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Introduction

Organizational culture, dynamics and professional practices are one of the vital elements of any organization which reflect the sense of identity. It determines the organization’s legends, rituals, meanings, value and norms, beliefs, language and the manner in which activities are performed around the organization (Cooke and Bartram, 2015, p.711). The essay revolves around exploring the dynamics, culture and professional practices of health care organizations. The part 1 of essay includes the discussion of the challenges faced by the health and care services in meeting the changing demands of public, overview of professional issues identified in light of a scenario and a focused analysis of the issues identified. The part two includes the opportunities for professional development for newly qualified nurses, swot analysis, a personal development plan of a critical stance in examining the nature of professional practice in context of contemporary health and social care.

Scenario

Here in this case the nursing staffs is looking after a service user going through his last stage of prostate cancer who shared his thoughts of committing suicide to senior nurse and asked her to keep it a secret. The nurse decided to share his thoughts of suicidal attempt with other professionals of healthcare and team members in order to provide extensive care not only from her side but from the whole team. Proper protocol regarding suicide and selfharm was followed by the nursing team and the senior nurse supervised it. Effective communication was maintained with Mr. Green, the factors which were causing the suicide attempt were identified, and appropriate nursing interventions were maintained in order to deal with the risk factors. Collaboration with other staff and health care professionals was also increased to ensure further care and minimize the risk. Mr. Green was moved to additional care service unit and with no sign of self-harm behaviour or suicide attempt he passed away after 76 days of discharge, peacefully with his relatives. The senior nurse set a good example of efficient leadership, team management and professional decision making, ethically addressing her job description and saving life of a service user.

Overview of Professional Issues

A health care system comprises of all organizations, people and actions whose sole and core purpose is to promote, restore and maintain health (Swayne, Duncan and Ginter, 2012, p.10).With the vicissitudes in population and the rise in death rate across globe has also given immense rise to the significance of health and social care for both the individuals and society (Swayne, Duncan and Ginter, 2012, p.10). Moreover, with the growing significance, the health care management is entitled with number of challenges and professional issues such as leadership, management, multidisciplinary teams, effective communication, risk management, accountability, change management, time management and managing junior staff etc. (Storey, 2016, p.20).Following are the overview of five vital challenges and issues faced by the health care system.

Leadership and management

The organization entails health care professionals from manifold chastisements forming several interconnected care teams that strives towards providing safe and consistent care. Therefore, good leadership is an important and critical success factor of an organization (Kim, Farmer and Porter, 2013, p.1060). With multi-disciplinary teams preforming both

homogenous and heterogeneous set of tasks, triggers management issues, since the job descriptions differ along with different cultures and work patterns which results in conflict and in few case complete miss-management. In view ofGlendon, Clarke and Mckenna, (2016, p.22), efficient leadership is a building pillar for an organization that can smoothly achieve all of the objectives, since it involves people, who are the best asset of any organization. In context of the above scenario, with the help of efficient leadership and management, the patient’s decision of suicide became void.

Multi-disciplinary team

According to Cameron, et.al, (2014, p.225), multidisciplinary is a key feature of the contemporary service model of health care. It involves professionals from an array of disciplines working together to provide inclusive care to many patients needs as possible. The disciplines includes general practitioners, practice nurses, community health nurses, allied health professionals such as physiotherapists, occupational therapists, dieticians, social workers and health educators. Working in a multi-disciplinary team can be challenging.The issues that may arise would be in context of team formation and implementation, training, conflict management, confidentiality, team policies and friction in supervision (Tousijn, 2012, p.522). In light of the above scenario, the nurse contacted various health professionals to address the issue of the expected suicidal attempt from the patient. The patient was saved due to efficient team work, but in case of lack of confidentiality and conflict management it could have been another way around.

Communication

As highlighted by Moorhead, et.al, (2013, p.85), health care and social care professionals need efficient communication skills to develop an affirmative relationship and share information with the patients. They need to master the art of communicating with the patient’s family and with colleagues and related professionals. In the field of health and social care, various factor effect the flow of efficient communication; sensory deprivation, foreign language, complex jargons, slangs, dialect, acronyms, cultural differences, distress, health issues, environmental problems and misinterpretation of message(Moorhead, et.al, 2013, p.85). Moreover, other barriers to effective communication include aggression and assertion(Thomson, 2015, p.634). The scenario depicts an upright example of efficient communication, where the senior nurse emphatically listened to the patient, established a relation of trust and confidentiality and meanwhile communicated the issue to other medical professionals who took over of the confidentiality and assures extensive care for the client.

Risk Management

Risk management refers to the process of identifying and analysing situations or practices that creates financial risk for the health and social care. It consists of developing strategies to control and mitigate the risk (Cameron, et.al, 2014, p.225). In view of Free, et.al, (2013, p.100), risk management cover the risks involved in service quality, staff risks, risks related to achieving goals and objectives and managing risks related to the health care reputation. The professional issues related to risk management consists of legal setting, dereliction, malpractice, mitigating malpractice and dereliction, confidentiality of medical records and patients’ rights (Szmukler and Rose, 2015, p.125). In case of the mentioned scenario, there was high risk of patient committing suicide which would have tarnished the goodwill of institution due to staff negligence.

Accountability

According to Magnan, et.al, (2012, p.37), accountability is the substantial issue in health care, it consists of the procedures and processes through which one party validates, justifies and takes responsibility for its activities. The health and social care accountability entails three core categories; financial accountability, performance accountability and political accountability. Financial accountability consists of tracking and reporting of resources allocation, disbursements and utilization by using financial tools of auditing, budgeting and accounting( Grajales,et.al, 2014, p.13). Performance accountability includes demonstration and accountability for target, outputs and services performance(Magnan, et.al, 2012, p.39). Political accountability includes institutions, procedures and mechanisms that ensure quality health and social services for the users. In light of the types of issues, the first issue is the miss-usage of financial resources. Secondly, the provision of appropriate and legal procedures, professional standards service and values. Thirdly, providing enhanced service delivery and management(Gradinger, et.al, 2015, p.661). As mentioned in the scenario, the nurse would he held accountable if the patient had committed suicide.

Focused Analysis

Leadership and management

The key challenge facing all health and social care organizations is to enrich cultures that make certain the conveyance of endlessly refining high quality, safe and compassionate health care (Abualrub and Alghamdi, 2012, p.668).Leadership is the most persuasive and influential force in shaping organizational culture and therefore ensuring necessary leadership behaviours, qualities and strategies is significant. A leadership task is to assure safe, Highquality patient care; building a culture that fosters safety and quality, providing sufficient number of competitive staff and other care providers, managing the human, financial,physical and information services and assuring a continuous flow of evaluation and performance improvement(Shirazi, et.al, 2015, p.125). The leadership issues in a health care organization stems from the absence of five pillars; using data, planning, communicating, changing performance and staffing. As mentioned by Laschinge and Smith, (2013, p.24), the pillars are inter-related and must function in coherence to one another. The leaders are required to develop a vision and goals for each pillar’s performance and to evaluate the performance. The health care systems require leadership at various levels of an organization. Firstly at individual basis, they are subjected to the issues of ensuring every patient’s voice is heard, the experiences, concerns, needs and feedback are acknowledged as done in the scenario, where the senior nurse listened to the patients concerns and took immediate actions. Secondly, the leadership is required at team level, where the professional issues of meeting team objectives, working with cross-cultural members and marinating cross-boundary working arise. Thirdly leadership is also essential and highly important at organizational level.This incorporates the boards’ leadership decision and approach towards attending, monitoring and rewarding on the basis of patient’s feedback and by addressing the concerns of employees towards improving patient care.

The core challenge is to address the cultural problems of staff, motivational issues and stakeholder issues (Anderson, 2015, p.18).Moreover, the leadership at a national level, which is engrossed with the potential challenge of developing a single integrated vision, values, processes and demands. Besides, these the need for efficient health care management is the decision of which leadership style to follow as each has certain advantages and disadvantages; autocratic, democratic and laissez faire( Fitzgerald, 2013, p.227). In light of (Munir, et.al, 2012, p.512), there are various professional issues and challenges in context of health care leadership, which will increase if the leaders will not exhibit the qualities of high energy levels and stress tolerance, self-confidence, internal locus of control, emotional maturity, personal integrity, socialized power motivation, achievement orientation and low needs of affiliation and leadership behaviours of being task oriented, relations oriented, external networking and change oriented(Asamani, Naab and Ofei, 2016, p.23). In the scenario, one can observe the clear reflection of effective leadership, where the professionals worked toward s single goal of saving the patient’s life, and altering his decision of suicide.

Multi-disciplinary team

According to Evans(2012, p.23) multi-disciplinary teams results in maximizing clinical efficacy. Multi-disciplinary is beyond the definition of various medical professionals from diverse disciplines working together.It is an art of shared goals and values in which the teams need to understand and acknowledge the competencies of other team members and need to develop an attitude of learning from other team members while respecting their beliefs and perspectives. Moreover, the teams need to reconsider and reassess exclusive claims to specialist knowledge and authority in order to provide best possible care to the patient. Working under a multidisciplinary team can be challenging, as professionals would find themselves dithering between adherences to their profession and to working to

comprehend team goals (Imison and Bohmer, 2013, p.12).

The factors which influences the effective multidisciplinary teams include the management structure of an organization, the orientation of employment contracts of team members with comprehensive employment policy, maintaining a balance between generic and specific professional roles, the client group of the team, conflict resolution, training and preparation for working in multidisciplinary teams, information sharing and efficient communication and insufficient team enrichment (Hartgerink, 2014, p.791),. The professional issues involves in multidisciplinary teams include team formation. The challenge of team formation entails efficient team building, the teams are usually not formatted in the earliest stage of team formation which results in lack of a common vision and goals, the service focus on the needs of the population is not specific due to lack of team building, absence of budget and accountability, absence of agreed operational procedures and absence of organizational support and development to the MDT

Secondly, the challenge of training, the team needs to be trained in the areas of team building, team working, medication management, mental health knowledge, interventions information and suicide awareness, prevention techniques and approaches. As in the scenario, the nurse had the training on suicide prevention and with a help of multidisciplinary teams efficiently prevented the suicide. Thirdly, conflict management since team members bring different ideas, goals, beliefs, values and needs to the teams, the difference are both a primary strength of team and a stimulus for conflict issues (Ke, et.al, 2013, p.1).

The professional issue in context of multidisciplinary team includes the element of accountability. There is lack of clarity regarding the roles and responsibilities engraved in the multidisciplinary team and ambiguity in the boundaries of accountability compared with the job descriptions of key workers. Furthermore, the concern of confidentiality is another stimulating problem in context of multidisciplinary teams. The patients expects service providers to assure confidentiality specially in mental health services, conversely in case of multidisciplinary team the information has to be shared among all team members which is against the confidentiality ethics (West and Lyubovnikova, 2013, p.134). As seen in the scenario, the senior nurse had to share the information with other key members in order to assure the patient’s safety and meanwhile marinating confidentiality.

Communication

In the contemporary health and social care effective communications play a significant role in working with varied range of people with the help of incorporating different forms of factors that affect communication and ways of mitigating the challenges and issues related effective communication ( Kitson, et.al, 2013, p.4). The health care organizations use various form of communication; verbal in form of responding to patient’s questions, identifying the problems faced by the patient, contribute towards team meetings, delivering bad news to patients or to their families, providing emotional support to the patient family and identify the individual’s care needs. In case on non-verbal communication, the care providers need to assure their body, appearance and attitude communicates optimistic messages to the patient’s regarding their feelings. Similarly the care providers need to develop efficient non-verbal communication skills e.g. interpreting the body language of patients; often patients say they are okay but their body language reflects the pain they are enduring. Non-verbal communication therefore entails facial expressions, touch or contact, gestures, proximity and eye contact (Weller, Boyd and Cumin, 2014, p.149). However, the health and social care providers face numerous communication challenges which often intrude the flow of efficient communication such as sensory deprivations and disability. E.g. in case of cerebral palsy, Down’s syndrome and autism limits an individual ability of verbal communication and therefore the care providers have to face the challenge of meeting additional communication needs by the sensory impaired and disabled patients(Tomori, 2014, p.306) Moreover, the challenge of foreign language and dialects; people from various backgrounds and cultures interprets non-verbal behaviour in diverse ways and may entail a diverse sense of humour.

which may result in misinterpretation of the message or lack of understanding from the receiver’s end. In addition, the distress and emotional difficulties also hinders the flow of effective communication such as in case of a depression, anger or any other mental problem. Thomson(2015, p.640) highlights the environmental problems which may hinder the effective communication. Such as noisy and uncomfortable environments, poor lightened environments, extra cold or hot environments and environment which lack privacy. Various professional issues may take place due to care provider’s inability to adapt the environment, understand language needs and preferences, maintaining pace, using electronic devices, being an active listener, using influential body language, proximity, facial expressions, eye contact and assuring clarity in messages (Kitson, et.al, 2013, p.10).