Introduction

Any student new to midwifery will very quickly become familiar with the Nursing and Midwifery Council (NMC) standards of conduct, performance and ethics. Students registered on any midwifery programme will remain familiar with these important standards throughout their programmes and then through their working lives.

The focus of this chapter is to integrate the following statement from these standards: ‘the people in your care must be able to trust you with their health and well-being’ (NMC 2008, p2) within the concept of interprofessional working. If we explore what is involved in how this trust is achieved, it inevitably leads us to our working relationships with other professionals as much as our relationships with the people in our care. Building on this, Midwifery 2020 (DH 2010) is more explicit in explaining the role of the midwife within multidisciplinary or multiagency teams. The vision described in this paper places the midwife firmly as the ‘key co-ordinator within the multidisciplinary team’ (DH 2010) for women with complex pregnancies. With direct reference to midwifery education, it states that there will be an ‘increased emphasis on the principles of autonomy and accountability within multidisciplinary and multiagency teams’ (DH 2010).

Other healthcare undergraduates such as nursing, physiotherapy and pharmacy have similar needs through their education and working practice. To help the undergraduate on a healthcare programme prepare for these responsibilities, higher education institutions have incorporated interprofessional education (IPE) within their healthcare programmes.

There has been a national mandate for interprofessional collaborative working within health and social care for many years. Initially, the need was identified and explored by the World Health Organization during the 1970s. This was followed in the UK by an acceleration of development because of the influence of government policy during the 1980s and 1990s. Continued well-publicised failures in the care of patients/service users/clients have meant that currently many healthcare regulatory bodies include the necessity of interprofessional collaborative working within their standards (GMC 2009, HCPC 2009, NMC 2008). Such is the fundamental importance of successful interprofessional working that healthcare ­programmes will usually incorporate elements of interprofessional education. The over-riding goal of interprofessional education must be to ensure that graduates are equipped with the knowledge, skills and attitudes to ensure they are able to work collaboratively for the benefit of their patients/service users/clients throughout their working lives.

Activity 6.1

Look up the reports of one of the following cases and read the summary.

• The Protection of Children in England: A Progress Report: www.education.gov.uk/publications/eOrderingDownload/HC-330.pdf (accessed May 2013)
  
• The Victoria Climbié Inquiry: Report of an Inquiry by Lord Laming: www.­publications.parliament.uk/pa/cm200203/cmselect/cmhealth/570/570.pdf (accessed May 2013)
  
• The Inquiry into the Management of Care of Children receiving Complex Heart Surgery at the Bristol Royal Infirmary: webarchive.nationalarchives.gov.uk/20090811143745/http://www.­bristol-inquiry.org.uk/final_report/rpt_print.htm (accessed May 2013)
  
• Final Report of the Independent Inquiry into Care Provided by Mid Staffordshire NHS Foundation Trust (The Francis Report): www.midstaffsinquiry.com/pressrelease.html (accessed May 2013)

---

Activity 6.2

Make a list of the points that are relevant to you in your professional practice as a midwife.

---

Central to the goal of IPE is a usable definition. It is most commonly described as ‘when two or more professions learn with, from and about each other to improve collaboration and the quality of care’ (CAIPE 2002).

We need to explore the meaning of interprofessional collaborative working in the context of ­midwifery. Services that are involved in providing maternity care for women may be from the NHS, social care, the voluntary sector or other organisations such as government agencies. Some women will have their care provided in the community, others in the hospital setting. Care will often be provided by midwives and obstetricians. However, the situation is not always as conveniently straightforward. There are women who will have more complex needs, some of which may be social needs. Maternity care may then involve organisations such as children’s services, learning disability and mental health teams, domestic abuse teams and drug and alcohol teams. Using this more complicated example, the situation can be more obviously seen to require interprofessional, interagency and cross-organisation collaboration in order to achieve seamless maternity care. The aim of the care would be for all the professionals in all the agencies to be communicating and collaborating effectively. Thinking of the most complex maternity care scenarios illustrates how important, and yet challenging, true collaborative working can be.

Working with other professionals

When you look at the codes of conduct of different professions, you will find many similarities between them. There are some general principles that apply to all healthcare professions. Some examples include always trying to do the best for the people in our care and co-operating with colleagues. Can you think of some others?

To help you learn more, look at the Nursing and Midwifery Council (NMC) code of conduct, performance and ethics and write a list of the qualities you need to consistently demonstrate throughout your professional life. Now think of a colleague from a different profession with whom you work regularly in the clinical environment. This could be a medical practitioner, paediatric nurse, radiographer or any other you think is particularly relevant to you. Look up their professional body’s code of conduct, performance and ethics and write a list of the qualities that they need to demonstrate. Place the two lists side by side and highlight all the similarities. Are there any significant differences? What are the consequences of the similarities and differences in the two sets of qualities for the people in our care?

To help you in this task, Box 6.1 gives a list for the profession of diagnostic radiography.

Now we are going to consider an episode of care where the interprofessional working was less than ideal. Use the example below to help you think of an episode that you were either involved in or know about. Start by writing a brief description of an event. Where were the challenges in achieving seamless care for the woman in the episode that you are aware of? Identify where you think events did not work as they should have. Can you identify possible reasons for the difficulties encountered?

Example

A woman who was 26 weeks pregnant was diagnosed with diabetes. She was referred to the medical team but the midwife responsible for her care was not informed. The woman attended her general practitioner (GP) in a state of distress because of the conflicting advice she was being given over her plans for breastfeeding and her care during labour.

Care pathways

One tool currently used to try and optimise care of women in maternity care (in common with many areas of health and social care) is a care pathway. The aim of a care pathway is to support the standardisation of care processes a woman may require so that there is decreased variability in care provided and the outcome is optimised. The multidisciplinary element (and interprofessional working) has to be implicit within any care pathway. Using care pathways helps to ensure that a specific group of service users are on a structured, organised and efficient clinical course which has their needs at the centre of care. Care pathways allow room for planning so that any interventions needed can be defined, used to the best effect and used at the right time.

Consider the scenario highlighted in Case study 6.1. How many of the professionals mentioned in Table 6.1 are likely to be involved in the care of this woman? What are their roles? Using a care pathway (based on the National Service Framework), draw a likely path for this woman through the variety of services that she may need to access. Make sure that the woman and her child are at the centre of the process. Use arrows to show how information is shared. You can use a variety of arrow formats to show how well the different agencies work together (e.g. bold arrows for ­established partners and interrupted arrows for liaisons that are more challenging). Retain your diagram so that you can review it after the next section.

Midwifery wisdom

One of the most significant aims is to ensure that the focus remains on the woman and her care rather than on the specialisms providing that care.

---

Case study 6.1

Paramedics are called to a shopping centre in a large city. A young woman has ­collapsed while browsing in the shops. Shop assistants have given basic first aid and the woman is now conscious but obviously unable to speak any English. The woman is taken to the nearest accident and emergency department where she is examined and noted to have a low Body Mass Index (BMI) and to be in the middle trimester of pregnancy.

---

Table 6.1 Professionals who may be involved (in alphabetical order)

Barriers to and opportunities for collaborative working

Collaborative working is so fundamental to the concept of interprofessional working that it is important to take some time to examine it in depth. We should start by being sure of what we mean by collaboration.

The definition below is appropriate for our purposes in this text:

an active and ongoing partnership, often between people from diverse backgrounds, who work together to solve problems or provide services

(Barr et al. 2005).

Language

We will start by considering the use of language when we are working with other professionals to provide a high-quality service to women and their families. If we take a moment to consider how we learned language as small children, we can see that some language is learned formally and some informally. As children, we began by hearing conversations around us, and being spoken to directly (informal learning). A more formal approach to learning language began when we started school. Here, we were asked to read, write and learn spellings. As we grew up, these ­different ways of learning language merged and we became able to put the informal and formal learning together.

There are very clear parallels with learning our own profession-specific language during higher ­education. In the academic environment, lectures, tutorials and textbooks are all used for formal ­learning of our new professions and the required language. This learning is then compounded, and sometimes ­confused, with informal learning of language in the clinical environment as students. Similarly, as we progressed through our early education, there was a process of socialisation with those we are ­surrounded by. One consequence of the higher education system for healthcare professions is that this language learning is often going on only in single profession-specific environments. The obvious ­outcome of all this learning, and the source of difficulties, is that each healthcare profession will have its own jargon (Marshall et al. 2011). Some words, abbreviations and acronyms will be the same, others different, depending on the professional group and scenario being considered. A good example is the acronym ‘BM’. Depending on your discipline, it could mean either breast milk or bowel movement. This is a really good illustration of some potential confusion. Can you think of other abbreviations that are likely to result in confusion?