multidisciplinary working in forres

Building a shared understanding and exploring models of care

Background

There is a lack of knowledge in Scotland about models of multidisciplinary ways of working and the formation of Multidisciplinary Teams (MDT) which requires the exploration of a new and different approach for providing health and social care services. As part of our collaboration with Health and Social Care Moray, through the Moray Integration project, The Innovation School at GSA worked with staff to scope a project which focused on exploring multidisciplinary working.

Aim

The project aimed to explore how care could be provided at home or close to home by informing the development and way of working of the Multidisciplinary Team (MDT) in Forres. The process aimed to support all stakeholders to build a shared understanding of the MDT and model of care in Forres.

The process supported participants to be open to possibility in terms of how care could be provided at home or as close to home as possible in the future. By collecting different perspectives on the current places and forms of care, lived experiences, and ideas for future ways of working, stakeholders were enabled to creatively explore future opportunities for sustainable change.

Questions

1. How can we further develop the multidisciplinary team in Forres by exploring how we support more people to receive care at ‘home first’ or as close to home as possible?

2. How can we build a shared understanding of the MDT and model of care in Forres among staff from across health and social care in Moray and the Forres community?

Objectives

• To understand current experiences of care across Moray from people who live in the Forres locality.

• To prototype and explore how the MDT and Forres model of care can be applied to care scenarios based on the experiences collected from people who have received care.

• To build a shared understanding of the MDT and model of care in Forres among all stakeholders.

Methods and process

Scoping (Sept. 2018)

Informal conversations were held with staff across the MDT in order to frame an initial scoping workshop for the project and gain an insight into the current landscape of multidisciplinary working.

Workshop (Oct. 2018)

A short scoping workshop was held at The GSA (Highlands and Islands Campus) with members of the MDT to understand the vision for multidisciplinary working in Forres. As an ice breaker, participants were invited to share a future headline for the ‘Multidisciplinary Times’ as a way to understand the aspirations for multidisciplinary working and areas of current challenge. A visual template was used to stimulate and capture insights around current understanding of ‘integration’ and how this applies to multidisciplinary working. A map of Forres which captured the existing Health and Social Care services was created to understand future opportunities for wider integration of community and other services to support future care provision.

The scoping period informed the development of the project brief which outlined the key questions and objectives of the project, as well as the process and anticipated outcomes.

Pop-up (Aug. 2019)

Researchers joined the ‘Partners in Care’ community event organised in the local Town Hall in Forres. Different health and social care services were represented at the event where people could drop in and ask more information if needed. The Innovation School designed an engagement tool that supported the researchers to have a more futuristic conversation with the public about their aspirations and ideas of how multidisciplinary working could be practiced in the future. We designed a key chain with coloured coded labels that each represented a question about what people, tools and ideas they would like to have for their care and support in the future.

Co-design workshop (Oct. 2019)

The workshop was held at The GSA (Highlands and Islands Campus) with members of the MDT. The aim of the workshop was to build a shared understanding of multidisciplinary working across the team and explore how the MDT can be further developed. The workshop began with a presentation and review of the research process to date and participants were invited to share their reflections in response to the emerging findings. A visual canvas was designed to support participants to share and discuss the values and purpose of multidisciplinary working in Forres. This supported the development of the Forres ‘brand’ and identity, enabling participants to consider how they can communicate the purpose of the MDT and model of care in Forres.

The main group activity involved mapping key elements of people’s care journeys based on their needs in the transition from Dr. Gray’s and other places of care to home. Participants responded to scenarios which were informed by the lived eperiences of people receiving care to identify the role of the MDT and wider ‘places of care’ in Forres to support people to positively transition to home. A visual canvas was created to structure the activity and capture the future scenario responses. This activity also supported participants to identify key actions (short and long term) and that could inform a pathway to implementation.

Findings

A person-centred vision for multidisciplinary working

The visual below illustrates a person-centred vision for multidisciplinary working. The visual shows how the MDT operates within a wider system of care and communicates the values of the MDT, the care values of people receiving care, and illustrates where in the system the design tools intend to support and develop multidisciplinary working and person-centred care. The vision for multidisciplinary working was also informed through the findings of the initial scoping workshop which outlined key principles and aspirations.

A future community of caring - not care

The findings of the pop-up engagement highlighted that a desire for more personal reciprocal care embedded in the community and in people’s own homes. Self-directed tools and training could support people to receive more efficient and high-quality care on all levels but there remains an unfamiliarity and anxiety among the older generation when it comes to using digital devices. Future aspirations related to support focused on the need to foster an intergenerational culture of caring - not care - that also informs future generations about health and social care through education. A overview of the insights can be viewed here.

Care journeys: Far away from home, not knowing when to go home and home sweet home

All participants who shared their care journeys experienced a transition from Dr. Gray’s to another place of care in Moray that was often far away from home due to the challenges of locally based care provision, admission criteria, or waiting for a care package. This made it difficult for family and friends to visit on a regular basis. Simple things like having WIFI in the room, nurses checking in from time to time or being able to contribute to the daily life of their place of care helped break the daily routine. Most of the participants were not given information about their anticipated care journey including how long they could expect to stay in the place of care or what other options they might have when being discharged or transferred. This uncertainty and not knowing what to expect can increase feelings of anxiety and despair and makes it difficult to fully understand the choices that are being made in relation to a person’s individual care and support journey. All participants were keen to return home and relieved when this was possible, however they still had questions about what to do in a crisis e.g. who to call in the middle of the night if something goes wrong.

All participants valued having a good relationship with carers and aspired to receive care locally whether this be at home or in their own community so that they can be closer to family. Participant’s would like to be informed about their care pathway and the choices they have; have access to information and availability of services; and receive timely communication (e.g. in relation to discharge and change of medication). This would allow people to see the ‘right’ person to meet their needs, be connected to services that can provide appropriate support and have more transparency around treatment and care options.

Emerging themes for Multidisciplinary Working

Theme 1: A shared understanding of the Forres model of care

Building the Forres ‘brand’ and identity emerged as a key theme during the first scoping workshop and is an important part of developing a shared understanding of the MDT among the Forres community and more widely across other ‘partners in care’. Creating the Forres identity is necessary to support realistic public awareness around care expectations and to recognise multidisciplinary working within the wider system. To develop the Forres ‘brand’ further, staff identified their shared values and the purpose of working together as a MDT during the co-design workshop.

The findings from the workshop activity show that staff already have a shared identity in terms of the values and purpose of multidisciplinary working. These included the values of person-centred care that is proactive and responsive; involves collaboration, respect and understanding of health and social care professional roles; involves patients, families and the third sector; supports transparent communication with approachability and availability; provides accountability and ownership balanced with positive risk taking; creates opportunities by identifying problems and works towards solutions; and ultimately enables holistic care, re-ablement and supports people to be at, or return, home. In relation to the purpose of multidisciplinary working in Forres staff discussed the need to enable and empower people to make choices around health and social care, facilitating independence and providing access to specialist services so that people experience a seamless care pathway. The need to be sustainable was also discussed which involved a balance of prioritising resources and supporting a continuous flow loop to and from hospital but also the need to involve the general public in change. Although staff have a shared understanding, further work is required in order to ensure that the values and purpose of the MDT are communicated to the wider community and partners, along with the current model of care in Forres.

Theme 2: Transparent communication to support care pathways

A key theme that emerged from mapping people’s care journeys was the need for clear information and frequent communication regarding expectations and progress related to their individual care pathway. This would support people to be involved in and make informed decisions regarding their care destination(s). This theme was reinforced when engaging with the Forres community where people expressed a need for information that would support them to navigate health and social care services. Further, staff acknowledged the need to have better communication between primary and secondary care to support multidisciplinary working and enable seamless care pathways where people can be supported in their own locality.

Theme 3: Forging new working relationships for coordinated support

The opportunity to develop new partnerships with wider organisations and the community has the potential to lead to transformational change in the way that person-centred care and support is designed and provided in Forres. A key finding across the interviews, public engagement and workshops is the need to receive and provide support at home or within the locality of Forres. In addition, the findings of the pop-up engagement suggest that the community are looking for ways to maintain healthy social relationships and to have easy access to local services. Furthermore, staff expressed the need to look at ways the community can play a more active role in local support. Exploring how new working relationships can be developed with local third sector and community groups is therefore required in order to understand the role of these organisations in supporting the coordination of local support.

Recommendations for Multidisciplinary working

Recommendation 1: Communicating the role of the MDT and the model of care in Forres

The MDT have been developing an information leaflet and we recommend that this includes or is part of a leaflet series that also explains the current model of care and way of working in Forres. This would allow members of the community to be aware of the services that exist, how to access them, and also begin to communicate the role that people can play in their own health and social care. The vision and purpose of the MDT and model of care in Forres supports a shift in the way people currently engage with health and social care and this leaflet is a simple step towards ensuring this shift is recognised more widely. It will also empower people to take control of finding local solutions and enhance pathways of care to ensure people receive care in the right place at the right time. Reviewing the current draft of the MDT leaflet, there is an opportunity to include further definition of the MDT and the model of care in Forres in order to support wider understanding of the ambitions in terms of the future way of working. A prototype of the MDT leaflet is suggested as part of the tools and concepts section and it is recommended that this is reviewed and agreed before sharing. The Locality Manager can then take responsibility to ensure the dissemination and wider marketing in collaboration with the expertise of the Community Engagement team.

Recommendation 2: Collating data on highly used services.

Data on highly used services was requested as part of this project, however it was not available to the design research team. The data was requested in order to build an understanding of the current use of services in order to support the MDT to identify areas of intensive need and consider future ways of working focused on prevention. It is recommended that this data be sourced in order to understand pressure points and support the MDT and wider partners to develop a collaborative response.

Recommendation 3: Developing relationships between primary and secondary care.

There is a need for a system-wide approach to work together to design care pathways to ensure positive transitions between Dr. Gray’s and Forres, whether to another place of care or to home. Further work should also explore potential ‘imaginary barriers’ in relation to sharing data in collaboration with health intelligence which links to the MDT vision to make visible who is involved in people’s care and provide clarity around who else needs to be involved. The Locality Manager can play a key role in facilitating connections between key parts of the system (e.g., Dr Gray’s and Data Analytics) in order to support communication and understand what data is required and what is feasible in terms of sharing of information.

Recommendation 1 as described in the previous section is also relevant as a key action to support transparent communication about care pathways in Forres. The leaflet can be extended to include an Asset Map of current health and social care services which is described in the tools and concepts section of this report. In addition, prospective care pathways could also be developed in order to communicate potential transitions from different ‘places of care’ to home, however it is crucial that these are developed with wider partners across the system and with people receiving care.

Recommendation 4: Involving the third sector as part of the MDT.

There is an opportunity to explore involving the third sector as an active member of the MDT. Representation from the third sector could support more coordinated, local pathways through their knowledge and networks of community-based support. This could play a key role for a more preventative approach and create awareness to connect people to appropriate forms of support in their community. Involving the third sector in the MDT requires further exploration around the infrastructure that would be required to enable this working relationship to ensure that it meets the needs of all involved. It is recommended that the Locality Manager is in the best position to coordinate this exploration by facilitating initial discussions between tsiMoray and the MDT.

Recommendation 5: ‘Partners in care’ community engagement and planning.

Building on the strategic vision for Health and Social Care in Moray, this approach can be developed further by the Community Engagement and Community Planning teams. They can bring members of the community and third sector partners together with the MDT to discuss shared challenges and collate ideas for community based solutions. Events can support mutual learning on how the community can play a more active role in supporting each other. This recommendation requires significant investment from all (e.g. trust, openness), however this has the potential to achieve transformational change in terms of integration in the wider context.

Tools and concepts to support multidisciplinary working

The following tools and concepts are proposed as ways to support the MDT and wider staff to take forward these recommendations, communicate the model of care and support in Forres, and support multidisciplinary working in practice. The tools and concepts are designed to support dialogue among the MDT and wider partners and are offered as a ‘guide’ rather than be solutions in themselves. Further refinement and appropriation are required before these are considered for implementation more widely.

• MDT information leaflet and asset map - example (print version, A3, coloured, double sided and fold twice to an A5)

• Care journey plan (print version, A3, colour, double sided and fold in the middle to an A4)

• Conversation cards (print version, preferable thick paper, A3, colour, double sided and cut out)

• ‘Partners in care’ event - example information leaflet

Conclusion

The journey and transition from hospital to home formed the core context for the project and is proposed as a key area of focus for future work. In the project, multidisciplinary working has shifted from a focus on how the MDT work together to the need to consider a system-wide approach to multidisciplinary working that supports people to positively transition from a place of care in Moray (e.g. Dr Gray’s or the ACU) to home. Communication and relationships are key to achieving positive transitions and this was evident regardless of perspective, i.e. whether you are a person receiving or providing care.

Building on the strategic vision theme of being supported at home or in a homely setting, and the aspiration from people receiving and providing care to have local forms of support, there is a need to explore future models of care where the journey begins at Dr Gray’s. The vision of ‘destination home’ would involve exploring the culture and practice within Dr Gray’s and the relationship to providers of care in Moray localities by reframing the perspective in order to reshape local care needs and the experience of this journey and transition. The shift in perspective to consider ‘destination home’ at the outset has the potential to positively impact care pathways and transitions, as well as establish more coordinated working practices among staff and wider partners (e.g. Dr Gray’s, local MDT’s and the third sector).

A copy of the report summary for printing can be downloaded here

acknowledgements

We would like to thank all of our interview participants for who took the time to meet with us and share their care journeys and experiences to support the design of future services in Moray.

We are grateful to the staff of the Forres Health and Care Centre and Health and Social Care Moray for their participation and support across the project, and for their enthusiasm around exploring the future of multidisciplinary working.

For more information:

Dr Tara French | t.french@gsa.ac.uk

Yoni Lefevre | y.lefevre@gsa.ac.uk