Trusted Advisers on General Practice:  Empowering divisions in partnership and collaborative work

Background:

GPDV received Department of Human Services (DHS) funding to provide workshops (one per region) for divisions that enhance their capacity to participate in primary care partnerships in ways that are effective, productive, and empowering.  The broad aims were to:

�         Develop skills and strategies for division staff to engage with DHS initiatives such as service coordination & integrated health promotion; and

�         Strengthen the role of division staff as trusted advisers to primary care partners in how to achieve effective referral and feedback and quality care planning with general practice.

The �Story� of division involvement in PCPs can be summarised as:

• High level of participation by divisions in PCP governance � in 2005 more than three quarters of PCPs report being advanced or at the sustained routine activity phase of implementation in engaging divisions formally in the PCP
• Majority of divisions believe that the benefits of being involved in PCPs outweighs any associated costs, but a few are not fully convinced

AND

• Most divisions report limited/some or little/no capacity to support GPs in the introduction of service coordination.  DHS Small Grants have been the key source of funds enabling divisions to stay connected with the service coordination protocols, and problem-solve issues in GP participation in them.

It is often the case that divisions either have to convince local partnerships to allocate GP engagement dollars, or the division role in the partnership activity has to be so well aligned to what the division is doing with their Department of Health and Ageing funded program that participation can be supported from core funds. 

Being a trusted adviser to partner agencies, and having a strong relationship with them is a way forward in this context.

The Trusted Adviser workshops:

Division work in �integration� means that the division functions as:

�          key point of contact with general practice

�          advocate and broker on behalf of general practice

�          point of influence with general practice

The key intention was empowering division staff for partnership work with practices and with PCPs/member agencies. Specifically, the project targeted the following change management skills of division program staff:

� Practical, proven consultative models

� Collaborative tactics that work

� Creating clear change outcomes

� Constructing mutually acceptable meanings

� Resolving conflicting interests.

Taken together, these skills will enable participants to go out and re-engage stakeholders; even where earlier discussions had stalled.

To achieve this, the project involved 122 representatives of 30 Divisions participating in one of nine regional workshops and then using a set of four tailored change management tools in their interactions with primary care stakeholders.

What we did:

A consultation workshop with CEOs was held in April 2006.  It was designed to introduce the key change management concepts and collaboration skills proposed for inclusion in regional workshops for division staff.  Through a parallel process, CEOs were consulted on the relevance and targeting of the content of the regional workshops.  CEOs provided information about the current state of partnership work with PCPs/member agencies, and priorities for �desired states�, or outcomes, of this critical area of division activity.

Key feedback from CEOs was to broaden the focus to include division program areas such as aged care, immunisation and mental health.  Adopting a broad, or at least de-siloed view of the work that divisions do in �integration� was important.

Eight regional workshops were held between May and July.  A maximum of 16 participants was set.  All divisions were represented by at least one program staff member, and a few divisions sent their program staff team.  Participants explored four key areas:

�         Establish trust & build credibility

�         Understand partner agencies needs

�         Handle objections

�         Offer opinions

The handouts and tools or worksheets for each of these change management areas are available as follows:  They are accessible, and yet cover complex material at the same time.

Resources:

Establish Trust and build credibility:

Tool 1 - Establish Trust (855 KB)

Worksheet 1 - Partner Org List (527 KB)

Understand Partner Agencies Needs:

Tool 2 - A Partner Agency's Needs (420 KB)

Worksheet 2 - Partner Agency's Needs (1.46 MB)

Handle objections:

Tool 3 - Work with Objections (48.6 KB)

Worksheet 3 - Objections (91.9 KB)

Offer honest opinions:

Tool 4 - Offer Opinions (38.2 KB)

Worksheet 4 - PEAR (635 KB)

Participant feedback:

Psychologist and organisational consultant, Andrew Hollo, proved to be an exceptional presenter and universally was given full marks (average rating of 9.4 out of 10) for the quality of his facilitation.  Feedback from participants showed that they judged themselves to have gained knowledge and skills in using tools in each of the four key areas � average rating was 8.5 out of 10.

Division program staff were asked which partner agencies were their highest priority for implementing the Trusted Adviser framework and tools.  The most common response was GPs and Practices, and the next most common response was PCPs and member agencies, particularly Community Health and acute services.  This highlights the complex role of division staff in collaboration and partnership work � they must be trusted by general practice in order to effectively advise partner agencies about how best to work with general practice to get better referral or other desired outcome.