The evolution of Multidisciplinary Medical Teams – Part 1

Jan Beger

I think we may all agree that in healthcare, group decision-making can be superior to individual decision-making.

When decision-making affects the patient care pathway, group decision-making is important and may enhance reliability beyond decision-making made by an individual clinician.

A multidisciplinary approach also helps. Traditional medical teams work within a limited specialist area and have an internal role hierarchy. Multidisciplinary medical teams (MDTs) are not teams in the traditional sense: Individual MDT members work relatively independently of one another, or as part of another team, in the course of their routine work. Building MDTs to address the complex problems arising in patient care can help reduce healthcare system error – and so multidisciplinary teamwork may help to improve medical care.

MDT meetings are typically forums that facilitate group decision-making, where the team members, specialists from different clinical domains with specialized skills and expertise, meet to review patient cases, establish a diagnosis and disease stage, and decide on the most appropriate course of management for the patient.

MDT meetings are patient-centered with a focus on efficiency and safety, and enable all healthcare team members to share individual expertise. One of the main functions of MDT meetings is to offer patients the best care available from the consensus of the numerous specialists while following clinical guidelines. In other words, the MDT meeting helps to enhance dependability for the patient care pathway.

Multidisciplinary teams and their meetings occupy a central role in developed health systems. In the 1990s, the concept of MDT meetings was presented as the preferred way of working in a highly specialized medical work [1]. They were established as a means of establishing the most appropriate treatment for a patient. In the case of cancer, the objective was to ensure that all patients, no matter where they might live, and to whom they may have been referred, would have equal access to a high and uniform standard of care. In past years, there has been significant growth in multidisciplinary team working as a result of increasing specialization and advances in medical technologies.

Poor communication and failures in interpersonal interaction can account for 70–80% of errors in healthcare [2]. MDT members, without exception, have busy schedules and each specialist area has separate work routines. Senior staff in radiology and pathology spend more than 20% of their time either preparing for, or participating in, meetings with clinical staff [3].

The extension of the MDT, to a wider geographic area, through the use of teleconferencing is a reality. When the MDT meeting is extended to service multiple hospitals, and individual team members participate in several MDTs, the synchronization of work schedules becomes even more difficult and is only possible with high levels of cooperation and goodwill.

The demand for MDT meetings continues to grow, given the success of current practices. Requests are going out for new MDT meetings and more in-depth discussion on a larger number of patients. But for the full benefits of MDT meetings to be achieved, improved technology solutions are needed to overcome the difficulties being experienced. Technology can help here, as it evolves. There are various ways in which technology can help people to work together.

In Part 2 of this series I’ll continue talking about current pain points around MDT meetings and a solution for them.

Until next time,

Jan Beger

 


 

[1] Calman & Hine, 1995

[2] EIGHTH FUTURES FORUM on governance of patient safety,  Arnaudova and Jakubowski, 2005

[3] Multidisciplinary team meetings and their impact on workflow in radiology and pathology departments, BMC Med. 2007


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