Challenges of managing a Transdisciplinary Team in a Neuropsychiatric setting

It should be obvious to all healthcare professionals, that all care should be patient centred and needs led.  Not only is this recognised as best practice, but ultimately based on the need of the patient and not that of the service.  Most people don’t want to have things done ‘to them’ no matter their diagnosis.

Developing a team within any healthcare service delivering a treatment model presents challenges to all involved when there are many different professionals, personalities and priorities but when working effectively as a team, this assures the best outcomes for our patients.

The function of a multidisciplinary team (MDT) and a transdisciplinary team (TDT) are often confused.  Although intrinsically different, both deliver care to a patient group, with a particular need.  An MDT can be effective within many settings and meet the needs of particular people.  One definition of a MDT is

Consisting of members of different disciplines, involved in the same task (assessing people, setting goals and making care recommendations) and working alongside each other, but functioning independently. Each member undertakes his or her own tasks without explicit regard to the interaction. These teams are traditionally led by the highest ranking team member.

A TDT description is

A transdisciplinary team is a team whose members have developed sufficient trust and correspondence, to engage in teaching and learning across disciplinary boundaries.  Team members entrust, prepare and supervise the sharing of function.”

Working within a TDT in a neuropsychiatric setting there are advantages for both the patients and staff.  There is 24 hour rehabilitation, increased opportunities to learn for the patient, new learning is more likely to become ‘norm’ if repeated throughout the day, there is blurring or roles which increases experience and knowledge, and a more engaged and happy workforce.

There are challenges to implementing this approach; developing this way of working is time and resource intensive, there is a lot of training required to support understand the approach/ethos of the team.  Challenges can be resolved with the support of others. You need experts in the field, to inspire and inform of the treatment approach.  Everyone needs to be able to recognise these experts otherwise issues can arise when a professional is unable to acknowledge them as experts, leading to interpersonal difficulties and disruption to the team working.

Where professional groups have become increasingly specialised and choose to work independently of others, there is a risk that care delivery is disjointed, and not meeting the needs of the patient, but what the individual profession deems the priority for that person.  Professionals train for years to develop their specialist skills, and it is understandable that people want to keep this identity.  However it is not about losing your identity or your role, but rather how you work collaboratively with other professionals, sharing your knowledge and specialist skills, working creatively with them to meet the overall needs of the patient.

Leadership is motivating a group of people to achieve a common goal, and demands a mixture of skills in order to define the vision and journey, and this is not always the most senior person.  A key part of a TDT is that everyone is equal, and holds an equal standing, whilst needing to recognise that ultimately you do have to have someone who is deemed to be in overall ‘charge’.  There are times when different people need to take the leadership role, and when different disciplines are going to be led by another.  A good leader is interested in how the pieces all fit together, able to learn about themselves and others and support the team to problem solve and move forward.

To drive a treatment approach, and embed this in culture, you need all of the team to buy into this.  Even one individual choosing to not follow the processes, interventions or approaches agreed by the team, can lead to inconsistencies and ultimately a potential splitting of the team and the service delivery being interrupted and ineffective. Embedding cultural change can be one of the hardest and time consuming activities that you have to undertake as the leader, requiring reinforcement of the approach, and people, on a continual basis.  Without this emphasis and drive, you run the risk of the approach diluting, the transdisciplinary way of working reducing, and then a gradual return to previous ways of working.  Suddenly you can find yourself back at the starting point!

– Louise Smith, Hospital Director, St Neots Hospital

 

St Neots Hospital provides mental health services for a range of patients with complex co-morbid mental and physical health conditions. Patients may require rehabilitation but patients can also require care through to end of life. Many patients have chronic treatment resistive mental health conditions whilst also experiencing multiple barriers to rehabilitation including physical, neurological and cognitive issues. We are also highly experienced in the care of patients with neurodegenerative conditions such as Huntington’s disease, early onset dementia, Pick’s disease and Korsakoff’s syndrome or those with an acquired brain injury.



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