Working Alongside a Client's Support Team

Podiatry is a small specialty that is now operating within large teams: the high-risk patient has a support worker at home; lives in accommodation which has a roster; sits in an NDIS plan with a coordinator; sees the feet for twenty minutes every six weeks and is the most marginalized clinician in the system.

This library creates complex collaboration apparatus for its high-touch professions; the podiatry edition is the peripheral clinician's, three habits that make a small touchpoint punch at full weight within a team it rarely meets.

Habit one: brief through the worker in the room

The collaboration channel was used deliberately in the accompanied appointment for this second article: the care instructions were given to the patient and worker together, the routine changes were shown and not explained, the new one-pager of the previous article was handed over, and the worker's fortnight report was given as the between-visit surveillance it is. In 20 minutes you have more than anything you've written to a provider, you have an arm to implement it on a daily basis, and you've just found the right two people in the room.

Habit two: route through the structures that exist

There are machines around supported patients in this library: coordinators who keep the plan, providers with briefing gates, escalation lines with numbers who answer. They're discipline-specific, and the peripheral clinician's job is to deliver them not duplicate them: the updated foot care requirements to the coordinator when the plan reviews; the watch-list into the briefing system that the provider runs; the same-day reports that come through the same pass the team runs; the two-sentence flags that the GP and physiotherapist have and their series in this library are designed to accept. Small professions preserve their influence by writing very short code into everybody else's systems, rather than by constructing their own.

Habit three: defend the clinical boundary from the periphery

The distance makes the boundary more salient, not less: the absence of the podiatrist when the corn plaster gets suggested, the nail scissors comes out, the lesion they've found meets a well-meaning home remedy, the report-everything rule, repeated every time they accompany someone: restating is what peripheral clinicians have instead of presence. The team hearing the same three sentences 6 weeks later retains them.

How this plays out in practice

Imagine one SIL resident with diabetes who has seven workers in her roster, sees a podiatrist twice a month (20 minutes each visit) and has a foot history that improves the year the three habits begin. All seven have the same routine: the accompanied appointments brief whatever worker attends; and the one-pager enters the house's briefing gate, the flag about her changing gait goes to the physio, and the July call from a weekend casual who has never met the podiatrist but has read the fridge goes to the physio series. The podiatrist didn't attend any of their meetings and was, for the feet, the most powerful member of the team. That's what the three habits are for.

Next steps

This week, practise habit #1: when you go on an appointment with someone, tell the worker as a peer, show them how it's done, and give them the page. The other two habits are follow-ons from the first.