Transit lounge

Last week I finished my interviews with general practice staff (practice managers and receptionists). I interviewed 11 people in total. The interviews took me across Melbourne into a range of practice types and sizes – from a small (3 GP) practice in the generally more disadvantaged (lower socio-economic) western suburbs to huge (16GPs) corporate, multi-site practices in the north and east.The aim of these interviews was to understand how the administration staff work, how technology is currently used and to investigate how they would see a pre-consultation screening app working in their setting most effectively.

I’ve spent the last week listening back to the audio and here are some reflections:

  • Firstly, I now have much more respect for this workforce: These are highly competent and professional people who have to juggle multiple demands, from (the wide range of) patients to owners to GPs.They are also generally highly committed and engaged in their work – quite a few having worked at their practice for 10 or even 20+ years.
  • Practice managers have the potential to be the conduit and gatekeepers of if and how innovations or changes are introduced and implemented into the practice. So it’s important to be able to articulate and argue the benefits of the new practice to them, their GPs and their patients.
  • Apart from the clinical and booking software (and the automatic importing of electronically received medical test results), technology uptake and integration is slow (the amount of scanning that is done was a surprise). Perhaps because there is so little time and little incentive to test and implement new technology. All practices still use paper forms for new patients, though there is a recognition that this needs to change in the future with a few introducing online bookings and facebook pages.
  • SMS seems to be widely used for appointment reminders and, in some, to notify normal results – integrated into the clinical software and viewed as making their job easier.
  • Patient satisfaction and care is important, but so is ensuring staff are happy and any new innovation does not impact too negatively on their capacity to see patients (and earn money).
  • Some GPs will not want to be part of the pilot. These are ‘wait and see-ers’ – they don’t want to commit to new practices without first seeing benefits and that processes have been worked out.
  • Parents are generally the main point of contact for young people under 18; often parents will attend reception when they come in and reception don’t even really talk to them (or have their contact details) – this has implications for my final study, not least including consent [more of this in future posts].
  • All practices work in slightly different ways, and have varying willingness and flexibility to incorporate new ways of working. This seems entirely justifiable! In a sense this is the most challenging (albeit realistic) finding – as it means it presents a real dilemma on how I design my final study…[more of that in future posts too]
mdxdt @flickr, creative commons

mdxdt @flickr, creative commons

At the moment it feels a little as if I’m in a transit lounge of my PhD – not necessarily in a bad way. I’m not sure if this is the most apt analogy, as it implies waiting and inactivity, when actually it’s much more active that that; I’m going back to the literature, reviewing my data, reflecting if my original design for the final study is the best way to go –  basically working out which is the best plane to catch (or maybe the best plane to fly!). It’s easy to feel a sort of inertia, or the creeping alarmist thoughts that ‘I am going backwards’, ‘I have achieved nothing!’ etc.  but part of me also realises this is actually really important and productive time.