Table 1 MDT-OARS quality criteria and shortened manual for rating each of 15 observable characteristics of effective teamworking in MDT meetings

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

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

Teamworking & culture

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