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Building for the future: developing a GP surgery in Leeds

1 September 2007

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Practice Manager
Burton Croft Surgery, Yorkshire

Dawn has worked in healthcare for 15 years, and moved into management following the completion of an Open University business qualification. She previously worked for a private hospital, and undertook many successful projects, including new hospital builds. Dawn is now a practice manager in Headingley. In her spare time, she enjoys gardening and undertakes freelance writing – she is currently writing her second nove

When I was offered the chance to work as a freelance project manager for Bellbrooke Surgery in Harehills, Leeds, I was ecstatic and jumped at the opportunity.
My remit was to help them make the transition from small, cramped and rundown doctor’s surgery to state-of-the-art medical facility, offering fantastic new opportunities for doctors, staff and patients.
The new facility was planned to meet the ever-changing legislation governing secondary care providers. It was to provide an abundance of consulting and counselling rooms, treatment areas, etc, allowing the opportunity for new services to be introduced into the facility in the future.
As project manager, I would have day-to-day responsibility for delivering the project on time and ensuring critical milestones were met. All activities would eventually achieve the predetermined business needs of the surgery.

Manor from heaven
The land had already been found just around the corner from the old surgery. Finding the land in such an overpopulated and built-up area was no easy task. Land is at a premium in Harehills, but the land found was on the site of the local parish church. The old church hall was in need of repair, the roof was leaking and the inside was damp and old.
I know churches are meant to have an “old” feel to them, but the church hall had gone beyond this. It was no longer suitable for use and was becoming a worry for the local congregation.

After much negotiation, the company employed to develop the new surgery struck a deal, whereby the old church hall would be demolished and a new one built adjoining the church building. The vacant land would become the site for the
new surgery.

Critical building blocks
Building work commenced, and the planning and commissioning started. It gave the practice partners a fantastic opportunity to review how the business was currently being run, and to
plan improvements.
We looked at several critical aspects:
•    Business processes.
•    Roles and responsibilities.
•    Technology.
Changing any one of these three critical aspects would inevitably have an impact on the other two. In order to deliver the potential benefits of the change, it was necessary to make them in an integrated and structured way, to make certain each one remained aligned so as to ensure stability in the new surgery:
•    We reassessed policies, protocols and business processes – a methodology that enables organisational change. We knew there were many aspects driving the need for change, eg, practice-based commissioning, Choose and Book, and the internal state of the current surgery. A need to re-engineer the whole surgery structure to meet the changing needs of the patient population and primary care trust was inevitable.
•    We looked at all aspects of IT to ensure the telephone system and computer network were adequate to manage a much larger and busier surgery.
•    The staffing infrastructure was scrutinised to make sure we had the correct amount of staff with the right skills to run the new surgery smoothly. An outside agency was employed to review job roles and enter into discussions with the various discipline groups, to make sure everyone understood how they would be placed in the new structure.
This can often be an unsettling time for members of staff. Reassurance is therefore needed to ensure a downward spiral of negativity does not become entrenched in their mindset.

Open communication
Good communication is imperative to making the transition period a smooth one and, with this in mind, the move became a regular agenda item, keeping the new build at the forefront of everyone’s minds, while continuing to manage a very busy and demanding practice.
Management styles and organisational culture are major factors in determining whether the communication climate is open and supportive. We embraced such a climate, giving everyone the opportunity to ask questions and speak freely about the move. Effective teamworking, flexibility and a sense of involvement all contributed to the success of the project.
A surgery newsletter was introduced to provide a communication link to the patients in the locality. It offered information about the new build, with timescales and what to expect as part of the transition. We also included information about  ocal services we felt were relevant to the patients. The newsletter was well received and will continue in the new building.
As we moved closer to the physical move from the old building to the new, we wrote to all households served by the surgery, informing them of the forthcoming move and asking them to support us through what was going to be a busy transition period.
It is difficult to prepare members of staff for the enormity of such a change, so we looked at the critical success factors – ie, the achievements identified by the surgery that would be key to the successful transition. If these factors were not achieved on time, every part of the transformation would be jeopardised.
We looked at the resources available to us, including the people and the physical resources required to ensure a smooth process. They helped us distinguish between what was a given and what was desirable and useful in prioritising our change requirements.

Breaking habits
One of the most difficult aspects of such a move is to change the way people think and review the way they do things. Habits are hard to break, and because something has always been done a certain way, it is assumed that it will work in the
new surroundings.
Unfortunately, this is often not the case and the method by which things are done has to be worked on step by step until it is redesigned to work effectively in the new environment. In all the projects I have managed in the past, when asked how things are going to work in the new environment, people generally reply:

“We will do it the same as we always have done because it works well now”

Changing that cultural way of thinking is difficult, and takes a lot of patience and hard work. Usually, it takes a very simple approach of “walking through” the process under discussion, eg, booking a patient into the treatment room.
Generally, I begin by looking at how it is currently done and then adapting that to fit the new environment. It is only by taking such a simple approach that everyone involved can understand the changes required to make it work effectively. This is not by way of criticism to anyone involved, but a logical and easy way of creating awareness of the changes required to ensure a smooth transition.
Generally, at the end of every process review you can see “the light go on” and the understanding of why the changes were required become clear to all involved.
A project plan was prepared, identifying all the above factors – to each one we added priority status and a timescale. All the identified key milestones were included on the commissioning agenda and discussed at biweekly meetings. These meetings became more regular as we neared the moving date.
Regular meetings with the builders were also held biweekly, and we planned our commissioning meetings to follow these so that feedback could be given and any actions required communicated to the surgery staff.
Deciding on how things are going to look in the new facility is often difficult, as is deciding what exactly to take with you. Weeks, possibly even months, before the move was due to take place, I asked people to start the “declutter”. If something had been in a drawer for a long time and never used, then it was probably surplus to requirements. It’s a bit like moving house, but on a much larger scale!

After moving in …
We didn’t get everything spot-on, and there have already been some changes to the building to make it more functional. For instance, extra storage space has been added in a corridor that was essentially a total waste of space, and now gives the administration team somewhere to keep all the leaflets and materials that are required on a daily basis.
A decision was made to have a settling-in period. As is the case when you move house, it is sometimes difficult to get a feel for where things need to be stored or what extra pieces of furniture you might need. This was a good decision, and the whole building is now very functional.
Ultimately, it is the people involved who determine the success of a project. It is important for them to feel valued and part of the change. With this in mind, everyone was given the opportunity to contribute to the move, and were recognised for their involvement.
The success of the new building is testament to the contribution from all staff, and their hard work and effort towards the project. The rewards of upgrading the surgery are endless: more treatment areas, better equipment, more space ready for future expansion, new technology, more structure to the working environment …

And finally …
The site on which Bellbrooke Surgery stood was originally a dwelling house, and an indenture was signed in 1908 to allow this residence to be used as a doctor’s surgery. I wonder if a project plan was written, and processes reviewed, when the doctors in the 1800s opened
for business?