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 whatever their role in healthcare. However the capabilities are necessarily broad, and each person’s role will determine which aspects of the capability will be more important. This page will focus on areas that a rehabilitation professional needs to be capable in. As will be shown, healthcare systems are very complex. Rehabilitation, because of its holistic approach and its use of the biopsychosocial model of illness (here), will interact with a great number of other services including many outside healthcare. This interaction will only succeed if the rehabilitation professional has a sound appreciation of the whole complex web of organisations that she or he needs to work within. The summary MindMap of generic capability one is here.
Context – network of systems
Society consists of multiple networks and groups, all intertwined, varying in size from small (a couple living together) to huge (the NHS). A rehabilitation team is a small network, set within a larger 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 both within and outside health. And those teams are set within their own larger networks. As I have said elsewhere (here): “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 teams. This depends upon good communication and an awareness both of the differences between teams, and the common features that unite teams. A focus upon a patient’s well-being, and a wish to help a patient is the greatest unifying force.
The core of this capability is that the professional is able to maximise the potential benefits arising from 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 greater network that is Society consists of groups of people. Groups of people have shared ideas, values, assumptions, and other characteristics that constitute their own culture. The culture of a group is an important factor determining the response of members of the group in their role as a member of that group.
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 large cultural differences within closely related teams. For example, acute care services pay little attention to long-term disability and, conversely, some rehabilitation services pay little attention to 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, so they should adjust their behaviour when interacting with other agencies and services.
Adapting behaviour to a different social environment depends upon both a recognition that the other person from another group has a different culture, and some knowledge of what the culture is 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 desirable behaviours can all be tracked back to the professional having an attitude of agreeing to be involved and to help, coupled with an attitude of understanding, respecting, and working with people and organisations that have different attitudes and values. Given the situation, most behaviours here are self-evidently the required behaviours; they nonetheless need to be made explicit.
One particularly important additional vital characteristic needed is the ability to accept that most other organisation have a limited and often incorrect understanding of rehabilitation. Rather than responding with slight irritation, the natural response to an almost universal lack of understanding, the rehabilitation expert needs to be positive in their response, and to take the opportunity to educate while avoiding a lecturing approach.
The rehabilitation expert professional will also need to know and remain committed to his or her 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 not prioritise the person as highly as we all should. Negotiation and compromise will always occur, but at times a professional may need to state that a suggested action is simply 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, they are illustrative examples. The behaviours can be divided into two groups:
- behaviours that are primarily concerned with an individual patient, and
- behaviours that are primarily related to the services the rehabilitation expert with collaborating with.
The rehabilitation expert’s indicative behaviours concerned with a specific patient are that the professional:
- Looks for and identifies services, teams, or individual people who are likely to be needed immediately, or within the foreseeable future. The professional should always be looking to the future, identifying resources that may be needed.
- Proactively contacts any services involved in the recent past, to gain information and to inform them of change, and proactively makes contact with 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 purpose, priorities and values of the other service.
- Identifies goals and actions that are shared 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 about past, present or potential future patients, fulfilling where appropriate their request for information, advice or other help.
- Engages proactively with service commissioners, and others providing resources, about service needs, changes and developments; and, where appropriate, about funds for specific patients.
- Prioritises and uses resources efficiently and effectively, recognising and respecting resource limitations and constraints, while providing evidence to obtain more resources if needed.
- Responds quickly and positively to all requests for advice about and help with new patients, not already known to the service.
Most of the knowledge needed is not explicitly taught. It is acquired both ‘as part of life‘, and through being curious about aspects of clinical and professional activities. Nevertheless, it is quite possible to set out to learn this. Much of the knowledge will apply wherever a person works, but it is also essential to learn the specific details about local services. For example the general purpose and culture of social services can be learned in an abstract way but, 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 on their ability to help.
The skills needed are very similar to the skills needed in relation to teamwork and to patient communication. Nevertheless, there are specific aspects that need to be developed within this capability.
For this capability, the rehabilitation expert needs to know:
- The purpose of other services: what (they think) their goals are and 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: the language they use, the assumptions they have, their understanding of disability and the role of rehabilitation.
- The processes they use, especially in relation to referrals and responding to referrals. Giving them the information they want in the way that they want engenders 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 usually 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, an awareness of how the roles are different from the roles of the same profession in rehabilitation is important, 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 to adapt their own approach and the team’s approach to the approaches, strengths and weaknesses of the collaborating person or team.
- be either a leader of, or an active member of, any cross-agency team formed around a patient.
- recognise, acknowledge, and adapt to the different priorities of different teams and services, while still ensuring a focus on the patient’s needs and priorities.
- communicate with other people and teams clearly, not using rehabilitation jargon,
- seek clarification from others about their communication, in a way that retains good relationships but also ensures correct understanding.
This page covers the first generic professional capability needed by a professional with rehabilitation expertise. Although much of it is probably 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.