Measuring the performance and organisational development of practices participating in the Collaboratives
Identifying the characteristics of high performing practices and how to spread high performance
Quality Improvement: Internationally, Collaboratives are the most common means for improving the quality of healthcare. The APCC Program, managed by Improvement Foundation Australia (IFA), is the Australian national initiative. After five years, 16% of general practices have demonstrated improved outcomes for their patients (1), but we know very little about the organisational processes of practices participating in the Collaboratives (2-4). For example, clinical leadership and teamwork have been recognised as crucial for the improvement of clinical outcomes (5,6). Yet there has been no systematic analysis at general practice or divisional level of the organisational development required to optimise leadership and teamwork. There is little understanding of the organisational development occurring among successful participants, or in their general practices.
Safety and Governance: The identification and reduction of harm has become a major priority for healthcare providers. The Australian Commission on Safety and Quality in Health Care (ACSQHC) has recognised (7) that little is known about safety in general practices even though general practice is the usual point of entry into the healthcare system. Standards for general practice set by the Royal Australian College of General Practitioners (RACGP) support quality improvement activities and the development of a clinical risk management system. Australian General Practice Accreditation Limited (AGPAL) accredits 85% of general practices by surveyor site visits assessing against the standards.
We propose eight research questions:
Several studies in Stream 2 will investigate the proposed research questions by using the clinical microsystem approach. Practices will be stratified by their performance in quality and safety by quality score based on data from Australian Primary Care Collaboratives Program (APCC) database for clinical performance and Australian General Practice Accreditation Limited (AGPAL) database for safety and governance. Three samples will be chosen for in-depth interviews.
The first sample is a national sample of general practices and medical Aboriginal services to identify the characteristics of high-performing general practices through interviews with general practitioners, practice nurses and practice managers.
The second sample is regional patients and consumers residing within the Greater Green Triangle region of South East Australia to gather their views and experiences on quality and safety.
The third sample is key informant interviews and case studies of Medicare Locals and general practices to examine the utilisation and spread of the Collaboratives.
IMPACT modelling will be used to assess the contribution of the Collaboratives to patient outcomes, especially imputed reduction in cardiovascular events.
Dr Amr Abou Elnour, MB BCh, PhD, Grad Dip PHC
Postdoctoral Research Fellow, Flinders University & Deakin University
To identify the characteristics of Australian general practices performing highly in safety and quality
To develop a safety collaborative manual to improve patient safety in Australian primary care
To investigate the Australian Primary Care Collaborative (APCC) Program impact on CVD outcomes.
In-depth interviews with a national sample from Australian general practices with high scores in safety and quality
Literature review and interviews with highly experienced surveyors who are involved in accreditation of Australian general practices and consultations with national and international experts on patient safety
A cohort study to follow up the CHD patients in the APCC program register for one year.
Characteristics of high performing Australian general practices in safety and quality
Safety Collaborative manual and a trigger tool
Measuring APCC Program impact on CVD outcomes
This project will develop:
Indicators to assess quality improvement, safety, and governance in the Australian primary healthcare system
A patient safety framework for Australian primary care
Optimal strategies to minimise CVD events in Australian primary care
The main aim is to improve our understanding of primary health Care Collaboratives in terms of:
How collaboratives are accessed (uptake)
How collaboratives are implemented and employed (utilisation)
How improvements are maintained (sustainability)
How we can promote the uptake of Collaboratives to other General Practices (spread)
A qualitative study is being conducted using individual face-to-face interviews with members of General practices and key informants from the Collaborative program. The interview questions will be specifically designed to ellicit responses on four different themes of uptake, utilisation, sustainability and spread.
It is predicted that the perceived enablers and barriers may be influenced by the demographic and structural characteristics of the practices (ie., rural vs urban locations or size of the practice) and possible the discipline and the role of ther person being interviewed.
If we can fully understand what makes Collaborative programs work, and what prevents them from working, then we have a greater hope of spreading improvement programs like Collaboratives throughout the remaining 80% of general practices in Australia. The significance of this will be greatly improved, sustainable primary health care for citizens across Australia.
Dr Siew Lim, BSc (Biomedical), MND, PhD
Postdoctoral Research Fellow, Flinders University & Deakin University
To determine the feasibility and short-term effectiveness of a Facebook-based intervention on increasing physical activity in postpartum women (6 months) with a history of gestational diabetes.
20 postpartum women (6 months postpartum) who had gestational diabetes will be recruited from Tasmania, Warrnambool, and Brisbane. Inclusion criteria include women who are 6 months postpartum, have a history of gestational diabetes, have private access to the internet, currently sedentary but willing to increase physical activity, and able to atten the initial in-person session. Exclusion criteria include those who are currently pregnant, currently diagnoses with diabetes mellitus, or currently exercise at moderate intensity for more than 30 minutes a day, 5 days a week. Subjects will receive and initial face-to-face consultation, followed by online support through Facebook messages. Subjects will be encouraged to provide and receive peer support through a designated Facebook group.
Frequency (the number of days per week) that participants reported at least 30 minutes of moderate to vigorous physical activity (MVPA) or walking for exercise, the total duration (min/week) of MVPA and walking for exercise (measured using the Australian Women's Activity Survey, AWAS), frequency of responding to weekly goal checks, perceived intervention usefulness.
This study will provide important information on the feasibility and effectiveness of delivering lifestyle intervention through social networking websites to women with a history of gestational diabetes. Such programs are much needed for those who could not attend regular, in-person sessions as required by conventional programs. This is particularly relevant in the rural and remote setting, but may also apply to other postpartum mothers who could not attend in-person group sessions due to childcare duties, time constraints, cultural barriers or other reasons.
Anne Sinclair, MEd, Grad Cert Health Management, RN
PhD Student, University of New South Wales
The aim of this study is to explore general practice microsystems from a learning organisation perspective. The focus will be on general practice in New South Wales.
A mixed methods study will be conducted. Quantitative data will include collection of demographics and completion of a Learning Organisation Questionnaire (Marsick et al. 2003) by staff in the practices. Qualitative data will include analysis of one on one interviews exploring responses to the Learning Organisation Questionnaire and patient survey responses.
This study will identify features of learning organisations demonstrated by the practices studied. It will contribute to our understanding of how learning needs are identified and addressed within a primary care setting.
With the emphasis continuing to move to preventive health it is imperative that Australia has contemporary and effective clinical microsystems that deliver high quality services. Learning organisations encourage learning, innovations and improvement, which increases the organisation's capacity to adapt to changing environments. In the business world, entities that have demonstrated excellence as learning organisations have also demonstrated innovation, market dominance and economic viability. Adoption and cultivation of the characteristics of the learning organisation has the potential to improve the quality and safety of care provided, benefiting health care delivery systems, consumers of primary healthcare, and the community.
Andrea Hernan, BPH&HP
Masters Student, Flinders University & Deakin University
This study aims to investigate patient and consumers' perspectives of safety and quality in general practice?
A qualitative focus group undertaken with rural and regional patients and consumers residing within the Greater Green Triangle region of South East Australia.
Patients and consumers were asked to discuss their experiences of particular aspects of safety and quality in general practice in order to obtain detailed, in-depth, and holistic descriptions of what patients value and the meanings they attach to experiences.
Patients' identified a range of safety and quality indicators that are considered to be important
These include but are not limited to:
timely access to services,
choice in provider,
continuity of care,
professional and personal competence,
referral systems and coordination of care,
relationship and communications, and
patient engagement in care
Little in known specifically about safety and quality in general practice in Australia
The majority of studies on safety and quality in general practice look at quantitative measures from a provider or organisational perspective
Little research has focused on patient values, experiences, and satisfaction of safety exclusively within general practice.