Chronic disease prevention and management in central coastal CA

Archive for the tag “http://www.aafp.org/fpm/20060100/47seve.html.”

Work relationship survey December 2011

Spent the end of last work completing a Workplace Relationship Survey, looking at preliminary self-awareness of how our team is working. Preliminary in the sense that I am preparing a Medical Assisstant Boot Camp and I want to see where we’re at before starting the training. The survey is based on this work by Tallia, MD et al http://www.aafp.org/fpm/20060100/47seve.html, first published in Family Practice Management. The suvery studies the dimensions: Trust, Respect, Mindfullness, Interelatedness, Diversity, Varied Interaction and Effective Communication. The authors report that successful practices score highly on these dimensions. I had also used this tool in another practice a few years ago.

Methods: Surveyed 26 staff including physicians, medical assistants and front office receptionist in a Community Health Center in a CA rural agricultural community.  I preceded the survey with a discussion of the various practice characteristics, answered any questions, then distributed the survey.  I scored the Always present, Sometimes present and Never present answers on a linear 0-5 scale and calculated the mean on each characteristic.

Results: Scale 0-5

Characteristic                Mean Score

Respect                                  3.60

Trust                                       3.32

Diversity                                3.32

Mindfulness                         3.17

Interelatedness                    2.93

Effective Communication  2.79

Varied Interaction               2.15

The results were surprisingly similar to results from another CHC office 3 years earlier, where again the lowest scoring parameter being Varied Interaction. The high scores speak for themselves and I will focus on the challenging one.  This characteristic of varied Interaction rates the ability for both task related and social interaction to be fostered.  Clearly, our practices need to work on this. I believe the reasons are both structural, the nature and socialization of a hierarchical field like medicine.  More opportunities for empathy are needed ironically, in a field historically known for compassion.  In terms of team building I mentioned to support staff that we cannot offer true customer service until we realize “internal” customer service, the behind the counter service we need to offer each other.  In our particular case, it needs to start with more opportunities for staff to interact socially.  Our office, by way of no prior planning, has no local break room.  Support staff and professional staff pragmatically break surreptitiously at their desks (we are hoping tom  move into a self-designed clinic within the next two years), in two different locations.  In terms of midway solutions, we did begin recently with a colocation PDSA where, we place a physician and their medical assistant in the same space during clinic, sitting across from each other in the middle of the Gemba, we call this “the fishbowl”.  So far, so good. The experience is getting positive reviews from the participants, yet too early to see improvements in cycle times.  We’re just beginning to look at which metrics to follow.  We are also trying an improved communication tool around uncompleted forms waiting around the office too long, a problem that surfaced when we discussed the characteristics of mindfulness and interrelatedness.

In any case I believe we are beginning to see changes in office relationship as a spin-off of the survey, an early Hawthorne effect that we’ll try to keep building upon.  And I recommend you review this article out of Family Practice management and consider surveying your own workgroup

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