In 2014 a survey of 140 Victorian cancer multidisciplinary team meetings (MDMs) conducted by the Department of Health and Human Services (DHHS) identified significant variation in their operation. Development of a quality framework was recommended, which health services could use to measure their activities against state-wide standards. In response, Integrated Cancer Services (ICS) supported a project to develop this MDM Quality Framework.
The Framework is an agreed set of standards, indicators and measures, and a set of quality monitoring tools, for all Victorian cancer MDMs. It was drafted with reference to peer-reviewed MDM literature, DHHS policy, and consultation including clinician interviews, surveys, peer review and a test audit in seven tumour streams across five health services. Project validation included input from 25 phase one survey responses, 197 MDM participants, 40 ICS staff and 10 DHHS staff.
Standards developed included infrastructure support alongside “clinically facing” areas including patient referral and communications, and meeting organisation and conduct. Surveys asked MDM participants to rate recognition of the eight draft standards in their current practice. Three standards (meeting organisation, membership and leadership) received 100% support and a further three standards (infrastructure and organisational support, patient referral and MDM recommendations and communication) received over 90% support.
Framework audit tools were designed for auditors with limited understanding of MDM. The tools use a combination of data collection, MDM participant surveying, and interviewing. Organisations planning to improve MDMs will conduct a baseline audit against the Framework using these tools.
This audit will allow comparison of practice between MDMs within a service and against other services. This will establish future work and quality improvement through local and state-wide projects. Auditing will allow health services to align MDMs with existing accreditation activities, provide data to engage executive in change, and underpin business cases for improvement.
Post-implementation, quality improvement via routine auditing against the Framework will map success and future priorities. Improvement activities have already been initiated in two regional and one metropolitan health service that participated in the test audit.