This paper is a mysterious artefact, coming back through a time portal from the future.

It is a page from the diary of an anonymous Practice Coach that was written in December 2021.

It was revealed at the Virtual Practice Coach Summit in December 2020 by Tony Lembke.

Medical Home Dinner

I start the day by reflecting on the Medical Home Dinner for the Hooterville Clinic that I auspiced and co-facilitated last night.
It was a Whole of practice dinner – reception staff, admin staff, nurses, allied health and doctors, and was held at the local Tavern.

We outlined

• the Principles of Medical Home (Care is Patient Centred, Accessible, Comprehensive, Coordinated, with a Focus on Quality and Safety)
• the Principles of Quality Improvement

Each member of the practice team nominated one particular improvement they’d like to address, the whole team voted on the top three, and they formed a group for each topic to decide on what success would look like and what would be the one small first step they could take.

My notes show that the practice wanted to work on more systematic Care Planning, a new telephone triage system, and a more functional tea room (in these ongoing times of social distancing)

I email the PM at Hooterville with a summary of their suggested improvements and the first steps they nominated. I remind her that I’ll follow up with her to see who are tasked with being in the improvement leadership team for each topic.

QI Meeting

Many meetings are still by Zoom, but some are now face to face as well.

This morning my fellow members of the Practice Coach Team are having our regular improvement meeting, where we review our progress on a number of measures, share our stories, and confirm what our next improvement steps will be. We have the same approach to QI that we expect our practices to use. We call this ‘Eating Our Own Cooking’. The most important measures relate to the health of the patients cared for by the practices that we visit. Our team finds it vital to understand and measure the impact of our work.

Training

I have one hour each day allocated to furthering my own education. I choose what skills I want to improve. The PHNs recognises that the success of the frontline Practice Support team is integral to the PHNs success as a network, and that the role requires skills in coaching, quality improvement, and in domain specific GP and other primary care systems. Some of the training is made available by more specialised teams within the PHN, and some is available through external sources.

Networking

As part of my training, I spend some time networking with my practice support team, teams form other PHNs, and gather international QI experience. I steal shamelessly and share generously.

Practice Advocate

At 11am I participate in the weekly Scrum Meeting for the PHN ‘Small Towns’ program. A member of the practice support team is now integral to every program in the PHN. They represent the eyes and ears and voice of the practices they serve.

Practice Relations

I have a couple of meetings this afternoon with practices. I reflect on how ny relationship with practices has improved.

During my initial vists I was reminded by a GP that Ronald Reagan had warned about the 9 most terrifying words in the English Language

“I’m from the government and I’m here to help you.”

We do out best to ‘see’ our practices and identify where they are. We aim for a ‘practice-centred’ relationship. We do not expect them to help us until we have helped them and are trusted.

To paraphrase Prof William Osler,

It is more important to know the type of practice that has the problem, than the type of problems the practice has.

In the experience of our PHN team, practices are motivated to adopt improvements if they

• improve health for their patients
  make it easier to deliver quality care
  improve the practice bottom line

Of these, we get most bang for our buck by making things easy

We have had a significant improvement in relationships with some – but not all – practices.

The resources for QI that practices receive through the enhanced QI PIP program has helped, as has the way that the PHN stood up during the COVID period and the Post COVID Vaccination program. The PHN reclaimed authority for local practice support and provision of information, immunisation knowledge, and cold chain management.

We had thought at Xmas 2020 that the next year would be easier. I guess it has – but 2021 has had challenges of its own. The National Vaccination program was a huge undertaking, with problems of logistics and scale, and cold chain, and managing the post vaccination adverse reactions. Most people had a few days of flu like symptoms after vaccination, so it was impossible to do whole workplaces at any one time – or there would be no-one to work for the next few days. Cold chain for the initial vaccine was critical. And it had to be given in a social distanced environment, protecting the health staff, and recording everything. The PHN stood up so that GP would have the key role in delivering the vaccination. I was able to bring together the three practices in Hooterville so that they could use their combined expertise and resources in a coordinated response.

Collaboration

Bringing practices together in a spirit of improvement and sharing has been the thing practices value most highly. They realise they all are dealing with the same problems – and collaboration has been a joy for them. We run regular meetings – which we call ‘Kaizen’ – for our practices to come together.

We also run a Nursing Network to enable practice nurses to share their skills. We have found Nurses to be great champions of improvement.

Monthly Clinical Meeting

I have my regular lunchtime monthly meeting with the Petticoat Junction Medical Centre today

I note the progress they have made on redesigning their ‘patient lounge’. I complement them on that, and note it down to include as a story I will share in the weekly email newsletter I send to my practices. My own stories are supplemented by ‘finds’ shared in my local and national PHN network.

I are accompanied this month by the PHN Mental Health Officer to let the practice know about the new services available and the access criteria for patients with Mental Health issues. I think to yourself that this changes so often and is so compicated that I could have the same topic for discussion every month – but I don’t say anything.

Last month we had run a session on ‘Health Literacy’, using the PHN project officer. Authoritative sources of information are valued by the practice.

As per the standing item, I report back to the practice on the impact of their work on the topics they have chosen – which currently is access to appointments and wound care. I share with them stories from other practices.

QI Team meeting

I stay on after the meeting to catch up with the practice QI teams and review their plans.
They have some detailed questions about their measures. It is good that I am an expert on Improvement Science.
They ask me about accreditation. It is good that I am expert in General Practice Systems
They ask me about new billing items. It is good that I am an expert in the Business of General Practice.
They are me about how they achieve change in less enthusiastic members of their administrative and clinical teams. It is good that I am an expert in Human Resources and Organisational Coaching.
They ask for your thoughts on their plans for expansion. It is good that I am an expert in Interior Design and Architecture.
The practice manager begins to discuss her sex life. It is good …. that I gently deflect the conversation

Academic Detailing

I have a meeting later that afternoon with Dr Druker at the Shady Rest Clinic. I teach him about the new RACF Medication Management System. After the report of the Aged Care Commission, at last something has been done about the SNAFU that is medication is aged care. There is now one point of truth that informs and is informed by the general practice software, the dispensing pharmacy, and the nurses on the floor. This process of ‘academic detailing’ with individual doctors or small groups of doctors has been shown to have a worthwhile impact and is valued by the practices.

Innovation Program

While at the Shady Rest Clinic, you meet with Sister Bradley to discuss the PHN Funded Innovation Program they have designed and are testing. In their practice, they have chosen to run a group based program to support carers of people with Dementia. Like the other Innovation Funding programs, if it demonstrates high impact and is a good ROI, funding will be continued and the program will be offered to other practices.

Reflection

The last part of the day is set aside for an ‘examen’ or reflection – for consolidating what I noticed that day, what I learnt, and what are my next steps. What will I share? The PHN now mandates protected time for thinking – for all staff – and it has made an enormous difference to effectiveness.

Home

As always, I leave work on time. Tonight I will be catching the Hooterville Cannon to Pixley for the Pixley Medical Centre’s Xmas shinding. I am such an integral team member in the practices I serve that I always get a bait to their parties. I decide that this year it might be best if I am not the last person left dancing on the table, like I was last year. But it was so good to celebrate the end of 2020!