Melody Rhydderch

Assessing organisational development in primary medical care using a group based assessment: the Maturity Matrix

Objective: To design and develop an instrument to assess the degree of organisational development achieved in primary medical care organisations. Design: An iterative development, feasibility and validation study of an organisational assessment instrument. Setting: Primary medical care organisations. Participants: Primary care teams and external facilitators. Main outcome measures: Responses to an evaluation questionnaire, qualitative process feedback, hypothesis testing, and quantitative psychometric analysis (face and construct validity) of the results of a Maturity Matrix™ assessment in 55 primary medical care organisations. Results: Evaluations by 390 participants revealed high face validity with respect to its usefulness as a review and planning tool at the practice level. Feedback from facilitators suggests that it helped practices to prioritise their organisational development. With respect to construct validity, there was some support for the hypothesis that training and non-training status affected the degree and pattern of organisational development. The size of the organisation did not have a significant impact on the degree of organisational development. Conclusion: This practice based facilitated group evaluation method was found to be both useful and enjoyable by the participating organisations. Psychometric validation revealed high face validity. Further developments are in place to ensure acceptability for summative work (benchmarking) and formative feedback processes (quality improvement).

Developing a facilitation model to promote organisational development in primary care practices

BackgroundThe relationship between effective organisation of general practices and health improvement is widely accepted. The Maturity Matrix is an instrument designed to assess organisational development in general practice settings and to stimulate quality improvement. It is undertaken by a practice team with the aid of a facilitator. There is a tradition in the primary care systems in many countries of using practice visitors to educate practice teams about how to improve. However the role of practice visitors as facilitators who enable teams to plan practice-led organisational development using quality improvement instruments is less well understood. The objectives of the study were to develop and explore a facilitation model to support practice teams in stimulating organisational development using a quality improvement instrument called the Maturity Matrix. A qualitative study based on transcript analysis was adopted.MethodA model of facilitation was constructed based on a review of relevant literature. Audio tapes of Maturity Matrix assessment sessions with general practices were transcribed and facilitator skills were compared to the model. The sample consisted of two facilitators working with twelve general practices based in UK primary care.ResultsThe facilitation model suggested that four areas describing eighteen skills were important. The four areas are structuring the session, obtaining consensus, handling group dynamics and enabling team learning. Facilitators effectively employed skills associated with the first three areas, but less able to consistently stimulate team learning.ConclusionThis study suggests that facilitators need careful preparation for their role and practices need protected time in order to make best use of practice-led quality improvement instruments. The role of practice visitor as a facilitator is becoming important as the need to engender ownership of the quality improvement process by practices increases.

Can knowledge tests and situational judgement tests predict selection centre performance

Medical Education 2012: 46: 777–784

Assessing organisational development in European primary care using a group-based method: a feasibility study of the Maturity Matrix.

PURPOSE The Maturity Matrix is a tool designed in the U.K. to assess family practice organisational development and to stimulate quality improvement. It is practice-led, formative and undertaken by a practice team with the help of trained facilitators. The aim of this study is to assess the Maturity Matrix as a tool and an organisational development measure in European family practice settings. DESIGN/METHODOLOGY/APPROACH Using a convenience sample of 153 practices and 11 facilitators based in the U.K., Germany, The Netherlands, Switzerland and Slovenia, feasibility was assessed against six criteria: completion; coverage; distribution; scaling; translation; and missing data. Information sources were responses to evaluation questionnaires by facilitators and completed Maturity Matrix profiles. FINDINGS All practices taking part completed the Maturity Matrix sessions successfully. The Netherlands, the U.K. and Germany site staff suggested including additional dimensions: interface between primary and secondary care; access; and management of expendable materials. Maturity Matrix scores were normally distributed in each country. Scaling properties, translation and missing data suggested that the following dimensions are most robust across the participating countries: clinical performance audit; prescribing; meetings; and continuing professional development. Practice size did not make a significant difference to the Maturity Matrix profile scores. ORIGINALITY/VALUE The study suggests that the Maturity Matrix is a feasible and valuable tool, helping practices to review organisational development as it relates to healthcare quality. Future research should focus on developing dimensions that are generic across European primary care settings.

Developing a Skills-Based Model to Promote Effective Appraisal Discussions Amongst GPs in Wales

WHAT IS ALREADY KNOWN IN THIS AREA . Annual GP appraisals are a contractual requirement. . GP appraisal has been running nationally in Wales since 2003. . Quality assurance (QA) activity has focused on system-level monitoring and evaluation to ensure equitable access to appraisals by every GP in Wales. . There is also a need to focus on developing approaches to QA and improvement that focus on the appraisal discussion itself.

Do general practice selection scores predict success at MRCGP? An exploratory study.

BACKGROUND Selection into general practice training is undertaken using a competency based approach. The clear advantage of this approach over traditional methods has been demonstrated through evaluation of its validity and reliability. However, the relationship between selection and performance in the Royal College of General Practitioner examinations (MRCGP) has yet to be explored. The MRCGP comprises of an applied knowledge test (AKT), a clinical skills assessment (CSA) and workplace-based assessments (WPBA). AIM To explore the predictive validity of general practice selection scores using the AKT and CSA elements of the MRCGP as a final outcome measure. METHODS This study carried out a retrospective analysis of 101 trainees from the Wales Deanery who were successfully selected on to general practice training in 2007. Selection data consisted of an overall selection score as well as scores from each individual stage of selection. Correlation was used to explore associations between selection scores and examination scores. RESULTS The score for overall performance at selection achieved statistically significant correlation with examination performance (r = 0.491 for the AKT and r = 0.526 for the CSA, P <0.01). CONCLUSIONS The general practice selection process is predictive of future performance in the MRCGP.

Making an objective assessment of a colleague’s performance

Background:  Historically, assessment of good medical practice has focused on clinical skills and knowledge. However, performance assessments and appraisal today encompasses the review of both non‐clinical, or behaviourial skills and the assessment of clinical practice.

A New Model of Educational Provision for GPs Directed to Undertake Further Training in Wales

Over the last two decades, the number of general practitioners (GPs) directed to undertake further training has increased. More frequent prescriptions for mandatory remediation and mandatory induction contribute to this growth and there are a number of factors promoting these trends. Firstly, there is now a more widespread awareness and a lower tolerance of medical underperformance. Secondly, there has been much progress in the reliable assessment of underperformance. Thirdly, there is a growing appreciation of the need to lessen the potential for future underperformance by properly assessing and inducting GPs whose performance in contemporary UK practice is untested. The latter consideration applies to both UK GPs wishing to return to the workforce after prolonged absence and to GPs who qualified abroad and have never worked in UK general practice. For a number of reasons, though, postgraduate medical deaneries have often found it difficult to respond effectively to deliver the further training which has been prescribed. In July 2006, Liam Donaldson’s review of medical regulation, Good Doctors, Safer Patients, brought the requirement for well-organised and sustainable models of further training provision into even sharper focus. Several of the consultation document’s recommendations, if implemented, point to an inevitable further growth in prescribed training. This paper first examines, in greater depth, the growing need for well-organised educational provision for GPs who are directed to undertake further training and the historical difficulties surrounding such training. Next, the Wales Deanery’s strategic response to these issues, which culminated in the introduction of the Advanced Training Practice Network (ATPN) in 2003, is described. This description provides an outline of the network’s development; its management and organisation; how training practices were recruited; how educational supervisors are trained and supported; and how a wide range of placements have been successfully organised in the first three years of the scheme’s evolution. The initial impact of the model is then examined and the implications for policy and research discussed. Education for Primary Care (2007) 18: 316–27 # 2007 Radcliffe Publishing Limited

The Advanced Training Practice Network: Providing Prescribed Further Training for General Practitioners In Wales

In this article the activity of an advanced training practice network (ATPN) in undertaking prescribed further training for qualified GPs is described. The network has been developed by the general practice section of the Wales Postgraduate Deanery and has been running since 2003. The ATPN, as it is known, has supported the assessment and induction or remediation of 15 GPs to date. The experiences of both Education for Primary Care (2007) 18: 572–81 # 2007 Radcliffe Publishing Limited

Exploring the perceptions of out-of-hours training for GP registrars in Wales.

This paper explores the perceptions of GP registrars about the quality of the training that they receive within out-of-hours (OOH) settings. Focus groups with trainers, clinical supervisors and GP registrars revealed three areas of interest: supervision, educational experience and system factors. Implications for OOH training are discussed.