Connecting the Dots: Improving Neighbourhood Multidisciplinary Team Collaboration in Child Health GP Hubs
What was our aim?
The significance of social determinants of health and their impact on medical care have become increasingly relevant, and affect a large part of paediatric practice in the UK¹.
As a GP trainee in both GP and Connecting Care for Children for the last 6 months, I have had the opportunity to spend some time participating in both the clinics within the Child Health Hubs and the multidisciplinary team meetings. These meetings are in conjunction with the clinics, where a variety of health and social care professionals come together to discuss cases and share their various areas of expertise to better support the paediatric patients discussed. As part of my project work for my role in Connecting Care for Children, I have been looking into collaboration within the multidisciplinary meetings in more detail, to assist other medical professionals interested in learning more.
After observing several Child Health Hub multidisciplinary meetings, we noticed as a team that although the meetings are well attended by a variety of community healthcare professionals (including GPs, school nurses, family care navigators, paediatric dieticians, health visitors and paediatric mental health workers) the discussion around cases in these meetings was mainly clinical, with limited social care input.
By encouraging a wider variety of contribution from the team, we can start to better address social determinants of health.
There is a wealth of knowledge, experience and resources provided by the community healthcare workers that attend the neighbourhood multidisciplinary meetings, and it is important to harness this to provide better holistic care for the patients that attend and are discussed in our clinics.
We wanted to look into why there was limited contribution by the wider team into the meetings and identify any potential barriers to community healthcare workers contributing.
How did we assess the problem and what results did we find?
We undertook structured interviews with various members of the multi-disciplinary team to identify any barriers to their contributions at the meetings and to assess the usefulness of a more collaborative approach. We primarily concentrated on school nurses, early years coordinators and family hub coordinators. Additionally, we visited family hubs within Westminster to better explore what resources were available at these hubs.
We used a motivational interviewing technique to encourage the individual members of the MDT to contribute to case discussion, and as with the school nurses, to bring back cases they had previously been consulted on. This meant that the whole team could follow up with that patient and learn from the case.
The diagram below shows some quotes from our various interviews with community health and social care practitioners who are regular attenders of the various multidisciplinary meetings:
To address information governance concerns, we adapted a pre-existing framework to ensure anyone in the team could reliably obtain verbal or written consent from each patient’s families, therefore aiding wider contribution from the team. An example of this is shown below:
Via our motivational interviewing, we encouraged individual members of the multidisciplinary team to contribute to case discussion following the interviews. In terms of measuring this contribution, we monitored allied healthcare input during the meetings and will continue to do so going forward, as part of our process measures.
The family hub coordinators exhibited expertise around local social services and resources, and during our interviews it became evident that better utilising this knowledge base within the multidisciplinary meetings would be invaluable.
The diagram below illustrates which health and social care practitioners work with and within the family hub, and what kind of resources are available. There is some variation between different family hubs and what services they provide.
The main themes of the interviews we undertook were that each member of the wider team would find a larger role in the meeting useful, and increased participation from the wider team would be a welcome contribution. However, participants often felt like they were not aware this was an option. There were several obstacles that came to light, with interviewees citing that their main barriers were time constraints within the meeting, and some reluctance to put cases forward due to a lack of confidence in their role within the meetings. There was also some perceived concerns relating to hierarchy within the team meetings, and concerns that cases they contributed wouldn’t be relevant to the attending GPs.
Both family hub coordinators and school nurses began to contribute more to cases after the motivational interviews, and followed up on patients after the clinics that they could then bring back to later meetings to be further discussed. We are keen to continue our study of wider multidisciplinary team members’ contribution going forward to assess for further improvement.
How can we improve things in future?
To address the significant socio-economic impact on clinical health in children, the barrier to collaboration between health and social care needs to be tackled. Through our study, we have identified ways of improving and streamlining the working relationships between medical and social care work; and this should provide better holistic care for the patient. Health systems could adopt these proactive ways to engage the wider, non-clinical professional team in order to impact the social determinants of health.
We found that the method of motivational interviewing was helpful for implementing change, as it enabled members of the team who would otherwise be reluctant to contribute more likely to do so. We have some on-going anticipated challenges which centre more about wider team members bringing specific cases themselves to the meetings, rather than just contributing to the discussion on cases brought by GPs.
We also found that the development of working relationships via individual meetings with specific members enabled a flatter hierarchy and improved wider member contribution.
References:
- Spencer N. The Social Determinants of Child Health. Paediatrics and Child Health. 2018 Mar;28(3):138–43. doi:10.1016/j.paed.2018.01.001
