From: Measuring the quality of MDT working: an observational approach
Characteristic of effective MDT working | Quality Criteria | Quality of team working (score in brackets) | ||||
---|---|---|---|---|---|---|
Very Poor | Poor | Good | Very Good | |||
The Team | ||||||
Attendance | Presence of relevant core team members at the meeting | at least one core team member (and their deputy) is not present for the whole meeting | at least one core team member (and deputy) is absent for most of the meeting (≥3 cases) | at least one core team member (and deputy) is absent for part of the meeting (≤ 2 cases) | all core team members (or deputy) present for whole meeting | |
(1) | (2) | (3) | (4) | |||
Leadership: chairing of meeting | · Keeps meeting to agenda (i.e. moves onto next case) | Satisfies none of criteria | Only satisfies 1–2 of criteria | Satisfies 3 of criteria | Evidence of all of the criteria | |
· Encourages overall participation | ||||||
· Encourages focussed discussion | ||||||
· Articulates recommendation | (1) | (2) | (3) | (4) | ||
Teamworking & culture | ||||||
a) Inclusion of relevant team members | · All relevant core members are actively and appropriately involved | Satisfies 1/none of criteria | Satisfies 2–4 of criteria | Satisfies “all relevant core members are actively and appropriately involved” and at least 3 other criteria | Satisfies all of the criteria | |
· Meeting not dominated by 1-2 people | ||||||
· Input/questions volunteered and encouraged | ||||||
· Contributions facilitate decision-making and/or inform discussion | ||||||
· Consensus of decision-making | (1) | (2) | (3) | (4) | ||
b) Team Sociability | · Evidence of humour | Satisfies none of the criteria | Satisfies 1 of criteria | Satisfies 2–3 of criteria | Satisfies all of criteria | |
· Team appear relaxed with each other | ||||||
· Warm and supportive team environment | ||||||
· Friendly and cooperative communicative style | (1) | (2) | (3) | (4) | ||
c) Mutual respect | · Focussed attention | Only satisfies 1 or none of | Satisfies 2–3 of criteria | Evidence of respect, | Strong evidence of | |
· Respect for speaker | criteria | evidence of at least 4 | respect in all/almost all | |||
· No concurrent discussions | criteria | cases | ||||
· Asking and valuing relevant contributions | ||||||
· General sense of politeness/courtesy (inc mobile phone etiquette) | (1) | (2) | (3) | (4) | ||
d) tension and conflict | Not rated on the same scale – see bottom of table | |||||
Personal development & training | Observable communication of research evidence and/or instances of learning | No observable communication of research evidence or instances of learning | Minimal communication of research evidence or instances of learning | Structured presentation of research evidence and/or learning through formal discussion (e.g. of audit findings | ||
(1) | (2) | (3) | ||||
Infrastructure for meetings | ||||||
Meeting venue | · Room size appropriate for number of team members | Satisfies only 1 or none of criteria | Satisfies 2 of the criteria | Satisfies 3 of the criteria | Satisfies all of the criteria | |
· Layout of chairs enables accessible viewing of diagnostics | ||||||
· Layout of room allows accessible viewing of other team members | ||||||
· All members seated on a chair | ||||||
· Suitable venue in terms of location, temperature, lighting etc | (1) | (2) | (3) | (4) | ||
Technology & equipment | Availability of diagnostic equipment to view and share images and pathology with the team. | No radiology imaging facilities | Light box available with hard copy film | Current images available digitally with facilities for projecting/viewing images | Current images available digitally with facilities for projecting/viewing images and capability of accessing retrospective images (e.g. use of PACS) | |
Availability of multiple screens scores extra 1 point. Score out of possible 9 is then standardised onto 1-4 scale to give overall rating. | ||||||
(1) | (2) | (3) | (4) | |||
No histopathology facilities | Microscope | Microscope with facilities for projecting/viewing specimen/biopsy | Microscope with facilities for projecting and viewing specimen/biopsy and accessing retrospective data | |||
(1) | (2) | (3) | (4) | |||
Meeting organisation and logistics | ||||||
Preparation prior to meetings: | ||||||
a) agenda | Availability and content of agenda | No available agenda | Agenda, but limited info | Comprehensive agenda | ||
(1) | (2) | (3) | ||||
b) prioritisation of complex cases | Prioritisation of complex cases on agenda to enable sufficient time for their discussion | No attempt is made to order cases in terms of complexity and an inappropriate amount of time is spent on cases (i.e. too much or too little) | Some attempt is made to order cases in terms of complexity but an inappropriate amount of time is spent discussing some of the cases | Patient cases are discussed in a clear order but time is used inappropriately in some cases | Patient cases are discussed in a clear order and an appropriate amount of time is spent discussing each case | |
(1) | (2) | (3) | (4) | |||
Organisation/admin during meetings: | ||||||
a) patient notes | Availability of patient notes | No patient records available at meeting | Some required past/current reports not available | Hardcopy and all necessary past/current reports available | Electronic access to patient notes and all necessary past/current reports available | |
(1) | (2) | (3) | (4) | |||
b) case presentation | Comprehensiveness and coherence of case presentation | Rambling; entirely reading from notes; does not seem familiar with patient | Some evidence of familiarity with patient and info presented in reasonable fashion | Comprehensive succinct coherent presentation (evidence of familiarity with patient and findings) | ||
(1) | (2) | (3) | ||||
Clinical decision making | ||||||
Patient centred care | Includes mention of patient-based information (e.g. demography; co-morbidities; psycho-social or supportive needs; patient wishes/family preferences) | Patient-centred factors sufficiently acknowledged in less than 20% cases | Patient-centred factors sufficiently acknowledged in less than 50% cases | Patient-centred factors sufficiently acknowledged in 50% + cases (but not all cases) | Patient-centred factors sufficiently acknowledged in all cases | |
(1) | (2) | (3) | (4) | |||
Treatment plans | Clarity of treatment plan | Treatment plan not discernable | Treatment plan communicated verbally | Treatment plan communicated verbally and recorded | Treatment plan communicated verbally, recorded with a clearly articulated plan regarding the next steps. | |
(1) | (2) | (3) | (4) | |||
Characteristic of Effective MDT-working | Quality Criteria | Quality of team-working (score in brackets) | ||||
Teamworking & culture | severe and sustained conflict | overt conflict un-sustained | tension sustained | tension un-sustained | no tension | |
(−4) | (−3) | (−2) | (−1) | (0) | ||
d) tension/conflict | Extent of tension and/or conflict observable in the team | ≥1clear example of conflict observed which persists throughout meeting | ≥1clear example of conflict observed does not persist throughout meeting | ≥1 instance of tension observed which persists throughout meeting | ≥1 instance of tension observed but does not persist throughout meeting | No tension |