Tim Hou is a general practitioner with Mangere Health Centre. He has played a leading role in two Counties Manukau Health improvement campaigns, including working on the Folau I Lagi-Ma project in Manaaki Hauora – Supporting Wellness and Diabetes Care Improvement Packages.
The Diabetes Care Improvement Packages (DCIP) programme, a quality improvement campaign led by Counties Manukau Health, aimed to improve diabetes care in participating primary care practices in South and East Auckland. This article explores seven common factors shared by practices which ran successful improvement projects under DCIP (Figure 1).
Figure 1: Success factors for DCIP improvement projects in primary care practices
1. Flexible, innovative leadership
Successful practices had GP owner-leaders or chief executives who were flexible, innovative and open to new ideas. Good leadership drove effective change management and underpinned all other success factors.
2. Change management capability
Leadership provides the vision and energy for change, but good change management makes it happen. Successful practices had strong managers with change management capability who looked after the practical aspects of improvement, such as internal communications and supporting staff with training, tools and resources.
3. Capacity for change
Practices were at different stages of readiness for improvement, and differed in their current capacity to effect change. Those which did well:
- had the physical and mental capacity to take on something different. In contrast, practices which were going through periods of instability, such as a change of management that required them to focus on embedding new systems, or which were so severely under-resourced that they struggled simply to stay open, did not do well.
- understood their readiness for change. Practices which had a good understanding of what type of change would be most feasible and beneficial for their current circumstances, and where they needed to focus their efforts, did better and got more benefit from their improvement projects.
For many practices, a readiness assessment was a helpful first step towards improvement.
4. Openness to external support
Successful practices were open to ideas and expertise from outside their own practice. They had leaders who were willing to learn, welcomed external facilitation and advice from improvement specialists, and used and adapted good ideas from other practices.
5. Good teamwork
Successful practices viewed their staff as a team of equals. Doctors, nurses and the wider practice team had good, non-hierarchical relationships. They worked together on ways to improve patient outcomes and work processes, and were open to some members of the team – particularly nurses – expanding their role and taking on greater responsibility. All staff were engaged in the change process, and everyone had the chance to express their views.
6. Permission to try new things
Leaders at successful practices gave enthusiastic staff permission to try new things, and supported them with appropriate resources. Often, the key resource needed was time.
7. Constant and persistent action
Successful practices maintained constant and persistent action in pursuit of improvement goals. Internal communications with practice staff constantly reinforced the message of why action was needed, how it was being taken, and the benefits it would have for the practice and its patients. Leaders were not discouraged by barriers, mistakes or failure.