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Critically consider the impact of the large number of recent structural changes, policy initiatives and targets imposed on collaborative working of NHS staff.
Introduction:
The Department of Health has laid down certain policy initiatives, targets and structural and organizational changes that can improve the quality of care received by patients through the NHS. These changes are emphasized along with the need for multi-agency and multi-organizational collaborative working across disciplinary boundaries. The four key interfaces for which collaboration and coordination measures are being suggested are health and social care; general medical and community health services; primary and secondary care; and interface with carers (DoH, 1996).
In this article we will discuss:
the policy measures and guidance documents provided by the Department of Health that stress on the need for collaborative working and how this approach could be implemented in the NHS
the targets set by the Department of Health for achieving certain levels in the quality of services and how an emphasis on collaborative working could help in enhancing quality of care
the structural and organizational changes that the Department of Health have specified to implement collaborative working within the NHS and how in turn these changes have influenced collaborative and multidisciplinary working within the NHS.
Our responses and analysis of the issues in consideration will involve these three major points and we will discuss the implications of strategies, policies, structural changes and targets on collaborative working and how these issues are related to the multi-organizational work culture as promoted in recent years by the Department of Health.

Collaborative working in NHS Key Issues and Concepts
The Department of Health has identified seven areas focused on cross boundary collaborative working and these include:

partnership with patients and carers;
the commissioning process;
inter- agency collaboration;
inter-professional collaboration and teamwork;
professional education and training;
communication and information sharing; and
research and development.

However, in order to examine the policy and structural changes within the NHS, the main structures and processes identified are :
Organisational processes and Infrastructure, Knowledge Management processes, and Knowledge management resources. In fact collaborative working relates to knowledge management and structural and organisational changes have been suggested to facilitate information sharing across departments, and professionals as well as to facilitate interaction between patients, doctors and carers. Knowledge management indicates the optimum use of knowledge across departments to enhance quality of care provided but relates not just people, collaboration or work culture but also to technology and upgradation of services provided.


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