MDT working & collaboration in SSI prevention – Does it improve overall patient outcomes?

Multidisciplinary team (MDT) working dynamics is thought to be an important marker for overall patient outcomes. In my last blog, I wrote about the importance of love, kindness, empathy and compassion in healthcare. These values are always at the centre of everything I do, without which I am unable to deliver safe compassionate patient-centred care. However, it’s not just about how I perform or behave around patients, it’s also about how everyone else endeavours to do the same. In another previous blog available on the NICE website, Dr Prabhu writes about happy staff and happy patients quoting ‘I believe we need to focus on staff happiness and wellbeing. We need to support each other better so that we can take care of ourselves and our patients,’ and I couldn’t agree more with his comments. Fascinating to hear him suggesting that addressing/improving staffing dynamics could reduce ‘medical errors’ by about 90%. I therefore feel that organisations must be doing more to promote staff happiness; staff should also take the initiative to become more self-aware so they can feel confident to challenge and address aspects of their attitudes that may contribute to team disharmony and vice versa.

There has been a lot of talk about multidisciplinary team working in health care in general and no surprise in surgical site infection (SSI) prevention work also. We published a paper in 2018 on reducing adult cardiac surgery SSIs, highlighting fantastic efforts from members of the multidisciplinary teams. Prior work by Gillespie and colleagues appeared to suggest the need for further research to fully evaluate individual contributions of members of the MDT particularly where bundled approach interventions are utilised. There is no doubt though that cohesive efforts from all members of a team yields positive outcomes. Our most recent Caesarean section (CS) SSI paper presents fantastic results, again from collaborative working partnerships that enabled us to make great progress in our CS SSI prevention work. In both of the published cases studies for adult cardiac surgery and CS SSI prevention work, multidisciplinary team working was a pinnacle for success and appears to be a formula that works in SSI prevention given most of the available evidence has to be bundled across a surgical pathway.

I previously wrote a blog presenting a case for CS SSI surveillance which I also recently shared as a poster at the recent Hospital Infection Society conference (#FISHIS20) as I am very keen to explore the concept of multidisciplinary team working in SSI prevention not only at local level, but also at national and global level. This work will help identify potential gaps in not only clinical practices but may enable us to also explore team dynamics that are key to successful implementation of evidence based SSI prevention care bundles across the CS and other surgical pathways. This in turn will help us to improve outcomes of mothers following caesarean section procedures and other surgery also.

Who constitutes surgical MDTs?

So who is or must be involved in surgical multidisciplinary teams? For our SSI prevention work, the multidisciplinary teams included: clinical governance leads, senior nursing teams, senior midwives, pharmacists, obstetricians, infection control and surveillance teams, microbiologists, infectious diseases consultants and registrars, clinical directors, all frontline staff covering preoperative, intra-operative and post-operative pathways, our communications team, allied health care professions, administrative staff as well as patients who completed questionnaires and answered telephone calls. Each member of the team made an important contribution to the success of our SSI prevention work. But, is it the same approach in all organisations and is it easy to manage dynamics of such teams?

I enjoyed listening to Kat Topley presenting working that the OneTogether UK is currently doing to support operating room staff through provision of assessment tools that can be used to carry out meticulous assessments of intraoperative pathways to facilitate implementation of potential improvement initiatives. The concept of collaborative working partnerships between healthcare professionals and industry to drive patient safety initiatives was also mentioned. It would appear that MDT working within and across teams is important in any patient safety work or quality improvement initiatives.

Maintaining team harmony & safe patient outcomes

Reviewing team dynamics on a continual basis should be every leader’s priority to maintain positive working relationships, thereby improving patient outcomes. There is no doubt that COVID-19 has interrupted surgical pathways as recently highlighted by Sid Mookerjee in his talk about the Imperial SSI story at the #FISHIS20 conference. I like the idea he presented of the 4 Es (Engage, Educate, Execute and Evaluate) which can be useful for introducing new changes or maintaining established gains and promoting MDT working. COVID-19 has made us all acknowledge the benefits of cross disciplinary team working, finding new ways of working in challenging scenarios to overcome any new barriers to patient safety. I feel that we must all continue building on the positives that have come out as a result of this pandemic.

Let's collaborate on CS SSI prevention work

I strongly believe in delivering safe compassionate care with love and kindness flourishing among colleagues. This approach can be useful when staff are under immense pressure especially during the current #COVID19 pandemic. If happy staff means less errors, perhaps compliance with evidence based SSI prevention measures can be improved where love, kindness and compassion among staff/colleagues is exuding. This consequently improves overall team performance and patient outcomes. I am therefore excited and look forward to working with colleagues on CS SSI prevention work and hope the above attributes will be embedded throughout. I believe good MDT working may improve overall patient outcomes as demonstrated by our results at local level, but let's go global. Firstly though, go on and #BeKind #BeLovely #BeCompassionate...