Table 2 Summary of developed themes and recommendations

Healthcare: a deeply embedded hierarchy

Subthemes

1. Physician authority

2. Factors influencing hierarchical decision-making

3. Perceptions of influence vs. experienced power

4. COVID-19 exposing contrasting experiences of interprofessional care

1.

“…we are still very much in a medical model, so the attitude and behaviour of the consultant is probably a really big factor in terms of how multidisciplinary teams work” (AHP02)

“doctors will tend to kind of, I suppose, they are first in command and it’s what they say kind of goes… it’s a historical issue. I think it’s probably just a structural thing within the teams here, ultimately, people are in an acute setting because of medical issues” (AHP11)

The governance of care must be reviewed and policies introduced to instil interprofessional decision-making irrespective of team context (e.g. team location (i.e. acute vs. community) or speciality).

As healthcare contexts are dynamic and continuously changing, future research should endeavour to explore the evolution of perceptions of power within MDTs.

2.

“So I think pressure, probably makes diamonds and that’s perhaps where you know team being the diamond in the emergency department we’re very reliant on it and we’re very reliant on team members” (Med10)

“…it often comes down to the specialty of the consultant. So we would find that you know maybe care of the older person would have a much greater understanding of the role that others play in overall patient care. I think the surgical disciplines tend to be much kind of cleaner- we go in, we take out whatever we need to take out, we operate, we do whatever and after that they’re less involved, I guess and it’s sort of like, look, you know what’s going on for the patient outside of here doesn’t really have any bearing in terms of their decision making” (AHP02)

3.

“{senior physicians} are the most influential…there’s no denying that there’s a huge positional difference… there’s a vast space between a consultant, and everybody else sitting at the table” (AHP06)

“I suppose there is that sort of hierarchy and even though you learn about organizational change and culture and you’re kind of tiptoeing around it and trying to kind of make it a win, and kind not step on egos and ask for advice and look for engagement {from senior managers} ehm because it’s never really going to be successful if you don’t get that management buy in” (Med09)

4.

Community

“for the first few months, ehm there was there was absolutely no communication, so I didn’t have access to you know, like say group telephone, you know the conference calls. So it was very much on an individual basis, and it kind of nearly felt for a while that you were holding the risk because you hadn’t a clue what was going on with the other team members, you hadn’t a clue… you know even in terms of the clients treatment plan it’s like everything just stopped” (AHP01)

Acute

“our team definitely bonded and got closer…especially in the early days of COVID like in March, April we were looking I guess at the TV and looking at scenes of Europe and other countries and thinking is this going to happen to us, so we very much just supported each other, you know because it was emotional some days and you really needed support and I felt like we all supported- it doesn’t matter who it, whether it was the cleaners, or the porters we all helped each other and supported each other so yeah I think definitely COVID did strengthen that relationship with everyone in the hospital” (Nurse03)

Team characteristics: the influence of team structure on MDT power dynamics

Subthemes

1. Team stability and visibility

2. Team interactions

1.

“…teams went kind of ward based for a lot of COVID, which was nice because you got to know people on a ward, and you were stuck with the same nursing staff, the same physiotherapist, the same occupational therapist, same social worker, same SLT, same dietetics, same chaplain for one ward which I think a lot of people did enjoy as opposed to traipsing around different sides of the hospital like it could be 20 min from one ward to another and you don’t know anyone up there and it’s just, it’s kind of more difficult. So I don’t know, ward based care probably did ehm have a positive impact” (Med05)

“we can be little bit isolated in that we get a list of patients to X Ray through the radiology information system and we could be just working away on those patients all day, all long without a lot of interaction or a lot of interaction with other disciplines unless they’re kind of coming to us directly for something. So it’s easy for us, I feel, to kind of be quite cut off unless you go out there and make those interactions happen” (AHP05)

Future research should endeavour to assess the feasibility of implementing ward-based care models to promote greater interprofessional collaboration.

2.

“the textures and the qualitative components of how we work within our professional domains, I think, is lost by the fact that we don’t meet. Like when you hear a colleague discuss even discuss a case whether it’s in terms of them describing you know their understanding of the case or the formulation of the work they’re doing you just learn a lot intuitively from that and there’s a lot of the qualitative understanding of one another’s roles. I think that’s kind of absorbed in those team meetings and in the absence of that, there’s much more sense of well again it’s like private practitioners in a sense” (AHP08).

“a massive, massive kind of effect or impact of COVID on that has been that we haven’t been able to meet as a team and kind of bond our relationships…” (AHP11)

“MDTs are still via zoom which is quite problematic… there isn’t as much of a flow in the interaction” (AHP17)

Development of local policies to ensure regular face-to-face MDT meetings occur when permitted by COVID-19 guidelines.

Ongoing effort to stimulate true collaboration

“for me creating a healthier environment is for everybody to actually understand their own worth and understand each other’s worth and that there’s… and that needs to start, probably in like nursing courses and doctor’s courses and then just courses that… because if the hierarchy’s there in the schools and then it’s there in the junior jobs it just sustains it I think” (Med09)

“like we did a thing as well before where say we had a group of really difficult patients and there just seemed to be like no result, there seemed to be nothing achievable with them but instead of us all going off to do our own say training needs or you know whatever we needed, we actually did it as a team… it was really, really good because then all of you know rather than the nurses coming saying oh we did a 3 day course in whatever that nobody else knew what we were talking about but we all did it together and kind of brought our brainstorming and that was really good” (Nurse01)

“…training development, no matter how small it is, it’s really important for understanding the roles that others have to play… there’s really small you know little tools and strategies you can use- lunches and learns or whatever it is that I think do help” (AHP13)

A more inclusive undergraduate curriculum is needed to weaken traditional status boundaries and improve interprofessional relationships.

Ongoing interprofessional training is necessary to promote and maintain collaborative MDT working.