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

Storyboards

Wave 4, Learning Workshop 3

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.

 

 

 

 

 

 

 

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.

 

Web Portal User Guides

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 enquiries@apcc.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.

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?

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.

Top

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

Top

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

Top

What is the Collaborative Handbook?
The Collaborative Handbook is a practical guide developed by the Improvement Foundation Australia (IFA) to support practices during the APCC Program. It combines evidence-based guidance with practical examples drawn from the field. In the Handbook, you will find change ideas and change principles in each topic area which have been formulated and agreed to by the Expert Reference Panels.


What is an Expert Reference Panel?
Each Program topic has an Expert Reference Panel (ERP). Each ERPconsists of topic area experts who seek to:

• Establish the aim for the topic area
• Identify key principles that underlie any improvement in each topic area
• Identify, where possible, successful strategies for change in each area (change principles)
• Suggest practical ideas for change in each area that will generate significant improvement (change ideas)
• Suggest measures that will assist teams in assessing their progress (improvement measures)
• There is an Expert Reference Panel in each topic area
• Click here to view the Expert Reference Panel pages.

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Improvement Measures

What are the improvement measures in the Collaborative Program?
There are several improvement measures in each topic area. For a full list of the improvement measures click here . For a summary list click here.


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

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Practicalities of participating in the APCC

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

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

Will taking part in this Program add to our operating costs?
Practices need to allocate time and resources for staff to work on the Program, and to attend the Orientation event and Learning Workshops. Participating practices will receive an incentive payment, which is distributed through the local divisions.

How much time do I need to commit to the APCC Program?
Participating practices have to set aside dedicated time each week to work on the Program. Practices would also need to allocate time for one GP and one practice staff member to attend the orientation event and learning workshops. For more detail on how much time you will need to commit to the Program click here.

What are the minimum requirements of participating practices?
The Program's minimum requirements are that practices:

• Undertake work in each of the wave's topic areas
• Submit at least one PDSA cycle every month (most practices submit more than this)

To achieve significant success within the Program, practices should be committed to:

• Set aside dedicated time each week to work on the Program
• Attend and actively participate in the Learning Workshops
• Submit a PDSA every month in each topic
• Collect and report data, and test and implement changes by using the PDSA cycles.

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What kind of support would we get on the Program?
The APCC Program team and your Division are a key resource and source of support for participating practices. Your Division will provide hands-on support and guidance on the collection of measures, submission of data, and implementation of change principles and ideas. The APCC Program provides a detailed handbook, a workbook, monthly feedback, analysis of monthly data, and maintains a website and web portal. The national Collaborative network provides a resource of knowledge and experience for practices to tap into. Participating practices are also eligible for practice incentive payments distributed through Divisions .


What have others achieved with a similar Program?
This Program builds on the success of work already done in the US and the UK . In the UK , the Improvement Foundation (formerly the National Primary Care Development team, NPDT) reports that over 5,000 practices serving almost 32 million patients have taken part in their program since it began in 2000, making it the largest primary care health improvement program in the world. The APCC Program aims to help general practice in Australia achieve significant improvements in the primary care they provide to their patients.

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What kind of improvements have other participants achieved?
By working with the Program, these are some of the measurable improvements in patient care other practices have achieved, so imagine the significant changes you can expect.

• Improved patient outcomes through better management of diabetes and coronary heart disease
• Changes in service delivery to improve efficiency within the practice
• Increased best practice care through better use of information systems (both medical and business systems)
• Shift from reactive individual patient care to proactive population based care
• Increased use of protocols and procedures to improve practice operations and efficiency
• Enhanced clinical reporting and functionality (i.e. data cleaning to produce valid registers and reports)

 

Learning Workshops and Activity Periods

What happens at an Orientation event?
Practices attend an Orientation event four to six weeks before the first Learning Workshop. Participating practices are provided with an introduction to collaboratives and how they operate, and details are given of the practical aspects of participating in the APCC Program. There is an opportunity to hear from practices who have participated in previous Programs and an overview of the results they achieved will be provided.

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What happens at a learning workshop?
The learning workshops provide a supportive environment for sharing learning and for formulating plans for action. At these two-day events, practices learn how to implement the improvement methodology and work in local divisional teams with a Division staff member to learn about the Improvement Model cycles that they will carry out in their practices. There are opportunities to hear from experts about quality improvement and the evidence in the topic areas of secondary prevention of coronary heart disease, diabetes, access and care redesign, chronic obstructive pulmonary disease, and chronic disease prevention and self management. Within the learning workshops, there are smaller facilitated breakout sessions where participants have an opportunity to learn from other practices about improvements they have made in their own settings.


Who should attend the Learning Workshops?
We recommend that one GP and one practice staff member attend each of the learning workshops. These should be staff who are in a position to influence and initiate change within their organisations.

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Can different people attend the Learning Workshops?
For best results and continuity, we recommend the same people attend all three learning workshops.


What is an Activity Period?
In the APCC Program framework, activity periods are scheduled between and after learning workshops for practices to deliver real and sustainable improvements in practice. In an activity period, practices test and implement their change ideas through using rapid time limited Plan, Do, Study, Act (PDSA) cycles. They also submit monthly measures in each topic area to track their progress.

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How long is an Activity Period?
The Activity Periods between Learning Workshops 1, 2 and 3 are about three months long. Practices continue to work using PDSA cycles and submit data for 12 months after Learning Workshop 3 to track their progress.

 

Model for Improvement

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

Where do we start? Which changes should we test first?
You will begin planning for change in the learning workshops. When you return to your practice, brainstorm ideas with the team, and talk to practice staff to get their input. Start with the first part of the Model for Improvement, and ask the three fundamental questions:

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What is a PDSA?
A PDSA (Plan, Do, Study, Act) is a small-scale, rapid-cycle test of change. It is used to determine if a change idea is one that will be beneficial before implementation on a wider scale. The PDSA cycle is a proven process intended to improve the quality of care at an accelerated pace.

How long/big should a PDSA cycle be?
If your PDSA cycle is large, it can be too complex and absorbs time and energy. Cycles should be short but significant; test a big idea on a small scale and in a short time frame (for example, on Dr Well's patients next Friday) so that you can identify ways to improve or change the idea.

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How do we write a good plan?
A plan should be time-specific and measurable. It is important that all team members agree on the plan and that the practice allocates the people and resources necessary to accomplish it. You will need to specify clearly the plan for change and the way in which it is to be carried out in order to test changes successfully.

How do we speed up our PDSA cycles?
Make sure your PDSA cycles are small and manageable, so that you are able to make incremental changes. As you try out changes on a small scale, and use the many consecutive PDSA cycles to build up information about how effective the change is, you can then implement it as part of your system.

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How much data do we need to collect to ensure that a PDSA cycle works?
You need to collect enough data to see if an improvement occurred.

Is it necessary to document every step of a PDSA cycle?
Yes. Documenting all four steps of a PDSA cycle - Plan, Do, Study, Act - has clear benefits:

• It helps teams get into the habit of doing all the steps.
• It is often the only way to follow the thread of the improvement journey.
• It also helps in communicating success and creating a coherent demonstration of progress for the future.
• Documenting is also useful for later review, comparison, and sharing with others.

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We have done several PDSA cycles, but we don't see an improvement. What's wrong?
Use the "Study" phase of a cycle to reflect on what was learned from the test and refer back to the three fundamental questions. Try brainstorming more ideas.

How do we ensure that one PDSA cycle is linked to the next?
Ensure that the "Act" phase of one cycle is connected to the "Plan" phase of the next one. Schedule specific times for reflecting on what was learned in carrying out cycles.

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How do we know a change is an improvement?
Without measurement it is impossible to know whether you have improved. Measures are a means for practices to tell if the changes you are making actually leads to improvement, so measurement is a critical part of testing and implementing change.

Think about how you want things to be different when you have implemented your change and agree in which data you need to collect to measure it. You can do this in terms of the way in which your results or outcomes might be different, how the service that your patients receive will be better, or how your processes might change.

Do we need to have an electronic means of capturing our data in PDSA cycles?
Use the resources available to you. It is not feasible to update your computer system for a short-term project; paper and pencil are good enough. It is possible to achieve a great deal of change and improvement using available resources and just enough data.

Disclaimer

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

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

Privacy Policy

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.

 

 

Who will see or have access to your Personal Information?

 

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

 

 

Links to other Websites

 

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 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

Home

Program Results

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

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

The Improvements

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

Phase 2 results

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, Coronary Heart Disease and Access & Care Redesign:

 

Wave 1 (NSW, QLD & ACT) Results

To view a PDF of the report, please click here.

 

Wave 2 (WA, SA & NT) Results

To view a PDF of the report, please click here.

Wave 3 (Victoria & Tasmania) Results (from baseline to month 17)

To view a PDF of the full report, please click here. Two key changes throughout the wave had a direct impact on wave results. These changes occurred at month 7/8 of the wave, they were:

• Changes to the measurement framework, including:
  a. a new 'cholesterol' measure introduced for the coronary heart disease (CHD) topic
  b. the CHD blood pressure (BP) measure changed from ≤140/90 to ≤130/80
• A change in collection and reporting systems, which required participants to transfer to a new reporting system.

It was expected that the introduction of these changes would cause some disruption to longitudinal measurement.

 

Wave 4 (national) Results (from baseline to month 10)

To view a PDF of the report, please click here. Key results to date include:

• A 14% improvement in patients on the diabetes register whose HbA1c was recorded (in the last 12 months) at ≤7.0%
• An 12% improvement in patients on the diabetes register whose cholesterol was recorded (in the last 12 months) at <4.  

To view wave 4 (month 9) results, please click here

To view wave 4 (month 8) results, please click here.

 

Chronic Obstructive Pulmonary Disease and Chronic Disease Prevention & Self Management:

Wave 5 (national) Results (from baseline to month 8)

To view a PDF of the report, please click here. Key results to date include:

• A 20% improvement in patients on the COPD register with a recorded Spirometry screen, at any time
• A 14% improvement in patients on the COPD register who have had their smoking status assessed within the previous 12 months.
  

To view wave 5 (month 7) results, please click here

To view wave 5 (month 6) results, please click here.  

---

 

For Phase 1 Results, click here.

 

 

The Collaborative Program

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

The Program consists of the following components:

Orientation

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

Baseline Data Collection

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

3 Learning Workshops

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

At learning workshops, participants:

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

Activity Periods

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

The Model for Improvement

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

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

The second part, the "doing part", is made up of rapid, small Plan, Do, Study, Act (PDSA) cycles to test and implement change in real work settings. The PDSA cycle provides a framework for testing ideas and assessing the results to determine if the change is an improvement. To find out more about the Model for Improvement click here.

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

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

Data Collection

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

Expert Reference Panel

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

Change Principles

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

Change Ideas

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

Shared Learning

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

Measurement

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

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

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

The Model for Improvement

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

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

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

 

Model for Improvement Example  

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

 

Model for Improvement templates

The Web Portal

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

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

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

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

 

What is the web portal used for?

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

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

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

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

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

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

 

Privacy

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

 

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.

APCC Team

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

To contact the APCC team, please click here

To see the IF team, please click here

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

APCC Clinical Director and Clinical Chairs

Project Management Advisory Committee (PMAC)

Expert Reference Panel (ERP) members

 

APCC Program Clinical Director and Clinical Chairs

APCC Clinical Director

Dr Tony Lembke, Alstonville Clinic, NSW

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

Clinical Chairs

NSW, QLD, ACT wave

Dr David Richardson, Royston Clinic, VIC

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

WA, SA & NT wave

Dr Mike Civil, Stirk Medical Group, WA

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

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

VIC & TAS wave & Virtual wave 1

Dr Richard Bills, Brooke Street Medical Centre, VIC

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

National Wave 4

Dr Charlotte Hespe, Glebe Family Medical Practice, NSW

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

COPD & CDPSM wave

Dr John Kastrissios, Springwood Group General Practice, QLD

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

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Program Management Advisory Committee (PMAC) 

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

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

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

Chair

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

Members
 

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

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

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

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

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

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

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

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

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

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

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

Top

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

For Divisions

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

For Practices

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

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

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

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

 

Benefits of Participation 

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

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

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

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

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

 

Requirements of Participation 

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

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

 

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

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

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

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

 

Funding for Practices

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

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

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

 

Professional Development Points for GPs and Practice Staff

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

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

ACRRM PDP
Australian College Rural and Remote Medicine Professional Development Program

RACN CNE
Royal Australian College of Nursing Continuing Nursing Education

AAPM CPD
Australian Association of Practice Managers Continuing Professional Development 

IFA has applied to the following organisations for points. 

• RACGP
• ACRRM
• RACN
• AAPM

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

Events

June 2010

Closing the Gap Local Wave Orientation Day

21 June 2010, Brisbane

 

May 2010

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

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

 

February 2010

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

 

December 2009

Virtuals (NSW, Qld, WA, SA, Vic & GPA Geelong)

7 - December, virtually

Wave 4 learning Workshop 2

4 & 5 Dec, Sydney

 

November 2009

Virtual GPA Geelong

10 Nov, virtually

 

October 2009

COPD & CDPSM LEarning Workshop 1

23 & 24 Oct, Brisbane

Virtuals (NSW, Qld, WA, SA, Vic & GPA Geelong)

19 - 21 Oct, virtually

 

September 2009

Wave 4 Learning Workshop 1

11 & 12 Sep, Sydney

 

August 2009

Virtuals (NSW, Qld, WA, SA, Vic & GPA Geelong)

10 - 12 & 24 - 26 Aug, virtually

Wave 4 Orientation Day

20 Aug, SA
13 Aug, NSW
6 Aug, Qld
4 & 5 Aug, Tas
30 Jul, Vic

 

Local waves are run throughout Australia by the Divisions of General Practice, For more information on local waves, please contatc your Division or Regional Manager on the contacts page.

Articles

July 2010

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

 

June 2010

The collaboratives experiment
Medical Observer, 18 June 2010
Download PDF

March 2010

APCC introduces patient involvement for the first time in Australia

Download PDF

 

December 2009

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

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

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

 

October 2009

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

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

 

September 2009

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

What patients want
Australian Doctor 18 Sept 2009 p35
Download PDF

 

August 2009

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

 

July 2009

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

 

May 2009

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

 

March 2009

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

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

Media Releases

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

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

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.

 

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).

 

“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.

 

November 2009 - Dr Michael Nolan wins John Aloizos Medal

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

 

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

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

View article in Medical Observer (PDF)

 

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

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

View Media Release (PDF)

 

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

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

View Media Release - New Measures (PDF)

View article in Pulse+IT (PDF)

Visit the measures page on the APCC website

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. 

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

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

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

For more information on Collaboratives see What is a Collaborative?

What’s new

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

 

Case Studies

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

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

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

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

Building a New Practice from Scratch with a Focus on Diabetes Management

Cleve Medical Practice

"Through 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.

 

Diabetic Improvements Through Data Analysis and Allied Health Partners

Prospect Medical Centre

"An idea that is developed and put into action is more important than an idea that exists only as an idea...the APCC Program assists practices to achieve this." Click here to read more.

 

Preventing Chronic Disease Through a Healthy Lifestyle Clinic

Coliban Medical Centre

"Being involved in the APCC Program has encouraged practices to form strong bonds and linkages with each other and share ideas and information long after the wave has been completed." Click here to read more.

 

Using Information Management to Improve Diabetes Care

Platinum Medical Centre

"To begin with the APCC work seemed daunting and too difficult to accomplish... However, it taught us to THINK about what we were doing and how we were delivering our healthcare. We soon saw gaps that were making our jobs unnecessarily complicated." Click here to read more.   

 

Multi-skilled, Holistic Agency Adopts “Wellness” Philosophy

Health & Wellbeing North Ward

"Systemized Chronic Condition Management has become the cornerstone, with the GP Service, Allied Health Providers, Practice Manager, Nurses and Receptionist all having input." Click here to read more.

 

 

Local Health Expo Builds Community Goodwill and Increases Awareness of Preventative Health Care

Keperra Family Practice

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

 

Introducing a Fluvax Clinic

Adelaide City General Practice

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

 

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

East Geelong Medical Centre

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

 

Click here to view archived Case Studies

Getting involved

Expressions of interest: local and virtual Program waves

How would you like to be involved in a Program that’s full of ideas on how to achieve improved health outcomes for your patients, by helping you build a stronger team and enhancing your health service’s operations and efficiency?

The Improvement Foundation is currently seeking expressions of interest for local and virtual waves of the Australian Primary Care Collaboratives (APCC) Program.The Program helps general practitioners 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.

Currently the Program is focussing on five main topic areas, which are:

• Access & Care Redesign
• Diabetes
• Chronic Heart Disease
• Chronic Obstructive Pulmonary Disease
• Chronic Disease Prevention & Self Management

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 organisational systems.

Local wave

A local wave of the Program is run by the Division or partnership network. Participants of a local wave will attend a series of local workshops, along with other health services, mostly from within the same Divisional area. The Program provides participants with access to ideas and examples generated from around Australia. For more information about local waves, click here to dowload a copy of the local wave brochure.

Virtual wave

A virtual wave in the Program is conducted in a virtual environment. The Program is delivered online and via teleconference, as an alternative to meeting at face to face workshops. For more information about virtual waves, click here to download a copy of the virtual wave brochure.

To register your interest in participating in a local or virtual wave, click here and email us your name and health service location. Alternatively, you can contact us on (08) 8422 7407.

 

Download a copy of our latest brochures here:

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

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.

Life in the fast lane

Andrew Knight

"Life in the Fast Lane,
Surely make you lose your mind"

The Collins Street Medical Centre has developed a strategy that has been effective in changing their capacity… read more

The Blue Folder

The team at Doctors Grand Plaza have had great success with their version of the patient held health summary – “the blue folder”

Melissa Cahill tells their story.

"Our finest… read more

Purple Time - Protecting Endangered Species

‘Protected time’ is invaluable for improvement work – but in a busy practice it is often hard to find. The Sorell Family Practice came up with a novel way… read more

Improving the patient environment

"In the spirit of PDSAs, I am submitting one "small" step in the multitude of changes we have… read more

Tracking Doctor Start Times

"It’s hard to choose just one from the most worthwhile collaboratives journey, however, the one that most stands out in my mind is ‘Tracking doctor starting times’. The graphing… read more

The rise and rise of the chronic care coordinator

The people at Mt Barker/Balhannah Medical Clinic in South Australia were part of the second wave of the Collaborative back in 2005. They remind… read more

Tracking Care

Tony Lembke
Have you ever worked out the steps involved in completing a GP Management Plan and… read more

Life in the Fast Lane

The Collins Street Medical Centre has developed a strategy that has been effective in changing… read more