Recognised for their outstanding commitment to quality improvements during the period 2015 – 2017, Gisborne Medical Centre was awarded the AGPAL Rural and Remote General Practice of the Year in 2018.
Gisborne Medical Centre has been providing quality medical care to the Gisborne and Macedon Ranges community for more than 40 years and has certainly demonstrated a history of quality, undertaking accreditation with AGPAL since 1998. The practice’s seventh assessment against the RACGP Standards 5th edition will take place later this year.
Gisborne Medical Centre commenced in 1979 with one GP in a room within a dental practice. Over the decades the practice relocated a few times to cope with increasing demand, and in 2007 settled in its existing location of Brantome Street. The practice has grown to having 20 GPs providing medical support to the community seven days a week.
Along with their on-going day-to-day provision of high-quality safety, care and services, it was the centre’s remarkable quality improvement journey from both a clinical and non-clinical perspective during the past few years that provided a compelling case for our judging panel to award them the 2018 Excellence Winner of the AGPAL Rural and Remote General Practice of the Year.
The journey started with the practice undertaking a comprehensive and rigorous review in 2015 to consider its infrastructure and staffing needs within the context of current and future community requirements. The review enabled the Directors of the practice Kulbir Gill, Steve Newton and Heena Choksey, to see they would struggle to cope with the additional demand of a strongly growing population in terms of quantity and variety of services needed.
It was also identified that the practice was finding it difficult to attract general practitioners and other specialists, as despite its regional location, Gisborne is not classified as an area of need.
At a high-level, the practice identified the need to better serve the region with after-hours services, increased numbers of specialists, and enhancing the skills of clinical staff to expand the practice’s service offering.
When the Gisborne Medical Centre team put their heads together to think of other ways they could better service their community, it was evident that a facility upgrade would provide space for medical students and/or general practitioner registrars on rural clinical placements and enable enhanced patient access to a broader range of health professionals. So it was the start of a period of substantial and accelerated continuous quality improvement programs, which have seen numerous infrastructure, system and process upgrades at the practice — each requiring the willing and helpful support of clinical and non-clinical staff for successful implementation.
The practice obtained a partial government grant to upgrade the facility, which resulted in: six additional consultation rooms and redevelopment of the treatment room to allow for GP registrars and medical students to attend to patients with improved privacy and confidentiality; a centre-wide IT infrastructure upgrade; a refreshed fit-out; and new medical and training equipment.
The centre and community responded positively, reporting that the upgrade continues to help meet growing demand, greatly enhances the patient experience and helps attract and retain medical students and registrars.
While the centre was already operating on a seven day per week basis, Gisborne Medical Practice commenced after-hours coverage via a ‘doctor on-call’ service for either home or clinic consultations to meet local community needs and to ensure their team ready for the ever-growing population within the region.
Increased number of specialists, services and upskilling of staff
To better meet community needs, Gisborne Medical Centre has significantly expanded its services since 2015 with the introduction of nurse clinics, a larger range of medical specialists and allied health providers—with the aim of providing patients with a complete health care experience in a welcoming and friendly environment. Gisborne Medical Centre has Specialists in various fields including but not limited to plastics, orthopaedics, gynaecology, cardiology, respiratory, geriatrics and endocrinology.
Through a program of upskilling and allocated targeted sessions, Gisborne Medical Centre’s service offerings have been extensively expanded during the past few years to now include immunisations and travel vaccines, Aboriginal and Torres Strait Islander health checks, a methadone program, iron infusions, spirometry, and cervical screening. For non-clinical staff, the practice optimises AAPM education resources via e-learning and webinars to support an environment of professional development and ongoing learning. Staff are able to allocate work time to complete training programs that cover contemporary topics and issues such as privacy legislation, risk management, infection control and patient management.
Processes and systems
Gisborne Medical Centre has an on-going program for both functional and cross-functional communication and shared learning. Discussion items include clinical cases, adverse events and near misses, advances in clinical practice, updates from relevant stakeholders and patient complaints. The forums also provide a conduit for information between the partners of the centre, doctors, nurses and management to openly discuss and, if necessary, quickly and collegiately resolve issues.
Multiple members of the practice monitor releases from relevant industry and government agencies and it is everyone’s responsibility to share industry issues—for example, changes to the cervical screening process, sexual boundaries guidelines, changes to My Health Record and euthanasia legislative amendments. There is a big focus on team-work across the centre, allowing everyone to contribute to the many positive outcomes being achieved.
The practice has developed a ‘blame-free culture’ where lessons learned from adverse events and near-misses are shared and highly valued to discourage any secrecy or cover-ups.
Gisborne Medical Centre has focused on improving and optimising staff interactions with systems to ensure best-practice clinical care and decision-making.
Patient and community engagement
The centre encourages patient feedback and provides and promotes several avenues to do so—all information is passed on to all relevant stakeholders. Feedback, both positive and negative, is read by the General Manager to help ensure service levels and standards of care are aligned to accreditation standards and meet patient expectations.
Gisborne Medical Centre is also proud of its community engagement activities, which include participating in Doctors in Secondary Schools program as well as attending and sponsoring local community events. Recognising the importance and effectiveness of the digital health space, Gisborne Medical Centre shares useful medical information on its social media channel to further connect with their community.
Our team caught up with Gisborne’s Managing Director, Simon Perdriau to check in and obtain an update on the practice since winning the award in May 2018.
AGPAL Team: How did the practice and your patients respond? Were there any special celebrations?
Simon: We had a morning tea to celebrate winning the award and to acknowledge our hard-working people. This award is a credit to all of our team members who have contributed over the decades. The founder of the practice, Dr Rod Guy, retired in July 2018 after 40 years of service to the community. It was an honour to share this award with him and a real testament to his contribution. The patient feedback has been overwhelmingly positive.
AGPAL Team: What do you think supported you in achieving this well-deserved recognition?
Simon: A lot of staff members have been with Gisborne Medical over the long term. There is a strong sense of shared values and culture focused on meeting our patient needs. We structure our appointments to ensure patients are seen on-time and our GPs work in a calm environment in an orderly manner for high-quality patient care. The practice will be undergoing its seventh accreditation with AGPAL later this year.
AGPAL Team: Have you or are you doing anything in particular to prepare for the fifth edition of the RACGP Standards?
Simon: We have been reviewing the 5th edition RACGP Standards to incorporate the new outcomes-based focus into our day-to-day operations. We hold regular meetings to discuss the implications of the new Standards to understand how we are doing things currently and identify areas for improvement.
AGPAL Team: Being an accredited practice since 1998, what role do you think accreditation plays across the sector? Are there any specific ways you think accreditation with AGPAL has supported your practice improve?
Simon: The accreditation process has changed enormously to a more collaborative and sophisticated approach than ever before. The underpinning of our practice has been our commitment to quality in partnership with AGPAL. Accreditation provides the framework for assisting in standardising our approach to service delivery without restricting our creativity. An example of this is the explanatory notes with the use of the ‘could’ and ‘must’ terminology. This acts as a guide for our practice without being too prescriptive.
AGPAL Team: What do you think is the underlying secret to Gisborne Medical Centre’s success?
Simon: We are part of the community and remain committed to providing best practice clinical care in a friendly and warm environment. We love our patients and attempt to nurture a positive culture in all aspects of the medical centre.