Practice Culture

1. Practice Culture GP VTS

2. Outline • What is culture • Organisational culture • How you might have experienced it • Why is it important • What makes a bad culture • Is there a best culture? • Can it be quantified? • Group work and examples

3. What is culture? • A system of shared values, attitudes and beliefs about what is important, and the behavioural norms… • “the way we see and do things around here…” • Not always explicit – unwritten rules

4. What is culture? • Team culture • Departmental culture • Organisational culture

5. Organisational culture • How things are done within your practice • The way things are done within your team – heavily influenced by shared unwritten rules • Tend to reflect what has worked well in the past

6. Within your workplace • How people go about their work • How they think • How they behave – what they do • Unique for different teams • Think of your last 6 months vs previous….

7. Remember that feeling? • Your last rotation • Which expectations and practices are different compared to the previous? • Which are the same?

8. Practice Culture • Every practice will have its own kind of culture, ways of working and unspoken values

9. The unwritten rules • Not often openly discussed • Therefore rarely questioned or challenged • Usually shared my most members • Can influence people without being obvious • Influence how people behave in practice

10. Unwritten Rules • “we know best” • “the patient won’t / can’t understand” • “filling in the form makes it happen”

11. Why does culture matter? • Long been recognised in business industry • Relatively recently, ‘culture change’ mentality in the NHS • Better patient outcomes (in some studies) • There is only so far that structural changes will improve things

12. What makes a bad culture? • Slow, unresponsive decision making process, poorly understood. • Not tackling the basics • Not sharing information • Training and development is a box ticking exercise • Accepting the inefficient status quo – “don’t bother trying to change it. Nothing will happen” • Keeping your head down and doing the minimum required

13. An ‘Improvement’ Culture • Patient Centeredness Respecting a patients values, preferences and needs Access to care Emotional Support Information, communication, education Coordination of care Physical Comfort Involving family and friends continuity and transition NHS Institute for Innovation and Improvement

14. An ‘Improvement’ Culture • Focus on Indivdual potential Values people, encourages their professional and personal development Individuals involved in decision making – those on the ‘shop floor’ and grass roots.

15. An ‘Improvement’ Culture • Encourage improvement and innovation “If it aint broke then don’t fix it” ? Need not apply New ways of improving services An absence of complacency People encouraged and enabled to improve services Experimentation and flexibility are valued, not stifled

16. An ‘Improvement’ Culture • Recognise the value of learning ability to be self critical and learn from mistakes Personal responsibilty and accountability Best available evidence guides clinical practice Knowledge is shared through the team..and other practices Constantly poor performance is not seen as acceptable and tolerated

17. An ‘Improvement’ Culture • Effective Team Working Is where the sum is greater than its parts Doctor led, but not dominated Focus on improving patients health, not ‘turf wars’ • Communication, Honesty and Trust Importance of informal channels and personal contact Keep people in the loop on important decisions Build trust, being able to discuss the ‘clangers’ as well the Good bits

18. Quantifying Culture

19. Group Work Using the values that contribute to an improvement culture, for each one think of a couple of real life examples that demonstrate that value in practice e.g patient centeredness – having a patient panel involved in decisions about the practice

20. Important values in practice culture • Patient centeredness • Belief in the individual potential of all staff • Encourage Improvement and Innovation • Recognising the value of learning • Quality and Safety of care • Effective team working • Communication • Honesty and trust

21. Examples • Pts able to see their full record online • Pts involved in GP recruitment • DVT clinic • Anticoagulant clinc • Risk stratify local population and target these • Register of pts likely to develop vascular dementia, focussed preemtive care.