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Why we need to bring back the tea cosy, and other things we learned

Rose shares her reflections from our Melting Pot Lunch with Nancy Kuchemann, where we discussed working as a multi-disciplinary team (MDT) as part of NHS England and Improvement's Integrated Care in Action week.

NHS England and Improvement describe multi-disciplinary team (MDT) working as ‘how health and care professionals work together to support people with complex care needs that have been identified through risk stratification and case finding’. As someone who spends a lot of time talking about how important ‘collaboration’ and ‘cross-sector working’ is for health (sorry – other jargon is available), this obviously sounds great.

However, we all know that bringing together a diverse group with different priorities is not a simple task in any setting, let alone in a system as complex as health and care. At our most recent Melting Pot Lunch we were joined by Nancy Kuchemann, GP and lead for mental health at Southwark CCG to discuss working as a multi-disciplinary team, and what this actually means in practice.

Here are my five reflections from the discussion…

1. How can we better understand each other?

‘Purpose’ is a topic that we always come back to at Melting Pots. Perhaps it’s getting a group together with diverse experiences, perhaps it’s having a space to reflect, perhaps it’s the meal deals going to our heads. This discussion was no different. We sought to understand the purpose of MDTs, how colleagues prioritise in different settings and, crucially, patients’ purpose.

Patients aren’t just a set of symptoms or data. We all go to the GP with our own experiences, assumptions, beliefs, knowledge, aspirations and purposes in life. In a previous conversation about Nesta’s People Powered Results programme, we discussed whether instead of a conversation based solely around the symptoms, we could be asking ‘what keeps you up at night?’. How can the health and care better understand and respond?

This feels like an important starting point for MDTs. If patient’s own purpose and aspirations are better understood, the power of different professionals working together.

2. Having the conversation is an intervention in itself

Nancy discussed how, in her own practice, working as an MDT might not necessarily mean they now have all the answers, but having the conversation helps to support each other to share the risk.

This was reflected in our own conversation, and I was struck by Nancy’s closing reflection about how comforting it is to hear that others in the room have similar challenges to making MDT working thrive.

Having a conversation is an intervention in itself. Coming out with actionable next steps that lead to change is important. But the power of having a better, patient-focused conversation and better understanding one another is something that is difficult to measure, but so important to improving our experience.

3. This is difficult to get right

With many people in the room currently in the midst of working as an MDT, they shared the challenges in practice. This could be difficult personalities, systems not being in place to share records, hierarchies and power dynamics at play or ways of working clashing. This was a good reminder that there is no ‘silver bullet’ to MDT working.

Change is hard, and even moving an inch forward in such a complex system is significant. But how can the system get out of the way of itself to let collaboration thrive?

Ultimately, this is hard. People spend their whole careers thinking about how to collaborate better and there are thousands of research papers that will tell you different answers. Nancy discussed in her blog how it can feel like we’re ‘inching’ forward on this.

Change is hard, and even moving an inch forward in such a complex system is significant. But how can the system get out of the way of itself to let collaboration thrive? We discussed the importance of shared records, better online systems in place, and having physical spaces for teams to meet and collaboration to happen.

4. Teaching collaboration

We know how impactful working in a multidisciplinary way is, but we also know how hard it is. We need to better embed collaboration into the core of the NHS and community services. The development of Integrated Care Systems is a great opportunity for this. How can we go further?

Collaboration is often seen as some of the ‘soft stuff’ or a ‘nice to have’. If it’s something that we know is important for improving patient care and experience, then it’s an essential part of how we need to be working in an ever more challenging, stretched and complex system, to share resources, knowledge and risk. Therefore, should collaboration be part of the curriculum? And if MDT working is so important, is multi-disciplinary education an answer?

5. Bring back the tea cosy

Overall, the story that will stay with me is one by Nancy about a tea cosy. She discussed how one of the many reasons that convinced her that she’d like to work at her practice is that they had a teapot and a tea cosy. This said to her that they not only drink tea, but they drink more than one cup.

This might seem like a small thing, but having a space like this for a team to come together, to have a conversation and take a breath is important for wellbeing and importantly it symbolises caring (also, there’s actually evidence that holding a warm drink means that you’re more likely to display ‘interpersonal warmth’). Others in the room discussed how their team always takes a lunch break together, and there are so many amazing examples across the sector.

My remaining question is how can MDTs incorporate the great work to nurture relationships like this between teams working in very different ways? I think we can all do more to nurture our human connections, whether that’s a tea cosy, taking time out to have lunch together or reflecting on how our own actions can impact others.

We’re on the 50th anniversary of Melting Pot Lunch.  What has made Melting Pots work so well for so long is hard to say, but I know that appetite isn’t just for the great range of meal deals we provide. I think what this Melting Pot like others really showed was that what people really value is the space to reflect and discuss in a way that is warm, safe and engaging, whether that is at a MPL (Melting Pot Lunch!), in an MDT, an ICS or a CCG, or any other three letter acronym…

Rose Minshall20 March 2020


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