Practice Managers Program

The Australian Primary Care Collaboratives Program was initially a 3-year program initiative announced in the 2003 – 2004 Australian Government Budget. The Program is of international significance and has been adopted in many countries. Due to its success in Australia the program has been extended. Phase 2 of the program commenced in 2008 and is being delivered to Divisions of General Practice and their member practices by the Improvement Foundation Australia. The CHGPN has 4 practices participating in Phase 2.

The Collaboratives 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 Collaboratives aims to find better ways to provide primary health care services to patients through shared learning, peer support, training, education and support systems.

The Collaboratives methodology, designed by the Institute for Healthcare Improvement in the USA, 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 topics addressed in the Australian Primary Care Collaboratives Program are Diabetes, the Secondary Prevention of Coronary Heart Disease, and Better Access to primary care.

What is a Collaborative?

A Collaborative is an improvement method that relies on the distribution and adaptation of existing knowledge to multiple settings to achieve a common aim. The Collaborative methodology is simple to apply and user friendly. It promotes rapid change, allowing practices to experience the benefits in short time frames. The Collaborative methodology works because it is straightforward, there is hands-on support, and the framework promotes protected time 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 in the UK.

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

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

The second part, the "doing part", is made up of rapid, small Plan, Do, Study, Act (PDSA) cycles to test and implement change in real work settings. The PDSA cycle guides the test of a change to determine if the change is an improvement.

What is a PDSA?
PDSA stands for Plan, Do, Study, Act. It's a model for testing ideas that you think may create an improvement. It can be used to test ideas for improvement quickly and easily based on existing ideas, research, feedback, theory, review, audit, etc or practical ideas that have been proven to work elsewhere. When developing your PDSAs it is beneficial to go through the 'Questions to consider for PDSA cycles'
PDSA Templates

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

Example of a PDSA
Plan: Order a list (in excel on disk) of HBA1cs from gribbles pathology that have been done in the last 2 years and compare list to the diabetes register to see if any patients have had an HbA1c and are not on the register. The list from pathology will be ordered by the practice manager on Tuesday 6th August and the lists will be compared on Friday 9th August at the practice by the practice manager. Data collected will be the names of people who have had an HbA1c in last 2 years and are not on the register.

Do: Ordered list as above however list not received until Monday 12th August and so lists were not compared until Monday 12th.

Study: 10 patients were found who have had an HbA1c in last 2 years and were not on the diabetes register.

Act: Follow up with the patients GPs to find out whether or not these patients had diabetes and if so which type and then record appropriately in the medical software.

CHGPN APCC PRACTICES 
Despite being a small Network there has been enormous interest in the APCC program. The APCC practices have been very successful and this reflects the high calibre of the participating practices. Sixteen practices have taken part in the three waves of phase 1. Four practices are currently participating in Wave 1 Phase 2 of the program. In addition, several practices that are not part of the program are submitting some de-identified practice data on a regular basis for analysis, benchmarking and feedback. Any other practices interested in submitting de-identified data for this purpose are able to do so. The analysis of practice data enables practices to examine their patient population and identify gaps or confirm areas where patients are being treated optimally. With the help of Network staff, any gaps can be addressed and practices can over time measure improvement of their data. Practices that have participated in the APCC program have found the networking component between practices invaluable. Meetings within the Network for all CHGPN APCC practices are usually held at one of the participating APCC practices. The meetings are chaired by the host practice and begin with a practice tour followed by a topic chosen relevant to the APCC program by the hosting practice. Many practices that have participated in the APCC program are beginning to extend the methodology to other chronic diseases not addressed in the APCC program such as asthma.

The practices that have participated in Phase 1 of the APCC program are as follows:

The practices that are participating in Phase 2 of the APCC program are as follows:

Chronic Obstructive Pulmonary Disease and Chronic Disease - Prevention and Self Management wave
The Improvement Foundation Australia has introduced two new topics to the APCC Program. The new topics, Chronic Obstructive Pulmonary Disease (COPD) and Chronic Disease Prevention and Self-Management (CDPSM) are being introduced to practices through a national APCC Program wave. Only practices that have already been involved in the APCC program in phase 1 are able to participate. With the COPD and CDPSM Program wave, colleagues get together at a series of learning workshops. Ideas are exchanged, experiences shared and knowledge gained by building on Phase 1 involvement. Back at the practice, improvements can continue that will make a difference to patient outcomes.

How are patients involved in this wave?
An innovative aspect of the COPD & CDPSM wave is the involvement of patients at workshop events and as key players in the Divisional team. Patient involvement has been an important part of the Improvement Foundation Collaborative Programs in the UK and has achieved great success. Given the nature of the COPD and CDPSM topics, patient involvement in the APCC Program is adding significant value to the generation and exchange of ideas and innovation. Patients are included in the Divisional team, and attend each of the workshops in the wave. Patients have a complete view of the care journey, have first-hand experience, and can tell practices what it is really like to receive the care that is being provided by a variety of organisations. Patients can act as a sounding board to determine if the changes planned will be an improvement from a patient's point of view. Given their experience navigating the care system, they can also contribute ideas for improvement to your Divisional team. Based on their personal background, the patient's role will vary from one team to another depending on the individual, the practices, and the Divisional team. 

Wave 1, COPD and CDPSM Wave
3 practices are currently completing Wave 1 of the COPD and CDPSM Collaborative from the CHGPN, these being The Springs Medical Centre in Daylesford, Coliban Medical Centre in Kyneton and Gisborne Medical Centre. Attended by GPs and managers or nurses from each practice, the national wave events are spread out over 8 months, and are combined with activity periods and ongoing data submission. Participants benefit from a rich workshop environment and the opportunity to network, share experiences and learn from a great number of people from different states.

For further information contact: Catherine Ferreira