Participants’ comments illustrating the reasons for supporting or opposing streamlining and the approaches for streamlining proposed in the survey
| Category | Reason for support | Reason for opposition |
| Impact of streamlining on the quality and safety of patient care | Straightforward cases do not require discussion giving more time for discussion of complex cases ‘Most urology cancer cases have straightforward management where the MDT discussion gives a very little added benefit and consumes time that should be spent on difficult cases…’. ‘The number of patients that are currently needing discussion is getting bigger, which means that the more complex cases don't get the full time needed. The above approach would be a suitable alternative’. Streamlining will speed up treatment ‘It will help patients progressing in diagnosis and treatment pathway more smoothly and quickly’. ‘Many patients follow a well-organised pathway. The MDT sometimes slows this!’ | Every patient is unique and should be discussed to ensure individualised, holistic care ‘I feel all patients have the right to get benefit from specialist knowledge of all members of the team’. ‘MDM allows us to discuss other medical and non-medical reasons why standard treatment by need to be altered’. Straightforward cases cannot be identified prior to MDM discussions ‘There's an underlying risk of wrongly categorising “simple” and “complex” pts at the beginning of the process … ending up with delays, wrong paths, wrong decision-making…’. MDM prevents errors ‘Some big mistakes can come from small errors, such as mislabelling or report being typed on the wrong patient, and the MDT is a good safeguard for this’. All cases need review by MDM to ensure safety ‘Wider team should see the minutes of those streamed in case they wish a wider review … Plus this should be audited to make sure that it fit for purpose using criteria laid down nationally’. Streamlining will delay treatment ‘I feel the above model adds complexity and uncertainty to the pathway that will lead to delays to patient treatment that are not present with a single full weekly MDT model’. |
| Impact of streamlining on time taken by clinicians time | Will save clinician time ‘Streamlining is vital, MDTs are very expensive in terms of consultant time and many patients can be treated according to predefined protocols and do not require endless pointless discussions’. ‘I agree mainly because I sit in an MDT that takes 4 hours, is full of patients who the majority of us feel that don't get benefit from discussion … I am certain that you could save valuable (and expensive) time to direct more time to cases that require it and ensure the decisions made at the end of an MDT remain robust (difficult sometimes after 4 hours!!)’. | Will take more clinician time, insufficient time available ‘All good ideas but to do this time needs to be taken to do it—we already spend a whole session on MDMs and we cannot afford more time off from clinical work’. ‘Where would we as radiologist find the time for a streamlining MDT meeting. I doubt our clinical managers would not allow us time in our job plan for this. It is difficult for even core members of the MDTs to be allowed to go to the MDT every week’. We have sufficient time already ‘We have no need of this in our centre. All our cases are discussed at MDT’. |
| Impact of streamling on clinician skills | De-skilling of clinicians ‘Far too many routine decisions made at MDTs. We are intelligent highly trained professionals but now have been trained to be unable to make a decision’. | Educational role of MDT ‘MDTs are opportunities for learning for junior members of the team’. |
| Governance issues | MDT should have autonomy ‘Local MDT should be able to decide level and length of discussion pertinent and relevant to each individual case’. Impact should be evaluated ‘Get evidence of efficacy before rolling this out’. | |
| Use protocols or initiate treatment prior to MDM in order to streamline discussions | Use protocols for straightforward cases ‘Most of the cases are treated through well set and known protocols, no need to discuss in an MDT, which is used by some to show authority and used for hidden agendas’. Initiate treatment prior to MDM ‘In haematology, this essentially happens already as the many patients commence treatment prior to the MDT and in fact would benefit from discussion much later when all prognostic results are available’. | Protocols prevent individualised care ‘Every patient is unique and the issue with having a protocoled pathway is that this may not necessarily meet with the needs of the patient’. ‘I disagree with protocolised treatment without discussion, as this does not reflect the holistic care that all patients should receive’. |
| Pre-MDT meeting to select cases for streamlined discussions | Pre-MDT meetings could contribute ‘This streamlining is done for MSCCpatients,where a smaller meeting is done during the week and is listed on the main MDT for documentation purposes’. | Pre-MDT will take more time ‘Initiating a pre-MDT will cause problems with job planning for already busy clinicians’. Increased process complexity could lead to errors ‘Another meeting would simply add more complexity, a greater chance for patients to get lost in an already creaking system that is barely coping with care delivery?’ |
| Clinicians to make independent decisions about treatment | Clinicians should make decisions for routine cases ‘Let's just return to relying on clinicians' specialist training and judgement for routine cases’. | Individual clinician decisions may compromise patient safety ‘This is potentially a dangerous backward step. The main function of the MDT is to prevent maverick clinicians treating patients without approval of the MDT…’. |
MDM, MDT meeting; MDT, multidisciplinary team; MSCC, metastatic spinal cord compression; pts, patients.