GPDU18 – Proving we’re better together!
Dr Ayman Shenouda
GPs Down Under
There was plenty of discussion about collaboration at the recent GPDU18 inaugural conference on the Gold Coast. This was collegiality at its best and perhaps not surprising given we know that flat hierarchies are where innovation and collaboration will thrive the most.
GPDU offers healthy debate which is open and inclusive with all members encouraged to moderate. There is very little censorship here provided you remain on topic – GP learning, peer support, and advocacy.
Enabling an inclusive dialogue is why this Facebook community of over 5000 members exists and thrives. It provides the opportunity for real-time online discussion in a forum for GPs - one that is free from corporate vetting offering a rare open communication channel.
If there was one clear connect from this conference it was that we need better collaboration.
Collaboration creates value in communities. It is about sharing vulnerabilities and being open and being brave enough to distribute your power to many.
For GPDU18, day one great debate certainly focused on a rather divisive topic: ‘The Three, Two, One Debate (how many colleges is too many?) which saw an overwhelming yes (79%) for a single united college.
Panelists’ Drs Cameron Loy, Fiona McKinnon, and Liza Lack in this session provided either the for or against – one, two or three (college) - noting they didn’t get to choose which side they were on. They each worked through issues including what a college should be doing for their members and more broadly about their values.
There was also a discussion during conference on tribalism and the stages of tribal culture led by Dr Edwin Kruys. Based on the work by Logan, King, and Wright in their bestseller Tribal Leadership which takes you through the five kinds of tribes that humans naturally form and the benefit of establishing triadic relationships.
It was a timely and interesting reflection allowing us to turn our attention towards building the culture we want. You could sum up both sessions in three words - we’re better together!
Building the culture, we want
In building the culture we want, it is important to understand why tribes exist. This is really important as an understanding of tribalism is a key strategy for improving collaboration.
And, certainly on both topics – one college and that of tribalism - I really don’t think these issues are necessarily separate. Collaboration begins with organisational culture and we are all seeking a more collaborative approach and there were plenty of lessons to take home here.
While I doubt the vision for a single college will ever be realised, I think what we certainly do need is more coalition building. This is what GPDU does really well and why it works. It forms coalitions with those holding similar values, interests, and goals to combine expertise and resources for a common purpose.
Primary care and collaboration
In a past blog about the possibilities of having a united front in primary care and the need to find some common ground, we established that for collaboration to work then this relies on respect and trust. A lack of trust only stifles collaboration. We need to create a shared vision of the future and move towards it together. Have an agreed common goal and sign up for it.
In a more recent blog, we discussed ways to position ourselves as leaders of primary care into the future and the idea of a College for Primary Care. Getting back to our value proposition to achieve integration as well as satisfy funders positioning ourselves together in the health system will be important. This is key to ensuring we make the shifts towards a health care system based on wellness rather than the treatment of illness.
Collaborative healthcare leadership
We need a focus on positioning ourselves together to advance primary care reform and to help orchestrate a collaborative culture. Formalising this structure more would create a work culture that values collaboration. It would help us to put in place the adaptive collaborative learning systems required for the future.
For me, GPDU18 just proved that we’re better together and certainly the key themes that emerged particularly around collaboration reinforced a need for a stronger focus around this.
Building trust and blurring traditional boundaries will help end tribalism and silos – it would help bring the ‘we’ (as in the primary care team) instead of ‘me’ (the GP) back into focus.
Our sector needs to find a place for more inclusive reform and opportunities for collaboration through communities like GPDU. Working together towards a common agenda is the only way we will see the sector-wide change required. Improving health value in the healthcare system starts with us and it’s time to reconnect.
Dr Ayman Shenouda
When each of us experience hardship, it changes us - yet not all of us experience lasting harm as a result. Stress affects people differently with many factors influencing the strength of our stress response.
Resilience is our capacity to overcome adversity and our resilience is shaped by our experiences – both good and bad. And it’s really only when you’re faced with extreme stress that your level of resilience can be determined.
‘You only know what you are made of when you are broken.’
This was the moving statement from a father who lost his unborn baby during the recent Grenfell Tower inquiry.
It is said that we can all overcome adversity and choose to be resilient. But how can we increase emotional resilience and cultivate more resilience for ourselves and for others?
Neuroplasticity and resilience
Can neuroplasticity help us to understand resilience?
Mindfulness sites are full of the promise of rewiring your brain through neurally inspired therapies to increase emotional resilience.
Brain researchers reassure us that the brain can change and that brain reorganisation is not limited by age. That it is the brain’s plasticity that can help us to overcome adversity.
Neuroplasticity is the brain’s ability to grow and change in response to experience. It is supported by chemical, by structural and by functional changes across the whole brain and together they support learning.
What is it that limits and facilitates neuroplasticity?
Dr Lara Boyd Neuroscientist and Physical Therapist at the University of British Columbia explains this well in her work which looks at what can be done to help patients recover from stroke.
In looking at how we learn she states that the best driver of neuroplastic change in your brain is your behaviour. But that it needs practice and you have to do the work with increased difficulty leading to more learning and greater structural change.
Our uniqueness holds the key
Dr Boyd’s research has looked to therapies that prime or prepare the brain to learn – brain stimulation, exercise, and robotics. But she also states that a major limitation is that patterns of neuroplasticity are highly variable from person to person.
It is this variability in studying the brain after stroke that she believes provides some valuable transferable lessons. Learnt neuroplasticity after stroke applies to everyone. It is these individual patterns and variabilities in change that allow us to develop new and effective interventions.
It is partly personalised medicine with each individual requiring their own intervention. However, this concept is then broadened through embracing our uniqueness with personalised learning being key.
This research shows that biomarkers are helpful to match specific therapies with individual patients. More specifically it is a combination of biomarkers that best predicts neuroplastic change and patterns of recovery after stroke.
Applying this learning
Dr Boyd’s advice is to study how and what you learn best. Repeat those behaviours that are healthy for your brain and break those that are not.
In applying this learning, it is clear that resilience can be taught. But it requires supportive relationships and opportunities for personalised learning.
Bringing this back to our own workplace, how can we harness the brain’s innate capacity to change? Not only in our patients and ourselves but applying this knowledge in equipping our trainees with strategies to cope in dealing with stress.
Resilience in the workplace
I think it is important to look at how can we inspire resilience in others. Working through what strategies work for the individual is important but so is providing a workplace free from harm, neglect, and disrespect.
More emphasis on building positive work environments, coping strategies and the importance of self-care is needed. Training in neuroplasticity and how to exploit it should be part of our armoury.
For our trainees, we need to think more about building their stress fitness and coaching and mentoring are helpful in developing this resilience. Trainees would benefit from a buddy and a mentor to improve resilience and this needs to be formalised in our training system.
Funding for formalised training programs to improve resilience in our trainees should also be prioritised. Webinars in workplace wellbeing, resilience, mindfulness, cognitive reappraisal training should all be pursued.
Resilient people are able to see things from others perspectives. They also tend to value others.
Simply conversing in a compassionate way changes the brain.
Coming back to neuroplasticity, if we repeat certain throughs or behaviours often enough the neural pathway can be created. Forming new connections and weakening those patterns that are not working for you being key.
In mastering resilience, we know that much of it has to come down to the individual and effort. Fixing a self-critical neural network is doable but takes practice and training to chart new pathways.
In untapping resilience by harnessing the brain’s innate capacity to change we must prioritise the tools proven to bring about these shifts. This is particularly important in supporting our trainees so that together we can inspire and create a more resilient workforce.
Dr Ayman Shenouda