Research On The Evaluation Of Team-working And Team Performance For Cancer MDTs And Improvement Strategies

[Objective] Based on the MDT Team-Working Assessment Measurement(TEAM),this study uses qualitative and quantitative methods to initially construct an assessment questionnaire of cancer MDT team-working,providing an effective evaluation and supervision of the MDT working in China.The newly developed questionnaire was used to evaluate and analyze the current status of the construction and operation for cancer MDT in China.By exploring the relationship between the MDT dimensions and the attitudes,the behaviors of medical staff in MDT relatively,the key elements in MDT management are summarized.The relevant theories and practical cases of team construction and management at home and abroad are combed,the MDT management experience and results are summarized,and the problems in practice are analyzed.To further develop MDT in practice,the strategies for optimizing the management of the cancer MDT are proposed.[Methods] 1.Literature research Search relevant theoretical and empirical literature on team working,process assessment of cancer MDT and the KAP theory.Combing the connotation of team-working,the theory of KAP,and the possible relationship between the two,analyzes related researches to provide reference for the research framework,sample selection,analysis methods and tool design.Summarize the advanced experience of MDT at home and abroad to provide improvement strategies.2.Expert consultation(1)Select 8 relevant scholars major in medical and health field,through focus group discussion and interviews to discuss some related topics,such as the process and key of MDT team working,the evaluation mechanism for implementation process of the health service project and the related theories on team building.(2)8 clinical specialists and administrative experts from Hubei Tumor Hospital and ChongqingTumor Hospital were selected.Two rounds of expert consultations were conducted on the preliminary MDT questionnaires for cultural adjustment and content validity evaluation.3.On-site research and secondary data collection Wuhan,Guangzhou,Shenzhen,Chongqing and Taiyuan were selected for investigation,which come from the central,southern,western and northern regions of China.According to stratified non-random sampling,a total of six sample hospitals were obtained.The first category was in the initial stage of MDT development,and the second category was in the substantive stage of MDT development,including three specialized cancer and three comprehensive hospitals.(1)Secondary data collection for sample hospitals.including:(1)related literature on the basic situation of hospitals and the cancer MDT(2)operating standards for MDT implementation in hospitals(3)documents for performance assessment,reward and punishment(4)summaries for MDT practice in hospitals such as reports,articles and other relevant information.(2)On-site questionnaire survey.In the first type of hospital,3-4 cancer MDTs more standard were selected and 5-7 cancer MDTs were selected in the second type of hospitals.For all members of the MDT group selected by each sample hospital,including expansion members,a questionnaire survey was conducted and the total number of questionnaires were 331.(3)Personal in-depth interviews were conducted with sample hospitals including hospital administrators,hospital administrators,tumor MDT team leader,and various members.A total of 25 people were interviewed.4.quantitative analysis A database was set up with Epidata 2.0,and SPSS 21.0 and AMOS 21.0 were used for quantitative data analysis.NViVo 11.0 was used for qualitative analysis.(1)Descriptive analysis.Descriptive analysis was used to summarize the basic information of the samples.(2)Univariate analysis and multiple linear regression analysis.By using one-way analysis of variance and chi-square test,we explored the differences in attitudes and behaviors of medical personnel in terms of personalcharacteristics.Taking attitude and behavior as the dependent variables,using related factors and five dimensions of team-working as independent variables,multiple linear regression analysis was conducted.(3)Path analysis.Using path analysis to explore the possible relationships between the various dimensions of team working and the attitude,behavior of medical staff,Analyze and explore the key links in the process of MDT team working.5.Qualitative analysis(1)Content analysis was used to summarize the interview,about actuality of the MDT,suggestions of team working,and the enthusiasm of the medical staff.(2)Selecting some hospital as a typical case,analyzes its history,operation,results and existing problems,and summarizes the experience and enlightenment that can be promoted.[Results] 1.After inspection by various indicators,the initial MDT self-evaluation questionnaire for the medical staff in this study have good reliability and validity.The split-half reliability coefficient was 0.883,P<0.01,the overall Cronbach's ?coefficient of the questionnaire was 0.911,and the Cronbach's ? coefficients in all dimensions were all above 0.7,suggesting that the internal consistency reliability was good;the same sample group scored twice before and after and the difference(P >0.10)was no significant,suggesting that the test-retest reliability is better.Among the39 questions,35 have I-CVI> 0.78 and Kappa values> 0.74.S-CVI/UA> 0.80,S-CVI/Ave> 0.90,suggesting that the content validity is good.The KMO coefficient was 0.940,Bartlett's test P value was less than 0.05.Five common factors were extracted through the rotation axis and the eigenvalues were all >1.The total variance explained was 62.42%,indicating that the structural validity was good.2.generally,the specialty hospitals generally score higher than the general hospital questionnaires.Hospital E scores high in most dimensions of the questionnaire,and all hospitals have lower scores in the fourth dimension.The rankingof the overall scores was Hospital E(149.25± 13.77),Hospital D(149.25 ± 13.77),Hospital F(149.25 ± 13.77),Hospital C(138.33 ± 13.92),and Hospital B(132.03 ± 16.08).There are significant differences in different disease of different hospitals and even in the same hospital.3.The third dimension has the largest direct influence on behavior(Beta=0.277,P<0.01),which exceeds the influence of attitude on behavior(Beta=0.146,P=0.015).The fourth dimension has no significant correlation with other dimensions,and mainly directly influences attitude(Beta=0.483,P<0.01).The fifth dimension has a negative influence on attitude(Beta=-0.149,P=0.033).The second dimension has no influence on Attitude and behavior,but is strongly related to the first,third,fifth dimensions(r=0.720?0.693?0.620),and is the only dimensions related to material conditions.The first dimension has an influence on behavior(Beta=0.176,P=0.020).It is mainly the content of spiritual culture,and has strong correlation with the second,third,fifth dimensions(r=0.720?0.785?0.693).Whether the core team members,working years and education have a significant influence on attitudes(Beta=0.120,0.153,0.162,P=0.040,0.006,0.002).Gender and working years have a significant impact on behavior(Beta=0.174,0.133,P=0.002,0.017).4.Use the content analysis to summarize ten aspects related to MDT team-working in interview.They are membership,case selection,patient participation,participation of MDT team members,the key and issues in MDT team-working,fees,inter-school exchanges,work that needs to be done,and comparisons between specialist and general hospitals.A typical case analysis was conducted at the Chongqing Cancer Hospital.Highlights included the establishment and promotion of a cancer system,improvement of the chief expert regulation,comprehensive development of cancer MDT related project,and continuous improvement of MDT management.[Conclusions] 1.It has a certain value to assess the team working of cancer MDT in China,butit is necessary to do more research and further revise and test the questionnaire.2.Currently,specialist hospitals generally perform better than general hospital.MDT work is generally less patient-centered in sample hospitals,and there are still many for improvement in management.It should be reasonable to select the disease to perform MDT and establish in stages,according to hospital nature,the specialty,disease needs,cost-effectiveness of MDT and so on.3.The third dimension has certain value for quickly improving MDT working efficiency.The fourth dimension can be independently developed and promoted,which can improve medical personnel's attitude.It is unsuitable to strengthen the fifth dimension alone.Joint management should be carried out even in advance,such as improving the recognition of medical personnel.The second dimension may be the basic condition for other dimensions,and the first dimension may be a prerequisite for the spiritual level.Some personal characteristics can serve as a reference for the management of different groups.4.Strengthen the initiative of the medical staff by strengthening the publicity and administrative call and establishing incentive and protection mechanism.Pay attention to patient needs,screen cases rationally,make individualized treatment decisions,emphasizing patient-centered MDT Management.Emphasis post-conference management,as well as assessment,summarization and feedback of MDT,forming a complete closed-loop management based on information.Focuses on the training and reserve of talent and achieve strategic layout and sustainable development with openness,differentiation and orderliness.