Delivering integrated care: the role of the multidisciplinary team

SCIE Highlights No 4 – July 2018

Multidisciplinary teams (MDTs) are promoted as a means to enable practitioners and other professionals in health and social care to collaborate successfully. Research suggests that MDTs can be effective in meeting the needs of some populations. They are identified in SCIE’s Integration Logic Model as a core desire of what good integrated care looks like. Sufficient diversity of professions and disciplines, suitable leadership and team dynamics, and supportive organisations are important enablers.

Key messages

Integrated care requires professionals and practitioners from across different sectors to work together around the needs of people, their families and their communities.

Not working together results in a poor experience of care, a waste of resources and in some cases people suffering harm.

The evidence is that MDTs can result in positive outcomes for people and their families, and improved job satisfaction for professionals and practitioners. However, this is not guaranteed.

Introduction

Integrated care requires professionals and practitioners from across different sectors to work together around the needs of people, their families and their communities. Not working together results in a poor experience of care, a waste of resources and in some cases people suffering harm.

Teams which bring together the relevant professionals and practitioners are seen as an effective means to encourage better coordination of their work. Often these are labelled as ‘MDTs’ but are in fact often seeking to enable ‘inter’ or ‘trans’ working between different ‘professionals’ and ‘practitioners’. MDTs are encouraged (and in some cases mandated) by policy-makers in relation to different populations and needs. Examples include:

Common elements of MDTs include:

Some professionals work mainly within a single MDT in co-located premises. Others may be members of multiple MDTs and not located with other team members.

Definitions

Discipline: a specialist field of practice or study within a profession and/or in academia.

Integrated care: services working together to ensure people can plan their care to achieve the outcomes that are important to them.

Practitioner: an individual who has the training and experience to undertake roles within health and social care.

Professional: an individual for whom qualification and registration are necessary to undertake a particular role.

Team: a group of identified individuals with a shared purpose for which they are mutually accountable and which requires interaction between team members.

What do we hope MDTs will achieve?

There are a common set of aspirations about what MDTs will achieve no matter what the population or need concerned.

What is the evidence on MDTs?

(Huxley et al 2011, Prades et al 2015, Cancer UK 2016, EU 2017)

The evidence from research is that MDTs can in some circumstances result in positive outcomes for people and their families, and improved job satisfaction for professionals and practitioners. However, this is not guaranteed, and if not well organised, MDTs can have no impact or in some cases a negative impact. The following case studies highlight different approaches taken by three local areas to encourage collaborative working between professionals and practitioners.

Views on multidisciplinary teams

Case studies

The case studies show that there are different ways to support groups of professionals and practitioners to collaborate successfully. Lincolnshire and Manchester have brought together those working within an identified locality into an MDT. Stockport has instead maintained single-discipline teams but enabled collaboration through shared principles, joint training and an emphasis on innovation and improvement.

Enablers that should be in place

Research has revealed that for MDTs to work successfully there are a set of enablers that should be in place.

Clear purpose: MDTs need a defined role that requires team members to interact across professional and disciplinary boundaries.

Institutional support: the organisations which employ staff and (if in place) the partnership bodies overseeing this area of collaboration must provide support. This should include pubic endorsement (and so legitimacy), ensuring that the MDT has the necessary resources, and developing integrated performance systems.

Team leadership: leaders should generally be facilitative in their approach to encourage different contributions, but be directional when necessary. An awareness of team dynamics and a willingness to challenge poor collaborative practice are important competences for a team leader.

Collaborative opportunities: teams must have physical space and time for their members to engage across professions and disciplines. This enables them to improve communication and better understand each other’s roles and resources.

Person-centric: there is a danger that teams can become too inwardly focused on their own functioning. This can lead to people and their families feeling more, rather than less, excluded from discussions about their care.

Role diversity: there is no magic formula for MDTs. Rather, the mix of professions and practitioners must respond to the needs of the population concerned while still being small enough to allow members to know each other.

Evidence focused: teams require timely and accurate evidence of their shared impact. Structured opportunities for teams to reflect on this evidence is one of the most impactful means to strengthen their work.

Conclusion

MDTs are likely to remain an important component of health and social care. It is important that those who create, lead and work in them are aware of both the pitfalls and opportunities of MDTs. The current integrated care developments in England and internationally should provide considerable evidence about their deployment within different populations. Learning from this evidence will enable us to understand when and how MDTs should be used in the future.

MDTs need a defined role that requires team members to interact across professional and disciplinary boundaries.

Further information