Advancing a Systemic Perspective on Multidisciplinary Teams: A Comparative Case Study of Work Organisation in Four Multiple Sclerosis Hospitals

Abstract

Introduction:Many care organisations claim to employ multidisciplinary teams, but the term is used to describe quite different forms of collaboration. A systemic view of the work organisation of care delivery is presented and applied in this article that allows to identify and understand often overlooked yet important differences regarding team composition, working relationships and therapeutic relationships.Theory and Methods:We used modern socio-technical systems theory to study care delivery for a particular patient population as a system of interrelated activities. The concept of work organisation refers to the way in which the composite task of care delivery is divided into distinct tasks and how these are grouped in either monodisciplinary or multidisciplinary organisational units. The systemic perspective was applied in a comparative case study of four Multiple Sclerosis hospitals.Results:Among the hospitals, one was characterised by a functional work organisation, with similar tasks grouped in monodisciplinary teams. Cross-disciplinary working and therapeutic relationships were established on an ad hoc basis. The three other hospitals adopted a more process-oriented work organisation (which groups all tasks related to a specific care process within a single, multidisciplinary team). The more process-oriented the work organisation, the more working relationships and therapeutic relationships appeared to be fixed and continuous.Conclusion and discussion:The systemic view adopted in this study yields a better understanding of multidisciplinary teams through the concept of work organisation. The actual composition of multidisciplinary teams, and the related working and therapeutic relationships will vary depending on the type of underlying work organisation. Further validation of this conclusion will be needed in other settings.

Challenges in multiple sclerosis care: Results from an international mixed-methods study

“…Neurologists and APNs should therefore receive more appropriate training to improve knowledge and skills regarding treatment monitoring, which could also be improved through enhanced communication and collaboration between neurologists and APNs. While previous studies have highlighted the importance of a multi-disciplinary team for continuous MS care (Feys et al, 2016;Pless et al, 2018), our findings show that work remains to achieve effective implementation and management of such collaborative structures between primary care practitioners and specialists, and among specialists.…”

Computer-Supported Knotworking

“…Furthermore, depending on the country and the care situation, care integration practices can be more or less institutionalized; from interdisciplinary teams being at the center of the care plan and supported by federal agencies or care facilities, to situations in which they are less explicitly envisioned and just emerge spontaneously, as health professionals need to coordinate their work and communicate about patients. Using socio-technical systems theory, Pless et al [43] have compared several multidisciplinary teams from four multiple sclerosis hospitals in Belgium, and identified important variation in care integration, along three dimensions: (1) whether multidisciplinary teams are limited to delivering care in a particular care phase or throughout the care process as a whole, (2) whether working relationships are maintained on an ad hoc basis or on a fixed basis, and (3) whether the therapeutic relationships are continuous or not, which reveals whether the care process is fragmented or integrated.…”

Organization and system theories in interprofessional research: a scoping review

“…Twenty-one studies primarily involved IPC among qualified professionals in the workplace (Applequist, Miller-Day, Cronholm, Gabbay, & Bowen, 2017;Barrow, McKimm, Gasquoine, & Rowe, 2015;Bergman-Pyykkönen, 2017;Bostock, Lynch, Newlands, & Forrester, 2018;Bunniss & Kelly, 2013;Burm et al, 2019;Buttigieg, Cassar, & Scully, 2013;Casimiro, Hall, Kuziemsky, O'Connor, & Varpio, 2015;Clemins, Brant, Kersten, Mullette, & Dickerson, 2016;de Bock, Willems, & Weinstein, 2018;Gilardi, Guglielmetti, & Pravettoni, 2014;Kallio et al, 2016;McDougall, Goldszmidt, Kinsella, Smith, & Lingard, 2016;Messenger, 2013;Meyer & Lees, 2013;Misfeldt, Suter, Oelke, & Hepp, 2018;Pless, Van Hootegem, & Dessers, 2018;Pype, Mertens, Helewaut, & Krystallidou, 2018;Solomon & Risdon, 2014;Teodorczuk, Mukaetova-Ladinska, Corbett, & Welfare, 2015;Vestergaard & Nørgaard, 2018). Workplace studies were conducted in acute, primary-care or disability settings and sought to explore/improve the IPC of healthcare teams in these settings.…”

“…Stakeholder theory (Applequist et al, 2017;Vestergaard & Nørgaard, 2018) and diffusion of innovation theory (Brewer, 2016;Bostock et al, 2018) were each used twice. Each remaining theory from those identified by Suter et al (2013) was only used once: organizational theory (Messenger, 2013) and socio-technical theory (Pless et al, 2018).…”