Pilot evaluation of a novel observational tool for collaboration and communication within multidisciplinary team meetings (MDTs)
Keywords:assessment, evaluation, group functioning, multidisciplinary team meeting, multidisciplinary tumour board, outcome
AbstractBackground: Despite widespread use of multidisciplinary team meetings (MDTs) to facilitate patient care, little evidence exists that MDTs improve patient survival or impact care. Research into MDT function and outcome is limited. This pilot study looks to validate a novel tool developed to assess MDT functioning. Methods: A tool was developed with predefined Likert behaviour stems in the areas of structure, communication and collaboration. The tool was evaluated in nine MDTs by three independent observers and included participant evaluation. Inter-rater reliability was calculated with intraclass-correlation coefficients (ICC); Student’s t-test was used to calculate significance in participant evaluation and matched observations. Results: The tool was used to evaluate 9 MDTs, discussing 133 cases. The overall ICC for the three coders was 0.935; for each MDT: 0.776–0.917. The inter-rater reliability for each MDT observation ranged from 0.245–0.923; the majority with an ICC >0.8. No significant difference was noted between participant evaluation and observer response. Discussion: MDTs provide a means of coordinating complex care for patients. This tool provides a means of evaluating group interaction within MDTs and is designed for use by different medical personnel. The pilot study has shown promising ICC; further evaluation is needed using a broader group of MDTs and including case complexity and outcome.
Donabedian, A. (1988) The quality of care: How can it be assessed? Journal of the American Medical Association 260 (12): 1743–1748. http://dx.doi.org/10.1001/jama.1988.03410120089033
Fennell, M., Prabhu Das, I., Clauser, S., Petrelli, N. and Salner, A. (2010) The organization of multidisciplinary care teams: Modeling internal and external influences on cancer care quality. Journal of National Cancer Institute Monographs 40: 72–80.
Flin, R., Martin, L., Goeters, K.-M., Hormann, H.-J., Amalberti, R., Valot, C. and Nijhuis, H. (2003) Development of the NOTECHS (non-technical skills) system for assessing pilots’ CRM skills. Human Factors and Aerospace Safety 3 (2): 95–
Frank, J. R. (ed.) (2005) The CanMEDS Physician Competency Framework. Ottawa: Royal College of Physicians and Surgeons of Canada.
Glickman, S. W., Baggett, K. A., Krubert, C. G., Peterson, E. D. and Schulman, K. A. (2007) Promoting quality: The health-care organization from a management perspective. International Journal of Quality in Health Care 19 (6): 341–348. http://dx.doi.org/10.1093/intqhc/mzm047
Head, S. J., Kaul, S., Mack, M. J., Serruys, P. W., Taggart, D. P., Holmes, D. R. Jr, Leon, M. B., Marco, J., Bogers, A. J. and Kappetein, A. P. (2013) The rationale for heart team decision-making for patients with stable, complex coronary artery disease. European Heart Journal 34: 2510–2518. http://dx.doi.org/10.1093/eurheartj/eht059
Irish Medical Council. Eight Domains of Good Professional Practice as Devised by Medical Council (2010) Retrieved from http://tinyurl.com/20120518204333
Kagan, A. (2005) The multidisciplinary clinic. International Journal of Radiation Oncology, Biology, Physics 61 (4): 967–968. http://dx.doi.org/10.1016/j.ijrobp.2004.10.040
Lamb, B., Green, J. S. A., Benn, J., Brown, K., Vincent, C. and Sevdalis, N. (2013) Improving decision making in multidisciplinary tumor boards: Prospective longitudinal evaluation of multicomponent intervention for 1,421 patients. Journal of the American College of Surgeons 217 (3): 412–420. http://dx.doi.org/10.1016/j.jamcollsurg.2013.04.035
Lamb, B., Wong, H., Vincent, C., Green, J. and Sevdalis, N. (2011) Teamwork and team performance in multidisciplinary cancer teams: Development and evaluation of an observational assessment tool. British Medical Journal Quality and Saftey 20 (10): 849–856. http://dx.doi.org/10.1136/bmjqs.2010.048660
Lemieux-Charles, L. and McGuire, S. (2006) What do we know about health care team effectiveness? A review of the literature. Medical Care Research and Review 63 (3): 263–300. http://dx.doi.org/10.1177/1077558706287003
Look-Hong, N., Wright, F., Gagliardi, A. and Paszat, L. (2010) Examining the potential relationship between multidisciplinary cancer care and patient survival: An international literature review. Journal of Surgical Oncology 102 (2): 125–134. http://dx.doi.org/10.1002/jso.21589
Martin, J. A., Regehr, G. and Reznick, R. (1997) Objective structured assessment of technical skills (OSATS) for surgical residents. British Journal of Surgery 84 (2): 273–278. http://dx.doi.org/10.1002/bjs.1800840237
McCarney, R., Warner, J., Iliffe, S., van Haselen, R., Friffin, M. and Fisher, P. (2007) The Hawthorne Effect: A randomised, controlled trial. BioMed Central Medical Research Methodology 7 (30). http://dx.doi.org/10.1186/1471-2288-7-30
Mickan, S. M. (2005) Evaluating the effectiveness of health care teams. Australian Health Review 29 (2): 211–217. http://dx.doi.org/10.1071/AH050211
Pucher, P. H., Aggarwal, R., Srisatkunam, T. and Darzi, A. (2014) Validation of the simulated ward environment for assessment of ward-based surgical care. Annals of Surgery 259 (2): 215–221. http://dx.doi.org/10.1097/SLA.0b013e318288e1d4
Raine, R., Wallace, I., Nic a’Bhaird, C., Xanthopoulou, P., Lanceley, A., Clarke, A., Prentice, A., Ardron, D., Harris, M., Gibbs, J., Ferlie, E., King, M., Blazeby, J., Michie, S., Livingston, G. and Barber, J. (2014) Improving the effectiveness of multidisciplinary team meetings for patients with chronic diseases: A prospective observational study. Health Services and Delivery Research of the National Institute for Health Research 2 (37). http://dx.doi.org/10.3310/hsdr02370
Sevdalis, N., Davis, R., Koutantji, M., Undre, S., Darzi, A. and Vincent, C. A. (2008) Reliability of a revised NOTECHS scale for use in surgical teams. American Journal of Surgery 196 (2): 184–190. http://dx.doi.org/10.1016/j.amjsurg.2007.08.070
Steinemann, S., Berg, B., DiTullio, A., Skinner, A., Terada, K., Anzelon, K., Ho, H. C. (2012) Assessing teamwork in the trauma bay: Introduction of a modified ‘NOTECHS’ scale for trauma. American Journal of Surgery 203 (1): 69–75. http://dx.doi.org/10.1016/j.amjsurg.2011.08.004
Wagner, E. (2004) Effective teamwork and quality of care. Medical Care 42: 1037–1039. http://dx.doi.org/10.1097/01.mlr.0000145875.60036.ed
Wiener, E., Kanki, B., Helmreich, R. and Anca, J. (2010) Crew Resource Management. Amsterdam: Academic Press and Elsevier.
How to Cite
copyright Equinox Publishing Ltd.