Planning Practice Priorities for 2018

January 2018

Magali De Castro Clinical Director, HotDoc

This session will cover

• How to effectively engage the practice team to participate in quality improvement activities

• Identifying the best ways for your practice to improve team and patient satisfaction

• Identifying ways to promote practice growth

• Strategies to meet the new RACGP accreditation standards on quality improvement and business planning

“Someone's sitting in the shade today because

someone planted a tree a long time ago.” 

― Warren Buffett

“Give me six hours to chop down a tree and I will spend the first four sharpening the axe.” 

― Abraham Lincoln

On planning…

“Plans are of little importance, but

planning is essential.” 

― Winston Churchill“Planning is bringing the future into the

present so that you can do something about

it now.”

- Alan Lakein

• Build a strong practice team where everyone feels their

contribution is valid and appreciated

• Identify areas or processes which could be more efficient (cost

savings and better use of staff time)

• Motivate staff to provide a high quality service

• Enhance clinical care for better health outcomes

• Identify opportunities for new patient initiatives which may

lead to better patient engagement or improved financial viability

Benefits of using a team approach:

Why plan practice priorities as a team?

Planning is now required

New indicators for accreditation

• Identifying Ethical dilemmas

• Having a Risk Management plan

• Running Quality Improvement activities

• Planning and tracking practice goals

• Creating and maintaining a business plan for the practice

Plus it’s now required for accreditation under 5th Ed standards!

Focus of your plan

When creating a plan that suits your needs, there are several things to consider:

Do you need an Individual plan or a Practice plan, or both?

Are you after Short, Medium and/or Long term goals

Will you focus on business financials, team performance, clinical outcomes, something else?

Is you aim to improve quality or improve quantity, or both?

Are you looking to Grow your practice or Maintain at current levels (and not go backwards)

What goals will you realistically have the resources to stay on top of?

Start small and evolve your plans as you get more comfortable with planning!

Individual goals

Clinicians are required to reflect on learning needs and plan/seek CPD activities that help meet those needs.

(Though not required) Administrative staff would also benefit from a similar approach

Individual learning needs could be around:

Clinical areas: First Aid/CPR, Triage, caring for patients with particular conditions e.g. Diabetes, Asthma, Heart Disease, etc.

Skill gap: Skills that would help with current or future role e.g. Staff management skills, performing or assisting with surgical procedures, workplace training skills, etc.

Personal development: Time management, conflict resolution, communication skills, stress management techniques, etc.

Practice goals

Practice goals affect the entire team and may be around:

• Improving business processes and financials

• Improving team performance

• Improving clinical outcomes for your patients

Use SMART Goals: Specific: What is it? Who is involved, where, when, how?

Measurable: What will there be more of or less of?

Achievable: Can this really be accomplished?

Relevant: Will it make a difference to our team/practice/patients?

Time-based: When will this be completed?

How will we know we’ve reached this goal? Success will look like…

Planning Business and Financial Improvements

Pick a priority area to focus on:

• Practice size: • Number of GPs • Number of patients seen (per year, quarter, month, week) • Number of new patients • Number of nurses • Number of allied health or other practice services

• Practice revenue (Profit/Loss - Income/Expenses) • Total revenue or total profit • Revenue per GP • Revenue per Nurse • Revenue per other clinician or services or non-MBS revenue

• Staff Retention (if high staff turn-over is an issue) • Identifying level of staff satisfaction • What would be needed to improve that? (support, training, better

systems/less chaos, etc)

Engaging the Practice Team

There are several ways to engage the practice team:

• Regularly invite staff to offer input. Listen to feedback and ideas with an open mind

• Support and acknowledge team feedback. Never use it to ridicule, coerce or discipline staff

• Use internal surveys and polls to get an idea of staff preferences and input around particular issues or about the practice in general

• Use team meetings as another opportunity to get staff input on changes needed or proposed

• Ensure there is two-way communication during team meetings. Staff should be encouraged to offer ideas and suggestions

• Take on ideas from the team and report back on what changes have been made in response to their input

Improving Team and Patient Satisfaction

In order to improve team and patient satisfaction:

• You’ll need to know how they currently feel and what they feel needs changing

• Best way to find out is to ask!

• Regularly use patient and team feedback in the form of surveys, polls, and suggestion boxes

• A blank ‘suggestion’ sheet in the waiting room or staff room is rarely enough

• Actively prompt for feedback at key times and on specific areas of the practice

• Keep a record of both staff and patient feedback (this is an accreditation requirement under 5th Ed Standards)

New RACGP standards on Quality Improvement

QI1.3 uB Our practice uses relevant patient and practice data to improve clinical practice (eg chronic disease management, preventive health).

You must:

• Show evidence that you have conducted a quality improvement activity, such as a PDSA cycle or clinical audit, at least once every three years.

What is Quality Improvement?

The RACGP defines Quality Improvement as:

“An activity used to monitor, evaluate or improve the quality of health care delivered by the practice.”

Quality Improvement Activities may include:

Changes to the day-to-day operations of the practice:

• Scheduling of appointments

• Opening hours

• Record-keeping practices

• How patient complaints are handled

• Systems and processes

Or activities designed to improve clinical care:

• Improve immunisation rates

• How the practice cares for patients with diabetes or hypertension

• Systems used to identify patients with risk factors

How to identify areas for improvement?

Make a list of areas in your practice that could run better, or more

efficiently

e.g. “How we handle requests for repeat referrals”

or areas your practice feels are important, but may have a knowledge gap

around

e.g. ‘As a practice, how well do we look after our patients with diabetes?’

For this activity it is good to simply write down things that immediately stand

out (top of mind).

Then as a team you may decide an order of priority for these areas.

Activity:

Clinical Audits

Helps clinicians to systematically review their individual or team

performance against best practice guidelines.

A clinical audit has two main components:

• An evaluation of the care that practitioners provide

• A quality improvement process

Some examples of clinical audits

• Identify patients with Allergy or Smoking Status NOT recorded

• Identify patients with diabetes without HbA1c results recorded in

the last 12 months

• Identify patients at risk of Influenza based on age, ethnicity or

pregnancy

• Identify Patients at risk of influenza with predisposing conditions

PDSA Cycles

Plan, Do, Study, Act or PDSA cycles

Planned improvement by:

• Breaking it down into small manageable stages and

• Testing each small change to make sure that things are improving

The idea is to start on a small scale and then reflect and build on

learning that occurs during each stage.

PDSA Cycles

• Check that your intended goals have been achieved

• Decide if the goals were realistic

• Was the result worth the effort?

• What helped or hindered the change?

• Are there any other strategies or measures needed to bring about the desired change?

Tips when reviewing your progress:

New RACGP Standards on Business Planning

C3.1 uA Our practice plans and sets goals aimed at improving our services

You must:

• Plan and set business goals

You could:

• Write a statement of the practice’s ethics and values

• Maintain a business strategy

• Maintain an action plan

What kind of business plan do I need?

• You could create a one-page business plan or an action plan that sets out goals and progress

• Update or create a complete business plan or strategy document

• Enlist help of your existing financial advisor, accountant, bookkeeper, etc.

• You could do a business audit (with your bookkeeper or accountant)

• Get a better understanding of your profit and loss (P&L)

• Find out your year or year profit/growth

• Identify main sources of income

• Where is the money going (expenses)? Is this getting worse in any area?

• Do you have a financial leaky faucet or an untapped gold mine somewhere?

Resources: One-page Action Plan

Resources: Business Plan Templates

Resources: Nurse CPD Planner

Resources: GP CPD learning needs (PLAN)

Where to next?

Commit to plan and outline your strategy:

Decide on focus: Individual or Team plans, or both?

Method for collecting input: Team meetings, staff poll/survey, notice board, other?

Timeframes: For planning, implementing, checking progress

Documentation: Where is the written plan going to live?

Type of document: Will you create a one-page business plan or a complete strategy document, a short action plan, an individual learning plan, start a staff or patient feedback log, etc.

Sample implementation plan

Keep it Simple!

• Set 1 to 3 main goals for the year

• Break these down into smaller targets which also serve as milestones or checkpoints to evaluate progress

• Set monthly, fortnightly or weekly tasks which are easy to track and that, if completed, will help you reach your targets

Sample implementation plan

Goal

• Review and update our entire Policy & Procedure manual to be in-line with the 5th edition standards

Quarterly milestones March: Total criterions revised ______ of 12 (cumulative target) June: Total criterions revised______ of 24 September: Total criterions revised ______ of 36 December: Total criterions revised ______ of 44

Weekly tasks Review and update policies for at least 1 criterion Completed (Y/N) Notes

Allocated to (Staff member) Yes 3 done

Thank you for participating!

Got a question? Email: md@hotdoc.com.au