetition to different healthcare professionals.
The Health Team model could be considered in any area with challenges to interprofessional working. Systems and culture change undertaken by clinicians working within the system may identify previously hidden problems and may be more sustainable than traditional top-down change. Further research is needed to evaluate how the Health Team model compares to external consultants in terms of local systems change impact, and cost effectiveness.