Working in Organisations

The aim of this assignment is to examine the concept of multidisciplinary working in relation to a practice experience. This will be achieved with reference to the multidisciplinary assessment of an older person using the single assessment process. The assignment will discuss multidisciplinary working in the context of teams, networks and organisations. It will further address both inter-agency and inter-professional working. Finally it will examine ways in which discrimination and oppression can occur within teams and organisations.

Weinstein et al. (2004) have said of the term multi, “The term ‘multi’ tends to be used where agencies, professionals and team members work in parallel, maintaining distinctive organisational, intellectual and professional boundaries” (p.16). Multi disciplinary working in the context of my practice therefore involves working alongside other professional from health and social care organisations.

The diverse nature of professionals involved in multidisciplinary working is precisely its strength. Valuing diversity and working positively with other professionals is an important part of practice in social work. This is recognised in The General Social Care Council Codes of Practice (2002) standard 6: 6.7. Multidisciplinary working should take a person centred, holistic approach. Work towards empowerment through effective partnership and collaborative practice amongst professionals should complement the partnership created between professionals and individual service users.

Multidisciplinary working has much to commend it, as it provides an arena for sharing responsibility and allowing workers and service users to benefit from the viewpoint and expertise of people from other disciplines.

(Thompson and Thompson, 2007, p.45)

The practice experience which I will refer to involved the multidisciplinary assessment of a 72 year old Asian female and Urdu speaker. I work in a sensory disability team and had received her referral through receipt of her Certificate of Visual Impairment from the local hospital. Following my own specialist assessment of need I had identified several needs which would require further specialist

assessment and with the consent of the service user made referrals to the appropriate services. “The care manager is the person who facilitates and co-ordinates a multidisciplinary assessment” (Coulshed and Orme, 2006, p.49).

The National service framework for older people (DOH, 2001a) identifies that systems should be in place which promote working between professionals in the assessment of older peoples needs. The single assessment process is defined in Standard 2 of the National service framework for older people. It requires that agencies and professionals work together at all levels to ensure the effective and co-ordinated assessment of needs.

It is important, therefore, that as professional social workers we recognise not only the value of our own contribution to the multidisciplinary arena, but the value of the skills and knowledge that other professionals bring.

(Crawford and Walker, 2007, p.144)

In referring to other disciplines the aim was to create a co-ordinated network of professionals working collaboratively to assess need across professional, team and organisational boundaries. A referral was made to a Visual Impairment Rehabilitation Officer, a different professional working within the same team. A referral to Occupational Therapy crossed team boundaries, but remained within the same agency. A referral to Physiotherapy crossed both team and organisational boundaries.

Assessment of need is a clear area where multidisciplinary working can be beneficial to a service user (Leathard, 2005, p.101). Within my own team I was able to liaise on a daily basis with the rehabilitation officer on the assessment and their professional opinion and recommendations. Within the agency I was able to check on the progress of the referral to Occupational Therapy through compatible technology. When a worker had been allocated and began to assess I was able to liaise directly with them in assessment and work in a complementary fashion. In crossing organisational boundaries I began to encounter barriers to and within multidisciplinary working.

“Professionals are naturally concerned with their relationship with service users and with one another, yet organisations frame much of what takes place in those relationships” (Weinstein et al, 2004, p.16).

I continued to monitor the progress of the referral to the physiotherapy team. I discovered that an appointment letter had been sent out to the service user in English but as no one has answered the door on the appointed day the case had been closed. The physiotherapist explained that the team operated this system in accordance with organisational policy. I challenged this decision on the grounds that the policy operated was discriminatory and the information that the team had sent to the service user was inaccessible for her. I was required to re-refer the individual who was again placed on a waiting list for assessment.

The situation highlighted the tension between organisational aims and resources. An organisation will be required to look outward and work with other organisations, but will simultaneously be required to look inwards towards financial resources. This may particularly be the case where organisations have performance targets to meet (Harrison et al, 2003, p.29). “Effective multidisciplinary work must be premised on a clear understanding and appreciation of the roles and pressures of other professionals” (Thompson, 2005, p.165).

Assessment and liaison between professionals was able to take place and the aim of maintaining the independence of the service user within the home was agreed. The experience highlighted the importance of effective communication. “Make sure that you consult with the relevant people when forming your view of the situation – work together on assessing the situation as far as possible” (Thompson, 2005, p.140). It also highlighted the importance of effective key working and co-ordination when working across professional boundaries (Crawford and Walker, 2007, p.151).

When assessment did take place barriers included a difference of opinion between the physiotherapist and occupational therapist. “Professionals must share information, clarify their respective roles, and overcome barriers caused by differences in status, training, values, organisational culture and defensiveness” (Weinstein et el, 2004, p.78). I was also required to challenge the oppressive work of the physiotherapy team who again failed to take account of the service users language needs when assessing. A full multidisciplinary assessment is not yet complete as a bathing assessment still needs to be carried out, dependent on repairs to the individual’s home.

In conclusion, though experiencing significant barriers to multidisciplinary assessment, clear benefits for the service user are also apparent. The interdependent relationship of all professionals, teams and organisations involved in the assessment of an individual is crucial to the success of meeting need. The ability to reconcile organisational, team and professional differences is a crucial part of social work practice. It will allow the empowerment of the individual service user to remain at the centre of the multidisciplinary process and maximise their chance of independent living.

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