The Multidisciplinary Team -A Special Group of Health Care Providers

1. The Multidisciplinary Team -A Special Group of Health Care Providers Geraldine O’Meara Sir Michael Sobell House, Oxford, UK

2. “If you want to travel quickly, go alone. But if you want to travel far, you must go together.”

3. Concept of MDT central to palliative care • Patients are referred to the service as a whole, not one individual • Holistic approach needs expertise from different areas

7. MDT structure exists in hospitals and community teams also • UK palliative care guidelines state that doctors, nurses, social workers, physiotherapists, chaplains etc are all essential parts of the team

8. Geographical proximity is important for exchange of information • Mutual respect & support are vital – how is this maintained?

9. Benefits of Teamwork • Palliative care teams are often fairly stable • This helps members develop trust and concern for each other • Mutual support – emotionally draining work • Help with sharing workload • Mentorship/learning role model • Financially most effective means of delivering care?

10. Common Problems • Can become ‘cosy’ – difficult to challenge accepted practice • Hospices separate from other health care providers are vulnerable to this • Internal conflict can lead to ‘scapegoating’ • Focus must remain patient care, not team happiness & comfort

11. Common Problems • ‘Martyrdom’ – staff member uses team/work for their own self fulfillment • Overwork due to emotional demands of the work; time is precious, pts don’t get a 2nd chance for best quality care • Conflict with other teams, eg oncology – what is best for the pt?

12. The Patient’s View • Pts likely to see themselves drawing on a pool of professionals using whoever can help best – GP, hospital team, hospice - interchangeably • Their priority is that different teams to be able to communicate with each other & work together – don’t care who does what • Palliative care specialists must continually examine their practice – change as needed

13. Responsibility • Each practitioner is responsible for their own work • More autonomy, more responsibility: nurse prescribing • Single member has to take ultimate responsibility for group decision: ward sister, hospice doctor, GP • Usually reach some consensus – joint agreement with team

14. Conflict • Hospice team vs oncology, surgery • Specialist community nurse vs GP (wants to prescribe too high/low dose of morphine) • Management of unconscious patient; family want IV fluids, feeding • Patient/family issues; relative feels unable to take pt home to die

15. Managing Conflict • Listen carefully to arguments on both sides – may need an arbitrator • Respect for the views of others • People do things for a reason – logic not always obvious, but it will be there • It takes courage to stand up for your views – on both sides

16. Poor Conduct • Rudeness; lack of compassion; dishonesty; stirring up trouble among teammates • Needs to be discussed; best by teammates initially, & if needed by manager • May be due to emotional exhaustion, depression, personal difficulties • May need lighter workload for a time, sick leave. Ultimately may need to leave team

17. Training, Supervision • Formal teaching • ‘On the job’ training – increases confidence & competence • Mentorship, reflection

18. Looking after the Team • Everyone needs regular time off • Create & protect regular time to discuss patient issues & team problems • Make sure people know where/how to get help • Ongoing training is important for morale • Make time to relax together – coffee, shared meal

19. T ogether • E ach • A chieves • M ore