1. UNSW research centre for primary health care and equity An intervention to enhance teamwork within general practice Jane Taggart

2. UNSW Research Centre for Primary Health Care & Equity Investigators Chief Investigators CIAProfessor Mark Harris CIBDr Judy Proudfoot CICProfessor Justin Beilby CIDProfessor Patrick Crookes CIEE/Prof Geoffrey Meredith CIFA/Professor 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

3. 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.

4. UNSW Research Centre for Primary Health Care & Equity Aim To describe: The Teamwork Study and intervention What helped / limited practices to achieve goals? What worked with the facilitation?

5. UNSW Research Centre for Primary Health Care & Equity 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

6. UNSW Research Centre for Primary Health Care & Equity 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

7. UNSW Research Centre for Primary Health Care & Equity 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

8. UNSW Research Centre for Primary Health Care & Equity Characteristics of practices Intervention (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)

9. 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

10. UNSW Research Centre for Primary Health Care & Equity Priorities chosen (29 practices) Planned care23 (80%) Communications and meetings 4 (14%) Roles and responsibilities 3 (10%) Patient disease registers 2 (6%) Recall and reminder systems 1 (3%) Clinical linkages1 (3%)

11. UNSW Research Centre for Primary Health Care & Equity 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

12. UNSW Research Centre for Primary Health Care & Equity 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

13. 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

14. 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

15. UNSW Research Centre for Primary Health Care & Equity

16. 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

17. UNSW Research Centre for Primary Health Care & Equity A case study Group 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

18. UNSW research centre for primary health care and equity Thankyou For more information M.F.Harris@unsw.edu.au or J.Taggart@unsw.edu.au www.cphce.unsw.edu.au