Evaluating the effectiveness of Multi-Disciplinary Team (MDT) working within the Waltham Forest and East London Collaborative (WELC) Integrated Care Pioneer Programme
The Waltham Forest and East London Collaborative (WELC) integrated care programme brings together commissioners, providers and local authorities to establish a more holistic approach to the commissioning and provision of healthcare. Initial findings of the WELC evaluation found that there is currently a lack of consistency around the form, function and organisation of Multi-Disciplinary Team (MDT) working. By working closely with front-line staff and key stakeholders we aim to collaboratively establish a set of shared principles for effective MDT working which will support an ideal model for MDT meetings and encourage an ethos of better MDT working across East London.
This project adopted a participatory approach which uses an innovative model placing the researcher as a core member of the programme team - the Researcher-in-Residence model. The initial development of the shared principles involved a literature review to identify key characteristics of effective MDT working. Participatory methods allowed for collective influence of the shared principles and these included: online questionnaires for front-line staff designed to understand the current climate of MDT working and identify key enablers and barriers to collaboration, meetings with key stakeholders to allow for locality specific input, and use of a locally developed MDT observation tool which allowed us to evaluate key elements of effective MDT meetings at 18 GP surgeries across East London.
The results indicate that the majority of meetings do not have adequate membership or attendance and there is a lack of collaboration within and between specialities. Improving meeting room size, seating arrangements, IT equipment and refreshments were all identified as important factors to improve MDT meetings in primary care. In terms of administration there was a need to improve both pre-meeting paperwork and information sharing in addition to real-time updating of patient information for improved action points, meeting outcomes and accountability. The evaluation provided insight into the different relationships amongst staff and highlighted the inconsistencies with regards to understanding roles and responsibilities and this was reflected in the participatory production of the shared principles.
There is currently variation in MDT membership, lack of prioritisation, inconsistencies in both attendance and enthusiasm at primary care MDT meetings and feelings of inclusion versus isolation amongst members. Importantly, the evaluation did reflect that when MDT meetings are well organised, well attended, and well run, they are highly valued by all members and are useful to staff in terms of relationship development; beneficial to service users in ensuring a more holistic provision of care; and able to reduce duplication within the health and social care system. Consequently, more effective MDT meetings are a key part of establishing a wider ethos of MDT working and therefore an important marker to better evaluate collaborative working across the health care network.