Single shared assessment : the limits to 'quick fix' implementation

Joint working between health and social services has been a key focus of policy in recent years, albeit - underneath the protocols and partnership agreements - integrated processes have developed unevenly. A single shared assessment tool has been one of the concrete expressions of policy on the ground. This paper explores the implementation of the shared assessment process in Scotland. It discusses the broader policy agenda, before exploring the introduction of the shared assessment tool in a large urban authority. Based primarily on interviews with front-line staff in health and social work and managers charged with delivering shared assessment, the paper suggests a lack of engagement on issues such as working cultures and equity of workloads, while some of the main reasons behind the implementation of shared assessment, such as overcoming duplication, have not generally materialised for staff. Overall, single shared assessment has been driven by process rather than by engagement with wider ideas about joint working, which has led to uneven and at times unwilling implementation

Professional differences in interprofessional working

UK government policy is encouraging healthcare staff to blur traditional roles, in the drive to increase joint working between practitioners. However, there is currently a lack of clarity regarding the impact that changes to traditional working practice might have on staff delivering the services, or on patient care. In this article, we report findings from three qualitative case studies examining interprofessional practice in stroke care, in which the influence of professional differences emerged as a significant theme. We draw on findings from individual semi-structured interviews, as well as fieldwork observations, to describe the influence of professional knowledge and skills, role and identity, and power and status considerations in interprofessional working. The insights that were gained contribute to the understanding of how professional differences impact on healthcare staff joint working, and suggest that the elements identified need to be fully considered in drives towards changed working practice

Multidisciplinary Teamwork in a UK Regional Secure Mental Health Unit a Matter for Negotiation?

Multidisciplinary teamwork in healthcare is strongly advocated in policy documents and the professional literature, but evidence about its value is sparse. This paper argues that multidisciplinary rhetoric disguises the complexity of the relational processes involved. These processes are explored with reference to a qualitative study, conducted during 2002–2004, of a UK medium secure forensic mental healthcare unit. Although some instructive examples of selective collaboration emerged from the present study, in general, non-medical professionals felt that their capacity to negotiate new ways of working was thwarted by medical dominance. Patients, the recipients of interventions from a range of professions, mostly bracketed them together as an all-powerful 'they'. Multidisciplinary working promoted only limited partnership in this organizational setting, and became primarily a process through which structural differences were reproduced. The paper draws on insights derived from symbolic interactionist theory to explore the achievement of, and failure to achieve, collaboration across professional boundaries. It will be argued, firstly, that organizational constraints on multidisciplinary collaboration together with actors' attempts to overcome them can be usefully analysed in terms of a dialectic between role-taking and role-making; and, secondly, that the impact of professional power differences can be understood through analysis of organizations as autopoietic systems