F1 – Defining and planning for the practice

Within a general practice, values are lived experiences and actions that reflect a practice’s commitment to its stated mission and vision. These could include:

• how the practice embeds a culture of continuous quality improvement
• its code of ethics, outlining the core principles and beliefs that guide the practice and set the tone for its culture
• patient and consumer empowerment
• cultural competence
• the adoption of innovation in healthcare delivery
• empathy and compassion
• engagement and collaboration with members of the practice team, consumers, and the community.

Promoting the practice’s mission, vision and values to the practice team helps to increase alignment, motivation, and productivity. To do so, the practice could:

• communicate the practice’s mission and values, as well as strategic goals and objectives through regular channels, such as team meetings, emails, internal memos, and digital discussion groups such as WhatsApp
• invite input from the practice team in order to support alignment and engagement
• use performance evaluations to assess how well employed members of the practice team reflect the practice’s values and ethics
• provide ongoing training to help the practice team understand the practice’s goals and objectives
• encourage the practice team to participate in reflective discussions to further inform the practice’s mission, vision, values and goals.

Governance refers to how a practice oversees and is accountable for its operations, decisions, and responsibilities, including clinical, organisational, financial, and ethical aspects. The practice could have a formal governance framework or a more informal process depending on its size.

Responsibility for the practice’s governance could rest with practice owners, management teams, clinical leads, or other designated roles.

The practice could:

• maintain a documented governance process, or a summary of the process, in the strategic plan or operational plan
• include governance responsibilities in role descriptions
• include governance review in team meetings
• periodically review the extent to which its governance arrangements are in line with F1.D to confirm that they are effective, fit for purpose, and aligned with the practice’s needs and externally imposed requirements.

The practice’s strategic plan could include high-level plans for the practice’s service development, financial goals, outcome goals, and delivery of safe and high-quality care. As an operational document, the strategic plan needs to be reviewed for currency every two years.

To develop a strategic plan, the practice could:

• assess its current operational and financial performance
• identify and document key areas where improvements are needed
• set goals that are specific, measurable, achievable, relevant and time-bound
• determine a timeframe to review and refresh its goals.

To measure progress towards the goals in the strategic plan, the practice could:

• define and track measurable key performance indicators related to those goals
• use benchmarking data to identify areas of improvement in the practice
• hold strategy review meetings with relevant members of the practice team
• collect and assess feedback from the practice team and consumers.

To measure progress towards the objectives in the operational plan, the practice could:

• monitor key performance indicators to see how its day-to-day activities align with operational objectives
• set and track the completion of milestones specified in the objectives
• implement performance dashboards that can give real-time updates on operational metrics, and use these to identify areas that need attention
• include discussion of operational objectives at team meetings
• audit key processes to assess their efficiency and effectiveness.

If your operational plan includes creating and maintaining interdependencies with external organisations (for example, public health units and PHNs), this can streamline referrals and access to resources. Incorporating communication strategies also helps align the team with operational goals.

As an operational document, the operational plan needs to be updated when relevant changes are identified and reviewed for currency every two years.

Embedding safety into the practice’s strategic plan supports a proactive practice-wide focus on safe, high-quality care. Strategies that address safety as a core element of the practice’s planning, leadership and culture could include:

• assigning clear responsibilities for safety leadership
• setting safety-related goals
• documenting workforce training needs
• identifying indicators for monitoring safety performance.

Assessing the practice’s safety culture helps leaders understand how to improve it. Safety culture assessments could involve:

• members of the practice leadership team observing how members of the practice team implement safety strategies in their daily activities (for example, risk mitigation, infection prevention and control, privacy measures)
• conducting surveys or focus groups with the practice team to collect feedback about the practice’s:
  • general safety processes, for example, in infection prevention and control, privacy, information technology
  • risk management and reporting systems
  • incident management and reporting systems
  • protocols for supporting team members to provide safe care.

The document control process needs to include:

• naming conventions
• versioning
• clear responsibility for review and sign-off.

Reviewing for currency needs to happen every two years or earlier, as circumstances require.

The practice could:

• implement centralised document storage (for example, use a digital folder such as Google Drive, SharePoint, or a practice management system) and train staff on how to use it
• use clear document-naming conventions that include the document name, version number, date of last update, assigned reviewer and next review date
• set up reminders to prompt reviews of governance documents
• discuss governance documents and their required updates at team meetings.

Table 1 identifies practical ways the practice could implement, monitor, review and report risk management and mitigation actions. These are suggestions only, as the specific actions, size and complexity of the practice’s risk framework can be proportionate to the practice.

Strategic, operational and service-related risks are different to clinical risks which are addressed in CG7 – Managing clinical risks and incidents.

Table 1 Practical actions for managing strategic, operational and service-related risks

Examples of ethical issues that could arise are:

• management of professional boundaries, for example when members of the practice team know patients outside of the practice, or when a patient offers them a gift
• management of confidentiality in the waiting room
• balancing legal obligations (for example, release of notes to child protection agencies)
• staff requests for appointments, including for workplace injuries.

To review, manage and resolve ethical issues, the practice could:

• encourage open communication by having clear practice policies that foster a culture where members of the practice team feel supported in raising and discussing ethical concerns
• provide education and support by offering training in ethical decision-making, that could include case-based and reflective discussions
• facilitate discussions about ethics and address challenges proactively by incorporating ethical considerations into team meetings or clinical case reviews
• establish ethical guidelines by developing clear policies that guide team members on how to manage ethical dilemmas, such as patients who are also staff or known to practice members
• support reflection, transparency, and continuous learning by developing and maintaining an ethical issues register so that team members can record ethical issues that arise in the practice, and the actions taken
• seek external expertise by consulting medical defence organisations or ethics advisory services when complex ethical issues arise.

When engaging independent doctors in practice, the practice needs to consider its procedures and/or agreements with the doctors to provide them with support services so that they are aware of the practice’s:

• mission, vision and values
• procedures concerning governance that support safe, high-quality care and accountable decision-making
• strategic plan, the operational plan, the strategic approach to safety; and
• ethical requirements.