Mentoring for population health in general practice divisions

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Mentoring for population health in general practice divisions

John R Moss, Sharon M Mickan, Jeffrey D Fuller, Nicholas G Procter, Barb A Waters and Peter K O'Rourke

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John R Moss, MSocSci, BEc, MB BS, FCHSE, Senior LecturerDepartment of Public Health, University of Adelaide, Adelaide, SA.Jeffrey DFuller, PhD, MSc, BN, Associate Professor; and Visiting Research Fellow, Department of Public Health, University of AdelaideDepartment of Rural Health, Northern Rivers University, University of Sydney, Lismore, NSW.Sharon M Mickan, BOccThy, MA, PhD, former Senior Research Fellow, School of Population HealthBarb A Waters, BScApp(HMS-Ed), MPH, Lecturer – Medical Education, School of MedicinePeter K O'Rourke, GCEd, PhD, BA(Hons), BSc(Hons), Associate Professor, School of Population HealthUniversity of Queensland, Brisbane, QLD.Nicholas G Procter, PhD, GradDipAdultEd, BA, RPN, RGN, CertAdvClin, Associate ProfessorDivision of Health Sciences, University of South Australia, Adelaide, SA.Correspondence: Mr John R Moss, Department of Public Health, University of Adelaide, Mail Drop 207, Adelaide, SA 5005. [email protected]

Aust Health Rev ISSN: 0156-5788 1 Feb-ruary 2006 30 1 46-55©Aust Health Rev 2006 www.aushealthre-view.com.auWorkforce

ing program was funded by the CommonwealthDepartment of Health and Ageing to enable stafffrom eight Divisions of General Practice in SouthAustralia to gain a sound understanding of popula-tion health concepts relevant to their workplace.The distinguishing features of service develop-ment mentoring were that the learning wasgrounded within an individual’s work setting and

AbstractThis paper describes the implementation andevaluation of a three-way model of service devel-opment mentoring. This population health mentor-

experience; there was an identified populationhealth problem or issue confronting the Division ofGeneral Practice; and there was an expectation ofenhanced organisational performance. A formalevaluation found a consensus among all learnersthat mentoring was a positive and worthwhileexperience, where they had achieved what theyhad set out to do. Mentors found the model oflearning agreeable and effective. Division execu-tive officers recognised enhanced skills amongtheir “learner” colleagues, and commented posi-tively on the benefits to their organisations throughthe development of well researched and relevantprojects, with the potential to improve the effi-

Aust Health Rev 2006: 30(1): 46–55

ciency of their population health activities.

THE CURRENT CLIMATE in general medical prac-tice in Australia is one of change and reform.1

There is increasing recognition of the role ofgeneral practitioners in population health activi-ties as part of the primary health care network.2,3

The Commonwealth Department of Health andAgeing4 defines population health as “the organ-ised response by society to protect and promotehealth, and so prevent illness, injury, disabilityand early mortality”. The report of the GeneralPractice Strategy Review Group5 has affirmed theimportant role of general practice in populationhealth and the need for more collaboration and

What is known about the topic?Divisions of General Practice have a crucial role to play in advancing population health in Australia. Effectiveness in this role will be supported by enhanced population health skills among divisional staff and general practitioner members.What does this paper add?A three-way model of service development mentoring is described, involving a staff member or a GP member (the learner), an academic mentor, and the GP division. The distinguishing feature is that the learning is grounded in the development of a plan for the resolution of a problem confronting the organisation. Service development mentoring can build population health knowledge and skills within Divisions of General Practice, while at the same time enabling the design of practical projects capable of enhancing the health of a specific group in the catchment population.What are the implications for practitioners?Decision makers in Divisions of General Practice may wish to adopt this model of service development mentoring as an organisational investment in staff development and population health capacity. The model is potentially transferable to capacity building activities in other health organisations.

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integration across the primary health sector toguide GPs in public health activities.

First appearing in 1992, and supported by thesubsequent emergence of state and national peakbodies, Divisions of General Practice provide afocus for strengthening the vitality of local medicalpractice. Their increasing involvement in popula-tion health activities calls for the development ofpopulation health skills among divisional staff andGP members. University departments of public orpopulation health may have a role in providing thiseducation.

Mentoring, in the present context, has beenunderstood to be a process of knowledge and skillexchange between peers in a working environment,one with a learning need and another who is able tomeet that need. This perspective stresses collegialitybetween the learner and the mentor, and acknow-ledges that the learner brings a store of importantknowledge and skills to the relationship.

Kolb has developed a useful model of adultlearning, which recognises that workers bring validexperiences to a learning situation.6 They can thenreflect upon these experiences and develop soundtheories which can be tested in new situationsthrough problem-solving activities. This modelenvisages learning as an iterative process, in whichnew experiences are generated by the problem-solving activities, and so the spiral of learningcontinues.

Mentoring is a well recognised strategy,accessed by health care professionals for educa-tion and professional development.7,8 The pro-cess of mentoring has been used to facilitatestudents and novice practitioners towards moreadvanced levels of clinical expertise.9 Mentoringhas also assisted experienced professionals todevelop specific knowledge and skills.10

Conceptually, mentoring often relates to a part-nership of mutual respect that promotes explicitlearning. There are a multiplicity of designs, roles,contexts and functions of mentoring agreements.Mentoring relationships can variously focus on taskdevelopment, information sharing, education, socialsupport or career guidance. They often provide theforum and skills for participants to reflect on andenhance their intellectual and emotional resources.8

Mentoring has been widely used to developspecific aspects of practice, such as research capac-ity and productivity.9,10,11 Predoctoral nursesreported increased confidence in the research proc-ess, increased productivity, work organisation andinnovative communication following a structuredmentoring relationship.12 An external mentoringproject promoted the research growth of facultymembers through exposure to highly productive,discipline-specific academics from other universi-ties.11 Mentoring has also been shown to enhanceretention and recruitment of skilled staff.13

While mentoring is largely an educationalprocess with individual benefits, alternative out-comes are also possible. In addition to the usualpractice of developing individuals in a traditionaltwo-person model, a three-way (triadic) relation-ship has been proposed to align individuals withthe strategic directions of their organisation.14

With careful planning and coordination, short-and long-term goals can be achieved for a men-toring triad of organisation, mentor and pro-tégé.15

The distinguishing feature of service develop-ment mentoring, the model used in the programreported here, is that the learning is grounded inthe development of a plan for the resolution of aproblem confronting the organisation. As well asbeing based in the work setting and experience,the learning is intended to lead to enhancedorganisational performance.

Thus there is a triangular relationship betweenthe learner, the mentor and the organisation.Experience in an earlier program in South Aus-tralian rural health regions has also confirmedthat there is an important role for a catalyst orprogram management team, who bring thesethree parties together. A funder is also essential,because this kind of relationship cannot usuallyproceed on goodwill alone.

These ideas about service development mentor-ing have been based upon advice one author (J M)received from D K (Don) White at the HealthServices Management Centre, University of Bir-mingham, UK in 1982–1983. White pioneered aone-year program for promising middle-rankedhealth service executives in an innovative three-

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way relationship between the student, the healthauthority and the university.

The aim of the overall program reported herehas been to enable staff from Divisions of GeneralPractice to gain a sound understanding of publichealth concepts and knowledge relevant to theirworkplace duties, using innovative mentorshiparrangements that enhance their skills in problemsolving and service development. There was aparticular emphasis on rural and regional divi-sions of general practice.

Methods

ImplementationAll fourteen Divisions of General Practice inSouth Australia were invited to participate in thisprogram, by identifying a population health issueand an activity to be planned. They were asked toclarify anticipated benefits in terms of improvedpopulation health practice and sustainability, andability to meet population health needs.

In response, executive officers from eight Divi-sions of General Practice identified a problem ofpopulation health significance and a staff memberor general practitioner for part-time release fromnormal duties to receive education and supportthrough a mentoring partnership with an experi-enced population health academic. The learner’stask was to develop a plan that would improvepopulation health services within their division.For ethical reasons, the development phase of theplan did not include provision of any service tothe general public. Eventual implementationremained the responsibility of the relevant Divi-sion of General Practice.

The program management team of three aca-demics facilitated the selection of learners andprojects through careful negotiation with theexecutive officers of each of the Divisions ofGeneral Practice. Projects were tailored to bepractical, feasible and intellectually rigorous,aligned with the skills and interests of prospectivelearners, and focused on the achievement of onemain goal.

Mentors were selected for their commitment toand skills in student-centred education and their

practical understanding of population health andprimary health care. All mentors held a higherdegree and a university appointment or affilia-tion. They came from a variety of disciplinarybackgrounds including medicine, nursing, physi-otherapy, epidemiology, education and publichealth. Mentors were selected through negotia-tion involving the nominated staff member andthe management team.

The program coordinator worked with eachtripartite mentoring group of executive officer,learner and mentor to develop for signing aspecific learning agreement (Box 1). Individualresponsibilities of all participants were delin-eated, learning objectives were identified, pro-posed activities were described against specifictimelines, and staff time-release was detailed. Theexternal funding was utilised to cover the learner’srelease from normal work tasks for one day perweek for 26 weeks and to reimburse the mentor’stime at standard university rates.

Each mentoring agreement was designed tostrategically develop the skills of middle-levelstaff in planning and resolving a populationhealth problem within a particular Division’smandate. Expected outcomes included both pro-fessional development of the designated learnerand an implementable plan, designed to improvean aspect of the health of the Division’s catchmentpopulation.

EvaluationEvaluation of this program focused on both theprocesses of accomplishment and the achieve-ment of specified learning outcomes. The processevaluation emphasised the way in which mentor-ing was both an educational and support strategyfor divisional staff. Learning outcomes were eval-uated against the original learning objectives andthe development of an implementable project toenhance a specific aspect of population health. Asa whole, the program was also evaluated for itsinnovative and transferable outcomes.

The primary process evaluation method wasindividual face-to-face semi-structured interviewswith three key groups of stakeholders; learners,mentors and executive officers.

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The conduct of the interviews and analysis tookplace within 2 months of the completion of thementorships by researchers independent of theprogram developers as an attempt to reducerespondent social desirability bias. Sets of about 20open-ended questions were developed and sent toeach group of stakeholders. While there wereunique questions for each group of stakeholders,there were common themes across all groups.

For the process evaluation, interview noteswere analysed in an iterative manner. The sched-ule of interviews was designed so that all mem-bers of each stakeholder group were interviewedby one of the evaluators. Therefore, commonali-ties of content and emerging themes were initiallynoted within each group of stakeholders. Inter-viewers were seeking to uncover the inherent

strengths and weaknesses of the mentoring pro-cess, and the barriers to change and implementa-bility for individual projects. A second iterationcompared the perspectives of each stakeholdergroup. Finally, ideas and suggestions for improve-ment and change were sought from the programmanagement team, after all other interviews hadbeen completed.

In evaluating learning outcomes, learners wererequired to present a 15 minute paper to a seminarcomprising their own and other mentors, execu-tive officers and other learners. Ample time was setaside for discussion of the substance of the paper,and for personnel from the other Divisions ofGeneral Practice to discuss its applicability to theirown local situation. These learning outcomes werealso verified during interviews with the executive

1 Key commitments made in a typical learning agreement

Executive Officer of the nominating Division of General Practice

■ agree on the population health issue to be analysed■ ensure that the participating staff member is released from their usual duties to

undertake the project■ attend the presentation seminar and participate in the assessment process■ monitor the development of the health plan to ensure that the agreed objectives

and timelines are met, and that the plan is achievable■ share the written report with other GP Divisions in South Australia and elsewhere in

Australia, and with the Commonwealth Department of Health and Ageing

The participating staff member

■ agree on the population health issue to be analysed■ undertake a relevant program of knowledge and skills development■ maintain contact with the mentor(s)■ undertake an analysis of the identified health issue/problem■ attend a mid-term workshop on report writing skills etc.■ present a verbal report at a presentation seminar■ provide a written report■ take all reasonable steps to ensure that the plan is implementable

The mentor ■ make available time in which to provide advice to, and facilitate the acquisition of knowledge and skill by, the participating staff member

■ take part in a mentoring skills workshop■ take part in the assessment

The representatives of the consortium members

■ match the participating staff member with a mentor■ monitor progress of the learning agreement■ convene the mentoring skills workshop, the mid-term workshop, and the

presentation seminar; and moderate the assessment

All parties ■ take part in an evaluation of the outcome in terms of gain in knowledge and skill, the process of problem identification and planning, and potential for problem resolution

■ respect individual privacy and commercial confidentiality■ agree on budgets and timelines in advance


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officers. Learners prepared and submitted a finalreport to the Board of their Division of GeneralPractice, and to the program management team.This report included a strategic plan that was ableto be implemented for the resolution of the identi-fied population health problem.

Results

ImplementationNine projects were completed; four in urbanDivisions of General Practice and five in ruralDivisions of General Practice. The size of Divi-sions varied widely, from 30 GPs and five staff inan extensive rural area to almost 400 GPs and 20staff in one urban Division.

The learners included three GPs active withintheir Divisions and seven salaried divisional staff.For one project, two staff members shared a singlementorship. The population health problems iden-tified are among those that commonly lead togeneral practice encounters and they representedmost of the national health priority areas publi-cised by the Commonwealth Department of Health

and Ageing.16 Specifically, projects covered cardio-vascular disease, asthma, diabetes, anxiety disor-ders, mental health, immunisation of hard-to-reach groups and illicit drug use (Box 2).

Process evaluationTwenty interviews were conducted across all threekey groups of stakeholders, in the following con-figuration: nine learners, seven mentors, and fourexecutive officers.

Learners’ commentsThere was consensus among all learners thatmentoring was a positive and worthwhile experi-ence, where they had achieved what they had setout to do (Box 3). Initially, most learners werefamiliar with the general area of population healththat was identified for their project, but theyperceived mentoring as an opportunity toincrease their knowledge and skills.

Learners reported that mentors provided direc-tion, support, constructive review and critique.They appreciated their mentors being readilyaccessible, sufficiently knowledgeable and experi-

2 Population health mentoring projects completed

Title of project Nominated learner

Urban divisions

Adelaide Northern Development of Registers and Recall Reminders as Prevention Tools in General Practice Settings

Two staff members sharing

Adelaide Northern A Proposal for a Project to Target Children Overdue for Immunisation in the Northern Adelaide Region

Staff member

Adelaide North East Population Health and Cardiovascular Disease Prevention —Using General Practice to Improve the Outcomes

General practitioner

Adelaide Southern Self-Management Resources Used by People on the Wait List for a [tertiary hospital] Centre for Anxiety and Related Disorders

Staff member

Rural divisions

Adelaide Hills Amphetamine Misuse in the Adelaide Hills Staff member

Eyre Peninsula Can Care Planning Prevent Poor Cardiovascular Outcomes? General practitioner

Limestone Coast A Strategic Plan to Best Facilitate GPs and their Clinics in the Uptake of the Chronic Disease Initiatives

Staff member

Murray Mallee Demonstrating the Benefits of Population Health Initiatives to Key Stakeholders

Staff member

Yorke Peninsula How Effective are GPs on Yorke Peninsula in Detecting and Managing Mental Health Problems in their Clinic Setting?

General practitioner


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enced, and able to understand their own workpressures and constraints. They emphasised thebenefits of personal qualities of flexibility, enthu-siasm, and good communication skills. Individuallearners expressed differing needs for communi-cation with their mentor. The frequency of con-tact varied from weekly face-to-face meetings toemail or phone contact every 4 to 6 weeks.

Learners felt supported and encouraged bytheir executive officers and work colleagues.However, at a practical level, back-fill arrange-ments were not upheld, and all individuals had toincrease their hours of work to incorporate theadditional time devoted to their project. Althoughthe majority of learners worked part-time, sometook on their project while doing their regular fulltime work, creating additional stress.

Most learners would recommend the mentor-ing program to colleagues, provided they hadtime to devote to it and were working on a projectthey were interested in with a mentor experi-enced in that area.

Mentors’ commentsMentors were enthusiastic about sharing theirresearch skills and expert knowledge in an alter-native manner to teaching or supervision. Allmentors were experienced in supervising post-graduate students. However, they perceived thementoring relationship as different from super-vision. Mentoring was seen to support learners’ideas in a more facilitative and less directivemanner than supervision.

Initially, each mentor facilitated their learner torefine their original ideas into a workable projectthat emphasised their current work interests andaligned their expectations with the Division’s prior-ities. Mentors described a greater variety of startingpoints for their learners than was their experiencewith postgraduate students. Initially, mentors hadto revise their “idealistic” expectations of merelyfacilitating their learner, to provide structures forlearners to engage in specific tasks such as litera-ture reviews, systematic analysis and report writ-ing. Several mentors described a veryindividualised process of identifying and remediat-ing specific weaknesses with their learners, espe-

cially for skills of writing and literature searching.These skills were also addressed in a mid-programworkshop to which all the learners were invited.

Although they gave expert advice and informa-tion, mentors encouraged learners to own theirprojects and guided them to improve their ownand the organisation’s performance. Generally,mentors reported asking questions of their learn-ers, rather than giving answers.

All mentors described positive working rela-tionships, based on shared understandings, com-mon interests and trust. Regular contact andfeedback enabled mentors to match the enthusi-asm, styles, strengths and needs of their learners.Face-to-face meetings were preferred, and theywere supported by email and phone conversa-tions. Generally, mentors felt sufficiently remun-erated for their work. They would all participatein a mentoring program again, and most wouldrecommend it to their colleagues, if they had thetime and expertise to contribute.

Mentors summarised the most important cri-teria for mentoring as needing experience inpopulation health, understanding primary health

3 Strengths and weaknesses of the mentoring process identified in the evaluation

StrengthsOpportunity to increase knowledge and skills relevant to population healthAccessibility of mentorsMore facilitative relationshipDirection, support, constructive review and critiqueRemediation of identified knowledge and skill gapsPractice in thinking strategicallyOpportunity to receive feedback from fellow learnersRelevance to local Division and local populationHigh percentage of completed plansImplementability of projectsWeaknessesDifficulty in releasing the time of a specialist staff memberBack-fill arrangements not upheldIncrease in learners’ overall hours of workWhether the expense is justified by the population and organisational benefits


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care research processes and models, using effec-tive communication and facilitation skills, facili-tating organisational and problem solving skills,having project management experience, and aknowledge of local resources.

Executive officers’ commentsExecutive officers reported initially high expecta-tions of these mentoring projects in relation toupskilling staff, developing well researched andrelevant projects, and improving the efficiency oftheir population health activities. During theproject they readjusted their expectations of indi-vidual staff to reflect the time frame of the projectand the other competing demands in their respec-tive work environments. They were keen to sup-port their individual staff members’ professionaldevelopment and they anticipated benefit fromaccess to academic mentors.

Executive officers contributed clear organisa-tional priorities and suitable projects for staffmembers to develop with their mentor. Theirdominant concern was releasing and covering theresponsibilities of a specialist staff member. Formost projects, suitable extra staff could not befound to back-fill the learners, who then neededto juggle responsibilities for their regular duties aswell as the project. As a result, projects werebetter suited to part-time staff, who were able toincrease their work hours to accommodate theextra responsibilities. Generally, executive officersagreed that staff had both consolidated existingskills and developed new skills and confidence inproject management and research areas. Theywere able to articulate how these skills contrib-uted to improved public health initiatives in their

Division. However, the major concern for execu-tive officers was the sustainability of skill devel-opment when the financial support for thisproject came to an end.

Evaluation of learning outcomesAll learners presented a seminar and submitted awritten report to the Board of their Division ofGeneral Practice, and to the program coordinator.Four criteria were used to evaluate learning out-comes: originality, scholarship, argument andimplementability (Box 4).

Originality was evidenced by the appropriateuse of recognised research methodologies toaddress the source population health problem. Alllearners addressed issues that were specificallyrelated to the catchment population for theirorganisation, using a range of qualitative andquantitative planning and evaluation designs.

Learners demonstrated enhanced scholarshipthrough greater awareness of the theoreticaldebates and methodological approaches. This wasdemonstrated in the discussion that followedtheir oral presentations, where mentors posedchallenging questions to their own and otherlearners. Executive officers also recognised theenhanced scholarship of some learners, throughplans to involve learners in new projects thatrequired them to generalise their new skills. Inone Division of General Practice, the learnerbegan teaching other staff specific skills for partic-ipation in these projects.

The criterion of argument concerned the abilityto think through a clear line of reasoning with validinferences from properly tested evidence, and was

4 Learning objectives and achievement of learning outcomes

Learning objectives Learning outcomes

Strategic development of the skills of middle level staff in planning and resolving a population health problem within a Division’s mandate

The learner’s ability to apply enhanced cognitive skills to the investigation of a topic relevant to population health

Professional development of the designated learner The learner’s enhanced originality, scholarship and argument

An implementable plan, designed to improve an aspect of the health of the Division’s catchment population

Implementability of the plan documented in the learner’s report to the Division


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most obviously demonstrated in the preparation ofthe strategic plan for implementation, within thewritten report. It was closely linked to the finalcriterion of implementability, which emphasisedorganisational alignment, affordability and realistictime lines. Although the learners were not respon-sible for the implementation of their projects,many had influenced the strategic and operationalplanning activities of their organisations to ensurethe resources were available to progress theirprojects. The implementation of these projectsneeds to be evaluated in the future.

A future project to evaluate the benefits forindividual staff and the organisation is required tofully assess the benefits of this program. Severalstaff talked about their intention to enrol intertiary studies, suggesting that this program gavethem a familiarity with, and confidence to under-take, formal study. Further, it would be importantto ascertain the degree to which these independ-ent projects were carried out within the Divisionsand whether they delivered organisational andfinancial benefits.

DiscussionThis program was considered by the three sets ofstakeholders to be an innovative and successfulopportunity for Divisions of General Practice todevelop their own staff to apply populationhealth and research skills, in order to betterimpact on local health services. Mentoringprojects focused on enhancing the learners’ spe-cific skills and understanding of populationhealth in ways that could enhance the activities oftheir organisation. In particular, mentoring pro-vided viable learning and professional develop-ment opportunities for some staff who had notyet had an opportunity to undertake a university-based learning program.

The program management team was keen todemonstrate a viable alternative pathway for indi-vidual learning about public health. The modelemphasises the importance of learning throughinvolvement in a meaningful project in such away as to enhance the organisational commitmentby Divisions of General Practice to population

health activity. This model was also seen asappropriate for rural staff, who often have feweropportunities for formal skill development.

Factors identified as important for a successfuloutcome included extended negotiation and think-ing through each project topic and design, negoti-ated selection of highly qualified and motivatedmentors and committed learners, and a Divisionalfocus on implementability through the executiveofficer. Having an efficient state-wide communica-tion network (through SA Divisions of GeneralPractice Inc.), signed learning agreements, andfunding for the learner’s time release, for the men-tor’s time and for the program management team asa catalyst were also important enabling factors.

Allowance had to be made for a considerablelength of time to get projects started. Thisentailed local health workers recognising theirlearning needs and placing the project in thecontext of the other work pressures operating onthe Division. The start-up phase could be quitestressful, and one role of the program manage-ment team was to reassure the learners that adegree of doubt and uncertainty is often a usefulpart of the process of innovation.

Barriers included divisional staff turnover, diffi-culties in freeing up the learner’s time under thepressure of other work priorities, a paucity ofpopulation health experience in some divisions,and, inevitably, limited available time andresources.

ImplementabilityAll projects were designed to be implemented andthere was agreement among mentors, learners andexecutive officers that most could indeed be imple-mented. However, final responsibility for imple-mentation remained with the Divisions of GeneralPractice. Therefore those projects which werealigned with current initiatives and priorities andthose that built upon previous work were morelikely to be implemented. Further, learners whowere interested in the outcomes of their work werealso more motivated to be involved in carryingthrough the implementation of their project.

Two barriers to implementation were repeat-edly reported. During the time of the project


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several Divisions changed their organisationalfocus and prioritisation, which in some casescaused conflict for the learners. Secondly, divi-sional staff discussed the challenges of recom-mending and promoting change in GP’s practicebehaviours, and this reflects a much deeper issuewithin primary care.

Five learners believed that the strategies withintheir project could be easily adapted and applied todifferent patient groups and to other Divisions ofGeneral Practice. Mentors were less enthusiastic,and recognised that many organisations wouldrequire additional support and resources to use theproject methods or tools. In one Division, two staffmembers could only free sufficient time to share aproject. A tenth project was begun but could notbe completed due to personal and workload pres-sures on the staff member.

Perceived benefitsThese mentoring projects were observed to legiti-mise and enhance what many staff in the Divi-sions of General Practice were already doing.Individual, organisational and community ben-efits were observed.

Individual learners used adult learning princi-ples to enhance their awareness of and involve-ment in population health strategies, and todevelop a better understanding of and enthusi-asm for research. They reported improved skillsin defining and directing projects, and in review-ing and using research evidence. When comparedwith formal study, learners achieved outcomes ina timely manner. Further, individuals’ enhancedskills and knowledge were retained in each organ-isation for future projects.

The economic advantages of this mentoringproject are less clear. It can be argued that the costof a project (about $10 000 each) was expensivewhen compared with a full fee postgraduatecourse cost for one semester (now around$4000). However, more than half the total was forback-fill costs for learners (typically not includedin the cost of postgraduate education). Further,given that the division as well as the individuallearner gained from the mentor’s advice and thedevelopment of an implementable project, the

benefits of service development mentoring mayjustify the cost. If organisational outcomes of theimplemented projects generate tangible healthbenefits or cost savings, this could demonstratethat service development mentoring is an organi-sational investment.

ConclusionThis three-way model of service developmentmentoring offers an innovative and successfulstrategy for enhancing individual education andprofessional development, in alignment with theorganisation’s strategic directions. Divisions ofGeneral Practice have a crucial role to play inmaximising the population health of all Austral-ians, yet they are often constrained by skilldeficits in their own staff and by the individualistfocus of GPs. This project has demonstrated thatservice development mentoring can develop pop-ulation health knowledge and skills for staff(including interested GPs) of the Divisions ofGeneral Practice, who were able to design imple-mentable projects capable of enhancing thehealth of a specific group of their population.Certain practical necessities have to be recog-nised. In particular, a Division needs sufficientresources and flexibility to enable staff or GPmembers to undertake a project, and suitablyqualified replacements have to be available, par-ticularly in rural locations, for back-filling.

While this current initiative emphasised thebenefits of population health mentoring for Divi-sions of General Practice, the structure is poten-tially transferable to capacity building activities inother health organisations.

It is argued that service development mentor-ing can achieve population health benefits whenGPs work with skilled and knowledgeable stafffrom the Divisions of General Practice. In thesescenarios, the GP contributes a client base and aninitial point of contact, while Divisional staffdesign and evaluate projects using appropriatepopulation health theory and methods.

Mentoring offers a viable alternative to formaleducation and represents organisational invest-ment in staff development. It is also an innovative


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means of capacity building. Theoretical populationhealth concepts were applied as a meaningful wayof integrating research into an organisation’s busi-ness. Evaluation of this program emphasised theneed for a structured approach to coordination anddedicated time and commitment by individuals toparticipate in the mentoring relationship.

AcknowledgementsThe program reported on in this article was developed bya consortium comprising the Departments of PublicHealth and General Practice, University of Adelaide; theSouth Australian Centre for Rural and Remote Health(now part of the Spencer Gulf Rural Health School); SADivisions of General Practice Inc.; the Division of HealthSciences, University of South Australia; and the School ofPopulation Health, University of Queensland. The pro-gram was funded by the Australian Government Depart-ment of Health and Ageing through the Public HealthEducation and Research Program (PHERP).Philip Ryan, Annette Braunack-Mayer and FlorenceKalambokas helped develop the application for funding.Valerie Williams and Tori Wade (SA Divisions of GeneralPractice Inc.) made available their email and postal linkswith the Divisions and provided seminar facilities.The members of the consortium thank all mentors, learn-ers and DGP executive officers who participated in thisproject and its evaluation.Mentors: Annette-Braunack-Mayer, Justin Beilby, JeffFuller, Matt Gaughwin, Jane Giles, Karen Grimmer, PeterHarvey, Janet Hiller, Ann Kempe, Nicholas Procter, JudithRaftery, Colleen Smith.Learners: Michelle Baker, Sam Battams, Chris Bollen,Heather Cormie, Louise Miller Frost, Georgina Moore,Peter Morton, Sheila Neve, Angela Newbound, JoanneTeakle.Executive Officers (Division of General Practice): BrentonChappell (Adelaide Hills); Chris Seiboth (Adelaide North-ern); Briony Glastonbury (Adelaide North East); Ian Dob-bie (Adelaide Southern); Glenys Bisset (Eyre Peninsula);Susi Tegen (Limestone Coast); Chris McRae (MurrayMallee); David Holman (Yorke Peninsula).

Competing interestsThe Commonwealth Department of Health and Ageinghad no role in study design, data collection, analysis andinterpretation, and writing and publication of this paper.

AuthorshipSharon Mickan developed the draft of this paper. She,Barb Hockings and Peter O’Rourke designed and con-ducted the evaluation. John Moss initiated and led theservice development mentorship program and wrote thefinal report. He, Jeff Fuller and Nicholas Procter consti-

tuted the program management team. All authors takeresponsibility for the submitted manuscript.

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(Received 15 Oct 2005, accepted 21 Nov 2005)


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