Abstract
Multidisciplinary Group meetings (MDGs) are seen as key facilitators of integration, moving from individual to multi-disciplinary decision-making, and from a focus on individual patients to a focus on patient groups. We have developed a method for coding MDG transcripts to identify whether they are or are not vehicles for delivering the anticipated efficiency improvements across various providers and apply it to a test case in the North West London Integrated Care Pilot. We defined 'integrating' as the process within the MDG meeting that enables or promotes an improved collaboration, improved understanding, and improved awareness of self and others within the local healthcare economy such that efficiency improvements could be identified and action taken. Utterances within the MDGs are coded according to three distinct domains grounded in concepts from communication, group decision-making, and integrated care literatures-the Valence, the Focus, and the Level. Standardized weighted integrative intensity scores are calculated across ten time deciles in the Case Discussion providing a graphical representation of its integrative intensity. Intra- and Inter-rater reliability of the coding scheme was very good as measured by the Prevalence and Bias-adjusted Kappa Score. Standardized Weighted Integrative Intensity graph mirrored closely the verbatim transcript and is a convenient representation of complex communication dynamics. Trend in integrative intensity can be calculated and the characteristics of the MDG can be pragmatically described. This is a novel and potentially useful method for researchers, managers and practitioners to better understand MDG dynamics and to identify whether participants are integrating. The degree to which participants use MDG meetings to develop an integrated way of working is likely to require management, leadership and shared values.
Highlights
Multidisciplinary Group meetings (MDGs) are seen as key facilitators of integration, moving from individual to multidisciplinary decision-making, and from a focus on individual patients to a focus on patient groups
Multidisciplinary team working or inter-professional collaboration has become a key feature of health care across many health domains [2,3,4,5] and has been shown to bring about positive health benefits when compared with traditional nonmultidisciplinary care
We describe a method that we have developed to identify whether MDGs are or are not vehicles for delivering the anticipated efficiency improvements across the various providers
Summary
Multidisciplinary Group meetings (MDGs) are seen as key facilitators of integration, moving from individual to multidisciplinary decision-making, and from a focus on individual patients to a focus on patient groups. Much importance has been attributed to factors such as mutual respect, trust and willingness to collaborate as determinants of good interaction between different professional groups [6]. Professional support, leadership and communication [7] stand out as important elements, as does motivation, culture and professional power [8] but these are all variably defined concepts. It follows that there are empirical challenges in determining what constitutes an effective multidisciplinary group and how to measure that effectiveness, in part because it is a negotiated agreement between professionals of different expertise and contributions to patient care [5]
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