Summary

MDT-FIT is a web-based platform that enables individual MDTs, Trusts and networks/systems to complete and oversee a three-stage process, incorporating self-assessment against the characteristics of an effective MDT, independent observation, anonymised feedback and facilitated team discussion. The aim is to improve the quality of service and benefit patient care. It facilitates teamworking and quality improvement at low cost and takes little time. It is also repeatable, allows issues to be prioritised and supports ‘benchmarking’ across teams and services.

Challenge

The highest cost in healthcare is staffing: one way to save money and improve efficiency is to help NHS staff to work better together, using all staff members to their full potential. Encouraging synergistic working would improve cancer care, patients’ experience and outcomes. There are often disconnects between team aspirations and Trust management, which means good ideas often do not get actioned. Other solutions like external consultancy, project managers and commercial solutions are expensive. Even releasing staff for training and brainstorming are costly and time consuming, and take the team away from direct patient care. 

Objectives

To allow cancer teams to self-assess against defined standards to improve functionality, and to do this anonymously so people can be empowered and honest about their team and the care they deliver. To identify what teams do well and what needs to be improved. To give teams a toolkit to prioritise areas for improvement, then the framework to develop and effect quality improvement projects. To empower team members to make differences to care with minimum investment in time away from patient care, at minimal cost.

Solution

A prototype was developed after input from over 60 cancer teams nationally, and was refined after testing and feedback. This version was tested by 23 cancer teams in four Trusts, exploring the feasibility of MDT-FIT being a Trust-managed process. Establishing it was appropriate for all common tumour types, four new items were added to the self-assessment component of MDT-FIT for teams working across multiple sites. It was then tested with less common tumour MDTs (including Paediatrics and Sarcoma) and piloted across multiple Trusts through management by an integrated cancer system. MDT-FIT is introduced via the Trust email using a cancer manager as the key contact. Once a team is ‘set up’ the clinical team lead and all the team’s correct email addresses are collated by the cancer manager. An observer and facilitator are found within the Trust and the facilitation meeting booked in advance. The automated process can then begin.

Results

Every team has found at least 4 areas for improvement, with an average 6 per Trust – and many found 8 or more. This includes highly-performing teams, demonstrating potential for improvement in all teams. More widely networks/cancer systems have been able to identify common themes for improvement. Outputs are quick to generate (taking hours rather than days) and are implemented by the teams themselves with the support of their Trust management. Feedback from NHS staff that have participated in MDT-FIT (as MDT members, observers, facilitators or managers) have highlighted that it promotes shared learning, development and organisational learning. Resources available on the website support NHS staff to develop skills as observers and team facilitators, and participation increases awareness of the importance of teamworking in cancer services. Ultimately it benefits patient care and experience.

Learnings

Evaluation

Audit and evaluation feedback was embedded into every stage to inform design improvements. It was tested with input from over 100 MDTs, involving more than 20 NHS Trusts across England, with interviews with over 250 NHS staff and questionnaire feedback from hundreds more. The majority of MDT members interviewed have expressed positive views about MDT-FIT (74%) and its capacity to facilitate improvements to teamworking and patient care. All reported the MDT-FIT IT platform to be user-friendly and fit for purpose. Feedback from NHS Staff & organisations has highlighted benefits in quality assurance, team appraisal, shared learning and development and influencing change at an organisational level. Resources developed for MDT-FIT, available on the website, support NHS staff to develop skills as observers and team facilitators, and participation can increase awareness of the importance of teamworking in cancer services and in the wider Trust.