Teaming with ideas
News of a new toolkit to help consultants in private practice get the most of multidisciplinary team working was featured on the front page of our previous issue. David Hare reveals more about the Independent Healthcare Providers Network (IHPN) initiative and its aim to support them in utilising all the expertise of their clinical teams in the best interests of patients.
As Independent Practitioner Today readers know well – as a clinician, you are only ever as good as your team.
And in the independent health sector, we are lucky to have some of the best healthcare professionals in the world, from surgeons to pathologists, oncologists to radiologists, nurses to physios, radiographers to occupational therapists.
But the difference between delivering good care versus great care is how all these individual parts of the puzzle work together in the best interests of patients. This is where multidisciplinary team (MDT) working comes in.
At their most basic level, MDTs are where healthcare professionals work together alongside patients to make team-based clinical decisions. The value of MDT working is well established in the medical world and for cancer care in particular it is seen as the gold standard.
With each patient, of course, being unique, MDTs offer practitioners the opportunity to:
Explore all potential treatment options;
Hear perspectives from other professionals with their own specialisms and expertise;
Discuss ideas and potential challenges;
Ultimately find the approach giving the best outcome for the patient and their own individual circumstances.
As I talk to many of my clinical colleagues in the sector, MDTs are viewed as one of the most rewarding parts of the job, providing a chance to share experiences and discuss and debate with some of the best healthcare brains.
But the failure to establish appropriate MDT working can have a hugely detrimental impact on patients. This was demonstrated in both the NHS and independent sector in the case of the jailed surgeon Ian Paterson, where the failure to hold effective MDT meetings for his patients meant his criminal actions could not be adequately challenged by his colleagues.
Sharing best practice
As part of IHPN’s ongoing programme of work to identify and share best practice around clinical governance, we have worked with NHS England, the Care Quality Commission – which looks at MDT working as part of its inspection process – royal colleges, insurers, patients’ charities and independent providers to produce a new toolkit.
This aims to help those in the private healthcare sector develop, strengthen and improve its approaches to MDTs.
This is particularly important considering the growing use of technology and the move towards virtual and hybrid MDT meetings.
The toolkit is designed to be used by clinicians in independent providers of all types, sizes and structures, and looks to support the use of MDTs beyond cancer care to a broader range of medical settings.
Patient’s best interests
It provides key principles to support providers in identifying when MDT meetings should be carried out in patients’ best interest. This is important because MDT meetings are not necessary for all patients and depend on the patient’s diagnosis and the nature and complexity of the care.
Rather than provide a list of conditions where MDTs should be considered standard practice, which would rapidly date, our resource provides two principles for independent providers to use to evaluate when patients being treated in their organisations should have an MDT review or could potentially benefit from one.
Firstly, is an MDT required by authoritative guidance – notably from a royal college, NHS England or GIRFT, the Getting It Right First Time benchmarking programme in the NHS? And secondly, is an MDT considered to be good practice?
This is particularly in the case where there is no clear standard treatment pathway or there is a range of different treatment options, including the use of an ‘innovative’ procedure and hence an MDT would be of significant value.
Effective chairperson
Staff at London’s Prostate Centre attend a multidisciplinary team meeting
Our resource also looks at what clinicians and providers should consider when setting up and running MDT meetings.
This includes the team itself and the presence of an effective MDT chair, meeting infrastructure and logistics such as whether meetings are in a physical meeting room, are virtual/hybrid meetings or asynchronous MDTs run entirely online.
Robust team governance processes and ensuring there is patient-centred clinical decision-making are also key, with the need for clinicians to ensure patients are fully aware of any MDT meetings and understand their purpose, its members and their roles.
We highlighted some best practice examples in the toolkit from across the independent sector, as well as the wider health service, to stimulate and support independent providers to strengthen their MDT governance and develop innovative new approaches.
These include exemplars around the leadership and management of MDTs. For example, MDT chairs having a standardised role/job description and access to a training scheme to help improve chairing skills where necessary – and the use of dedicated MDT co-ordinators who work closely with the MDT chairs to ensure processes run smoothly.
There are also fantastic examples of the use of asynchronous MDT platforms that are available to consultants doing complex spinal surgery.
Patients are added to the electronic platform by their consultant prior to surgery, and information on demographics and relevant clinical details are uploaded.
Virtual meeting
The digital platform is available for use 24 hours a day and can be accessed at the MDT panel member’s convenience and independently of other panel members. All members of the MDT review the patient details, proposed surgery and relevant imaging.
If there is any uncertainty over the surgery that requires further discussion, a virtual MDT meeting is scheduled with the panel and the listing consultant.
The platform has been well received by consultants and is recognised as an effective use of time, with further MDTs being developed based on these principles.
A crucial factor in the MDT meeting process is also the quality of patient engagement. We highlight examples where consultants write to patients if they are to be discussed and are notified of the MDT outcome.
Practical solutions
If mobility concerns are raised at the MDT meeting, the physiotherapists call the patient to discuss their home and social support situation for the patient to put practical solutions in place prior to surgery to enhance their recovery.
If required, the spinal nurse calls any complex patients and/or their care-givers to instigate conversations regarding realistic expectations of surgery.
This includes discussions about preparing physically and mentally for surgery and post-op recovery, and to initiate care planning and support for discharge.
Through engagement with the patient, a collaborative approach aims to proactively set the patient up for the best chance of success and a positive outcome from their surgery.
Patients feel more confident in their medical management plan as further expert clinical opinions have been sought and given.
These are just some of the brilliant examples of how MDT working can benefit both clinicians and patients.
We hope all clinicians across the independent healthcare sector find this resource useful and that it supports them in their work to fully utilise all the expertise of their clinical teams in the best interests of patients.
David Hare (right) is the chief executive of the Independent Healthcare Providers Network (IHPN)
