Guidelines for the implementation of prevention in the general practice setting


The Green Book
2.2 Your practice team 
☰ Table of contents


Practice teams will vary in size and composition. It’s not the size, but the diversity of the team, that’s most important in terms of improving quality.3 Each member of your practice team will have some complementary expertise that can be harnessed to improve preventive care.

Bringing the team together requires a common purpose, leadership and a culture of QI.


A culture of QI


A culture of QI means that quality is prioritised. It is a continuous process integrated into the way the practice operates and where every member of staff is involved in the delivery, review and improvement of care.4 It also implies receptiveness to change.5

A key element of a QI approach is patient-centred care:

Patient-centred care is recognised as a dimension of high-quality healthcare in its own right and is identified in the seminal Institute of Medicine report, Crossing the Quality Chasm,6 as one of the six quality aims for improving care.7

Although an overall culture of QI is vital, a total overhaul of practice workflow is rarely necessary to improve preventive healthcare.
 

Icon

When seeding a culture of QI in our practice, we found that identifying change champions within the practice was key.

– Dr Cory Lei, Green Book Editorial Committee

 
Icon

We recognised that we had to have a dedicated meeting time for QI, supported by monthly reports on data and a dedicated staff member to do and follow up the actions.

– Assoc Prof Charlotte Hespe, Green Book Editorial Committee


Team roles and capabilities


  • Every QI team focusing on prevention (Figure 6) should include at least one member for each of the following:
  • Change champion(s) – this person or people are catalysts for the consideration and adoption of change within the practice.
  • Clinical leadership – this person needs to provide solutions to the preventive care needs of your patients and understand how changes will affect broader clinical care and impact on other parts of the practice.3
  • Technical expertise – your team may need several forms of technical expertise, relating to areas such as QI processes, health information technology (IT) systems needed to support the proposed change (eg audits), and specifics of the area of care affected by preventive activities.3
  • Day-to-day leadership – this person is the lead for the QI team and ensures completion of the team’s tasks, such as data collection, analysis and change implementation. This person must work closely and effectively with the other team members and understand the full impact of the team’s activities on other parts of the practice as well as on the area they are targeting.3
  • Patient care management – these team members work closely with patients and their families, and assess patients’ care needs; develop, reinforce and monitor care plans; provide patient education and encourage
  • self-management; communicate information across clinicians and settings; and connect patients to community resources and social services.5
  • Practice facilitation – this team member could either be internal or external to the practice team and works with practice staff to help organise, prioritise and sequence QI activities; train practice staff to understand and use data effectively (to identify need and evaluate interventions); and redesign workflows and processes so staff can better serve patients.5,8 Although this individual does not usually participate on a daily basis with the team, they can assist the team in obtaining resources and overcoming barriers encountered when implementing improvements.9,10 PHN QI support officers may fulfil this role.

Depending on the complexity of your prevention QI project and the skills of your team, you may have the capacity to fill these roles from within your practice. In some practices wanting to make small or simple improvements, a single person may drive the whole project. However, many, if not most, practices will need to bring in some help from external sources for larger projects, particularly for technical expertise and practice facilitation. Key resources for expertise include your PHN and local health district.11

 
Icon

A change champion might not be one of the usual suspects (such as the principle GP). It may be the PN, or practice manager, who has a vision to take the rest of the practice with them.
It’s important to recognise that people outside your practice (within the healthcare neighbourhood/community) may be part of your QI team too.

– Prof Mark Harris, Green Book Editorial Committee


Figure 6. The QI team
Figure 6. The QI team

Reproduced with permission from The Medical Home. ‘The person centred health system and the Medical Home’. Australia: Australian Centre for the Medical Home, [no date].[Accessed 26 February 2018].

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.