“It has become necessary to develop medicine as a cooperative science; the clinician, the specialist, and the laboratory workers uniting for the good of the patient, each assisting in elucidation of the problem at hand, and each dependent upon the other for support.”
—William J. Mayo in his 1910 commencement address to Rush Medical College
The concept of multidisciplinary teamwork originated with the Mayo brothers at the turn of the 20th century. Their Mayo Clinic Model of Care laid down a set of principles for how their organization would deliver coordinated patient care through a multidisciplinary team approach to treating the whole patient.
Healthcare, by design, is a multidisciplinary profession in which doctors, nurses, and health professionals from various specialties must work together, communicate often, and share resources. A successful multidisciplinary health team strives to make the most comprehensive assessment of a patient’s situation and to follow it up with a full-range plan of treatment. Teams may also work together to create and promote health initiatives for diverse communities and to provide education to instill disease-prevention behaviors amongst patients.
Teamwork Is a Cornerstone of Good OutcomesClinical care has become more complex and specialized, forcing medical staffs to deliver complicated health services and to quickly learn new skills. Other factors, such as aging populations and the increase of chronic diseases (diabetes, cancer, heart disease) and the task of managing patients suffering from multiple health problems have forced medical staffs into the multidisciplinary approach.
Researchers have found that when healthcare professionals work together, the number of medical errors is reduced and the level of patient safety rises; additionally, teamwork has been found to diminish the work culture issues that lead to professional burnout. One reason is that health teams help break down the hierarchy and centralized power of health organizations, giving more leverage to healthcare workers and producing a higher level of work satisfaction.
Because teamwork is centered on solid communication, patients and their families sometimes feel more at ease and report that they accept prescribed treatments and feel more satisfied with their healthcare regimens when a multidisciplinary teamwork approach is in place.
Multidisciplinary Health Teamwork in PracticeTo ensure optimum functioning of the team and effective patient outcomes, the roles of the multidisciplinary team members in care planning and delivery must be clearly negotiated and defined. This requires:
- respect and trust among team members
- best use of the skill mix within the team
- agreed-upon clinical governance structures
- agreed-upon systems and protocols for communication and interaction among team members.
The AMA Journal of Ethics emphasizes that the three most important team competencies are:
- maximizing collective intelligence
- inclusive collaboration
- open communication.
Multidisciplinary teams are already at work at major health institutions, with documented results. The Cleveland Clinic employs a multidisciplinary approach to treat cancer patients; a “tumor board” of practitioners meet as a team to discuss difficult cancer cases and to work out the best way to treat each patient. Brian Burkey, MD, Vice-Chairman of Head and Neck Surgery and Oncology at Cleveland Clinic, answers questions in this article about how a multidisciplinary team improves care for people with cancer.
In another example, in October 2012, physicians at Massachusetts General Hospital created a multidisciplinary rapid-response team to coordinate care for pulmonary embolism (PE) patients. PE is a major cause of death in hospitalized patients, and its incidence in the United States is on the rise. If not recognized and treated within the first hour, PE causes mortality levels that can reach up to 50 percent at three months for those with higher-risk forms of the condition.
At Johns Hopkins Medical Center, the Multidisciplinary Pancreatic Cancer Clinic integrates international experts in the fields of basic research, pathology, radiology, medical, radiation, and surgical oncology. Each year, over 240 Whipple procedures are performed at Johns Hopkins. Patients are referred from all over the world to be operated on by their highly experienced team. In addition, last year, over 80 distal pancreatectomies were performed.
Finally, the Mayo Clinic is the largest integrated transplant provider in the United States. Mayo’s campuses in Arizona, Florida, and Minnesota include more than 150 surgeons and physicians and hundreds of allied health staff who are trained in caring for transplant patients. Treatment is delivered by a multidisciplinary transplant team.
Improving Multidisciplinary TeamworkIn 2013, researchers identified team training as a top patient-safety strategy to be adopted in acute care settings. However, interpersonal communication and the ability to work in a team environment are two skills often overlooked in healthcare training programs.
The first steps of developing training for multidisciplinary teams, like any training development, must always involve a performance gap analysis and a learning needs assessment. I’ve personally implemented both of these evaluations in various healthcare settings and have uncovered a long list of common barriers to team effectiveness, including the following.
Barriers at the Team Level
- Lack of a clearly stated, shared, and measurable purpose
- Lack of training in interprofessional collaboration
- Role and leadership ambiguity
- Team too large or too small
- Team not composed of appropriate professionals
- Lack of appropriate mechanism for timely exchange of information
- Need for orientation for new members
- Lack of framework for problem discovery and resolution
- Difference in levels of authority, power, expertise, income
- Difficulty in engaging the community
- Traditions/professional cultures, particularly medicine’s history of hierarchy
- Lack of commitment of team members
- Different goals of individual team members
- Apathy of team members
- Inadequate decision making
- Conflict regarding individual relationships to the patient/client
Barriers Faced by Individual Team Members
- Split loyalties between team and own discipline
- Multiple responsibilities and job titles
- Gender, race, or class-based prejudice
- Persistence of a defensive attitude
- Reluctance to accept suggestions from team members representing other professions
- Lack of trust in the collaborative process
Improving Multidisciplinary Healthcare TeamsSome healthcare organizations have internal organizational development staffs with the performance-consulting, learning-design, and team-effectiveness expertise and facilitation skills to design and deliver a world-class program. My work involves both blended learning and coaching initiatives.
For the many that don’t, there are national and regional team-effectiveness training companies that provide healthcare organizations with tailored or customized team-effectiveness learning and development solutions.
Coaching Healthcare Teams and Physician LeadersAs a Marshall Goldsmith Stakeholder Centered Certified Coach, I’ve delivered new thinking about emotional intelligence and appreciative inquiry to healthcare teams and processes and helped break down the barriers to team effectiveness.
Over the course of my career, I have found that both training and coaching approaches are effective in overcoming the common barriers, with a focus on these outcomes:
- Agree on a unifying philosophy centered on primary care of the patient/client and the community.
- Develop a commitment to the common goal of collaboration.
- Learn about other medical professions.
- Respect others’ skills and knowledge.
- Establish positive attitudes about own profession.
- Develop trust among members.
- Be willing to share responsibility for patient/client care.
- Establish a mechanism for negotiation and renegotiation of goals and roles over time.
- Establish a method for resolving conflicts among team members.
- Be willing to work continuously on overcoming barriers.
If our healthcare system is to thrive within the demands and challenges of the 21st century, the multidisciplinary approach must be implemented widely—sooner rather than later.
Looking to learn more about multidisciplinary healthcare teamwork? Please join me for the ATD webcast entitled “Improving Multidisciplinary Healthcare Teams” on Monday, July 23, at 1 p.m. ET.