First Core Capability:

Definition

Successful Multidisciplinary Meetings
Narrative

MDTs are able to organise and manage formal meetings, record and communicate discussions, decision making processes and actions.

In situations where operational working relationships are less established or organisational systems and practices are immature, practitioners need to be able to deploy a set of core skills and understanding to enable information, analysis and judgements to be shared. This requires a level of structure and formality suited to the purpose of the MDT that enables participants to actively contribute everything they think is valid or valuable. This exchange must be accurately recorded and communicated to ensure that decisions and actions are effectively carried out to agreed timescales and minimises any misinterpretation and avoids subsequent inappropriate or unilateral decisions and actions.

Rationale
IET (2010) Interprofessional Capability Framework, Skills for Health GEN 39 ‘Contribute to effective multidisciplinary team working’, CMC5 Build a partnership between team, patients and carers.

This first core capability demonstrates knowledge skills and attitudes which are considered to be common between all professional roles (Barr, 1998). Poor team working is often found as a result of a breakdown in communication across individual professionals and across and within their agencies (Anderson et al, 2006). Therefore the focus in this first core capability is on enabling the MDT worker to cultivate and promote conditions within which information, professional judgement or individual views are freely and clearly exchanged between participants of the MDT resulting in effective decision making.

Competency
The practitioner is able to demonstrate knowledge and skills in communication, collaboration and decision making in order to achieve identified individual outcomes. This is progressed in partnership with the person and family as the focus of the MDT:

Cultivate and promote conditions within which information, professional judgement or views are freely exchanged between participants of the MDT resulting in effective decision making
Apply knowledge and skills in communication both verbal and written with appropriate questioning, listening skills and ability to summarise, how to document MDT meetings.
Demonstrate knowledge of the person including their level of participation, roles and responsibility of professionals and agencies required to attend the MDT in order to achieve the expected individual outcome.
Applies knowledge and skills in decision making (eg Carrol and Johnson (1990) seven temporal stages of decision making).

At this level the MDT should:

Demonstrate a clear identity with organisational recognition
Generate agreed ground rules, including setting objectives, response times and language for operating the multidisciplinary team
Demonstrate early engagement with the person and family, identifying approaches taken to ensure CHC processes and structures of meetings are clear and accessible to them e.g. consider capacity, vulnerability, advocacy, interpretation.
Demonstrate an effective range of verbal and written flexible communication skills, and understanding of the appropriate communication modes and structures to be used when communicating with different people and organisations.
Identify and address the information sharing needs of the person, family, practitioner and their agencies.
Demonstrate knowledge and practice of effective team working
Identify the roles, responsibility and availability of individual members required to participate within the MDT
Generate records of all communication within and around the MDT e.g. e-mails or letters of invitation to the meeting, minutes of meetings held, and actions agreed, evidence of person and family participation within the process, agreed decisions. Ensuring that timely distribution is made to allow for individual preparation.
Identify the key roles of MDT chair, the care coordinator, the note taker for each MDT
Demonstrate effective and timely consensus decision making
Identify a quorum i.e. a fixed minimum number of members (which are proportionate to the needs of the person) who must be present in order to conduct the MDT meeting.
Actively foster positive attitudes towards colleagues from other professions and agencies.
Audit the knowledge, skills and outcomes of the MDT in order to promote learning and sustainability.

Subject Areas
Examples of topics covered in training and practice development:

Introduction to purpose and benefits of multidisciplinary working:
An introduction to person centred planning
Communication skills and styles
Organisational culture and structure
General meeting skills and experience
Consensus decision making
Recording and auditing skills
Customer care, engagement and consent

An understanding of the policy and regulatory frameworks relevant to the person concerned:
CHC Circular 015/2010
Mental Capacity Act 2005
Human Rights and Advocacy
Equality and Diversity
Information Sharing
Commissioning and Contracting Long Term Care
Sustainable Care Planning
Protection of Vulnerable People

Understanding the roles and responsibilities of different professions and the enabling roles within the MDT and processes for determining appropriate membership?

Development of effective ground rules for MDT meetings and establish individual roles at each meeting ie Lead, Coordinator and Administrator.

Adapting to working in different locations and in a different context to change the form and function of meetings and preparation necessary to work effectively.

General tools and techniques for care planning:
Triggers for multidisciplinary assessment
Assessment tools and techniques
Writing and reviewing care plans

Effective communication within a multidisciplinary team:
Involvement and participation with people and families
Use of communication aids, range of media and the use of interpreters
How early engagement with the person and carers can lead to more reliable care plans and better outcomes.
Practical techniques to ensure people are engaged and involved, as equal partners in the care planning process.

Tools and techniques for identifying triggers for complex care:
Scope of normal living arrangements
Scale and consequence of existing needs
Agreement of longer term personalised goals
Levels of intervention, care and support to address needs
Planned next step to achieve goals

Standards
Practice standard to be reached and assessed:

The practitioner can form, develop and sustain the structures and processes of successful multidisciplinary meetings
Assessed through undertaking team audit of MDT working (including structures and processes) to evaluate team performance in order to identify good practice and implement necessary changes

Second Core Capability:

Definition

Coordinated Assessment & Planning
Narrative

The MDT is able to initiate and coordinate multidisciplinary assessment and care planning activities with allied organisations.

The second core capability demonstrates knowledge, skills and attitudes required for those practitioners who are endeavouring to effectively coordinate person centred assessments and planning for people who are considered to have needs which are mild to moderate complexity. This is often whilst undertaking day to day care for other people in their care. Therefore in order to successfully achieve Capability Two, Capability One is also relevant and serves as a foundation as multidisciplinary team meetings will also take place.

Rationale
Managing conflicting opinion is key to delivering timely person focussed decisions. As the complexity of the task increases proactive management of each journey through care is required to ensure that the coordination of the agreed tasks continue and practitioners do not revert back to one to one conversations only, without engaging with the MDT. This proactively avoids multidisciplinary ‘disequilibrium’, practitioner conflict and resulting gaps in multidisciplinary performance (Alter & Hage, 1995).

Another source of conflict can arise from the fact that professionals working within MDTs have a dual role, that of a team member and also as a member of their own professional discipline. Where the interests demanded by each role diverge, this conflict may maintain the demarcation of professional boundaries and ultimately hinder effective communication within the team (Webster, 2002). Poor decision-making in MDTs emanates less from personality clashes between its members but more often is a consequence of a person’s professional responsibilities preventing them from agreeing or reaching collective decisions (Ovretveit 1995).

Competency
The practitioner is able to demonstrate knowledge, skills and attitudes in the three key components of coordination of assessment and planning, which are comprehensiveness, accessibility and compatibility. This is achieved in partnership with the person and family as the focus of the MDT:

Effectively coordinate assessments and plans to ensure that the person received appropriate assessment and services in a timely manner.
Have a clear understanding of the contributions that different professionals can make to the individual’s assessment, plan and review of service delivery.
Establish clear person focussed goals with the individual and MDT members
Know their context of practice including the law, guidelines, protocols, pathways, organisational and professional constraints which may prevent the realisation of consensus decision making.

At this level the MDT should:

Demonstrate knowledge and understanding of the CHC Circular 015/2010 and guidance
Demonstrate an ability to easily communicate knowledge and understanding of the CHC Circular 015/2010 to the person and family at the focus of the CHC meeting
Summarise detailed knowledge of the person, their family including disease trajectories and needs.
Discriminate between all assessments required, planning and reviews necessary to produce clear person focussed outcomes and individual MDT worker actions (Comprehensiveness)
Demonstrate knowledge of all potential services (including eligibility criteria and triggers for referral) available to the service user and family (accessibility)
Demonstrate knowledge and understanding of the timely linking and sequencing of assessments and service planning that should occur ensuring a fit between assessment, need and service delivery (Compatibility)
Identify all assessor and service information needs during the development of the assessment process and care planning in order to avoid conflict
Demonstrate a working knowledge of the Unified Assessment Process.
Generate and demonstrate a willingness to work together
Execute appropriate actions which are required in accordance with the unique context of practice (defined by the individual needs) and may include the law, protocols, pathways, constraints which may prevent the realisation of consensus decision making.

Subject Areas
Examples of topics covered in training and practice development:

Detailed knowledge of Unified Assessment and Care Management Process (UAP) and Care Programme Approach (CPA) and CHC Circular 015/2010 Practice Guidance

Passing the Baton: A Practical Guide to Discharge Planning:
Understanding personal knowledge and skill
Professional communication and negotiation skills
Engagement with the person and their family
Person centred care assessment and planning
Sustainable care planning options and recommendations
Legal and regulatory framework specific to the field of practice
Development of operational tools and techniques

Specialist tools and techniques for comprehensive assessment of need
Introduction to team working
Working in networks and coordinating care

Local operational system knowledge:
Management of Resources
Service Portfolio and Availability
Eligibility Criteria
Referral Management
Interagency Processes and Agreements

Interprofessional working:
Professional roles and responsibilities
Professional practice and supervision
General knowledge of governance
Contingency and collaborative theory

Working with unpredictability and problem solving:
Complex judgement and decision making
Dealing constructively with conflict, disputes and general differences of opinion.

Meeting the needs of carers:
Carer involvement information and advice
Carers’ Assessment

Tools and techniques for managing outcomes for complex care:
Scope of normal living arrangements
Scale and consequence of existing needs
Agreement of longer term personalised goals
Levels of intervention, care and support to address needs
Planned next step to achieve goals

Standards
Practice standard to be reached and assessed:

The practitioner can effectively initiate and coordinate multidisciplinary assessment and care planning to ensure that the person centred outcomes are achieved in a timely manner
Assessed by undertaking audit of individual and team performance in order to identify good practice and implement necessary changes

Third Core Capability:

Definition

Integrated Systems & Practices
Narrative

The MDT is able to lead and develop multidisciplinary systems of practice that are integrated across traditional organisational boundaries.

The third capability recognises the importance of professional and organisational ‘reciprocal interdependence’ (Alter & Hage, 1995). MDTs should understand the policy context for working across professional and organisational boundaries and the responsibility to develop the right working relationships that produce the best outcomes for people with complex needs. This third capability should not be considered in isolation from capability one and two. They both underpin the evidence in capability three for the multidisciplinary worker who works with those people and their families who have the greatest complexity of need.

Interdisciplinary practices are the normal work, practitioners share records and assessments and engage with the person throughout. Meetings are very strong and quick, described as specific, succinct and sincere but less formal in structure and process. Information is shared in a single comprehensive record rather than in a selection of forms, meeting notes or other standardised independent documentation.

Rationale
The third capability draws on the Organisational Competence (OC) L3 (IET, 2010) and the literature reviewed. The most effective and enduring systems contain high performing groups of people who have established intelligent, mature and resilient interpersonal relationships.

Professional’s perceptions and beliefs about role identity, knowledge and skills shape the kind of interprofessional working that takes place. They will often emphasise the importance of maintaining and clarifying professional boundaries and roles and the core competencies related to their profession while acknowledging, that there is a need to work outside the established social structures. There is scope for sharing and exchanging knowledge and skills and instances where blurring of boundaries is necessitated (Baxter & Brumfitt, 2008). The blurring of boundaries can facilitate the team to adopt a more holistic approach to meeting needs (Proctor-Childs et al. 1998). The practice of joint planning and establishing goals enables team members to become aware of the different professional values and beliefs within the team and to learn to work together (Proctor-Childs et al. 1998). An absence of team goal setting and evaluation has been found to hinder effective multidisciplinary working (Atwal & Caldwell, 2006).

Competency
The Practitioner is able to demonstrate knowledge and skills in leadership, managing change and integrating multidisciplinary practices into systems of work:

Lead or participate across teams in wider inter-agency work to ensure responsive and integrated, person focussed services
Demonstrate awareness of the services provided within and across organisations and can point to examples of how these are appropriately delivered.
Interact and co-operate with others within and across organisations in providing person focussed services.
Apply knowledge of the services provided within and across organisations to participate in the delivery of, and where appropriate to take a lead, in the services provided.’
Undertakes audit of MDT working to evaluate individual and team performance in order to identify good practice and implement necessary changes.

At this level the MDT should:

Demonstrate effective participation in interdisciplinary assessment
Demonstrate an ability to systematically share tasks which are common across disciplines
Generate and review shared care plans together
Generate common terminology to promote understanding to different people
Execute the practice consensus decision making
Execute an effective balance of impersonal methods (e-mail, face-to face) and group methods (MDT) of communication
Critically analyse research evidence to enhance MDT practice and manage change
Identify, list and demonstrate a wide network of colleagues across agencies with whom the practitioner actively problem solves on behalf of the individual and family in accordance with identified need
Demonstrate leadership (as appropriate) in the delivery of specialist knowledge or services within or across disciplines or agencies in order to provide person centred care and planning
Generate and disseminate knowledge of services provided within and across agencies, to others including the individual and family.
Generate evidence for appropriate measures which identify gaps in evolving individual and service requirements
Ensure that of the core members are identified and recognise themselves as such (eg people dedicated to role and team) and have a common view of their collective identity

Subject Areas
Examples of topics covered in training and practice development:

Advanced methodologies for developing and improving multidisciplinary working and team performance:
Establishing and maintaining team identity
Working to a collective high level purpose
Balancing individual and professional practice and experience
Collective and individual accountability for performance

Leadership and management:
Service integration levels and mechanisms
Service improvement knowledge, skills and techniques
International and speciality specific health and social care policy
Management of access systems and triggers for service
System’s thinking and working in complex human systems
Understanding performance management and outcome measures

Advanced interprofessional practice and development
Models of professional decision making
Interprofessional assessment, planning and review
Developing and implementing common processes and documentation
Creating shared interprofessional language and terminology
Professional delegation and escalation
Coaching and mentoring and practice development
Counselling and interpersonal communication tools and techniques

Research, audit and evaluation of practice:
Production and analysis of information on MDT performance
Quality of interprofessional decision making
Design and management of safe systems of care
Effectiveness of outcomes of individual care plans
User and provider participation and satisfaction
Reflective practice and active case review

Tools and techniques for developing practice for complex care:
Scope of normal living arrangements
Scale and consequence of existing needs
Agreement of longer term personalised goals
Levels of intervention, care and support to address needs
Planned next step to achieve goals

Standards
Practice standard to be reached and assessed:

The practitioner is able to lead, develop and integrate practices in wider inter-agency work to ensure timely and integrated, person focussed services.
Assessed through individual and family satisfaction and performance outcome measures team and wider impact on performance in order to identify good practice and implement necessary changes.

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