Impact of complacency and lack of assertiveness on interprofessional teams in Health and Social care. 

Human Factors are known to impact on collaboration and service user safety. Critically discuss the impact of complacency and lack of assertiveness on interprofessional teams in Health and Social care.

Introduction

Interprofessional collaboration has become an important part of any healthcare organisation, as effective collaboration of team from different health care section plays significantly to meet all the complex needs of a patient (Karam et al., 2018). Health and social care studies strengthened Interprofessional team ability to deliver various unique elements of healthcare, such as the context of medical practice, the social construction of patient safety, and the perseverance of hazardous cultures and systems (Anderson & Price, 2017). However, Interprofessional team can be inadequacy practice in healthcare with result patient safety problem or mortality (Versteeg et al., 2012). The Care Quality Commission (CQC) (2018) reported that between 2017 and 2018 human errors caused 96% of the Never Events that has the potential to cause serious patient harm or death in NHS (National Health Service) England. The article implies most of the incidents is due to human factor such rigid hierarchical structures which caused not speaking up when critical incident occurs and encouraging leadership style which promote complacency.

Human factors described as impact on individual performance which is key to critical in healthcare (Stephens et al., 2016). Health Care and professional council (HCPC) (2020) stated that Radiographer must be honest and speak up when witnessing anything which could put service user safety at unacceptable risk. In this essay the author will critically discuss impact of human factor lack of assertiveness and complacency on collaborative work and service user within interprofessional teams in Health and social care.

Complacency

Extreme hierarchical structure affects team cognition and lead to disputes the interprofessional team in lower hierarchies and result poor patient experience (Brennan & Davidson, 2019). Surgical Never Events report confirmed that 38 cases between 2016 and 2017 in United Kingdom hospitals occurs due complacency and rigid hierarchical structure which discourage individual from speaking up about the negative impact of complacency (CQC, 2018). For instance, the case of Elaine Bromiley, in which young women died cause of professionals’ error of induction of an aesthesia procedure that lead to in to cannot intubate or cannot express the crisis. Pattni et al. (2019) state that even though the nurses recognize the Tracheostomy procedure was needed and provided the required equipment, the team failed to challenge the two anesthetist and ENT (ear, nose, and throat) surgeon as they were impacted by hierarchical barriers. Friedman et al. (2015) found that this crisis occurs due to complacency and ignoring the information from the team that could have save her life. Hence when the patient safety is compromised, it is everyone responsibility to address the issue clearly and acknowledge them to resolve the crisis (Binnie, 2011). This could be improved by maintaining a good relationship between the team which encourage to accept feedback, initiate resilience, and share necessary information with each other which break down hierarchies (Green et al.,2017).

Lack of assertiveness

Effective collaborative teamwork requires a capability of learning about everyone responsibility and multidisciplinary development to adhere cultural respect and mutual trust among the other profession (Sears et al., 2013; Vogel et al., 2018;2019). However, human factors are known to impact on collaboration as commonalities and difference among interprofessional team may lead to inefficient exchange of information that breakdown and cause sever crisis to patient safety (Friedman et al., 2015). The finding of (Gillespie et al., 2016) stated that inability to express your opinion assertively and to challenge superior when clearly wrong decision done during life threatening crisis is a sign of incompetence thus, result in losing of patient.

For instance, radiographer might concern about the radiation protection in theater, however struggle to deliver the information to professionals and not able to speak up or feel betraying the superior due to communication skills and lack of knowledge. This shows that lack of assertiveness of the radiographer impacted by the communication skill as the more effective the challenge is the higher the result of the patient Centered care

demonstrated (Vosper et al., 2018). It is radiographer responsibility to adhere following the radiation protection rule and keep the dose as low as reasonably

Practicable (ALARP) hence assertiveness is vital part of protecting patient and team member to deliver clear instruction to ensure patient and staff safety Society college of radiographers (SCoR (Society and College of Radiographers), 2012; CQC, 2018). At the point when a matter of patient safety is included, it ought to be certain that it is the radiographer duty to communicate the concerns unmistakably and the employer obligation to recognize and address them without any complacency (Gillespie et al., 2013; Tawadros, 2015).

complacency

Self-directing and working independently is significant in teamwork. Gillespie et al. (2016) study demonstrated that working solely can result on focusing on specific professional prospected, constrains opportunities for deliberate, and open communication among the interprofessional. Curtis et al. (2011) supported that the radiographer or health care worker might be using previous unpleasant experience to improve the procedure, and this might seem complacency and avoid accepting information from team thus a teammate member should respect and anticipate that the information does not destruct from making crucial decision which affect the patient. Moreover, (Nzelu, 2018) commented that complacency demonstrates when working pre-existing scenario which may negligate easily from thinking out of the box. For instance, when using pre- designed stickers to describe cardiotocographs (CTGs), it is possible to become complacent because you are less likely to take the whole clinical image and think of the physiology behind changes in CTG. However, study by (Gillespie et al., 2013) argues that Interprofessional should adhere the importance of collaborative work to share perspectives of each profession gathering ideas and rendering a proactive to expected and unexpected events prior to commenting or judging on the procedure. It seems it is important to acknowledge and anticipating when complacency occur and the importance of when to speak up.

Less assertiveness

Through investigative studies, (Ingle,2018) confirms the centrality of effective communication encourage radiographers, nurses, and doctor to create suitable environment to reflect on experience and self-confidence to convey necessity contribution. However, Lack of assertiveness in interprofessional team and voicing concerns directly causes contradiction on preforming on their higher capability which potential caused by feeling less subservient to supervisor or doctors (Curtis et al., 2011). This potentially introduce extreme hierarchy among team members that affect the feedback exchange process in teamwork as some senior hierarchical professionals may supply punitive feedbacks which criticise and attack the junior members openly (Ashley et al., 2013). Pearsall & Ellis (2016,2006) stated that dispositional assertiveness ensures to exchange elucidating information and suggesting feedback, solution to the problem, and supplying support in critical time to the expertise to perform on   the task effectively. Stephens et al. (2016) has a strongly oppose the notion of extreme assertiveness as it hinders team performance causing dominance on a team that preforming effectively thus construct a barrier in making critical decision making which could affect patient safety.

In a theory of social identity, (Bochatay et al., 2019; Pearsall and Ellis, 2016;2006) commented that sub dimensional extraversion occurs on interprofessional team as dominance communication exists only within specific team member which hinder team performance as exclude the other team member from effectively participating. However effective communication between the team improve patient care. For instance, case of the conjoined twins Marieme and Ndeye shared linked circulation system demonstration of effective communication and collaborative work during the meeting make them realise the case is unique and complex. This case shows that every professional participates assertively showing capacity of resilience and treat the patients with commitment and compassion.

Complacency

Shared situational awareness is an important aspect of interprofessional activity that respect and appreciate others role and share common prospective on the same goal (Gillespie et al., 2013). The study carried out by Blankenship (2010) claimed that high mortality rate reported in patients due to lack of interprofessional support. This show that complacency occurs in the sector that interprofessional negligent the issue or unawareness, assuming completely satisfying by their performance. Nzelu (2018) support the notion that interprofessional which dissociate from the situation adhere low morale among staff and lack of acceptance that lead to inadequate quality care. For instance, Daniel Pelka case the four years old died because of domestic injury of head, there was no professional who work sufficiently hard to relate his diagnostic with abuse. Rogers (2013) stated that the detail of the fracture associated bruising could have been reported as suspected physical abusenot only as non-accidental and this shows there was complacency which harm the patient, and this compromise the assessment of family in regard the domestic abuse. This show that the negative impact of complacency which encourage rule of optimization and the consequence of which causes failure to protect the patient. Ashbrook (2014) suggested that instead of assuming, professionals should avoid complacency and play significant role in shared situational awareness as hazardous improve by constantly attentive safety, good teamwork and taking part and involving colleagues in decision making.

Less assertiveness

Ray-Barruel et al. (2018) studies show that 30 -50 % of intravenous (IV) catheters causes complications before care is completed that requiring a new device to be installed due to consultant error. This shows that the improvement in evaluating and participating of the interprofessional team could reduce the unnecessary pain, risk of infection and treatment delay by being assertive and challenge the consultant during the procedure. HCPC (2020) stated that Radiographer or health care worker must address the question or query immediately if worried about patient safety because of a service management or practices. However, (Sevdalis & Brett, 2009) claimed that being more assertiveness on a scenario which require attention might lead for potential error and compromise patient safety and efficiency of the surgent thus being less assertive is positively contribute on this situation. Friedman et al. (2015) support and pervade the concept of less assertiveness in surgical area perceive as effective as it encourages to demonstrate competence. In a multidisciplinary team (Pearsall & Ellis 2016;2006; Wukich et al., 2011) stated that radiographers should practice in an atmosphere of diagnostic that allows to be reflective and self-critical to avoid risk development. In a care setting where patients need critical decision, it seems important radiographers to deliver clear information and be assertive to address the issue to responsible person to provide solution to the healthcare service in a humble and reasonable way.

In conclusion, the impact of human factor affects patient safety and destroy collaborative working on interprofessional team. Binnie (2011); CQC (2018) stated that interprofessional’s should encourage colleagues to speak up when it is necessary as lack of assertiveness destroy creativeness,criticalthinking, and effective patient care. HCPC (2020) stated that radiographer should sharerelevant information with colleague, whereappropriate to supply patient satisfaction. Therefore, A high-performance team requires evaluation of assessment taken placeappropriately, anticipate when expected or unexpected events occur, and respond effectively to avoid complacency (Gillespie et al., 2013). Wukich et al. (2011) stated that clinical supervision defines as a systematic professional support and learning process that helps practitioners to develop expertise and skills, take responsibility for their own practice and improve patient health and safety in complex circumstance. As successful interprofessional team tackles lack of assertiveness and complacency issue on a team by offering strategies that enhance the quality of support to deliver efficient healthcare service while meeting the diverse needs of patients. The author learnt several aspects of human factors and how to deal with them. Communication skills is significant on clinical aspect and learnt when to be assertive and appreciate team members professional role and identifying complacency and report if experienced hierarchical difference and link theoretical lesson from the IPE (interprofessional education) module in