A common approach is the development of community-based multidisciplinary teams (MDTs), in which a mix of health and care professionals come together to plan and coordinate people’s care. Many MDTs are based around general practices and typically focus on care for adults with complex health and care needs.
Establishment of teamwork and collaboration in multi-professional teams is a major skill-mix change and is key for organizing and coordinating health and care services.
Integrated care requires professionals and practitioners from across different sectors to work together around the needs of people, their families, and their communities. Teams which bring together the relevant professionals and practitioners can be an effective means to encourage better coordination of their work. Multidisciplinary teams (MDTs) have long been deployed within services for individuals with complex needs such as young people who have offended; people diagnosed with cancer; people with severe mental health issues; and people who are at risk of abuse or neglect. In more recent times, they are also being deployed for more diverse populations, such as those within a community at high risk of poor health and social outcomes, people being discharged from hospital, and older people living in residential care homes.
Common elements of MDTs include: an identified manager and/or practice leader who facilitates the work of the whole team; a single process to access the team with joint meetings to share insights and concerns; shared electronic record of all contacts, assessments and interventions of team members with an individual and their family; a key worker system through which care for those with complex support packages is coordinated by a named team member; and diversity of professions and disciplines which reflect of the needs of the target population.
What are multidisciplinary teams? (Integrated care)
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How do multidisciplinary teams support integration?
On the overall question of ‘added value’ of the MDTs, we found indications of this in a number of respects: sharing information about patients, often in ‘real-time’; learning about services, processes, and decision-making of other participating agencies; planning strategies for patients and/or their carers that services found difficult to engage; managing risk; and sharing support for often distressing and stressful cases.
MDTs can enable professionals and practitioners from different backgrounds who work with an identified population and/or transition process to collaborate better. Through meeting on a regular basis and following shared processes, professionals develop a better understanding of each other’s roles, responsibilities, and resources. MDTs can generate a shared identity and purpose that encourages team members to better trust each other and to provide constructive criticism and alternative perspectives on an individual’s needs and opportunities. If person-centred practice is embedded within the MDT, then they facilitate better involvement of individuals and families within assessment, care planning and decision-making processes.
Who will benefit from a multidisciplinary team’s care coordination?
Research evidence indicates that integrated care, and MDTs in particular, are especially suitable for people with complex needs and long term-conditions, who benefit most from a holistic provision of care.
MDTs and inter-professional collaboration is a flexible and adaptable approach, shown to be effective for a whole range of populations, including older people, children and people with mental health problems.
What do multidisciplinary teams need to succeed?
MDTs need to have a clear role and purpose, be well led and organised, have sufficient diversity of professions and disciplines, and be supported by an enabling infrastructure. They must be pro-active in how they engage individuals and families in their discussions and decision making. MDTs should also connect with other services and teams in their neighbourhoods and place.
Homelessness multidisciplinary teams should engage in reflective practice, including opportunities to share experience and learning with other relevant teams, including homelessness multidisciplinary teams, and to review complex or difficult situations.
MDTs need practical support from the system in which they operate, including clarity on their overall purpose and performance metrics which reflect their integrated care responsibilities. Team leaders of MDTs should generally be facilitative in approach to encourage different contributions but be ready to be more directional when necessary. An awareness of team dynamics and a willingness to challenge poor collaborative practice are important competences for team leaders. Supportive physical and/or virtual environments and dedicated team reflection time improve communication and strengthen constructive discussion between members.
MDTs need to engage with other teams and services in their local neighbourhoods to help their wider systems better understand the role and skills of the team. A commitment to person-centred care should be an explicit value within shared practice and processes to encourage members to embed open communication with individuals about their care and options, and so provide genuine opportunities for co-production in decision-making. Timely and accurate evidence of the impact of teams which relate to their overall purpose and the organisation of structured opportunities to reflect on this evidence strengthens their effectiveness.
What is the evidence for outcomes and impact?
Enhancing IC through increased medical, pharmaceutical and voluntary sector input, coordinated through a daily MDT, in a highly vertically and horizontally integrated system appears to increase service efficiency, reduce acute attendances and provide benefits across the care system, whilst delivering a person-centred service.
There is evidence that MDTs can lead to a range of positive impacts for individuals and families, including increased survival rates for people diagnosed with cancer, reductions in the number of people at risk of abuse being taken into care, and gradual reductions in people with long term conditions and/or older people undergoing unplanned admissions to hospital. MDTs can also result in professionals feeling more supported and positive about their work, and therefore improving their overall wellbeing and motivation. However, other studies have found that MDTs have little or no impacts in relation to reducing people’s reliance on health and social care services on a population level and that they can result in people feeling less, not more, able to influence decisions over their care. Therefore, the way in which MDTs are designed, implemented and resourced is crucial to positive impacts being achieved. Furthermore, as MDTs are generally introduced as one element of an overall programme of integrated care, it can be difficult to isolate their contribution alongside other initiatives.