A pleasure to host the final GP Leaders Dinner for the year on Wednesday at El-Phoenician Restaurant in Parramatta.
The WSyd GP Leaders Dinner continues to be an incredible forum for collaboration and shared learnings. A diverse range of topics.
1) Social media and podcasts;
2) Consumer-clinician collaboration through The King’s Fund Collaborative Pairs model – brought to Australia by Consumers Health Forum of Australia and delivered in partnership with Primary Health Networks; to
3) Measuring and publishing measures of high-performing primary care in Australia
Great to spend the evening with my passionate colleagues and hear a diverse range of perspectives, united by a common thread of delivering exceptional care to the community.
WentWest Ltd and our partners have embraced the concepts of the Patient-Centred Medical Home and our GP Leaders are leading the nation in implementing the principles of person-centred, comprehensive, coordinated, accessible and evidence-based interdisciplinary primary care.
Cheers to a bigger and better 2019.
Hosted by Dr Edwin Kruys, Dr Ashlea Broomfield and Dr Jaspreet Saini, the theme of the new BridgeBuilders podcast is collaboration.
A wide variety of guests, including some of our healthcare leaders, give us their view on teamwork, trust, integrated care, leadership and what needs to happen to make Australian healthcare an even better connected place!
Listen on iTunes here.
Listen on SoundCloud here.
Listen to our new BridgeBuilders healthcare collaboration podcast
I am not available to see patients on Mondays. In health care, access to care is everything. So, I better have a really good reason to not be in clinic. This post is dedicated to my patients, to whom I owe so much, and who are ever so generous with their understanding.
On Mondays, I work as the Director for Clinical Governance at WentWest Western Sydney Primary Health Network. Now bear with me, because even my hospital specialist buddies have a hard time understanding what this means.
It’s called integrated care.
Primary care is a grand mix of lots and lots of GPs, and lots and lots of what we call Allied Health Professionals (you know, physiotherapist, dietitians, podiatrists and the like). They’re all independent small businesses, which makes the whole affair a big jigsaw puzzle. My patients know that it’s sometimes hard to explain something all over again to a GP working in the same clinic as me, so moving from one place to the next in primary care is inefficient – it’s better just to stick to the one person that knows a little bit about you.
But there are times when you have to move around – from one practice to another, from your GP to your exercise physiologist, or between primary care and the hospital docs.
Your government knows that there is nothing quite so frustrating as working in silos. So they set up ways to bridge the gaps, and to make sure people don’t fall through the cracks. Organisations like PHNs enable this, and good IT through things such as the MyHealthRecord helps. Amongst other things, PHNs are a mechanism to reduce fragmentation in health care, and increase collaboration between the primary and tertiary care sectors. But they are often misunderstood.
Should we just invest more in primary care and let the GPS figure it out?
To answer this, we need to answer three questions:
- Is health care in Australia currently operating in an organised enough manner to drive high quality outcomes regardless of where a patient is in their health care journey?
- Are you confident that your loved ones will receive high quality primary health care regardless of which of their local general practices they visit?
- If we are not quite there yet, and we believe our system is fragmented and disconnected, how do we ensure that as taxpayers, we do not just pay for more of the same?
Let’s also consider:
- Are practices set up in a way that they would be able to demonstrate improvements in health outcomes over a period of time?
- How many practices in Australia routinely collect and scrutinise their data?
- How many practices have a comprehensive understanding of their patient population?
- How invested are our professional bodies in considering alternative models of funding to fee for service?
- In the USA, a certain practice has been able to demonstrate a reduction in the 28 day readmission of their patients due to medication errors from 20% to 2%. How close is our current system from being able to achieve this? Where is the data?
These are all the questions that organised care could answer. PHNs could play a key role in this area, but nationally, they are not perfect.
What are some of the key areas in which PHNs can play a role?
The table below highlights some of the ways in which my PHN, WentWest Western Sydney Primary Health Network provides support to general practices in western Sydney. This is just a brief snapshot from the WentWest brochure, Transforming Primary Care Part II, and you can find out more by visiting the WentWest website.
Source: WentWest Transforming Primary Care Part II, Brochure
WentWest sums it up in this way:
“Accelerated quality improvement calls upon a coordinated and sustained approach to change management across all levels of the healthcare sector. William Edwards Deming states that “It is not necessary to change. Survival is not mandatory”. He uses irony to demonstrate the critical importance of change for general practice to survive. WentWest has positioned itself well as a change leader, with critical success at the forefront of primary care.”
What are others saying?
Dr Charlotte Hespe provides an excellent summary of what primary health networks are, and why they might help us to achieve a better and more connected future.
“[PHNs] are tasked with facilitating and assisting general practice to deliver improved high-quality, patient-centred healthcare and outcomes and can provide assistance by the provision of new services to bridge the current gaps in care that are vitally needed and should be supported to do so.”
Read more of what Dr Hespe has to say here. She’s done a really good job at explaining things from a patient perspective so I do hope you’ll stop by and have a read.
Want to find out more? Why not connect with me and have a conversation, I’d love to talk to you about it. After all, I don’t give you my Monday so it’s the least I could do!
According to Dr Rodger Dean-Duncan, author of ‘Change-Friendly Leadership: How to Transform Good Intentions into Great Performance‘, in any organisation, people can be either:
- Disenfranchised; or
On average, 22% of employees are engaged in the business – and align their success with the success of their organisation.
Engaged employees are happier, more productive and are more effective at connecting with each other. The most effective and productive employees trust their managers, and each other.
Most organisations will consider one of two mechanisms to ensure employees are doing their best work.
- Compliance – “ticking the boxes”
According to Stephen Covey, compliance mechanisms are a slow-moving and costly prosthesis for lack of trust. Nonetheless, compliance mechanisms are important and necessary to ensure those that are disengaged are still performing to a minimal standard.
- Commitment – “being genuinely engaged and finding joy in work”
Commitment is achieved through authentic, transformational leadership, which I will explore in my next post.
According to the Harvard Business Review, and demonstrated in the image below, leaders need both warmth and competence, however “leaders who project strength before warmth run the risk of eliciting fear.” This is counter-productive. Instead, once you establish your warmth, your strength is a welcome reassurance.
Image courtesy: Tanmay Vora, QAspire.com
This is as true of general practice as it was for Ray Dalio in building up Bridgewater Associates, one of the world’s largest investment management firms. Here is what he has to say in his book, ‘Principles: Life and Work’.
“It would take me about 165 hours a week to achieve the level of excellence that I would be satisfied with.”
Can you imagine how long it would take us each day in general practice to deliver guideline-based care for each and every patient? Can you see why episodic care, that denies us the opportunity to plan for our patients, is inadequate? Treating the patient in front of us means that we must often focus on people’s most immediate and urgent needs. This robs us of the opportunity to practice holistic medicine, and fully engage our patients in other important aspects of their care such as preventative health.
Mr Dalio goes on to say, “That was obviously impossible. Since I wanted to delegate things as much as possible, I asked if the things I was doing could be done excellently by others, and if so, who were those others.
Everyone agreed that most of those areas could not adequately be delegated. I clearly hadn’t done a good enough job of finding and training others to whom I could delegate my responsibilities.
To me, the greatest success you can have is to orchestrate others to do things well without you. A step below that is doing things well yourself. And worst of all is doing things poorly yourself.”
Despite our amazing achievements, General Practice in Australia has not achieved this success. In fact, we are still struggling with doing things well ourselves. Even though we have one of the most effective and efficient primary care sectors in the world.
I challenge you all to take the next step #teambasedcare #trainanddelegate
A fundamental shift is happening in health care. More than ever, the dials are shifting towards patient-centred care. This is not more of the same. Business as usual is shifting from volume to value. Government policies are catching up, and will continue to do so. Sooner or later, we will be funded for value, not volume. Indeed, “the 21st century is the century of the patient.” Professor Sir Muir Gray.