Background Breastfeeding has significant health benefits for mothers and babies. Severe mental illness (SMI) affects around 3 % of women giving birth but very little is currently known about their infant feeding experiences. Due to a paucity of evidence, support needs are largely unknown. Aim To explore the infant feeding experiences and supports needs of women with SMI. Methods Semi structured interviews were conducted online and in person from 2022 to 2023 with 20 women under care of perinatal mental health teams in England. Interviews were audio-recorded, transcribed and anonymised. Reflective thematic analysis was used to analyse the data. Findings Four key themes were identified; (1) The intersection between infant feeding and mental health; (2) Infant feeding support from maternity services; (3) Infant feeding preparation; and (4) Specific considerations for women with SMI. The concept of ‘collaborative practice to support infant feeding and mental health’ draws the themes together and is marked by a disconnect in collaborative care supporting both infant feeding and mental health. Discussion SMI can manifest itself in beliefs and emotions related to infant feeding. Experiences of support highlighted the need for better anticipatory guidance around infant feeding for women with SMI, including contexts specific to perinatal SMI like psychiatric inpatient settings, psychotropic medication use, and the challenges associated with sleep deprivation. Conclusions Negative experiences with infant feeding and poor support have a significant impact on women with SMI. Support should focus on the emotional and practical demands of breastfeeding and how women can manage this alongside their illness.

Background:The Hypoglycemia Awareness Restoration Program for people with type 1 diabetes and problematic hypoglycemia with severe episodes persisting despite optimal care (HARPdoc) uniquely focusses on addressing cognitive and motivational barriers to hypoglycemia avoidance associated with impaired awareness to hypoglycemia. We aimed to compare perceptions of acceptability, feasibility, and appropriateness of HARPdoc intervention to an existing program, Blood Glucose Awareness Training (BGAT) and understand how these implementation outcomes relate to cognitive and mental health clinical outcomes. Methods:The HARPdoc trial was a hybrid randomized clinical trial delivered in the United Kingdom and United States between July 2018 and December 2019. Implementation outcomes, including perceived acceptability, appropriateness, and feasibility, were measured using published validated surveys. These surveys were completed by the people with diabetes, healthcare professionals, and relatives of participants. Clinical outcomes, including attitudes to awareness, diabetes distress, anxiety, and depression, were measured using validated self-reported questionnaires. We explored differences of perceived implementation outcomes between HARPdoc and BGAT and associations between implementation and clinical outcomes using quantile and linear regression. We also assessed whether the effect of HARPdoc on cognitive and mental health outcomes were mediated by implementation outcomes. Results:HARPdoc was perceived as more appropriate than BGAT at 12 months, with a median difference of 0.75 (95% CI 0,26,1,24) by both those involved in delivering the programs and the HARPdoc participants. All stakeholder groups also perceived HARPdoc intervention as more acceptable (MD 0.50 95% CI 0.13, 0.87), but as feasible (MD 0.00; 95% CI -0.31, 0.31) as BGAT. Each of perceived acceptability, appropriateness, and feasibility were significantly linked to improvements in clinical outcomes (feasibility- anxiety: Mean Difference: -1.07; 95% CI: -2.03, -0.10); feasibility-depression (MD: -5.25, 95% CI -9.09, -1.41)). No evidence of mediation was observed. Conclusions:HARPdoc compared to BGAT was perceived as more appropriate and acceptable and subsequently higher perceived appropriateness, acceptability and feasibility was linked to better cognitive and mental health outcomes. Our findings provide important insights for the development of an implementation blueprint and the expansion of HARPdoc and BGAT programs into routine healthcare services and highlight the need for larger, better-powered hybrid trials.

BACKGROUND:This paper synthesizes a series of four studies in the exploration of the concept of Return on Investment (ROI) in relation to healthcare Quality Improvement (QI) programmes (QI-ROI). METHODS:We followed a multi-stage mixed-methods integration approach where four studies were first conducted and reported separately. The four study designs were linked to enable us to build a cohesive understanding of QI-ROI. Collective findings were then analysed and interpreted to identify the main QI-ROI concept domains. Two studies were based on an extensive global interdisciplinary systematic literature review N = 68; one a qualitative study N = 16, and last, a Delphi study N = 23. For the latter two studies, participants were from the UK National Health Service and included 24 board members, 15 service and clinical directors, and QI leaders. RESULTS:Several benefits were seen to represent ROI from QI programmes. These encompassed internal (e.g. development) and external (e.g. service user socio-economic benefits), intervention outcomes (e.g. clinical benefits) and implementation outcomes (e.g. spread). Further, the benefits included lessons from 'failed' QI programmes. Together, these benefits encompass monetary and non-monetary value of QI along a programme's journey. We view these benefits as four main domains: development, improvement, savings, and sustainability or DISS. CONCLUSION:QI has several organizational and health system benefits contained within the DISS construct. These benefits support various organizational goals such as quality improvement, organizational development, performance and resilience. We posit that the collective findings are applicable to many organizations that provide interdisciplinary healthcare services globally.

Multidisciplinary team meetings (MDTMs) are central to cancer treatment planning in the UK, but increasing caseloads, growing clinical complexity, and workforce constraints have raised concerns about the sustainability of a “discuss-every-case” model. National guidance in England now promotes MDT streamlining, using Standards of Care (SoCs) to stratify cases requiring full multidisciplinary discussion from those suitable for standardised pathways. However, there remains limited clarity on how SoCs should be specified and governed to ensure safety, consistency, and clinical accountability in routine practice. This mini-review synthesises national policy, emerging empirical literature on MDT streamlining, and evidence from complexity research to examine SoCs as a mechanism for operationalising MDT reform. We highlight that empirical evaluations of streamlining remain limited and heterogeneous, and that reported effects depend less on caseload reduction than on information readiness, organisational context, and explicit escalation criteria. Drawing on NHS England guidance, specialty recommendations from the British Association of Urological Surgeons (BAUS), and the Measure of case-Discussion Complexity (MeDiC), we present a structured framework to support SoC development. The framework specifies parameters across patient, pathology, and treatment domains (in line with the MeDiC tool), alongside explicit eligibility, exception, and escalation logic, and interfaces with governance requirements for triage, data completeness, and audit. By making decision boundaries transparent and multidimensional, this approach addresses key risks associated with oversimplification and inappropriate exclusion while preserving clinical judgement and patient-centred care. Structured approaches to SoC development provide a defensible foundation for focusing MDT discussion where it adds greatest value under increasing service pressures.

Background:There is a rapidly growing evidence base for the effectiveness of creative health interventions in improving mental health, but few studies have explored implementation and scaling of these interventions. The aim of this study was to evaluate the perceived acceptability, appropriateness, and feasibility of a ten-week singing group programme (Breathe Melodies for Mums (M4M)) for mothers experiencing symptoms of postnatal depression (PND) and their babies as well as the programme ingredients that affected these implementation outcomes. Methods:A mixed methods design was adopted. Quantitative data was collected via the Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM), and Feasibility of Intervention Measure (FIM) from 109 intervention participants at 6, 20, and 36 weeks and analysed descriptively. Qualitative semi-structured interviews were conducted with 22 programme participants and 15 professional stakeholders involved in implementing the programme. Qualitative data were analysed using framework analysis. Results:Quantitative results showed high levels of acceptability, appropriateness, and feasibility among M4M participants, with median scores of 5/5 achieved on the AIM, IAM and FIM at 20 and 36-week follow up. Qualitative results gave insights into the ingredients of M4M that made the programme acceptable, appropriate, and feasible to participants and professional stakeholders. These included "project" ingredients (dose, design, content), "people" ingredients (social composition, activity facilitation), and to a lesser extent, "context" ingredients (setting, project set-up). While participant and stakeholder experiences were largely positive, some challenges and suggestions for improvement were also identified, including broadening recruitment strategies to reach more women. Conclusion:M4M was highly acceptable, appropriate, and feasible to participants and stakeholders. By identifying the "core" ingredients that facilitated implementation success and strategies to address implementation barriers, these findings have important implications for future implementation and scale-up of M4M and similar creative health programmes. Clinical Trial Registration:identifier (NCT04834622).

Multidisciplinary teams (MDTs) and their meetings are central to cancer care and other chronic conditions: promoting treatment standardization, reducing geographical variability, and improving patient outcomes. However, increasing complexity, workload pressures, and resource constraints require effective leadership and chairing. Leadership sets strategic goals, shapes team culture, and drives long-term improvement, while chairing ensures operational efficiency through structured and efficient discussions. These complementary roles demand adaptive styles to balance inclusivity and efficiency within and beyond meetings. Transformational and facilitative leadership inspire innovation and collaboration, while directive approaches help maintain focus in high-pressure contexts. Human factors, including cognitive fatigue and authority gradients, influence MDT dynamics, highlighting the need for workflow optimization, shared responsibilities, and fatigue management. Equally important is empowering followers through training in communication and collaborative skills, which further mitigates power imbalances. By aligning chairing and leadership styles with meeting demands and integrating supportive technologies, MDTs can sustain their pivotal role in patient-centred care and achieve both strategic and operational success in cancer treatment planning.

Return on Investment (ROI) is a recommended and thus legitimatised approach to assessing the value of healthcare programmes, including in Quality Improvement (QI). In its accounting origins, ROI estimates monetary benefits against investments. In health economics, ROI estimates a monetary value of healthcare related benefits against costs. In a recent single site study, we explored the metaphorical use of ROI as a concept of benefits from QI in-order to develop a QI-ROI conceptual framework. We found that in QI, both monetary and non-monetary benefits are deemed as legitimate ROI by mental healthcare leaders. However, various ambiguities and uncertainties associated with QI-ROI conceptualisation were also apparent. As such, in the current study, we explored consensus on the QI-ROI concept with a wider group of mental healthcare leaders across multiple sites. We then assessed the potential impact of the consensus levels on the stability of our QI-ROI conceptual framework. We ran two rounds of Delphi through Qualtrics online platform. Public sector mental health leaders were approached UK-wide (N = > 100). Only leaders from England participated (N = 23). This included board members (n = 15), directors (n = 2), and QI leaders (n = 6). Sixty-seven items were rated, including patient outcomes, development (e.g., culture), external benefits (e.g., socio-economic), incentives (e.g., reputation), implementation outcomes (e.g., sustainability), and monetised benefits. Consensus was measured using interquartile range and median. We also collected qualitative data to help explain participant responses. There was consensus on 45 of 67 (67

Background To date, beneficial effects of multimodal exercise programmes on Parkinson’s disease (PD) have focused on motor symptoms and little attention has been paid to the potential effects of such programmes on the non-motor symptoms of PD, which are now universally known as one of the key drivers of quality of life and a key unmet need. We aim to explore clinical effectiveness of a ballet-based dance programme in addressing non-motor and motor symptoms of Parkinson’s disease across all stages of progression. Methods A randomised, single-blind, controlled trial of 160 people with Parkinson’s across all motor stages (Participants will be stratified into three groups of motor advancement: Hoehn and Yahr (HY) stages I and II being Mild Group, HY Stage III being Moderate Group and HY Stages IV and V being Severe Group) will be randomly allocated to either an intervention or a control group using an independent randomisation body. The primary outcome is an improvement in non-motor symptoms as measured by the Movement Disorders Society Non-Motor Scale (MDS-NMS). The intervention protocol consists of 12 one-weekly dance sessions led by English National Ballet. Each session is followed by a ‘tea and biscuit’ social time. Control group follows standard clinical pathway and joins the ‘tea and biscuit’ to control for any positive effects of social interactions. All participants are assessed at baseline, immediately after completion of the intervention and 3–6 months later to explore any potential longitudinal effects. Discussion To our knowledge, no adequately powered study has explored the effects of a dance-based intervention on non-motor symptoms of Parkinson’s disease, assessing these on both holistic and granular levels. We also aim to stratify participants in accordance with their motor state as assessed by. HY staging to explore specific effects on the symptoms at the initial, moderate and complex stages of the disease. If successful, this trial provides first evidence on clinical effectiveness of a ballet-based dance intervention for symptoms of Parkinson’s disease, assessed in a robust, rigorous manner. Trial registration NCT04719468.

In January 2020, NHS England and NHS Improvement, in the United Kingdom, issued a permissive framework for streamlining cancer multidisciplinary (MDT) meetings. Streamlining is defined as a process whereby complex cases are prioritized for full discussion by an MDT in an MDT meeting (MDM), while the management of straightforward cases is expedited using Standards of Care (SoC). SoC are points in the pathway of patient management where there are recognized guidelines and clear clinical consensus on the options for management and should be regionally agreed and uniformly applied by regional Cancer Alliances. While this report marks the first major change in cancer MDT management since the Calman-Hine report in 1995, its implementation, nationally, has been slow with now nearly four years since its publication. It is argued however that streamlining is a necessary step in ensuring the viability of MDT processes, and therefore maintaining patient care in the current socioeconomic context of rising workload and cancer incidence, financial pressures, and workforce shortages. In this mini review, we offer a succinct summary of the recent developments around the implementation of the 2020 streamlining framework, including challenges and barriers to its implementation, and the potential future directions in this field, which we propose should increase utilisation of implementation science. We conclude that ensuring successful implementation of the framework and the SOC requires securing a buy-in from key stakeholders, including MDTs and hospital management teams, with clearly defined (a) management approaches that include triage (e.g. through a mini MDT meeting), (b) assessment of case complexity (something that directly feeds into the SOC), and (c) roles of the MDT lead and the members, while acknowledging that the SOC cannot be universally applied without the consideration of individual variations across teams and hospital Trusts.

AIMS:To assess the cost-effectiveness of HARPdoc (Hypoglycaemia Awareness Restoration Programme for adults with type 1 diabetes and problematic hypoglycaemia despite optimised care), focussed upon cognitions and motivation, versus BGAT (Blood Glucose Awareness Training), focussed on behaviours and education, as adjunctive treatments for treatment-resistant problematic hypoglycaemia in type 1 diabetes, in a randomised controlled trial. METHODS:Eligible adults were randomised to either intervention. Quality of life (QoL, measured using EQ-5D-5L); cost of utilisation of health services (using the adult services utilization schedule, AD-SUS) and of programme implementation and curriculum delivery were measured. A cost-utility analysis was undertaken using quality-adjusted life years (QALYs) as a measure of trial participant outcome and cost-effectiveness was evaluated with reference to the incremental net benefit (INB) of HARPdoc compared to BGAT. RESULTS:Over 24 months mean total cost per participant was £194 lower for HARPdoc compared to BGAT (95% CI: -£2498 to £1942). HARPdoc was associated with a mean incremental gain of 0.067 QALYs/participant over 24 months post-randomisation: an equivalent gain of 24 days in full health. The mean INB of HARPdoc compared to BGAT over 24 months was positive: £1521/participant, indicating comparative cost-effectiveness, with an 85% probability of correctly inferring an INB > 0. CONCLUSIONS:Addressing health cognitions in people with treatment-resistant hypoglycaemia achieved cost-effectiveness compared to an alternative approach through improved QoL and reduced need for medical services, including hospital admissions. Compared to BGAT, HARPdoc offers a cost-effective adjunct to educational and technological solutions for problematic hypoglycaemia.

Purpose In this article, we outline our views on the appropriateness and utility of Return on Investment (ROI) for the evaluation of the value of healthcare quality improvement (QI) programmes. Design/methodology/approach Our recent research explored the ROI concept and became the genesis of our viewpoint. We reflect on our findings from an extensive research project on the concept of ROI, involving a multidisciplinary global systematic literature review, a qualitative and Delphi study with mental healthcare leaders from the United Kingdom National Health Service. Research participants included board members, clinical directors and QI leaders. Our findings led to our conclusions and interpretation of ROI against the broad QI governance. We discuss our views against the predominant governance frameworks and wider literature. Findings ROI is in-line with top-down control governance frameworks based in politics and economics. However, there is evidence that to be of better utility, a tool for the assessment of the value of QI benefits must include comprehensive benefits that reflect broad monetary and non-monetary benefits. This is in-line with bottom-up and collaborative governance approaches. ROI has several challenges that may limit it as a QI governance tool. This is supported by wider literature on ROI, QI as well as modern governance theories and models. As such, we question whether ROI is the appropriate tool for QI governance. A more pragmatic governance framework that accommodates various healthcare objectives is advised. Practical implications This article highlights some of the challenges in adopting ROI as a QI governance tool. We signal a need for the exploration of a suitable QI governance approach. Particularly, are healthcare leaders to be perceived as “agents”, “stewards” or both. The evidence from our research and wider literature indicates that both are crucial. Better QI governance through an appropriate value assessment tool could improve clarity on QI value, and thus investment allocation decision-making. Constructive discussion about the utility and appropriateness of ROI in the evaluation of healthcare QI programmes may help safeguard investment in effective and efficient health systems. Originality/value The article raises awareness of QI governance and encourages discussions about the challenges of using ROI as a tool for healthcare QI governance.

Healthcare quality and safety span multiple topics across the spectrum of academic and clinical disciplines. Keeping abreast of the rapidly growing body of work can be challenging. In this series, we provide succinct summaries of selected relevant studies published in the last several months. Some articles will focus on a particular theme, whereas others will highlight unique publications from high- impact medical journals.

Purpose This paper aims to highlight the factors influencing the conceptualisation of return on investment (ROI) from healthcare quality improvement (QI) programmes. Design/methodology/approach In their previous work, the authors found that the concept of ROI from QI is broad and includes numerous internal and external benefits for organisations. In this paper, the authors developed a framework outlining the factors that influence this conceptualisation of QI-ROI from an institutional theory perspective. The framework is based on the synthesis of their serial studies on the determinants of the concept of ROI from QI. The research was performed from 2020–2023 and involved a global multidisciplinary systematic literature review ( N = 68), qualitative interviews ( N = 16) and a Delphi study ( N = 23). The qualitative and Delphi studies were based on the publicly-funded mental healthcare in UK. Participants included board members, clinical and service directors, as well as QI leaders. Findings The authors outline a framework of internal and external institutional forces that influence the conceptualisation of ROI from QI programmes in mental healthcare and similar organisations. Based on these factors, the authors state several conjectures. In doing this, the authors highlight the ambiguities and uncertainties surrounding QI-ROI conceptualisation. These challenge leaders to balance various monetary and non-monetary benefits for organisations and health systems. This explains the broadness of the QI-ROI concept. Originality/value The authors developed a framework highlighting the forces underpinning the broad, ambiguous and sometimes uncertain nature of the QI-ROI concept. They raise awareness about dilemmas to be confronted in developing or applying any tool to evaluate the value for money of QI programmes. Specifically, the work highlights the limitations of the ROI methodology as a primary tool in the QI context and the need for a more comprehensive tool.

To evaluate the effects of a ballet-based world first dance intervention on the key non-motor and motor symptoms of Parkinson's disease using validated outcome measures.

BackgroundReturn on Investment (ROI), whereby the ratio of costs to benefits is assessed, is encouraged in-order to justify the value of Quality Improvement (QI) programmes. We previously performed a literature review to develop a ROI conceptual framework for QI programmes. We concluded that, QI-ROI is conceptualised as any monetary and non-monetary benefit. In the current study, we explored if this finding is shared by mental healthcare leaders. We also investigated the stability of this conceptualisation against influencing factors and potential for disinvestment.MethodsWe performed qualitative interviews with leaders in an NHS mental health organisation. There were 16 participants: nine board members and seven senior leaders. The interviews were held online via Microsoft Teams and lasted an hour on average. We performed deductive-inductive analysis to seek data from our initial ROI framework and any new data.ResultsWe found that in mental healthcare, QI-ROI is also conceptualised as any valued monetary and non-monetary benefits. There was a strong emphasis on benefits to external partners and a de-emphasis of benefit monetisation. This conceptualisation was influenced by the 1) perceived mandates to improve quality and manage scarce resources, 2) expectations from QI, 3) health and social care values, 4) ambiguity over expectations, and 5) uncertainty over outcomes. Uncertainty, ambiguity, and potential for disinvestment posed a threat to the stability of this conceptualisation but did not ultimately change it. Health and social care values supported maintaining the QI-ROI as any benefit, with a focus on patients and staff outcomes. Socio-political desires to improve quality were strong drivers for QI investment.ConclusionMental healthcare leaders primarily conceptualise QI-ROI as any valued benefit. The inclusion of externalised outcomes which are hard to attribute may be challenging. However, mental healthcare services do collaborate with external partners. The de-emphases of benefit monetisation may also be controversial due to the need for financial accountability. Mental healthcare leaders recognise the importance of efficiency savings. However, they raised concerns over the legitimacy and utility of traditional ROI as a tool for assessing QI value. Further research is needed to bring more clarity on these aspects of the QI-ROI concept.

Throughout its history, the National Health Service (NHS) in the UK has undergone numerous reforms. One such historical transformation occurred in cancer care in the mid-1990s, spurred by below-average survival rates, variability in treatment quality, and fragmented care. In response, the UK Government prioritised enhancing care quality and survival, with the Calman-Hine report1Calman K Hine D A policy framework for commissioning cancer services: a report by the Expert Advisory Group on Cancer to Chief Medical Officers of England and Wales. Department of Health and Social Care, London1995https://iiif.wellcomecollection.org/pdf/b3221926xDate accessed: August 14, 2023Google Scholar in 1995 and the NHS Cancer Plan2UK Department of HealthThe NHS Cancer Plan. A plan for investment. A plan for reform.https://dera.ioe.ac.uk/id/eprint/4423/1/04055783.pdfDate: July, 2000Date accessed: August 14, 2023Google Scholar in 2000 guiding the efforts. These strategic documents promoted an integrated and coordinated approach to cancer care and a move towards cancer-specific specialists within cancer multidisciplinary teams. The focus shifted from introducing new health technologies to improve patient care to revamping the infrastructure and prioritising human factor dynamics—specifically, the interactions and collaborations between specialists within care teams. Although some of the reform's underpinnings have been debated since—particularly the notion that specialisation and concentration of expertise (with high caseloads) would lead to better outcomes for patients—the Government showed its commitment to cancer care by investing substantial resources in its roll-out between 1995 and 2020.1Calman K Hine D A policy framework for commissioning cancer services: a report by the Expert Advisory Group on Cancer to Chief Medical Officers of England and Wales. Department of Health and Social Care, London1995https://iiif.wellcomecollection.org/pdf/b3221926xDate accessed: August 14, 2023Google Scholar, 2UK Department of HealthThe NHS Cancer Plan. A plan for investment. A plan for reform.https://dera.ioe.ac.uk/id/eprint/4423/1/04055783.pdfDate: July, 2000Date accessed: August 14, 2023Google Scholar, 3Morris E Haward RA Gilthorpe MS Craigs C Forman D The impact of the Calman-Hine report on the processes and outcomes of care for Yorkshire's colorectal cancer patients.Br J Cancer. 2006; 95: 979-985Crossref PubMed Scopus (91) Google Scholar The multidisciplinary team meeting became central to the implementation of the 1995 reform and a gold standard in cancer care.1Calman K Hine D A policy framework for commissioning cancer services: a report by the Expert Advisory Group on Cancer to Chief Medical Officers of England and Wales. Department of Health and Social Care, London1995https://iiif.wellcomecollection.org/pdf/b3221926xDate accessed: August 14, 2023Google Scholar, 2UK Department of HealthThe NHS Cancer Plan. A plan for investment. A plan for reform.https://dera.ioe.ac.uk/id/eprint/4423/1/04055783.pdfDate: July, 2000Date accessed: August 14, 2023Google Scholar, 3Morris E Haward RA Gilthorpe MS Craigs C Forman D The impact of the Calman-Hine report on the processes and outcomes of care for Yorkshire's colorectal cancer patients.Br J Cancer. 2006; 95: 979-985Crossref PubMed Scopus (91) Google Scholar Its pivotal role in improving care quality and reducing treatment variations has since been reinforced by generally supportive evidence.4Lamb BW 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: 2116-2125Crossref PubMed Scopus (314) Google Scholar, 5Soukup T Lamb BW Morbi A et al.A multicentre cross-sectional observational study of cancer multidisciplinary teams: analysis of team decision making.Cancer Med. 2020; 9: 7083-7099Crossref PubMed Scopus (19) Google Scholar, 6NHS England and NHS ImprovementStreamlining Multi-Disciplinary Team Meetings – Guidance for Cancer Alliances.https://www.england.nhs.uk/wp-content/uploads/2020/01/multi-disciplinary-team-streamlining-guidance.pdfDate: 2020Date accessed: August 14, 2023Google Scholar The multidisciplinary team meeting provides value through a formal, dedicated setting for the cancer-specific specialists to meet regularly to methodically review cases, provide specialist knowledge, and collectively formulate treatment recommendations.1Calman K Hine D A policy framework for commissioning cancer services: a report by the Expert Advisory Group on Cancer to Chief Medical Officers of England and Wales. Department of Health and Social Care, London1995https://iiif.wellcomecollection.org/pdf/b3221926xDate accessed: August 14, 2023Google Scholar, 2UK Department of HealthThe NHS Cancer Plan. A plan for investment. A plan for reform.https://dera.ioe.ac.uk/id/eprint/4423/1/04055783.pdfDate: July, 2000Date accessed: August 14, 2023Google Scholar, 3Morris E Haward RA Gilthorpe MS Craigs C Forman D The impact of the Calman-Hine report on the processes and outcomes of care for Yorkshire's colorectal cancer patients.Br J Cancer. 2006; 95: 979-985Crossref PubMed Scopus (91) Google Scholar, 4Lamb BW 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: 2116-2125Crossref PubMed Scopus (314) Google Scholar, 5Soukup T Lamb BW Morbi A et al.A multicentre cross-sectional observational study of cancer multidisciplinary teams: analysis of team decision making.Cancer Med. 2020; 9: 7083-7099Crossref PubMed Scopus (19) Google Scholar, 6NHS England and NHS ImprovementStreamlining Multi-Disciplinary Team Meetings – Guidance for Cancer Alliances.https://www.england.nhs.uk/wp-content/uploads/2020/01/multi-disciplinary-team-streamlining-guidance.pdfDate: 2020Date accessed: August 14, 2023Google Scholar However, the landscape of cancer care is now at another historic crossroad. Growing demands on multidisciplinary team meetings, driven by increasing cancer incidence in an ageing population, complex diagnostic and treatment modalities, and fiscal and workforce constraints, are straining the system.5Soukup T Lamb BW Morbi A et al.A multicentre cross-sectional observational study of cancer multidisciplinary teams: analysis of team decision making.Cancer Med. 2020; 9: 7083-7099Crossref PubMed Scopus (19) Google Scholar, 6NHS England and NHS ImprovementStreamlining Multi-Disciplinary Team Meetings – Guidance for Cancer Alliances.https://www.england.nhs.uk/wp-content/uploads/2020/01/multi-disciplinary-team-streamlining-guidance.pdfDate: 2020Date accessed: August 14, 2023Google Scholar, 7Hoinville L Taylor C Zasada M et al.Improving the effectiveness of cancer multidisciplinary team meetings: analysis of a national survey of MDT members' opinions about streamlining patient discussions.BMJ Open Qual. 2019; 8e000631Crossref PubMed Scopus (29) Google Scholar Recognising these challenges, NHS England's 2016 cancer strategy and Cancer Research UK in 2017 called for caseload streamlining to conserve time and resources, while ensuring specialists focus on more complex cases. This directive heralded a historic shift in cancer care planning, marked in 2020 by the release of the NHS England streamlining guidance.6NHS England and NHS ImprovementStreamlining Multi-Disciplinary Team Meetings – Guidance for Cancer Alliances.https://www.england.nhs.uk/wp-content/uploads/2020/01/multi-disciplinary-team-streamlining-guidance.pdfDate: 2020Date accessed: August 14, 2023Google Scholar For the first time since the mid-1990s, it became no longer mandatory for all cancer cases to be discussed at multidisciplinary team meetings. Now, only complex cases requiring multidisciplinary input require detailed discussion in multidisciplinary team meetings, while patients on predetermined pathways need to be registered but not deliberated by the multidisciplinary team.6NHS England and NHS ImprovementStreamlining Multi-Disciplinary Team Meetings – Guidance for Cancer Alliances.https://www.england.nhs.uk/wp-content/uploads/2020/01/multi-disciplinary-team-streamlining-guidance.pdfDate: 2020Date accessed: August 14, 2023Google Scholar Although streamlining offers a potential solution5Soukup T Lamb BW Morbi A et al.A multicentre cross-sectional observational study of cancer multidisciplinary teams: analysis of team decision making.Cancer Med. 2020; 9: 7083-7099Crossref PubMed Scopus (19) Google Scholar, 6NHS England and NHS ImprovementStreamlining Multi-Disciplinary Team Meetings – Guidance for Cancer Alliances.https://www.england.nhs.uk/wp-content/uploads/2020/01/multi-disciplinary-team-streamlining-guidance.pdfDate: 2020Date accessed: August 14, 2023Google Scholar to challenges confronting multidisciplinary team meetings, there is a scarcity of published evidence that the NHS England streamlining guidance6NHS England and NHS ImprovementStreamlining Multi-Disciplinary Team Meetings – Guidance for Cancer Alliances.https://www.england.nhs.uk/wp-content/uploads/2020/01/multi-disciplinary-team-streamlining-guidance.pdfDate: 2020Date accessed: August 14, 2023Google Scholar has been adopted widely since its release in 2020—a situation that could amplify inequitable access to proven and innovative treatments. There is a concern that without evidence-based strategies to streamlining, we risk reintroducing the very inconsistency in patient care that multidisciplinary team working was designed to eliminate after the Calman-Hine report.8Winters DA Soukup T Sevdalis N Green JSA Lamb BW The cancer multidisciplinary team meeting: in need of change? History, challenges and future perspectives.BJU Int. 2021; 128: 271-279Crossref PubMed Scopus (22) Google Scholar, 9Soukup T Lamb BW Sevdalis N Green JS Streamlining cancer multidisciplinary team meetings: challenges and solutions.Br J Hosp Med. 2020; 81: 1-6Crossref Scopus (19) Google Scholar Adopting an evidence-based approach will ensure that patient safety and care quality are uncompromised,7Hoinville L Taylor C Zasada M et al.Improving the effectiveness of cancer multidisciplinary team meetings: analysis of a national survey of MDT members' opinions about streamlining patient discussions.BMJ Open Qual. 2019; 8e000631Crossref PubMed Scopus (29) Google Scholar, 8Winters DA Soukup T Sevdalis N Green JSA Lamb BW The cancer multidisciplinary team meeting: in need of change? History, challenges and future perspectives.BJU Int. 2021; 128: 271-279Crossref PubMed Scopus (22) Google Scholar, 9Soukup T Lamb BW Sevdalis N Green JS Streamlining cancer multidisciplinary team meetings: challenges and solutions.Br J Hosp Med. 2020; 81: 1-6Crossref Scopus (19) Google Scholar and address the reported apprehension of multidisciplinary teams to streamlining,7Hoinville L Taylor C Zasada M et al.Improving the effectiveness of cancer multidisciplinary team meetings: analysis of a national survey of MDT members' opinions about streamlining patient discussions.BMJ Open Qual. 2019; 8e000631Crossref PubMed Scopus (29) Google Scholar thus facilitating consistent adoption of the guidance.6NHS England and NHS ImprovementStreamlining Multi-Disciplinary Team Meetings – Guidance for Cancer Alliances.https://www.england.nhs.uk/wp-content/uploads/2020/01/multi-disciplinary-team-streamlining-guidance.pdfDate: 2020Date accessed: August 14, 2023Google Scholar With the crucial need to streamline multidisciplinary team meetings, we propose an evidence-based research effort grounded in implementation science to minimise risks and maximise learning. Implementation science can drive rapid and effective translation of the streamlining guidance into practice, ultimately enhancing care quality and patient survival. First, the effectiveness of streamlining approaches and strategies against implementation, patient, and service outcomes, should be evaluated with validated tools.9Soukup T Lamb BW Sevdalis N Green JS Streamlining cancer multidisciplinary team meetings: challenges and solutions.Br J Hosp Med. 2020; 81: 1-6Crossref Scopus (19) Google Scholar, 10Soukup T Morbi A Lamb BW et al.A measure of case complexity for streamlining workflow in multidisciplinary tumor boards: mixed methods development and early validation of the MeDiC tool.Cancer Med. 2020; 9: 5143-5154Crossref Scopus (19) Google Scholar This adds value by revealing unintended consequences, both positive and negative, ensuring that streamlining is implemented effectively and safely. Second, data on the facilitators and barriers to streamlining should be collected systematically. This will inform development of effective implementation strategies and approaches, ensuring consistent adoption of streamlining. Third, drawing on methodologies such as Getting it Right the First Time (GIRFT), the identification of strategies and approaches to streamlining that work, those that do not, and the circumstances under which they succeed or fail should be recorded systematically. Finally, building on GIRFT's success, in particular recent GIRFT Guidance for Kidney Cancer, and British Association of Urological Surgeons Guidance on Implementing Streamlining in Urology multidisciplinary team meetings, data-driven insights from in-depth reviews of streamlining should be converted into a practical gold standard implementation manual for multidisciplinary team meetings across different tumour types, containing: identified and anticipated determinants to streamlining; effective implementation strategies and instructional procedures, enriched by real-world case scenarios (akin to those adopted by, for example, the Civil Aviation Authority's CAP737: Flight Crew Human Factors Handbook); and a toolkit equipped with validated instruments for evaluating the impact of streamlining and promoting a culture of continuous improvement and audit. As we navigate this transformative phase in cancer care, it is crucial that streamlining remains rooted in evidence-based strategies and approaches. Building on the legacy of the Calman-Hine report,1Calman K Hine D A policy framework for commissioning cancer services: a report by the Expert Advisory Group on Cancer to Chief Medical Officers of England and Wales. Department of Health and Social Care, London1995https://iiif.wellcomecollection.org/pdf/b3221926xDate accessed: August 14, 2023Google Scholar we should strive to combine historical lessons, evidence-based methodologies, and future-forward strategies, ensuring equitable, and consistently high-quality care for every patient with cancer. GDS and BWL contributed equally to this work. Infrastructure support for this research for TS was provided by NIHR London Medtech and In vitro diagnostic Co-operative. BWL and TS received funding from Cancer Alliances and NHS England for training multidisciplinary teams in assessment and quality improvement methods in the UK and honoraria for public speaking from Parsek. TS received consultancy fees from Roche Diagnostics, Parsek, and Salutare. BWL received consultancy fees from Digital Surgery, MDOUTLOOK and honoraria from AstraZeneca and Astellas, and has a leadership role in the British Association of Urological Surgeons (Section of Oncology). GDS received educational grants from Pfizer, AstraZeneca, and Intuitive Surgical; consultancy fees from Pfizer, Merck, EUSA Pharma, and CMR Surgical; and travel expenses and speaker fees from Pfizer. GDS also has a leadership role in GIRFT (kidney cancer guidance), NICE kidney cancer guideline, and the National Kidney Cancer Audit.