Model of multidisciplinary teamwork in hip fracture care: a qualitative interview study

Objectives
Hip fractures are common injuries in older age with high mortality requiring multidisciplinary clinical care. Despite guidance, there is considerable variation in hip fracture services and patient outcomes; furthermore, little is known about how successful multidisciplinary working can be enabled. This study aimed to characterise professionals’ views about the core components of multidisciplinary teamwork in hip fracture care.

Design
The study comprised qualitative interviews with healthcare professionals delivering hip fracture care. Interviews were audio-recorded, transcribed and analysed abductively: material was coded inductively and grouped into higher level concepts informed by theories and frameworks relating to teamwork.

Setting
Four hospitals in England.

Participants
Participants were 40 healthcare professionals including orthopaedic surgeons, orthogeriatricians, physiotherapists and service managers.

Results
Results identified four components of successful multidisciplinary teamwork: 1) defined roles and responsibilities, 2) information transfer processes, 3) shared goals, and 4) collaborative leadership. These were underpinned by a single concept: shared responsibility, Defined roles and responsibilities were promoted through formal care pathways, reinforced through induction and training with clear job plans outlining tasks. Information transfer processes facilitated timely information exchange to appropriate individuals. Well-defined, common purpose was hindered by complex inter-disciplinary professional relationships, particularly between orthogeriatric and orthopaedic staff, and encouraged through multidisciplinary team meetings and training. Clinical service leads were integral to bridging interdisciplinary boundaries. Mutual trust and respect were based on recognition of the value of different professional groups. Teamwork depended upon formal clinical leads with facilitative and motivational roles, and on hospital leadership that created an environment supporting collaboration. Shared responsibility for patients was encouraged by joint orthopaedic and orthogeriatric care models. Staff shared responsibility by assisting colleagues when needed.

Conclusions
Shared responsibility across the multidisciplinary team is fundamental to delivery of hip fracture care. Findings will inform development of clinical practice recommendations and training to build teamworking competencies.