Measuring the quality of MDT working: an observational approach

Cath Taylor, Louise Atkins, Alison Richardson, Ruth Tarrant, Amanda-Jane Ramirez, Cath Taylor, Louise Atkins, Alison Richardson, Ruth Tarrant, Amanda-Jane Ramirez

Abstract

Background: Cancer multidisciplinary teams (MDTs) are established in many countries but little is known about how well they function. A core activity is regular MDT meetings (MDMs) where treatment recommendations are agreed. A mixed methods descriptive study was conducted to develop and test quality criteria for observational assessment of MDM performance calibrated against consensus from over 2000 MDT members about the "characteristics of an effective MDT".

Methods: Eighteen of the 86 'Characteristics of Effective MDTs' were considered relevant and feasible to observe. They collated to 15 aspects of MDT working covering four domains: the team (e.g. attendance, chairing, teamworking); infrastructure for meetings (venue, equipment); meeting organisation and logistics; and patient-centred clinical decision-making (patient-centredness, clarity of recommendations). Criteria for rating each characteristic from 'very poor' to 'very good' were derived from literature review, observing MDMs and expert input. Criteria were applied to 10 bowel cancer MDTs to assess acceptability and measure variation between and within teams. Feasibility and inter-rater reliability was assessed by comparing three observers.

Results: Observational assessment was acceptable to teams and feasible to implement. Total scores from 29 to 50 (out of 58) highlighted wide diversity in quality between teams. Eight teams were rated either 'very good/good' or 'very poor/poor' for at least three domains demonstrating some internal consistency. 'Very good' ratings were most likely for attendance and administrative preparation, and least likely for patient-centredness of decision-making and prioritisation of complex cases. All except two characteristics had intra-class correlations of ≥0.50.

Conclusions: This observational tool (MDT-OARS) may contribute to the assessment of MDT performance. Further testing to confirm validity and reliability is required.

Figures

Figure 1
Figure 1
Quality of teamworking across the four domains of teamworking.
Figure 2
Figure 2
Variation in quality of team performance according to characteristic of effective teamworking.

References

    1. Taylor C, Munro AJ, Glynne-Jones R, Griffiths C, Trevatt P, Richards MA, Ramirez AJ. Multidisciplinary team working in cancer: where are we now? British Medical Journal BMJ. 2010;340:c951. doi: 10.1136/bmj.c951.
    1. Lamb B, Brown K, Nagpal K, Vincent C, Green JSA, Sevdalis N. Team decision making by cancer care multidisciplinary teams: a systematic review. Ann Surg Oncol. 2011;18(8):2116–2125. doi: 10.1245/s10434-011-1675-6.
    1. Department of Health. The Manual for Cancer Services. Department of Health, London; 2004.
    1. National Cancer Action Team. National Cancer Peer Review Programme 2004–2007. National Report: An Overview of the Findings from the Second National Round of Peer Reviews of Cancer Services in England. National Cancer Action Team, London; 2008.
    1. Davies AR, Deans DA, Penman I, Plevris JN, Fletcher J, Wall L, Phillips H, Gilmour H, Patel D, de Beaux A, Paterson-Brown S. The multidisciplinary team meeting improves staging accuracy and treatment selection for gastro-esophageal cancer. Dis Esophagus. 2006;19(6):496–503. doi: 10.1111/j.1442-2050.2006.00629.x.
    1. Coory M, Gkolia P, Yang I, Bowman R, Fong K. Systematic review of multidisciplinary teams in the management of lung cancer. Lung Cancer. 2008;60:14–21. doi: 10.1016/j.lungcan.2008.01.008.
    1. Burton S, Brown G, Daniels IR, Norman AR, Mason B, Cunningham D. MRI directed multidisciplinary team preoperative treatment strategy: the way to eliminate positive circumferential margins? Br J Cancer. 2006;94(3):351–357. doi: 10.1038/sj.bjc.6602947.
    1. Leo F, Venissac N, Poudenx M, Otto J. Mourox Jand the Groupe d'Oncologie Thoracique Azureen (GOThA): Multidisciplinary management of lung cancer: how to test its efficacy? J Thorac Oncol. 2007;2(1):69–72. doi: 10.1097/JTO.0b013e31802bff56.
    1. Stalfors J, Lundberg C, Westin T. Quality assessment of a multidisciplinary tumour meeting for patients with head and neck cancer. Acta Otolaryngol (Stockh) 2007;127(1):82–87. doi: 10.1080/00016480600740589.
    1. Blazeby JM, Wilson L, Metcalfe C, Nicklin J, English R, Donovan JL. Analysis of clinical decision-making in multidisciplinary cancer teams. Ann Oncol. 2006;17(3):457–460. doi: 10.1093/annonc/mdj102.
    1. Lamb BW, Sevdalis N, Arora S, Pinto A, Vincent C, Green JS. Teamwork and team decision-making at multidisciplinary cancer conferences: barriers, facilitators, and opportunities for improvement. World J Surg. 2011;35(9):1970–1976. doi: 10.1007/s00268-011-1152-1.
    1. Lanceley AS, Savage J, Menon U, Jacobs I. Influences on multidisciplinary team decision-making. Int J Gynecol Cancer. 2008;18(2):215–222. doi: 10.1111/j.1525-1438.2007.00991.x.
    1. Kidger J, Murdoch J, Donovan JL, Blazeby JM. Clinical decision-making in a multidisciplinary gynaecological cancer team: a qualitative study. BJOG. 2009;116(4):511–517. doi: 10.1111/j.1471-0528.2008.02066.x.
    1. Carthey. The role of structured observational research in healthcare. Qual Saf Health Care. 2003;12(Suppl II):ii13–ii16.
    1. Bower P, Campbell S, Bojke C, Sibbald B. Team structure, team climate and the quality of care in primary care: an observational study. Qual Saf Health Care. 2003;12:273–279. doi: 10.1136/qhc.12.4.273.
    1. Undre S, Sevdalis N, Vincent C. In: Safer surgery: analysing behaviour in the operating theatre. Ashgate. Flin R, Mitchell L, editor. 2009. Observing and assessing surgical teams: The Observational Teamwork Assessment for Surgery©(OTAS)©.
    1. Healey A, Undre S, Vincent C. Developing observational measures of performance in surgical teams. Qual Saf Health Care. 2004;13(Suppl 1):i33–i40.
    1. Taylor C, Ramirez AJ. Multidisciplinary team members' views about MDT working: results from a survey commissioned by the National Cancer Action Team. National Cancer Action Team, ; 2009. Available at: .
    1. The National Cancer Action Team. The Characteristics of an effective multidisciplinary team (MDT) February 2010. Available at: .
    1. Taylor C, Sippitt J, Collins G, McManus C, Richardson A, Dawson J, Richards M, Ramirez A. A pre-post test evaluation of the impact of the PELICAN MDT-TME Development Programme on the working lives of colorectal cancer team members. BMC Health Serv Res. 2010;10:187. doi: 10.1186/1472-6963-10-187.
    1. National Cancer Action Team. Holistic Needs Assessment for people with cancer: a practical guide for healthcare professionals. 2011. Available at: .
    1. National Institute for Clinical Excellence. Guidance on cancer services: improving supportive and palliative care for adults with cancer. NICE, London; 2004.
    1. Lamb BW, Wong HWL, Vincent C, Green JSA, Sevdalis N. Teamwork and team performance in multidisciplinary cancer teams: development and evaluation of an observational tool. BMJ Qual Saf. 2011;20(10):849–856. doi: 10.1136/bmjqs.2010.048660.

Source: PubMed

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