2
Multi-Disciplinary Team working
Andrew Walker
Overview
INTRO
MDT working
Some evidence
Key concepts
Theory to practice
Team task
Reflection
MDT
What is it?
The MDT
Purpose
Multidisciplinary team working in practice is a collaborative process among groups of individuals with different backgrounds, for example nurses, psychologists, occupational therapy, doctors, psychiatrists, health visitors, social workers and others who share common objectives.’
Hogston and Marjoram (2007)
Advantages
Professionals will be more familiar with one another’s
activities and roles thereby improving inter-professional
communication
Professionals will be better able to work collaboratively
thereby improving high-quality care
Professionals will have broader repertoires of knowledge
and skills thereby increasing access to care
Professionals will have more career mobility as the
healthcare environment changes.
Advantages
Finkelman (2006)
Limitations
Incorrect facts
Lack of trust
Misunderstanding of role and responsibilities
Unclear or conflicted goals or objectives
Inadequate action plans
Receiving direction from two or more ‘bosses’
Lack of ability to accept change
Lack of leadership
Limited staff participation in decision-making
Ndoro, 2014
Task
Who is more important?
Hierarchy
The MDT
Jeremia Khanye
What is your role?
?
Ratidzo Moyo
Jessica Tibbs
?
Adeniyi Adebowale
Caitlin Lloyd
Kelly Humphreys
?
Jake Evans
Sarah Kerr
?
Regardless of role or organisational position, people do carry authority, influence beyond their team and impact on the delivery of services.
(Peate, 2016)
Students were not afraid to express their views, share concerns, raise questions and generate possible explanations and/or solutions.
(Smith and Stephens, 2001)
Evidence
Evidence
Better functioning teams make better quality decisions, cope better with complex tasks, produce more integrated care plans based on combined expertise, and better coordinate their actions.
Grumbach and Bodenheimer, 2004
Fosker and Dodwell, 2010
The size of an MDT is large: one study reported that there were an average of 14. The average length was 2.14 hours to discuss 31 cases, which allowed an average of 4 minutes per case. 4 minutes is not likely to deliver the level of cross-functional consideration that patients may assume their case will receive.
The MDT decides the patient treatment plan without the patient being present; this seems to fly in the face of the principle of 'no decision about me without me' and risks breaching the GMC good practice requirements to share information and discuss treatment options with the patient before making treatment recommendations.
Thornton, 2015
Physical health patients emphasised their faith in the judgement of MDT clinicians, described experiencing high quality care and expressed a strong preference not to attend MDT meetings.
Mental health patients highlighted a range of negative experiences, were frequently sceptical about their diagnosis, and expressed a desire to have greater involvement in the decisions directing their care.
(O'Driscoll, 2014)
The basics
First impressions
Humour
The basics
Enthusiasm
Professionalism
Answering the phone
Political party
Health manifesto
TASK
Reminders
Good teams are clear about their task as a team
They are clear about what skills they need in the team to achieve this purpose and therefore make appropriate choices about who should be the team members – not people with inappropriate skills, who display aggressive or disruptive behaviours
Teams should be clear about who the members of the team are
Team size is an issue. Once teams go above 8 or 9 members, effective communication and coordination become more difficult. We are often told that trusts have teams of 50+ - the equivalent of a small to medium sized enterprise, not a team
Team members need to understand clearly their roles and the roles of other team members, so there is no ambiguity about who is responsible and accountable for what tasks
Research shows that teams with a positive supportive, humorous, appreciative atmosphere deliver better care and staff are significantly less stressed
Positive teams are more optimistic, cohesive and have a stronger sense of their efficacy as a team
Teams also have to meet regularly and have useful meetings that enable them to reflect on the quality of care they provide and how to improve it.
GO!
Reflection
Reflection
What kind of team player are you?
Final thoughts
Theory
Practice