UNSW research centre for primary health care and equity
An intervention to enhance teamwork within general practice
Jane Taggart
UNSW Research Centre for Primary Health Care & Equity
InvestigatorsChief Investigators
CIA Professor Mark HarrisCIB Dr Judy ProudfootCIC Professor Justin BeilbyCID Professor Patrick CrookesCIE E/Prof Geoffrey MeredithCIF A/Professor Deborah Black
Associate InvestigatorsA/Professor Elizabeth PattersonDr David PerkinsMr Gawaine Powell DaviesMr Matt HanrahanDr 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
UNSW Research Centre for Primary Health Care & Equity
• 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; 8:55.
UNSW Research Centre for Primary Health Care & Equity
AimTo describe:• The Teamwork Study and intervention
• What helped / limited practices to achieve goals?
• What worked with the facilitation?
UNSW Research Centre for Primary Health Care & Equity
The Teamwork StudyTo 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 satisfactionTeam climate, staff roles, readiness for change and job
satisfaction of staff Clinical linkages
UNSW Research Centre for Primary Health Care & Equity
Our previous researchBuilding 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
UNSW Research Centre for Primary Health Care & Equity
11 Systems1. Structured Appointment System2. Patient Disease Register3. Recall & Reminder System4. Patient Education and Resources5. Planned Care6. Practice Based Linkages7. Roles, Responsibilities & Job Descriptions8. Communication & Meetings9. Practice Billing System10. Record Keeping11. Quality
UNSW Research Centre for Primary Health Care & Equity
Characteristics of practicesIntervention (n=30) Control (n=30)
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)
UNSW Research Centre for Primary Health Care & Equity
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
UNSW Research Centre for Primary Health Care & Equity
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%)
UNSW Research Centre for Primary Health Care & Equity
ObservationsWhat helped practices achieve goalscommitted driverskilled and motivated staffrange of staff involved in intervention meetingsstructured practice visits by facilitatorswriting goals and timeframesuseful resources
UNSW Research Centre for Primary Health Care & Equity
ObservationsWhat 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
UNSW Research Centre for Primary Health Care & Equity
“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)
“having the goals and tasks written with
target dates helped to set things in motion”.
(PM)
"it made us sit down and look at what we do, what we want to do and how we go about doing
it”. (GP)
What worked with the facilitation
UNSW Research Centre for Primary Health Care & Equity
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
UNSW Research Centre for Primary Health Care & Equity
UNSW Research Centre for Primary Health Care & Equity
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
UNSW Research Centre for Primary Health Care & Equity
A case studyGroup practice – regional NSW
5 GPs, 2 PNs, Full Time PM
11 staff attended education session
Visits 1, 2 & 3 with PM and PN
Worked on goal: All diabetes patients onto GPMPs and annual cycle of care
Audit showed 60% were on GPMPs
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
UNSW research centre for primary health care and equity
ThankyouFor more information
or
www.cphce.unsw.edu.au