Practices in Focus
Hunters Hill Medical Practice
Recognised for their outstanding achievements during 30 June 2015 to 31 December 2017, Hunters Hill Medical Practice (HHMP), were recently awarded Excellence Winner of the AGPAL Chair General Practice of the Year.
HHMP has a multi-disciplinary team that works collegially to maintain the highest standards in care and service provision through involvement in teaching, regular multi-disciplinary professional development meetings and involvement in ongoing medical research. They are forward-thinking, maximising technological advances to better communicate with patients, ensuring improved patient identification and streamlined workflows. Quality improvement initiatives are constantly at the forefront of HHMP’s thinking.
First accredited with AGPAL in 1999, HHMPs commitment to the accreditation process and the continuing development of quality of care, safety and risk management in their practice is outstanding. HHMP is supported by a team that is truly committed to achieving the best outcomes possible for their patients.
We caught up with Dr Charbel Badr, Managing Doctor and Katrina Arcus, Practice Manager, to see how things have been since winning the award.
AGPAL Team: Congratulations on being awarded AGPAL Chair General Practice of the Year Excellence Winner! How did the team react and celebrate?
Dr Badr: It is a great honour and we are still talking about it. On the night, at the gala dinner, while the announcement was being made, the staff there started crying, which showed how committed they are to their roles. The SMS’s and emails flew thick and fast! Since we have been back at the practice, all the staff have been very excited about it and many of the patients too. The winner logo now adorns the doors, and the award is being framed for pride of place in our waiting room. It has been fantastic to see the level of support from our patients.
AGPAL Team: What do you feel is the secret to Hunters Hill Medical Practice’s success?
Dr Badr: The practice has been built on a good foundation. The plan has always been to keep it simple; to hire genuine people who are capable but also willing to learn. Then give them the resources and support to allow them to focus on patient care. This has been done with an open mind and with an eye towards quality and continuous improvement.
Katrina: The multi-disciplinary team has been such a winner for our staff and patients. We also focus on education, with extra sessions for staff, teaching medical students and having registrars.
AGPAL Team: Have any plans been made on what the financial benefit of winning will be spent on?
Katrina: This award resulted from the hard work of our staff, so we have allocated the prize money to a celebratory staff get together and our Christmas party. It only seems fair to ‘celebrate quality’!
Road to excellence
Below we share some of the HHMP team’s achievements that contributed to them being awarded our Excellence Winner for AGPAL Chair General Practice of the Year Award.
In addition to using technology such as online bookings and SMS reminders and recalls, HHMP utilises a self-check-in kiosk system, allowing patients to check in on arrival at the practice. The kiosk is a quality improvement tool as it ensures improved patient identification and contact detail updates combating the frequent changes of address of young adult patients. It has increased accuracy of patient records, freed up front desk staff and allows for a patient survey tool to get feedback from patients to further enhance services. The staff particularly appreciate the increased capacity to have quality interactions with patients.
Teaching and Mentoring
HHMP has an impressive teaching and mentoring program, providing placement for GP registrars, third year medical students, student nurses and some overseas trainees, such as Vietnamese doctors and some international medical students. The medical students are usually surprised by the breadth and depth of general practice, at the same time they ask the sort of questions that challenge the doctors to seek out evidence for common practice recommendations.
Sydney University Medical School’s Hoc Mai Foundation is a philanthropic organisation that has helped improve the standard of medicine and medical education in Vietnam over the last 20 years. HHMP has been invited to contribute to this Foundation as a ‘model General Practice’. Each year 25 Specialist Doctors from Hanoi’s Hoc Mai University visit HHMP, as part of their immersion programme in Australia. Dr Andrew Bowes from HHMP visits Vietnam twice per year to lecture on general practice.
Since 2016 HHMP has had two GP registrars employed at any given time, who usually sit their Fellowship examinations during their placement. Senior doctors in the practice have experience with the regional training provider and the college examinations and help the registrars with case discussions and mock cases.
Engagement with Community
General practitioners have a long history of involvement in the Hunters Hill community dating back to 1860. Continuing this tradition, the HHMP team play an active role in their local community and have formed close relationships with many local community and school groups. HHMP provide medical care for almost 600 boarders at a local private school, offering onsite consultation sessions and have a strong focus on concussion and post injury care.
They also work closely with the school counsellors to provide mental health care when needed. Additionally, HHMP medical students attend two local public schools each term to engage with year 11 students on various topics including mental health, cyber-bullying and recreational drugs.
A close relationship with the local council has led to HHMP supporting community groups, including the Hunters Hill Theatrical Society, Heritage Association, Musical Society and Bowls Club. The doctors and allied health team members play a major role in the promotion of health care and regularly give talks on men’s health, healthy ageing, travel medicine and falls prevention. The Hunters Hill Art Show is the largest municipal art show in New South Wales, and within their practice, HHMP provide hanging space for 50 paintings as well as sponsoring the “People’s Choice Award”.
Art is well recognised as a therapeutic tool in the maintenance of good health, and HHMP’s patients appreciate seeing the work of local artists on the waiting room walls as they wait to see their health care provider. A knitting corner has also been incorporated into the HHMP waiting room, where patients knit while they wait for their appointment and the squares produced are donated each year to overseas charities.
Secret Scenario Training
Creating scenes you’d expect to see on the big screen, HHMP takes their team training to a new level with the implementation of secret scenario training to ensure their team are prepared for all types of situations.
In one of these secret scenario trainings, an ‘incident’ took place in mid-2017 with only one doctor, the head nurse and practice manager aware that this was just a practice exercise for the team. Together with head nurse Dee, Dr Badr created a run sheet detailing the events that would occur every minute of this scenario and trained a local drama student on what to say and how to behave when he presents as ‘the patient’.
The treatment room was set up by Dee with one bed ready for the expected patient and the other set up with a resuscitation dummy but with the curtains closed and the practice manager filmed the drama. Most of the unsuspecting staff were gathered in the staff room expecting the beginning of a typical education session.
The ‘patient’ came in through the door and presented to reception sweating (the team had wet his face), short of breath and mumbling about a bee. The receptionist immediately identified the serious nature of the presentation and called the registered nurse to help the patient down to the treatment room. On the way, a doctor was coming out of her room and started to assist. The receptionist then went to the staff room to call for further assistance.
The patient deteriorated with the blood pressure machine pre-set to a specific reading, and Dee proceeded to give out saturation and heart rate data as per the run sheet, further complicating the situation with multiple staged errors. As per the plan, the Dee gave incorrect information contrary to the machines e.g., if saturation showed 98% and the heart rate was 80 this would be called out the other way around; when someone asked for adrenaline they were passed an ampoule of Lasix, etc.
The intent of these ‘errors’ was to see if the team was checking the information they were getting and, if not, to create discussion points for the debrief.
The ‘patient’ rose to the occasion with increasing wheeze, claiming his throat was getting tighter and later collapsing. At this point, it was obvious to the team that this was a scenario but they were advised to proceed as they would in a real emergency and moved to the other bed where the dummy was set-up.
Once the scenario concluded, the team were taken through an education session. Initially a debrief using video, prepared discussion points and staff input. Staff roles, team work and protocols for checking information were discussed at length. Mistakes were noted and various alternative approaches discussed. After this discussion, a formal education session on anaphylaxis, resuscitation and Australian Resuscitation Council protocols took place followed by question and answer time, and further discussion.