MDT in healthcare refers to a team composed of members from different disciplines in a medical team. The topic, has gained significant traction within the global health community over the past four decades. The COVID-19 infection has demonstrated that it can affect multiple organ systems. Some of the professionals seen in COVID-19 MDTs include physicians, nursing staff, dieticians, social workers, physiotherapists, psychologists, neurologists, speech and language pathologists, and occupational therapists. However, despite forming the basis of numerous problem-solving and decision-making techniques in healthcare, dysfunctional team dynamics are attributed to more than 70% of medical errors. These medical errors occur despite the numerous problem-solving and decision-making techniques in healthcare. Moreover, the MDTs’ effectiveness and performance depend on several factors, including leadership, team dynamics, communication and decision-making features, and organizational constraints.
- This investigation aims to review, analyze, and critically synthesize extant research on the needs of MDTs in healthcare. The analysis will also be used to recognize gaps in the literature and formulate areas for future research.
- Therefore, the following research questions will provide the direction of this systemic review: What management needs and issues arise during the formation and implementation of MDTs in health care?
- In analyzing the health MDT literature, we also expect to expand our knowledge on the transitioning to the multidisciplinary approach, focusing in particular on the two following aspects:
- What MDT needs arise in a hospital transitioning from conventional model care to a multidisciplinary care approach?
- What is the impact of the interventions for tackling challenges associated with the effective implementation of MDTs in hospitals transitioning from conventional models of care to a multidisciplinary care approach?
- We identified and coded 369 relevant, English, and peer-reviewed articles from 141 journals. The items reviewed consisted of literature of diverse and fragmented extant research on multidisciplinary teams’ (MDTs) needs in health care organizations. Although several systematic reviews have been conducted in the field of MDTs, these have limitations. Most of them focus on specific aspects of this topic, and excludes a systematic and integrated approach to research.
For a comprehensive database of MDT in healthcare, we defined the inclusion criteria of scholarly articles. The preferred time frame for published peer-reviewed articles was between 1978 and December 2020. Only peer-reviewed articles published in journals were considered to ensure the quality and scholarly standards. Moreover, MDT in healthcare was defined as professional teams composed of two or more different healthcare disciplines. Works featured in conference papers, books, and book chapters were part of the excluded data sources. Interdisciplinary and inter-professional teams were considered too common forms of MDT to ensure consistency with previous literature. The narrative synthesis process was used to analyze data. The process reviewing each study in the final sample to establish the context of MDTs, the study’s geographical location, the research setting, and methodology. We use Content analysis methods. The inductive and deductive approaches were used to examine for completeness in antecedents, mediators, moderators, and outcomes. Upon determining the review conceptual boundaries, we developed several a lists of keywords consistent with prior literature. We conducted title, abstract, and keywords searches through three electronic databases (Web of Science, Proquest, and Ebsco) using a combined Boolean search string. To meet the objectives of this study, the fit-for-purpose criteria studies, we removed duplicate queries, used the filter Research Domains Subject Areas, and prioritized articles (1) where MDT discussions were overtly linked to health care (2) whose context concerns the implementation of MDTs in the healthcare field. Ultimately, the abstracts of the studies were examined. The process produced 369 studies. The sample was considered adequate for a systematic review with some previous studies using a similar number of articles. The review sample predominant authors focused their research in MDTs on leadership, team diversity, organizational structure, training, team structure, knowledge transfer, and team effectiveness. The leadership component is considered necessary for tackling challenges arising from the complexity of health-related MDTs like ineffective communication, prohibitive professional identities, traditional hierarchy team systems, and providing direction to new teams. Team dynamics and team diversity were a recurring topic from the most prominent authors observed in this review. Team diversity stemming from interprofessional members in MDTs is shown to influence team dynamics, which have both positive and negative effects on the teams’ effectiveness. Among the positive effects, the authors include focus on innovation (Mitchell et al., 2012) and quality care coordination (Singer et al., 2011). ). Adverse outcomes of team diversity include potential conflicts (Mitchell et al., 2014), tension, high rates of professional identification (Singer et al., 2015), and lack of responsibility and role awareness (Cain et al., 2009). Finally, organization-related factors, such as structure and capabilities, got significant attention from prominent authors. Organizational support through strategies like team-based training, development of team-based structures, creating knowledge management structures, and leadership. The most prevalent topics are the effectiveness of the MDTs and their impact in implementing an interdisciplinary care approach (e.g., Mitchell et al., 2011; Brooks et al., 2020), change management (e.g., Careau et al., 2014; Waring et al., 2019), leadership (e.g., Mitchell et al., 2014; Chreim et al., 2016), and training (e.g., Singer et al., 2011; Mitchell et al., 2017). Additionally, we observed heterogeneity in the most mentioned keywords concerning MDTs and multidisciplinary care approach. In terms of keywords, the most prevalent were teams, management, care, and health. The results demonstrated the existence of several stakeholders in an MDT. These include patients, physicians, nurses, patients’ families, pharmacists, administrative personnel, and social workers. Nevertheless, most of the study findings emphasize three key relationships: patient-physician relations, nurse-physician relation, and family-physician and nurse relation (Singer et al., 2011; Chreim & Macnaughton, 2016; Hughes et al., 2016; Mitchell, Israel, Diehl, & Galindo-Gonzalez, 2020). Topics that received little research interest regarding MDTs and multidisciplinary care include behavior (e.g., Davison, 2005; Singer, Hayes, Gray & Kiang, 2015), coordination (e.g., Song et al., 2017; Waring et al., 2019), existing barriers to implementation effectiveness (e.g., Mitchell & Boyle, 2015; Heale et al., 2020), awareness (e.g., Sandahl et al., 2013; Mitchell et al., 2020), attitude (e.g., Bakar et al., 2008; Ahmadieh et al., 2020), and climate in MDTs (e.g., Singer et al., 2009; Araujo & Figueiredo, 2019). The least addressed subjects on MDTs and multidisciplinary care in healthcare were budget, boundaries, competence, burnout, and benchmarking. Team effectiveness and training were critical issues in health-related MDTs. We identified various themes related to the study of MDTs in healthcare when organizations are transitioning from traditional to interdisciplinary care approach. Among them are conflict theme (Mitchell et al., 2014), communication theme (Waring, 2019), collaboration (Bedwell, 2012; Palumbo et al., 2016), training, leadership, planning (Gertner et al., 2010), knowledge, team members’ personalities, organizational culture, competence, diversity, gender issues, and errors. Studies focusing on the conflict theme examined how the interprofessional composition is related to the affective conflict. The analysis demonstrated that interprofessional composition affects team dynamics, increasing the likelihood of conflict. Besides, affective conflict mediates a decrease in open-mindedness and elaborative conduct. Research on the communication theme investigated its significance and potential interventions. The findings revealed that clear and effective communication was necessary for achieving a conducive working environment and promoting trust-based relationships among team members. Concerning interventions, well-designed information systems were considered suitable for facilitating routine and standardized information exchange. Studies concentrating on collaboration examined the driving and impeding factors regarding MDTs. Co-creating partnerships between health care practitioners and patients can mobilize the dormant resources of healthcare professionals. Collaboration in healthcare-based MDTs is enabled by effective communication and a shared understanding of patients’ and colleagues’ goals. Individual personalities, ineffective communication, failure to understand roles and responsibilities, and lack of comprehending organizational structure inhibit collaboration in health-based MDTs. Despite the growing adoption of health information systems in health care and their broad applications, the topic has gained little attention in relation to MDTs. Acknowledging the rising trend in technology, we propose that future studies investigate how health information systems can be used to improve the management of MDTs and their performance in providing quality care, particularly through virtual meetings. Moreover, the COVID-19 pandemic has promoted health information systems as a critical resource that can be used in team management.
References
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