Legal challenges of multidisciplinary  approach to healthcare in the context of Australian psychiatric units

Background                                                                                                        1

Literature review                                                                                                3

Duty of care                                                                                                    3

Confidentiality                                                                                                 5

Conclusion                                                                                                      6

Research Questions and Objectives                                                                  7

Methodology and theoretical framework                                                           8

The working title for the research project                                                       11

The rationale for the research project                                                              11

Timeframe and probable research challenges                                                 12

Reference                                                                                                      13

Background

Multidisciplinary care is  an approach whereby a team of health care specialists are collectively involved in providing care to patients, and  it has teamwork as its key element.   Multidisciplinary care occurs when clinical teams (i.e. blocks of clinical staff) composed of aides, nurses, physician assistants,  physical theorists, social workers working collectively with a view of attaining the shared goals, and sharing responsibility for patient outcomes^[1].  The teams can be completely different in size depending on the nature of health care being provided. The integrated teams of doctors and health care specialists can enhance communication between workers, and usher in less adverse effects, generating value for both the patient and the clinics, while mitigating the communication barriers between clinical staff and enhancing communication^[2].

Multidisciplinary approach to providing health care has gained sustained traction among clinics in Australia, with more and more clinics and hospitals adopting the multidisciplinary approach to provide standard health care and  ensure patient satisfaction.   By implementing patient-centered multidisciplinary approach to health care, many clinics can ensure that the health care is quality, the clinical staff is satisfied with their work, and that patients consider the care as satisfactory.

For all the benefits which can be derived from successfully implementing multidisciplinary approach to providing care, there  persists a number of legal issues associated with  multidisciplinary approach in clinics Australia.  Nevertheless, the preponderance of the academic literature has exclusively focused on how clinics could provide more -patient centered care, and improve patient-related outcomes by introducing  multidisciplinary approach in Australia.  On the other hand, the  legal issues and associated with implementing a multidisciplinary approach within psychiatric units has largely been overlooked by health care researchers. This proposed research looks into the  legal issues associated with implementing multidisciplinary approach in within psychiatric units  Australia, and suggests how these complications and barriers can be minimized, if not eliminated.

Literature review

Even though legal issues associated with multidisciplinary team approach are key, there persists a clear  void in academic research into the  correlation between legal issues and implementation of multidisciplinary approach within mental health care units in Australia. The following paragraphs will look into the literature review on the topic.

Duty of care

The concept of duty of care is a cornerstone of law and medicine, and is conducive to establishing medical negligence in medical law. To establish medical negligence, it is key to establish that a professional duty of care was owned to the patient. Nonetheless, establishing whether or not such as duty of care was owned gets cumbersome to determine in the context of multidisciplinary team members, as asserted by Bryedn (2011)^[3]. Babiker et al (2014), on the other hand, has concentrated on the challenges to multidisciplinary approach in clinics, by citing instability in teams and hierarchies as the two most important barriers to multidisciplinary approach^[4]. Babiker et al (2014) also looked into the changing role of team members, and how it impedes establishing duty of care. As Babiker et al (2014) suggests the roles of multidisciplinary team members are not conspicuous and well- defined. This interrelated responsibilities culminate in a clinical environment where it is onerous to identify who will be medically liable for a  particular medical error. Campagne (2013) cites that as all team members are involved in collectively providing health care, where their duty of care arises in relation to the patient is not well defined. Norton et al (2003) also concentrated on how multidisciplinary team approach cannot be compatible with the key concept of duty of care in medical negligence as assigned duty of care can be onerous to establish in relation to multidisciplinary team members^[5].

Confidentiality

There are a number of studies conducted into how multidisciplinary approach can culminate in more divulgence of patient information.

Gupta (2007) exclusively concentrated on how multi-disciplinary approach is not compatible with disclosure of patient data, a key element in medicine.^[6]  Multi-disciplinary approach is  nonetheless gives rise to a number of issues under both Privacy Act 1988 and Health Records and Information Privacy Act 2002 (NSW), suggests Licitra et al (2016).^[7]

Moreover, referral is a key element of a  multidisciplinary approach and has key implications for legality of the multidisciplinary meetings, whereby health information pertaining to patients is extended to other experts even in the absence of patient consent, as suggested by Paterson and Mulligan (2003).^[8] Sharing patient information is  considered as one of the most important types of personal information which need to be protected. As such, patient confidentiality is an essential element which falls under the ambit of Privacy Act 1988. Information sharing is a key element to the functioning of an multidisciplinary team, as suggested by Webster and Harrison (2004)^[9]. Liew (2012) also considered the balance between confidentiality and collaboration in the context of multidisciplinary teams.^[10] Liew (2012) emphasized the importance of cross-communication between team members, and noted that psychologists tended to be less open to sharing information, and presented a number of steps which can be taken to minimize the risks arising out of confidentiality. The views posited by Webster and Harrison (2004), Millet et al (2005) are corroborated by Speck (2006), who postulates that implementing a multidisciplinary team approach culminates in a number of ethical and legal issues. Ugwumadu et al (2017) also suggest that the absence of patients at multidisciplinary meetings is conducive to disclosure of patient information without his or her consent.^[11] Overall, the academic literature suggests that sharing patient information is not compatible with the long-standing legal approaches to handling patient information.

Conclusion

Webster and Harrison (2004) has considered the multidisciplinary phenomenon, and noted its success^[12]. Nonetheless, they cite how there is a void into the  legal issues related to implementing multidisciplinary approach at primary care divisions. Roncaglia (2016) cites  that there is a clear gap in research into the barriers to multidisciplinary approach in health care clinics, and has considered these barriers at clinics based in UK^[13]. To conclude, the literature reviewed largely suggests that there are legal issues associated with multidisciplinary approach to care. Nonetheless, none of the academic research has exclusively concentrated on examining these  legal issues in the context of  the mental health units of Australian clinics and hospitals. The literature review conducted into the legal issues demonstrate that the legal research has concentrated on two legal issues.

Research Questions and Objectives

Smart and viable research objectives and questions are key to ensuring that the research project can be executed within the time frame, and dictates the methodologies for data collection. As the literature review suggests, even though multidisciplinary approach to health care has been advocated for in a number clinics in Australia, there persists a number of  legal challenges associated with a multidisciplinary approach to health care at mental health units in Australian clinics.

The objectives of the proposed researchers are:

• Identify the legal challenges associated with implementing multi-disciplinary approach to health care in Australian psychiatric clinics in Australia
• Determine the relative importance of each legal challenge associated with multidisciplinary approach within psychiatric units of clinics and hospitals

Methodology and theoretical framework

Haregu (2012) suggests that a research into medicine has to be purposeful, credible, targeted, and timely, and choosing the most practical research method ensures that credibility and reliability of the research results.^[14]

To choose the optimal research method, the researcher has considered a number of research methods such as quantitative and qualitative. Notwithstanding how both types of research methods are prevalent in health care research, the researcher has decided to employ the qualitative research method for a number of reasons. Qualitative research is a term used to describe methods used employed by researcher to recode, and interpret phenomenon in natural settings. Qualitative research has a number of data-collection method such as interviews, observations, and analysis of documents.    Unlike quantitative research, qualitative research is more viable in enabling researchers to concentrate and examine qualities, such as efficacy, and improvement at clinics (Pope et al, 2010).^[15] Qualitative research method is considered the most viable when it comes to  examining the quality of healthcare in natural settings (Al-Busaidi 2008)^[16]. Benson and Britten  (2002) suggest that qualitative research method such as observation is viable when it comes to researching obstacles and challenges to practice.^[17] Pope et al (2002) suggest that for health care researches into a number of factors impacting the implementation of new programs and technologies at hospitals, qualitative data is the most viable option^[18].  Furthermore, Grol  (1997) indicates that qualitative research is considered the most practical when it comes to identifying the barriers or challenges which exist in implementing new practices within health care^[19].  Observation is a type of qualitative research and involves the researcher systematically observing the organizational settings, team performance, an and other variables with a view to unravel and look into the phenomenon the researcher is seeking to research (Pope et al, 2002).  Observations, as a viable research method, has gained substantial traction among researchers studying phenomena including management and delivery of healthcare (Murphy, 2001). Going into the field is the core element of observation data-collection method, and is a key advantage over other data-collection methods such as interviewing and document analysis (Mays  and Pope 1995). Walshe el al (2012) cited observations as a viable method to understand how one thing is performed in a clinical setting, and cited that observation as a data-collection method can facilitate understanding of how people act.  Moreover, collecting data with observation method is not contingent upon the willingness or capacity of participants to disclose information, allowing the researcher to directly observe the health care clinics. On the other hand, interviews are contingent upon self-reporting, as suggested by Morgan et al (2016), which is a key advantage of observations as  data-generation method for health care research^[20]. Benson (2008) suggests that observation has another key advantage over other research method as it helps mitigate the discrepancy between what team members in MDTs assert that the do, and they do^[21]. Types of observational methods have been compartmentalized as structured and unstructured. Structured observation is predetermined, and unlike unstructured observation concentrated on certain aspects of a phenomena persists and to what extent (Gillham 2008).^[22] The researcher will employ  the structured observation method.

Sampling is key to any health care research, and has substantial implications for the validity and reliability of the results presented by the research. Patton  (2002) suggests that purposive sampling can be the optimal sampling process whereby the researcher selects samples based on their specific characteristics, and criteria which is closely aligned with research objectives of the researchers^[23]. Probability sampling can be cost-prohibitive and time-consuming, rendering it inappropriate for this research method. Based on the above analysis of qualitative research, the researcher has decided upon observation data-collection method as it is aligned with the objectives of this research, and is conducive to credible data-generation.

The working title for the research project

The preliminary title of research project is ‘What are the key legal challenges associated implementing multidisciplinary team approach to care in psychiatric units within hospitals in Australia?’ and some of its key words are ‘multidisciplinary approach’ ‘MDT’, ‘team’ and ‘psychiatric units’.

The rationale for the research project

There has been voluminous research conducted into the advantages which can be derived from implementing multidisciplinary approach to care in both primary care and secondary and tertiary services, with the number of clinics and hospitals adopting MDTs inexorably increasing.  On the other hand, minority of the research has been conducted into the legal challenges of multidisciplinary approach adoption in a clinics, with no research concentrating on the challenges faced by units providing mental health care to patients in Australia. By employing the observation method, the research aims to identify the key obstacles and challenges of implementing MDT in psychiatric units of hospitals.

Timeframe and probable research challenges

The observational research into the complication of implementing multidisciplinary approach within psychiatric units in Australia will take around 2 years to complete.  Observation, as a research method, tends to more susceptible to ethical issues and challenges.

Reference

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^[1] Zorbas, H. et al, ‘Multidisciplinary care for women with early breast cancer in the Australian context: what does it mean?’ (2003) MJA; 179 (10): 528-531.

^[2] Epstein N, ‘Multidisciplinary in-hospital teams improve patient outcomes: A review’ (2014) Surgical Neurology International

^[3]Bryden D, ‘Duty of care and medical negligence’, (2011) Continuing Education in Anaesthesia Critical Care & Pain, Volume 11, Issue 4

^[4] Babiker et al, ‘Health care professional development: Working as a team to improve patient care’  (2014) Sudanese  Journal of Paediatrics, vol. 14(2)

^[5] Morton et al, ‘Individual responsibilities in multidisciplinary working’, (2003) Current Paediatrics, Volume 13, Issue 4

^[6] Gupta T, ‘Multidisciplinary clinics in oncology: The Hidden Pitfalls’ (2007) J Oncol Pract Vol. 3 Issue 2

^[7] Licitra et al, ‘Evaluation of the benefit and use of multidisciplinary teams in the treatment of head and neck cancer’, (2016) Oral Oncology, Volume 59

^[8] Paterson M, Mulligan E, ‘Disclosing health information breaches of confidence, privacy and the notion of the “treating team”, (2003) J Law Med

^[9]Webster and Harrison, Multidisciplinary approach to mental health crisis management: an Australian example’ (2004) Journal of Psychiatric Mental Health Nursing, 12:9

^[10] Liew V, ‘Balancing confidentiality and collaboration within multidisciplinary health care team’ (2012) J Clin Psychol Med Settings 19(4):411-7

^[11] Ugwumadu et al, ‘The role of multidisciplinary team in the management of deep infiltrating endometriosis’ (2017) Gynecol Surg, 14(1)

^[12] Webster S and Harrison L, ‘The multidisciplinary approach to mental health crisis management: an Australian example’ (2004) Journal of PsychiatricMental Health Nursing, 12:9

^[13] Roncaglia I, ‘A Practitioner’s Perspective of Multidisciplinary Teams: Analysis of Potential Barriers and Key Factors for Success’ (2016) Psychological Thought 9-1

^[14] Haregu T, ‘Health Research Methods’  (2012) <https://www.slideshare.net/tilahunigatu/health-research-methods> accessed 28 February 2018

^[15] Pope C and et al ‘Qualitative methods in research on healthcare quality’ (2002) BMJ Quality & Safety:148-152

^[16] Al-Busaidi , Z ‘Qualitative Research and its Uses in Health Care’  (2008) Sultan Qabbos University Medical Journal 11-9

^[17] Benson J and Britten N, ‘Patients’ decisions about whether or not to take antihypertensive drugs: qualitative study’ (2002) BMJ; 325(7369):873

^[18] Pope C and et al ‘Qualitative methods in research on healthcare quality’ (2002) BMJ Quality & Safety:148-152

^[19] Grol R, ‘Personal paper. Beliefs and evidence in changing clinical practice’ (1997) BMJ 418-21

^[20] Morgan et al, ‘Case Study Observational Research: A Framework for Conducting Case Study Research Where Observation Data Are the Focus’ (2016). Qualitative Research

^[21] Benson S, ‘A Review of “Observation Techniques: Structured to Unstructured” (2009) The Journal of Educational Research- 103:1

^[22] Gillham B’ Observation Techniques: Structured to Unstructured’ (London & New York: Continuum International Publishing Group 2008

^[23] Patton,  ‘Qualitative research and evaluation method’. (3rd edn Sage Publications; Thousand Oaks, CA,  2002)