After reading this article, you should be able to:
- Understand what a multidisciplinary team (MDT) is and its importance to healthcare;
- Describe some of the principles and skills needed to be an effective member of the MDT;
- Understand the main barriers of effective MDT working and ways they can be overcome;
- Work more effectively as a pharmacist within the MDT.
A multidisciplinary team (MDT) is a team of individual healthcare workers from different disciplines or professions who work towards a common goal. The MDT has been a well established concept in the healthcare field for a long time. However, in recent years, there has been an even greater focus on it to improve patient outcomes. In 2019, the ‘NHS Long Term Plan’ highlighted the importance of breaking down traditional barriers to meet the ever-increasing demand for healthcare services. Additionally, the recently published ‘NHS long-term workforce plan’ describes how “building broader teams with flexible skills” is a priority area for reforming the NHS workforce.
As of 30 September 2023, there were more than 64,000 pharmacists on the register, the vast majority of whom will be working within an MDT. Medicines are a vital part of healthcare within the NHS, with the estimated spend on medicines in the NHS for 2021/2022 at £17.2bn. It has also been shown that pharmacists improve patient safety and experiences with regards to medicines through utilisation of their expert medicines knowledge and offer significant value to the MDT[6–10].
Types of multidisciplinary teams
Pharmacists can work in a variety of MDTs across different healthcare sectors. In secondary care, for example, pharmacists are part of clinical MDTs at ward level. This could involve working within an MDT on ward or board rounds, or working generally as part of the ward team, troubleshooting pharmaceutical care issues and working together to achieve optimal outcomes. Pharmacists can also contribute to specialist MDTs. This is where a pharmacist working in a particular specialty usually sits on a panel as the pharmacy specialist within that setting. Pharmacists working up to consultant level make significant contributions to these MDTs, using their specialist knowledge of both pharmacy and the specific clinical specialty.
In addition to clinical MDTs, pharmacists can also contribute to others, such as electronic prescribing/digital services, governance, operational and patient safety MDTs. These often take the form of groups or committees, such as medicines management committees or medicines safety groups. Other pharmacy roles in MDTs include medicines finance or formulary pharmacists.
Pharmacists also play a major role in primary care MDTs. Pharmacists are now well established in the GP and primary care network workforce, as well as in community pharmacies. Pharmacists bring a range of skills to these sectors to improve medicines optimisation for both acute and chronic conditions.
Principles of multidisciplinary team working
The principles of working within an MDT can be mapped to the General Pharmaceutical Council’s standards for pharmacy professionals.
Teamwork is an essential skill when working within an MDT. It is important all members understand not only their own roles and responsibilities, but those of their colleagues. The best teams understand each other’s strengths and weaknesses.
A pharmacist’s role is primarily focused on medication, but as the role evolves into more areas of clinical practice, traditional professional boundaries are becoming blurred. Pharmacists are now providing an increasing range of services, including examination, diagnosis and prescribing. This represents an exciting opportunity for the profession, but pharmacists must be careful to use their team members’ expertise appropriately and not work outside their scope of practice. One of the main benefits of the MDT is being able to work as a team to achieve optimal outcomes. Pharmacists should focus on what value they can bring to the team and how this helps meet the team’s objectives.
There are many proven benefits of improved communication between healthcare professionals and their patients[1,12]. The World Health Organization (WHO) describes ineffective communication as a leading cause of patient harm. Ineffective communication can lead to various undesirable outcomes, such as duplication of work, delays in investigations, treatment or discharge, patient harm, hospital re-admission and more[14–18]. Pharmacists working in MDTs need to be able to communicate complex medication-related issues to colleagues from different backgrounds, tailoring the style and level to the recipients appropriately.
Communication is essential to ensure that roles and responsibilities are well understood and to remove ambiguity. The most appropriate method of communication should also be considered; most often, this will be verbal communication, but written communication (or a combination of both) can be suitable, depending on the situation or setting. For example, a pharmacist might verbally communicate a pharmaceutical care plan to the medical team in secondary care but then back this up with documentation in the medical notes. Positive body language and attitude are also essential. Communication skills may come more naturally to some, while others may have to work on them. The more pharmacists engage with the MDT, the more their communications skills will develop.
Pharmacists may or may not have formal leadership responsibilities within their MDT but, irrespective, they will be the leader for pharmacy-related issues. Strong MDTs embrace the principles of collective leadership, where all members of the MDT take responsibility for the success of the team. Good leadership requires skills such as communication and teamwork, but also confidence and assertiveness. It can sometimes be a fine line separating confidence and assertiveness with behaviour that could be perceived as rudeness.
Part of effective leadership is listening to and respecting colleagues’ opinions and understanding their viewpoints and reasoning for them. Sometimes a situation is clear cut, and a firm response will be appropriate, with further escalation if patient safety is a concern (backed up with clear documentation). However, there is often no obvious right or wrong answer in healthcare. It is the pharmacist’s job to advise colleagues from a position of expertise and work together with other team members to formulate the most appropriate way forward.
As a professional, honesty is paramount at all times. Honesty is fundamental to the effectiveness of the MDT. If the pharmacist does not know the answer to a problem or is unsure, then this must be communicated to the MDT. Of course, it is appropriate to offer to find out the answer and often it may be necessary to seek help from a suitable colleague. This is nothing to be ashamed of and should be actively encouraged. In healthcare, there is no room for false bravado, arrogance or dishonesty, as patient safety is at stake.
An MDT is made up of highly trained professionals who should be respected as such. It is paramount to show respect to other members of the MDT and attempt to understand everyone’s viewpoint, even if it differs from your own. Every role within the MDT is crucial. Encourage a culture of respect so that all members feel valued and comfortable to share opinions and raise concerns, if needed. Where opinions differ or challenging conversations arise, MDT members should be able to articulate their views in a respectful, non-judgemental and rational way, working together to come to the most appropriate resolution — sometimes seeking outside opinion may be necessary in cases of uncertainty or conflict.
Overcoming challenges of multidisciplinary team working
Anyone working within an MDT will face challenging situations. Below are some of the most common challenges and advice and tips on how to overcome them.
Time and workload pressures are frequently cited as reasons why an MDT is not working effectively. The NHS is currently experiencing some of the most severe pressures in its 75-year history. These pressures can be felt across the whole system, from community pharmacy to primary and secondary care. Although it is beyond the scope of this article to fully discuss these issues, there are some ways in which they can be minimised.
Sometimes rethinking how to approach the workload can help. For example, in secondary care, if pharmacists attend the ward round, it can ensure that all problems are identified at the point of prescribing with staff involved in decision making present. A proactive, rather than reactive, approach is usually the most efficient use of time and resources, and better for patient safety and experience too. The goal should always be to get it right first time.
Rethinking the skill mix can also help. Are the skills of pharmacy technicians or assistants being used to their full potential? Time is always a factor, but when it is particularly short, we should ensure we always make the best use of it. Consider questions such as: what are the essential conversations to have with the MDT to ensure patient care is optimised? Which tasks can be delegated and which tasks can be delayed? For example, if time is short and it is not possible to attend the full ward round, consider which patient cases are most complex and would benefit most from a robust MDT review.
A major challenge to the MDT working well are staff shortages. Prioritisation is essential throughout periods of poor staffing. Staffing often fluctuates, with good and bad periods. Effective communication with other members of the MDT is vital to ensure that they understand the reasons for any reduced presence or input.
When setting up new MDTs, or considering adding a pharmacist to existing MDTs, staffing can sometimes feel like a paradox: to demonstrate the value and need for well-trained staff within an MDT, you need to have well-trained staff working within the MDT. However, at first there may not be the resources available to demonstrate this. One option is to negotiate a trial period. Often, teams will see the benefits that having a pharmacist on board brings, and a permanent position may be more likely to be approved at the end of the trial.
Resistance to change
Often, in healthcare, there can be resistance to change, which can be a barrier to effective MDT working. It can be particularly difficult to break down these barriers if the culture is long standing. Pharmacists may hear statements such as “we’ve never needed a pharmacist before” or “we have always done it this way”.
When faced with these views, it is important to demonstrate the pharmacist’s value to the team. Focus on what can be done to make the MDT’s job easier, while also improving the care of patients. Always remember the key principles of effective MDT working — teamwork, communication, leadership and respect. Showing respect can be particularly important; do not try to change everything all at once.
Working within and expanding the scope of practice
Working beyond your comfort zone and challenging your scope of practice can present in a number of ways. Perhaps a senior pharmacist has worked in a particular way for a long time and is resistant to changing their practice or taking on new roles within the MDT. For this reason, they may feel outside of their comfort zone and be unwilling (or unable) to expand their scope of practice. Another example could be the opposite end of the spectrum — a junior pharmacist, who has only been practising a few months, feeling uncomfortable with being asked to do something new with more involvement with the MDT. There is no one-size-fits-all solution to these issues.
As professionals, we are responsible for knowing our own scope of practice and individual strengths and weaknesses. It is expected that pharmacists will be constantly learning, challenging our boundaries and safely expanding our scope of practice. The profession is changing and pharmacists are taking on new and exciting roles and responsibilities. However, there is a fine balance to be struck. It would be inappropriate for a newly qualified pharmacist to sit on a specialist MDT. However, we should be embracing new ways of working and looking to become established within MDTs at every opportunity.
As explained earlier in this article, honesty is crucial and pharmacists should always be open with the MDT if they are being asked to do things outside their scope of practice. Pharmacists should take things one step at a time, slowly growing their sphere of competence and learning from others in the MDT. Embedding reflective practice may also provide pharmacists with a way to identify their strengths and weaknesses, which may help their professional development.
The MDT is an essential component of safe, efficient and effective healthcare in all sectors. The benefits of MDT working to patients and professionals are well established and plentiful. There are several principles to focus on when considering how to effectively work within the MDT: teamwork, communication, honesty, leadership and respect. There are also several barriers to effective MDT working, but pragmatic solutions to help overcome these are possible. Pharmacy professionals should embrace working as part of the MDT in order to provide the best possible patient care, develop their own practice and further the pharmacy profession.
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