Abstract
Introduction
Horizontal integration of health and social care in England is frequently supported by multi-disciplinary (MDT) case management focused on high-risk older people with multiple chronic conditions living in the community. This analysis aims to understand the experience of frontline staff in such MDTs of working with professionals and staff from multiple sectors, and their perceptions of the roles and benefits of integrated working.
Methods
We conducted semi-structured interviews with a purposive sample of 54 frontline staff from a range of professional backgrounds working in 11 community-based MDTs in two Integrated Care and Support Pioneers. A largely inductively developed coding frame was used to thematically code and guide analysis of verbatim interview transcripts from audio recordings.
Findings
Staff conceptualised the team as a cohesive yet ‘porous’ entity, able to evolve a shared sense of purpose to deliver holistic care that helped to level traditional professional hierarchies, enable collective problem-solving and share responsibility for patient care. MDT working was seen as benefiting staff and patients. Despite strong similarities between the MDTs in members’ understandings of the role and purpose of a MDT, each MDT was adapted to the context and the needs of the population served. The process of working through inter-professional tensions seemed to strengthen relationships within the team and enhance its ability to work effectively in the local health and care system. However, without performance or outcome measures, these perceptions were driven by soft intelligence alone.
Conclusions
Frontline staff accounts of MDT working demonstrate their strong commitment to this way of working, as a mechanism enabling them to deliver more holistic care with perceived benefits to patients.
Horizontal integration of health and social care in England is frequently supported by multi-disciplinary (MDT) case management focused on high-risk older people with multiple chronic conditions living in the community. This analysis aims to understand the experience of frontline staff in such MDTs of working with professionals and staff from multiple sectors, and their perceptions of the roles and benefits of integrated working.
Methods
We conducted semi-structured interviews with a purposive sample of 54 frontline staff from a range of professional backgrounds working in 11 community-based MDTs in two Integrated Care and Support Pioneers. A largely inductively developed coding frame was used to thematically code and guide analysis of verbatim interview transcripts from audio recordings.
Findings
Staff conceptualised the team as a cohesive yet ‘porous’ entity, able to evolve a shared sense of purpose to deliver holistic care that helped to level traditional professional hierarchies, enable collective problem-solving and share responsibility for patient care. MDT working was seen as benefiting staff and patients. Despite strong similarities between the MDTs in members’ understandings of the role and purpose of a MDT, each MDT was adapted to the context and the needs of the population served. The process of working through inter-professional tensions seemed to strengthen relationships within the team and enhance its ability to work effectively in the local health and care system. However, without performance or outcome measures, these perceptions were driven by soft intelligence alone.
Conclusions
Frontline staff accounts of MDT working demonstrate their strong commitment to this way of working, as a mechanism enabling them to deliver more holistic care with perceived benefits to patients.
| Original language | English |
|---|---|
| Journal | Journal of Health Services Research and Policy |
| Publication status | Accepted/In press - 28 May 2025 |