Improving multidisciplinary team working: Phase 2 of a quality improvement project in a tertiary care university hospital

Introduction

The Multi-disciplinary team meeting (MDM) underpins geriatric medicine.  The previously-described first phase of this project addressed variations in MDM frequency and practice across Healthcare of Older People (HCOP) wards. This second phase built on those changes with the aim of improving three key areas; process, values and skills.

efficiency / effectiveness of meetings (process)

team-working (values)

empowering of individuals (skills)

quality of the documentation (skills)

Methods

A previous survey of MDT members on 2 HCOP wards identified areas of focus and suggestions for achieving these changes. Subsequent interventions included

education sessions for resident doctors

“live” MDT document available for editing by the team before the meeting

dedicated resource folder

rotating MDT chair

support and role-modelling to encourage any MDT member to chair the meeting.

A further survey was conducted after these interventions had been embedded.

Results

The post-intervention survey of 13 MDT members found that

-54% felt satisfied with the format

-85% were satisfied with discussion content

-23% were satisfied with documentation.

An average reduction in meeting length by 12 minutes was noted. Qualitative feedback described greater efficiency of meetings. It also highlighted the need to further improve the accuracy and completeness of documentation. A rotating chair was seen as positive to the discussion and empowerment of the team.

Conclusion

These results are encouraging and give focus for future work. Next steps include

-improving documentation through rotating the role of scribe and encouraging all team members to add to the template before meetings

-regular teaching to rotating doctors on aspects or rehabilitation and MDT working

-role-modelling and support to further increase sharing of roles traditionally taken by medical staff (documentation and chairing)

-weekly MDT learning to foster a team atmosphere / empower all individuals.