Guidelines for the implementation of prevention in the general practice setting


The Green Book
2.3 Team collaboration 
☰ Table of contents


When bringing together a team, consider the nature and extent of collaboration necessary. Factors important in the development of collaboration include:12–17

  • sharing of vision, goal-setting, planning, and protecting QI time
  • clarification of roles, responsibilities and tasks
  • sufficient support and resources
  • regular and open communication
  • adequate time to develop relationships, working arrangements and trust
  • adequate commitment to the process
  • recognition and acceptance of separate and combined areas of activity
  • familiarity and acknowledgment of expertise
  • local advocates and champions
  • decision-making, problem-solving and goal-setting
  • opportunities for cooperation and coordination.
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While all of the points above are important, I find the following are the most important:

  • Understand and respect the roles and capabilities of all members of the team (including non-clinical).
  • Identify common goals and understanding – what makes sense to everyone.
  • Foster open communication where it is okay for everyone to have a say.
  • Reflect on how the team is actually working – seeking comment from all the team members (did everyone feel able to contribute, be heard).

Protected time is important, but it doesn’t have to be extensive. Some of the best teamwork can come from 10–15-minute informal meetings at the beginning or end of clinical sessions.

– Prof Mark Harris, Green Book Editorial Committee


All members of the team should work together to maximise the ability of patients to lead their own healthcare.11

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Working together to provide comprehensive care: Case study

Background

A north-west Queensland practice team and broad range of allied health providers and specialists are brokered through a subsidised scheme on a monthly roster. They have a total patient load of 5400, with 2900 active patients.

The group provided high-quality comprehensive primary healthcare with a key focus on Aboriginal and Torres Strait Islander patients that present with chronic comorbidities.

Issue

Patient information systems were incomplete and did not accurately reflect the active client load. Follow-up items of care were undertaken in an ad hoc manner without due diligence to providing comprehensive primary healthcare against cycles of care.

Goals

To ensure patients have access to the cycles of care against particular comorbidities, such as type 2 diabetes or CVD.

To maximise capacity in both the administrative and clinical team to incorporate principles of improvement, namely ensuring data quality and adequacy of patient record information.

Process

The first step was to ensure that the data contained in the patient records was appropriately recorded (clean), and that demographic information was current and completed. Administrative and clinical staff were trained in the use of a data cleansing tool, and were tasked with ensuring data was clean and complete. This activity identified missing demographic information and prompted all clinical staff to complete clinical information for each patient being seen for the day.

Once the clinic had access to high-quality data, systematic recall processes were put in place. At weekly meetings, there was a focus on the follow-up care items suggested for chronic comorbidities. Ongoing reviews of increases in episodes of care were also discussed, and priorities were set for the following week.

Outcomes

  • Completed demographic information now ensures record accuracy.
  • Increased identification of patients with chronic obstructive pulmonary disease (COPD), risk of CVD and type 2 diabetes.
  • Smoking status is recorded on 78% of patient records for patients aged ≥18 years.
  • Follow-up care has increased by 45% for type 2 diabetes cycles of care.
  • Review of recall systems review has resulted in an increase of 200% in recalls.
  • Communication and role autonomy across the administrative and clinical team has been strengthened.
  • The Continuous Quality Improvement program has been added to the weekly staff agenda.
  • Local hyperosmotic hyperglycaemic syndrome (HHS) reports indicate that hospital/emergency presentations have reduced.
  • The Aboriginal community-controlled health service has positioned itself as an employer of choice.

Conclusion

The Aboriginal community-controlled health service has access to patient information systems that reflect their current client load and the team is committed to ongoing Continuous Quality Improvement.

The team are involving all staff from when the patient walks through the doors to when they leave, maximising care and ensuring role autonomy with staff. All position descriptions have been reviewed to include QI. Performance appraisals set and measure achievements against measurable indicators. The Aboriginal community-controlled health service has included the use of the data tools in induction and orientation processes. The service has established and embedded principles to ensure ongoing improvement of the data systems that support patient care.

– Ms Lauren Trask, Accreditation Specialist, Queensland Aboriginal and Islander Health Council

The Green Book



 
 
  1. Nutbeam D. Building health literacy in Australia. Med J Aust 2009;191(10):525–26.
  2. von Wagner C, Steptoe A, Wolf MS, Wardle J.Health literacy and health actions: A review and a framework from health psychology. Health Educ Behav 2009;36(5):860–77.
  3. Agency for Healthcare Research and Quality. Practice facilitation handbook. Module 14. Creating quality improvement teams and QI plans. Rockville, MD: AHRQ, updated 2013.  [Accessed 2 March 2018].
  4. Dawda P, Jenkins R, Varnam R. Quality improvement in general practice: An inquiry into the quality of general practice in England. London, UK: The King’s Fund, 2010.
  5. Taylor EF, Machta RM, Meyers DS, Genevro J, Peikes DN. Enhancing the primary care team to provide redesigned care: The roles of practice facilitators and care managers. Ann Fam Med 2013;11(1):80–83.
  6. Institute of Medicine. Crossing the quality chasm: A new health system for the twenty-first century. Washington: National Academies Press, 2001.
  7. Australian Commission on Safety and Quality in Healthcare. Patient-centred care: Improving quality and safety by focusing care on patients and consumers. Discussion paper. Sydney: ACSQHC, 2010.
  8. Mader EM, Fox CH, Epling JW, et al. A practice facilitation and academic detailing intervention can improve cancer screening rates in primary care safety net clinics. J Am Board Fam Med 2016;29(5):533–42.
  9. Michie S. Implementation science: Understanding behaviour change and maintenance. BMC Health Serv Res 2014;14(Suppl 2):9.
  10. Cane J, O’Connor D, Michie S. Validation of the theoretical domains framework for use in behaviour change and implementation research. Implement Sci 2012;7:37.
  11. Lembke T, Ewald D, Rahbar S. Patient centred medical home: A quality improvement handbook for general practice [V1.0]. NSW: Australian Government; North Coast Primary Health Network, [date unknown].
  12. Walters SJ, Stern C, Robertson-Malt S. The measurement of collaboration within healthcare settings: A systematic review of measurement properties of instruments. JBI Database System Rev Implement Rep 2016;14(4):138–97.
  13. 1Reeves S, Perrier L, Goldman J, Freeth D, Zwarenstein M. Interprofessional education: Effects on professional practice and healthcare outcomes (update). Cochrane Database Syst Rev 2013;(3):CD002213.
  14. Long JC, Cunningham FC, Braithwaite J. Bridges, brokers and boundary spanners in collaborative networks: A systematic review. BMC Health Serv Res 2013;13:158.
  15. Grimshaw JM, Eccles MP, Lavis JN, Hill SJ, Squires JE. Knowledge translation of research findings. Implement Sci 2012;7:50.
  16. Chung VC, Ma PH, Hong LC, Griffiths SM. Organizational determinants of interprofessional collaboration in integrative health care: Systematic review of qualitative studies. PLoS One 2012;7(11):e50022.
  17. Christl B, Lloyd J, Krastev Y, Litt J, Harris M. Preventing vascular disease: Effective strategies for implementing guidelines in general practice. Aust Fam Physician 2011;40(10):825–28.