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21 February 2020
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Dr Farzana Hussain gives her top tips for boosting staff morale at your practice
Morale in GP practices has rarely been lower. The triple burden of workload pressure, dwindling staff retention and inadequate funding is causing a strain that’s felt in every corner of the UK.
However, there are methods that savvy partners can employ to boost morale, improve efficiency and keep valuable team members as just that – part of the team.
1. Understand your staff and their levels of morale
You won’t get very far without acknowledging staff as individuals, so accept that management needs vary from person to person, and avoid simply grouping them together.
It’s not just about remembering birthdays (although cake is always a good idea), but understanding what life is like for staff members.
If someone has been up all night with their child, they may struggle the following day. It pays dividends to support them, think about how you would respond in their situation, and realise that we all have days where we aren’t at our best.
If you expect slightly less of the staff member that day, they will appreciate your understanding and are likely to make up for it later.
Also, remember your staff are probably keen to advance in their careers. Practice managers who started as receptionists had the opportunity to learn their strengths and reach new heights in the practice.
So equip everyone with the space to develop and nurture their ambitions.
2. Be present, visible and yourself
Provide formal opportunities for feedback.
Many GPs will relate to the frustration of being unaware of what’s going on, so make sure there’s a forum for everyone to raise issues beyond the mechanism of formal appraisals.
If you suspect morale is low, whether throughout the whole team or in a particular individual, investigate why. You’ll never fix a problem by making assumptions.
Make yourself a trustworthy listener. Be approachable and listen closely to what’s said, whether a person is talking about serious concerns or making lighthearted observations.
Chatting to colleagues after busy clinics works wonders for spirits. It doesn’t have to take long – a quick catch-up about how the day has gone is enough – but it may allow you to delve a little deeper and help unearth the root of any problems. A GP’s working life centres on communication and this shouldn’t be solely reserved for patients.
Also, be yourself. As a mum to two teenagers and wife of a surgeon, I know that busyness shouldn’t be a deterrent to learning about yourself. This is sound advice for life in general, but especially applicable to a GP practice. The confidence to be open with colleagues, within reason, will release you from the trappings of a rigidly hierarchical structure.
Five years ago, one of our GPs died suddenly. I couldn’t hide behind a brave face, and because the loss was felt so sorely by everyone, it really bonded our team. If your personality is more guarded, you’ll find it more difficult to summon the courage to vocalise vulnerabilities, but people respond positively to truthfulness, so try to be authentic with the staff in your practice.
3. Give your staff adequate training and stretch those who want a challenge
Staff can become demoralised if inductions and subsequent training are inadequate. But you can boost morale if you identify enthusiasm and a desire to progress, and provide training opportunities to enable this.
For GPs, there are plenty of officially accredited post-qualification courses, such as the RCGP’s leadership strategy and the Faculty of Medical Leadership and Management’s mentoring scheme. For non-GPs, the National Association of Primary Care runs a year-long diploma in advanced primary care management, and earlier this year NHS England commissioned provider Beyond Coaching to coach and mentor practice managers. The scheme is ongoing but currently oversubscribed – details can be found at beyond-coaching.co.uk/nhs-gp-coaching.
Also, don’t discount informal training – remember that older GPs have valuable lessons to share with younger team members, and vice versa.
4. Cultivate a shared purpose
It’s easy to be the boss, but less easy to be a reputable leader. These days, practices have many targets, divided between the teams, so these could be used as an opportunity to build a sense of mutual goals. Involve everyone in the decisions about how to achieve these and why. Staff will feel empowered by it, which will benefit their own work.
My own mindset certainly shifted when I realised that as the partner, I didn’t have to do everything.
Delegating responsibilities made life more orderly and effective for everyone involved.
And such delegation does not have to come from the top – staff can suggest taking on responsibilities too. I often share the story of the time my receptionist’s grandmother was gravely ill and she made a commitment to improving end-of-life care. She led a change in how we structure our end-of-life care home visits, teaching me that personal links improve wellbeing for people connected to the practice, whether that’s staff, patients or the wider community.
Clearly, you need to maintain a boundary between the professional and personal, but you shouldn’t automatically resist opportunities to bring shared interests together.
Equally, staff are thankful when GPs assist with remits that might not be officially theirs, such as signing extra prescriptions or making phone calls for the admin team. Of course, you’ll have to think about circumstances and timings, but the gesture will be appreciated by the team.
5. Manage the size of your teams, then offer praise
I’m fortunate to work in a team of 10, where we can easily get to know each other. If your practice is larger, you can create micro-teams to nurture relationships. The ‘two-pizza rule’ devised by Amazon chief executive Jeff Bezos is apt – if you can’t feed your team with two pizzas, it’s too big (appetite dependent, of course).
We all enjoy praise. And praise bolsters productivity across the board. It’s important to acknowledge the hard work you see around the practice; doing so will inspire staff to achieve more.
Their efforts can be acknowledged through passing comments, employee of the month initiatives, bonuses or performance-related pay. All of these will increase morale.
Finding the time to do this may verge on impossible, but it’s worth making the effort. If you only speak to staff negatively (purely logistically, identifying downfalls, or criticising), you’ll risk creating hostility, not harmony.
6. Money, money, money
Praise shouldn’t only come in the form of words. Positive appraisals should be complemented by promotions and pay rises.
If finances and successes allow, you could reward staff with Christmas bonuses, for all levels.
In a similar vein, staff appreciate extra annual leave. You’ll see positive effects if they have time to focus on themselves.
The newly announced GP contract in England discusses a 2% rise, but practices make their own decisions on pay. To understand whether your staff’s salaries are normal, compare them with rates at nearby practices. Don’t be afraid to reach out to other practices to make this comparison. There are other benefits to be gained from liaising with local GPs, in terms of knowing what’s standard, gaining inspiration, and widening your professional friendship pool.
7. Limit damage to your reputation
Reputations are fragile. They take a long time to build, but can be pulled down very easily. How your practice is regarded in the outside world is an important but often overlooked determinant of morale.
Complaints, whether about the entire team or an individual, affect the reputation of the entire practice, whether they are justified or not. If it concerns an individual, you’ll be walking a tightrope – to avoid isolating your employee and to contain the reputational damage.
You’ll encounter times where sustaining your reputation and morale will require help from your medicolegal organisation. You might also join a union, such as the BMA, as they offer a strength in numbers that won’t go amiss during adversity.
8. Flexibility and remote working opportunities
Remote working options are becoming more popular in all walks of life.
Although general practice shares little common ground with the office-based nine to five, working from home isn’t out of the question. The extra flexibility and autonomy will help avoid resentment and raise morale.
One of my salaried GPs processes blood results and hospital letters from home so she can pick up her child from school on time.
Examples like this are win-win situations – the standard of work doesn’t slip, the task is probably completed more promptly and the staff member can prioritise important aspects of their life when they need to.
Obviously there are many tasks that can only be conducted in a clinical environment, but for tasks when remote working is possible, start the conversation with your staff.
9. Quality improvement methods to speed up proceedings
Quality improvement (QI) methods from NHS Improvement are a series of measures designed to improve patients’ health and staff members’ professional development. They will also help with assessing the systems that increase efficiency and reduce workload (see below).
Consider using QI methods to reduce the number of repeat prescriptions being processed, and limit the number of GP appointments made by improving signposting to other health professionals and services. Although staff will need to learn the methods, they will recognise the time-saving potential when they complete the project, so setting aside the hours is worthwhile.
On the subject of quality, don’t put off revamping your HR systems, especially procedures for grievances and bullying. With luck you’ll have little need for them, but employees will have peace of mind if they know they’re in place.
10. Have fun
Few members of the public would name their GP practice – or any healthcare-based environment – as somewhere they associate with fun. Similarly, your staff are unlikely to feel their workplace is a place of mirth. But although we rightly prioritise serious matters, fun is a restorative antidote to the mounting pressures of general practice.
It’s worth having meetings that involve the whole practice. As well as keeping everyone in the loop – sharing successes, lessons and plans – they allow the chance to connect, engage and, yes, have fun. We host ours monthly, and add games every quarter; half-hour games of Articulate! and Twister prove particularly popular. We also pencil in communal lunches. Don’t dismiss these as timewasting; they’re amazing for resilience, teambuilding and the power of laughter.
Thoughtful gestures and team events will also pay off. Christmas presents, celebratory meals or teambuilding awaydays might seem obvious, but staff will probably be surprised and touched.
Of course, during extreme stress, this might be difficult. But dedicating a little attention to the lighter part of the GP experience goes a long way.
Dr Farzana Hussain is a GP partner in Newham, east London
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• The ‘change model’ promotes a shared purpose between staff in particular areas, removing unnecessary hierarchies. For example, administrative staff inviting patients to a flu jab campaign are as important as the nurse conducting it. Everyone realises they are integral to a successful outcome
• ‘Process mapping’ is a visual tool where every staff member can give their views on a process, such as the repeat prescriptions protocol. This develops an understanding of others’ roles and responsibilities
• ‘Plan do study act (PDSA)’ is a four-stage pattern that revamps processes by encouraging staff to think of changes then act on them. We used this in our practice to implement our online booking system
Further details: improvement.nhs.uk/improvement-hub
West M, Lyubovnikova J. Real Teams or Pseudo Teams? The Changing Landscape Needs A Better Map. Industrial and Organisational Psychology 2012;5:25-8
NHS England. Sustainable Improvement Team Change Model. tinyurl.com/SIT-Change
Dweck C. Mindset: How You Can Fulfil Your Potential. London: Robinson, 2012.
Perlo, J. et al. IHI Framework for Improving Joy in Work. IHI White Paper. Massachusetts: Institute for Healthcare Improvement, 2017