MDT’s are in vogue, not because they are the next buzz word but because they are an enabler to fully integrated health and wider wellbeing.
In 1974, management theorist Jerry Harvey told a story about his family in Texas. One sweltering afternoon, his father-in-law suggested a 50-mile drive to Abilene for dinner. Everyone agreed. The drive was hot, the food was dreadful, and on returning home they discovered that not one of them, including the man who suggested it, had actually wanted to go. Each had assumed everyone else was keen and didn’t want to rock the boat.
Harvey called it the Abilene Paradox: a group cheerfully agreeing to do something nobody wants to do.
If that doesn’t ring a bell, you’ve clearly never sat in a neighbourhood multidisciplinary team meeting.
Picture it. Twelve professionals around a table (or, more likely, eleven muted rectangles on Teams and one person on a train). Someone suggests a new weekly huddle, a shared template, or yet another referral pathway. Heads nod. “Sounds sensible.” “Happy to support that.” Three months later, the huddle is attended by two people and a sense of quiet resentment, and everyone privately admits they thought it was a daft idea from the start.
Nobody lied, exactly. They just assumed the GP wanted it, who assumed the district nurses wanted it, who assumed the social prescriber wanted it, who assumed it must have come from the ICB and was therefore inevitable, like weather.
The cure isn’t more meetings (put the agenda down). It’s building MDTs where disagreement is treated as a contribution, not a character flaw. That means chairs who ask “who thinks this won’t work?” and genuinely want an answer. It means testing agreement rather than harvesting nods. It means recognising that the most dangerous phrase in neighbourhood health isn’t “no”, it’s “yeah, fine, whatever works for everyone else.”
Because a neighbourhood team that can’t say what it actually thinks isn’t integrated. It’s just car-sharing to Abilene. Have a look at Wikipedia for a full description if you like the idea. https://en.wikipedia.org/wiki/Abilene_paradox
So lets be positive, my suggestion of three ways to stay off the road to Abilene:
- Appoint a designated dissenter. Rotate the role each meeting, someone whose job is to argue the opposite. It’s remarkable how honest people get once disagreement has been officially licensed.
- Test agreement, don’t assume it. Replace “everyone happy?” with “what would make this fail?” Silence is not consent; it’s usually someone quietly composing an email.
- Close every decision with a named owner and a review date. If nobody volunteers to own it, that’s not bad luck, that’s your answer.
At Scale helps NHS neighbourhood teams build MDTs that make decisions people actually believe in, with governance, facilitation and readiness support that turns polite nodding into genuine agreement. If your team keeps ending up somewhere nobody meant to go, talk to us at www.atscale.co.uk or drop Mike a line at mike.gill@atscale.co.uk.
