Enhanced

Primary Care

Who should you have at the

practice leadership table?

Andrea Stringfield BA (Hons) Psychology

THE ROLE OF LEADERSHIP

The challenge

for us…. …in 2015Two GP

‘Businesses’

merging with two

different operating

practices

Different

ownership models in

the network – from 0%

to 100%

Many and

varied remuneration

models

A large

proportion of

ex owners with

high remuneration

across the

network

VLCA; co-pay with wide

variation in fees; urban,

rural, nationwide

The Leadership Challenge

100% Ownership – with ex owners

working with us in the business

100% Ownership – previous owners

departed

Partner Model working with GP

Director Shareholders

Zero Equity- Providing

business support only

Support Services from Centre with a variety of needs for

governance, leadership,

management and support.

We understood that…

› When practices joined the network, not enough time was spent with GPs talking about how the change would impact them

› Owners often partner with us so we can ‘do’ all the leadership stuff

› Practice managers often had responsibility for leadership - few GP Leads/Nurse Leads

› Some Directors and Boards were involved in the day to day running of the business

› Some issues of ‘them and us’ between practices and ‘corporate’ GXH

› Lack of Leadership was impacting service, financial performance and morale.

What we did – we….

› Identified our high, average and poor performing practices – what were the differentiators?

› Examined the services Support Office had been delivering and audited effectiveness

› Examined our remuneration schemes – how they impacted individual practice performance

› Researched and identified key changes/influencers to GP Practice now and anticipated

› Talked with GPs, Nurses, Administrators, the Colleges, NZMA, PHOs and others

› Assessed the information that practices got and information they needed

What we learnt - #1

› A GP sat at the leadership table with the PM

› Nurse leadership was strong

› Decision making was shared

› Financial information was shared and understood

› Teamwork was strong - and employee engagement high

› Leadership basics were done well: reviews, feedback, WIPs, communication

› New services were introduced easily

In high performing

practices…

What we learnt - #2

› Only a PM was identified as a leader and often did not have the level of relational or leadership skills needed

› GPs did not have a ‘leader’

› Nurses were not involved in the business

› The business data was not shared nor well understood

› High turnover of staff

› Staff conflict or HR issues

› Resistant to change

In poorer performing

practices

What we learnt - #3

› Our GPs wanted to grow and develop and have us

invest in them

› We need to base our remuneration on capability and

contribution – and recognise experience

› We need to build a much richer database – clinical,

business, people and performance

› Business information needs to be shared

› Nurses need to have a seat at the leadership table

› Governance versus operations needs to be clarified

› Leadership training for all leaders is needed

› We need to communicate and lead change more

effectively

Our GPs wanted

leadership (not many

wanted to lead!)

We introduced a new leadership model

GOVERNANCEClinical, Quality, Business

MANAGER

CLINICAL SERVICES

& QUALITY

Professional

Leadership, SOPs,

Audit, Risk, guidance

and support

BU

SIN

ES

S L

EA

D

MEDICAL CENTRE

LEADERSHIP TEAM

CLINICAL

ADVISORY GROUP

Professional

leadership and

mentoring, advice,

issue resolution and

support

SUPPORT OFFICE Operations, Finance, IT, Marketing, Communications, Business Performance, People and Capability,

Learning & Development , Clinical & Quality Services, Leadership Coaching & Support

Clarity of Role and Responsibility is Essential

Medical Centre Leadership Team Terms of Reference

PURPOSE

The purpose of this

team is to provide

a sound business

planning and

performance

framework that

achieves the

overall goal of a

financially healthy

practices, with

engaged and

productive teams

of employees,

achieving excellent

patient outcomes

and delivering

consistent quality

service.

KEY FOCUS AND DELIVERABLES

› Working with Centre Metrics, keep up to date with performance and service standards

› Use Centre data to make changes that improve performance

› Work together to create a positive and engaged working environment of care, courtesy

and continuously improving capability of employees

› Monitor how Centre employees are working together to help individuals and resolve

issues that come up

› Work together to identify opportunities for improved patient service and outcomes

› Make operational decisions as a collective group

› Work together on initiatives to work with and engage local community

› Ensure that decisions agreed by the leadership are actioned and followed up

› Work with Support Office staff to provide feedback and reports or request additional

support to support actions or roll out of plans – IT/HR/Marketing/Finance/Ops

› in consultation with the wider community, take responsibility for creating and

implementing patient service plan that meets with the needs for that particular community

› Review and update the Medical Centre Performance Plan – and engage in the annual

planning and budgeting cycle

Clarity of Role and Responsibility cont’d

Medical Centre Leadership Team Terms of Reference

SCOPE

› The MCLT is an operational group

rather than strategic – focusing on

delivery of well formed plans and

using the Centre metrics and data to

drive performance

› The MCLT is responsible for ensuring

that local community needs are

understood and reflected in the

business plan for the Centre.

› The MCLT may identify a need or a

change that needs to be made - and

then involve Support Office to assist

with the development of a new service,

policy, operational process etc..

› The MCLT will lead the delivery of

agreed new services, change

initiatives, governance requirements,

policy and procedural change, and

improvements driven from the quality

improvement process.

MEMBERSHIP (May include others depending on the scope and services of the Centre)

› GP Lead

› Medical Centre Manager

› Nurse Lead

ROLES AND RESPONSIBILITIES

› The chair of the MCLT may vary according to the skills and

experience of the members of the team, however it is envisaged that

the GP Lead will be chair in most Centres over time.

EXPECTED CONTRIBUTION

› Each MCLT member will attend weekly planned meetings, monthly

KPI meetings, quarterly reviews with Support Office, and be available

to address leadership issues with their own team members, or step in

should other Leads be absent

GP Career

Development,

Leadership

and Rem

Ensure Medical Centre remains

financially healthy

Have clear core KPIs e.g. patients per

session over time

Acknowledge progressive

clinical competence, capability and contribution

Recogniseleadership –and pay for it

Be accessible, simple,

transparent, consistent and clear

Recognise teachersand strong team

players

Recognize variation in

patient complexityand the time taken

Recogniseflexibility and innovation in

service delivery

Encourage GPsto develop and use

specialist skills

Reward everyone on the

team for high performance

Our revised

plan and processes

must:

Key Elements

of GP

Remuneration

Med Centre KPI’s achieved

Profit/Success Share

Scheme

Patient retention / growth / contact

Fees/funding

Patient Partnership/Outcomes

Business Leadership

MY CAPABILITY AS A GP

Qualifications

Skills and experience

Teamwork/people skills

Teaching and Leadership

Complexity and perf excellence

GP Leadership

GP L1s would have some of most of the following:

› GPEP1 – completed or IMG under supervision

› 2 years in service training – working towards FRNZCP: must have this within 3 years

› Seeing 13 patients a session over time and managing admin

› Are working well under supervision

› Working to a jointly agreed plan and achieving goals and KPIs

› Part of a peer review group

› Positive performance review which will have 360 feedback

› Positive 'patient partner' index

› Team players - collaborative, respectful and providing back up to others

› Flexible, open to change, improvement focused

› Good understanding of NZ health system

› Junior GPs and IMGs will start here - plus anyone who is not vocationally registered. 10-20% in this group

› Salary Range GP1

GP LEVEL 1 GP LEVEL 2 GP LEVEL 3

GP Leadership

GP L2s would have ALL of GP1 plus some of the following

› Vocationally registered

› Developing and using special interests e.g. teaching / research / long term conditions / minor surgery /

dermatology / OCC Health

› Emerging leadership

› Supporting the business performance of the Medical Centre

› Active in self audit and quality improvement – self / team / practice / GXH

› Contributing to the NZ health systems e.g. local/community or wider

› Contributes to Medical CentreTeam Performance - i.e. not just individual achiever

› Uses feedback and metrics to continuously lift performance

› Supporting new initiatives and change

› Most GPs 60-70% will be in this range with higher salary for people with special interests/skills

› Salary Range GP2

GP LEVEL 1 GP LEVEL 2 GP LEVEL 3

GP Leadership

GP L3s would have ALL of GP2 plus some of the following

› Leader in the community

› Leadership of GPs in the Medical Centre

› Key role on the Medical Centre Leadership Team that delivers success in terms of operational and financial

performance

› Leading new services for patients

› Using data and feedback to drive improvements in outcomes

› Leadership/projects across the Group e.g. integrated services

› Teaching and lifting performance -and across network

› Mentoring others for growth - not just GPs

› Change agent - adapting service from a patient satisfaction and health outcome perspective

› Sought out for expertise/guidance - not just GPs

› Special interest is developed and contributes to Medical Centre performance

› Only about 10% of GPs will be in this group (eventually)

› Salary Range GP3

GP LEVEL 1 GP LEVEL 2 GP LEVEL 3

Personal &

Leadership

Development

Has it worked?

› Rev Share to Salary has had some expected and

unexpected benefits

› GP Leads have had a positive impact in many ways

› Medical Centre Managers feel more fully supported

by GP Leads

› Behavioural issues are being addressed

› Teamwork is more visible

› New solutions are being introduced

› Financial health has improved

› No ER issues with rem change and positive feedback

from GPs

› Regional Nurse Lead role has emerged

Definite progress

Has it worked?

› Finding Nurse Leads is difficult

› Leadership and change training

› Clarifying the role of Boards versus operational

management

› Business dashboards that show up to date data on

clinical, business and people performance are in use

but need more business data

› Business coaching for leaders

› Clinical Advisory Group established

Work in progress

Perfect

three legged

stools?

No!

Thank You

ANY QUESTIONS ?