SKILLS & LEARNING
EFFECTIVE MULTIDISCIPLINARY TEAM WORK Nikki Brierley Specialist Dietitian and CBT Therapist
An effective multidisciplinary team (MDT) is an essential part of delivering person-centred care and is associated with positive treatment outcomes. MDT working involves utilising the knowledge, skills and best practice from various disciplines and service providers.
Nikki has been a HCPC Registered Dietitian for eight years and more recently gained BABCP accreditation as a CBT Therapist. She currently works in a dual role within the Adult Community Eating Disorder Service at Cheshire and Wirral Partnership NHS Foundation Trust.
The key traits of successful MDT working have been identified as leadership, relationships, culture, clinical engagement, developing workforce, information, communication and commissioning. However, it is suggested that the most important guiding principle for MDT working is a shared commitment to delivering person centred and coordinated care. Care co-ordination is directly correlated with successful MDT working and improved long-term outcomes. It is suggested that key skills are required to undertake the role of care co-ordination, but that the clinical background or organisational base of the individual is less important. The elements required and the role of the care coordinator are summarised in table 1.
There is also an argument that the patient themselves is encouraged and supported to become their own care coordinator, with the aim of promoting independence and resilience in line with the underlying ethos of integrated care.1 IDENTIFYING AND OVERCOMING POTENTIAL BARRIERS
When introducing MDT working there are inevitable barriers which may present, it is important that these are acknowledged and overcome to ensure effective MDTs can be established and maintained. Indeed, part of the NHS 5 year forward view (2) requires that the traditional boundaries that exist between services are dissolved and the obstacles that prevent personalisation and coordination of health services be removed. Table 2 lists the potential barriers to MDT working.
Table 1: The role of care coordinator Form a proactive working relationship with the patient. Complete a holistic, person-centred assessment with the patient. Provide a central and continuous point of contact for the patient and professionals involved. Act as a key advocate for the patient if required. Assist the patient in the successful navigation of complex health and social systems. Demonstrate local knowledge of the range of health and care services. Take responsibility of care planning and ensure this takes place as agreed. Hold other providers within the care plan to account. Monitor and review care plans and agreed outcomes in partnership with the patient and evaluate outcomes. Provide direct care where appropriate. Adapted from NHS England MDT handbook, Jan 20151
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Table 2: Potential barriers to MDT working Cultural boundaries across pathways Systems and bureaucrat boundaries Funding and budgets Not looking beyond own expertise Focusing on professional intervention, in place of promoting independence, building competencies and self-care Changing patient profiles Adapted from NHS England MDT handbook, Jan 20151
DEVELOPING A TEAM
There is a wealth of information that indicates that developing a team is associated with a variety of positive outcomes, including improved service provision, innovation of service, enhanced patient satisfaction and increased staff motivation and mental wellbeing. It is recognised that teams go through different stages of development. Figure 1 demonstrates these stages and can be a useful tool in identifying why certain behaviours may be occurring and the feelings associated with these. There is also a variety of different models of team development that can improve self and team knowledge and encourage integrated working (i.e. Myers Briggs, Insight Discovery and Aston).
ASSESSING EFFECTIVENESS
Tools and frameworks to allow the assessment of MDTs have been developed and include establishment, ongoing development and regular review of effectiveness. Table 3 overleaf lists an example of the proposed indicators of effectiveness of MDTs. REFLECTIONS ON POSITIVE MDT WORKING
Drawing on personal experience of working within a specialist community eating disorder service, it is clearly evident that the effectiveness of the MDT is of paramount importance in promoting positive treatment outcomes. It is successful MDT working that ensures effective care planning and well informed clinical decisions. As such without
Figure 1: Bruce Tuckman’s model of group development
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SKILLS & LEARNING Table 3: MDT effectiveness indicators Execution of task MDT structure and membership Meeting management Roles and functions Integrated care process Debate and discussion Trust within teams Individual/collective agreement Acceptance and accountability Attention to results Adapted from Bradford, Airedale and Craven; Integrated care for adult’s programme: Effective MDT development tool.3
an MDT approach it would not be possible to meet the complexities of this patient group. MDT working provides the ideal environment to greatly increase professional knowledge and significantly contributes to continual professional development. It facilitates a greater understanding of where the knowledge and expertise of specific professionals are required, where there is overlap and indeed where gaps in provisions can emerge. This improves collective understanding and allows solutions to be identified. The result of which can greatly increase overall job satisfaction, as each individual is recognised as a valuable and contributing member of team.
Establishing effective MDTs, and moving away from the limited practice of focussing on delivering individual professional expertise (i.e. providing dietary advice alone), requires the prioritisation of time. This time is needed for case discussions, team meetings, team development (i.e. Myers Briggs), information sharing and meeting with external teams. This investment however can result in significantly increased knowledge, skills and understanding, alongside enhance team functioning. Thus has the potential to not only greatly improve the patients experience, but also the experience of those professionals who are privileged to work as part of an effective MDT.
References 1 NHS England, Jan 2015, MDT Handbook: www.england.nhs.uk/wp-content/uploads/2015/01/mdt-dev-guid-flat-fin.pdf 2 NHS England, 2014, 5 Year Forward View: www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf 3 Bradford, Airedale and Craven; Integrated care for adult’s programme: Effective MDT development tool www.airedalewharfedalecravenccg.nhs.uk/ what-is-integrated-care
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