Generic capability 1
This page explores generic rehabilitation professional capability one: the rehabilitation professional is “able to identify and work collaboratively with all people and teams from Health, Social Services, and the many other organisations that may be needed by a patient with a rehabilitation service.” This capability must be set in the context of (a) the other six generic capabilities and (b) the general professional standards of practice associated with the person’s profession. Generic capabilities are capabilities that all professionals working in healthcare need to have, whatever their profession and role in healthcare. However, the capabilities are necessarily broad, and each person’s role will determine which aspects of the capability will be more critical. This page will focus on areas where professional rehabilitation needs to be capable. As will be shown, healthcare systems are very complex. Because of its holistic approach and use of the biopsychosocial model of illness (here), rehabilitation will interact with many other services, including much outside healthcare. This interaction will only succeed if the rehabilitation professional understands the complex web of organisations they must work within. The summary MindMap of generic capability one is shown below and can be downloaded here.
Table of Contents
Context - network of systems
Society consists of multiple interconnected networks and groups, varying in size from small (a couple living together) to huge (the NHS). A rehabilitation team is a small network set within a more extensive network of local rehabilitation and disability health services and then within the hospital or community service. Moreover, it interacts with many other small team networks within and outside health. And those teams are set within their own more extensive networks. As I have said elsewhere: “No team is an island entire of itself; every team is a piece of the healthcare system.”
It might have been better to say: “No rehabilitation team is a network entire of itself; every network is a piece of the web of social networks, a part of the main; any action in one network reverberates across all networks; they influence us too.”
Naturally, most of our interactions are with local teams and networks, and interactions are likely to be more effective if there is a good mutual understanding between groups. This depends upon good communication, an awareness of team differences, and the common features that unite teams. Focusing on a patient’s well-being and a wish to help a patient is the most significant unifying force.
The core of this capability is that the professional can maximise the potential benefits of joint, collaborative working. Competition has no place in an effective and efficient network. Imagine the effect of competition between sub-networks in the most complex network known to us, our body – cancer is its name.
Context - properties of a social system.
All the component systems of the largest network in a country, that is, society, consist of groups of people. Groups of people have shared ideas, values, assumptions, and other characteristics that constitute their culture. The culture of a group is an essential factor determining the response of members of the group in their role as a member.
In rehabilitation, the expert professional will be part of a rehabilitation team, within (often) a rehabilitation service, and will usually be part of a larger healthcare organisation. The expert will be aware of the culture of each of these groups and will usually be aware that, even between closely allied groups, there are significant cultural differences within closely related teams. For example, acute care services pay little attention to long-term disability, and some rehabilitation services pay little attention to the disease and ‘medical’ aspects of a person’s illness.
Every rehabilitation team and service will inevitably and frequently need to work with organisations outside health – Social Services, Housing Departments, employers, Social Security, etc. Just as rehabilitation professionals adjust their behaviour – what they say, how they act – when interacting with an acute care team, they should change their behaviour when interacting with other agencies and services.
Adapting behaviour to a different social environment depends upon recognising that the other person from another group has a different culture and some knowledge of the culture and how best to adapt to it to achieve what you want.
A simple example is to consider how to get an ambulance quickly. Phoning to explain that the patient has severe abdominal pain will usually be answered by suggesting ways to reduce pain; one mention of breathlessness and possible chest pain will summon an ambulance immediately.
The attitudes required for this capability are:
- acceptance of position and role in short-term teams
- willingness to share responsibility
- willingness to help and teach other teams
- empathy, able to appreciate and show respect for the perspective of other organisations
The desirable behaviours can all be traced back to the professional agreeing to be involved and to help, coupled with an attitude of understanding, respecting, and working with people and organisations with different perspectives and values. Given the situation, most behaviours here are self-evidently the required behaviours; they need to be explicit.
One fundamental additional vital characteristic needed is the ability to accept that most other organisations have a limited and often incorrect understanding of rehabilitation. Rather than responding with slight irritation, the natural response to an almost universal lack of knowledge, the rehabilitation expert needs to be positive and take the opportunity to educate while avoiding a lecturing approach.
The rehabilitation expert professional must also know and remain committed to their professional values, especially being patient-centred. Even in health, service pressures, resource priorities and many other factors may influence decision-making such that it is no longer driven by or even influenced by patient needs and priorities. Other organisations may prioritise the person less than we all should. Negotiation and compromise will always occur, but a professional may sometimes need to state that a suggested action is not acceptable to them.
The behaviours associated with this capability are listed below. It must be noted that these are indicative behaviours. They are not a comprehensive and exhaustive list, nor are they a necessary list, nor are they a sufficient list. They guide, and they are illustrative examples. The behaviours can be divided into two groups:
- behaviours that are primarily concerned with an individual patient, and
- behaviours mainly related to the services the rehabilitation expert is collaborating with.
The rehabilitation expert’s indicative behaviours concerned with a specific patient are that the professional:
- Looks for and identifies services, teams, or individuals likely to be needed immediately or within the foreseeable future. The professional should always be looking to the future, identifying resources that may be required.
- Proactively contacts any services in the recent past to gain information and inform them of change.
- Proactively contacts teams needed or wanted well before the need arrives to ensure their suitability and the transfer information they prefer.
- Communicates proactively with all services currently involved, and in the communication, demonstrates an awareness of the other service’s purpose, priorities and values.
- Identifies shared goals and actions with one or more collaborating services or people and negotiates and specifies each service’s responsibilities for any shared actions.
The rehabilitation expert’s indicative behaviours concerned with the services worked with are that the professional:
- Responds promptly and promptly to all services making contact with past, present or potential future patients and fulfilling their requests for information, advice or other help where appropriate.
- Engages proactively with service commissioners and others, providing resources about service needs, changes and developments; and, where appropriate, funds for specific patients.
- Prioritises and uses resources efficiently and effectively, recognising and respecting resource limitations and constraints while providing evidence to obtain more help if needed.
- Responds quickly and positively to all requests for advice about and help with new patients yet to be known to the service.
Knowledge and skills
Most of the knowledge needed needs to be explicitly taught. It is acquired both ‘as part of life‘ and through curiosity about aspects of clinical and professional activities. Nevertheless, it is quite possible to set out to learn this. Much knowledge will apply wherever a person works, but it is also essential to know the specific details about local services. For example, social services’ general purpose and culture can be learned abstractly. Still, when interacting with a local service, it is likely to be more effective if the rehabilitation expert is aware of the many local factors that impact their ability to help.
The skills needed are similar to those required in teamwork and patient communication. Nevertheless, specific aspects need to be developed within this capability.
For this capability, the rehabilitation expert needs to know the following:
- The purpose of other services: what they think their goals are and what their specific knowledge and skills are. Rehabilitation services are often surprised and upset by misunderstandings in other services; we should avoid mirroring their lack of awareness of other services.
- The culture of other services: their language, their assumptions, their understanding of disability and the role of rehabilitation.
- The processes they use, especially concerning referrals and responding to referrals, give them the information they want in the way they wish and engender a more positive response.
- The resources that other services have and how these are allocated to them. All services have limited, and usually insufficient resources, and showing awareness and understanding will engender more cooperation.
- When it is possible to access specific resources needed for a patient from any available source, and how to do it.
- The roles of the various professions working in other services. If the profession is the same, understanding how the functions differ from those of the same job in rehabilitation is essential to avoid misunderstanding.
- As many specific details about local services as possible (people, places, strengths and weaknesses), it always helps to develop collaborative relationships if you have shared knowledge and interests.
The skills needed by the rehabilitation professional are to be able to:
- negotiate shared goals and actions, and adapt their approach and the team’s approach to the methods, strengths and weaknesses of the collaborating person or group.
- be either a leader or an active member of any cross-agency team formed around a patient.
- recognise, acknowledge, and adapt to the different priorities of different groups and services while focusing on the patient’s needs and preferences.
- communicate with other people and teams, not using rehabilitation jargon,
- seek clarification from others about their communication in a way that retains good relationships and ensures correct understanding.
This page covers the first generic professional capability needed by a professional with rehabilitation expertise. Although much of it is obvious and well within most people’s ability, the page does emphasise the need always to consider the goals and priorities of other teams and services, especially those outside healthcare. It is also important to acknowledge that others will have a limited understanding of rehabilitation and often will have false beliefs and ideas. Awareness of these two facts will help ensure good collaborative relationships. More can be read about generic capabilities in practice here.