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APCC Program - some frequently asked questions
Below is some frequently asked questions about the collaborative program, it's methodology and framework and how particpating in the Program will impact you.
Questions (click on question to take you to the answer)
The APCC Program
What is a Collaborative?
A Collaborative is an improvement method that relies on the adaptation of existing knowledge to multiple settings to achieve a common aim. It consists of a series of learning workshops interspersed with activity periods during which measures common to the participating practices are used to track progress. Its user friendly and simple approach is effective because of the support and framework, which allow for protected time for participants to spend together solving problems as a team.
A Collaborative is not a research project, a set of conferences, or a passive exercise. It is about actually doing and improving.
What is the Collaborative Program?
The Australian Primary Care Collaboratives Program is funded by the Australian government to support Australian general practices deliver systematic and sustainable improvements in the quality of primary care they provide to their patients. It focuses on three areas: the secondary prevention of coronary heart disease, diabetes, and access and care redesign.
The Collaborative Program is based on methodology designed originally for health care by the Institute for Health Care Improvement in Boston, Massachusetts, USA . The Improvement Foundation UK (formerly the National Primary Care Development team, NPDT), led by Sir John Oldham, adapted it for use in primary care in the UK in 2000, and has produced significant results. In the UK now, over 5,000 practices serving almost 32 million patients have taken part in the program since its inception, making it the largest primary care improvement program in the world. Our Program aims to replicate and expand on these improvements in general practice in Australia .
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What is a wave?
Attended by a GP and a staff member from each practice, a “wave” consists of an orientation session, followed by three learning workshops spread out over 9 months, activity periods in between, and ongoing data submission.
Workshops will give you the opportunity to:
- hear about the pros and cons of changes implemented by other practices
- discuss aspects of the Program with topic experts
- share improvement ideas and experiences
- replicate successful changes made by other practices
- test your ideas back in your own practice
- learn practical and hands-on quality improvement skills to make changes with increased confidence.
- use the Improvement Model to introduce change and measure the effect of the changes you make.
Practices can be involved in the Program through state, local, or virtual waves.
The APCC Program is structured in waves to enable optimal numbers to join in each wave while achieving maximum participation overall for each state. Practices that join the APCC Program participate in a 'wave'. A GP and manager or nurse from each practice come together with other practices in their wave that is made up of an orientation session followed by three learning workshops. These events are spread out over a nine month period and, combined with activity periods and ongoing data submission, are called a wave. The activity periods of three months between learning workshops 1, 2 and 3 enable practices to test and implement change in their teams.
State Wave
State waves will be held in central locations in NSW, VIC, and WA. Each state learning workshop will run for two consecutive days in a central location and will involve participants from all over the state and may involve Divisions from other states also (i.e. the NSW waves will include QLD and ACT Divisions). There will be three waves held in NSW, two in Victoria and one in WA.
Local Wave
A local wave is run by the Division or Divisional group. Participating in a local wave will usually require less time out of the practice and involve mainly practices from within the Division or Divisional group. However, you’ll still have access to ideas and examples generated from around Australia.
Virtual Wave
A virtual wave is the Program conducted in a virtual environment. The Program may be delivered online, via video, or other interactive telecommunications media as an alternative to meeting at face to face workshops. This generally requires less time out of the practice than other workshop styles and may suit practices where travel or other constraints do not readily allow time away from practice.
What topic areas does the APCC Program focus on?
The APCC Program focuses on three topic areas:
- secondary prevention of coronary heart disease
- diabetes
- access and care redesign
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What are the benefits of using the Collaborative methodology?
The Collaborative methodology uses knowledge about what already works rather than trying out new ideas through research or pilot studies. It uses a change management method that is designed to identify where a change actually leads to an improvement. Changes are tested sequentially in small cycles so they are rapid and manageable. The results of such changes are measured so that the improvement can be demonstrated.
What does the Program aim to achieve?
This Program has three broad aims:
• To improve clinical outcomes and reduce lifestyle risk factors
• To help maintain good health for those with chronic conditions
• To promote a culture of quality improvement in primary health care
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What is the Collaborative Handbook?
The Collaborative Handbook is a practical guide developed by the Improvement Foundation Australia (IFA) to support practices during the APCC Program. It combines evidence-based guidance with practical examples drawn from the field. In the Handbook, you will find change ideas and change principles in each topic area which have been formulated and agreed to by the Expert Reference Panels.
What is an Expert Reference Panel?
The Expert Reference Panel consists of topic area experts who will seek to:
- Establish the aim for the topic area
- Identify key principles that underlie any improvement in each topic area
- Identify, where possible, successful strategies for change in each area (change principles)
- Suggest practical ideas for change in each area that will generate significant improvement (change ideas)
- Suggest measures that will assist teams in assessing their progress (improvement measures)
There is an Expert Reference Panel in each topic area.
Click here to view the Expert Reference Panel pages.
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Improvement Measures
What are the improvement measures in the Collaborative Program?
There are several improvement measures in each topic area. For a list of the improvement measures, click here .
How do we extract our improvement measures from our software program?
This depends on the clinical software that you are using. For users of Medical Director and Medical Spectrum, an extraction tool is available from the APCC to extract your data from your database system. See also Clinical Practice Software - Compatibility with APCC (March 2006)
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Practicalities of participating in the APCC
When do the Program waves start?
Click here for state wave dates.
How do I participate in the Collaborative Program?
To participate in the Program, contact your Division. Alternatively you can contact us to register your interest. Contact APCC Program
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Will taking part in this program add to our operating costs?
Practices need to allocate time and resources for staff to work on the Program, and to attend the Orientation event and Learning Workshops. Participating practices will receive an incentive payment, which is distributed through the local divisions.
How much time do I need to commit to this Program?
Participating practices have to set aside dedicated time each week to work on the Program. Practices would also need to allocate time for one GP and one practice staff member to attend the orientation event and learning workshops. For more detail on how much time you will need to commit to the Program click here.
What are the minimum requirements of participating practices?
The Program's minimum requirements are that practices:
- undertake work in all three topic areas
- submit at least one PDSA cycle every month (most practices submit more than this)
To achieve significant success within the Program, practices should be committed to:
- set aside dedicated time each week to work on the Program
- attend and actively participate in the Learning Workshops
- submit a PDSA every month in each topic
- collect and report data, and test and implement changes by using the PDSA cycles.
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What kind of support would we get on the Program?
The APCC Program team and your Division are the key resources for participating practices. Your Division will provide hands-on support and guidance on the collection of measures, submission of data, and implementation of change principles and ideas. The APCC Program provides a detailed handbook, a workbook, monthly feedback, analysis of monthly data, and maintains a website and online reporting system. The national Collaborative network provides a resource of knowledge and experience for practices to tap into. Participating practices are also eligible for practice incentive payments distributed through Divisions .
What have others achieved with a similar Program?
This Program builds on the success of work already done in the US and the UK . In the UK , the Improvement Foundation (formerly the National Primary Care Development team, NPDT) reports that over 5,000 practices serving almost 32 million patients have taken part in their program since it began in 2000, making it the largest primary care health improvement program in the world. The APCC Program aims to help general practice in Australia achieve significant improvements in the primary care they provide to their patients.
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What kind of improvements have other participants achieved?
By working with the Program, these are some of the measurable improvements in patient care other practices have achieved, so imagine the significant changes you can expect.
- improved patient outcomes through better management of diabetes and coronary heart disease
- increased best practice care through better use of information systems (both medical and business
systems)
- shift from reactive individual patient care to proactive population based care
- changes in service delivery to improve efficiency within the practice
- increased use of protocols and procedures to improve practice operations and efficiency
- enhanced clinical reporting and functionality (i.e. data cleaning to produce valid registers and reports)
Learning Workshops and Activity Periods
What happens at an Orientation event?
Practices attend an Orientation event four to six weeks before the first Learning Workshop. Participating practices are provided with an introduction to collaboratives and how they operate, and details are given of the practical aspects of participating in the APCC Program. There is an opportunity to hear from practices who have participated in previous Programs and an overview of the results they achieved will be provided.
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What happens at a Learning Workshop?
The learning workshops provide a supportive environment for sharing learning and for formulating plans for action. At these two-day events, practices learn how to implement the improvement methodology and work in local divisional teams with a Division staff member to learn about the Improvement Model cycles that they will carry out in their practices. There are opportunities to hear from experts about quality improvement and the evidence in the topic areas of secondary prevention of coronary heart disease, diabetes, and access and care redesign. Within the learning workshops, there are smaller facilitated breakout sessions where participants have an opportunity to learn from other practices about improvements they have made in their own settings.
Who should attend the Learning Workshops?
We recommend that one GP and one practice staff member attend the Learning Workshops. These should be staff who are in a position to influence and initiate change within their organisations.
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Can different people attend the Learning Workshops?
For best results and continuity, we recommend the same people attend all three Learning Workshops.
What is an Activity Period?
In the APCC Program framework, activity periods are scheduled between and after learning workshops for practices to deliver real and sustainable improvements in practice. In an activity period, practices test and implement their change ideas through using rapid time limited Plan, Do, Study, Act (PDSA) cycles. They also submit monthly measures in each topic area to track their progress.
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How long is an Activity Period?
The Activity Periods between Learning Workshops 1, 2 and 3 are three months long. Practices continue to work using PDSA cycles and submit data for 12 months after Learning Workshop 3 to track their progress.
Improvement Model
Where do we start? Which changes should we test first?
You will begin planning for change in the learning workshops. When you return to your practice, brainstorm ideas with the team, and talk to practice staff to get their input. Start with the first part of the Improvement Model, and ask the three fundamental questions:
- What are we trying to accomplish?
- How will we know that a change is an improvement?
- What changes can we make that will result in an improvement?
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What is the Improvement Model?
The Improvement Model is a simple yet effective tool for improvement. It consists of two parts. The first part, the "thinking part", consists of three fundamental questions to guide improvement work. They are:
- What are we trying to accomplish?
- How will we know that a change is an improvement?
- What changes can we make that will lead to an improvement?
The second part, the "doing part", is made up of rapid, small Plan, Do, Study, Act (PDSA) cycles to test and implement change in real work settings. The PDSA cycle guides the test of a change to determine if the change is an improvement.
What is a PDSA?
A PDSA is a small-scale, rapid-cycle test of change. It is used to determine if a change idea is one that will be beneficial before implementation on a wider scale. The PDSA cycle is a proven process intended to improve the quality of care at an accelerated pace.
How long/big should a PDSA cycle be?
If your PDSA cycle is large, it can be too complex and absorbs time and energy. Cycles should be short but significant; test a big idea on a small scale and in a short time frame (for example, on Dr Well's patients next Friday) so that you can identify ways to improve or change the idea.
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How do we write a good plan?
A plan should be time-specific and measurable. It is important that all team members agree on the plan and that the practice allocates the people and resources necessary to accomplish it. You will need to specify clearly the plan for change and the way in which it is to be carried out in order to test changes successfully.
How do we speed up our PDSA cycles?
Make sure your PDSA cycles are small and manageable, so that you are able to make incremental changes. As you try out changes on a small scale, and use the many consecutive PDSA cycles to build up information about how effective the change is, you can then implement it as part of your system.
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How much data do we need to collect to ensure that a PDSA cycle works?
You need to collect enough data to see if an improvement occurred.
Is it necessary to document every step of a PDSA cycle?
Yes. Documenting all four steps of a PDSA cycle - Plan, Do, Study, Act - has clear benefits: It helps teams get into the habit of doing all the steps. It is often the only way to follow the thread of the improvement journey. It also helps in communicating success and creating a coherent demonstration of progress for the future, for senior leaders and stakeholders. Documenting is also useful for later review, comparison, and sharing with others.
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We have done several PDSA cycles, but we don't see an improvement. What's wrong?
Use the "Study" phase of a cycle to reflect on what was learned from the test and refer back to the three fundamental questions. Try brainstorming more ideas.
How do we ensure that one PDSA cycle is linked to the next?
Ensure that the "Act" phase of one cycle is connected to the "Plan" phase of the next one. Schedule specific times for reflecting on what was learned in carrying out cycles.
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How do we know a change is an improvement?
Without measurement it is impossible to know whether you have improved. Measures are a means for practices to tell if the changes you are making actually leads to improvement, so measurement is a critical part of testing and implementing change. Think about how you want things to be different when you have implemented your change and agree in which data you need to collect to measure it. You can do this in terms of the way in which your results or outcomes might be different, how the service that your patients receive will be better, or how your processes might change.
Do we need to have an electronic means of capturing our data in PDSA cycles?
Use the resources available to you. It is not feasible to update your computer system for a short-term project; paper and pencil are good enough. It is possible to achieve a great deal of change and improvement using available resources and just enough data.
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