Assessing the organization of family practices in Slovenia

1. Assessing the organization of family practices in Slovenia Department of family medicine Medical faculty of Ljubljana – Slovenia Tatjana Cvetko Vlasta Vodopivec - Jamšek Janko Kersnik

2. Background • organization of primary care practice is inherently difficult to assess • in the future the organization might be the key for quality improvement • improvement is a matter of changes…. …development is a matter of implementing these changes in every day practice.

3. Background/ 2 orl • The group assessment process starts at the point of existing competence. • Systems judged : • against minimal standards, can often fail to inspire improvement • against gold standards, can discourage practices with substantial developmental needs. • For practices at various levels of development and motivation the group assessment with facilitator is very useful for formative approach.

4. Aims of the study • to assess the current level of organizational development of practices in Slovenia, • assessing the practices we can compare, improve and develop them. • results will help us to identify the priority areas for further organizational improvement and development.

5. Sample: • 30 practices of primary care from Slovenia • public and private practices, • teaching and non teaching practices • 154 participants (64%), 63 GPs (73%)

6. Maturity Matrix method • A self-assessment method for members of a primary care practices for use in a group setting with assistance of external facilitator. • First individually scoring using the Maturity Matrix table in the group session of all the members of the team • 11 dimensions of the organization • 8 different development possibilities of each dimension • Facilitator conducts the disscusion about each of these 11 dimensions to reach the consensus about the achived level of organizational development in their practice.

7. 11 dimensions of assessment: • Clinical data • Audit of clinical performance • Use of guidelines • Access to clinical information • Prescribing • Human resource management • Continuing professional development • Risk management • Practice meetings • Sharing information with patients • Learning from patients

8. Clinical data • Most of the practices (87%) use the combination of computer and paper record

9. Feedback information • Every practice will receive their own Maturity Matrix feedback profile. • two different types of information. • grafical and visual information • written feedback information • The feedback information should be discussed with all the team members. • Discussion in the team about the results concludes the first circle of their learning and implementing changes.

10. Graphical and visual feedback information

11. Written feedback information • general data from the study • the data for the practice • suggestions for further development

12. Mean score EU – Slovenija (scale 1-8) • Mean score of EU practices is 4,7, in Slovenia 4,3. • Main differences between EU and Slovenian practices are: • Clinical data(1) - 2,1 • continuous prefessional development (7) and + 2,1 • access to clinical information (4) and HRM (6) - 1,1

13. Mean score of the practices(scale 1-8) • Practices in Slovenija 4,3 • Size • 1GP 4,1 • Group 4,4 • Location • Rural 4,2 • Urban 4,3 • Status in healthcare system • Public 4,1 • Privat 4,4 • In general, the mean scores between different properties of the practices are not statistically significant (p>0,05)

14. Properties of the practice • hi2 Regression Beta • Size of the practice (small/medium/large) • Audit of clinical performance p= 0,05 -0,133 • Use of guidelines p= 0,01 -0,037 • Prescribing drugs p= 0,01 0,120 • Location of the practice (rural/urban) • Access to clinical information p= 0,02 -0,230 • Status in the healthcare system (public/privat) • Continuous profess. development p= 0,05 0,132 • Sharing information with patients p= 0,02 -0,390

15. Multivariant analysis • Human resource management shows important, but not yet significant difference (p=0,06) and is • better developed in rural and privatpractices, • but independent from the size of the practices.

16. MM….the numbers ….the goals … ……all the members of the team feel a need of change, seat together at the meeting, think and talk about the organization, about competences of each member of the team, about their personal career, seeking for the way to improve their work and start the process of changing quality of our work ………………………… quality of our life

17. Conclusions • Using the MM method is an opportunity for the team to start the process of changing the organizational culture in the practice. • Group based self-assessment is a good way of organizational learning and provide targets for future development at the end of group session. • It is an appropriate tool for assessing the organization of different types of practices and atvarious levelsof their development. • According to the data priority areasfor improvement in Slovenia are: • use of the information technology • clinical audit and use of the guidelines • human resource management

18. Thank you for your attention! tatjana.cvetko@guest.arnes.si