Chairing and leadership in multidisciplinary cancer teams: Development and evaluation of an assessment tool
Authors: Jalil Rozh 
Published: November 2013

Introduction: The Multidisciplinary team (MDT) is defined as a "group of people of different healthcare disciplines, which meets together at a given time (whether physically in one place, or by video or teleconferencing) to discuss a given patient and who are each able to contribute independently to the diagnostic and treatment decisions about the patient". These teams meet regularly, review investigation results and discuss best available, evidence based treatment options for cancer patients. Cancer MDTs have been embraced in many countries as a standard practice to deliver cancer care. Evidence suggesting that MDTs are associated with better treatment decisions, improved survival and reduced in survival variation among hospitals has been reported. The role of MDT chairperson is central to effective-running of the meetings. The MDT chair exercises a broad range of functions and has ultimate responsibilities. These include ensuring integrity of team functioning, achieving team cohesion and goals in a timely and effective manner. These functions can only be served in a setting of collaboration between different professionals on the team and in the contribution to decision making. A good working relationship between the chair, MDT Coordinator and other team members is critical to the successful functioning of the team. In a leadership model, the leader has a unique role in decision making process that is different from other team members. Furthermore most effective leadership is when the leader guides or influences the team towards reaching the goal (which is a decision in a MDT meeting setting). In order to achieve this, a leader must have the necessary skills. The aim of this study was to develop a robust and valid tool to evaluate the MDT chairperson in leading the meeting through criteria that are set by MDT leads and members to be critical for a chairperson to have when leading and chairing the MDT meeting, as no tools exist for assessment. Our objective was to construct a robust tool for assessment of MDT-chairing performance. Methods: An observational tool was developed to assess the chairing and leadership skills of MDT chair. The tool includes 11 elements of effective MDT chairing. After it was content-validated by 10 senior MDT members, the MDT chair person was assessed by two surgeons (blinded to each other) in seven live-observed Urology MDT meetings (286 cases) and ten video recorded MDTs (131 cases) of different specialties. All chairing elements were analysed via descriptive statistics. Intraclass Correlation Coefficients (ICCs) were used to assess inter-rater agreement and assessors' learning curves. Results: The inter-rater agreement was adequate-high (ICC= 0.63-0.91) for all of the chairing elements. Agreement was higher in live MDT ratings (mean 0.79, SD 0.092) compared to video ratings (mean 0.72, SD 0.069). Conclusion: an observational assessment tool can be reliably used for assessing the chair person in cancer MDTs (both in live and video-recorded). Such robust assessment tools provide part of a toolkit for MDT leadership evaluation and enhancement. The ability to feed back their performance to MDT leads can enable promotion of good practice.