Inflammation is having a moment. Perhaps due to COVID-19 and the puzzling inflammatory cascade, all health practitioners are diving a bit deeper into the role of inflammation in illness and healing. With that in mind, we present this review of the function of inflammation in acute musculoskeletal injuries. An understanding of injury starts with a... MORE
Making the most of multidisciplinary teams
In a post-pandemic world, multidisciplinary teams (MDTs) become more important as sports professionals navigate best practices for their athletes to return to play. While they seem like a great idea, MDTs may lose their luster once you’re in the trenches. Jason Tee explains the intricacy and finesse required to fashion an MDT that provides the best outcomes for athletes.
In theory, MDTs increase the range of skills and expertise available to support athletes and treat patients. In practice, they are breeding grounds for professional mistrust and disagreement. Multidisciplinary teams promise improvements in patient outcomes but are often rendered ineffective by in-fighting and conflict(1,2).
Working within an MDT environment is inherently difficult. Team members from different professions inevitably adopt divergent approaches to dealing with the same problem(2). Teams consist of multiple colleagues with various tools but similar tendencies to want to use their preferred method at every turn. This diversity of perspective is what gives teams their strength, yet disagreements will inevitably present themselves.
Social scientists recognize that conflict is necessary for group success, but it often makes people feel uncomfortable or threatened(3). For practitioners working in the pressurized world of sports, this can be daunting. To address this problem, researchers analyzed a highly effective MDT serving elite athletes and described the principles and strategies used to develop their cohesion(4). This description provides beneficial insights into how to organize MDTs to obtain better performance and more positive results for the athletes they manage.
What is a multidisciplinary team?
An MDT is a group of professionals from one or more disciplines who make decisions in the best interests of their clients (see figure 1).
In Sports, MDTs are responsible for:
- Training prescription
- Injury prevention
- Injury rehabilitation and return to play
Figure 1: A multidisciplinary team
Creating a high performing MDT
The researcher’s identified a highly effective multidisciplinary team using a positive deviance approach. Positive deviance is a methodology in social change research that identifies and studies groups with the same resources and characteristics but different outcomes. In the current case, the sports team managed by the selected MDT lost approximately 20% fewer days to injury than teams with similar levels of resources in the same professional league. The investigators interviewed each member of the MDT to understand how the team managed to operate more effectively than their competitors.
Rather unsurprisingly, the researchers identified that the MDT was well supported operationally and its members demonstrated high levels of professional expertise. The group met frequently and had access to high-quality data to support decision making. However, lots of MDTs are full of experts, have access to reams of data, have more than adequate time for discussion, and are still ineffective. While important, the presence of these factors doesn’t define MDT success. Rather, the values that guide the interactions and behaviors of the MDT members are what appear to determine their positive outcomes.
Shared value system
Researchers have previously suggested that MDTs would function best if the MDTs members’ goals and values were aligned(5). The MDT interviews demonstrated that the members universally agreed that the team’s primary goal was to ensure that all players were as healthy as possible because, “Future sporting performance is driven by healthy performers.” On this basis, the deciding criteria for difficult decisions were always what is best for the athlete’s health. The MDT members also described shared values and principles that defined how they interacted with each other (see figure 2).
Figure 2: Shared value dynamic within a successful multidisciplinary team
Historically, a sports teams’ organizational structure is arranged hierarchically, with coaches as the key decision-makers. In this model, a performance support team leader gathers information from sports science and medical personnel and reports back to the head coach (see figure 3)(6). This type of organizational structure conflicted with two of the studied MDT values – that injury prevention is everyone’s responsibility, and all expertise is equally valued. As a result, an alternative flat organization structure was adopted (see figure 3). All MDT members had access to the players and other MDT members as required, and were thus able to collaborate effectively. In this model, all MDT members felt heard and included.
Figure 3: A comparison of hierarchical versus flat organizational structures for multidisciplinary teams.
Within the studied flat and unstructured organization model, group leaders emerged who were ultimately required to either make decisions or empower others to make decisions. As would be expected in professional sports, the coaches became the de facto leaders within the group, but the way they chose to manage the group was fairly unique. Guided by the MDT’s shared values, the coaches adopted a management style that displayed several agile management aspects.
Agile management processes have emerged from the software design industry. In the tech industry, teams design products for environments and consumers that are both complex and rapidly evolving. Therefore, their goals and performance indicators are often blurry and hard to pin down. As a result, agile management processes call for frequent iterative cycles that achieve small targets and assess goals in the context of the evolving understanding of the larger project (see figure 4).
In some ways, the world of professional sport mimics the software development environment. In sport, the basis for decisions changes from week to week depending on previous results, the upcoming opposition, injuries to key players, etc. As a result, situations frequently emerge that require dynamic and responsive planning.
Figure 4: Agile management iterative implementation cycle
The agile approach led to the development of unique management strategies for leading teams in dynamic environments. The following two tactics were used extensively by the MDT studied:
- Stand up meetings – Agile teams make use of short daily sessions to address problems and provide regular updates quickly. Each individual engaged in daily check-ins with other MDT members to fulfill this function.
- The person closest to the problem makes the decision – Agile leaders recognize that the person closest to the problem understands it best, and is, therefore, best positioned to solve it. While all team members contributed to the decision making processes, the professional responsible for that aspect of care ultimately made the decision (e.g., the physiotherapist decides the injury rehabilitation process). Each MDT member was trusted to make the best decisions in their areas of responsibility, without second-guessing from the team.
These strategies made every MDT member feel both valued and empowered in their roles.
Internet giant Google famously recruits the best of the best graduates into its employment each year. Yet, it recognizes that having a staff full of stars doesn’t necessarily equate to continued success. That why in 2012 they initiated Project Aristotle, a broad internal research project aimed at discovering what makes teams effective. The researchers identified that the number one trait of effective teams was the presence of psychological safety.
Psychological safety is a shared belief that the team is safe for interpersonal risk-taking(7). Within this type of culture, team members feel included, safe to learn, contribute, and challenge the status quo – all without fear of reprisal (being embarrassed, marginalized, or punished in some way). Psychological safety emerges when team members are trusted to fulfill their roles, and when all team members feel like they have a voice. While it is the team leader’s responsibility to create this environment, psychological safety also depends on active listening and sensitivity amongst all team members. Thus psychological safety is a function of the organizational structure, leadership, and individual contribution of all team members.
The MDT interactions of the studied team displayed all the hallmarks of a psychologically safe environment. The creation of a secure culture was essential to support the team’s desire for continuous improvement, whereby systems and processes were under constant scrutiny to identify areas of needed change. Improving working processes relies on both self-reflection and the ability to ask for and receive feedback. In more malevolent environments, well-intended feedback can be misconstrued as criticism or a lack of trust, leading to conflict. The presence of psychological safety in the studied MDT allowed for giving and receiving constructive feedback in a manner that was non-threatening and supported improvements in team processes.
This research presents usable information for anyone working as part of an MDT. While MDTs may naturally foster conflict, value-driven, agile, and empathetic management can improve both MDT success and athletic team performance. A common goal and shared values can guide MDTs to behave in ways that demonstrate trust in each other’s abilities and appreciation for everyone’s contributions. With these strategies in place, MDTs can fulfill their promise to leverage the team member’s different skills and expertise to provide better service to athletes and clients.
- Inter J Mental Health Nurs.2006 Mar;15(1):19-28.
- The Sport Psychologist.2004 Jun;18(2):204-17.
- Brown, R., Pehrson, S. Group Processes: Dynamics Within and Between Groups. Wiley-Blackwell; 2019 Dec 5.
- SportRxiv.com. 2020 May; doi: 10.31236/osf.io/7qh4c
- Psychological Thought.2016 April;9(1):15–23
- Br J Sports Med.2018 Aug;52(16):1014-1015
- Administrative Science Quarterly.1999 Jun;44(2):350-383