Role of the Chair
Good leadership and facilitation are key factors in the success of multidisciplinary care meetings. The Chair does not have to be the same person in every meeting, as long as the leadership and facilitation roles are fulfilled. The role may be shared between several team members. The Chair should be aware of the need for strong leadership. It is important to recognise that this does not equate to dominance of clinical decision-making. Rather, the Chair’s role is to facilitate participation by all members of the multidisciplinary team in clinical discussions and decision making, and to ensure that meetings are not dominated by a few clinicians.
It is the role of the Chair to:
- keep meetings to the agenda
- commence discussions
- prompt the full range of input into discussions
- summarise the discussion and invite any further input before moving to the next case
- negotiate resolution of conflict if necessary
- promote mutual professional respect among all team members.
Managing group dynamics
Mutual respect and positive group dynamics are important factors in effective MDC meetings. Participant’s input into discussions should be valued and respected by the other participants. To promote positive group dynamics and understanding of team roles and role boundaries it may be beneficial to:
- clarify role perceptions and expectations of each other
- identify your own and other professionals’ competencies
- explore overlapping responsibilities
- re-negotiate role assignments.
Communication skills training
Effective communication between health professionals is vital but may be challenging with an expanded team of professionals. For MDC teams to be effective, all members must communicate effectively with one another.
The way a clinician and the treatment team relate to, and communicates with, a patient can significantly benefit the patient and their family. Benefits may include improvements in psychosocial adjustment, decision-making, treatment compliance and satisfaction with care.
A range of Communication skills training modules have been developed for health professionals about how best to address issues with patients and improve communication within multidisciplinary care teams.
It is important for teams to establish a process for communicating case discussion outcomes and recommendations to the patient and their GP. The treatment and care plan should be formal, in writing, and consider the full range of treatment and care options available to the patient, while taking into account the patient’s preferences.
Where possible, written care plans should be made available to the patient. In addition, patients’ access to a second opinion outside the initial team should be respected and facilitated.
Re-evaluating treatment and care plans should be done at critical points during the course of disease including diagnosis, change in treatment, recurrence, or at the end of active treatment. It is essential that treatment and care plans are assessed regularly because many changes will occur during the course of the patient’s disease. Any changes made to the patient’s treatment plan should be discussed with the patient and documented.
A number of steps have been identified to assist the MDC team in effective decision making when developing the treatment plan:
- clarify roles and involvement by relevant MDC team members in the decision-making process
- ensure sufficient and relevant data are presented about the diagnosis through the use of a synoptic report that provides a summary of the essential diagnostic information
- consider all relevant treatment options
- consider psychosocial status and support needs
- identify responsibilities for actioning and communicating the agreed treatment plan.
Common documentation processes that suit all team members should be established. Teams may consider using a grid where details from the meeting are filled in by all team members. Documentation can also support accreditation activities at the local level. Regular recording of attendance, frequency of meetings and decisions made, provides a record of the multidisciplinary process. Associated clinical audit processes can also assist in the collection of clinical indicator data for the purpose of quality improvement.
Reviewing multidisciplinary care team process
Each MDC team should establish a process to review and audit team functionality. Team functionality refers to how members of the team work together, how the MDC meetings are set-up and sustained and how team members support each other. Reviewing functionality can include how meetings are organised, the purpose of the meeting, team membership, attendance, communication among team members, patients and caregivers, and meeting outcomes. Auditing team functionality is an ongoing process which aims to ensure that the team is working in an effective way and there is optimal team interaction.