Tuesday, December 12, 2006

Proposal for a clinical department of Family Medicine


The outpatient department has 19 clinical staff members and performs a vital function in administering care to approximately 100,000 attenders each year. Its efficiency is impaired by a number of factors:
Lack of leadership
There is an identified senior management team but no leadership. There are no departmental or management meetings and as a consequence the department does not work as a team. Some of the staff members’ attendance and time keeping is poor.
Lack of systems
There are no protocols or guidelines for patient management.
There is no drug formulary.
There is no system for the ordering of stock.
Lack of training
There is no attention to service development.
There is no regular in-house staff training.
Prescribing knowledge is largely driven by the pharmaceutical industry.
Inadequate finances
There is no discrete budget for the department.
Pharmacy stock is inadequate for the demand.
Poor relationships with other departments
Not all outpatient attenders are seen each day and the overflow arrives directly at the wards.
Referrals to other departments are perceived as being too high.
There is no coordination or planning with other departments.
There is no coordination or planning with the wider community
Many staff members seem opposed to change.

On the positive side:
There is adequate infrastructure.
Many staff members are very experienced and capable.
Some staff members would welcome attention to organisational development.

The Department of Family Medicine and Community Practice should assume managerial control of the Outpatient Department in order to;
Provide leadership
Monitor the service, campaign for budget increases and explore limited cost sharing schemes
Introduce a drug formulary for outpatients and improve drug ordering systems and supply
Contribute to the clinical workforce (minimum 2 lecturers)
Provide an organisational development role with regular team meetings and in-service training
Develop protocols and guidelines with particular attention to rational prescribing and appropriate referral
Introduce audit as a routine tool for the development and improvement of the service
Create an environment for clinical research
Provide a teaching environment for undergraduate and postgraduate students of all disciplines
Liaise with other departments and specialties
Liaise with community health facilities to improve patient flow and management

Jan Power and Mark Russell. December 2006

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