A qualitative case study in the social capital of co-professional collaborative co-practice for children with speech, language and communication needs.

BACKGROUND: Effective co-practice is essential to deliver services for children with speech, language and communication needs (SLCN). The necessary skills, knowledge and resources are distributed amongst professionals and agencies. Co-practice is complex and a number of barriers, such as 'border disputes' and poor awareness of respective priorities, have been identified. However social-relational aspects of co-practice have not been explored in sufficient depth to make recommendations for improvements in policy and practice. Here we apply social capital theory to data from practitioners: an analytical framework with the potential to move beyond descriptions of socio-cultural phenomena to inform change. AIMS: Co-practice in a local authority site was examined to understand: (1) the range of social capital relations extant in the site's co-practice; (2) how these relations affected the abilities of the network to collaborate; (3) whether previously identified barriers to co-practice remain; (4) the nature of any new complexities that may have emerged; and (5) how inter-professional social capital might be fostered. METHODS & PROCEDURES: A qualitative case study of SLCN provision within one local authority in England and its linked NHS partner was completed through face-to-face semi-structured interviews with professionals working with children with SLCN across the authority. Interviews, exploring barriers and facilitators to interagency working and social capital themes, were transcribed, subjected to thematic analysis using iterative methods and a thematic framework derived. OUTCOMES & RESULTS: We identified a number of characteristics important for the effective development of trust, reciprocity and negotiated co-practice at different levels of social capital networks: macro-service governance and policy; meso-school sites; and micro-intra-practitioner knowledge and skills. Barriers to co-practice differed from those found in earlier studies. Some negative aspects of complexity were evident, but only where networked professionalism and trust was absent between professions. Where practitioners embraced and services and systems enabled more fluid forms of collaboration, then trust and reciprocity developed. CONCLUSIONS & IMPLICATIONS: Highly collaborative forms of co-practice, inherently more complex at the service governance, macro-level, bring benefits. At the meso-level of the school and support team network there was greater capacity to individualize co-practice to the needs of the child. Capacity was increased at the micro-level of knowledge and skills to harness the overall resource distributed amongst members of the inter-professional team. The development of social capital, networks of trust across SLCN support teams, should be a priority at all levels-for practitioners, services, commissioners and schools.

The gastroenterology and endoscopic nursing delegation to China: summary of our professional and cultural experience.

In October 2004, the authors had the opportunity to participate in an international professional and cultural exchange program, coordinated by the People to People Ambassador Programs. A delegation of gastroenterology nurses traveled to China. During the trip, the authors visited hospitals in Beijing, Chongquing, and Kunming. The hospital visits included tours of endoscopy units and other departments within these hospitals. The two groups engaged in dialogue to better understand each other and develop a better understanding of practice standards, education of nurses, and healthcare delivery systems in their respective countries. Formal presentations and informal dialogue were held at each professional exchange and served as the method of discussing the respective professional perspectives on gastroenterology nursing.

Implementing "lean" principles to improve the efficiency of the endoscopy department of a community hospital: a case study.

Many endoscopy units are looking for ways to improve their efficiency without increasing the number of staff, purchasing additional equipment, or making the patients feel as if they have been rushed through the care process. To accomplish this, a few hospitals have looked to other industries for help. Recently, "lean" methods and tools from the manufacturing industry, have been applied successfully in health care systems, and have proven to be an effective way to eliminate waste and redundancy in workplace processes. The "lean" method and tools in service organizations focuses on providing the most efficient and effective flow of service and products. This article will describe the journey of one endoscopy department within a community hospital to illustrate application of "lean" methods and tools and results.

Teambuilding.

The term "team" is often used in healthcare to describe a work group. But what really makes a team? Three critical elements are involved in the development of a team: goal setting, establishing ground rules, and role clarification. Becoming a "team" will not, however, solve every performance problem or enhance all results. Effective teams can develop in settings where nurses are committed to a common purpose, everyone believes in the goal, roles are clearly defined, and trust is present.

The benefits and challenges of the computerized electronic medical record.

Data from aggregate individual patient records can be gathered to answer many clinical and nursing research questions about quality assurance and resource allocation, assisting in the measurement and evaluation of patient care outcomes. The use of standardized nursing language, large integrated computer databases, and information management processes provide for the use of patient-specific data and information to facilitate patient care. The use of aggregated data can also facilitate the comparison of nursing practice across populations, demonstrate and project nursing care trends, serve as a financial and legal record, aid in clinical research, support decision analysis, and guide professional and organization performance improvement.