Doctors, nurses, health leaders, health care assistants and allied health professionals were urged to grasp the opportunity to think differently to implement meaningful change at the Interdisciplinary Masterclass Programme at St Christopher’s on 6 February.
‘A fantastic opportunity to learn as a team, to network, and to enhance understanding of interdisciplinary and rehabilitative palliative care’
A truly integrated interdisciplinary approach to palliative care which sees boundaries blurred between different disciplines is the only way hospices will be able to meet the predicted significant increase in demand for their support as the population ages and lives with multiple, often complex co-morbidities, delegates were told.
Rather than having to start from scratch to re-imagine their whole approach to looking after people at the end of life, professionals should consider it more as a case of going back to the future.
As Helena Talbot-Rice, Rehabilitation and Wellbeing Consultant at St Christopher’s said, it is in fact a doubling down on the original ethos of the hospice’s founder Dame Cicely Saunders.
Helena added:
“It’s about doing what we were founded to do. It’s all about putting the person at the heart of what you do. True holism is paying attention to all aspects of the person.”
This, the first of an innovative two-day programme, led by Gail Preston, Senior Physiotherapist and Visiting Lecturer at St Christopher’s challenged participants to reflect on precisely what’s meant by an Interdisciplinary approach, who’s involved and provided delegates with examples of how it can and does work in practice.
This then fed into day two of the Masterclass which enabled participants to reflect on and apply this new thinking to their own practice. Facilitated by Rebecca Tiberini, Consultant in Strategic Leadership, Coach and Chair of the EAPC Taskforce for Rehabilitation in Palliative Care, participants had the opportunity to create a strategic action plan to implement interdisciplinary palliative care in their place of work that would be supported over the next year through the St Christopher’s Community of Practice. The approach represents a shift where participants not only come away with new learning, but also critically with a tangible plan and programme of support for how they will implement it in their practice to impact directly on patient support and care.
With so much information shared, this article aims to provide an overview of some of those key points of the first day:
1. What is an Interdisciplinary approach?
Rebecca Tiberini explained that a truly Interdisciplinary approach is one that respects and values the unique contributions of each discipline but also effectively blurs the boundaries that normally exist between disciplines to co-create a single integrated plan of care to support the person at the centre of that care. This, she said, has to operate between specialisms, between services and sectors and between disciplines in teams.
While a Multidisciplinary approach is good, Interdisciplinary is better. These terms however are frequently used interchangeably, Rebecca added, saying that understanding what we mean by interdisciplinary palliative care is a critical first step if we aspire to deliver this approach in practice.
2. Put the person at the heart of everything you do
Sam, a healthcare assistant on the wards at St Christopher’s expressed this concept compellingly. She said that without finding out about the person she was supporting she couldn’t create a trusting relationship. Knowledge is powerful, she said, adding:
“while breath is still taken, life is still to be lived.”
So, she takes great care to get a real sense of their identity to help build a rapport.
3. What matters to you?
This is the simple and instructive question that initiates the Interdisciplinary process, establishing each person’s goal or what matters to them at the centre of all interdisciplinary support and care, delegates were told. Rather than asking people what’s the matter with you, simply switch it to what matters to you?
By asking the question you can then start to focus on function beyond symptoms and start to support a person, rather than treat a patient, Helena said, adding:
“Help people to be the best they can by supporting their capacity. It’s not just about how bad the pain is, but more about what’s the pain preventing you from doing.”
4. When and how to ask THE question?
Social worker Michelle urged delegates to ask people to express their goal before doing the assessment so they can be thinking about the barriers, how to overcome them and which members of the Interdisciplinary team need to be involved.
Several of the day’s speakers recommended using language everyone understands and feels comfortable with. St Christopher’s physiotherapist, Lauren Stell suggested that people don’t always understand what the word ‘goal’ really means. Instead, she suggested asking people what their priority is, right now, today.
5. Involve the whole team in the process
Completing a joint holistic assessment, might seem resource intense, but Helena said, having all disciplines represented in the room ensures everyone receives the same message and its saves time in the long term as well as protecting the person from having repeatedly to tell their story.
After the person has shared their personal goal, Rebecca advised all members of the team discuss their understanding of it as their interpretation will be influenced by the discipline in which they work. A collective understanding of each person’s goal and the plan of support to enable them to work towards this then forms the shared purpose of the interdisciplinary team.
6. Meeting people’s goals
An Interdisciplinary approach encourages less hierarchical management, leading to an atmosphere that encourages trust, constructive criticism, idea generation and a greater freedom to express vulnerabilities and shortcomings – all in search of the golden prize – enabling the person to achieve what matters to them.
Person-centred goal setting lies at the heart of rehabilitative palliative care. But discussing goals does not come naturally to all members of the team, who may be worried about people raising unrealistic goals.
Lauren Stell, was one of several speakers who said that transparency and honesty was important to acknowledge uncertainty. Sometimes the role of the team will be to support people to adjust to a new level of disability by providing coping strategies and this can be just as important as realising the goal itself.
7. Be risk confident
This principle was brilliantly explained by Grace Larder, a St Christopher’s nurse who says she draws heavily on the Lantern Model of palliative nursing.
“Our success isn’t measured in risks we help people avoid, but goals we help them achieve.”
Michelle King, St Christopher’s Social Work Lead, encouraged people to view risk as an enabler in order to strike the right balance between protection and autonomy.
The important point about an Interdisciplinary approach is that the team start from the point of maximising opportunities for the people we support and then everyone shares responsibility, everyone contributes, and risk is shared.
Helena and Ward Manager Emily Alcock recounted a powerful story of shared risk. A woman in her 40s with cancer, close to dying had repeatedly expressed a wish to have one last cold-water swim in the lake near her home. Nurses, Health Care Assistants and Physios worked together to make it happen.
Emily said she felt confident holding the risk for the medical element while being completely transparent with the woman and her partner about the chance that she could die during her outing to the lake.
“Be honest with the risk because you don’t have to carry all of it yourself,”
said Emily.
For this woman, the risk was worth it, and she achieved what mattered to her most, swimming one final time with her partner in the lake. With an ambulance, all essential equipment and representatives of numerous disciplines on hand, the team were risk confident and subsequently deeply rewarded having helped the woman fulfil her goal.
Risks come in all shapes and sizes as Andrew Goodhead, St Christopher’s chaplain, explained. Just allowing someone to talk can be a risk, but it might allow them to find meaning in their life by being given the opportunity to talk to someone who isn’t a medical professional or family member. Once you’ve taken the risk to ask what might be seen as a difficult question, you do have to allow the person to finish their story, Andrew added.
Nurses, HCAs and therapists working together in an Interdisciplinary way to support people to achieve goals that were superficially small, but meant the world to them, like sitting in a chair for ten minutes a day or going outside to smoke a cigarette, were other examples of risks being tackled with confidence.
8. Who’s in the team and how do they collaborate
Short answer – everyone.
For a truly Interdisciplinary approach this will include all professionals involved in the person’s support and care – including those from outside your organisation. Sara Robbins, St Christopher’s Palliative Care Consultant, acknowledged that not all doctors outside the hospice buy into an Interdisciplinary approach (more about how to take them on the journey below in Key Point No.9).
It can also include volunteers as illustrated by Dilip who visits people in their own homes and on the wards. When someone on the ward whose bed had been moved against the wall to prevent them falling out, said they loved nature, Dilip engaged help from colleagues to shift the bed 90 degrees so the person would still be safe, but also able to enjoy the view out over the garden. Small differences that start from finding out what matters to each person.
9. How to engage colleagues outside the hospice and the difference it makes
St Christopher’s in-house GP George Pavey spends much of his time collaborating with local GPs – in part through a community of practice they’ve established for those who’ve qualified in the last five years. Through six weekly meetings and an online platform, local GPs have been able to share ideas, knowledge and issues on topics they choose. The meeting times are varied too to accommodate different schedules.
George reported that local GPs now have the confidence to tackle more complex palliative care cases without feeling the need to engage specialist palliative care.
Care homes, dubbed the ‘hospices of the future’, are another central partner in a truly Interdisciplinary approach. Gill Early, who manages St Christopher’s relationship with the more than 100 homes across the five London boroughs the hospice serves, said by valuing the homes, walking the journey with them, joining them in their aspirations and demonstrating commitment to maintain that relationship enables the homes to undergo transformational culture change employing a rehabilitative approach. Gill runs an ongoing, regular education programme for the homes and speaks to every home manager at least once a month.
10. Sharing good practice through stats, research and stories
Influencing and educating has been an important part of St Christopher’s Interdisciplinary journey, Helena said, citing the workshops the hospice hosted after its former CEO Heather Richardson and Rebecca Tiberini partnered on the publication of Rehabilitative palliative care: enabling people to live fully until they die.
Presenting credible, meaningful statistics with human stories has helped to persuade more people, internally and externally, of the effectiveness of an Interdisciplinary rehabilitative approach.
Deidre Morgan, Occupational Therapist and Associate Professor from Flinders University, Australia, augmented this with an overview of the growing body of research and policy to support interdisciplinary rehabilitative palliative care as best practice.
Delegates were asked to finish the day by engaging in an exercise run by Marie Cooper, St Christopher’s Senior Nursing Adviser. She asked them to consider what impact they’d like to deliver to evolve their interdisciplinary working, the assets at their disposal and the actions needed to make that impact.
Participants left this first day full of ideas and inspirations for interdisciplinary working. Day two of the programme, together with the ongoing support of the St Christopher’s Community of Practice and offer of coaching with Rebecca Tiberini, then enabled participants to transform these ideas and inspirations into actions to make them interdisciplinary realities.
To discover more learning opportunities at St Christopher’s click here.
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https://www.stchristophers.org.uk
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