From tutus to morning teas, Australian general practitioners are beginning to think about team spirit
bseiling, paintball, crazy races and other team-building antics have long been considered the province of corporate human resources budgets rather than the slim margins of general practice.
But as Australian practices grow in size, some are realising the business sense in fostering staff dynamics amid the day-to-day rigours of running a medical centre — ensuring everyone from the receptionist to the registrar knows why they are there and how to work well together. At the same time, research is showing this approach can improve patient care, particularly when it comes to chronic disease management.
Victorian GP Dr Richard Bills has done more team-building than most (see Box). For 15 years he and his colleagues have been fostering the collaborative spirit within their practice with a mix of philosophy, communication and fun. There has been tutu-wearing, go-kart racing and even what he calls a “pilgrimage” to Seattle’s Pike Place fish markets.
“I think it’s not a cost. It’s an investment”, Dr Bills says. “Team-building is an investment.”
Building a team spirit within a practice means creating an environment in which all staff — doctors, receptionists, nurses, allied health practitioners, registrars and students — feel they are an important part of the practice’s success, says organisational psychologist Dr Paul Waight.
Dr Waight is a lecturer at Central Queensland University and tells the story of a recent first visit to a new general practice. After suffering a long period of benign neglect in the waiting room, he was ushered in to see the GP.
“[And] when the doctor saw what I did, he said ‘Oh, maybe you could help me run this place?’.”
“I said no, as it was a conflict of interest”, Waight laughs. But his waiting room experience had suggested that some help was needed. It appeared that the staff were so focused on their own roles that they hadn’t been able to acknowledge his presence as a client.
“It’s worthwhile putting the client at the centre of the organisation. It sounds trite, but so often people get so enmeshed in the day-to-day running of things — the procedures, the rules and things — that the client is pushed to one side.”
Dr Waight says that the foundations of team-building are setting clear goals for the organisation and establishing lines of communication between all levels. “We see with most organisations there seems to be a certain level of deafness to upward communication. That’s always a problem.”
This can be overcome with a combination of formal channels, as in practice meetings; semi-formal get-togethers, as in morning teas; and informally, as in corridor talk or instant messaging.
Goals and communication
Creating effective practice teams through communication and goal-setting is a focus of the Australian Primary Care Collaboratives (APCC) program run by the South Australian-based Improvement Foundation (IF). When the program was first established in 2004 to encourage quality improvements in general practice, the IF quickly realised that effective change required a team approach in which all staff were engaged.
To help practices achieve this, they developed five “Change ideas”:
- • Set realistic goals
- • Communicate with other team members
- • Engage the team
- • Develop the team
- • Reflect on and review what you are doing
Clinical adviser Dr Andrew Knight says that in the end the improved cohesion and communication this creates can lift both practice income and patient outcomes, particularly when it comes to chronic care.
“If all of your team — from the receptionist to the nurse to the doctor — understand what your goals are, say with diabetes care, they understand that what we’re aiming for is that most people have an HbA1c [glycated haemoglobin] of less than 7, then they take a sense of pride in achieving those goals”, he says.
“To me, it’s essential that if you’re going to achieve things, everyone’s on board, pulling in the same direction.”
Evaluation of the APCC has shown improved outcomes for chronic disease management, thanks in part to effective team management with the participating practices.
“If you organise all of your diabetes patients to have a care plan properly done and you do that in a comprehensive way because of your practice systems, you will increase the income of the practice [Chronic care item numbers are higher earning] — but you’ll also improve your chronic disease care”, Dr Knight says.
However Dr Knight says there is a lot working against team-building in general practice.
“All the drivers in Australian general practice are for a GP to sit in their room and see more patients because that’s where the financial results are.
“There is no quick money in stopping and thinking about what you’re doing, talking to your colleagues, organising things to be done better.
“But there is long-term money in it. It just requires great self-discipline to step out of the practice for an hour, forgo all the income, just to talk to each other and plan.”
Dr Bills has been stepping out of his practice to talk and make plans for 15 years. His practice now spends more than $1000 per staff member per year on team-building activities, and they have a staff of 52.
“So that’s $50 000 a year from my practice. But I get great value for that”, Dr Bills says.
Although such costs are tax deductible, the tight margins in Australian general practice mean that courage is required to make investments of any amount in team-building, let alone $50 000. And with recent cutbacks, including in mental health rebates and immunisation, Dr Knight fears the ability of practices to devote money to this area is vulnerable.
But because he feels it is so important to practice cohesion, efficiency and ultimately care, he suggests there could be a future Practice Incentives Program (PIP) in this area, perhaps related to practice meetings.
“Something that promotes team functioning within Australian general practice”, Dr Knight says, noting that some APCC participants had never had a practice meeting before joining the program.
Far from requiring abseiling, paintball or other extreme bonding sessions, it’s increased communication and shared goals that can make the difference when it comes to everybody in the practice working well together. In a practical way, this can mean practice principals contributing to a staff dinner once or twice a year, staging an end of year Christmas party for staff and family, and birthday wishes for everybody.
“One of the notions about the team is about people looking out for each other, people recognising that they’re part of a chain and that if a link is missing, you don’t have a good chain”, Dr Bills says. “It’s not necessarily about flying all your staff to the Bahamas for a love-in for a week. It’s often about acknowledging the little things.”
It was the growing number of staff that prompted the Brook Street Medical Centre to begin actively fostering their practice team in the mid-1990s. They soon adopted the FISH! management philosophy, developed by Steve London after observing the fishmongers at Seattle’s Pike Place Fish Markets.
Today, all staff learn the four principles: Be there, Play, Make their day, and Choose your attitude.
“The staff have been uniformly very positive towards it for two reasons”, Dr Bills says. “One of them is the fact that everybody does it. In particular the owners of the business do it — ‘walk my walk’ is a pretty strong theme. The converse of that is that there’s nothing we’d ask our staff to do that we wouldn’t be prepared to do ourselves.”
Communication is also important. Semi-formally, all staff birthdays are celebrated with a choice of birthday cake, bottle of wine or movie voucher. Professional achievements are also acknowledged with after-work drinks.
For formal discussion, the practice holds all-staff team meetings twice a year on top of the regular clinical staff and administration staff meetings. At these times they shut the practice down for two hours on a weekday and provide lunch.
And the highlight of the year is an annual winter dinner party. Months of light-hearted planning goes into the event, which has previously involved mystery bus trips, go-kart racing, riddle trails and the directors dressing in tutus.
Dr Bills says that while results are not immediately measurable, a simple example of the difference it has made is the fact that staff will always go the extra mile — stopping in at the weekend to finish something — because they’re supported. “Everybody knows that they’re part of the team.”
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