Annals of Surgical Oncology

, Volume 19, Issue 13, pp 4019–4027 | Cite as

Developing and Testing TEAM (Team Evaluation and Assessment Measure), a Self-assessment Tool to Improve Cancer Multidisciplinary Teamwork

  • C. TaylorEmail author
  • K. Brown
  • B. Lamb
  • J. Harris
  • N. Sevdalis
  • J. S. A. Green
Healthcare Policy and Outcomes



Cancer multidisciplinary teams (MDTs) are well established worldwide and are an expensive resource yet no standardised tools exist to measure performance. We aimed to develop and test an MDT self-assessment tool underpinned by literature review and consensus from over 2000 UK MDT members about the “characteristics of an effective MDT.”


Questionnaire items relating to all characteristics of MDTs (particularly Leadership and Chairing; Teamworking and Culture; Patient-centred care; Clinical decision-making process; and Organisation and administration during meetings) were developed by an expert panel. Acceptability, feasibility and psychometric properties were tested by online completion of the questionnaire by 23 MDTs from 4 UK NHS Trusts followed by interviews with 74 team members including members from all teams and nonresponders. 10 of the MDTs also completed questionnaires that directly translated each characteristic to an item (for the five domains above) to test content validity.


A total of 47 items were created, each rated for agreement on a 5-point scale. A total of 329 (52 %) of 637 team members completed the questionnaire, including representation from medical, nursing and clerical MDT members. Responses correlated well with domain-specific questionnaires (r > 0.67, p = 0.01), most domain-scales had acceptable internal consistency (Cronbach alpha > 0.60), and good item discrimination (majority of items r < 0.20). Team members were positive about its value.


Self-assessment of team performance using this tool may support MDT development.


Team Member Item Discrimination Team Assessment Alpha Rating Cancer Team 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We thank the team members who participated in the development and testing of TEAM (as part of testing MDT-FIT) and the Trust personnel who facilitated their involvement; other affiliate members of Green Cross Medical Ltd who have supported this work; and the NCAT MDT Development steering group and subcommittee members for their input and comments. Supported in part by the NCAT. Sevdalis, Brown, and Lamb are also affiliated with the Imperial Centre for Patient Safety and Service Quality, which is funded by the National Institute for Health Research (NIHR).


  1. 1.
    Saini KS, Taylor C, Ramirez AJ, et al. Role of the multidisciplinary team in breast cancer management: results from a large international survey involving 39 countries. Ann Oncol. 2011;23:853–9.PubMedCrossRefGoogle Scholar
  2. 2.
    Kane B, Luz S, O’Briain DS, McDermott R. Multidisciplinary team meetings and their impact on workflow in radiology and pathology departments. BMC Med. 2007;5:15.PubMedCrossRefGoogle Scholar
  3. 3.
    Taylor C, Munro AJ, Glynne-Jones R, et al. 2010 Multidisciplinary team working in cancer: where are we now? BMJ. 2007;340:c951.CrossRefGoogle Scholar
  4. 4.
    Department of Health. Manual for cancer services. London: Department of Health; 2004.Google Scholar
  5. 5.
    National Cancer Action Team. National Cancer Peer Review Programme. Report, 2009/2010: an overview of the findings from the 2009/2010 National Cancer Peer Review of cancer services in England. London: National Cancer Action Team; 2010.Google Scholar
  6. 6.
    Lamb B, Brown K, Nagpal K, Vincent C, Green JSA, Sevdalis N. Quality of care management decisions by multidisciplinary cancer teams: a systematic review Ann Surg Oncol. 2011;18:2116–25.PubMedCrossRefGoogle Scholar
  7. 7.
    Lamb BW, Green JSA, Sevdalis N. Decision-making in surgical oncology. Surg Oncol. 2011;20:163–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Davies AR, Deans DA, Penman I, et al. The multidisciplinary team meeting improves staging accuracy and treatment selection for gastro-esophageal cancer. Dis Esophagus. 2006;19:496–503.PubMedCrossRefGoogle Scholar
  9. 9.
    Coory M, Gkolia P, Yang I, Bowman R, Fong K. Systematic review of multidisciplinary teams in the management of lung cancer. Lung Cancer. 2008;60:14–21.PubMedCrossRefGoogle Scholar
  10. 10.
    Burton S, Brown G, Daniels IR, Norman AR, Mason B, Cunningham D. MRI directed multidisciplinary team preoperative treatment strategy: the way to eliminate positive circumferential margins? Br J Cancer. 2006;94:351–7.PubMedCrossRefGoogle Scholar
  11. 11.
    Haward R, Amir Z, Borrill C, et al. Breast cancer teams: the impact of constitution, new cancer workload, and methods of operation on their effectiveness. Br J Cancer. 2003;89:15–22.PubMedCrossRefGoogle Scholar
  12. 12.
    Lanceley AS, Savage J, Menon U, Jacobs I. Influences on multidisciplinary team decision-making. Int J Gynecol Cancer. 2008;18:215–22.PubMedCrossRefGoogle Scholar
  13. 13.
    Kidger J, Murdoch J, Donovan JL, Blazeby JM. Clinical decision-making in a multidisciplinary gynaecological cancer team: a qualitative study. BJOG. 2009;116:511–7.PubMedCrossRefGoogle Scholar
  14. 14.
    Leo F, Venissac N, Poudenx M, Otto J, Mourox J; Groupe d’Oncologie Thoracique Azureen (GOThA). Multidisciplinary management of lung cancer: how to test its efficacy? J Thorac Oncol. 2007;2:69–72.PubMedCrossRefGoogle Scholar
  15. 15.
    Stalfors J, Lundberg C, Westin T. Quality assessment of a multidisciplinary tumour meeting for patients with head and neck cancer. Acta Otolaryngol (Stockh). 2007;127:82–7.CrossRefGoogle Scholar
  16. 16.
    Blazeby JM, Wilson L, Metcalfe C, Nicklin J, English R, Donovan JL. Analysis of clinical decision-making in multidisciplinary cancer teams. Ann Oncol. 2006;17:457–60.PubMedCrossRefGoogle Scholar
  17. 17.
    Lamb BW, Sevdalis N, Arora S, Pinto A, Vincent C, Green JS. Teamwork and team decision-making at multidisciplinary cancer conferences: barriers, facilitators, and opportunities for improvement. World J Surg. 2011;35:1970–6.PubMedCrossRefGoogle Scholar
  18. 18.
    Vincent C, Moorthy K, Sarker SK, Chang A, Darzi AW. Systems approaches to surgical quality and safety: from concept to measurement. Ann Surg. 2004;239:475–82.PubMedCrossRefGoogle Scholar
  19. 19.
    Hull L, Arora S, Aggarwal R, Darzi A, Vincent C, Sevdalis N. The impact of nontechnical skills on technical performance in surgery: a systematic review. J Am Coll Surg. 2012;214:214–30.PubMedCrossRefGoogle Scholar
  20. 20.
    Hull L, Arora S, Kassab E, Kneebone RL, Sevdalis N. Observational Teamwork Assessment for Surgery (OTAS): content validation and tool refinement. J Am Coll Surg. 2011;212:234–43.PubMedCrossRefGoogle Scholar
  21. 21.
    Undre S, Koutantji M, Sevdalis N, et al. Multi-disciplinary crisis simulations: the way forward for training surgical teams. World J Surg. 2007;31:1843–53.PubMedCrossRefGoogle Scholar
  22. 22.
    McCulloch P, Rathbone J, Catchpole K. Interventions to improve teamwork and communications among healthcare staff. Br J Surg. 2011;98:469–79.PubMedCrossRefGoogle Scholar
  23. 23.
    Lamb BW, Sevdalis N, Mostafid H, Vincent C, Green JSA. Quality improvement in multidisciplinary cancer teams: an investigation of teamwork and clinical decision-making and cross-validation of assessments. Ann Surg Oncol. 2011;18:3535–43.PubMedCrossRefGoogle Scholar
  24. 24.
    Jamtvedt G, Young JM, Kristoffersen DT, Thomson O’Brien MA, Oxman AD. Audit and feedback: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2003;(3):CD000259.Google Scholar
  25. 25.
    Taylor C, Ramirez AJ. Multidisciplinary team members’ views about MDT working: results from a survey commissioned by the National Cancer Action Team. London: National Cancer Action Team; 2009.
  26. 26.
    National Cancer Action Team. The characteristics of an effective multidisciplinary team. London: National Cancer Action Team; 2010.
  27. 27.
    Fleissig A, Jenkins V, Catt S, Fallowfield L. Multidiscpilinary teams in cancer care: are they effective in the UK? Lancet Oncol. 2006;7:935–43.PubMedCrossRefGoogle Scholar
  28. 28.
    Abell N, Springer DW, Kamata A. Developing and validating rapid assessment instruments. Oxford: Oxford University Press; 2009.CrossRefGoogle Scholar
  29. 29.
    Spector PE. Summated rating scale construction. London: Sage Publications; 1992.Google Scholar
  30. 30.
    Cortina JM. What is coefficient alpha? An examination of theory and applications. J Appl Psychol. 1993;78:98–104.CrossRefGoogle Scholar
  31. 31.
    Taylor C, Brown KB, Sevdalis N, Green JSA. Developing and testing a novel, evidence-based and user-tested toolkit for assessing and improving teamworking in multidisciplinary cancer teams (abstract). Paper presented at: European Cancer Congress Stockholm, September 25, 2011.
  32. 32.
    Yun GW, Trumbo CW. Comparative response to a survey executed by post, e-mail, and Web form. J Comp Mediat Commun. 2000;6(1).Google Scholar

Copyright information

© Society of Surgical Oncology 2012

Authors and Affiliations

  • C. Taylor
    • 1
    Email author
  • K. Brown
    • 2
  • B. Lamb
    • 2
    • 3
  • J. Harris
    • 1
  • N. Sevdalis
    • 2
  • J. S. A. Green
    • 3
    • 4
  1. 1.Florence Nightingale School of Nursing and MidwiferyKing’s College LondonLondonEngland
  2. 2.Department of Surgery and CancerImperial College LondonLondonEngland
  3. 3.Department of UrologyWhipps Cross University HospitalLondonEngland
  4. 4.Faculty of Health and Social CareLondon South Bank UniversityLondonEngland

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