Successful change in GP practice requires meeting discipline, well-designed incentives and structured improvement cycles. Meetings without written actions and deadlines produce conversations rather than change. Incentives that reward proxy behaviour instead of the behaviour you want will backfire. PDSA cycles and collaborative improvement models build improvement capacity that individual practice efforts alone cannot generate.
The first post in this series covered why change fails, how to build a shared vision and how to translate ambiguous goals into concrete behaviour. This post covers the operational side: the role of meetings and preparation, how to design incentives that support change rather than undermine it, the breakthrough collaborative model and what to do when change fails.
How do you run meetings that drive change rather than just discussion?
Change does not occur without sharing thoughts, and sharing thoughts means meetings. I know that sentence will not make anyone enthusiastic. Meetings in general practice are often seen as a waste of time, and many of them are. The problem is not the meeting. It is the lack of preparation, structure and follow-through.
Put your thoughts down in writing before a meeting. Not a polished document, but enough for the other participants to read beforehand and come prepared to respond. Keep control of the agenda, the minutes and the actions. If a meeting generates no written actions with names and deadlines attached, it was a conversation, not a meeting. And conversations, however pleasant, do not drive change.
I covered daily team huddles in my earlier post on time management. Rodriguez et al. (2021) found that standardised huddles are a feature of high-performing health systems, with over 92% of identified problems resolved. Huddles work because they are short, structured, regular and action-oriented. The same principles apply to any change-related meeting: short, prepared, focused and followed up.
How do you design incentives that support change rather than undermine it?
Sharing small, incremental goals and developing appropriate incentives that support the change are part of speaking to people's feelings. Still, they are also part of the operational design. The King's Fund evidence review (2022) found that financial incentives and targets can change activities, but this does not necessarily translate into improved outcomes. Incentives work when they reward the behaviour you want. They backfire when they reward something adjacent to it.
The Australian childhood vaccination incentive model is a good example of layered incentive design that aligned multiple players towards the same outcome. The Immunise Australia Seven Point Plan, launched in 1997 when coverage sat at 53%, combined four types of incentives: service incentive payments to GPs for each completed schedule, practice incentive payments for meeting coverage targets, support through Divisions (now Primary Health Networks) to coordinate local activity, and direct incentives to parents linking welfare payments to immunisation status. Within two years, coverage among two-year-olds rose from 80% to 94%. The design worked because it aligned the behaviour of GPs, practices, networks and parents around the same goal, with each layer reinforcing the others.
The ePIP (eHealth Practice Incentives Program), introduced in 2012, followed a different path. It offered financial incentives to practices that adopted digital health technologies: electronic health records, secure messaging, electronic prescriptions and My Health Record uploads. The approach was less multi-layered, relying on practice-level payments tied to meeting five technical requirements. Adoption of electronic prescriptions, for instance, required the practice to ensure the majority of prescriptions were sent electronically to a Prescription Exchange Service. The ePIP drove compliance with technical standards but did not, on its own, change clinical behaviour. The lesson is that an incentive can get a system installed without getting it used well.
At the practice level, the same principles apply. If you want GPs to complete health assessments for Aboriginal and Torres Strait Islander patients, a target number alone is not enough. You need the appointment template set up, the practice nurse briefed on their role, the recall system running, and the GP confident that the time spent is recognised in the practice's billing and workload planning. Each supporting element is an incentive in its own right. Remove one, and the others weaken.
How does the breakthrough collaborative model work in general practice?
The Institute for Healthcare Improvement developed the Breakthrough Series in 1995, and it remains one of the most tested models for driving quality improvement across multiple healthcare sites. The premise is that sound science exists to improve costs and outcomes, but much of it sits unused. There is a gap between what we know and what we do. The Breakthrough Series is designed to close that gap by bringing teams from different sites together to learn from each other and from experts.
A typical collaboration lasts 6 to 15 months. Teams from 12 to 160 organisations attend three learning sessions, then return to their own sites to test changes using PDSA cycles, report results and share what they learn. Since 1995, IHI has run over 50 collaboratives involving more than 2,000 teams from 1,000 organisations. Reported results include reducing waiting times by 50%, reducing ICU costs by 25% and reducing hospitalisations for congestive heart failure by 50%.
A qualitative systematic review of collaboratives in general practice (published in BMJ Quality & Safety) found that they can be useful for improving target topics, developing practices and providers, developing the health system and building quality improvement capacity. The review noted that the impact extends beyond the target topic itself: practices that participate in collaboratives often develop broader improvement capability that they apply to other areas.
The message at the heart of a breakthrough collaborative is this: 'This is what we are trying to achieve. You are the experts in implementing change in your practices and your communities. Go away and try what you think will work in your practice, and measure how it goes. Come back and tell us what works and what doesn't. Steal shamelessly from each other and share generously.' That approach respects the autonomy and expertise of each practice while creating the structure, accountability and peer learning that individual practices cannot generate on their own.
How do you capture learning and handle change that fails?
Capture and share the benefits of change as you go. Small wins sustain momentum. The TransforMED researchers found that positive patient feedback from group visits served as a motivator for both physicians and staff: the emotional payoff of seeing patients benefit was more powerful than any operational metric. If your chronic disease review programme produces a measurable improvement in HbA1c for a cohort of patients, share that with the team. If a new reception workflow reduces phone wait times, make sure the reception staff knows.
When change fails, and it will fail, the response matters more than the result. If the team treats a failed PDSA cycle as evidence that change is too hard, the practice stops learning. If the team treats it as information about what does not work in their context, the practice keeps moving. This is not a question of temperament. It is a question of how the leadership frames it. If the owner reacts to failure with frustration or blame, the team will stop trying. If the owner asks, 'What did we learn and what do we do even better next time?', the team stays engaged.
The same principle applies to fear. Many clinical staff have been trained to work in structured environments. Ambiguous projects can feel threatening. The TransforMED practices found that acknowledging staff's fears about the unknown and reassuring them that mistakes are a natural part of learning helped people move past initial resistance. Eventually, the fear of group visits in one practice was replaced by positive feelings about creating a space where patients could interact with the health care team. But that shift did not happen by ignoring the fear.
What does the evidence on change management mean for GP practice owners?
The common thread across all of this research is that change in general practice is a people problem, not a planning problem. The plan matters, but it is the easier part. Getting the people in your practice to understand, want and sustain a new way of working is where the real work sits. Start with shared values and a concrete picture of the near-term future. Engage feelings before logic. Script the moves so people know exactly what to do. Shrink the change so it feels achievable. Remove friction so the right thing is the easy thing. Meet, prepare, follow up. Build incentives that reinforce the behaviour you want at every level. And when it does not work, treat it as a data point, not a defeat.