Unquestionably, general practice is going through a time of pressure and change. Whatever the causes and whoever is to blame, resilience is now the key to coping.
What is 'resilience'?
Both organisational and individual resilience are important for survival. Darwin said ‘It is not the strongest of the species that survives, nor the most intelligent that survives. It is the one that is most adaptable to change.’
In terms of an individual, resilience defines an ability to handle reality effectively and successfully. In terms of an organisation, resilience defines an ability to withstand pressure, recover quickly and reorganise to move forward.
Diane Coutu from the Harvard Business Review describes the following characteristics of resilience:
- Training for survival by accepting and enduring reality
- Adhering to established values to find a meaning and purpose
- The ability to improvise – solving problems in innovative ways
- This series of articles will explore both organisational and individual resilience and the practical things practices and individuals can do to improve their resilience and cope with our present reality
The pressure of change
The seismic shifts we are experiencing in organisational, workload, financial and workforce terms conspire to exert immense pressure on general practice. Although many individuals and organisations thrive on change, the volume of current changes feels overwhelming rather than stimulating. Our chances of survival rely on our ability to develop resilience in ourselves and in the practice.
First steps to creating a resilient practice
Resilient people and organisations are not idealistically optimistic. Neither are they so pessimistic that they feel the future holds no hope. Rather, they are willing to:
- Engage with what is happening
- Find a sense of purpose
- Restore a sense of control
What might this mean in a pressurised practice today? This might take the form of the following steps.
Step 1: Reviewing the present situation – what is the reality we are facing in the practice?
This is a cool-headed analysis of the current situation. We all know patients who become so afraid of their finances that they stuff all their bills in the bin, unopened. A review of our current state is the management equivalent of opening all the envelopes and taking a hard look. This review process will be more effective if the analysis is based on data prepared beforehand. Its purpose is to provide an objective basis on which to move forward.
It will include the following main questions:
- What is the current state of our workforce and what changes will impact it?
- What is our workload situation, including demand and access data?
- What is our current and planned/foreseeable financial situation?
- What is the current situation with our premises?
- What external factors are impacting us?
Step 2: Reviewing our values in the practice – why are we here and what is important?
In the constant hamster-wheel of dealing with the day-to-day demands, it is easy to feel that spending precious time planning and reflecting is just too difficult. By the same token, it is very easy to lose a sense of direction when we never raise our heads.
Reaffirming the practice’s values or the values of partnership helps construct a bridge between today’s pressure and the future. The activity of looking at what is important has an impact on the feelings of being overwhelmed and helpless. A strong sense of purpose can help the practice identify a way through the maze of problems and potential options.
Questions to ask:
- What are the core values and behaviours which are shared in the practice and which never change? Although other elements in the practice may change, such as delivery models or team structures, core values will remain constant and provide a compass for decision-making
- What is the general strategic direction of the practice? Accepting that quality of care is a given, do you want to prioritise service development or income generation? What balance works for everyone? The Productive General Practice programme has some useful tools for looking at this
- What do we need to start (or stop) doing, or do differently, in order to help ensure that we are investing time and effort on the right things according to our agreed values and priorities?
Step 3: Restoring a sense of control – what can we do to feel we’re back in the driving seat?
Resilient organisations and their staff react creatively at times of pressure. Practices which look out for opportunities they can tailor to suit their priorities are a good example. Commonly, these will be practices which have good contacts with, and possibly direct involvement in the local primary care organisation or possibly the LMC or RCGP Faculty.
They will have a proactive management team and be well-organised. This is not to say that these practices do not have their share of hardship and challenge. But their reaction to stress is to take creative action – Dr Naomi Beer and her team’s recent campaigns to save the Jubilee Street Practice in Tower Hamlets are an example of this kind of innovative thinking.
Questions to consider:
- What internal resources do we have to solve this problem?
- What external resources do we have?
- What solutions might our practice team and patients suggest?
- What contacts do we have that might be useful?
- What are the risks of 'no action' against 'action'?
- Why is resilience important?
The purpose of thinking about the practice and individuals in terms of resilience is to explore ways of building strength. It is no longer sufficient to assume that general practice as it has functioned for the last twenty years will still be here in the same form in another twenty. Practices who build organisational strength to withstand change will have a greater chance of evolving and succeeding.
Fiona Dalziel FRCGP (Hon) is a practice management consultant www.dlpracticemanagement.co.uk