Identifying a target goal provides something to aim for and a benchmark against which to measure progress.
Identifying and addressing barriers to implementation
It is also useful to identify the actual and potential barriers and difficulties that may be encountered when trying to improve performance.43–48 For example, consider the health literacy of the target population, as this may be a significant barrier to patients engaging with and taking up preventive activities and adhering to preventive advice.
One simple strategy is to ask all the practice team about the potential (and actual) challenges that they will likely face if implementation is to proceed. Also ask the team about possible ways of addressing these barriers and challenges.
Knowing how well the practice is performing, together with an understanding of barriers, will assist in the development of appropriate strategies to overcome the difficulties.
When implementing prevention activities for our Aboriginal and Torres Strait Islander patient group, we identified that the biggest barrier was keeping appointments. The practice team agreed to change our approach to targeting patients opportunistically in the waiting room. This meant ensuring nursing staff have capacity to do this without disturbing the flow of appointments. We achieved this by empowering the nurses to:
- review the appointment book and the waiting room, both in the morning and during the day, to identify potential patients to invite in for ‘added value care’
- invite the patients to spend some time updating their records while they are waiting for their doctor. They are often able to get preventive care activities started or finished while patients are waiting. They are also able to have patients come back to finish their prevention activities after seeing the doctor (if not completed during the appointment)
- have adequate ‘unscheduled’ patient time slots to enable this flexible approach to care.
– Assoc Prof Charlotte Hespe, Green Book Editorial Committee
Common challenges to effective implementation relate to a practice’s capability in terms of whether practice members have:
- adequate knowledge
- positive attitudes/beliefs about prevention
- sufficient skills
- enough time, resources and personnel
- adequate organisational infrastructure.