Green Book

Putting prevention into practice - Chapter 4.8

Collaborating to make it work

Key points

The PRACTICE framework:

  • Is useful when implementing preventive activities – it incorporates elements of several other theories and frameworks
  • Helps identify and overcome barriers to implementation (eg engagement, collaboration and systems)
  • Helps remind us that change is incremental and that we should plan for and recognise ‘small’ successes along the way.

The Green Book brings together two main themes: prevention and implementation.

Both of these sit within QI and are inherently associated with behaviour change.

The whole process is also more feasible if the practice collaborates with others who have relevant skills or programs (eg allied health providers such as Quitline counsellors, diabetes educators). Collaboration with the patient is also an essential element and part of the patient-centred approach. Knowledge of local services, supports and agencies can facilitate collaboration. The local PHN should be aware of potential partners and supports.

Nevertheless, better collaboration is often challenging. Groups tend to promote an inwardly focused identity and values. Similarly, group members develop strong in-group norms and behaviours that collectively create mental or physical boundaries. This makes it more difficult for external agents and persons to engender networked behaviours and collaboration.105

Strategies to improve collaboration include:105

  • more attempts to gain a better understanding of the nature of gaps (social or physical spaces, structural holes, disconnected ties) between teams and groups
  • use of opinion leaders and facilitators to help span boundaries; these boundary spanners are people who bridge two or more groups, enabling exchange of information or communication
  • using strategies to stimulate more interactive relationships (eg joint agendas, identifying common purpose, sharing a common space).


GPs Assisting Smokers Program

As part of GASP, GPs and PNs were offered an opportunity to enhance their counselling skills in smoking cessation by attending a 2.5-hour workshop on motivational interviewing and brief behaviour change. There were two workshop leaders: a GP and a Quitline counsellor. Several strategies were used to enhance the recognition and referral to Quitline counsellors:

  • the GP and the Quitline counsellor conjointly ran the workshop
  • in small group sessions, each facilitator demonstrated their approach to counselling
  • a one-minute ‘referral to Quitline’ spiel was developed to provide GPs and PNs with an efficient approach for referral to the Quitline.

The benefits of involving the Quitline counsellor were many. GPs and PNs saw, first hand, the high-level skills and competencies of a Quitline counsellor. This had several follow-on effects, including greater subsequent referrals to the Quitline and greater preparedness of the practices to use PNs as counsellors. It saved the GPs time and many PNs embraced the opportunity to improve counselling skills that they have used with a number of different patient groups, including patients with asthma and diabetes.

Participants commented positively on the conjoint approach and how it added to the effectiveness of the GP and practice team intervention. They reported that Quitline referrals in their practices were subsequently monitored and improved.

– Assoc Prof John Litt and the GASP team, including Flinders University and Quitline South Australia

Are all the key players involved?

Provision of best practice in both prevention and management of chronic illness would add an additional 9–10 hours to a normal day,106,107 making it difficult to provide high levels of prevention outside a partnership approach. Partnerships and collaboration operate at different levels: between the GP and patient; PNs and patient; GPs, PNs and practice team; and between the practice, PHN and/or the broader community and the health system.

There is evidence that when GPs and PNs regard patients as active partners in seeking preventive healthcare advice, patients are more likely to adhere to treatment plans.108,109 This requires teamwork and respect for others’ ideas and views.110 Referring to, and communicating with, certain services and community agencies may be the most cost effective way of providing particular types of prevention activities for patients. Improving the integration of preventive activities through greater collaboration leads to enhanced effectiveness and efficiency.96,111

To what extent does the practice coordinate with other services and agencies?

A range of other players and agencies are involved in promoting health and preventing disease. A number of studies40,112 have demonstrated that collaboration and teamwork is associated with the largest gains in prevention outcomes. Partnerships are associated with improved delivery of care.

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