Analysis And Strategy Of Influence Factors On The Implementation Of Multi-disciplinary Team In A 3-A-grade Comprehensive Hospital In Guangdong Province

BackgroundWith the rapid development of medical technology and further subdivision of medical subjects, each clinical subject or subspecialty has gradually upgraded. However, doctors’scope of clinical knowledge becomes increasingly narrower. In addition, the progress of the society and the alternation of people’s life style resulted in the changes of disease spectrum. The medical pattern has transformed from the homogenous biological mode to the Bio-psycho-Social Medical Pattern, which requires doctors to consider patients as an integrated system, and to solve medical problems through a more general knowledge. Multi-disciplinary teamwork has become the best treatment mode, which is fully approved by experts from home and abroad.Comprehensive hospital has professional advantages and a wide range of disciplines, but there exists mechanism defects due to the over division of subjects, which benefits the development of subspecialties but ignores the integration of disciplines. After the implementation of grading treatment system, large comprehensive hospitals should focus on the treatment of critical illness and incurable disease. This task could only be completed by multidisciplinary teamwork, which provides patients with therapeutic regimens. Therefore, it will be an inexorable trend for large comprehensive hospitals to break the boundaries of specialties and to form the chain of diagnosis and treatment, which brings better treatment for patients with the help of multidisciplinary teamwork.In the traditional consultation of incurable disease, outpatients would be assigned to different specialists, while inpatients would be diagnosed individually by doctors in certain department. Such kind of consultation not only increases patients’ consulting time due to the complicated process, but also causes patients’ confusion when argues occur because of communication failure between different specialties. On this basis, the consultation model of MDT excels, for it optimizes medical treatment process, and improves patients’ experience.ObjectiveMDT model has not yet been popularized since the day it was introduced. Due to the imperfect domestic medical system and the interest conflict between clinical departments, MDT model sticks in a dilemma in implement and promotion, and faces difficulties in forming an effective mechanism which fits national or local conditions. Therefore, it is necessary to study and analyze the factors in implementing MDT model, and then propose targeted countermeasures and suggestions. The objective of this paper is mainly to, taking a certain 3A grade hospital as an example, find out the difficulties and influencing factors in implementing MDT model through literature analysis and surveys, and then to proposed feasible countermeasures.SignificanceThe research of MDT model is of great value for the medical industry in our country. This research would provide medical administrative departments with references in the practice of MDT model. Furthermore, this research would play a role in providing learning experience to other comprehensive hospitals which are eager to carry on MDT model, and in that way, promote the applications of this new medical service model that benefits the health of all people.Contents(1) To investigate the current situation of MDT model using literature review, survey questionnaires, and face to face interview method. And it mainly focuses on the status quo of MDT model, patient and doctor’s awareness about MDT model.(2) To find out influencing factors systematically through statistics and induction based on the data in questionnaire and literature.(3) To propose countermeasures targeting each influencing factor in order to promote the development of MDT model and to provide experience for hospitals all over the country.Methods(1) Literature analysis:literatures related to MDT model were mainly collected through electrical databases such CNKI, Wangfang, VIP, Pubmed and ScienceDirect. After summarizing related theories, the subjects, contents and methods of this study are decided.(2) Face to face interview:interviews were made in the certain hospital with the doctors having or not having established MDT, and heads of administrative departments. The purpose of the interviews is to get to know the current condition of MDT model and the influencing factors in implementation.(3) Questionnaire survey:questionnaires were designed aiming at two groups including patients and doctors, and revised after pre-survey. Of the 249 questionnaires collected,141 were from patients, and 108, doctors. Main contents of the questionnaires were to look into patients’ awareness of MDT,and doctors’ awareness of implementing MDT.Through the survey, feasible suggestions would be made considering the current situation and difficulties of MDT implementation.(4) Statistic analysis: data collected were studied by statistic analysis.Qualitative analysis and quantitative analysis were both applied to made the result more reasonable and more precise.(5) Systematic analysis: a systematic and objective analysis of implementation situation of MDT was made in order to find out all influencing factors.Results The result of this study indicates that the implementation of MDT model in the certain hospital is influenced by six factors including medical system, social awareness, system construction,operation mode,price charges and team culture.These factors can be further induced as followed:① Medical system: the traditional teaching method and course designed hider the development of MDT to some extent.② Social awareness; patients lack knowledge of MDT, and even have some misunderstanding.③System construction: the system constmetion of MDT is lagging behind, which lacks specific operation procedures and standards.④Operation mode:it is difficult to cany on the "three-fixed-modd" which means fixed time,fixed location,and fixed staff. In addition, MDT model is not suitable for traditional out-patient procedure. ⑤Price charges: there is no clear price of medical service of MDT interiorly, it is difficult to reflect the value of MDT⑥ Team culture:MDT team has to be led by movers and shakers and run by kindred spirits in order to ensure the durable effective operation.Countermeasures are proposed aimed at the six influencing factors:① to explore talent training fitting MDT development, and to enhance doctors’ awareness of MDT. ② to popularize the MDT model in more angles in order to increase patients’ need in MDT. ③ in the aspects of nation, to speed up in the construction of implementation principles of MDT. In the aspects of hospital, to improve related administration system. ④ through applying MDT in diverse forms and "2.5 fixes" mode, to carry on hierarchical appointment system, and to establish MDT assisted information system, in order to improve operation mode of MDT, and improve working efficiency. ⑤ the price monitoring department should modify the price of medical service which needs to reflect the value of MDT. ⑥ to establish incentives based on performance appraisal, and to encourage the formation and development of MDT team.