Introduction[edit | edit source]
Cohen and Mohrman define a team as ”a group of individuals who work together to produce products or deliver services for which they are mutually accountable”.  The shared goals of the team are made manifest by mutual and cordial interaction by team members, and the roles of each professional in the team are mutually interdependent and accountable to enable achievement of set goals. Similarly, Eduardo Salas defines a team as a “distinguishable set of two or more people who interact dynamically, interdependently, and adaptively toward a common and valued goal, objective or mission, who have been each assigned specific roles or functions to perform, and who have a limited life-span of membership.”  Basically a team consists of a group of people with complementary skills who are committed to a common purpose, performance goals, and approach, for which they hold themselves mutually accountable.
"The premise underlying team care has always been that assorted professionals, each contributing their own discipline's expertise and closely cooperating through oral (team rounds, informal hallway discussions etc.) and written communication (medical record entries, reports etc.) are able to achieve outcomes that are superior to those of a lone clinician, or of a number of different clinicians each practising independently of all others."  Reliance on multifaceted team-based care enables an evolving health care system to address the changing patient needs with regard to physical, psychological, and social aspects of health.
Types of Teams[edit | edit source]
The terms “multidisciplinary,” “interdisciplinary,” and “transdisciplinary” are increasingly being used interchangeably to define health and social care and rehabilitation teams and outline the various degrees of involvement of the multiple disciplines within the team environment, but there are clear differences between these different approaches to care. 
Multidisciplinary[edit | edit source]
According to Jefferies & Chan (2004), multidisciplinary team working is described as the main mechanism to ensure truly holistic care for patients and a seamless service for patients throughout their disease trajectory and across the boundaries of primary, secondary and tertiary care. The Multidisciplinary Team (MDT) is a team of professionals that includes representatives of different disciplines e.g. Physiotherapy, Occupational Therapy etc., who coordinate the contribution of each discipline with little overlap to assess and treat the patient separately with discipline specific goals. There are different definitions and descriptions which capture important features of multidisciplinary work. Each discipline could function autonomously, working in parallel towards a shared goal; acknowledging one other’s contributions and sharing successes.  The patient’s progress within each discipline is communicated through written documentation and regular team meetings and as such does not emphasize an integrated approach to care. This type of team approach is predominantly what we see in an acute hospital setting. 
- Each discipline works in parallel with clearly defined roles with the team
- Each discipline sets their own individual, specific goals with the patient and communicates these goals and outcomes with the team through written documentation or within team meetings where appropriate
- In most cases within an Acute Setting the team is Consultant / Physician led
Interdisciplinary[edit | edit source]
Interdisciplinary teams differ from multidisciplinary teams in that they overlap practice with shared goals coordinated into a unified management plan, rather than working individually, allowing for group decision making and group responsibility, with the patient considered an active member of the team. Each team member in an interdisciplinary team build on each other’s expertise to achieve the common, shared goals. Patient progress is communicated through written documentation and regular team meetings as in the multidisciplinary approach but reports tend to focus more on the common overall patient goals rather than on discipline specific goals.  According to Fergusson (2014) an interdisciplinary care plan generally is developed by cosidering the following questions:
- What are the issues?
- Who will be involved?
- What will the interventions be?
- What are the goals of the intervention?
- When will re-evaluation occur?
- Professionals involved in joint problem solving
- Overlapping, patient focused teatment goals
- Collaboration with other disciplines
- Regular communication between team members
- Active involvement of the patient
Transdisciplinary[edit | edit source]
Transdisciplinary teams share roles across disciplinary boundaries so that communication, interaction, and cooperation are maximised among team members with an overlap of responsibilities that allows flexibility in problem solving and produces closer interdependence of team members. Team members jointly communicate, exchange ideas and work together to come up with solutions to problems from day one of working with the individual. In this approach, there is no hierarchy among the disciplines, and there is a higher level of communication and cooperation among the individual members of the organization.  Flexible boundaries and interchangeable roles and responsibilities encourage the exchange of information, knowledge and skills.The interwoven nature of transdisciplinary teams broaden the skill sets of each therapist due to their exposure and substantial interaction with others outside their discipline, but it also allows the team of professionals to work together to reinforce and maintain goals not normally monitored. With a truly transdisciplinary team, the typical boundaries of each professional discipline tend to disappear. 
The individual and family are central to this type of team and are respected as equal, and valued team members, often the final decision makers in the team. As such this model is an extension of the interdisciplinary team and seen as a family friendly approach, operating within a family centred practice model. This model is frequently used in environments where there are inadequate numbers and / or unavailability of specific disciplines e.g developing countries, rural or isolated communities, leading to other team members taking on these missing roles. 
- Professionals have an overlap of responsibilities
- Flexibility in problem solving
- Closer interdependence of team members
- Active involvment of the patient and family
Comparison of Teams[edit | edit source]
According to Kirshblum (2013) and Fergusson (2014) the collaborative approach is the fundamental difference between both the interdisciplinary and transdisciplinary team approach in comparison to the multidisciplinary team, which does not emphasize an integrated approach to care.  In the multidisciplinary approach each discipline approach a situation or problem from their own perspective and then share findings, often presenting problems with development of a cohesive management plan. This interdependance is also seen with interdisciplinary teams, but efforts are much more collaborative and team members work together toward a resolution, building on each other’s expertise to achieve common, shared goals. While with a transdisciplinary teams the lines are more blurred, and the typical boundaries of each professional discipline tend to disappear. The interdisciplinary approach to patient care has shown better results for team effectiveness in comparison with a multidisciplinary approach. 
Resources[edit | edit source]
References [edit | edit source]
- Mohman SA, Cohen SG, Mohrman AM. Sr. Designing Team-Based Organizations. San Francisco: Jossey-Bass.1995.
- Salas E, Dickinson TL, Converse SA, Tannenbaum SI. Toward an understanding of team performance and training.nce and training. In: Sweeney RW, Salas E, eds. Teams: their training and performance. Norwood, NJ, Ablex, 1992.
- Marshall, R and Hasnan, N. Chapter.27 Team Based Care. In: Chhabra HS, ISCoS Textbook on Comprehensive Management of Spinal Cord Injuries. International Spinal Cord Society. 2015
- Dijkers MP, Faotto RM. Team Size in Spinal Cord Injury Inpatient Rehabilitation and Patient Participation in Therapy Sessions: The SCIRehab Project. The Journal of Spinal Cord Medicine. 2012 Nov 1;35(6):624-34.
- Ferguson, M. Multidisciplinary vs. Interdisciplinary Teamwork: Becoming a More Effective Practitioner. 2014 Available from: http://www.socialworkhelper.com/2014/01/14/multidisciplinary-vs-interdisciplinary-teamwork-becoming-effective-practitioner/ (Accessed 2 October 2018).
- King JC, Nelson TR, Blankenship KJ, Turturro TC, Beck AJ. Rehabilitation Team Function and Prescriptions, Referrals, and Order Writing. Rehabilitation Medicine: Principles and Practice (ed by Delisa JA). 4th Ed, Lippincott Williams & Wilkins, Philadelphia. 2005:1051-72.
- Norrefalk JR. How do we Define Multidisciplinary Rehabilitation?. Journal of Rehabilitation Medicine. 2003 Mar 1;35(2):100-1.
- Jefferies H, Chan KK. Multidisciplinary team working: is it both holistic and effective?. International Journal of Gynecologic Cancer. 2004 Feb 1;14(2):210-1.
- Kirshblum, S. The Academy of SCI Professionals: Multidisciplinary or Interdisciplinary?Journal of Spinal Cord Medicine. 2013 Jan; 36(1): 3.
- Melvin JL. Status Report on Interdisciplinary Medical Rehabilitation. Arch Phys Med Rehabil. 1989;70(4):273–6 [PubMed]
- Körner M. Interprofessional Teamwork in Medical Rehabilitation: A Comparison of Multidisciplinary and Interdisciplinary Team Approach. Clin Rehabil. 2010;24(8):745–55 [PubMed]
- Bakheit AM. Effective Teamwork in Rehabilitation. Int J Rehabil Res. 1996;19(4):301–6 [PubMed]
- Interprofessional Teamwork in Medical Rehabilitation: A Comparison of Multidisciplinary and Interdisciplinary Team Approach. Clin Rehabil 2010;24:745-55.