About the Medicare Local National Wave

Supporting Medicare Locals to embed Continuous Quality Improvement

The Improvement Foundation is now delivering comprehensive training that will give your Medicare Local team the skills to build continuous quality improvement (CQI) systems into all aspects of your organisation.

 

Through your involvement in this wave, you will benefit from networking and team building opportunities with staff from other Medicare Locals and sharing ideas and experiences with fellow professionals who are facing similar challenges.

 

For more information about this innovative new wave, click on the headings below:

 

What is the Medicare Local National Wave?
Working through a ‘real world’ problem

Developing a Quality Improvement Plan

Funding for your QIP

Sharing ideas with other Medicare Locals

Workshop dates

How is this wave different?

Improve the way you work

What is required of participating Medicare Locals?

Payments for Medicare Locals

Measuring for improvement

What happens to my data?

How do I participate?

What participants said about QUISP training

Case Studies

 

What is the Medicare Local National Wave?

This innovative wave provides a great opportunity for your Medicare Local to take part in:

• A comprehensive quality improvement training program
• Working with peers from other Medicare Locals
• Developing a quality improvement plan for your Medicare Local
• Engaging with local practices and health services.

The wave will include working through a ‘real world’ problem relevant to your Medicare Local. You’ll hear from experts in quality improvement, work towards embedding continuous quality improvement (CQI) skills and tools into your everyday work, and have ‘protected time’ to work with your team to problem solve, innovate and plan to implement changes.

 

Working through a ‘real world’ challenge

The Improvement Foundation (IF) will work with your team on a ‘real world’ challenge relevant to your organisation – you pick the specific area you would like to improve and we give you the skills to tackle it. 

 

We’ll support your team to apply your new quality improvement (QI) skills to your specific challenge and then support you to embed your learnings by developing a Quality Improvement Plan (QIP).  You can get the most out of working through your challenge by choosing an area that you think will directly relate to your QIP.

 

By participating in this wave, you’ll develop the skills to build capacity for QI into all aspects of your Medicare Local.

 

Developing a Quality Improvement Plan

During the activity periods of the Medicare Local National Wave, IF will support your

team to develop a QIP that engages your general practices and other health services and supports them to move towards best practice in the management and prevention of chronic disease.

 

Your QIP activity will include a Priority Workshop for your general practices and health services to attend. IF will support you with the design and implementation of this workshop. Some of the benefits you can expect to see through delivering a Priority Workshop include:

• Engaging your practices and health services
• Collecting data, benchmarking and displaying local results
• Assisting your practice and health service professionals to understand the value of measurement and the role of quality improvement in improving patient care
• Engaging health service professionals to identify local health needs and priorities
• Working with your health services to identify strategic solutions to local priorities
• Embedding CQI to address priority areas within your Medicare Local.

We’ll help you with the recruitment process by delivering a recruitment webinar and providing you with recruitment materials.

 

Funding for your QIP

IF will make available an incentive payment of up to $4,000 for each practice or health service (to a pre-agreed total) who engages with your Medicare Local and participates in the QIP.  We’ll work with Medicare Locals to develop and test a simple funding model which supports their general practices and health services to participate in your QIP.

 

IF will work with your Medicare Local to determine an appropriate financial incentive model for your QIP, and to determine exactly how many practices or health services will be funded to participate.

 

While participating general practices and health services will need to meet some specific milestones, there will also be flexibility for your Medicare Local to adapt elements of the financial payment in accordance with the design of your QIP.

 

When developing your incentive payment model, there will be some minimum requirements that need to be met, such as :

• Payment at sign up
• Regular submission of quality indicators
• Achieving agreed outcomes, including participation in quality improvement activities, such as a priority workshop.

Within this structured incentive model there is also flexibility for your Medicare Local to adapt elements of the financial payment in accordance with the design of your QIP. For example:

 

Medicare Local A	Medicare Local B	Medicare Local C
Medicare Local A provides a $1500 sign up payment to participating health services, a further $1000 for regular submission of quality indicators and a final payment of $1500 for health services that meet agreed outcomes, such as participation in quality improvement workshops.	Medicare Local B provides a sign up payment of $500, a further $1500 for regular submission of quality indicators and $2000 for health services that meet agreed outcomes.	Medicare Local C provides a smaller overall incentive to each participating practice or health service. This enables Medicare Local C to engage with additional practices and health services within their region.

Course content

Throughout this wave you’ll learn to use many simple yet highly effective QI tools and techniques to investigate, test and implement quality improvement ideas in your workplace, such as:

• The psychology of change
• Spread and sustainability of change
• Model for Improvement
• Analysing information and data
• Measuring improvement
• Process mapping
• Root cause analysis.

 

Sharing ideas with other Medicare Locals

This wave will bring your Medicare Local team together with colleagues from around Australia in an environment of peer-to-peer learning and sharing to promote innovation and ideas for improvement.

 

Your team will benefit from networking and team building opportunities with peers from other Medicare Locals, and sharing ideas and experiences with fellow professionals who are facing similar challenges.

 

Workshop dates

Three of your lead staff members will attend an orientation session and participate in three face-to-face workshops over five months, with supported activity periods in between. Learning workshops (LW) will be held on the following dates:

• LW1 - Friday 10 Feb 2012
• LW2 - Friday 23 March 2012
• LW3 - Friday 11 May 2012

 

How is this wave different?

This wave differs slightly from previous Australian Primary Care Collaboratives Program waves. Modelled on the highly effective QuISP (Quality Improvement Skills Program), some of the key differences include:

 

• This wave is only open to teams from 14 of the first tranche of 19 Medicare Locals
• Your team will participate in three face-to-face workshops over five months, with supported activity periods in between
• IF will deliver four virtual training webinars so you can involve more of your Medicare Local team in CQI
• Before the first workshop, IF will work with your Medicare Local team to identify a local priority that you would like to focus on throughout the wave. Using what you’ll learn at the workshops and with our support throughout, you can then apply your new skills to your unique local priority.

 

For more information about IF’s QuISP Program, visit the IF website: http://www.improve.org.au/our-work/quality-Improvement-skills-program/

 

Improve the way you work

If your team participates in the Medicare Local National Wave you can expect to benefit from:

• A flexible and supported approach to engage your organisation in CQI
• An increase in knowledge and skills within your team through the practical application of quality improvement approaches to real world problems
• Flexibility to bring your own local priorities for discussion at workshops. This will enable you to respond to primary care needs of immediate local importance
• The ability to respond to and implement change more effectively.

 

What is required of participating Medicare Locals?

There are some minimum requirements that participating Medicare Locals must meet:

 

• Three relevant staff members to attend and actively participate in orientation and all learning workshops. As each workshop builds on the work completed in the one prior, it’s important to have the same three team members attend all workshops
• Develop a QIP and engage your local general practices and health services in CQI
• Submit Plan, Do, Study, Act (PDSA) cycles
• Deliver a Priority Workshop
• Collect and submit data on a monthly basis.

  

Payments for Medicare Locals

IF will fund the costs of:

• Reasonable travel and accommodation for all participants to attend the Medicare Local National Wave workshops
• Agreed operational and other associated costs of delivering workshops
• Incentive payments for general practices and health services who participate in your QIP.

 

Measuring for Improvement

The ability to measure change and improvement is at the heart of the collaborative methodology. Measuring will help you identify opportunities for improvement, and you can track where your change efforts are getting results.

 

Through IF’s secure online web portal, participating Medicare Locals will be able to:

 

Benchmark your Medicare Local and your general practices and health services

• Use feedback graphs to identify areas for improvement
• Track the results of your improvement work using feedback graphs.
• To read more about measures, the web portal and how the measures are submitted to the web portal click here.

 

What happens to my data?

Any Medicare Local, practice and health service data that is submitted by you is aggregated to protect your privacy and then made available to you each month on the IF secure web portal.

 

How do I participate?

Places are limited. Register your interest by completing an expression of interest (EOI) form and faxing it to IF on (08) 8231 6690.

 

To download the EOI form click here.

 

If you are unable to download the form contact IF at enquiries@improve.org.au or phone (08) 8422 7400.

 

Registrations Close Friday 27 January 2012

We will contact you by Tuesday 31st January to confirm your registration and discuss an orientation time.

 

What participants said about QUISP

 

“This Program has given our team the tools to help us identify improvement opportunities and the skills to be able to generate change and evaluate the process.”

 

“The tools we learnt about during QuISP can be easily applied to other areas of our work, and other departments within our organisation.”

 

“Thanks to our involvement in QuISP we now have the skills to plan more effectively, identify risks, and ensure our goals are achieved!”

 

“At QuISP our team learnt how to identify priorities and then make changes in small, bite sized, chunks. We now focus on our successes!”

 

Case Studies

An organisation wanted to improve overall efficiency by educating all staff to follow a consistent process of data cleaning, creating, editing, filing and archiving electronic documentation. By applying tools learnt at QuISP, understanding of the structure of the network drive increased from 62% to 100% and confidence in applying the new process when using the network rose from 0 to 89%.

 

An organisation wanted to increase the uptake of a Lifestyle Modification Program (LMP). By applying quality improvement tools learnt at QuISP the team identified a significant increase (100%) in the uptake of the LMP. In addition to this the Division identified improved teamwork and improved external relationships as other benefits experienced through applying the skills and tools learnt at QuISP.

 

 

 

Hybrid Waves

A hybrid wave is a combination of national or state based workshops, and virtual workshops.

The national or state workshops are held in central locations across Australia. They run for between one and two consecutive days, bringing participants together from across Australia or a consortium of states.

The virtual workshops are generally delivered via webinar and/or teleconferencing. They are designed to allow greater learning flexibility for teams to participate in the Australian Primary Care Collaboratives (APCC) Program without leaving their practice or health service.

Participants in a hybrid wave will generally attend two state or national learning workshops, and between two and four virtual workshops over the course of the wave.

A hybrid wave begins with an orientation session where participants will be introduced to the wave and how it will operate. The workshops and support are delivered alternately face-to-face, and online (via GoToWebinar, teleconference, or other interactive media).

In between the state or national and the virtual workshops, practices and health services will have time called ‘activity periods’ where they’ll be able to use the Model for Improvement and PDSA (Plan, Do, Study, Act) cycles to implement changes in small manageable cycles and identify where change actually leads to improvement.

 

Website Feedback

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Combined State and Virtual Wave

The Improvement Foundation announced the introduction of a new wave of the APCC Program in November 2010. This wave will be delivered using a combination of the local and state based frameworks.

The Diabetes Prevention and Management wave is targeting NSW health services and will begin with individually tailored orientation sessions, followed by two Sydney state based learning workshops and four virtual workshops, across 18 months, including monthly data submission.

Learning Workshop (LW) Dates:

• State LW1, Sat 5 March 2011 (Sydney)
• Virtual LW2, week beginning Mon 16 May 2011
• Virtual LW3, week beginning Mon 25 July 2011
• State LW4, Sat 17 Sept 2011(Sydney)
• Virtual LW5, week beginning Mon 28 Nov 2011
• Virtual LW6, week beginning Mon 20 Feb 2012

For more information about the Diabetes Prevention & Management wave, click here.

National and State based | Local | Virtual

National and State Waves

National or State based Collaborative waves are held in central locations across Australia. They run for two consecutive days, bringing participants together from across Australia or a consortium of states.

A National or State wave begins with an orientation session where participants are introduced to the Collaborative 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.

Participants will attend three Learning Workshops over the course of the wave, which provides opportunity to network with peers and share stories of ideas and approaches in a supportive environment.

In phase two (2004-2011) of the APCC Program, three State waves have been completed:

• New South Wales, Queensland & Australian Capital Territory (Wave 1)
• Victoria & Tasmania (Wave 2)
• Western Australia, South Australian and Northern Territory (Wave 3)

Two National waves are currently in progress:

• Diabetes, Coronary Heart Disease and Access & Care Redesign (Wave 4)
• Chronic Obstructive Pulmonary Disease (COPD) & Chronic Disease Prevention & Self Management (CDPSM) (Wave 5)

To view program results, click here.

Local | Virtual | combined State & Virtual.

Access Resources

"Appointments - Getting it right"
Andrew Knight & Tony Lembke
January 2011, Australian Family Physician
Click here to access the article.

 

To download some useful Access and Care Redesign resources, please click on the links below.

Measuring Demand Information Sheet (sourced from Upper Mountains Medical Centre)

Measuring Demand Sample Tally Sheet (sourced from Upper Mountain Medical Centre)

Demand and Capacity Spreadsheet (click on the bottom tabs to access the different pages)

GP 3rd Available and Patient Satisfaction Spreadsheet (Click on the bottom tabs to access the different pages)

Measuring Access and Demand (extracted from the APCC Handbook 'Diabetes, Coronary Heart Disease and Access & Care Redesign)

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.

Increase in 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 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 it still works well.
• We are about to use Pen Tool upgrade to replace our book and our trawling through billing records."
Woodside Surgery, SA.

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.

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.

Acute Cases Management

We have made lots of changes to update our Chronic Disease registers and to keep them accurate by coding correctly. 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. 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 a different Dr if 'their' GP is fully booked."           Chancellor Park Family Medical Practice, QLD.

Database tidying and data 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

Local Waves

An APCC Program local wave will feature a series of workshops run by your network, or network group, in your local area. Local workshops are planned and delivered by the network, with the support of the Improvement Foundation. Participants generally take much less time out of practice to attend a local workshop than they do to attend a state based APCC Program workshop.

At the workshops participants share ideas and experiences with other each other. This helps participants to make improvements back at their practices. In between workshops, practices will have time called ‘activity periods' where they'll be able to use the Model for Improvement and PDSA (Plan, Do, Study, Act) cycles to implement changes in small manageable cycles and identify where change actually leads to improvement.

Local wave practices in the first phase of the Program achieved some outstanding improvements:

• 37% improvement in the number of patients with CHD whose last recorded blood pressure within the last 12 months was less than 140/90mmHg
• 207% improvement in the percentage of patients with diabetes whose last measured total cholesterol was less than 4 mmol/l within the previous 12 month
• 43% improvement in the number of patients with diabetes whose last recorded blood pressure within the last 12 months was less than or equal to 130/90mmHg within the previous 12 month
• 130% improvement in the percentage of patients with diabetes that had a diabetes Service Incentive Payment (SIP) claimed for them within the last 12 months.

Local waves are currently focussed on the topic areas of Diabetes, Coronary Heart Disease and Access & Care Redesign.

For more information on local waves, click here.

Closing the Gap

The Improvement Foundation is launching the 'Closing the Gap' local wave in June 2010. This local wave has been specifically designed to support health services to improve access to services and health outcomes for Aboriginal and Torres Strait Islander people. This exciting initiative is being launched in Queensland with interest expressed by 10 Divisions, who plan on supporting approximately 50 health services. The Improvement Foundation is working towards expanding this Program nationally and is currently in early discussions with the Victorian State Based Organisation.

For more information about Closing the Gap, click here.

The Collaboratives methodology is now embedded in our practice...
we will be looking to apply our learnings to other areas of the
practice such as asthma, immunisation and mental health.”

Dr Vadlamudi,
Biota Street Medical Centre, QLD,
Local wave practice.

National and State based | Virtual | combined State & Virtual.

Using the Web Portal

The web portal is a new way to communicate with the APCC Program. It will simplify Program reporting tasks (including monthly data uploads and PDSAs), allow greater access to Program resources, and save you time.

Improvement Foundation (IF) sends APCC practices their usernames, passwords and CAT (Pen Clinical Audit Tool) via email. IF will include all of the web portal user guides, and the Quick Start Guide below, as attachments. For more information about the web portal click here to view the About the web portal page.

For those users already signed up to the web portal, you can access your Web Portal Dashboard here (NB you will need your username and password to access this page).

Web Portal User Guides

Click here to download the complete web portal user guide for Wave 6 (Diabetes Prevention & Management).

Click here to download the complete web portal user guide (PDF).

 

PenCAT Support

If you run into any difficulties and need extra help, in the first instance talk to your CPM or Division support person. If they are not able to answer your questions contact IF on 1800 771 522 (Toll Free. Office hours only) or email data@improve.org.au

 

Virtual Waves

A Virtual Collaboratives wave is designed to allow greater learning flexibility for practices to participate in the Australian Primary Care Collaboratives (APCC) Program without leaving their practice to attend state or local workshops.

A Virtual wave begins with an orientation session where practices will be introduced to the virtual wave and how it will operate. The virtual workshops and support are delivered online, via iPresent, teleconference, or other interactive media as an alternative to face-to-face communication. This generally requires less time out of practice than other workshop styles and may suit practices where travel or other constraints do not readily allow time away from the practice.

In between workshops, practices will have time called ‘activity periods’ where you’ll be able to use the Model for Improvement and PDSA (Plan, Do, Study, Act) cycles to implement changes in small manageable cycles and identify where change actually leads to improvement.

Results

There were two virtual waves delivered as part of Phase 1 of the APCC Program. Virtual practices participating in the first phase of the Program achieved some outstanding improvements:

• 74% improvement in the number of patients on a statin
• 99% improvement in the number of patients with CHD whose last recorded blood pressure within the last 12 months was less than 140/90mmHg
• 379% improvement in the percentage of patients with diabetes whose last measured total cholesterol was less than 4 mmol/l within the previous 12 months
• 158% improvement in the number of patients with diabetes whose last recorded blood pressure within the last 12 months was less than or equal to 130/90mmHg within the previous 12 months
• 29% improvement in the percentage of patients with diabetes that had a diabetes Service Incentive Payment (SIP) claimed for them within the last 12 months.
• These results are relative to baseline and an aggregate of two virtual waves in Phase 1 as at Dec 2007

 

 

If you would like to know more about the APCC Virtual waves you can download the Virtual Wave brochure, speak to your Division, or contact Improvement Foundation.

National and State based | Local | combined State & Virtual.

Lifestyle & Risk Modification: Expert Reference Panel

Chairperson

Prof Rob Moodie

Chair of Global Health
Nossal Institute, University of Melbourne

Members

Dr Dale Ford

Improvement Foundation

Dr Tony Lembke

Improvement Foundation

Dr Lynne Davies

General Practitioner, Tintenbar Medical Centre
CHD Expert Reference Panel Chair, APCC

Dr Prasuna Reddy

Director
Health Services Implementation Research
Deakin University

Prof Stephen Colaguiri

Professor of Metabolic Health, University of Sydney

Dr Nancy Huang

National Manager, Clinical Programs
Heart Foundation

Dr Ralph Audehm

General Practitioner, Darebin Community Health
Diabetes Expert Reference Panel Chair, APCC

Prof Brian Oldenburg

Professor of International Public Health, Department of Epidemiology and
Preventive Medicine
Monash University, Australia
Bachelor of Science (Honours) in Psychology, University of New South
Wales
Master of Psychology, University of New South Wales
Ph.D., University of New South Wales

Marion Goodman

Lifestyle Sister at Barton Lane Practice
Registered Nurse
Cert IV Personal Trainer and Soft Tissue Therapist

Jan Chaffey

Practice Manager, Camp Hill Medical Centre
Australian Association of Practice Managers

Russell McGowan

Consumer's Health Forum of Australia

David Menzies

Population Health
General Practice Victoria

Sara Drew

GPLO Support Officer
General Practice Gold Coast

Prof Kerin O’Dea

Director of the Sansom Institute,
Division of Health Sciences, UniSA

Dr Igor Jakubowicz

General Practitioner, Knoxfield Medical Practice

Dr David Johnson

Kidney Foundation, Princess Alexandra Hospital

Dr Terry Rose

General Practitioner, Aberfoyle Park Medical Centre

Prof Danielle Mazza

Department of General Practice, Monash University

Chronic Obstructive Pulmonary Disease: Expert Reference Panel

Members

Judi Wicking

National Asthma Council Australia
Asthma and Respiratory Educator

Debbie Croydon

Team Leader
Brisbane South Division

Ms Kristine Whorlow

CEO – National Asthma Council Australia
D.A. Dip Ed

Bryan Clift

Patient Advocate
Australian Lung Foundation

Bonnie Bereznicki

BPharm (Hons)
Clinical Research Pharmacist, School of Pharmacy at the University of Tasmania
Temporary lecturer in Pharmacology and Pharmaceutical Science

Dr Anton Knieriemen

GP
Melbourne Wholistic Medicine

Pilvikki Absetz

(PhD, health psychology
Senior researcher
National Institute for Health and Welfare

Events Test

Events Test

Access & Care Redesign: Expert Reference Panel

Chair

Dr Andrew Knight

Medical Director of WentWest GP Education and Training, GP and visited Sir John Oldham’s National Primary Care Development Team for Training in 2003

 

Members

Dr Evan Ackerman

RACGP representative
 

Dr Peter Del Fante

Chief Executive Officer
Adelaide Western General Practice Network
 

Ms Judy Evans

Australian Prictice Nurses Association
 

Dr Tony Lembke

Tony has been a partner at the Alstonville Clinic in NSW for 12 years. He is Chairman of the Northern Rivers General Practice Network & GP Advisor to the Information Management & Parenting Support projects within the Division. He is also the Clinical Chair for the APCC.
 

Dr Robert Grenfell

Medical Director Westvic Division of General Practice and one of the leading thinkers in the Divisional movement

Diabetes: Expert Reference Panel

Chair

Dr Ralph Audehm

GP in Melbourne. Ran a project to improve diabetes care in 5 Melbourne Divisions
 

Members
 

Professor James Best

Diabetologist at University of Melbourne and Project Director for COACH which seeks to improve the care of diabetes in the community
 

Ms Robina Bradley

Project Manager at the National Institute for Clinical Studies who has been undertaking a scoping study of the needs for developing General Practice to better manage chronic disease
 

Dr John Buckley

GP at Pindara Medical Centre on the Gold Coast
 

Jan Chaffey

Immediate Past President
Australian Association of Practice Managers
 

Professor Stephen Colagiuri

Professor of Metabolic Health
University of Sydney
Diabetologist at UNSW and coordinator of the NHMRC guidelines on diabetes
 

Geraint Duggan

National Institute of Clinical Studies
NHMRC
 

Mr Gawaine Powell-Davies

Director, Centre for General Practice Integration Studies
School of Public Health and Community Medicine
University of NSW
 

Maryke Stockbridge

Primary Health Care Nurse
Kelvale Medical Group, WA
 

Ms Linda Zanette

Australian Practice Nurses Association
Practice nurse at the Camp Hill Medical Centre, QLD

Coronary Heart Disease: Expert Reference Panel

Chair

Dr Lynne Davies

GP at Tintenbar Medical Centre, NSW and on the board of the local Division of General Practice. She trained and worked in the UK before working in rural and remote areas of Australia and New Zealand.

Members

Dr Andrew Boyden

Medical Affairs Manager for the National Heart Foundation

Professor Derek Chew

Department of Medicine
Faculty of Health Sciences
Flinders University, Adelaide

Ms Amanda Fitzgerald

Australian Practice Nurses Association

Dr Dale Ford

Clinical Director, Improvement Foundation 

 

Professor Mark Harris

Executive Director
Centre for Primary Health care & Equity
University of NSW

Dr Lyndsay Hyde

Resevoir Medical Group

Dr Sue Phillips

Director
Research Implementation Program
National Institute of Clinical Studies
National Health and Medical Research Council
and expert on Collaborative methodology

Dr Margarite Vale

Clinical Associate Profesor of Medicine
University of Melbourne
Director, the COACH Program

Ms Jane Williams

President South Australia
Australian Association of Practice Managers

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.

Database Tidying and Data 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...read more

Acute Cases Management

"We have made lots of changes to update our Chronic Disease registers and to keep them accurate by coding correctly...read more

Data Cleansing

"In the last month, we have inactivated all patients who have not attended the surgery within the past two years...read more

The Rise and Rise of the Chronic Care Coordinator

“We have made quite a few changes but I believe the most significant change was brought about by employing a Registered Nurse to co-ordinate chronic disease management....read more

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...read more

Increase in 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...read more

Tracking GP Management Plans and Team Care Arrangements

"I think these days a CCC is a must...read more 
 

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 blue speech bubble link to view the story as a virtual tabletop, or click on the 'read more' links below to be taken to each practice's story.

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 and 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

How are the measures collected and submitted to the Program?

The IF team have been working with Pen Clinical Systems (PCS) to ensurethe Pen Clinical Audit Tool (CAT) will collect the measures from practices' clinical software.

The PCS Clinical Audit Tool (CAT) is a software tool that operates with the GP Clinical Desktop System to present the GP and other practice staff with meaningful clinical information. CAT scrutinises the aggregated patient information of the practice and presents it quickly and accurately in a way that is easy to understand.

IF and Pen CS provide all APCC practices the full version of CAT for free for a two month trial. At the end of the two month trial, CAT will revert back to a limited version that will only work with the standard APCC reports. The limited ‘standard reports’ version will remain on your practice system free of charge. 

Currently, CAT is compatible with the following clinical software:

Medical Director 2 
Medical Director 3 
Best Practice 
Genie 
Zedmed 

If you are not using any of the above clinical software you can submit your monthly data by logging in to the web portal, and manually entering it.

Note - We have provided all clinical software providers with all the information they need to make their software compatible with CAT. You may need to ask your clinical software provider to update their software to make it compatible with CAT.

To find out more about the PenCAT visit PenCAT Support

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?

Data submission testimonials

"When I’m driving I check the speedo, my rear view mirror & watch my fuel & temperature gauges, to check how I am travelling, to see if I am safe & to ensure a timely arrival. In life we monitor data constantly, but sometimes in General Practice we monitor data piecemeal.  By providing data regularly to a collating body that analyses it and then returns that data in a measurable and informative way, I can see exactly how I am travelling, build on my strengths and eliminate my weaknesses. Analysed data helps my practice create a profile of disease and morbidity which in turn can be used realistically to enable us to target areas of need and improvement within the practice and indeed contribute to our community’s health in a meaningful way"  - Dr Nick Stephens, Daisy Hill Medical Centre, Qld

“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! It has engaged us as a team [clinical + admin] all working towards the same goal of improving our patients' health."  - Dr Alison Edwards, Broughton Clinic, SA

“The new measures for CHD and diabetes gave us renewed interest in improving patient care. As staff at the practice changed we found it really useful to look at the Access data to monitor how changes to the appointment system and staffing levels have impacted on the measures. We also found that educating new staff about our systematic approach to patient care means that knowledge of the Collaborative approach is passed on from old to new staff members."  - Dr Lynne Davies, Tintenbar Medical Centre, NSW

"Our monthly results continue to stimulate discussion amongst the team about how we approach patient care, and gets us thinking about how we manage key issues. With clear data, we can continue to keep track of how we’re going and what needs to be done next."   - Carole Meade, Brooke Street Medical Centre, Vic 

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 developing 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.

Top

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

Improvement Foundation (Australia) Limited - Privacy Policy

 

 

In this Privacy Policy (Policy): 

• a reference to "us", "our" or "we" is to the Improvement Foundation (Australia) Limited (Australian Company Number 122 939 299).
• Personal Information means information or an opinion about an individual whose identity is apparent or can reasonably be ascertained from the information or opinion. 
• Website means all of the pages located on the website you are currently viewing being www.improve.org.au or the website www.apcc.org.au (APCC Program Website).

 

We respect and protect your privacy

 

Thank you for visiting our Website and for reviewing our Policy. We have created this Policy in order to demonstrate our firm commitment to your privacy.  We are subject to the National Privacy Principles which are set out in the Privacy Act 1988 (Act). This Policy is part of our compliance with the National Privacy Principles.

 

This Policy sets out how we collect, use and disclose information (including Personal Information) that we obtain from you (including via our Website or through other dealings with you).

 

 

What information do we collect?

 

We will only collect Personal Information about you from you (including via any emails you send to us via our Website).  For example, you may provide us with Personal Information (such as your name and contact details) via the APCC Program Website in order to receive information from us about the APCC Program. 

 

Through technology we may automatically record details including your internet address, domain name and the date and time of your visit to our Website (including the web pages viewed), your browser and operating system. Where we use cookies to collect information you can disable cookies on your computer by changing the security and privacy settings in your browser. We do not collect Personal Information about you if you do nothing during your visit to our Website but browse (including downloading information). If you linked to our Website from another website then that information will also be recorded. We may use this information for statistical analysis.

 

 

How we will use Information collected or provided?

 

Generally, we use information (other than Personal Information) collected from your visit to our Website to assist us in deciding how to improve our Website (including its utility, content and accessibility) and to monitor the users and usage of our Website.

 

We will only use your Personal Information for the purpose for which it is provided.  For example:

 

• if you provide Personal Information (such as your name and contact details) via the APCC Program Website in order to receive information about the Program we will use your Personal Information to provide such information to you.
• if you are applying for employment with us, we will use your Personal Information to assess your application and we may also use this to contact you.

 

 

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Unless required by law we will not sell or disclose your Personal Information to any other person or company unless we have your prior consent.  Your Personal Information will only be available to our relevant employees and contractors.

 

 

How do we keep your Personal Information secure?

 

We take reasonable measures to ensure that any Personal Information we hold or disclose about you is complete and correct.  We also take reasonable measures to protect your Personal Information from misuse, loss, and unauthorised access, modification and disclosure.   We will destroy or delete any of your Personal Information which we no longer need to retain.

 

If you email us any information (including Personal Information), it is sent at your own risk, as it may not necessarily be secure against interception.

 

 

Accessing Personal Information and contacting us

 

You can ask us to provide you with access to the Personal Information we hold about you.

We will comply with any such request except where the Act allows us to refuse to do so.

We do not generally charge for providing such access but we may do so in certain circumstances.  We will try to respond to your request within 10 days.  We will correct any Personal Information we hold about you if you notify us that the same is incorrect.

 

If you wish to contact us about the Personal Information we hold about you or generally about our Policy please write to Improvement Foundation (Australia) Limited, Attention Chief Operating Officer, Level 5, 19 Grenfell Street Adelaide, SA 5000 or email us at enquiries@improve.org.au

 

 

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When you leave this Website, you will be going to websites that our beyond our control. Such third party websites may collect Personal Information or other information from users. Our Policy does not apply to any third party websites.  We encourage you to read the Privacy Policies of any third party websites.  You may not link to our Website without our prior approval.

 

 

Change to Policy

 

We may change this Policy at any time.  If we do so, we will include a notice on our Website.

 

Brochures

The following APCC Program Brochures are available for download:

  To find out more about the Diabetes Prevention & Management wave of the APCC Program view -
  New Wave, New Model, New Topic Mix
  Diabetes Prevention and Management wave. Recruiting now.

 Download PDF

 

 To hear how other health services improved diabetes care through the APCC view -
 See how the APCC Program helped these services improve diabetes care... 

  Download PDF

 

 

 To find out more about the Closing the Gap local wave of the APCC Program view - If you'd like to help
 improve the health of Aboriginal & Torres Strait Islander People, consider the APCC Program - Local wave

 Downlaod PDF

 

 For general information about the APCC Program, view - If you'd like to create a better
 practice all 'round, consider the APCC Program.

 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 - If you'd like to create a better
  practice all 'round, consider the APCC Program - Local wave

  Download PDF

 

 

  To find out more about the 'virtual' waves of the APCC Program view - If you'd like to create a better
  practice all 'round, consider the APCC Program - Virtual wave

  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

Improvement Foundation

Phone: 08 8422 7400

Toll Free: 1800 771 522

Fax: 08 8231 6690

Level 5, 19 Grenfell St, Adelaide SA 5000

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 either Alison Coughlin or Colin Frick.

Alison Coughlin - National Program Director
0438 691 283

Colin Frick - Chief Operating Officer
0410 790 187

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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 90 Divisions and over 1100 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

The graphs in the following documents are not intended for academic or research reference. They are produced for the purposes of managing, tracking and monitoring improvements through the APCC Program.

• Diabetes Prevention and Management
  

To view a PDF analysis of the results for each completed APCC Program topic, please click on the topic name below.

• Diabetes

• Coronary Heart Disease

• Access & Care Redesign

• Chronic Obstructive Pulmonary Disease

• Chronic Disease Prevention & Self Management
  

 

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For Phase 1 Results, click here.

 

 

The APCC Program

There is sound scientific evidence which tells us that current primary health care practices can be greatly improved, however, there is a gap between what we know and what we do. The Breakthrough Series Collaborative methodology is designed to help organizations close that gap by creating a structure in which teams can easily learn from each other and from recognised experts in selected topic areas.

 

Collaborative Methodology

The Improvement Foundation has adapted the Breakthrough Series Collaborative methodology and applied it as the framework for the Australian Primary Care Collaboratives (APCC) Program.

With the APCC Program:

• Colleagues get together at a series of learning workshops.
• Participants exchange ideas, share experiences, and learn • from experts about practical quality improvement skills.
• Participants learn how to make and test changes using • the Model for Improvement* which includes the 3 Fundamental Questions and Plan, Do, Study, Act (PDSA) cycles.
• Through shared learning, teams from a number of • general practices work together to rapidly test and implement changes that lead to lasting improvements.

The Collaborative methodology promotes rapid change. It works because:

• It is straightforward and structured.
• There is dedicated support for participants.
• It promotes ‘protected time' (time specifically set aside • for quality improvement work), for participants to spend together solving problems as a team.
• It is designed to implement change in small • manageable cycles and identify where a change actually leads to an improvement.

Breakthrough Series Collaborative methodology, first developed in the USA by the Instititute of Healthcare Improvement, has been applied to a wide range of management challenges. It was originally applied to healthcare systems in the USA, and has been adopted in other countries, including the UK, Scotland, Canada and New Zealand.

The APCC Collaborative Framework

The Collaborative framework, as used in the APCC Program, starts with the selection of Program topics, then Expert Reference Panels (ERPs) are formed to develop aims, measures,  change principles' and ‘change ideas' for each topic. This work is then compiled into the Program handbook. Practices that participate in the Program attend an orientation session and a series of learning workshops, undertaking improvement/change activities in their health service during activity periods and collecting monthly data to track their progress.

Role of the Expert Reference Panels (ERPs)

The ERPs consist of a range of research and clinical experts in each particular topic area of the Program. Their job is to identify the topic aims, measures, change principles, develop strategies and ideas for implementing change and to suggest measures for tracking these changes.

Change principles and change ideas

The change principles are milestones that the practice should aim to achieve, while change ideas are the practical steps that can be used to achieve them.

Aims and measures

Each topic in the Program has a specific aim. Aims are targets that will assist in achieving the overall objective for the Program. Measures are the data collected for tracking improvements. To view the current Program measures visit http://www.apcc.org.au/about_the_APCC/program_results/program_measures/

Waves

Health services that join the APCC Program participate in a ‘wave'. A GP and a staff member from each health service come together with other health services in their wave to participate in the Program. A wave is made up of an orientation session followed by a series of learning workshops. These events are spread out over approximately a nine month period, with activity periods inbetween, and a further 9 months of data submission after the final workshop. There are currently four types of 'waves' in the APCC Program; National and State based; Local; Virtual and combined State & Virtual.

Measuring for Improvement

Health services collect baseline data at the beginning of their Program wave. This provides an important snapshot of their position before they begin making improvements. Health services track their improvements through monthly data submissions.

Learning workshops

Learning workshops allow participants to hear from topic area and quality improvement experts and actively share knowledge and experiences with their peers in the wave.

Activity periods

These are periods of time between and after learning workshops. They enable the practice team to test ideas using the Model for Improvement and carry out change.

The Model for Improvement

The Model for Improvement provides a framework for developing, testing and implementing changes.

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

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@improve.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 organisation. 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.

 

Portal and PenCat User Guides

For practical step-by-step guides on how to use the web portal and the Pen Clinical Audit Tool (CAT) visit the Using the Web Portal page on this site.

 

For more information about how the web portal can benefit you, download one of the following fact sheets.

• Measuring for Improvement in the Web Portal
• Your Health Service: Measuring for Improvement in the Web Portal
• Your Division: Measuring for Improvement in the Web Portal

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 and Diabetes Prevention & Management wave (NSW)

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) 

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

Practices & Health Services

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 80 Divisions and over 1000 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).

 

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 'wave's' topic areas 
• submit at least one PDSA every month for each topic area 
• complete and submit data on a monthly basis for at least the duration of the wave 

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 (all amounts are GST exclusive.): 

State Wave $7,500 - 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.

Hybrid Wave $4,000 -  A hybrid wave offers a combination of state based events and virtual workshops.

Local Waves $2,000 - Local waves are delivered by the Division or Medicare Local, to their member practices and health services, in their local area.

Virtual Waves $1,000 - Virtual workshops are delivered via webinar and teleconference and require less time out of the practice than other workshop types.
 

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 

• RACGP
• ACRRM (on request)

Divisions & Medicare Locals

The Australian Primary Care Collaboratives (APCC) Program is one of the largest health quality improvement programs in Australia. The APCC works with many organisations to introduce a range of improvements in participating practices and health services across Australia.

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 in small cycles so they are manageable
• Changes are measured so that the improvement can be demonstrated.

Benefits to Divisions and Medicare Locals

Just some of the benefits of being involved with the Program that your Division or Medicare Local may see are:

• Improved health outcomes for patients
• There’ll be training and development for Division or Medicare Local staff that will help them better support practices and health services
• Enhanced collection and reporting of practice level data will help your Division or Medicare Local target areas for improvement and help inform strategic and business plans
• In some cases, the information will help you report on the NPIs and support business cases for health improvement initiatives
• Practices and health services participating in the program will make improvements and local leaders will emerge who will help your Division or Medicare Local further your local quality improvement agenda
• A shift from reactive individual patient care to proactive population based care
• Improved communication between your Division or Medicare Local and participating practices and health services.

Payments for Divisions and Medicare Locals

IF will provide you and your team with training and support to help you achieve your core funding objectives, and embed continuous quality improvement into the work you do with general practices and other health services in your region.

As part of the health reform agenda, Medicare Locals are now directly funded to support general practices and other health services embed quality improvement activities across their work. As such, no specific payment is available for Medicare Locals and Divisions to participate in this Collaborative wave. However, IF will fund the costs of travel and accommodation for all participants, including Medicare Local, Division, general practice and other health service teams to attend workshops.

Funding for practices and health services

As each wave requires different amounts of time away from the practice or health service, funding will vary from wave to wave. Each wave's brochure will contain information about what funding is available for participants.

What is required of my Division or Medicare Local?

IF will be on hand to guide you each step of the way. These are the key activities or steps involved:

• IF will contact Divisions or Medicare Locals prior to a wave to seek expressions of interest
• We’ll work together to finalise your participating practice numbers
• Your Division or Medicare Local would then provide support to participating practices or health services
• Participating Divisions or Medicare Locals will be required to complete monthly and wave based reporting. These reports are template based and relate to practice performance in the Program.
• Initially, you’ll promote the Australian Primary Care Collaboratives (APCC) Program within your Division or Medicare Local, recruiting and supporting practices or health services participating in waves.

Once practices or health services have been recruited into a wave, you’ll provide a range of Program support functions to participating practices or health services. This includes coaching and motivating practices to apply and use the Program’s Model for Improvement, and other Quality Improvement techniques. IF will provide full training and support to your staff prior to the first wave, to enable them to provide Program support to your practices and health services.

Local waves

Following a national or state wave, your Division or Medicare Local may choose to promote and hold your own local workshop series. IF will assist you with the planning and implementation of a local Program and we will provide the funding for the agreed operational costs associated with the workshops. When delivering the Program locally, you may choose to partner with other Divisions in your area (to save costs or increase numbers).

Virtual waves

Some participants may find it difficult to allocate even short periods of time to leave the practice for workshops, or may be located in a geographically dispersed area. These practices may prefer to participate in virtual learning workshops where the Program is delivered via teleconferencing, videoconferencing, webinar, and online.

Recruiting Practices

How many practices within a Division or Medicare Local can participate?

Recruitment targets will depend on wave capacity and the number of Divisions or Medicare Locals and practices or health services interested in participating. IF will work with you to decide on recruitment targets, then you can work towards recruiting participants.

To support the promotion you do within your Division or Medicare Local, IF will provide you with recruitment materials, such as brochures, direct mail devices and other marketing materials to help you with the recruitment process.

What if my Division or Medicare Local wants to register participants over and above our agreed allocation?

In some instances, additional practices or health services are welcome to participate in the Program, however additional practices will not be funded by the Program. The cost for each practice or health service to participate in a wave differs depending on the type of wave. If this cost of participation can be funded via other means (including practices self-funding) and your Division or Medicare Local can provide support for the additional practices, then additional participation is possible. This will be subject to venue and overall wave capacity.

Training and Support for Divisions

Training for Division staff

Support staff in your Division or Medicare Local will have the opportunity to participate in training for the Program and Quality Improvement skills. Who actually takes part in the training will be pre-agreed with the Division or Medicare Local. The training and development opportunities will help your Division or Medicare Local's support team build capacity for supporting Quality Improvement activities in your general practice and health service community.

A primary point of contact at the Division or Medicare Local

Each Division or Medicare Local will nominate a primary point of contact for Program purposes. This person will provide a liaison, leadership and coordination role for practices and health services participating in the APCC Program. This person will be the lead support for the Program within the Division or Medicare Local and a main contact person for practices, IF, and the SBO.

Program training for Division or Medicare Local staff is generally delivered prior to the beginning of each wave, and in the days before each workshop. It can be delivered via a face-to-face workshop, webinar or teleconference, and throughout a wave IF may use a combination of all three delivery mediums.

Marketing support

You’ll support IF national and state-based marketing and promotion initiatives through promotional activity at the Division or Medicare Local. We will provide you with practice recruitment materials, such as brochures, direct mail devices and other marketing materials, to ensure your practices are informed about all aspects of the APCC Program. IF will also provide training and development to agreed Division or Medicare Local staff who will then lead the recruitment process from within your organisation.

Practice Data & Privacy

What Data is collected?

The Program collects aggregated practice level data only, specifically in the areas of diabetes, coronary heart disease, chronic obstructive pulmonary disease, chronic disease prevention and self management and improving patient access to care. A practice participating in the APCC Program will only submit aggregated de-identified patient data (being percentage based measurements). This data does not include the personal health information of any of the practice’s patients.

Do Commonwealth privacy laws require practices to obtain patient consent to submit data?

No. Commonwealth privacy laws do not apply to de-identified information or statistical data sets which would not allow the patient to be identified.

What use will be made of information about the performance of the practice?

Improvement Foundation (IF) (the delivery organisation of the APCC Program) and the local Division or Medicare Local will only use information about the performance of a practice or health service in the Program (performance data) to help improve that practice or health service’s performance. IF will only use de-identified performance data (which does not identify the practice from which the performance data originates) for the purposes of reporting on and evaluating the Program. Aggregated de-identified performance data for multiple practices may be used to promote the benefits of the Program for quality system and health service improvements. The local Division or Medicare Local may use de-identified performance data for local quality system and service improvements.

If you would like to get involved with the Australian Primary Care Collaboratives Program, or would just like more information, please contact the Improvement Foundation.

Improvement Foundation
Level 5, 19 Grenfell St
Adelaide SA 5000
PO Box 3645 Rundle Mall SA 5000
T. 08 8422 7400 (or Toll Free 1800 771 522)
F. 08 8231 6690
E. enquiries@improve.org.au
W. www.improve.org.au

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

 

A cast of 1000s...

Improvement Foundation have delivered the APCC Program to more than 1000 practices and health services with the support of State Based Offices in WA, SA. NT, NSW, QLD, ACT, VIC & TAS and more than 80 Divisions Australia-wide.   

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

Media Releases

October 2011

APCC Program Extended

"The Improvement Foundation (IF) is pleased to announce that the Australian Primary Care Collaboratives (APCC) Program has been extended until 30 June 2012..." Read more.

November 2010

APCC Program - New Wave, New Model, New Topic Mix

"Improvement Foundation is pleased to announce an exciting new wave of the Australian Primary Care Collaboratives (APCC) Program. Focusing on Diabetes Prevention and Management, the wave will be delivered in an innovative new Collaborative model combining state and virtual workshop delivery." Click here to read more.

 

July 2010

"Improvement Foundation and OBS selected to develop a web based reporting tool for Aboriginal health services"

Download PDF

May 2010

"Nurse funding initiative for general practice – a great opportunity for improvement in patient care and outcomes"

Download PDF

 

April 2010

"Improvement Foundation - pioneering chronic disease prevention"

Download PDF

 

March 2010

"Kevin Rudd’s ‘surprise’ visit to Canning Division"

Download PDF

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

Events

2012

JANUARY	FEBRUARY Diabetes Prevention & Management (W006) Virtual Learning Workshop 4 Multiple streams, week beginning 20 February Diabetes Prevention & Management (W007) Learning Workshop 2 (virtual) Multiple streams, week beginning 13 February	MARCH
APRIL Diabetes Prevention & Management (W007) National Learning Workshop 3 Saturday 21 April	MAY	JUNE   Diabetes Prevention & Management (W007) Learning Workshop 4 (virtual) Multiple streams, week beginning 18 June
JULY	AUGUST	SEPTEMBER
OCTOBER	NOVEMBER	DECEMBER

2011 

JANUARY	FEBRUARY Diabetes, CHD & Access Virtual Wave Learning Workshop 3 3 Feb Closing the Gap (South Australia) Learning Workshop 2 5 Feb Tristar Virtual Learning Workshop 9 Feb Closing the Gap (Victoria) Learning Workshop 3 26 Feb	MARCH Diabetes Prevention & Management (W006) Learning Workshop 1, Sydney 5 Mar Tristar Virtual Learning Workshop 9 March
APRIL Tristar Virtual Learning Workshop 13 April Diabetes, CHD & Access Virtual Wave Learning Workshop 4 Thursday 21 April	MAY Tristar Virtual Learning Workshop 7 May Diabetes Prevention & Management (W006) Virtual Learning Workshop 1 Multiple streams, week beginning Monday16 May	JUNE Tristar Virtual Learning Workshop 8 June
JULY Diabetes Prevention & Management (W006) Virtual Learning Workshop 2 Multiple streams, week beginning Monday 25 March	AUGUST	SEPTEMBER Diabetes Prevention & Management (W006) State Learning Workshop 2, Sydney Saturday 17 September
OCTOBER	NOVEMBER Diabetes Prevention & Management (W006) Virtual Learning Workshop 3 Multiple streams, week beginning Monday 28 November Diabetes Prevention & Management (W007) National Learning Workshop 1 Saturday 26 November	DECEMBER

 

2010

JANUARY	FEBRUARY Wave 4 Learning Workshop 3 26 & 27 Feb, Sydney COPD & CDPSM Learning Workshop 2 12 & 13 Feb, Brisbane Virtuals (NSW, Qld, WA, SA, Vic & GPA Geelong) 15 - 17 Feb, virtually	MARCH
APRIL	MAY COPD & CDPSM Learning Workshop 3 21 & 22 May, Brisbane QIP/AGPAL Quality Around the World Conference 20 - 22 May, Melbourne	JUNE Closing the Gap Local Wave Orientation Day 21 June 2010, Brisbane
JULY Closing the Gap, QLD Local Wave, Learning Workshop 1 17 July 2010, Brisbane	AUGUST Closing the Gap, VIC Local Wave, Learning Workshop 1 7 August 2010, Melbourne	SEPTEMBER
OCTOBER Closing the Gap, QLD Local Wave, Learning Workshop 2 30 October 2010, Brisbane	NOVEMBER Closing the Gap, VIC Local Wave, Learning Workshop 2 13 November 2010	DECEMBER

 

Articles

April 2011

Measured medecine benefitting patients, reducing costs
Melissa Parke, MP for Fremantle Newsletter, Autumn 2011, p. 2
Click here to access the article.

Clinic tackles diabetes
Whittlesea Leader, 5 April 2011, p. 17

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January 2011

Clinic's war on diabetes
Albert & Logan News, January 5 2011, p. 17
Click here to access the article.

Appointments - Getting it right
Andrew Knight & Tony Lembke, January 2011, Australian Family Physician
Click here to access the article.

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October 2010

It's never too late
Australian Doctor, 15 October 2010, p. 52
Click here to read more.

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September 2010

A fight against time
Australian Doctor, 3 September 2010, p. 45

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August 2010

Positive change for patients from Australian Primary Care Collaboratives (APCC) Program
LungNet, August 2010, p.4
Download PDF

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July 2010

Outcomes evidence of program success
Australian Doctor, 23 July 2010, p. 4

The Australian Primary Care Collaboratives: an Australian general practice success story
MJA, vol. 193, no. 2, 19 July 2010

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June 2010

The collaboratives experiment
Medical Observer, 18 June 2010

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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
Click here for more information

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

Copyright to Australian Family Physician. Reproduced with permission.
www.afp.org.au.

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October 2009

Bridging the Gap in Meeting Clinical Targets for the Treatment of Type 2 Diabetes
NATSEM Report, University of Canberra

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

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September 2009

Collaboratives - Team effort pays off
Australian Doctor 4 September 2009, p40
Click here to read more.

*Please note you must be an Australian General Practitioner to access the link.

 

What patients want
Australian Doctor 18 Sept 2009 p35
Click here to read more.

*Please note you must be an Australian General Practitioner to access the link.

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August 2009

Collaboratives Program expands scope
Australian Doctor 21 August 2009, p6
Click here to read more.

*Please note you must be an Australian General Practitioner to access the link.

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July 2009

All aboard for data blitz
Australian Doctor 3 July 2009, p42
Click here to read more.

*Please note you must be an Australian General Practitioner to access the link.

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May 2009

APCC add new measures to practice reporting program
Pulse + IT May 2009, p20-21
Click here to read more.

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March 2009

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

 

AGPAL turmoil over patient outcomes
Australian Doctor 27 March 2009, p3
Click here to read more.

*Please note you must be an Australian General Practitioner to access the link.

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.

Updates

Extension for the APCC Program

The Improvement Foundation (IF) is pleased to announce that the Australian Primary Care Collaboratives (APCC) Program has been extended until 30 June 2012. The implementation of the Program will take shape in a number of ways – all of which continue to focus on developing and delivering quality improvement programs that support the delivery of measureable, systematic and sustainable improvements to primary health care systems and patient care, in line with IF’s core objectives.

IF will be working with Medicare Locals and Divisions of General Practice in the following ways...  Click here to read more

To view the media release click here

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International Promotion of the APCC Program

Dr Dale Ford, Principal Clinical Advisor of the Improvement Foundation and Bryan Foley, APCC Program Manager attended the International Forum on Quality & Safety in Healthcare in Amsterdam on April 5 - 8. IF was invited to present two posters at the forum, on the scope of the APCC Program at large, and on measuring for improvement through the web portal. To download a PDF of these posters, please select the link below:

'Improvement down under - The APCC Program' Download PDF

'Measuring for quality improvement using a web portal' Download PDF

 

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November 2010 - IF announces new 'Diabetes Prevention and Management State wave'

Beginning in March 2011 and to be delivered in Sydney, recruitment for this wave will be targeting NSW health services and aims to help health services develop systems for improving the prevention and management of care for patients with diabetes. Click here to find out more.

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April 2010 - Website treasure hunt winner announced!

Congratulations to Christine O'Shea of Bright Medical Centre, Victoria, for winning the lucky draw website competition! Christine wins an 8GB iPod Nano. Thank you to all those who entered the competition and took the time to provide valuable feedback and suggestions. Keep an eye on the website as we endeavor to develop it.

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March 2010 - New APCC website'treasure hunt'

To celebrate the launch of the new website, Improvement Foundation are running a website treasure hunt competition. The new APCC website is your hunting ground and the pages are your ‘treasure’. Click here to download an entry form. Competition closes Friday 9 April 2010. (Competition only open to APCC participating practices and CPMs).

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“Quality improvement initiatives, such as the APCC, should be made available more broadly to practices to support continuous quality improvement in the provision of care for people with, or at high risk of, CVD.”

Improving cardiovascular health outcomes in Australian general practice. Facts and recommendations to support government relations and policy development. February 2010, National Heart Foundation of Australia, p7. Click here to view this PDF document on the Heart Foundation website. 

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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.

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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)

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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)

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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

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

Ideas for Improvement

Practices involved in the APCC Program are generating hundreds of bright ideas for improvement to try out in their practices. Here, practices 'share generously' some of these ideas. Clink on the links below to be taken to each ideas section. 

Are you an APCC practice? Do you have a bright idea that worked in your practice that you'd like to share with others? Click here to send us your idea. (Remember to include your practice name and state)

Build the practice team

Change your business

Be systematic and proactive in managing care

Involve patients in delivering & developing their care

Identify effective links with key local partners

 

Build the practice team

• Provide cultural awareness training for your staff.
• Create a weekly practice staff newsletter to keep everyone ‘connected’.
• Document changes in roles and processes to embed new systems.
• Orientate new staff in the practice to the APCC program and get their feedback. They will have some great ideas to share! But, don’t forget to evaluate it!
• Make it easy for the practice staff by providing data submission calendars and resources to the practices can help make their Collaborative journey smoother.
• Try to resolve IT related issues early. If you can resolve issues early, practice motivation is more easily maintained.
• Explore the barriers and find ways to overcome them. The barriers in reality may be quite small but may seem huge while at the coal face.
• The carrot is mightier than the stick! Demonstrating the benefits is a lot easier (and a lot more pleasant) than reminding staff of contractual obligations.
• Spend time with those staff who are resistant to change. If you can engage these staff early, barriers can be quickly overcome and progress is much easier to make.
• Keep an eye out on the Rural Health Education Foundation website for upcoming education programs for GPs and practice nurses. Podcasts are now available for many of the PHEF programs. For a list of available programs, visit: http://www.rhef.com.au.
• Encourage your clinical and non-clinical staff to participate in professional development activities, for example:
  • Practice Managers Certificate IV and Diploma;
  • Computer courses;
  • All CDM, EPC and Practice Nurse MBS item number training;
• Develop training skills in some staff so they can educate other staff at the practice about the Collaboratives and 'systems' thinking. 

 

How healthy is your team?

Use the Team Health Check questionnare to survey your team then collate the results in the Health Check spreadsheet to assist with the collation and presentation of feedback.

 

Change your business

• Consider using templates, for example:‘12 minute’ slips to keep appointments to time;
  • ‘12 minute’ slips to keep appointments to time;
  • ‘Encounter’ slips for patients to list the issues they wish to discuss with their GP. This will be handed to the GP at the beginning of the appointment;
  • ‘Fit-in’ slips so patients understand their GP will only deal with the urgent matter at that time;
  • ‘Follow up’ slips with priority ratings to assist reception to enter a timely next appointment;
  • ‘Patient history update’ slips – include ‘stopped smoking’, ‘started smoking’, etc.
• Script/referral emails to streamline communication between GPs and front desk.
• Change last 3 appointments in each session to 10 minute appt instead of 15 minutes, for recall appointments as most recalls only need shorter appointments.
• Develop a 4 week trial of 10 minute recall appointments for an hour at end of each session with one GP to free up GP time.
• Use a ‘buddy system’: Each GP will be allocated a practice nurse to work in the room beside the GP to commence the GP Management Plan (GPMAP) or Team Care Arrangement (TCA) with the patient and organise referrals points as needed. The patient will then see the GP for completion of the GPMP/TCA.
• Use a triage flowchart so staff can quickly assess patients needs.
• Develop a schedule of times for practice nurse tasks so reception can allocate adequate amounts of time e.g. 20 minutes for a dressing, 45 minutes for GPMP preparation.

Be systematic and proactive in managing care

•  Identify patients on chronic disease registers who smoke and send a recall letter with a Lifescripts smoking assessment form attached for a follow up consultation.
• Source CHD resources from Heart Foundation with the aim of improving and standardising patient information and distribute these to CHD patients.
• Prevent leg amputations and improve shared antenatal care: Purchase a venous doppler that can double up as a foetal doppler and records results directly into clinical software.
• Put a system in place to ensure that all patients seen over a 2 month period have a weight, height and BMI documented in their clinical record.
• Create templates in clinical software to include the goals/recommendations of national guidelines (i.e. Diabetes Management in General Practice 2008?09, Red Book, Heart Foundation)
• Roster a rural locum to return on a monthly basis to run CHD clinics.
• Implement a “red sheet” diabetes summary for every diabetic patient using ‘team centric documents‘ from the Doctors’ Control Panel (DCP). Doctors will be encouraged to use the “red sheets” and be prompted to improve their management of diabetic patients utilising the diabetes cycle of care.
• Improve cholesterol level control on diabetic patients. Identify the number of patients with cholesterol > 4mmol/l and non recorded. Use this information to remind doctors about the importance of cholesterol control and to develop patient education.

Involve patients in delivering & developing their care

• Advise patients with consistently high BP to get a home BP monitor. Ask the patients to measure and report their physical activity levels and monitor for improved BP control
• Establish an insulin support group to improve the care of patients with poorly controlled diabetics.
• Design a patient survey to be circulated to all patients so that information around a number of issues can be collected.

Identify effective links with key local partners

• Practice team obtained pedometers and skipping ropes from the Division to get all staff skipping and walking. The aim is for practice member act as mentors for the local community.
• Obtain Pedometers from local reps to issue to patients in order to get them involved in the 10,000 steps program.
• Making CDM more understandable to patients by developing hand held records and more detailed recall letters.
• Align care planning for a particular disease group with promotion events for that disease run by local health, newspapers, national bodies etc.
• To encourage our CHD patients to be more active. Implement regular exercise regime for CHD patients and any others who wish to join. Contact local council and get posters and information re walking programs in local area.
• Introducing the food portion plate for diabetic patients to assist in weight management BSL’s.
• Hold regular meetings with Allied Health Providers employed/contracted to your surgery to improve communication and integration.
   

Newsletter

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

Recent Newsletters

August 2011

June 2011

April 2011

February 2011

December 2011

September 2010

July 2010 

May 2010

April 2010

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 was delivered to Divisions and their member practices by the Improvement Foundation (IF).

In July 2009 additional funding was granted to IF 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 was delivered in addition to the; Access and Care redesign, Diabetes and Coronary Heart Disease (CHD) topic waves.

In September 2011 additional funding was granted to extend the Program to 30 June 2012. The extension incorporates a national APCC Diabetes Prevention and Management wave, and work with the first tranche of Medicare Locals, and their general practices and health services. Click here to read more.

For more information on Collaboratives see What is a Collaborative?

Getting involved

If you'd like to know more about what's involved with the National APCC Diabetes Prevention and Management wave, or how we'll be working with Medicare Locals, read on...

APCC Diabetes Prevention and Management Wave

This wave aims to help general practices and health services improve the care of patients with, or at risk of developing diabetes. Practices and health services will participate in two state learning workshops and two virtual workshops. They will receive hands-on support, the ability to monitor improvements via the IF web portal, and the opportunity for sharing ideas and experiences with colleagues.

This wave of the APCC Program focuses on two topic areas:

• Diabetes Prevention
• Diabetes Management 

   

A framework for success

The APCC Program will provide practices and health services with a framework to build a stronger team and enhance systems and efficiency. Participants will learn the skills and get support to:

• Identify goals and work towards them in a systematic way
• Change service delivery to improve efficiency within the practice or health service
• Improve and develop existing systems to make chronic disease management easier, and more satisfying
• Optimise roles and responsibilities to build a stronger team
• Develop business systems to identify and maximise potential income streams

 

Sharing ideas with others

At APCC workshops participants will:

• Exchange ideas and experiences through networking with peers
• Stimulate innovation and learn about practical quality improvement skills
• Pick up tips and practical ideas from peers
• Hear about what has worked, and what hasn’t, in other practices and health services.

 

Improving patient outcomes

By working with the APCC Program, practices and health services have made measurable improvements in patient care. Some of the improvements your team can achieve include:

• Incorporating diabetes prevention work into a busy practice or health service
• Improving health outcomes for patients with diabetes, and patients ‘at risk’ of developing diabetes
• Moving from reactive to proactive patient care

 

Learning Workshop (LW) dates:

 LW1, (national) Saturday 26 November 2011

LW2 (virtual), week beginning 13 Feb 2012

LW3, (national) Saturday 21 April 2012

LW4 (virtual), week beginning 18 June 2012

 

 

Practice and health service payments

IF will fund a practice or health service $4000 (GST exclusive) to support participation in this wave.

 

Register your interest

Registrations of interest for this wave are now closed.

 

Working with Medicare Locals

IF will bring together key members of the first tranche of Medicare Locals in an environment of peer learning to address some of the immediate challenges facing their Medicare Local. By using a structured approach to quality improvement to address the key issues facing each Medicare Local at a regional level, knowledge and ideas will be rapidly spread across the network. 

Quality improvement workshops for general practices and health services within Medicare Locals

IF will support the first tranche of Medicare Locals to plan, implement and monitor quality improvement activities as an integral part of their core business, including the delivery of a locally based quality improvement workshop.

Through this workshop, Medicare Locals will be able to engage general practices and other health services, involve them in identifying the health needs of their local area, and develop locally focused and responsive services that are underpinned by a continuous quality improvement approach.

If you'd like to find out more about either the Diabetes Prevention and Management Wave, or how we will be working with Medicare Locals, contact IF at apcc@improve.org.au or on (08) 8422 7400.

 

 

 

 

 

 

 

 

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.

 

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.

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

 

Small changes lead to big improvements in patient access to care

Derwent Valley Medical Centre

Derwent Valley Medical Centre joined the APCC Program to learn about implementing new systems that would help improve patient access to care. They successfully tested and implemented ideas they learnt through attending APCC workshops. The team now has a greater focus on shared learning, improving team skills and strengthening partnerships with other health services within their Division.

Click here to read more.

 

Setting up a lung function clinic to improve peventative care

Dr John Troy Medical Centre

Dr John Troy Medical Centre recruited a respiratory technician and implemented a lung function clinic, in order to provide more proactive care to patients with chronic respiratory diseases. The health service further developed their recall systems and use GP Management Plans in order to provide better healthcare for people with chronic disease, in their community.

Click here to read more.

 

Using population health data to chart improvements and measure outcomes

Broughton Clinic

Broughton Clinic joined the APCC Program to learn how to use their patient population health data more efficiently. Through regular data cleansing and analysis, they were able to more accurately define their patient population and measure health outcomes.

Click here to read more.

 

Building on established initiatives to improve patient care

Busby Medical Centre

To provide proactive care to their patients with a chronic disease, the team at Busby Medical Centre adopted a ‘cycle of care’ plan. The care plan assists patients in managing their own condition as well as planning their care thoroughly with the practice team, utilising a whole-of-team approach. Access was also improved dramatically by modifying their existing duty doctor initiative, which lightened the workload for the GPs and provided greater capacity for ‘on the day’ appointments.

Click here to read more.

Patients benefit from proactive, team-based approach to care

Daisy Hill Medical Surgery

After attending the first learning workshop of the APCC Program, representatives from Daisy Hill Medical Surgery were enthusiastic about employing a practice nurse. By embracing this new role at the practice, the entire team were able to provide better care to their patients, particularly in improving access and providing a proactive and patient-centred approach to chronic disease care.

Click here to read more.

 

Working collaboratively to implement new systems to improve diabetes care

Seville Drive Medical Centre

Seville Drive Medical Centre has improved its processes and systems to ensure all patient data and information is correctly recorded in the clinical software, which allows for more proactive care of patients with chronic diseases. The practice now prides itself on its diabetes care, provided by a whole-of-team approach.

Click here to read more.

 

Preventing chronic disease through a team approach to care

Maddington Village General Practice

Maddington Village General Practice developed a stronger team approach by holding regular team meetings and improving communication. The practice team has successfully implemented a number of changes that benefit both the patients and staff.

Click here to read more.

 

Adopting new systems to improve preventative care

Hope Island Medical Centre

Hope Island Medical Centre has improved preventative care and planned chronic care for their patients by adopting more systematic and efficient work processes. The practice nurses now play a key role in recording vital information about their patients which assists the GPs in taking a more proactive approach to chronic disease care.

Click here to read more.

 

Building a new practice from scratch with a focus on diabetes management

Cleve Medical Practice 

With the help of the APCC Program, the Division and EEHAC, Cleve Medical Practice successfully changed ownership from private to public, while developing a strong focus on diabetes management and ultimately improving the overall care for their patients.

Click here to read more.

  

New care program improves outcomes for patients with diabetes

Prospect Medical Centre

Prospect Medical Centre developed a care program for patients with diabetes, which required correct data input, registers and more specific programming. They also extended their allied health and nursing services to provide more comprehensive, systematic and proactive care for patients with diabetes.

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Healthy lifestyle clinic helps prevent chronic disease

Coliban Medical Centre

Coliban Medical Centre implemented a Healthy Lifestyle Clinic to assist patients to address the reasons for their weight gain and assist them to make positive lifestyle changes, in order to decrease their risk of developing a chronic disease.

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Using information management to improve diabetes care

Platinum Medical Centre

Platinum Medical Centre (MC), while operating a successful holistic healthcare service, recognised that by introducing standard systems they could improve their services even more. Through data cleansing, building their registers and employing a chronic disease specialist nurse, the clinic is able to actively manage the care of patients with diabetes.

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Multi-skilled, holistic agency adopts “wellness” philosophy

Health & Wellbeing North Ward

With a large Aboriginal and Torres Strait Islander Community in the area, the practice expanded their services to include a dedicated Indigenous Healthcare worker to achieve their aim of providing holistic and culturally aware care to all patients. 

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Local health expo increases community awareness of preventative healthcare 

Keperra Family Practice

Located in a shopping centre, alongside a number of other health providers, the practice saw the opportunity to build on their already strong partnerships and hold a health exhibition in the local shopping centre, to promote community health and educate the public on proactive and preventative healthcare.

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Introducing a fluvax clinic

Adelaide City General Practice

The practice nurse at Adelaide City General Practice took on the responsibility of creating and running a flu vaccination clinic. The aim was to free up doctor appointments and to proactively vaccinate patients early in the season.

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Updating patient information to meet accreditation, ensure accuracy and better patient care

East Geelong Medical Centre

The practice saw the need to cleanse the practice data and update patient records in order to provide more systematic and proactive care for their patients.

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