Interdisciplinary Care Planning

Once programmatic goals are determined, team members next must agree on what they mean in reality. For example, if "improve patient outcome" is a goal used by a team, successful outcomes will need to be defined case by case.

Once team members agree upon the general treatment goals of optimum health for the patient, how to attain that will be considered differently by the various disciplines on the team.

For all the great effort put into developing a care plan, the plan cannot work unless the team has a system for documenting it and clearly indicating who will be responsible for what and by when. This documentation should be completed before the end of the meeting and available to all team members to remind them of their responsibilities. In addition, there must be in place a system (formal and informal) for communicating and continuing with the next steps of the care plan between team meetings. This is most often done informally with the different disciplines talking with each other as needed.