Innovative practice in the process of patient management in palliative care

This thesis examines the management of multidisciplinary teams in a highly innovative environment through a study of multidisciplinary patient care teams in palliative care. It investigates management that enables spontaneous innovation where necessary, yet maintains discipline and compliance with legislation, regulation and policy. To assist the explanation a model of palliative care multidisciplinary team management and operation is developed, building on work described in the continuous innovation and organisational configuration literatures. This thesis describes innovative practices as focusing on changing the organisation’s social potential, when necessary, in order to match changes in an individual patient’s situation. A definition of innovation suitable to this environment is developed here, adapted from the innovation literature. A definition of social potential suitable to this environment is also developed, based primarily in the literature of the socialisation of organisations. In palliative care organisations, care is delivered to the patient and any group of people supporting the patient during the end of life process. Care provided to these supporters, referred to in this thesis as patient-based carers, can extend beyond the death of the patient. Palliative care is more than symptom management during the dying process and can involve an interaction lasting weeks or months between the organisation and patients and patient-based carers. A patient’s situation is described at many levels and involves a number of aspects of the patient’s condition and life; for example medical, social, psychosocial, spiritual and physical. In palliative care, patients and patient-based carers are the major sources of information about their situation and changes to it. This makes them active participants in the care team, although some patients and patient-based carers choose not to take this role. Every patient and every group of patient-based carers creates individualised situations when progressing through their end of life processes, requiring individualised care from teams that can change the membership mix to suit the situation. Palliative care professionals can be members of multiple individual patient care teams simultaneously and teams can include heads of discipline (managers). Multidisciplinary palliative care teams can be managed from inside or outside the team, as the situation requires. Uncertainty pervades this environment and the response is flexibility based in learning and understanding. From the model developed of the management of innovation in the palliative care environment implications for the management of multidisciplinary teams in a highly innovative environment are drawn