Luminary Learning Gastrointestinal Disorder- Issue 1

‘Clinicians Versus Clinicians Versus Managers’ or a New Patient Centred Culture That Eradicates... •  45 teamwork and sharing of practice, as services are transformed into new, more patient centred integrated care models. This chapter will explore how doctors develop a positive self identity through their Royal Colleges ‘scope of practice’ and how the employing organisation or the wider context of health- care practice seeks to challenge this scope of practice when disciplinary boundaries come under pressure as a result of staffing shortages in medicine, nursing and allied health professions [2]. Within this context there is very little self-determination [3–6] of doctors, (which is a critical condition for doctors to remain motivated and engaged), when the development of knowledge is constrained by a managerialist agenda [2, 7]. We will explore a specific case study of two medical specialities, Vascular Surgery and Interventional Radiology whose ‘scope of practice’ overlaps and argue for the introduction of (1) a quality improvement competency based programme for all clinicians and non-clinicians in healthcare and (2) the introduction of an organisational Quality Excellence award such as the European Foundation for Quality Excellence (EFQM). We argue that a QI competency framework combined with the EFQM could help to facilitate the development of team working across medical, clinical and non-clinical staff and focus all efforts to provide a high level of excellence in patient centred care. Such a focus on patient centred care will serve to focus the efforts of all team members emphasising an ‘integrated model of care’. Our case study will explore how executive hospital leadership in the United States have developed new initiatives to ‘integrate’ surgical and radiology skills with a ‘new’ medical role in Vascular services. This project was successful in achieving an integrated social identity of vas- cular surgery and radiology which generated effective team working to deliver a quality service for patients. We go one step further and argue that to sustain collaborative working practices and to support effective team working, healthcare organisations should engage with the Quality Excellence model (EFQM), (Australian Quality Award or Baldrige Quality Award) which embeds the needs of its customers, patients and end users as being the primary focus for the business of healthcare, driving more demand for shared and overlapping multi-professional ‘hybrid’ roles. We conclude with a recommendation that a healthcare organisation’s leadership strategy should actively concern itself with the development of a patient centred quality improvement culture, that provides the rationale for the development of clinical and non-clinical competence. If such a step is not undertaken, then Social Identity Theory (SIT) explains that deep divisions will occur in the workforce and professionals will continue to become defensive and territorial about their own ‘scope of practice’. The hospital executive board needs to act in a facilitative role to broker a more harmonious, happy and positive medical, clinical and non-clinical workforce. Each of the Medical Royal Colleges or colleges of Nursing, physiotherapy and other profes- sions in healthcare, are defined by a ‘scope of practice’ which sets out the legal and professional scope of practice of a given profession. Royal College specialties are further sub specialised. So for example the Royal College of Surgeons has separate register requirements for competence in general surgery and vascular surgery and the Royal College of Nursing is sub specialised to parts of the register for adult, child, mental health and learning disability nursing. A scope of practice will inform ‘credentialing’ which is a verification of the experience and expertise of a scope of practice and also documents personal interest and willingness to provide medical or nursing care within this ‘scope of practice’. This is used as a process to establish a contract between providers