Transforming multidisciplinary team Reflection on the Process from

Transforming multidisciplinary team – Reflection on the Process from the Domov Sue Ryder Care Home Matěj Lejsal Karolína Hrdá Domov Sue Ryder, z. ú. Grant: Multidisciplinary Team in Action

Case: Sue Ryder Nursing Home • Residential LTC centre – social service • Capacity: 52 residents, av. age 87, 5; median lenght of stay 1, 3 • 74% cognitive impairment; 46% middle or late stage of dementia • 66% 3 rd, 4 th grade of care allowance – high dependency • Residents with geriatric frailty syndrome, multimorbidity • No permanent doctor service • Strict distinction between health and social sector (different ministries, different legislation, no specific LTC legislation) • „Chance for dignity aging“ – person-centered care delivery

Definition of Team • Team (Mohman in Borril et al. , 2000) – group of individuals – working together to meet a particular goal or goals – own group dynamics – own culture, rules… – Interdependent relationships between members – member‘s role, sometimes even multiple – shared identity – shared decision-making – joint responsibility for the fulfillment of the goals or tasks

Multidisciplinary Team • Foreign literature no clear distinction between multi, inter, trans – disciplinary (professional) • Following the most frequent terminology in social services in the Czech Republic, we use the term Multidisciplinary team collaboration – Multidisciplinary cooperation exists if two or more social and health professions work together in a team (Booth et al. , 2008, p. 8) – Exists within context of broader organizational context (Tyler, Parker, 2011), more teams in one organization (not necessary MDTs)

Different forms of a multidisciplinary team • Context of a care home – different goals, different arrangements of multidisciplinary team Management - MDT Operational - MDT Case MDT

Why we start? • External influence – Nurse shortage – Flexibility in service delivery providing (3 2 wards) • Internal need – Strenghtening the role of social work in the organization – Higher flexibility in care delivery – Capacity for quality of care development

Original MDT architecture Ward Nurse – manager Nurses Carers Care helpers Social worker Physiotherapist Occupational therapist Nutrition therapist

MDT architecture – pros and cons • Simple structure • Communication delays • Clear responsibility • Overloaded manager • Simple decision making • Responsibility transfer „upwards“ • Simple communication channels (6) • Clear Goal Ownership • Long response to clients needs • ? mutual ability to see the perspective of each other proffesions?

NEEDS TASKS WARD NURSE - MANAGER GOAL COMPLETED TASKS GOAL OWNERSHIP I.

MDT architecture II. Nurse Social worker Carer Nutrition therapist Physitoherapist Occupational therapist

MDT architecture II. – pros and cons • Instant communication • Complex structure • Manager = facilitator • Shared responsibility • Responsibility held with team • Time demanding decisionmaking • Partnership - equality • Multiple communication channels (? ) - clashes • Professional value and dignity • GOAL OWNERSHIP

GOAL OWNERSHIP II. NEEDS ACTION GOAL 1 GOAL 2 GOAL 3 GOAL 4 GOAL 5 GOAL 6 RESULT?

GOAL OWNERSHIP II. NEEDS RISK OF COMPETING/CLASHING GOALS AND ACTIONS ACTION GOAL 1 GOAL 2 GOAL 3 GOAL 4 GOAL 5 GOAL 6 RISK OF „EXPERT COMPETITION“ RESULT?

NEW CHALLENGES • Understanding each others professions perspective • On-going verification of the GOAL with the resident – response time • Sharing vision, goals, plans with other team members • Solution in the place of origin • Competence of managers to facilitate • Relevant tools • Communication – dialog, discussion, shared terminology

Sources • Borril et al. Team Working and Effectivness in Health Care. Available at: http: //homepages. inf. ed. ac. uk/jeanc/DOH-glossy-brochure. pdf • Smith et al. Intedisciplinary Management Tool – Workbook. 2012. Available at: https: //www. researchgate. net/publication/234093973_The_Inte rdisciplinary_Management_Tool • TYLER, Denise A. ; PARKER, Victoria A. Staff Teamwork in Long-Term Care Facilities. The Influence of Management Style, Training, and Feedback. Research in gerontological nursing, 2011, 4. 2: 135 -146. • WILSON, Valerie; PIRIE, Anne. Multidisciplinary teamworking indicators of good practice. Scottish Council for Research in Education, 2000. • SFECTU, Raluca. Collaborative practices in mental health care: multidisciplinary teamwork or inter-professional collaboration groups? Management in sanatate, 2013, 17. 2: 21 -24.