What are the Keys to a Healthy Practice?

Five key drivers of workplace excellence

According to a comprehensive Australian study, there are five key factors that drive excellence in any workplace. Hull and Read (2003) interviewed and surveyed hundreds of people from different workplaces of varying quality. While medical practices are not specifically discussed in Hull and Read’s study, they state that their findings are relevant to all workplaces irrespective of industry.1 Thus their results can be applied to medical practices. Although there are different types of medical practices, each facing unique demands, there are overarching principles which apply to all.

Hull and Read (2003) identified 15 factors that need to be present in the foundations of a workplace if excellence is to be achieved – of which five factors in particular have the most weight as potent drivers of workplace excellence. The five key factors are:¹

• safety
• clear values
• having a say
• high quality working relationships
• workplace leadership

These foundations of a “healthy” practice support optimal healthcare service and job satisfaction for all your staff.

High quality working relationships is the critical key

The presence of high quality working relationships was identified as the primary factor driving all others.¹ High quality working relationships among the team allow practices to respond to the changing environment and improve practice processes and care.² Strong working relationships increase “joy in daily work”.² Happy staff are more likely to stay with the workplace and produce high quality work.

For high quality relationships to develop there needs to be:

• an atmosphere of mutual trust and respect¹
• ongoing connection between all team members¹
• a feeling of secure identity and self-worth in each team member¹
• emotional competence³
• strategic effort²

The other four keys to workplace excellence

Leadership

A great leader needs to:

• empower employees^1,4
• support all staff in professional development⁵
• model professionalism, patient-focus, and respect for everyone’s contribution^1,4
• embrace a nonhierarchical leadership style⁶
• foster creativity^5,6
• unify differences within the team⁶

Clear values

Team members need to understand the workplace’s purpose and expectations of behaviour.¹ They also need to know what makes the practice important and meaningful.⁷

Individual excellent workplaces demonstrate a variety of values; what is important is that they are explicitly stated and used to frame multiple workplace systems and structures⁸, e.g. task prioritising and budget decisions.⁷ Any inconsistencies or conflicts between actual actions and the values, due to competing priorities, need to be quickly and openly discussed.¹

Safety

A workplace needs to create physical and psychological safety. Team members need to feel “protected by the system”. This leads to emotional stability and improved outputs.1

There needs to be continual review of best practice and what is actually occurring in the workplace. Real safety is not about policies in a manual. “Feeling safe and secure comes from confidence, knowledge, training and particularly the experience of knowing that other people care for your wellbeing.”1

Effective quality improvement activities are only possible when staff feel psychologically safe and able to contribute.⁷

Having a say

Team members being able to “have a say” allows them to make valuable contributions to the workplace and be independent. It brings “brains and heart” to work and that increases satisfaction and improves workplace outcomes. Individual initiative is encouraged in an excellent workplace.¹

Conclusions

Strong workplace foundations allow practices to individually flourish

Many of the characteristics that make a workplace excellent – such as openness, inclusive decision making, and building strong relationships – overlap with what is strived for in patient-centred care. Thus developing these skills brings wide ranging benefits to a practice. Having different professionals working together as a clinical practice is not easy. It takes reflection, discussion, knowledge and effort to build a great workplace. Ensuring that your practice has high quality working relationships, good leadership, clear values, safety, and an open environment in which everyone can “have a say” provides the foundation for true excellence.

MDA National can provide resources and advice to assist practice improvement efforts. Contact the Support in Practice team on 1800 011 255 or email peaceofmind@mdanational.com.au

If you are interested in participating in further education on the drivers of workplace excellence, email events@mdanational.com.au

1 Hull D, Read V. Simply the Best. Workplaces in Australia Sydney: acirrt, University of Sydney; 2003. Available from: www.cosolve.com.au/files/ simply_the_best.pdf.
2 Crabtree B, Miller W, McDaniel R, Stange K, Nutting P, Jaén C. A Survivor’s Guide for Primary Care Physicians. J Fam Pract. 2009;58:E1–7. Available from: www.jfponline.com/Pages.asp?AID=7761.
3 Helge D. Positively Channeling Workplace Anger and Anxiety. Part 1. AAOHN. 2001;49:445–52.
4 Lasserre C. Fostering a Culture of Service Excellence. J Med Pract Manage. 2010;26:166–9.
5 Jakielo D. How to Survive and Thrive in Today’s Medical Practice. J Med Pract Manage. 2011;26:267–9.
6 Howard M, Brazil K, Akhtar-Danesh N, Agarwal G. Self-reported Teamwork in Family Health Team Practices in Ontario. Organizational and Cultural Predictors of Team Climate. Can Fam Physician. 2011;57:e185–91. Available from: www.cfp.ca/content/57/5/e185.long.
7 Miller W, Crabtree B, Nutting P, Stange K, Jaén C. Primary Care Practice Development: A Relationship-Centred Approach. Ann Fam Med 2010;8(S1):s68–79. Available from: www.annfammed.org/cgi/content/ full/8/Suppl_1/S68.
8 Cunningham A, Bernabeo E, Wolfson D, Lesser C. Organisational Strategies to Cultivate Professional Values and Behaviours. BMJ Qual Saf. 2011;20:351–8.