title: Use of a formal consensus development technique to produce recommendations for improving the effectiveness of adult mental health multidisciplinary team meetings.
abstract: BACKGROUND
  Multidisciplinary team (MDT) meetings are the core mechanism for delivering mental health care but it is unclear which models improve care quality. The aim of the study was to agree recommendations for improving the effectiveness of adult mental health MDT meetings, based on national guidance, research evidence and experiential insights from mental health and other medical specialties.
  
  
  METHODS
  We established an expert panel of 16 health care professionals, policy-makers and patient representatives. Five panellists had experience in a range of adult mental health services, five in heart failure services and six in cancer services. Panellists privately rated 68 potential recommendations on a scale of one to nine, and re-rated them after panel discussion using the RAND/UCLA Appropriateness Method to determine consensus.
  
  
  RESULTS
  We obtained agreement (median ≥ 7) and low variation in extent of agreement (Mean Absolute Deviation from Median of ≤1.11) for 21 recommendations. These included the explicit agreement and auditing of MDT meeting objectives, and the documentation and monitoring of treatment plan implementation.
  
  
  CONCLUSIONS
  Formal consensus development methods that involved learning across specialities led to feasible recommendations for improved MDT meeting effectiveness in a wide range of settings. Our findings may be used by adult mental health teams to reflect on their practice and facilitate improvement. In some other contexts, the recommendations will require modification. For example, in Child and Adolescent Mental Health Services, context-specific issues such as the role of carers should be taken into account. A limitation of the comparative approach adopted was that only five members of the panel of 16 experts were mental health specialists.
authors.affiliation: Department of Applied Health Research, University College London, London, WC1E 7HB, UK. r.raine@ucl.ac.uk.
authors.forename: Rosalind
authors.initials: R
authors.lastname: Raine
authors.affiliation: Department of Applied Health Research, University College London, London, WC1E 7HB, UK. c.bhaird@ucl.ac.uk.
authors.forename: Caoimhe Nic
authors.initials: CN
authors.lastname: a' Bháird
authors.affiliation: Department of Applied Health Research, University College London, London, WC1E 7HB, UK. P.D.Xanthopoulou@exeter.ac.uk.
authors.forename: Penny
authors.initials: P
authors.lastname: Xanthopoulou
authors.affiliation: Department of Applied Health Research, University College London, London, WC1E 7HB, UK. i.wallace@ucl.ac.uk.
authors.forename: Isla
authors.initials: I
authors.lastname: Wallace
authors.affiliation: Patient and Public Involvement Representative, North Trent Cancer Research Network, Consumer Research Panel, ICOSS, The University of Sheffield, Western Bank, Sheffield, S10 2TN, UK. daveardron@aol.com.
authors.forename: David
authors.initials: D
authors.lastname: Ardron
authors.affiliation: Patient and Public Involvement Representative, London, UK. miriam@harrises.eu.
authors.forename: Miriam
authors.initials: M
authors.lastname: Harris
authors.affiliation: Department of Statistical Science, University College London, Gower Street, London, WC1E 6BT, UK. j.barber@ucl.ac.uk.
authors.forename: Julie
authors.initials: J
authors.lastname: Barber
authors.affiliation: Royal College of Pathologists, 2 Carlton House Terrace, London, SW1Y 5AF, UK. archie.prentice@rcpath.org.
authors.forename: Archie
authors.initials: A
authors.lastname: Prentice
authors.affiliation: National Heart and Lung Institute, Imperial College London, Du Cane Road, London, W12 0HS, UK. s.gibbs@imperial.ac.uk.|Department of Cardiology, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK. s.gibbs@imperial.ac.uk.
authors.forename: Simon
authors.initials: S
authors.lastname: Gibbs
authors.affiliation: Division of Psychiatry, University College London, Charles Bell House, 67-73 Riding House St, London, W1W 7EH, UK. m.king@medsch.ucl.ac.uk.
authors.forename: Michael
authors.initials: M
authors.lastname: King
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, BS8 2PS, UK. j.m.blazeby@bristol.ac.uk.
authors.forename: Jane M
authors.initials: JM
authors.lastname: Blazeby
authors.affiliation: UCL Centre for Behaviour Change, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK. s.michie@ucl.ac.uk.
authors.forename: Susan
authors.initials: S
authors.lastname: Michie
authors.affiliation: Department of Women's Cancer, UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, Medical School Building, 74 Huntley Street, London, WC1E 6AU, UK. a.lanceley@ucl.ac.uk.
authors.forename: Anne
authors.initials: A
authors.lastname: Lanceley
authors.affiliation: Department of Plastic and Reconstructive Surgery, The Royal Free Hospital, Pond Street, Hampstead, London, NW3 2QG, UK. alexmacleodclarke@gmail.com.
authors.forename: Alex
authors.initials: A
authors.lastname: Clarke
authors.affiliation: Mental Health of Older People, Division of Psychiatry, University College London, Charles Bell House, 67-73 Riding House Street, London, W1W 7EH, UK. g.livingston@ucl.ac.uk.
authors.forename: Gill
authors.initials: G
authors.lastname: Livingston
mesh_terms: D000328:Adult; D003226:Congresses as Topic / Q000458:organization & administration*; D032921:Consensus; D019033:Delivery of Health Care, Integrated / Q000379:methods / Q000458:organization & administration; D006287:Health Planning Guidelines; D006801:Humans; D033183:Interdisciplinary Communication; D008603:Mental Health; D008605:Mental Health Services / Q000592:standards*; D017146:Models, Organizational; D011361:Professional Competence; D058996:Quality Improvement