An intervention to enhance teamwork within general practice Jane Taggart

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An intervention to enhance teamwork within
general practiceJane Taggart
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Investigators

• Chief Investigators CIA Professor Mark
  Harris CIB Dr Judy Proudfoot CIC Professor
  Justin Beilby CID Professor Patrick
  Crookes CIE E/Prof Geoffrey Meredith CIF A/Pro
  fessor Deborah Black
• Associate Investigators A/Professor Elizabeth
  Patterson Dr David Perkins Mr Gawaine Powell
  Davies Mr Matt Hanrahan Dr Barbara Booth
• Team Bettina Christl, Jocelyn Tan, Anita
  Schwartz, Corinne Opt Hoog, Pauline Van Dort,
  Linda Greer, Mahnaz Fanaian, Shane Pascoe, Sue
  Kirby, Leigh Cantero, Peta Sharrock, Oshana
  Hermiz

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• Taggart J, Schwartz A, Harris MF, Perkins D,
  Powell Davies G, Proudfoot J, Fanaian M, Crookes
  P. Facilitating teamwork in general practice
  moving from theory to practice. Australian
  Journal of Primary Health. 2009 15 24-28.
• www.publish.csiro.au/journals/py
• Perkins D, Harris MF, Tan J, Christl B, Taggart
  J, Fanaian M. Engaging participants in a complex
  intervention trial in Australian General
  Practice. BMC Medical Research Methodology. 2008
  855.

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Aim

• To describe
• The Teamwork Study and intervention
• What helped / limited practices to achieve goals?
• What worked with the facilitation?

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The Teamwork Study

• To evaluate the impact of an intervention
  designed to enhance the role of non GP staff in
  chronic disease management in general practice
• The quality of care to patients with diabetes,
  ischaemic heart disease/hypertension
• Patient satisfaction
• Team climate, staff roles, readiness for change
  and job satisfaction of staff
• Clinical linkages

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Our previous research

• Building effective teams requires
• defined roles and responsibilities
• clear protocols
• effective communication
• leadership
• training
• linkages with other services

Aspect of teamwork most associated with quality
chronic care was utilising administrative staff
in systems
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11 Systems

• 1. Structured Appointment System
• 2. Patient Disease Register
• 3. Recall Reminder System
• 4. Patient Education and Resources
• 5. Planned Care
• 6. Practice Based Linkages
• 7. Roles, Responsibilities Job Descriptions
• 8. Communication Meetings
• 9. Practice Billing System
• 10. Record Keeping
• 11. Quality

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Characteristics of practices
Intervention (n30) Control (n30)
Metro / region Rural / remote 12 18 19 11
1-3 GPs ? 4 GPs Mean FTE GPs (SD) 12 18 3.07 (1.70) 13 17 3.49 (2.39)
0 PN 1 PN ? 2 PNs Mean FTE PNs (SD) 2 9 19 1.09 (0.77) 3 14 13 1.12 (1.01)
Mean FTE PMs (SD) 0.69 (0.33) 0.92 (0.51)
Mean FTE Admin (SD) 2.55 (1.87) 2.92 (1.96)
Mean FTE Allied Health (SD) 0.13 (0.38) 0.12 (0.38)
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Structure of intervention

• Education session 1 to 2 hours
• Background, evidence, clinical guidelines,
  teamwork and systems
• Practices identify driver / practice lead
• 3 practice visits over 3 to 6 months 1 to 1.5
  hours each
• Worked on priority system chosen by practice
• Set goals, tasks and timeframes
• Roles of non-GP staff
• Resources
• Manuals and workbooks for each system

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Priorities chosen (29 practices)
Planned care 23 (80)
Communications and meetings 4 (14)
Roles and responsibilities 3 (10)
Patient disease registers 2 (6)
Recall and reminder systems 1 (3)
Clinical linkages 1 (3)
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Observations

• What helped practices achieve goals
• committed driver
• skilled and motivated staff
• range of staff involved in intervention meetings
• structured practice visits by facilitators
• writing goals and timeframes
• useful resources

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Observations

• What limited practices achieving goals
• no leader or lead person did not have skills to
  be proactive
• low staff morale
• staff not ready for change
• clinical software limitations or lack of
  knowledge of clinical software
• lack of space
• other practice priorities
• not starting on planned care component

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What worked with the facilitation
liked having someone from outside the practice
providing advice and resources and time to
discuss ways to improve the care of chronic
disease patients. (PN)
"it made us sit down and look at what we do, what
we want to do and how we go about doing it. (GP)
having the goals and tasks written with target
dates helped to set things in motion. (PM)
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What worked with the facilitation

• Practices in control
• Range of staff participating in visits
• Flexibility cater for differences
• Setting follow-up visit in 4 to 6 weeks time
• Facilitators with practice support experience
• Walking through resources / tools

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What practices achieved

• Expanded roles of non-GP staff, electronic
  templates, diabetes clinic, group sessions,
  health assessments
• Written procedures and pathways to combine GPMP,
  TCA and SIP, wallet card for patients with
  appointments, questionnaire to patients for HMR
• Reviewed roles and responsibilities of PNs,
  planned and structured meetings for all staff,
  Friday Facts
• System to identify diabetes patients at risk,
  recall for planned care
• Diabetes clinic coordinator position, structured
  meetings

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A case study
Group practice regional NSW 5 GPs, 2 PNs, Full
Time PM 11 staff attended education session
Audit showed 60 were on GPMPs
Visits 1, 2 3 with PM and PN Worked on goal
All diabetes patients onto GPMPs and annual cycle
of care
1. Developed a care pathway and billing charts
for GPMPs, TCAs and the Diabetes SIP
2. Designed flexible working model for diabetes
clinic in consultation with DGP
3. Took to clinical meeting for input and
commitment
4. Whole practice meeting to plan implementation
in more detail
5. Started with 1 GP, modified and extended to
all GPs

• Whole practice commitment
• Leadership from PM and PN
• All staff informed and involved

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Thankyou

• For more information
• M.F.Harris_at_unsw.edu.au
• or
• J.Taggart_at_unsw.edu.au
• www.cphce.unsw.edu.au