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Collaborating with other healthcare services

In this video, Nathaniel Scherer considers how healthcare professionals can collaborate with other healthcare providers.
NATHANIEL SCHERER: Children with developmental disabilities and their families often receive support from a number of different health care services across primary, secondary, and tertiary care. For instance, children with complex developmental disabilities may need to visit community health workers, psychologists, physiotherapists, occupational therapists, paediatricians, and orthopaedic surgeons. Ideally children and families will have the opportunity to visit just one location in which to address a range of healthcare needs. But more often than not, healthcare services are scattered across different facilities. This can be confusing, time consuming, and resource intensive for a child and their family. If these services do not coordinate their efforts, service provision can become severely fragmented. Parents are often overloaded with appointments.
And different messages and fragmented services can mean that parents and children receive inconsistent, conflicting healthcare information and advice, causing children and families additional unneeded stress and anxiety. They may also undergo a duplicated assessment and appointments. And healthcare interventions may interfere with one another, resulting in extra travel costs. These stressors may cause parents to develop negative attitudes towards healthcare professionals. Evidence shows that collaboration between healthcare providers will help professionals meet the variety of needs facing a child with a disability. Collaboration thereby improves long-term health outcomes for children with developmental disabilities, including reduced symptoms of poor health and lower mortality rates.
The World Health Organisation calls for interprofessional collaborative practice in which healthcare professionals across various disciplines and locations work together to provide the best quality care. This collaborative practice can occur within the same service or organisation, such as a hospital, or between different organisations in different locations. In this video, we’ll be focusing primarily on interorganizational collaboration between different services, although many of the concepts will be relevant to multidisciplinary teams within the same healthcare organisation. So, how do we achieve collaboration? In 2001, Arthur Himmelman developed a framework for collaboration between organisations. And these principles are useful to consider when discussing improved healthcare for children with developmental disabilities. Himmelman’s framework comprises four levels.
In its most simple form, collaboration can include the simple exchange of information between two or more healthcare services. For example, one healthcare care professional may inform another on their procedure for child development assessments. Himmelman called this process ‘networking’. It requires little time commitment and limited levels of trust but requires healthcare professionals to have an understanding of other services in their network. At the next level, healthcare services could alter their activities to achieve a common purpose. For example, two services may adapt their schedules to better support a child and their family so that a child does not have to travel from a rural area on two separate days. This is called ‘coordination’.
Although this requires a higher level of trust and greater time commitment, it enhances accessibility for children and their families by creating more user-friendly services. Sharing resources is another important activity. And it allows healthcare services to begin to take part in ‘cooperation’. Services that share resources in the form of staff, technology, property, or knowledge can provide a much higher quality of care to children and their families. This does, however, require a high level of trust and coordination. There may also be practical barriers to overcome, like how different services manage their human resources. The ultimate approach to service provision is what Himmelman called ‘collaboration’. Collaboration goes beyond information sharing, altering activities, and sharing resources.
And asks that services help to build the capacity of one another, enhancing each other’s service capabilities. This may include skills-based professional development training between services, for instance, nutrition services providing training on good diet to physiotherapists. Evidently, collaboration requires the most intensive commitment by healthcare service providers, but it has the potential to realise huge improvements in the care for children with developmental disabilities. The suitability and viability of these collaboration frameworks will depend on your setting and public healthcare system. In some settings, it may be feasible to reach the ultimate stage of collaboration, whereas in other contexts, targeting the simpler requirements of networking or coordination may be more appropriate.
We encourage you to adapt the lessons learned in this video to what can work in your setting. To help you do this, let’s think of some principles to facilitate each of these collaborative stages. First and foremost is communication. Communication between healthcare providers in a network is needed to establish trust and share targets, enabling greater service provision. Healthcare professionals of different services need to continually share information about a child and their family, including information on medical history, results of tests, healthcare recommendations, and appointment scheduling. This communication will help promote continuity of care and means that parents are not constantly having to bring different healthcare professionals up to speed on their child. Communication needs to be regular, active, and open.
This effective communication helps different healthcare services and professionals develop a set of shared goals and values, such as improved physical access across different facilities or a reduced number of appointments for children and families. It is important that services negotiate a suitable balance of power so there are no power struggles to the detriment of a child and their family. Finally, and as recognised throughout this course, collaboration between healthcare services should be patient and family-centred. Ensure that children and their families are active members in goal setting and decision-making. Listen to their needs and work with other services to best address them. Of course, collaboration is easier said than done. And it’s difficult to achieve collaboration in practice.
Constraining factors to collaboration include insufficient funds or resources to support the collaborative project, a lack of time and competing priorities for healthcare professionals, making it difficult for individuals to engage in collaboration activities and develop meaningful relationships with professionals in other organisations. Power imbalance and conflict can also arise between professionals and different healthcare providers, especially when roles are not clearly defined. There may be unequal power between a hospital and community health group, for example. Barriers can only be overcome with good leadership and a strong commitment from healthcare providers and healthcare professionals who recognise the benefits of collaboration in the care of children with developmental disabilities. To end, let’s think of an example of collaborative practice.
One of the major difficulties of maintaining effective collaboration is the complex task of sharing up-to-date patient records and communicating. Although many countries use electronic notes, different facilities can use different systems. And this can make sharing patient details difficult, causing inaccurate or missing patient records. This means that parents and children may have to continually recall their own history with a new healthcare professional. This isn’t an issue unique to low- and middle-income countries. And many high-income countries, such as the UK, face these issues, despite heavy investment. To combat this issue, an example solution comes from Malawi. Officials have introduced the child health passport, which is given to parents when a child is born.
In this, parents can record their child’s healthcare appointments, medication, and so on, with help from their healthcare provider. Many countries do not trust patients to maintain their own healthcare records. But evidence from Malawi shows that parents and children maintain these records in good order. This can facilitate information sharing between healthcare providers, can help ensure that all health professionals easily know a child’s medical history. Could something similar work in your setting? Perhaps parents and children could be given a simple notebook in which to record conversations with different healthcare professionals, appointments, and exercises to perform at home. Healthcare professionals can even use the notebooks to write notes for each other so they don’t have to rely solely on the family’s recall.
In the next step, we want you to discuss how you could promote better collaboration between healthcare services in your setting. Think about the changes you can make tomorrow and what challenges there are to doing this. We look forward to hearing your ideas.

Improving access to healthcare services for children with developmental disabilities across the healthcare journey cannot be achieved by one healthcare professional alone. Only by working with other healthcare service providers can access be improved.

In this step, Nathaniel Scherer (LSHTM) explains why collaboration is needed, before discussing Himmelman’s framework of collaboration, a simple model for understanding how services can work together.

In the next step, we will ask you to discuss collaboration in your setting and think about the changes that can be made to promote a greater level of collaboration between service providers.

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Integrated Healthcare for Children with Developmental Disabilities

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