Virtual Tabletops

What is a virtual tabletop?

At the APCC workshops we often have round-table discussions, or 'tabletops', where a practice will come to the table to share their ideas, experiences and improvement how-tos with others. The participants at each table then have time to discuss, ask questions and offer suggestions of their own. The tabletops are very popular with participants, but what happens if you can't attend a workshop? We don't want you to miss out on all those great ideas, and the opportunity to contribute to the discussion, so the 'virtual tabletops' were created.

Please feel free to join one of the 'virtual tabletops' to comment on these stories, and indicate how you might adapt or extend these ideas to use in your own practice. We'll be posting stories regularly, so stay tuned...

Do you have a story of your own? We'd love to hear about a change idea that your practice has implemented. Please send your story to tony.lembke@improve.org.au

Here are the first of our virtual tabletops...

Chronic Disease Stories

The work that the practice team does in the Chronic Disease topic areas can make significant improvements to patient outcomes. Here, practices generously share their stories of change.

Click on the links to be taken to each practice's story.

Change Principal 1 - Building the practice team

Change Principal 2 - Establish a system for creating, validating, and updating a register of people with diabetes

Database tidying and data extraction
Acute cases management
Data cleansing

Change Principle 3 - Be systematic and proactive in managing care

The power of a registered nurse
CHD reminder system
Increase in annual diabetes checks
Tracking patient care

Change Principle 4 - Involve Patients in delivering and developing their care

Change Principle 5 - Develop effective links with key local partners
 

Change Principal 2 - Establish a system for creating, validating, and updating a register of people with diabetes

Database Tidying & Extraction

"I must say we did embrace the concept and greatly appreciated being led along the path of tidying our databases and being able to extract accurate informative data. We thought we were doing pretty well with our diabetics but our numbers showed room for improvement. We are now up to month 46 and still run our extraction every month and consider how we could be doing things better - as there is still room for improvement! The other important point to make would be the fact that it has engaged us as a team [clinical + admin] all working towards the same goal of improving our patients' health."  Broughton Clinic, SA

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Acute Cases Management

We have made lots of changes to update our Chronic Disease registers and to keep them accurate by correct coding. Whilst it can be difficult to instigate change we did manage to get everyone on board with this!

The flow on results have been standardising of care across the practice giving better patient outcomes and more timely performing/billing item numbers which keeps everyone at the practice happy!

We decided to have one GP responsible for acute cases and treatment room each morning. This has been without doubt the most positive change we have made. On a recent staff feedback survey, the receptionists stated it had made their life easier as urgent cases are seen promptly, patients are happy and less time is spent per phone call in triage/assessment. The nurses are happy as work flows more coherently in the Treatment Room with a Doctor on hand to review where required and GPs are happy as they know there won't be "fit ins" (at least for the morning session). Finally, principals are happy as the patients get to meet a range of GPs and are happier then to see different Dr if 'their' GP is fully booked."   Chancellor Park Family Medical Practice, QLD.

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Data cleansing

"In the last month, we have inactivated all patients who have not attended the surgery within the past two years. Furthermore, we have had to manually inactivate patients who weren't actually seen in the last two years, but whose files have been accessed for administrative purposes. This was necessary as administration was deemed a visit by the computer program. The process was tedious, but interesting. We found two deceased patients on the register!

Through these data cleansing processes, we have removed approximately 150 patients from our CHD and Diabetes Register. Now we have a more accurate and relevant register, and thus save resources in our recalls. This will also help us target our current patients, maintaining and improving our care for them. As new patients are added to the register, the framework is in place to provide high quality chronic disease management."  Alpha Medical Centre, NSW.

 

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Change Principle 3 - Be systematic and proactive in managing care

The power of a Registered Nurse

"The most significant has been employing a Registered Nurse to co-ordinate chronic disease management. In our Practice of six/seven doctors, the demands of clinical nursing were increasing rapidly. By using our Chronic Disease Management Nurse were able to rethink how we addressed our patients' needs, we had more time to look at being much more pro-active in seeking out patients who were at risk.

Our GP Division plagiarised the extraction tool developed for NPCC/APCC and modified it so we could firstly compare our data with local demographics in the form of the Health Atlas, and then we could de-encrypt our filtered data to obtain the identity of patients whom we could target for HMR's and GPMP's.

We continue to develop the Registered Nurse role and with the ongoing modification of the PENCAT extraction tool, we are able to refine searches of data, improve recording and cleaning up our system. With the ultimate aim of achieving ultimate patient care in ever widening circles, encompassing all forms of chronic disease."  Mt Barker/ Balhannah Medical Clinic, SA.

To view this story as a 'virtual tabletop' and add comment see The rise and rise of the chronic care coordinator in the virtual tabletops pages.

 

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CHD Reminder System

"We needed to find a reminder system for the doctors, when consulting patients who are on the CHD register (these patients are identified very easily, they are coded blue on the doctor’s appointment screen) to check that patients are up-to-date with recommended readings, levels and medications.

Importantly it also reminds the doctors to enter the data into the correct fields. We identified this as perhaps one of the issues which was affecting our percentages. We developed a screensaver so at the start of each day, when the doctors turned their computers on this would act as a reminder. We also ensured they had the desktop button installed on their taskbar so if they wanted to refer to the criteria it was a simple process, which did not involve having to close down their programs."   Kyabram Regional Clinic, VIC.

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Increased annual diabetes checks

"We at Woodside Surgery have increased the rate of annual diabetes checks from a low 12% in 2005 to 73% in 2009 by:
• Blocking out same day appointments to smooth the flow of patients generally, and aiding the task of doing Today's work today
• Sending reminder letters more boldly than ever before, with over 70% response
• Tic-tacking within the team (a cross between action research and PDSA) about how to make it all work ok.
• Being personable and being confident because we know what to do and why we do it - we have a plan.
• We keep a book of recalls due rather than use printouts it is 4 years since it started and still working well.
• We are about to use Pen Tool upgrade to replace our book and our trawling through billing records."
Woodside Surgery, SA.

 

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 Tracking GP Management Plans and Team Care Arrangements

The Doctors of Ivanhoe mapped out the steps involved in completing a GP Management Plan and Team Care Arrangments. They also produced a tracking sheet to assist in making sure each step is completed.

The Doctors of Ivanhoe tracking sheets are available from the links below:

• GPMP / TCA Tracking Sheet (pdf version)
• GPMP / TCA Tracking Sheet (spreadsheet xls version)
• DMMR Tracking Sheet (pdf)

Doctors of Ivanhoe, VIC.

To view this story as a 'virtual tabletop' and add comment see Tracking GP Management Plans and Team Care Arrangements in the virtual tabletops pages.

 

Access and Care Redesign Stories

The work that the practice team does in the Access and Care Redesign topic can make significant improvements to the experience that they, and their patients, have at the practice. Here, practices generously share their stories of change.

Click on the links below to be taken to each practice's story.

Change Principle 2.1 Know your business

Doctor Start times

Change Principle 2.2 Change your business

Swift Clinic
Script, Referral, BP & BSL Clinics
'Book on the day only' appointment system
The Blue Folder
Improving the patient environment
Script Only Appointments
Register Review
The Wall of Propaganda!
Notice Boards
Notice board in the waiting room
Monday's memo
Day Clinics
PDSA’s a Blessing in Disguise
All space is valuable!
'Open Access' Mondays
Purple Time - Protecting Endangered Species
 

Change Principal 2.1 Know your business 

Doctor Start Times

"It’s hard to choose just one from the most worthwhile collaboratives journey, however, the one that most stands out in my mind is ‘Tracking doctor starting times’. The graphing of which named (and sometimes shamed) each doctor’s performance in this area. It basically measured how long after the 1st booked appointment the doctor actually saw the first patient and drew direct correlations between this and session times blowing out. It was obvious that those doctors who regularly started their session late, finished even later, and those who started on time fared much better. As a result, we have seen a behavioral shift in ‘promptness’ which has benefitted everybody;
• the doctor (not feeling so stressed by the end of a session),
• reception (not copping so much abuse from patients), and
• patients (not having to wait as long to see the doctor). 
 
If that’s not a win/win/win, I don’t know what is!!! "  Romsey Medical Centre, VIC.

To view this story as a virtual tabletop and add comment, visit Tracking Doctor Start Times in the virtual tabletops pages.

 

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Change Principal 2.2 Change your business

Swift Clinic

"Our most successful change idea was not our own. Whilst we have made several innovations since participating in the NPCC/APCC program, our most successful to date is the introduction of the Swift clinic. A clinic set up daily for each doctor for approximately one to one and a half hours with each appt time being 5 mins instead of 15. A nurse sees patients first and checks blood pressure etc...or arranges what’s necessary for the patient. Patients are triaged at reception and educated about the clinic.

This clinic is suitable for: Repeat scripts, blood pressure checks, minor paper work (signature), sick cert (for a patient who has been treated by the practice already) results (if advised by the doctor to book swift) etc....The clinic is set up after lunch or first thing in the morning to prevent a late start. Usually bulk billed. Patients’ are very happy as are the doctors and reception staff. The original idea came from Collins Street Medical Centre, thank you!"  Clinic Name

 

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Script, Referral, BP & BSL Clinics

"For one of our doctors, we have initiated script and referral clinics (for ongoing referrals and repeat scripts for patients seen within a 3 month period), BP clinics (for those patients who utilise the chemist, we now have them book here), and BSL Clinics. We have put these clinics in place to help the waiting time for patients with appointments and to stop the interruptions for these types of visits. The clinics have proven popular with the patients and other doctors have now started to follow."  Bribie Medical Centre, QLD.

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'Book on the day only' appointment system

Following attendance at the NPCC/APCC Workshop we reviewed out reservations system. The outcome has been the introduction of a "book on day only" appointment. This brought a smile to the faces of our reception staff. They could greet the morning knowing there were at least some appointments available for urgent cases. It also lessened the crowding and double bookings for the doctors - lightening the daily load. Mt Barker/ Balhannah Medical Clinic, SA.

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The Blue Folder

"Our finest achievement conceived through the collaborative process is our “blue folder”. The blue folder is our version of the hand held record and the patients are encouraged to take it with them to specialist appointments, allied health appointments or to the ED if they need to present there.

The folder contains:
• a copy of the patient’s medical history,
• current medication,
• allergies,
• immunisations,
• management plan inc. The Care Calendar
• recent results (bloods, x-rays, echos etc) and
• current ECGs or ABIs.

The care calendar is a one paged three columned monthly calendar that sets out what needs to be done by the patient and the doctor for each month. The three columns include last year, this year and the next year. That way I can see what has been done when (i.e. the patients last yearly eye check was in Aug 2008 so it must be due again in Aug 09) and what is due to come before they are seen in 3 months time and what is due in the future.

If updated correctly and regularly (I try to update the calendar even when I get a specialist letter telling me the patient is due to see them in 6 months), it is an easy way to know what is due when and keep the patient organised as well.

We continually get great feedback via the patients from the hospitals about our folder. One of my regular patients came in to see me today. We had tried very hard to sell him the idea of the blue folder but he finally took it in with him when he saw a physician at the PAH. He told me with great pride that the physician and the registrar poured over the folder with its depth of information like “piranhas” and that the comments they gave were “impressive” and “every doctor should look after their patients like this”.

Needless to say that made me quite proud and ensured that he would continue to take his blue folder to all his specialist appointments in future."  Doctors Grand Plaza, QLD.

 

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Improving the patient environment

"In the spirit of PDSAs, I am submitting one "small" step in the multitude of changes we have made (and will make) at our practice as a result of being involved in the APCC program...

Our waiting room is relatively small, but its walls have always been filled with many posters and signs. Following one of the APCC workshops, we returned home and decided to create an electronic noticeboard.

Ingredients:
1. One old laptop
2. PowerPoint
3. PDF converter software
4. TV screen with wall bracket and cabling
5. One practice principal with an interest in IT and in being a handyman!

Recipe:
• Strip waiting room walls of existing posters/signs.
• Download posters from the Internet where possible and use PDF converter software to turn these into PowerPoint slides; create versions of remaining posters/signs as PowerPoint   slides; add some slides of beautiful scenery (so patients can momentarily dream that they are in South America and not in a doctors waiting room in Dubbo)
• Mount wall bracket, mount TV screen onto wall bracket
• Run cable from TV screen up through ceiling, across ceiling space, and down to laptop hidden in cupboard
• Run repeated PowerPoint presentation throughout the day
• Delegate one receptionist task of maintaining electronic noticeboard slides
• Stick back a few posters/signs on areas of walls that require a re-touch paint job!"   Dubbo Family Doctors, NSW.

 To view this story as a virtual tabletop and add comment, visit Recipe for an Electronic Noticeboard in the virtual tabletops pages.

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Script Only Appointments

The main change we introduced was to allocate 1 hour a week to "script only" time. Patients now know that if all they need is a repeat script they can book in at that time with next to no wait but, it can ONLY be for a script. So far it has worked extremely well. It has reduced the time taken up by script only appointments in day to day and the patient's are happier that they don’t wait for "just a script”.  Doctor Boyapati Surgery, VIC.

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Register Review

"We have inactivated all patients who have not attended the surgery within the past two years. Furthermore, we have had to manually inactivate patients who weren't actually seen in the last two years, but whose files have been accessed for administrative purposes. This was necessary as administration was deemed a visit by the computer program. The process was tedious, but interesting. We found two deceased patients on the register!

Through these data cleansing processes, we have removed approximately 150 patients from our CHD and Diabetes Register. Now we have a more accurate and relevant register, and thus save resources in our recalls. This will also help us target our current patients, maintaining and improving our care for them. As new patients are added to the register, the framework is in place to provide high quality chronic disease management."   Alpha Medical Centre, NSW.

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The Wall of Propaganda

"We decided to have a large white board put up on the wall in the office to assist with relaying information about collaborative for all the doctors and staff members to see.
It is used to relay ideas and responses and to display our graphs to show if there is an improvement each month. It has proved to be very successful. One of the doctors named it "The wall of propaganda!"  Caledonian Medical Centre et al, TAS.

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Notice Boards

"We have installed a Collaboratives Notice Board in our Medical Centre where doctors communicate regarding patients.We also have a new white board and a new noticeboard for APCC info."  Synergy Medical Centre, NSW.

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Notice board in the waiting room

"The most important change we have made is we have put a notice board in our waiting room, which explains to all new patients that they have to fill in an information sheet before receptionist prepares their new file."   Dr Shree Joshi Wyong, NSW.

 

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'Monday's memo'

"Our practice starts each week with “Monday’s memo” which is emailed to all staff. This memo lets all staff know who is on leave, if there are any visitors expected, practice issues and scheduled meetings. We also include an accreditation standard for the practice to consider, and now a collaborative section which lets all staff know what we are working on, and our achievements. All staff look forward to 'Monday’s Memo' and are very well informed of what’s going on in the practice."  Third Avenue Surgery, WA.

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'Day Clinics'

"We’ve recently participated in our 4th accreditation of which the patient feedback survey is an important part of re-accreditation. Patient feedback told us we needed to address our appointment system for those 'sick on the day' with minor ailments.

We did this by introducing 2 x 2 hour 'day clinics' each day, (on a roster system) for non-complex medical problems i.e. coughs and colds, medical certificates etc. Generally our appointments are booked at 15 minute intervals – the 'day clinics' are booked at 10 minute intervals. We found this addressed a need for those struggling to get in to see ANY doctor on the day, for a non-complicated medical problem."  Third Avenue Surgery, WA.

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PDSA’s a Blessing in Disguise

"APCC with their PDSA’s (Plan, Do, Study, Act cycles) are a blessing in disguise due to the fact that we have an Accreditation deadline looming for early to mid next year – scary thought if you stop to think of all the work this can entail.

We decided as a practice that for each goal and or idea that we decide to work on or towards, if relevant we would write/update our policy and procedure manual as we implemented it. We have now added or updated four policies relating to inactive, visiting and deceased patients. This will help to keep our database up to date and help to assist all our staff and our patients with more accurate records. The biggest advantage is we are tackling a task once and as it is relevant to both our Accreditation and the APCC, this is better use of our resources, time and personnel."  James Street Medical Centre, VIC.

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All space is valuable!

"I work as a Practice Nurse in Broome. With 1-2 permanent Droctors and varying numbers of locums and Medical Students I was shifted almost daily from room to room for space for my 'Well Women’s' consults.

I finally convinced the Practice Principal to let me have the storeroom! It had good lighting, tile floors and A/C. I removed the shelving, painted it, bought some furniture and had a privacy curtain installed. All the stores fitted into several new office cupboards we bought and put in the treatment area.

I now have my own room, it's much easier to keep track of stock and we cleared out a lot of junk!!!“  Broome Medical Clinic, WA.

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'Open Access' Mondays

"Mondays are now 'Open Access' unless the doctor requests we make an appointment for the patient. This was brought about by receiving 61 phone calls one Monday and 77 the next. All patients hoped to see our Doctor on the day and many patients became unfriendly to our receptionist when she could not get them an appointment.

We are very happy with the new system so far and it has certainly prevented our hard working receptionist from resigning!"   Pingelly Medical Centre, WA.

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Purple Time - Protecting Endangered Species

‘Protected time’ is invaluable for improvement work – but in a busy practice it is often hard to find. The Sorell Family Practice came up with a novel way to indicate that the staff member wearing it is doing important work and is not to be interrupted. A purple smock enables the wearer to take 'purple time' to undertake this work without having them called away to deal with more pressing and immediate problems.

“When people see you behind closed doors, and they don’t know what you are doing, they wonder why you aren’t out helping them. the Purple Smock has been successful in letting people understand that you are doing important and valuable work”

The practice also shares the results of this work via a special collaborative noticeboard, where the results of their improvements and suggestions and ideas are posted. Sorrell Family Practice, TAS.

To view this story as a virtual tabletop and add comment, visit Purple Time - Protecting Endangered Species in the virtual tabletops pages.

 

 

Archived Newsletters

 The APCC Newsletter is distributed to those involved in the APCC Program.

December 2008

October 2008

December 2007

September 2007

July 2007

May 2007

Chronic Heart Disease

 

Change Principle 1: Building the Practice team
 

Park Ridge Family Practice - Queensland

Change Principle 2: Establish a system for creating, validating anf updating a register of people with Chronic Heart Disease
 

Parade Medical Centre - South Australia

Fulham Medical Centre - Western Australia

Medical Clinic Millicent - South Australia

Yarra Health - Victoria

Reservoir Medical Group - Victoria

Murgon Family Medical Practice - Queensland

Change Principle 3: Be systematic and proactive in managing care
 

The Street Doctor - Western Australia

Change Principle 4: Involve patients in delivering and developing their care
 

Biota Street Medical Centre - Queensland

Bywater Medical Jindalee - Queensland

Central Bayside General Practice Network - Victoria

Robina Town Medical Centre - Queensland

Murgon Family Medical Practice - Queensland

 

 

Program Measures

The APCC Program measures were created for each topic by expert reference panels (ERPs) comprised of GPs and specialists. The APCC reports are a standard set of measures that look at key clinical indicators. Practices submit monthly reports to the APCC Program which include measures for the following topic areas:

• Diabetes
• Coronary Heart Disease
• Access
• Chronic Obstructive Pulmonary Disease
• Chronic Disease Prevention and Self Management

Program Reporting

What is the purpose of the APCC reports?

APCC reports rapidly and easily present you with information about the "overall state of play" of your patients with diabetes and CHD as groups. Knowing the "state of play" of a particular cohort of patients provides you with insight into the mechanisms of care delivery at work within your practice and can reveal opportunities to enhance earning potential, streamline practice systems, and improve the quality of care that you may have been unaware of. This type of information has not been readily available to GPs before.

What are the actual measures that the report(s) cover?

The APCC Program Measures cover Diabetes, Chronic Heart Disease (CHD), General Prevention Measures, Chronic Obstructive Pulmonary Disease (COPD) & Chronic Disease Prevention and Self Management (CDPSM).

To view a summary of the APCC Program Measures please click here

To view the full version of the APCC Program Measures please click here

What is the web portal?

The web portal allows participating practices to lodge their monthly data electronically and review their improvement progress over the course of the Program. Practices can also compare and benchmark their progress in relation to other practices within the Program. Each participant in the Program has a unique log-in that allows them to submit their data securely. This login can be obtained from your Divisional Collaboratives Program Manager (CPM) or the APCC team. Practices who are not actively participating in the APCC Program are welcome to submit data to the portal to track their improvements. Please contact your Division for more information

How do they do this?

APCC reports collate selected measures from your electronic patient records. This collated information is presented to you in the form of a percentage of your patients who meet certain criteria. For example, the percentage of your diabetic patients with a current HbA1c of less than 7. 

I'm doing ok. Why should I bother?

Experience from GPs in over 1000 Australian practices indicates that you will find the information in APCC reports surprisingly useful. By considering your patients with diabetes and CHD as a whole group, a new perspective on your patients is available to you. From this new perspective, you can consider issues that affect both patient care and business profitability.

APCC reports produce very powerful information which is immediately useful in your practice. For example, A simple statistic like the % of your diabetic patients with an HbA1c <7 might trigger an examination of many aspects of your practice. If the percent of patients with this reading is low, questions might include:

• how much income are we missing from diabetes SIP payments?
• do the GPs in this practice have a consistent understanding of when a new HbA1c test is required?
• are we recording this information properly?
• is our recall system working?
• is our delivery of diabetes care sufficiently methodical or do gaps exist in our systems?
• are we setting ourselves up for a high future workload with acute diabetic patients by constantly missing opportunities to intervene early?

Diabetes

 

Change Principle 1: Building the practice team
 

Park Ridge Family Practice - Queensland

Nguiu Health Service - Northern Territory

 

Change Principle 2: Establish a system for creating , validating and updating a register of people with diabetes
 

Murgon Family Medical Practice - Queensland

 

Change Principle 3: Be systematic and proactive in managing care

 

Kelvale Medical Group - Western Australia

Breed Street Clinic - Victoria

The Street Doctor - Western Australia

 

Change Principle 4: Involve patients in delivering and developiong their care
 

Bywater Medical Jindalee - Queensland

 

Change Principle 5: Develop effective links with key local partners
 

Dr John Troy's Surgery - Western Australia

Access & Care Redesign

 

Change Principle 1: Build the Practice Team
 

Palm Beach Family Practice - Queensland

Brunswick Heads Medical Centre - New South Wales

Kangaroo Island Medical Centre - South Australia

Change Principle 2.1: Know your Business
                              2.2 Change your Business
 

Franklin Street General Practice - South Australia

Brighton Medical Centre - Victoria

Brighton Family & Womens Clinic - Victoria

Woodville Family Practice - South Australia

Nuggets Crossing Family Practice - New South Wales

 

Archive Case Studies

These archived case studies were developed by practices who participated in the first phase of the Program (2005-2007, the National Primary Care Collaboratives Program) and are sorted first by topic area then by Change Principle. To find out more about the APCC Change Principles click here.

To access the case studies, click on a topic below.

Access & Care Redesign

Diabetes

Chronic Heart Disease (CHD)

Frequently Asked Questions

Below are some frequently asked questions about the APCC Program, the methodology and framework and how particpating in the Program will impact you.

Click on each question for the answer.

The APCC Program

What is a Collaborative?
What is the Collaborative Program?
What is a wave?
What topic areas does the APCC Program focus on?
What are the benefits of using the Collaborative methodology?
What does the Program aim to achieve?
What is the Collaborative Handbook ?
What is an Expert Reference Panel?

Improvement Measures

What are the Improvement Measures in the APCC Program?
How do we extract our improvement measures from our software program?

Practicalities of participating in the APCC

When do the Program waves start?
How do I participate in the APCC Program?
Will taking part in this Program add to our operating costs?
How much time will I need to commit to the APCC Program?
What are the minimum requirements of participating practices?
What kind of support would we get on the Program?
What have others achieved with a similar Program?
What kind of improvements have participants achieved?

Learning Workshops and Acticity Periods

What happens at an orientation event?
What happens at a learning workshop?
Who should attend the learning workshops?
Can different people attend the learning workshops?
What is an activity period?
How long is an activity period?

Model for Improvement

What is the Model for Improvement?
Where do we start? What changes should we test first?
What is a PDSA?
How long/big should a PDSA be?
How do we write a good plan?
How do we speed up our PDSA cycles?
How much data do we need to collect to ensure that a PDSA cycle works?
Is it necessary to document every step of a PDSA cycle?
We have done several PDSA cycles, but we don't see an improvement. What's wrong?
How do we ensure that one PDSA is linked to the next?
How do we know a change is an improvement?
Do we need to have an electronic means of capturing our data in PDSA cycles?

 

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. It is 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 Commonwealth of Australia 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.

National Wave
National waves are held in central locations in major capital cities. Each national learning workshop runs for two consecutive days in a central location and is attended by participants from all over the country.


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).

Local Wave
A local wave is the APCC workshops run in the local area 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 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 five topic areas:

• Secondary prevention of coronary heart disease
• Diabetes
• Access and care redesign

In July 2009 IF introduced two new topics to the APCC Program. The new topics were introduced to practices in a national wave starting in September 2009:

• Chronic Obstructive Pulmonary Disease
• Chronic Disease Prevention and Self Management

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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?
The APCC 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?
Each Program topic has an Expert Reference Panel (ERP). Each ERPconsists of topic area experts who 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 full list of the improvement measures click here . For a summary list click here.


How do we extract our improvement measures from our software program?
This depends on the clinical software that you are using. There are data 'extraction tools' that are avaliable at no cost to APCC participants. The data extraction tools are designed to work with a number of clinical software programs. New participants are informed about data extraction options upon joining the Program.

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Practicalities of participating in the APCC

When do the Program waves start?
Click here to be taken to the Events page.

How do I participate in the Collaborative Program?
To participate in the Program, contact your Division. Alternatively you can contact Improvement Foundation (IF) to register your interest. Contact IF.

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 the APCC 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 each of the wave's 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 a key resource and source of support 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 web portal. 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
• Changes in service delivery to improve efficiency within the practice
• 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
• 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, access and care redesign, chronic obstructive pulmonary disease, and chronic disease prevention and self management. 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 each of 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 about three months long. Practices continue to work using PDSA cycles and submit data for 12 months after Learning Workshop 3 to track their progress.

 

Model for Improvement

What is the Model for Improvement?
For more information about the Model for Improvement click here to be taken to the Model for Improvement page on this website.

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 Model for Improvement, and ask the three fundamental questions:

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What is a PDSA?
A PDSA (Plan, Do, Study, Act) 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.
• 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.

Disclaimer

Every effort is made to ensure information on this web site is up to date. However, the Australian Primary Care Collaboratives Program gives no warranty and accepts no responsibility for the accuracy or completeness of the material, and reserves the right at any time to make changes as it deems appropriate. No reliance should be made on the material.

The user should check for confirmation with the originating or authorising faculty, department or other body. The Australian Primary Care Collaboratives Program provides external links as a service to users of its web site but does not accept responsibility for, or endorse the content or condition of, any linked site.

Privacy Policy

Brochures

The following APCC Program Brochures are available for download:

For general information about the APCC Program view - What if you could create a better practice all 'round?

Download PDF

To browse through some FAQs view - What if we could answer your Frequently Asked Questions?

Download PDF

To find out more about the 'local' waves of the APCC Program view - What if you could create a better practice all 'round - Local waves?

Download PDF

To find out more about the 'virtual' waves of the APCC Program view - What if you could create a better practice all 'round - Virtual waves?

Download PDF

To see some practice testimonials view - If the APCC Program worked so well for these practices, imagine how it could help yours...

Download PDF

To see some Division testimonials view - If the APCC Program worked so well for these Divisions, imagine how it could help yours...

Download PDF

Contact

Phase 2 of the APCC Program is being delivered by Improvement Foundation (IF)

Address:
Level 5
19 Grenfell St
ADELAIDE
SA 5000

Postal Address:
PO Box 3645
ADELAIDE SA 5000

Phone: (08) 8422 7400

Freecall: 1800 771 522

Fax: (08) 8231 6690

Email: apcc@improve.org.au

In the first instance, please direct all Program enquiries to the IF number (above). If for some reason you are unsuccessful in your attempts to contact IF please direct your call to to either Alison Coughlin or Colin Frick.

Alison Coughlin - National Program Director
0438 691 283

Colin Frick - Chief Operating Officer
0410 790 187

Home

The Collaborative Program

The Australian Primary Care Collaboratives (APCC) Program framework consists of an orientation activity and three learning workshops over a nine-month period with activity periods in between, and ongoing data submission. This framework is often referred to as a Program 'wave'. The activity periods allow for practices to test and implement change in their organisations. 
 

The Program consists of the following components:

Orientation

At orientation, practices are provided with an introduction to Collaboratives and how they operate, plus an understanding of the procedures for collecting and reporting the improvement measures, and implementing PDSA (Plan, Do, Study, Act) cycles.

Baseline Data Collection

Baseline data is a snapshot of a practice's position before they begin with the Program.

3 Learning Workshops

The learning workshops provide participants with access to stimulating ideas and approaches in a supportive environment. Having access to what others have done successfully will short cut the learning process and speed up practices' ability to deliver improved care for their patients. learning workshops also provide a hothouse of ideas. By listening to others' experiences, new ideas are generated and innovation occurs.

At learning workshops, participants:

• hear from topic areas and quality improvement experts
• listen to fellow practices about how they have sought to improve their own care systems
• get 'protected' (dedicated) time to formulate plans for action
• contribute their experiences to help others learn and stimulate innovation
• share, debate and learn from each other.

Activity Periods

Activity Periods are periods of time between learning workshops where practice staff implement ideas they have been exposed to and formulated during the workshops. Practices test ideas using the Model for Improvement*.

The Model for Improvement

The Model for Improvement* is a simple and effective tool for improvement. It consists of two parts; the first part, the "thinking part", consists of three fundamental questions to guide improvement work:

1. What are we trying to accomplish?
2. How will we know that a change is an improvement?
3. What changes can we make that will result in 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 provides a framework for testing ideas and assessing the results to determine if the change is an improvement. To find out more about the Model for Improvement click here.

PDSA Cycles & Testing of Ideas
Small incremental changes are tested and implemented at a practice level using "Plan, Do, Study, Act" (PDSA) cycles. To find out more information about PDSA cycles click here.

The PDSA cycle enables practices to break down change into manageable chunks so that they are able to make incremental changes. Practices try out changes on a small scale, and use consecutive PDSA cycles to collect information about how effective the change is.

Data Collection

Monthly data collection and reporting enables participants to track their improvement. Regular reporting and measurement is a key feature of the Collaborative Methodology and a powerful tool by which participants can assess their progress, and benchmark themselves against other participants, according to the APCC's defined clinical measures. This reporting is not a performance management tool. It is part of the Collaborative learning process to track progress and improvement in the systems of care.

Expert Reference Panel

At the development stage an Expert Reference Panel is formed for each topic area. An ERP is a group of experts and key professionals with experience in the key topic areas. To find out more about the APCC ERPs please click here.

Change Principles

The Program provides a set of change principles, which underpin best practice in each topic area. These are documented in the handbook which all participants will be provided with at Orientation. To veiw the Change Principles for the Program click here.

Change Ideas

Change ideas are practical examples of how practices can implement and achieve change. To see some change ideas that APCC practices have tested visit the Ideas for Improvement, 1001 Stories, or Virtual Tabletops pages.

Shared Learning

Practices which have made improvements by applying the principles and ideas to their own practices, have a platform to share their specific learning with their peers. In addition to driving change, this approach to improvement helps reduce anxiety to change by seeing that others have done it.

Measurement

The Program uses specific improvement measures to enable participants to monitor the impact of the changes they make and assess the improvement gained over time. To view the Program measures please click here.

For more information see: APCC Team (ERPs), Model for Improvement, Goals and Aims of the Program, & Program Results
 

*(Langley, Nolan, Nolan, Norman & Provost (1996) "The Improvement Guide" Jossey Bass, USA)

The Model for Improvement

Making improvements to products, systems or services requires change. Although change can seem threatening or overwhelming for busy people, it can be successfully managed if well planned. The Model for Improvement* provides a framework for developing, testing and implementing changes. It helps to break down the change effort into small, manageable chunks which are then tested to ensure that things are improving and that no effort is wasted. It is always worth remembering that while every improvement is certainly a change, every change is not an improvement.

The Model for Improvement consists of two equal parts; the first part, the "thinking part", consists of three fundamental questions to guide improvement work:

1. What are we trying to accomplish?
2. How will we know that a change is an improvement?
3. What changes can we make that will result in an improvement?

 

Model for Improvement Example  

You can continue to use PDSA cycles to test ideas from the 3rd fundamental question until you are satisfied that you have achieved your goal.

 

Model for Improvement templates

Program Results

The APCC Program has resulted in key changes within Australian primary care and better health outcomes for patients with chronic disease, including: 

• Improved patient care through better management of Chronic Disease
• Increased best practice care through better use of information systems (both medical and business systems)
• Evolving roles among practice staff to better meet patient demand
• A cultural shift from individual patient care to population based care
   

The Improvements

To date, more than 70 Divisions and over 1000 Australian general practices have achieved significant improvements through their involvement in the APCC Program. The following improvements in evidence based clinical measures have been recorded.

Phase 2 results

For Phase 2 results to date please click here
 

Phase 1 results

Phase 1 practices (phase 1 of the Program was delivered between 2005 & 2007 and was known as the National Primary Care Collaboratives) acheived outstanding results through their work with the Program. Results are relative to baseline data and national aggregates of all core waves as of December 2007 data submission:

Diabetes

• 97% improvement in the percentage of patients with HbA1c levels equal to or below 7%
• 132% improvement in the percentage of patients with diabetes whose cholesterol was recorded below 4mmol/L
• 101% improvement in the percentage of patients with blood pressure equal to or below 130/80mmHg
• 84% improvement in the percentage of patients who have had a SIP claimed for them
• 34% improvement on the number of patients on the diabetes register

 Coronary Heart Disease (CHD)

• 28% improvement in the percentage of patients with CHD recorded as being on aspirin medication
• 26% improvement in the percentage of patients with CHD recorded as being on a statin medication
• 52% improvement in the percentage of patients who have had a myocardial infarction in the last 12 months who are on a beta blocker medication
• 50% improvement in the percentage of patients with CHD whose last recorded blood pressure was below 140/90mmHg
• 45% improvement on the number of patients on the CHD register

 Access and Care Redesign

• 7% improvement in the percentage of patients seen by a GP on the day of their choice
• 35% improvement in the practice nurse 3rd available appointment

APCC Team

Improvement Foundation delivers the Australian Primary Care Collaboratives (APCC) Program. The APCC consists of a team of managers and support staff who work within the wider IF team. Each participating Australian Division of General Practice and State Based Organisation receive funding from Improvement Foundation (IF) to provide support and guidance to practices participating in the Program. Each state has an APCC Program Manager, and Regional Manager, and each participating Division involved has a Collaborative Program Manager, based at the Division to support participating practices within that Division.

To contact the APCC team, please click here

To see the IF team, please click here

Use the links below to take you to each of the sections:

APCC Clinical Director and Clinical Chairs

Project Management Advisory Committee (PMAC)

Expert Reference Panel (ERP) members

 

APCC Program Clinical Director and Clinical Chairs

APCC Clinical Director

Dr Tony Lembke, Alstonville Clinic, NSW

Tony has been a partner at the Alstonville Clinic in NSW for 12 years. He is Chairman of the Northern Rivers Division of General Practice & GP Advisor to the Information Management & Parenting Support projects within the Division. He is editor of the online journal ‘MedicineAu’ and a regular columnist in ‘GP Speak’ and is a Board Member for the Australian General Practice Network.
 

Clinical Chairs

NSW, QLD, ACT wave

Dr David Richardson, Royston Clinic, VIC

David has been a doctor for more than 20 years. Special interests include minor procedures, preventative medicine, mental health and anti ageing medicine. He has developed special interest and knowledge in Natural (Bio-identical) Hormone Replacement Therapy and has an interest in "Life Extension" therapies. David is currently completing a Nutrition Course at Swinburne University.

WA, SA & NT wave

Dr Mike Civil, Stirk Medical Group, WA

Mike has been a GP at the Stirk Medical Group for the past eight years. Prior to this he ran his own practice in Kalgoorlie for six years, with his wife Cathy (who is also a GP). Originally trained in the UK, they moved to Australia in 1992.

He has a keen interest in computers, having been on the GP Computing Group and has worked in a paperless surgery for nearly 10 years now. He has furthered his interest in computing by obtaining a Graduate Diploma in Computing. Mike also works as an AGPAL surveyor and has been involved with the orientation of overseas trained doctors with WACRRM in WA.

VIC & TAS wave & Virtual wave 1

Dr Richard Bills, Brooke Street Medical Centre, VIC

Richard has been a rural GP in Victoria's Central Highlands for 18 years, and is one of three owners of the Brooke Street Medical Centre - a purpose built, multidisciplinary centre which is strongly focussed on team-based care. His practice was involved in the Collaborative Program during the initial wave that went on to take the RACGP Victorian Practice of the Year in 2006. Richard was a presenter at subsequent waves during the first phase of the Program.

National Wave 4

Dr Charlotte Hespe, Glebe Family Medical Practice, NSW

Charlotte is the GP principal and teaches medical students in a group Family Medical Practice in Glebe, Sydney. She is also the Co-assessment Panel Chair for the NSW Faculty of the RACGP and sits on the RACGP National Fellowship Sub Committee and NSW Faculty Education Committee. She has recently been appointed a Senior Lecturer position for the Notre Dame Post Graduate Medical Program in Sydney. Charlotte is also the Director and Chair for SIGPET (Sydney Institute of General Practice Education and Training) and has been involved in medical education for the SIGPET GP Re entry Program.

COPD & CDPSM wave

Dr John Kastrissios, Springwood Group General Practice, QLD

Dr John Kastrissios was a foundation board member of SouthEast Primary HealthCare Network in 1993. He is also the current Chair for 2009. John has been a General Practice Queensland (and QDGP) board member since 2001 and is also currently the Chair. He was the recipient of the Australian General Practice Network's 2008 John Aloizos Medal for outstanding contribution to the Divisions Network. John is also the Principal in a group general practice in Springwood and has worked there since 1986. He is a general practice supervisor / mentor, involved in the training and supervision of GP registrars and medical students in general practice, on behalf of CSQTC and Griffith University Medical School. He is also a Member of the NeHTA Clinical Leads Program.

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Program Management Advisory Committee (PMAC) 

Improvement Foundation (IF) has been contracted by the Commonwealth to deliver the Australian Primary Care Collaborative Program. To meet governance requirements IF established a Project Management Advisory Committee (PMAC).

The PMAC team draws together the considerable skills of Alan Bansemer (Chair), Rosey Batt, Rob DiMonte,  Dale Ford, Richard Reed, and Paula Arnol to offer continuing strategic advice and APCC project assurance to the Improvement Foundation Australia (IF) Board.

The PMAC team will provide a valuable resource of experience and expertise across a range of key areas including health policy, primary health care delivery, law, governance, financial management, and organisational change.

Chair

Alan Bansemer
Formerly the Commissioner of Health, Health Department of Western Australia, Alan now acts as a consultant within the Health Sector (nationally) and brings with him extensive experience in governance in not-for profit, finance, primary health care delivery, health policy and an understanding of consumer and carer perspectives. 

Members
 

Ms Paula Arnol
Paula is the CEO of Danila Dilba Health Service, the principal Aboriginal comprehensive primary health care service for Darwin and surrounding areas. 

Ms Arnol is currently a member  of the Aboriginal Medical Services Alliance of the Northern Territory (AMSANT), Chairperson of the Northern Territory Aboriginal Health Forum, Co-Chair of the Northern Territory Emergency Response Health Expert Panel and a board member of The Cooperative Research Centre for Aboriginal Health (CRCAH). 

Ms Rosey Batt
Rosey founded Rosey Batt & Associates in 2001 with the vision of creating a highly professional legal firm that valued its clients and provided a family friendly environment for staff. The firm now employs 5 full time lawyers and a number of law clerks. 

Rosey has had extensive commercial legal experience acting for Publicly Listed Companies, SME’s and individuals. For a number of years she was a partner with Minter Ellison. Her primary areas of practice are in Business Transactions, Trade Practices, commercialisation of business opportunities, resolving disputes and Intellectual Property. Rosey has extensive Board experience and today sits on a number of Private and Public Sector Boards. Her broad knowledge of Corporate Governance issues has been enhanced by having held the positions of Chair, Deputy Chair and Chair of a number of Corporate Governance committees. 

Rob DiMonte
Rob qualified as a Chartered Accountant in 1984 and has worked for small and large accounting practices over the past 25 years. Rob’s professional expertise has spanned many of the competency areas for a Chartered Accountant including - audit, tax, business services and for the past 20 years, management consulting. His skills are in business strategy, performance measurement, customer and product profitability, shared services, and process re-engineering. Rob is currently the Managing Partner for Deloitte in Adelaide and also continues to lead their management consulting activities in South Australia. His clients range from large corporations to small and medium enterprises.

Some of Rob's major clients include Australia Post, Mitsubishi Motors, Bridgestone, the Universities of Adelaide, Flinders and South Australia, ETSA Utilities, SA Water, Vodafone, Owens Corning, Santos and General Motors. Rob is a Fellow of the Institute of Chartered Accountants, a Certified Management Consultant, Member of the Institute of Company Directors, former Deputy Chairman of SA Great, former Chairman of VIVASA, Former National President of the Institute of Chartered Accountants in Australia,  Board Member, Institute of Chartered Accountants Benevolent Fund,  Vice Chairman of the Deloitte Foundation, AMCHAM Governor and CEDA Trustee

Dr Dale Ford
Dr Dale Ford was previously Clinical Director of National Primary Care Collaboratives Program (Phase 1 of the APCC), a role he held for approximately two years. Dale is a GP and has been a partner in a group practice in Hamilton, Western Victoria for more than 20 years. He is Medical Director of Otway Division of General Practice and has held that position for the past six years.

Dale helped set up Greater Green Triangle GP Education and Training, a regional general practice training provider, was their inaugral Chair and is currently on their Board. He has interests in Diabetes and Cardiovascular Disease, working in ICU at Hamilton's Hospital. He is involved in a Diabetes Prevention Project with Greater Green Triangle University Department of Rural Health. He is currently running a Chronic Disease Management Project in conjunction with Wester District Health Service and his practice, using the elemts of the wagner Chronic Disease Model. Dale is an employee of IF and therefore is classed as an internal member. 

Professor Richard Reed
Professor Reed is head of the Department of General Practice at Flinders University and has been since 2005 when he migrated to Australia from the USA. Richard possesses American Specialty Certificates in Family Medecine, Geriatric Medicine and Preventative Medicine. He is a Fellow of the Royal Australian College of General Practice and is clinically active in Adelaide.

Professor Reed has expertise in quality improvement including participation in the implementation of a 48 hospital clinical trial comparing Continuous Quality Improvement to State-of-the-art continuing professional development for the prevention of pressure ulcers. He has also led a clinical trial of a structured approach to the management of diabetes mellitus in 12 large general practices and has an extensive background in guideline implementation and quality improvement methodologies.

Professor Reed also has substantial administrative experience including Chairing the Department of Family Medicine and serving as Acting Dean at United Emirates University before assuming his post at Flinders University.

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Expert Reference Panels (ERP)

An Expert Reference Panel is a group of experts and key professionals with experience in the key topic areas. Each panel has worked together to: 

• Identify key principles that underlie any improvement in each topic area 
• Identify, where possible, successful strategies for change in each area 
• Suggest practical ideas for change in each area that will generate significant improvement 
• Suggest simple measures that would assist teams in assessing progress 

The APCC Program began in Australia with three topic areas, Coronary Heart Disease, Diabetes, and Access and Care Redesign. In July 2009 two additional ERPs were created to work together on the new topics of Chronic Obstructive Pulmonary Disease and Chronic Disease Prevention and Self Management.

The APCC has Expert Reference Panels in the five topic areas of: 

• Coronary Heart Disease (CHD) 
• Diabetes 
• Access and Care Redesign 
• Chronic Obstructive Pulmonary Disease (COPD) 
• Chronic Disease Prevention and Self Management (CDPSM) 

The Web Portal

The web portal is an extranet* and works like any internet site you may visit on the web, however it is a secure site that requires a username and password to gain entry. IF will provide participants involved in the APCC Program with a username and password to access the web portal.

The web portal is an online tool for reporting and submitting data, sharing ideas and staying involved in the Program. The web portal provides essential information for participants, including resources, calendars, results and reports, event information, registrations and a lot more!

You don’t need to be participating in an APCC Program wave to track your improvements through the web portal. Simply contact data@apcc.org.au and we can send you a username and password. Once activated in the web portal you can then submit your monthly practice data and automatically generate feedback graphs in real time. The Pen data extraction tool is freely available to all activated practices to assist with extracting monthly improvement measures.

*An extranet is an intranet that is partially accessible to authorised persons outside of a company or organization. For example, when someone enters a bank website and logs-in to use internet banking, or visits their public library website and logs-in their membership number to order a book to borrow they are using an extranet.

 

What is the web portal used for?

Practices and health services generally use the web portal for the following tasks:

Electronic monthly data reporting – When combined with a compatible data extraction tool (e.g CAT) the web portal allows for fast, easy, electronic uploading of the monthly clinical measures. If your clinical system is not compatible with a data extraction tool data can be entered manually.

Reviewing feedback graphs – The web portal converts the raw data into easy to read feedback, or improvement, graphs. Practices and health services view their improvement graphs on the web portal.

Viewing comparison graphs - Through the web portal practices and health services are able to compare their improvement graphs with those of their Division, their wave, and the national averages.

Entering the Model for improvement, 3 Fundamental Questions and PDSAs – This enables practices and health services to keep an electronic record of their change cycles and improvement work .

Accessing Resources – All available APCC workshop presentations and handbooks, templates, and other resources are available within an electronic library. Items can be checked out to just to review, or downloaded to keep. The web portal comes with an excellent search facility.

 

Privacy

The web portal is a secure site. Members' details are not visible to other users and will remain confidential. Improvement Foundation (IF) will be able to see your personal details as they are used for administrative purposes. Practice or health service  details are visible by other practice or health service team members that have been granted access to the web site. Your practice or health service data and feedback graphs are confidential and only your team, the Divisional support team and IF can see these graphs. As for data, it is all be de-identified and aggregated prior to being extracted from your clinical software.

What is a Collaborative?

There is often confusion between the Collaborative method and collaboration in general. The Collaborative method has a specific approach, which is user-friendly and simple. A Collaborative is an improvement method that relies on the distribution and adaptation of existing knowledge to multiple settings, to achieve a common aim. 

For example, with the APCC Program, colleagues get together at a series of learning workshops. Participants exchange ideas, share experiences and learn about practical quality improvement skills, which can all be easily implemented using the successful Model for Improvement.  Through shared learning, teams from a number of general practices work with each other and the Improvement Foundation to rapidly test and implement changes that lead to lasting improvement. To learn more about what's involved with this collaborative see The Collaborative Program.

The Collaborative methodology promotes rapid change, allowing practices to experience the benefits in short time frames.  It works because it is straightforward, there is hands-on support, and the framework promotes 'protected time' (protected time is time specifically set aside for practice staff to focus on APCC Program work)  for participants to spend together solving problems as a team. 

Healthcare Collaboratives are built on a tried and tested method, developed in the USA , which has been applied to a wide range of management challenges. It was originally applied to healthcare systems by the Institute of Healthcare Improvement (IHI) in the USA , and has been adopted in other countries, most recently and effectively through the National Primary Care Development Team, now known as Improvement Foundation, in the UK. 

A Collaborative is not a research project, a set of conferences or a passive exercise. A Collaborative is about actually doing and improving.

See also Objective & Aims of the APCC & The Model for Improvement

For Practices

How would you like to be involved in a Program that’s full of ideas on how to achieve improved health outcomes for patients by helping you build stronger practice teams and enhance your systems and efficiency?

With the APCC Program, it’s all about getting together with colleagues at a series of learning workshops. You’ll exchange ideas, share experiences and learn about practical quality improvement skills, which can all be easily implemented using the successful 'Model for Improvement'.

Then, you can apply what you’ve learnt to deliver measurable, systematic, and sustainable improvements in the care you provide to patients. 

To date, more than 60 Divisions and over 800 Australian general practices have achieved significant improvements through their involvement in the APCC Program.

 

Benefits of Participation 

Just think of the kind of improvements you could make, such as:

• Improved health outcomes for patients with chronic diseases
• Doctors running on time
• Accurate and up-to-date patient registers
• Improved team based culture within the practice
• Doctors being available at short notice
• Patients receiving best standard of care possible
• Improved GP and staff morale.

By applying the user-friendly 'Model for Improvement', teamed with local, hands-on support, you’ll be able to implement change in small manageable cycles and identify where change actually leads to improvement.  The good thing is, the Program’s quality improvement methods and skills have already been tried and tested in over 800 Australian general practices, so you can be sure they work.

Below are some changes that other practices have achieved through the APCC Program:

• Improved patient care through better management of chronic diseases
• Increased best practice care through better use of information systems (both medical and business systems) 
• A cultural shift from individual patient care to population based care
• Changes in service delivery to improve efficiency within general practice
• Increased use of protocols and procedures to improve practice operations
• Enhanced medical software reporting and functionality (i.e. data cleaning to produce valid registers and reports)
• Increased use of patient self-management plans
• Evolving roles among practice staff to better meet patient demand
• Increased uptake of practice nurses in chronic disease management
• Better relationships with external agencies contributing to patient care (i.e.hospitals and allied health professionals).
• To view practice testimonials and more comprehensive case studies of what some practices have achieved, click here.

 

Requirements of Participation 

To be involved in the APCC Program, a practice needs to meet certain minimum requirements, which are:to: 

• have one GP and one staff member attend each of the learning workshops 
• undertake work in each of the 'waves' topic areas 
• submit at least one PDSA every month for each topic area 
• complete and submit data on a monthly basis for at least 18 months 

 

Set aside dedicated time to work on the Program
Practices are required to commit time each week to undertake Program work. While significant time is not required, regular dedicated time helps participants move through their change agenda at a reasonable pace. 

Attend and actively participate in the learning workshops
The program consists of one orientation session and three learning workshops. There will be activity periods of approximately three months between learning workshops 1, 2 and 3 when practices will be able to test and implement change in their organisations.

Practices will continue to submit data for a subsequent 12 months after learning workshop 3, to track their progress. 

Collect and report data, and use PDSA cycles to test and implement change
During the activity periods, practices test and implement change ideas through the Plan, Do, Study, Act (PDSA) cycles. They also submit monthly measures in each topic area to track their improvement. 

 

Funding for Practices

As state, local, and virtual waves each require different amounts of time away from the practice, funding varies for each. The IFA will fund practices the following amounts for participation: 

State Wave $7,500
Local Waves $2,000
Virtual Waves $1,000
(All amounts are GST exclusive.)

While there is more time away from practice in the state based events, participants do benefit from a richer workshop environment and the opportunity to network, share experiences with, and learn from, a greater number of people, from different areas.

 

Professional Development Points for GPs and Practice Staff

Participants from practices involved in the Collaborative Program are eligible to earn points with the following providers for their involvement in APCC activities: 

RACGP QA&CPD
Royal Australian College of General Practitioners Quality Assurance & Continuing Professional Development 

ACRRM PDP
Australian College Rural and Remote Medicine Professional Development Program

RACN CNE
Royal Australian College of Nursing Continuing Nursing Education

AAPM CPD
Australian Association of Practice Managers Continuing Professional Development 

IFA has applied to the following organisations for points. 

• RACGP
• ACRRM
• RACN
• AAPM

For Divisions

Click here to download a PDF booklet with information relating to Divisions.

Media Contact

For all media queries, please speak to Rebecca Esteve, Communications and Marketing Coordinator,
or Kirsty Dummin, Communications Officer.

Improvement Foundation
P: (08) 8422 7400 
PO Box 3645 Rundle Mall SA 5000

Who’s Involved

The Australian Commonwealth

The Australian Primary Care Collaboratives Program is funded by the Australian Government Department of Health and Ageing.

 

The Improvement Foundation

The Australian Primary Care Collaboratives Program is delivered by Improvement Foundation (Australia) Ltd (IF). IF is a not-for-profit organisation whose core business is to provide expertise in the development and delivery of quality improvement programs to bring about systems change. IF was established in Adelaide as an Australian not-for-profit organisation and registered as an Australian public company on 30 November 2006.

If you'd like to know more about Improvement Foundation please visit www.improve.org.au

Events

May

COPD & CDPSM Learning Workshop 3
21 & 22 May, Brisbane

QIP/AGPAL Quality Around the World Conference
20 - 22 May, Melbourne

Articles

December 2009

Quality Improvement in Action: Learning from four years of collaborative access work in Australia
Quality in Primary Care, 2009; Issue 17, p71 - 74
Download PDF

Health Update: Improvement Foundation (Australia) Ltd (IF)
Quality News, Summer 2009, p24 - 25
Download PDF

Are general practice networks 'ready' for clinical data management?
Australian Family Physician, Vol. 38, no. 12, December 2009, p1007
Download PDF

 

October 2009

Holistic approach inspires GP of the Year
Medical Observer 9 October 2009, p 4
Download PDF

 

September 2009

Collaboratives - Team effort pays off
Australian Doctor 4 September 2009, p40
Download PDF

What patients want
Australian Doctor 18 Sept 2009 p35
Download PDF

 

August 2009

Collaboratives Program expands scope
Australian Doctor 21 August 2009, p6
Download PDF

 

July 2009

All aboard for data blitz
Australian Doctor 3 July 2009, p42
Download PDF

 

May 2009

APCC add new measures to practice reporting program
Pulse + IT May 2009, p20-21
Download PDF

 

March 2009

GPs urged to measure up
Weekend Australian - Weekend Health 21-22 March 2009 p14
Download PDF

AGPAL turmoil over patient outcomes
Australian Doctor 27 March 2009, p3
Download PDF

Media Releases

June 2009

"Improvement Foundation Australia to introduce new topics for Australia Primary Care Collaboratives Program"
Download PDF

May 2008

"Collaboratives Program will continue"
Download PDF

December 2007

"Improvement Foundation Australia awarded National Primary Care Collaboratives tender"
Download PDF

Updates

November 2009 - Dr Michael Nolan wins John Aloizos Medal

At the 2009 AGPN National forum, the John Aloizos Medal (JAM) winner was awarded to Dr Michael Nolan from Bayside General Practice Network. The prestigious medal is the highest honour of the Network and recognises the individual commitment of a member to the Network. Dr Nolan participated in the wave 2 of Phase 1 of the APCC Program for Cheltenham Park Family Medical Centre.

 

October 2009 - Dr Ayman Shenouda wins RACGP GP of the Year

Congratulations to Dr Ayman Shenouda, of Glenrock Country Practice, who won the RACGP GP of the Year award. Dr Shenouda participated in Phase 1 of the Program.

View article in Medical Observer (PDF)

 

July 2009 - IF introduces two new topics to the APCC Program

Improvement Foundation introduces the topics of Chronic Obstructive Pulmonary Disease (COPD) and Chronic Disease Prevention and Self Management (CDPSM). These topics will be introduced to general practices through a national Program wave starting in August 2009.

View Media Release (PDF)

 

June 2009 - Improvement Foundation introduces new measures to the APCC Program

Improvement Foundation, in consultation with the APCC Expert Reference Panels, Diabetes Australia and Heart Foundation Australia, has introduced new measures to the APCC Program. 

View Media Release - New Measures (PDF)

View article in Pulse+IT (PDF)

Visit the measures page on the APCC website

Program Support

Participating practices in the APCC Program are supported in the following ways:

Support from their Division

Hands-on Program support and guidance is available from the Division. The Division is a key resource for participating practices; providing advice, support and assistance on all aspects of the Program.

Improvement Foundation provides Program support and training to participating Divisions on all aspects of the Program.

Program materials and support

Improvement Foundation provides the following resources for APCC Program participants:

• Collaborative handbook
• Collaborative workbook
• Website
• Online data reporting
• Online resource library
• Analysis of monthly data
• Monthly feedback
• Local and national co-ordination and networking.

1001 Stories

In October 2009 we welcomed our 1001st Collaborative practice - so that's 1001 stories to share!

Practices have been celebrating by generously sharing one of their change ideas with us. (For more information about Change Principles and Change Ideas click here)

We're posting some of these to this site as 'virtual tabletops'. If you see this icon there is a virtual tabletop associated with this story.

What is a virtual tabletop?

At the APCC workshops we often have round-table discussions, or 'tabletops', where a practice will come to the table to share their ideas, experiences and improvement how-tos with others. The participants at each table then have time to discuss, ask questions and offer suggestions of their own. The tabletops are very popular with participants, but what happens if you can't attend a workshop? We don't want you to miss out on all those great ideas, and the opportunity to contribute to the discussion, so the 'virtual tabletops' were created.

Please feel free to join one of the 'virtual tabletops' to comment on these stories, and indicate how you might adapt or extend these ideas to use in your own practice. We'll be posting stories regularly, so stay tuned...

Do you have a story of your own? We'd love to hear about a change idea that your practice has implemented. Please send your story to tony.lembke@improve.org.au

Here are the first of our 1001 stories...

Access and Care Redesign
Chronic Disease

Newsletter

Improvement Foundation distributes the APCC newsletter bi-monthly, to all those involved in the APCC Program.  

December 2009

November 2009

September 2009

April 2009

March 2009

 

Click here to view archived newsletters from 2007 - 2008

About the APCC

The Australian Primary Care Collaboratives (APCC) Program helps general practitioners (GPs) and primary health care providers work together to:

• Improve patient clinical outcomes
• Reduce lifestyle risk factors
• Help maintain good health for those with chronic and complex conditions and;
• Promote a culture of quality improvement in primary health care.

Ultimately, the APCC Program aims to find better ways to provide primary health care services to patients through shared learning, peer support, training, education and support systems.

The Program uses Collaborative methodology, designed by the Institute for Healthcare Improvement in the USA. This methodology provides a generic quality improvement model that can be applied to achieve incremental, rapid and locally relevant improvements across a broad range of clinical and practice business issues.The APCC Program began as a three-year, $14.6 million initiative funded from the Focus on Prevention - Primary Care Providers Working initiative announced in the 2003 – 2004 Australian Government Budget. The Program is of international significance.

In December 2007 funding was granted for Phase 2 of the APCC Program. Phase 2 is delivered to Divisions and their member practices by the Improvement Foundation (IF).

In July 2009 additional funding was granted to Improvement Foundation to deliver a national wave focusing on two new topics, Chronic Obstructive Pulmonary Disease (COPD), and Chronic Disease Prevention and Self Management (CDPSM). This wave is delivered in addition to the; Access and Care redesign, Diabetes and Coronary Heart Disease (CHD) topic waves.

For more information on Collaboratives see What is a Collaborative?

Getting involved

To find out how you can get involved in the APCC Program, please contact either:

• Improvement Foundation office
• Your Local Division of General Practice

Download a copy of our latest brochures here:

• APCC Program Brochure PDF
• Local Collaborative Wave Brochure PDF
• Virtual Collaborative Wave Brochure PDF

What’s new

The What's new pages have the latest Updates on APCC Program news and milestones, what Events are coming up and where, who's publishing Articles and stories about the Program and what they are saying, Media Releases generated by IF about the Program and, in case you want to contact IF for comment about the Program, Media Contact details.

 

Case Studies

The Australian Primary Care Collaboratives (formerly the National Primary Care Collaboratives) Program encourages practices across Australia to share ideas about the improvements and positive changes they have made through networking at workshops as well as through their Division.

This page provides links to a variety of case studies provided by some practices participating in the APCC Program who have made significant improvements to their systems and the care they provide to their patients. In the case studies featured here, practices can see the step-by-step process a practice has taken to implement change.

The case studies are sorted first by topic area then by Change Principle. Change Principles form a key element of the APCC Program. To find out more about the APCC Change Principles click here.

If you have made some improvements and would like to share your story with others, please fill out this case study template and send it to kirsty.dummin@improve.org.au

 

Local health expo builds community goodwill and increases awareness of preventative health care

Keperra Family Practice

“As the practice manager, I always looked at the big picture, and often struggled to achieve the end. The Collaboratives taught me how to take ‘baby steps’ in everything we do. Consequently, larger projects, like a health expo, are now more achievable.” Click here to read more.

 

Introducing a Fluvax Clinic

Adelaide City General Practice

“As a new practice nurse, starting in a new change of career, the APCC Program was truly a great way to learn and network... My mind now boggles with the many things we could do to improve our patient care..." Click here to read more.

 

Updating Patient Information to meet Accreditation, Ensure Accuracy and Better Patient Care

East Geelong Medical Centre

“Developing and implementing the updating patient information form as part of the APCC Program was a great way to improve smoking and allergy status...which benefits in the
accreditation process..." Click here to read more.

 

Click here to view archived Case Studies

Sharing Ideas

One of the most powerful elements of a collaborative is the opportunity for participants to actively share knowlege and experiences with their peers. They are able to hear one another's ideas and generate new ideas that will translate to improvements in their own unique working environment. Collaboration between practices in the APCC Program has enhanced their understanding of the overall role in the delivery of primary care services to their communities, and allowed for the spread of ideas to make 'the possible' become 'the usual'.

If you are looking for some inspiration visit the 1001 Stories page to see a selection of improvements APCC practices have made. Some of these stories have been chosen to become interactive Virtual Tabletops where visitors to the site can ask questions and offer comment. The Case Studies pages offer more detailed stories of improvements within APCC practices and the bi-monthly APCC Newsletter will keep readers up to date with all the goings-on within the Program.

The collaborative process of the APCC Program has been immeasurably enhanced by the enthusiasm of the GPs, practice nurses, practice managers, and reception staff who have shared their skills, knowlege, ideas and experiences with fellow participants. Thank you to all of the practices who have so generously allowed us to share their stories through this website.