Spotlight on Collaboration
Wendy MacDonald has worked as a Speech-Language Pathologist (S-LP) for 19 years; 14 of them at Stanton Territorial Hospital in Yellowknife. During that time, she has seen a lot of changes in the way services have been provided, but nothing that has been quite as effective and worthwhile as her time spent working with the Child Development Team.
"The team began as the dream of Dr. Nicole Chatel," explains Wendy. "She envisioned collaboration between different professionals at the hospital who were working with the same children but doing so independently of each other. To her, it only made sense to bring those professionals together to exchange ideas and information and then meet with the families as a team. This was back in 1989 and at the time it was very innovative thinking."
But while the idea was right, the timing was not. It wasn't until 1993 that things really got underway, with a new round of hiring at the hospital that brought the right mix of interested professionals together. The original team — a pediatrician (Dr. Chatel), social worker, audiologist, physiotherapist, S-LPs (including Ms. MacDonald) and Occupational Therapists (OTs) — would meet on an informal basis whenever their schedules would allow.
"There was an understanding at that time," says Wendy "that while we had the desire to make the team work and we could definitely see the benefits of our efforts, we lacked the coordination. We really needed someone to get it all together for us — to arrange regular meetings, schedule co-visits with our clients and keep track of all the meeting notes and decisions."
Without funding available for a manager or coordinator, the team was struggling. Finally, one of the OTs offered to devote 20 percent of her clinical time to team coordination and the hospital gave its approval. The impact of having someone to oversee the administrative end of things was immediate. Common forms were created and a step-by-step protocol was established so that when a child was referred to the team there was a set process in place that everyone could follow. With the administrative issues out of the way, team members also had more time to get to know each other and better understand one another's perspectives.
As Wendy recalls, it was a real turning point in the development of the team. "We pulled resources from what we already had and changed the way we worked. We went from operating in isolation to a unique collaborative effort that made a huge difference to how we tackled our day-to-day responsibilities. I know my job satisfaction skyrocketed and I think I can safely say the same for the others. Best of all, the children and their families were better served."
Instead of hearing thirty recommendations about what to do next from four different professionals that had to be met at separate appointments, families would be called in for one meeting where the team would come together and provide a list of the top five to ten core recommendations. Questions could be asked of more than one professional and a social worker would help identify relevant programs and services in the community that could offer support to the family. For those travelling a great distance for an appointment, the team approach meant a tremendous savings in time and money since all appointments were booked within the same week, with a final team meeting at the end. Feedback from the parents showed that this approach was really appreciated and, in fact, preferred.
From a professional standpoint, the team members grew to understand and appreciate the expertise brought to the table by the different disciplines. Seeing the value of these various approaches led them to begin asking some of the questions and disseminating additional information typically associated with other professions. In essence, their voices became more unified, which — again — was of benefit to the families.
"Working collaboratively certainly helps you place greater value on what the other professionals are doing and brings a greater sense of job satisfaction," explains Wendy. "Suddenly, you start to see the child as a whole – especially if they have a complex diagnosis. As a team, you can visualize the bigger picture. The pieces just fall into place and you can see how one approach can complement your own and how things can move forward in sync with each other."
As a result of using the team approach, different professionals began working together whenever possible. For example, S-LPs and OTs will now routinely travel with one another to see the same child. It comes from recognizing the value of working together, where there is a better opportunity to collect more information and analyze things from different perspectives. Wendy remembers working with a child with cerebral palsy. "An OT was there when I was working with the child and she told me that how you position these children is important in helping them to speak. If they are slouching, they can't use as much force to get the sounds out. I had never thought of that. It made sense. And it helped me to realize how different professionals can help each other to get the best results."
While Wendy is a great advocate of interdisciplinary collaboration – and believes it is gaining momentum across the country — she feels that it is still very much in its infancy in the North — not so much from the standpoint of professionals, but from those who provide the fiscal and human resources.
She sites the demise of the Child Development Team as an example. "The OT who had taken on the administrative duties for the team found that these additional responsibilities took too much time away from her clinical work. At that point an S-LP took over and devoted half of her time to the job. But the work of the team was never officially recognized by outside agencies and, despite attempts at increasing our visibility through presentations and word of mouth, everything fell apart when the coordinator's position was vacated in 2002. There was just no money to bring in someone to fill that gap and though we've been pushing for a coordinator on and off since then, it's not happening."
The original team members still work loosely with one another when they can, but it takes a huge effort to pull together a collective meeting. Members have to coordinate these meetings on their own time, which takes time away from their direct caseload and therapy time from their other clients. Another barrier is physical location. The hospital has expanded over time and where everyone was once housed in the same location, team members are now scattered amongst various locales.
"Being a part of the Child Development Team was really a highpoint of my career," says Wendy. "I still work in collaboration with others, which is a step in the right direction, but nothing compares to the satisfaction of being part of a well-coordinated team. My dream would be to have a Child Development Centre here at the hospital where families could come to see all the professionals together. Everyone would work collectively so that families would be presented with one clear and unified assessment and a straightforward set of recommendations to follow. That would be amazing."