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Historically, the concept of health has focussed principally on the absence of illness (Taylor,

Foster & Fleming, 2008). Today, our understanding of health extends not only to the optimal

functioning of body structures, but to how this functioning affects participation in a personal and

environmental context (World Health Organisation WHO 2001). Health care consumers are more

educated regarding their health and are required to take greater responsibility for their health outcomes.

Subsequently, an intervention that focuses not on disease, but rather on the empowerment of the

patient and their social, psychological and physical treatment needs, requires active participation of

several health care disciplines and professionals (Stewart, Brown, Weston, McWhinney, McWilliam,

& Freeman, 2003). Thus many health care facilities are now adopting an interdisciplinary model for

treatment, such as aged care wards at Melbourne’s Caulfield General Medical Centre (CGMC) where

the benefits of its effectiveness were undoubtedly supported by first-hand clinical experience on

student placement.

A simple explanation of interdisciplinary practice may be ‘two or more disciplinary

perspectives collaborating in a manner so that the sum of the effort is greater than how each discipline

might interpret a situation…individually’ (Redman, 2006, p105). Further to this, the inclusion of the

patient as a part of this team is generally ideal (Wiecha & Pollard, 2004) and should be considered for

a comprehensive understanding of the interdisciplinary team. The goal of such collaboration, in a

health care context, is to ensure that thorough care plans are developed for each patient in a manner

that addresses the increasing complexity of client needs in this day and age (Cooper, Carlisle, Gibbs &

Watkins, 2001, as cited in Redman, 2006).

In the context of the changing needs of today’s patients, there are several key potential benefits of

interdisciplinary practice that enables this model of health care management to best support the

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achievement of an optimal health workforce. This practice not only encourages, but requires,

improved communication between team members (Bynon, Eyres & Maguire, 2008). It could be said

such communication is the essence of best care in health, as lack of communication between

professionals and between patient and therapist is often the cause of harm in health care (Drinka &

Clark, 2000). Communication between interdisciplinary team members is most often maintained at a

high level through regular team meetings, such as was utilized at CGMC. Each inpatient was

discussed twice weekly by all professionals relevant to their health and welfare care, in which time

therapy goals, patient education strategies, discharge timeframes and discharge service requirements

were discussed and implemented. Additionally, ‘family meetings’ were conducted frequently which

allowed for the team to take into consideration the needs of primary carers – an assessment of

particular relevance in this aged care setting.

Enhanced communication between practitioners/therapists goes hand in hand with a reduction in

duplication of work and, subsequently, of staff workloads (Bynon, et al, 2008). Furthermore, the

overlapping of competences amongst these health care professionals (Satin, 1994) acts to increase the

flexibility of roles and work practices. This gives interdisciplinary teams an advantage over their

independently practicing colleagues in terms of adaptability in the workforce and, again, time- and

cost-efficiency.

An example of such efficiency on CGMC’s aged care ward was the collaborated approach to the

use of interpreters. As necessary, an interpreter would be booked for a time convenient to several

disciplines that required this service. Then, professionals would either see the patient with the

interpreter all together, or visit consecutively, giving verbal handovers to team members to reduce

overlap of patient questioning. Not only did this maintain good communication with the team, it also

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reduced costs of multiple interpreter visits and, moreover, reduced the frustration of repetition for the

patient.

This issue of patient satisfaction is increasingly pertinent in today’s society where there is an

evident trend for health care to be offered as a commodity for sale and for patients to be viewed more

as customers, vying for the best deal (Ife, 1997, as cited by Gardner, 2006) Likewise, health care

consumers are more educated and want to know that they are receiving the best possible treatment

reflecting the latest research. Appreciation and utilization of other team members’ knowledge and

resources enables interdisciplinary teams to keep abreast of new research and provide evidence based

health care service (Drinka & Clark, 2000).

Noted on student placement, the practitioner/therapist with the predicted greatest input into a

patient’s effective discharge would assume the role of ‘case manager’ for that patient. As the role was

shared around, this practice reduced the potential for dominant hierarchical behavior amongst staff and

fostered greater respect for all disciplines (Trede & Smith, n.d., as cited in Higgs, Ajjawi, McAllister,

Trede & Loftus, 2008). Spreading the ‘case manager’ workload maximized each team member’s

productivity at work and maintained a high level of discharge planning.

Of course, ‘team work’ is not often synonymous with easy and this theme of hierarchy in teams

is a common cause of conflict (Higgs, et al, 2008). Differences in philosophies, whilst being

beneficial in enhancing creativity of care, can also cause tension when deciding on best care - an issue

further compounded by lack of consistency in language and terminology used by different disciplines

(Robertson, Martin & Singer, 2003). Yet, the benefits of collaborative practice far outweigh the

struggles in organisational dynamics (Turner, Ireland, Krenus & Pointon, 2008) and thus various types

of team work training are becoming increasingly available in the health care setting and through

tertiary study.

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Whilst interdisciplinary health care practice was pioneered in the early 1900s (Baldwin, 1996),

it was not until the 1960s that interest in this practice grew (Drinka & Clark, 2000). The recent

investment in interdisciplinary practice has coincided with an era that sees the Australian Government

working to create ‘systems of health care delivery that provide the best care to the most people at the

least cost’ (Drinka & Clark, 2000, p.xv). As such, national health policies have evolved.

At a Macro-policy level, a trend towards developing a national framework for action can be

noted in the government’s attempts to address specific health issues (Taylor, Foster & Fleming, 2008).

This devised framework addresses the current increase in prevalence of chronic conditions in Australia

and the increasing complexity of social and environmental factors underpinning development of

chronic disease. Deemed ‘National Health Priority Areas’(NHPA), diseases of significant

contribution to Australia’s burden of illness and injury include asthma, cancer, diabetes, cardiovascular

disease, arthritis and mental health (Taylor et al, 2008). These are rarely the result of a single cause

and each condition presents sufferers with a plethora of treatment options. Thus, policies that address

NHPA, such as the National Chronic Disease Strategy 2005, stress the importance of an

interdisciplinary intervention and a patient-centred focus in prevention and management of disease

(National Health Priority Action Council (NHPAC), 2006).

It must be noted that the increasing presence of chronic disease is most prevalent in socio-

economically disadvantaged sectors of our population (NHPAC, 2006). As such, some reforms in the

financing of health care provision proposed by the Australian Government may in fact lead to further

inequalities in service reception (Taylor et al, 2008). As suggested by Taylor et al (2008, as cited

Baum et al, 2009, p.77), ‘policies are supporting a stronger user-pays system whereby capacity to pay

is an important determinant of access to health care.’ Tackling this obstacle has further highlighted

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the importance of interdisciplinary practice. Negotiating inequality relies heavily on the use of ‘front-

line discretion’ (Taylor et al, 2008) by health care workers to conduct their work in a way that evenly

distributes resources and services (Lipsky, 1980, as cited by Taylor et al, 2008). For example, private

practitioners who actively seek out and work together with professionals from publicly funded health

care services may help in the development of treatment plans that offer greater financial affordability

for the patient (Kelehe, 2001, as cited by Taylor et al, 2008).

Further to the issue of policy changes in funding is the increasing pressure on health care providers

to meet more defined and often smaller budgets as a result of the changing structure and distribution of

the Australian health workforce (Australian Health Ministers Conference (AHMC), 2004). The

number of skilled health care professionals is declining (AHMC, 2004) and the population is aging.

Thus the supply of health care professionals and funding across care facilities will be increasingly

stretched to match health care demand. In response, research by Cowan et al (2006), suggests that

thorough collaborative efforts of disciplines in discharge planning effectively reduces length of stay,

decreased patient readmissions to hospital and improved hospital profits when compared to other care

management strategies.

Nonetheless, it must be noted that there have been several adjacent changes in funding policy that

have enhanced the potential for various health disciplines to work together. One such example is new

Medicare initiatives for allied health workers, providing greater access to a wider range of health

services for consumers (Taylor et al, 2008). Another example is the trend towards increased funding

for primary care teams, rather than individual health care professionals, like is evident in the ‘Practice

Incentive Program’ recently introduced in Australia (Young, Gunn & Naccarella, 2008).

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Clearly, the discussed benefits of interdisciplinary professional practice and their impending

relevance in the future have been noted by all levels of parliament as further educational investments in

this area have ensued. Integrating interdisciplinary practice at the tertiary level means that new

graduates in health care professions are well equipped with a high level of skill in communicating and

working effectively with others possessing different norms and conventions to themselves (Cox,

Patterson, Lee & Rahgeb, 2008). Recent personal experience of such team work training at university

enabled a greater understanding of, and appreciation for, other health disciplines but also highlighted

the importance of practising teamwork skills. In reflection, challenges arose when recognising

personal limitations in knowledge and realising that other members of the group were better equipped

to respond to questions at hand. Similarly, delegation of work when partaking in a group ‘leadership’

role was challenging due primarily to differences in individual work standards. It took weeks of

regular group work to recognise that equal allocation of tasks produced a better quality of collaborated

work, in the most time and effort efficient manner. Evidently, skills obtained through team work

education increase a new graduate’s flexibility and adaptability upon entering the workforce (Cox et al,

2008), both traits NHWSF is striving to enhance within the Australian health care system.

Thus, a collaborative approach to health care surely allows for better communication among

health providers, optimizes staff participation in clinical decision making and fosters respect for the

contributions of all those involved (Interprofessional Education for Collaborative Patient-Centred

Practice Research Group, 2008). At best, it enables the implementation of health interventions,

tailored to a patient’s needs and desired goals. Moreover, interdisciplinary professional practice not

only accommodates, but embraces cultural and political influences affecting Australian health care

today (Trede & Higgs, 2003). This, combined with a patient-centred approach to health care, appears

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to best meet the needs of the Australian community today and is necessary for the sustainability of

Australia’s health care and welfare systems in the future.

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