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Abstract
\n<\/span>Background
\n<\/span><\/strong>Pelvic floor disorders (PFD) require collaboration across specialities, making multidisciplinary teamwork essential. However, little is known about how such collaboration unfolds within teams guided by a moderator.
\n<\/span>Aim
\n<\/span><\/strong>To identify drivers that contribute to multidisciplinary collaboration from the perspectives of health-care professionals participating in moderator-guided joint consultations.
\n<\/span>Method
\n<\/span><\/strong>A qualitative hermeneutic study inspired by Braun and Clarke was conducted. Eight healthcare professionals from a Danish pelvic floor clinic were interviewed, and data were analysed thematically using an interpretive approach.
\n<\/span>Results
\n<\/span><\/strong>One overarching theme, <\/span>Resources in collaboration<\/span>, was identified, supported by five subthemes: <\/span>Personal relations<\/span>, <\/span>Professional competencies<\/span>, <\/span>Respect<\/span>, A<\/span> common goal<\/span>, and<\/span> Moderator grounded in caring competencies<\/span>. Respect and interpersonal familiarity enhanced communication, while the moderator played a key role in structuring consultations and maintaining overview and emotional awareness. Team effectiveness appeared to develop over time toward a high-performing phase.
\n<\/span>Conclusion
\n<\/span><\/strong>Effective moderator-guided multidisciplinary consultations rely on both relational and organisational resources. Shared goals, knowledge, and mutual respect supported collaboration, while the moderator functioned as a central structural and relational facilitator requiring empathic, organisational, and coordination skills. Team effectiveness evolved over time, underscoring the need for adjustment periods when implementing multidisciplinary models.
\n<\/span>Implications for practice
\n<\/span><\/strong>Successful implementation of multidisciplinary teams requires time, planning, and coordination. Moderators appear central to facilitating collaboration and clinically relevant outcomes. Structured adjustment phases may support new teams in aligning roles and expectations, and the findings may inform future integration of moderator roles and research on interprofessional collaboration.<\/span><\/p>\nKeywords: <\/span><\/strong>Interprofessional collaboration, multidisciplinary consultations; pelvic floor disorders, incontinence.<\/span><\/p>\n<\/div>\n\n
Tv\u00e6rfagligt samarbejde i moderatorstyrede konsultationer: Ressourcer og drivkr\u00e6fter<\/span><\/h4>\n <\/p>\n
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Resum\u00e9
\n<\/span>Baggrund
\n<\/span><\/strong>B\u00e6kkenbundslidelser kr\u00e6ver samarbejde p\u00e5 tv\u00e6rs af specialer, hvorfor tv\u00e6rfagligt teamwork er vigtigt i behandlingen. Der er imidlertid begr\u00e6nset viden om, hvordan samarbejdet udfolder sig i teams faciliteret af en moderator.
\n<\/span>Form\u00e5l
\n<\/span><\/strong>At identificere faktorer der fremmer det tv\u00e6rfaglige samarbejde set fra sundhedsprofessionelles perspektiver i moderatorstyrede f\u00e6lles konsultationer.
\n<\/span>Metode
\n<\/span><\/strong>Et kvalitativt, hermeneutisk studie inspireret af Braun og Clarke blev gennemf\u00f8rt. Otte sundhedsprofessionelle fra en dansk b\u00e6kkenbundsklinik blev interviewet, og data blev analyseret tematisk med en fortolkende tilgang.
\n<\/span>Resultater
\n<\/span><\/strong>\u00c9t overordnet tema, <\/span>Ressourcer i samarbejdet<\/span><\/em>, blev identificeret med fem undertemaer: <\/span>Personlige relationer<\/span><\/em>, <\/span>Faglige kompetencer<\/span><\/em>, <\/span>Respekt<\/span><\/em>, <\/span>Et f\u00e6lles m\u00e5l<\/span><\/em> samt <\/span>Moderatorens omsorgskompetencer<\/span><\/em>. Respekt og kendskab til hinanden styrkede kommunikationen, mens moderatoren havde en central rolle i strukturering af konsultationerne samt i at bevare overblik og emotionel opm\u00e6rksomhed. Teamets effektivitet udviklede sig over tid mod en h\u00f8jtydende fase.
\n<\/span>Konklusion
\n<\/span><\/strong>Effektiviteten af moderatorstyrede tv\u00e6rfaglige konsultationer afh\u00e6nger af b\u00e5de relationelle og organisatoriske ressourcer. F\u00e6lles m\u00e5l, viden og gensidig respekt underst\u00f8tter samarbejde, mens moderatoren fungerer som en central strukturel og relationel facilitator, hvilket kr\u00e6ver<\/span> empatiske, organisatoriske og koordinerende kompetencer. Teamets effektivitet udviklede sig over tid, hvilket understreger behovet for en tilpasningsperiode ved implementering.
\n<\/span>Implikationer for praksis
\n<\/span><\/strong>Effektiv implementering af tv\u00e6rfaglige teams kr\u00e6ver tid, planl\u00e6gning og koordinering. Moderatoren fremst\u00e5r central for at underst\u00f8tte samarbejde og klinisk relevante patientforl\u00f8b. <\/span>Nye teams kan blive st\u00f8ttet i at afstemme roller og forventninger ved hj\u00e6lp af strukturerede faser, hvor deltagerne kan tilpasse sig teamet. Resultaterne kan bidrage til udvikling af moderatorfunktionen og kvalificere videre forskning i tv\u00e6rprofessionelt samarbejde.<\/span><\/p>\nN\u00f8gleord<\/strong>: <\/span>Tv\u00e6rprofessionelt samarbejde, tv\u00e6rfaglige konsultationer, b\u00e6kkenbundslidelser, inkontinens.<\/span><\/p>\n<\/div>\nIntroduction
\n<\/span><\/strong>Healthcare settings today are organised to handle single diseases in different clinical specialities (1). However, a multidisciplinary perspective is needed to manage the growing number of cases of patients with complex health care challenges (1).<\/span> To deliver the highest quality of health care across complex settings, there is a demand for health care to incorporate multidisciplinary approaches. These are defined as health workers from multiple professional backgrounds who work together with patients and families to explore multiple conditions and symptoms, and to define patients\u2019 preferences for treatment and solutions in a person-centred approach (2).<\/span><\/p>\nMultifactorial symptoms and multidisciplinary consultations
\n<\/span><\/strong>Given the growing need for multidisciplinary approaches in complex healthcare, patients with multifactorial conditions highlight the importance of effective collaboration across specialities. This is particularly evident in the care of pelvic floor disorders (PFDs). Patients with PFDs can suffer from a range of multifactorial symptoms, e.g. urinary problems ranging from urinary incontinence to urinary retention, bowel problems ranging from faecal incontinence to obstipation, and pain from various compartments of the pelvic floor and subsequently affect their sexual health due to the various symptoms (3). The multiple problems significantly affect quality of life (4-6).<\/span><\/p>\nThe patients do not necessarily have multiple conditions, but their symptoms can arise from multiple compartments of the pelvic floor, creating uncertainty about the best treatment options (3). A symptom, such as pelvic pain, which often leads to sexual problems, can originate from not only different anatomical and physiological challenges but also behavioural and psychological aspects. Thus, helping patients with PFDs is complex and involves a range of specialities, including gynaecology, urology, proctology, and sexology. Consequently, the various professional disciplines and their collaboration play an important role in the care of patients with PFDs.<\/span><\/p>\nWe therefore argue that the field of PFDs has needs comparable to those observed in multi-disciplinary treatment and care across complex health care settings. <\/span>Given these considerations, this article focuses on multidisciplinary consultations, which must explore patients\u2019 multiple complex symptoms and preferences to offer the best options. Such consultations require effective working relationships across professions and specialities. However, the concepts used to describe such interprofessional working relationships \u2013 including collaboration, coordination and cooperation \u2013 have been applied inconsistently in the literature (7). In this paper, we adopt the term \u201ccollaboration\u201d as defined by Casta\u00f1er et al.:<\/span><\/p>\n\u201ccollaboration refers to voluntarily helping others to attain a common interorganisational goal or a private goal\u201d<\/span><\/em> (p. 994).<\/span><\/p>\nWe consider this definition to reflect the requirements of multidisciplinary collaboration in health care, where professionals are expected to support one another and work towards shared goals to ensure optimal patient care. Collaboration depends on effective communication, shared situational awareness and alignment around common clinical goals (8).<\/span> However, such collaboration may also give rise to intra- and interprofessional conflicts, leading to inefficiency and ultimately reduced quality of care (9).<\/span><\/p>\nA review by Gregorieu et al. shows that physicians and nurses find it important to collaborate; however, they do not agree on their roles. The physicians tend to regard themselves as the principal decision makers, thereby perpetuating a hierarchical structure (10). That said, physicians have also been found to be the drivers in negotiating and dealing with overlaps in areas of responsibility. In contrast, nurses are shown to be more active in bridging gaps between professional perspectives and transferring knowledge between professionals (11).<\/span><\/p>\nThe frames of collaboration in the context of PFDs have been studied previously. In a Danish pelvic floor clinic, the organisational setup, including a multidisciplinary consultation and a moderator, was explored through interviews with healthcare professionals. The set-up proved to support patient-centeredness and collaboration (12). It was found that the moderator identified and prioritised which professions\u2019 input was needed to meet the patient’s preferences and kept an overview of the dialogue and timelines. Furthermore, this study showed that using a moderator seemed to increase the focus on multidisciplinary collaboration. However, it was unexplored which supporting factors came into play during the consultation.<\/span><\/p>\nA substantial body of research has examined teamwork, team collaboration, and performance (13). Still, new contexts and organisational set-ups continue to emerge, underscoring the need for ongoing investigation to ensure that research keeps pace with contemporary developments(14).<\/span><\/p>\nHealthcare remains largely organised around single-disease specialities, despite the growing need for multidisciplinary approaches in complex conditions such as pelvic floor disorders. However, the drivers of effective collaboration in such settings are not well understood.<\/span><\/p>\nTo our knowledge, there is a lack of evidence on how collaboration unfolds in practice within moderatorled consultations for patients with PFDs, and which specific organisational and re-lational factors drive this process. We therefore seek to understand what unfolds within this framework and which drivers may be mobilised to strengthen collaboration.<\/span><\/p>\nThus, for this study, we developed the research questions:
\n<\/span><\/p>\n\n- How is collaboration experienced during joint multidisciplinary consultations?<\/span><\/li>\n
- How does the moderator facilitate collaboration in the joint multidisciplinary consultations?<\/span><\/li>\n<\/ul>\n
Aim
\n<\/span><\/strong>This study aimed, through the perspectives of health care professionals participating in joint multidisciplinary consultations guided by a moderator, to identify drivers that may serve as specific contributors to multidisciplinary collaboration.<\/span><\/p>\nMethods
\n<\/span><\/strong>The study is a qualitative interview study. The method is inspired by Braun and Clarke\u2019s original work on thematic analysis (15). It uses the operationalised hermeneutic approach by Steinar Kvale & Svend Brinkmann (16) to analyse interviews with healthcare professionals within a multidisciplinary team (MDT), conducted with a moderator. The team conducts joint multidisciplinary consultations at a pelvic floor clinic (PFC). Interview data originated from a previous interview study (12) and were reanalysed in line with this study’s aim. Methodological framework and reporting were based on the COREQ checklist (17).<\/span><\/p>\nSetting
\n<\/span><\/strong>The PFC was established in 2019 at a hospital in Denmark. The MDT conducts multidisciplinary consultations once a week. The PFC has an annual capacity of approximately 250 joint mode-rator-guided, multidisciplinary consultations, primarily with female patients presenting with a combination of urinary and bowel problems. Ten appointed healthcare professionals from different departments and specialities, with different professions, belong to the PFC and are involved in these multidisciplinary consultations.<\/span><\/p>\nOnce a week, five of these healthcare professionals constitute the team that performs the multidisciplinary consultation: three consultants; one gynaecologist, one urologist, one proctologist, one specialist nurse, and one specialist physiotherapist. Due to initial problems with tracking time for each consultation, qualitative work was facilitated by the Hospital’s Qualitative Department and by PDSA circles (18). This process identified the need for a chairman, and after one year, the concept of a moderator was implemented.<\/span><\/p>\nOne team member moderates each multidisciplinary consultation; intentionally, the moderator is never one of the consultants, but either a nurse or a physiotherapist. To our knowledge, this concept has not been implemented in other PFC settings.<\/span><\/p>\nData collection
\n<\/span><\/strong>To obtain a nuanced and valid picture of the collaboration in the study, eligible informants were all healthcare professionals (consultants, nurses, and physiotherapists) who were involved in most multidisciplinary consultations during the year before the interviews. Nine of the ten healthcare professionals from the PFC were eligible and had been involved in between 100 and 250 of the total 250 consultations. One consultant was excluded because she participated in only 18 joint consultations in the preceding year. All nine eligible healthcare professionals were invited and consented to participate. In the end, one eligible female consultant could not participate after all because of the workload. Thus, interviews were performed with three consultants, four nurses and one physiotherapist.<\/span><\/p>\nA semi-structured interview guide was developed in collaboration with healthcare professionals who had prior experience conducting semi-structured interviews and working in the field of PFDs. The format was inspired by Tanggaard and Brinkmann (19), see <\/span>Table 1.<\/strong> <\/span>The semistructured format allowed for both guided and emergent questions, ensuring focus on the research domains while enabling participants to elaborate freely. Interpretive follow-up questions were used to validate understanding, and interviews concluded with open prompts to invite additional perspectives. <\/span>Thereby, the interview guide included introductory, follow-up, and descriptive questions as recommended by Tanggaard and Brinkmann (19). During the interviews, further probing questions were asked. Encouragement was provided through verbal affirmations and nodding from the interviewer to demonstrate active listening toward the informant. At the same time, attention was paid to ensure that the research questions were addressed.<\/span><\/p>\n![\"\"](\"https:\/\/i0.wp.com\/sygeplejevidenskab.dk\/wp-content\/uploads\/2026\/04\/Table-1.png?resize=703%2C436&quality=80&ssl=1\")
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According to the hermeneutic approach, interpretive questions were also employed when they arose during the interview to confirm the accurate understanding of the responses. Finally, each informant was asked whether there was anything they wished to add to the topic. This served both to open up perspectives that the interviewer had not anticipated and to allow the informants to correct or nuance their statements.<\/span><\/p>\nThe co-author and nurse (BTE) collected data from the eight interviews. BTE was employed outside the PFC in a speciality other than PFDs and therefore did not know the informants, was na\u00efve to their work situation or the practice of joint consultations. Although BTE\u2019s clinical background as a nurse provided contextual insight into professional roles and challenges in the field, it may also have influenced the emphasis placed on topics during the interviews. To mitigate potential bias and power dynamics, the interviewer had neither current nor previous employment in the department under study or in any PFC.<\/span><\/p>\nBTE<\/span> conducted semi-structured individual interviews, either face-to-face or by phone, in a secluded office. Interviews were audiorecorded, and recordings were anonymous to others from the PFC, including the team member who is also a co-author (MH). The importance of this confidentiality lies in ensuring free speech for all interviewees.<\/span><\/p>\nData analysis
\n<\/span><\/strong>A naive listening of the audio recordings (Phase 1) (Braun & Clarke) was conducted, followed by transcription of the interviews. Transcription was performed by BTE. Phase 2 included several readings to identify recurring patterns and code important text sequences. In Phase 3, themes were identified using an interpretive approach seeking not only \u2018what is said\u2019 but also to understand \u2018what is the meaning\u2019 of the text, which is also called the latent level in the coded text. The hermeneutic spiral was applied to understand and interpret the meaning the interviewee ascribed to their experiences.<\/span><\/p>\nThrough a process in which the nurse interviewer moved between the parts and the whole, each data unit was subjected to in-depth reflection to uncover its unique significance. Subsequently, these interpreted elements were synthesised into a new, coherent interpretative whole, providing a deeper understanding of the phenomenon (Phase 4).<\/span><\/p>\nThe inductive approach was data-driven, and codes were organised into themes. BTE continuously tested codes and themes in a hermeneutic spiral throughout the analysis (Phase 4). To ensure the integrity of the analysis, the researcher (BTE) engaged in continuous reflexivity. BTE\u2019s own professional background as a nurse and pre-understandings of multiprofessional collaboration were critically acknowledged, as these preconceptions inevitably shape the interpretation of the interview data and the identification of emerging themes. BTE named the themes (Phase 5), which were reported (Phase 6) in accordance with the COREQ checklist. <\/span>Data extraction with coding examples is illustrated in <\/span>Table 2<\/strong>. Analysis and theme definition were initially performed by BTE and followed by discussions between BTE and an outside researcher with a background in the social sciences, the co-author (BRT).<\/span><\/p>\n![\"\"](\"https:\/\/i0.wp.com\/sygeplejevidenskab.dk\/wp-content\/uploads\/2026\/04\/TABLE-2.png?resize=335%2C197&quality=80&ssl=1\")
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Ethics
\n<\/span><\/strong>According to Danish law, approval from the National Committee on Health Research Ethics was not required for this project, as no biomedical intervention was conducted. The study was performed in accordance with the Declaration of Helsinki (20).<\/span> All participants gave informed, written consent. To address the challenge of anonymity, given the small number of interviewees, an outsider interviewed, transcribed, and pseudoanonymized the data.<\/span><\/p>\nAfterwards, an analysis was performed by two outsiders. All participants were informed of the possibility of withdrawing consent and of withdrawing specific statements from the interview, or the entire interview, if they regretted anything afterwards. Data was handled in accordance with GDPR and Danish Law and stored on a secure regional server (SharePoint site). Data permission was obtained (Journal number: 19\/46391).<\/span><\/p>\nFindings \/ Analysis
\n<\/span><\/strong>The qualitative data were collected in November 2023. The PFC has had joint MDT consultations since 2019. The eight healthcare professionals interviewed had been working together since the start-up of the implementation. They were interviewed individually, each interview lasting from 16 to 48 minutes.<\/span><\/p>\nThe informants had individually worked with patients with PFDs for between 5 and 33 years. Four interviews were conducted face-to-face, and four were conducted by phone. Five informants were identified as potential moderators (four nurses and one physiotherapist), and three were team members who did not hold the moderator role, as they were consultants. No informants have withdrawn any consent for certain statements or for the entire interview.<\/span><\/p>\nThematic analysis
\n<\/span><\/strong>Based on the analysed data, we formed one main theme with five subthemes, see <\/span>Figure 1<\/span><\/strong>. The themes are analysed in sections, and findings for each section are supported by selected quotes. Interviewees are identified as having or not having the moderator function.<\/span><\/p>\n![\"\"](\"https:\/\/i0.wp.com\/sygeplejevidenskab.dk\/wp-content\/uploads\/2026\/04\/FIGURE-1.png?resize=328%2C272&quality=80&ssl=1\")
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Main theme – Resources in collaboration
\n<\/span><\/strong>The main theme, <\/span>Resources in Collaboration<\/span>, demonstrates that team members are aware of the various factors that influence collaboration across professional groups and specialities. <\/span>The theme unfolds that the patients\u2019 needs promote multidisciplinary effort and ultimately, professional collaboration. Working in a multidisciplinary team setting requires that one’s own professional identity is not the most important, and that everyone works towards common ground to meet the patient’s needs. Thus, if the highest priority is one\u2019s own professionalism, this will be an inhibiting factor for collaboration, which the quote below reveals: <\/span><\/p>\nI think it\u2019s important to forget about your job title; everyone is equal- physiotherapists, nurses, doctors, everyone is on the same level when collaborating with the patient, and each person contributes to the whole. It only works if everyone collaborates. And that\u2019s the most important thing. That\u2019s why I believe our pelvic floor clinic works so well\u2026 because we like each other and our collaboration works well<\/span><\/em><\/strong><\/span> (Informant F – without the moderator function).<\/span><\/p>\nRespect and good interpersonal relationships are required for satisfactory collaboration. To further strengthen collaboration, recognising each other as equals and entrusting the moderator role during consultations promotes unity and a shared goal. Having a moderator is valuable for the PFC because she can maintain an overview while ensuring the relevant perspectives are considered:<\/span><\/p>\n(\u2026) Our moderator also keeps an eye on the other colleagues. (\u2026) But I think the moderator more or less manages everything; I pay attention to my recommendations, and the moderator manages all recommendations from all colleagues \u2026<\/strong><\/em><\/span>(Informant F – without the moderator function).<\/span><\/p>\nDeveloping an understanding of each other and gaining a broader overview enables collaboration and a focus on the patient\u2019s pathway. The clinical challenges and the necessary processes require openness to this process. This generates new organisational resources within a complex system that is inherently dependent on effective multiprofessional collaboration. However, an adjustment period is important for aligning roles and contributions in the collaboration:<\/span><\/p>\n\u2026 and professionally, of course, since we all participate in the same consultations, we inevitably start to learn how things are connected when we see things from different perspectives, and that\u2019s what makes this quite exciting, right? <\/span><\/strong><\/span><\/em>(Informant G – without the moderator function).<\/span><\/p>\nThis shared participation in clinical consultations catalyses a collective learning process, in which the convergence of diverse professional perspectives transforms individual observations into a holistic understanding of the patient\u2019s pathway, ultimately fostering an organisational culture that views complexity as an opportunity for multiprofessional growth.<\/p>\n
The organisation of the PFC and the framework for team collaboration are valuable contributors to the unit\u2019s ability to work in a robust, structured manner. As a further enhancement to organising the PFC, a daily manager ensured that the practical aspects of the PFC were handled, e.g., vacations and short-term sick leave, creating space for a common focus on new developments and relationship-building. The staff had requested a manager to gain better control over the context that could influence the PFC and support them as a team, arranging staff meetings, etc:<\/span><\/p>\n.<\/span>..we wanted an operational manager. We said it can\u2019t work if we each have to go back to our own departments and figure out holiday schedules, because it needs to match the clinic, right? I think collaboration is really important here<\/span><\/strong><\/em><\/span> (Informant A – with the moderator function).<\/span><\/p>\n
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