Chiropractic + Naturopathic Doctor • May 2020 • A true approach to collaboration

A look at interdisciplinary vs. multidisciplinary clinics for patient care and satisfaction

Many clinics offer multidisciplinary approaches to care, where patients can utilize a variety of services from numerous health care professionals. While offering a variety of services may be attractive to therapists and patients alike, these independent therapists may not be providing continuous patient experience.

The patient experience is what keeps them coming back to your clinic, along with the excellent care they receive. Prakash (2010) listed patient satisfaction as a useful indicator of success in medical practice. While patient satisfaction encompasses a variety of factors, high levels of satisfaction equate with higher levels of patient retention and improved clinical outcomes.

Some clinics operate with several independent contractors who rent space in the clinic to provide their professional services. While this is a solid business practice, it may lead to a silo-based approach for the patient. This silo-based approach could involve the patient visiting several different practitioners for the same complaint and recounting their entire history repeatedly to receive a full complement of the necessary therapy. While this may undoubtedly be beneficial and result in good therapeutic and clinical outcomes, it lacks an authentic, collaborative feel.

For health care professionals, it is vital to establish trust with their patients as well as their health care network. Communication between professionals is essential so that they can deliver the highest standard of care and not be concerned about who “owns the patient.” True interprofessional collaboration breaks the stigma surrounding the stealing of patients and focuses on optimizing the shared patient experience on behalf of all health care professionals involved.

When a patient enters a multidisciplinary clinic, they essentially have two options:

1.Each therapist they will see for their complaint operates independently, and it is up to the patient to communicate the diagnosis and plan of management between practitioners

2.The clinic operates using a truly interdisciplinary model, where the therapists will collaborate on behalf of the patient.

In our professional experience, offering an interdisciplinary model can provide improved clinical outcomes. Being truly interdisciplinary, rather than multidisciplinary, involves a synthesis of approaches to achieve a coordinated and coherent whole (Choi and Pak, 2006). This approach relies heavily on teamwork in healthcare. Nancarrow et al. (2013) define teamwork in healthcare as “a dynamic process involving two or more health professionals with complementary backgrounds and skills, sharing common health goals and exercising concerted physical and mental effort in assessing, planning, or evaluating patient care. This teamwork is accomplished through interdependent collaboration, open communication and shared decision- making. In turn, this generates value-added patient, organizational and staff outcomes.”

This definition allows for individuality amongst health care professionals, but emphasizes communication and prioritizes patient care through collaboration.

While many manual therapists offer similar treatment approaches, each person has a specific niche and skill set that can be maximized to enhance the patient experience. We are advocates of using a collaborative team-based approach, whether the patient requires one profession or multiple, with open communication amongst health care professionals and the patient to provide optimal results and an amazing therapeutic experience. Communication with the patient to ensure they understand their condition and their proposed course of care, as well aa communication amongst health care professionals is key.

While the approach our team uses may not necessarily be ideal for every clinic or practitioner, we utilize the following forms of communication:

• We have well-defined vision and mission statements for the clinic. Each therapist is encouraged to use these statements and develop their own, to help guide them.

• Weekly division meetings and bimonthly team meetings ensure our entire team is aligned in terms of providing cost-effective and time efficient care based on the patient’s diagnosis and management plan. We utilize our differential diagnoses to provide patient education as well as a combination of active and passive therapies that can be done both in-office and at home.

• Coaching sessions are offered amongst our team to ensure trust and enhance both communication and the quality of care we provide.

• We encourage open lines of communication regarding cases, patients, research, and treatment techniques.

• All of our health care professionals utilize an electronic medical record in accordance with their respective college guidelines. This allows all of our professionals to share assessment and treatment notes, and communicate regarding patient progress. Be sure to consult your relevant college guidelines concerning patient information.

• We have a formal position within our clinic devoted to communication. This communications manager helps facilitate our team interactions and maintain open lines of dialogue.

Here is one example of how our team functions as an interdisciplinary unit: Recently, a 12-year old skier presented to the clinic with a chief complaint of left knee pain. The pain occurred following an incident on the ski hill, where his skis become crossed, and he experienced a valgus collapse with tibial internal rotation. He presented to the chiropractor, who performed an assessment and felt that the issue was primarily mechanical rather than structural. Following a manual therapy treatment, he was referred to the physiotherapist for manual therapy and rehabilitation. After a brief discussion between the two health care professionals, they agreed that as a precaution, they would advise the patient to consult with a sports physician for imaging if the pain did not subside within two weeks. This allowed the two independent health care professionals to observe the patient and assess his injury. While we did not evaluate the interrater reliability of our assessments, we agreed regarding the treatment plan. Throughout this process, there was open dialogue and sharing of clinic notes between the various health care professionals involved in the case. Following his acute phase of treatment, our patient was able to walk and run pain-free with a full range of motion in his knee. While he still had mild pain with more challenging movements, such as cutting and jumping, he was doing much better. The chiropractor that initiated the plan of management then sat in on treatment with the physiotherapist to observe the patient and maintain open communication.

To have a truly interdisciplinary practice requires trust, open communication with the patient and across health care professionals, an ability to change and adapt the treatment plan based on shared decision making, and a focus on patient satisfaction. At the end of the day, patient satisfaction is paramount.

We encourage you to assess your operations and ask if the care you provide is multidisciplinary or interdisciplinary.

DR. BRETT GUIST BHSc, MS, DC, CSCS, graduated from CMCC in 2015. Brett has been involved in research projects and has been published in several peer-reviewed journals. He continues to be involved in academia by lecturing at CMCC in orthopedics, diagnosis, chiropractic technique, and rehabilitation.

COLBY BUCCI BA (KIN), MScPT, is a managing partner of The Centre for Fitness Health and Performance in Toronto, Ontario. He believes in a whole system treatment approach, consisting of manual therapy, education, lifestyle advice and exercise prescription.

DR. CHRIS OSWALD BSc, DC, owns and operates The Centre for Fitness Health and Performance in Toronto, Ontario. Dr. Oswald is also the founder and creator of MuscleCare, a product line ranging from topical ointments, to ergonomic pillows, to back supports.