Practice | CMO configurations |
---|---|
1 | Context: self-referral for management and leadership problems Early negative reasoning mechanism: mistrust related to communication with the team, leading to a delay in further engagement Positive reasoning mechanism: external view/corroboration Positive resource mechanism: the expertise of the team's manager in recruitment Outcomes: perceptions of a more appropriate skill mix within the clinical and managerial teams and better access to appointments for patients. Ongoing work with the SCGP team |
2 | Context: practice approached by the SCGP team as an outlier in NHS performance indicators. Problems with management and leadership Positive resource mechanism: the SCGP team's manager, while the team as a unit was a negative mechanism due to disruption/divisions caused by the report Negative reasoning mechanism: corroboration in that the practice perceived that they already knew what their development needs were and were addressing them Outcome: perceptions that communication improved. The practice did not work with the SCGP team after the initial phase. |
3 | Context: self-referral re an anticipated CQC inspection. Concerns about the nursing team Positive resource mechanisms: the specific expertise of the SCGP team's manager and nurse, the action planning and the clinical backfill Positive reasoning mechanisms: better preparation for the CQC inspection (related to better function and workload management) and advocacy within the practice teams Outcomes: effective recruitment, better workflow and a good result in the CQC inspection. Ongoing work with the SCGP team |
4 | Context: practice approached by the SCGP team as an outlier in NHS performance indicators. Problems with skill mix in the nursing and managerial teams, and workflow Early negative reasoning mechanism: shame Positive reasoning mechanism: corroboration Positive resource mechanism: expertise and practical support of the SCGP team's manager Outcomes: better skill mix in the management and nursing teams, and better workflow. Ongoing work with the SCGP team |
5 | Context: practice ‘in special measures’ after a CQC inspection with requirement for an action plan in a specific and short timescale. Management and leadership, deployment of clinical staff, and governance needed to be improved Positive resource mechanisms: the expertise of the team members and the action planning. The lead GP in the SCGP team was a specific resource for the lead GP in this practice working on the organisational aspects of his consultations. Positive reasoning mechanisms: ‘sustainability’ (in that the practice thought its viability as a provider of general practice services would improve if it engaged with the SCGP team), and ‘action planning’ which would result in better function in terms of the CQC's requirement that they produce and implement an action plan Negative reasoning mechanisms: shame, mistrust and regulation/inspection. Outcomes: increased morale of practice staff, more appointments for patients by means of recruitment and better skill mix, and ‘better workflow’. Ongoing work with the SCGP team |
6 | Context: practice approached by the SCGP team. There were a number of areas for development which the practice staff knew about but were unable to address because of workload. Positive reasoning mechanisms: external view/corroboration and development of better functioning practice team Positive resource mechanisms: multidisciplinary expertise. No negative resource or reasoning mechanisms identified in the early interviews, but engagement ceased before some of the leadership development was completed. Outcomes: staff perceptions of better communication, a more appropriate skill mix and more appointments for patients. Work with the SCGP team ceased after the report was produced. |
7 | Context: practice approached by the SCGP team as an outlier in NHS performance indicators. Problems with deployment and development of clinicians, and management and leadership Positive resource mechanisms: expertise of the SCGP team and lack of disruption Positive reasoning mechanisms: corroboration and normalisation Negative reasoning mechanism: “there wasn't anything they could offer to help us with.” Outcome: increased morale as a direct result of external view mechanism. Work with the SCGP team ended after the report was produced. |
CMO, contexts, mechanisms and outcomes; CQC, Care Quality Commission; GP, general practitioner; SCGP, Supporting Change in General Practice; NHS, National Health Service.