Pain management, especially chronic pain management, is characterised by using an interdisciplinary approach rather than a multidisciplinary one. Distinguishing between the two can be a case of splitting hairs at times, but the fundamental difference is that in multidisciplinary teams, treatment is carried out by different team members who may work with the patient concurrently, but not necessarily using the same underlying model or framework for treatment. In an interdisciplinary team, treatment is carried out by different team members using a common model to address common goals – working collaboratively and in close communication with each other.
Interdisciplinary teams take time to develop. The members of the team learn more about each other’s professional roles the longer they work together. They become familiar with, and trust each other to support the common messages such as ‘don’t use pain as your guide’, or ‘do no less on a bad day, do no more on a good day’. Interdisciplinary teams rely on each other to help the person with pain move forward towards the life they want to live. To become effective, interdisciplinary team members need to learn to trust each others practice, to have confidence in their own practice, and to develop a common language and approach to clinical situations they encounter.
The problem with these teams is that much of the ‘work’ of a team occurs during meetings, and meetings of groups of health professionals look costly. Five or more therapists sitting together for a couple of hours seems to be an inordinate waste of productivity when you think of the number of patients they could be seeing during that time! Not only that, but developing effective team processes including good induction and dispute resolution also takes time. And it’s invisible input with little visible output. No wonder managers think teams like this could surely be done differently.
The research on effectiveness of interdisciplinary pain management continues to support this model, despite erosion of it in some countries (notably North America). I’m not going to review the literature here, but a couple of good references (and yes, these are old ones, but still relevant) are Turk and Okifuji (1998), and Okifuji, Turk & Kalauokalani (1999), and of course, Main and Spanswick who wrote the book Pain Management: An interdisciplinary approach (2000). A more recent edition of this book has been published, further extending the application of the biopsychosocial model in pain management.
When we’re trying to identify what constitutes an effective interdisciplinary team so we can perhaps develop it more quickly, or refine it, the elements that make up a good team become incredibly complex. The individuals themselves, the communication style, the procedures that structure their work, the roles people play within the team – all of these elements need to be understood to work out how a good team becomes more than the sum of its parts.
Humphrey, Morgeson and Mannor (2009) produced a paper outlining a theory that considers not just the individuals and the roles they play within a team, but also the composition of the roles. Recognising that not all roles are made equal, in this paper they look at what they call ‘strategic roles’ – those roles that either encounter more problems, or are more involved in critical activities, or are in a central position in the workflow of a team. This definition describes strategic roles according to the structure of a team rather than the performance of a team.
They then looked at a number of teams (OK, they used sports teams, but the model can apply to health teams too), and identified that it is not the individuals within a team, but the roles they fulfil in a team that make a difference to the effectiveness of a team. Some roles are more important to the outcome than others. They then suggest that by investing more heavily in the ‘core roles’ of a team, overall performance increases – this investment could be in terms of resources available for the people fulfilling these roles, or rewards for those individuals in this role, or time available to the people fulfilling those core roles.
Another facet to this study looked at the place of experience and skill on team performance – it matters who has experience depending on the roles that person fulfils. This suggests that investing time, training and possibly even monetary reward for those people who fulfil important or core roles could pay dividends in terms of output or outcome of the entire team.
Interdisciplinary teams are complex beasts. While most of us work within some sort of team, many of us don’t know what our contribution actually does within the team. And most of us haven’t been trained in how to work effectively in teams – after all, our training has been primarily to develop our individual professional skills, rather than to recognise the strengths of a collective. Perhaps this is an area for us to explore in more detail – and maybe managers can learn from research such as Humphrey, Morgenson & Mannor’s team roles theory, and look at how to resource team members to enhance their work.
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Humphrey, S., Morgeson, F., & Mannor, M. (2009). Developing a theory of the strategic core of teams: A role composition model of team performance. Journal of Applied Psychology, 94 (1), 48-61 DOI: 10.1037/a0012997
Okifuji AA, Turk DC, Kalauokalani D. Clinical outcomes and economic evaluation of the Multidisciplinary Pain Centers. In: Block A, Kremer EE, Fernandez E, editors. Handbook of Pain Syndromes. Mahwah, NJ: Lawrence Erlbaum Publishers; 1999. pp. 77–97.
Turk DC, Okifuji A. Treatment of chronic pain patients: clinical outcomes, cost-effectiveness, and cost-benefits of multidisciplinary pain centers. Critical Reviews in Physical and Rehabilitation Medicine. 1998;10:181–208.