Leading Multidisciplinary Improvement Projects in the NHS

Why this topic matters

Healthcare problems are rarely confined to a single specialty or department. Patient journeys often span multiple areas, from primary care to tertiary services, involving doctors, nurses, allied health professionals, pharmacists, administrators, and support staff. Effective improvement therefore requires insights and collaboration from all these stakeholders.

Multidisciplinary improvement projects are essential for:

• Holistic problem-solving: Combining different perspectives leads to more comprehensive understanding of issues and innovative solutions.
• Sustainable change: Solutions co-developed and owned by a diverse group are more likely to be embedded and sustained.
• Improved patient experience: Breaking down departmental silos can streamline care pathways and reduce fragmentation.
• Enhanced staff engagement: Involving staff from various disciplines fosters a sense of ownership and collective responsibility for improvement.
• Optimised resource utilisation: Understanding processes from multiple viewpoints can identify efficiencies and reduce waste.

Practical explanation

Leading an MDT improvement project is about more than just managing tasks; it's about facilitating collaboration, building consensus, and navigating organisational dynamics. It requires strong communication, an understanding of stakeholder motivations, and a structured approach to change.

Key elements of a successful MDT improvement project

• Clear scope and objectives: Everyone must understand what the project aims to achieve and what is out of scope to prevent 'scope creep'.
• Diverse and engaged team: The right mix of skills and perspectives, with individuals committed to the project's success.
• Effective communication strategy: Regular updates, clear meeting agendas, and accessible information sharing.
• Shared understanding of data: Consistent metrics and a common understanding of baseline performance and progress.
• Supportive leadership and organisational buy-in: Senior sponsorship is critical for removing barriers and allocating resources.
• Iterative approach to change: Testing changes on a small scale, learning, and adapting rather than aiming for perfect, large-scale implementation from the outset.

Common pitfalls

Despite the benefits, MDT projects often encounter hurdles. Being aware of these can help you proactively mitigate risks.

• Lack of clear leadership or scattered responsibility: When no one feels ultimately accountable, progress can stall.
• Poor stakeholder engagement: Key individuals or groups may feel excluded, leading to resistance or lack of cooperation later on.
• Conflicting priorities: Different departments or specialties may have competing objectives or perceive the problem differently.
• Communication breakdowns: Ineffective information sharing can lead to misunderstandings, duplicated efforts, or missed opportunities.
• Resistance to change: Staff may be comfortable with existing practices, even if suboptimal, and require careful persuasion and support.
• Insufficient resources: Lack of protected time for team members or inadequate funding can cripple a project.
• Failure to use data effectively: Without clear measures and regular review, it's hard to track progress or demonstrate impact.
• 'Pilot purgatory': Successful small-scale pilots that never get embedded or scaled up more widely.

A structured approach to leading MDT improvement projects

Adopting a recognised improvement methodology can provide a valuable framework. The Model for Improvement (Plan-Do-Study-Act or PDSA cycles) is widely used within the NHS and highly applicable to MDT projects.

Step 1: Define the Problem and Form the Team

• Identify the problem: Clearly articulate the problem using data where possible (e.g., 'X% of patients experience delayed discharge due to Y').
• Establish project aim: Set a specific, measurable, achievable, relevant, and time-bound (SMART) aim. This provides a tangible target for your MDT.
• Identify key stakeholders: Think broadly about who is affected by the problem and who has insight into potential solutions. This will inform your team composition.
• Assemble the MDT: Invite representatives from different disciplines. Aim for a manageable size (e.g., 5-9 key members), recognising that others can be consulted during the project. Secure protected time for them if possible.
• Define roles and responsibilities: Clearly outline who is responsible for what. Assign a project lead (often yourself!), a data lead, a communication lead, etc.

Step 2: Understand the Current System (Baseline) and Involve Stakeholders

• Map the current process: Work with the MDT to map out the existing patient journey or process. This highlights bottlenecks, inefficiencies, and areas for improvement. Techniques like value stream mapping or process flow diagrams can be useful here.
• Collect baseline data: What are your current metrics? How are you measuring the problem? This establishes a starting point for assessing the impact of changes.
• Gather staff and patient perspectives: Conduct surveys, interviews, or focus groups with staff who work in the process and patients who experience it. This invaluable qualitative data can uncover hidden issues and potential solutions.
• Build consensus: Facilitate discussions within the MDT to synthesise findings and agree on the main drivers of the problem.

Step 3: Develop and Test Solutions (PDSA Cycles)

• Brainstorm potential interventions: Based on your understanding, generate ideas for change with the MDT. Prioritise them based on feasibility, potential impact, and resource requirements.
• Plan a small-scale test (Plan): For your chosen intervention, define precisely: what will be changed, who will be involved, where it will happen, when, and what data you will collect to evaluate the change.
• Implement the change (Do): Carry out the planned intervention on a small scale. This might involve a single patient, a specific ward, or one shift.
• Observe and collect data (Study): Monitor the impact of your change. Compare your observed results with your predictions. What went well? What didn't?
• Analyse and adapt (Act): Discuss the findings with your MDT. Based on what you learned, decide to: 1) Adopt the change; 2) Adapt it and try another PDSA cycle; 3) Abandon it and try a different idea.
• Repeat PDSA cycles: Continue to iterate. As confidence grows, you can expand the scope of your tests.

Step 4: Implement and Sustain Change

• Scale up successful changes: Once a change has proven effective through small-scale testing, plan for broader implementation across the relevant areas.
• Standardise the new process: Develop clear guidelines, protocols, or training materials to embed the change into routine practice.
• Monitor sustained impact: Continue to track your key metrics to ensure the improvements are maintained over time. This helps identify drift or new issues.
• Celebrate successes and communicate widely: Recognise the team's efforts and share the positive outcomes across the organisation. This builds morale and demonstrates the value of improvement work.
• Identify next steps: What further improvements could be made? Has the project revealed new areas for investigation?

Example in clinical practice: Reducing length of stay for elective hip replacements

Problem: Increased length of stay (LoS) for elective hip replacement patients, leading to bed pressures and patient dissatisfaction.

MDT Composition: Orthopaedic surgeons, anaesthetists, physiotherapists, occupational therapists, ward nurses, discharge coordinators, pharmacists, and administrative staff.

Structured Approach:

1. Define and Team:
   • Aim: Reduce average LoS for elective hip replacement patients by 1.5 days within 6 months, whilst maintaining or improving patient satisfaction and complication rates.
   • Team: Established an MDT lead by a consultant orthopaedic surgeon and a senior physiotherapist.
2. Understand Current System:
   • Process Map: MDT mapped the entire patient journey from pre-op assessment to discharge, identifying delays in physiotherapy assessment, slow medication reconciliation, and lack of clarity on discharge criteria.
   • Data: Baseline average LoS was 6.2 days. Patient satisfaction scores were moderate regarding discharge planning.
   • Perspectives: Staff surveys highlighted communication gaps between physiotherapy and nursing teams; patient interviews revealed anxiety about post-discharge support.
3. Develop and Test Solutions (PDSA):
   • Intervention 1 (PDSA 1): Introduce a 'Discharge Checklist' completed by the MDT daily from post-op day 1. Test on one ward.
     • Result: Improved clarity, but some checklist items were not consistently completed at weekends due to staffing.
   • Intervention 2 (PDSA 2 - adapted): Revise checklist, incorporate weekend staffing plan, and pilot a daily MDT 'huddle' to review discharge readiness. Test on one ward for two weeks.
     • Result: Significant improvement in LoS for tested patients (average 5.0 days); positive feedback on huddle efficiency.
   • Intervention 3 (PDSA 3 - new idea): Develop a standardised patient information leaflet on post-discharge exercises and contact numbers and deliver at pre-op assessment. Test with 10 patients.
     • Result: Reduced patient anxiety, improved adherence to exercises.
4. Implement and Sustain:
   • Rollout: Adopted daily MDT huddle and revised discharge checklist across all orthopaedic wards.
   • Standardisation: Incorporated new patient information into routine pre-op processes. Ran training sessions for new staff.
   • Monitoring: Continued to track LoS data and patient satisfaction scores monthly. Observed sustained reduction in LoS to 4.8 days.
   • Communication: Presented findings at clinical governance meetings and shared lessons learned with other surgical specialties.

How Lazomis can help

Lazomis provides a suite of tools that can significantly support the planning, execution, and monitoring of your multidisciplinary improvement projects:

• Project Setup and Management: Our project wizard helps you define your aim, team, and key milestones, ensuring a clear project structure from the outset.
• Data Collection and Visualisation: Use Lazomis to define and track your key metrics, effortlessly collecting and presenting data in intuitive dashboards. This allows your MDT to clearly see baseline performance and the impact of your interventions.
• Communication and Collaboration Features: Facilitate document sharing, meeting agendas, and action tracking, keeping your MDT aligned and informed.
• Impact Reporting: Generate professional reports that articulate your project's achievements, making it easier to share successes and gain continued organisational support.

This resource supports, but does not replace, clinical judgement. Local policy, formulary and specialist advice should be followed.

Key takeaways