Issue 4 â€“ 2016
AAPM National Conference Crown Melbourne all wrapped up
In this issue National conference wrap
To update or not to update
Effective communication in employment
member benefits DISCOUNTS AND OTHER FINANCIAL BENEFITS
AAPM members receive a generous discount with Industrial Relation advocates, the Australian Health Industry Group (AHIG) for an advice service available to members by subscription. Please call 03 9280 8061 Australia’s first and only health IT magazine. As part of your membership, AAPM members receive access to all content released on the Pulse IT website and a digital subscription service to the Pulse IT magazine.
AAPM members receive a $400 discount on enrolment fees for UNEP courses. Contact 1800 066 128 to speak to a course advisor. www.practicemanagement.edu.au
GoShare Healthcare is a health education and content distribution platform that enables your staff to access trusted health resources and send customised bundles of information to patients. AAPM members receive a 20% discount on their GoShare Healthcare purchase. Free trial available. AAPM members receive a discount on Qantas Club Corporate Membership, representing savings of over $220.00. Call AAPM Head Office 1800 196 000 for the code.
AAPM members receive a personalised website planning session and fully integrated, easy to use website solution for a fraction of the cost of typical website providers. www.websites.aapm.org.au
AAPM members receive 10% discount from IMGA Mediprotect for Practice Manager Professional Indemnity Insurance & Business Insurance. Please call 1800 177 163 www.mediprotect.com.au
AAPM members receive a discount on Evolved Sounds Tailored On Hold Package • Free set up • Two months free service This provides members with a saving of at least $300.00, depending on the chosen package. Phone 1300 784 440
For the latest member benefits head to the website: www.aapm.org.au
Your association AAPM Board
AAPM Life Members
Vice-president Cathy Baynie
Non-Executive Directors Richard Evans Cecily Igglesden Brett McPherson Gary Smith
Secretary Fiona Wong
Chief Executive Officer Gillian Leach
President Danny Haydon
Life Membership is bestowed on members who have made an extraordinary contribution to the Association.
Treasurer Jackie Beer
VISIT THE WEBSITE www.aapm.org.au
HEAD OFFICE Level 1, 60 Lothian Street, North Melbourne, Vic 3051 P 1800 196 000 F (03) 9329 2524 E firstname.lastname@example.org
LIKE US ON FACEBOOK www.facebook.com/AAPMAustralia FOLLOW US ON TWITTER @AAPM_NATIONAL
Editorial/Advertising Marilyn Bitomsky P (07) 3371 3057 E email@example.com
Institute of Healthcare Management
18-21 Morley Street, London SE1 7QZ P +44 20 7460 7623 F +44 20 7460 7655 E firstname.lastname@example.org W www.ihm.org.uk PMAANZ Practice Managers and Administrators Association of New Zealand
contents Your association
Board members, contacts President’s message From the CEO’s desk
First non-Australian Fellow
Fellowships, scholarships and awards
To update or not to update
Who’s the leader of your practice
What is leadership?
IT revolution or evolution?
Newsbites 6 Our new Board
Practice managers of the year
New resource from AAPM and Avant
Effective communication in employment
Thank you to our National Partners
3 | Issue 4 – 2016
A message from the president Well it’s back to the grindstone after an
needing people in our communities. Driven
amazing national conference experience in
by their compassion and “can do” attitude
Melbourne. Congratulations and thanks to
they have made a difference, changed lives
the conference organising committee and
and made Australia a better place, all without
Victorian state committee for delivering such
relying on government. It is a great reminder
a high-quality conference program.
that our opportunities are often very limited
With the health, disability and aged care sectors on the cusp of massive reforms, we celebrated the role that healthcare managers play as the agents of change in facilitating and managing the change process in their practice, to ensure they can continue to operate as viable businesses and deliver high-quality services to
while we look to and rely on governments to address inequities and unresolved needs in the community. We have the opportunity in this environment of change to determine our own innovative solutions for ensuring the viability of our businesses and delivering high-quality services to the community.
the community. AAPM has partnered with Avant
AAPM continues to strive to deliver the support
to draft a discussion paper titled “The practice
and services to our members that are required
manager: A change agent for healthcare
to assist them to navigate the changes ahead.
practices”. The purpose of this paper is to
We have a strong focus on advocacy and
promote and advocate to stakeholders across
bolstering AAPM’s profile as a peak body of
the sector, and especially to government, that
significance, and will be looking to leverage
the role of the healthcare manager is critical for
the reputation of healthcare managers as the
the successful implementation of change.
agents of change to gain greater respect and
The Health Care Home model, mental health funding directed through the Primary Health Networks, the National Disability Insurance Scheme and aged care reforms all share some common principles: • Increased consumer choice for the purchase and or selection of services; • Stratification or tiering of the level of support with funding allocations prioritised to reflect need; • Increased accountability through quality outcomes and performance measures.
recognition for the importance of their role. You can assist us by downloading and reading “The practice manager: A change agent for healthcare practices” discussion paper and providing us your feedback. You may also wish to provide your principals with a hard copy to read and consider. AAPM also remains committed to our core purpose of delivering relevant information and high-quality education for healthcare managers. Our National Education Framework has continued to develop and in 2017 will deliver improved education programs across all the
Matina Jewell, in her amazing story of “Courage
states. Healthcare managers are encouraged
under fire”, reflected that through her challenging
to look at the education program and plan your
experiences change created opportunity.
professional development schedule for 2017.
Collectively these reforms are creating great
AAPM will also continue to keep members
opportunities as well as an increased level of
abreast of the latest news across the healthcare
competition across the respective sectors. For
industry through the fortnightly AAPM eNews
us as healthcare managers, it is essential to
reorientate our practices to this new approach to service delivery, so that we can take up these opportunities. The inspirational young men who founded Orange Sky Laundry proved that, by focussing on their purpose and remaining true to their core objectives, they were able to realise their goal of supporting the homeless, the most 4 | Issue 4 – 2016
From the desk of the CEO AAPM has enjoyed a very successful year in 2016, with an increase in membership growth, more education events and a higher average attendance rate, an increase in sponsorship income, and a 10% rise in member satisfaction! One of the highlights this year was the launch at the national conference of the AAPM/Avant Discussion Paper, The practice manager: A change agent for healthcare practice (see p.23, and also see AAPM website, under News). This paper highlights the growing role of the practice manager as positive change agents within practices and an important government interface. They are able to take responsibility for the administration of the practice, allowing the healthcare professionals to focus on the clinical aspects. Ultimately, this results in improved patient care and health outcomes. Professional practice managers are taking up the challenge to equip themselves for the changes ahead so that they and their practices are ready to navigate successfully the impact of the changes to come. Participation in AAPM’s education program of webinars and face-to-face seminars has doubled in the last year as AAPM has progressed with implementing a National Education Framework. This national program is aimed at providing all members with access to education to enhance their skills across the eight core principles of practice management, providing them with information about new technologies and with tools to manage the changes that are coming in with the government’s health reforms. The benefits of AAPM’s education program, industry information and resources enable our members to improve their practices’ efficiency and effectiveness in contributing to better patient outcomes. AAPM’s growth in 2015/16 was supported by our national partners, state sponsors and event exhibitors. We would particularly like to thank our national partners, Avant, Medibank, 1stAvailable, AGPAL, Medical Director, Medical Channel, Cutcher and Neale, and University of New England Partnerships. Their support and contributions to member resources and to our education programs have significantly assisted us to achieve growth in membership and education attendance. The AAPM national conference in Melbourne attracted over 750 participants who enjoyed the wide range of education, the opportunity to explore a range of services and products provided by exhibitors and also the advantage of networking and forming continuing
friendships with like-minded people from all over Australia. We are most appreciative of the support provided by our conference partners (Avant, 1stAvailable and Medibank), our many conference sponsors, and exhibitors in making this event such a success. Initial feedback shows that almost 85% of the attendees were satisfied or very satisfied with the conference. Congratulations to the National Practice Manager of the Year, Deborah Stidwell from rural Victoria, and to all the State Practice Manager of the Year winners who are an inspiration to members everywhere. These awards are sponsored nationally and in all states by AGPAL. The Chronic Disease Management Award sponsored by MSD was presented this year to Jeannine Armstrong from Victoria. This award highlights the important role practice managers play in introducing innovative ways of assisting patients to successfully manage chronic conditions. AAPM is a strong proponent of education and we encourage members to attain qualifications in management to achieve Certified Practice Manager and Fellowship status. This year, we were very pleased to offer nine scholarships to the UNEP Certificate IV or Diploma of Practice Management for study in 2015. Five of these are supported through our national partner, Avant. Congratulations to the recipients of these scholarships – Jodie Boyce (NSW), Gail Lloyd (NSW), Rachael Hatzopoulos (Vic), Annette Ah Shay (Qld) and Elli Lazarov (WA). The Colleen Sullivan Scholarship was awarded to Jennifer Lang (Queensland). The Medical Director Indigenous Scholarship was presented to Natalie Dunk-Andrews (Queensland), and two new Indigenous Scholarships supported by University of New England Partnerships were awarded to Theresa Symes and Chantal Draper, both from Queensland. More information and photos of these members can be found on pages 20-22. My best wishes to all members, supporters, sponsors and partners for a very Happy Christmas. We look forward to an exciting 2017.
Chief Executive Officer
5 | Issue 4 – 2016
news bites Adios but not goodbye from Marilyn Bitomsky Twenty-five years ago, Colleen Sullivan asked me to become involved with AAPM and assist with producing a national journal, the Practice Manager. Colleen is a former national president, former Queensland president, AAPM Life Member, and so much more. She is also a sincere and much-loved friend and mentor to many in numerous areas of the healthcare industry. So for 25 years I have been your editor. Now, I feel it is time for someone else to take this role. I have made countless friends through my involvement with AAPM, and was surprised, delighted, and truly honoured to have been awarded Honorary Membership of the Association earlier this year. The honour was even greater, knowing that I was only the second to receive this award – following the esteemed Professor Geoffrey Meredith.
Convocation Convocation is an opportunity for members to raise matters of importance with other members and to alert AAPM to the issues that practice managers consider important. Held at the national conference each year, this is an open forum between the Board, management and members. This year there was one motion which was proposed by Brett McPherson and seconded by Colleen Sullivan, both AAPM Life Members and former national presidents. The motion was that “the state committees be given the appropriate recognition and flexibility to support member needs and effectively promote AAPM to members, prospective members and key stakeholders.” At the Convocation meeting, Mr McPherson put forward his view that there is a perception the Association may have moved too far towards centralisation, limiting the ability of state branches to respond to members’ needs. “The states should be encouraged to be innovative and flexible,” he said. Mrs Sullivan added that what was right for one state is not necessarily right for all. “This motion allows us to revisit the previous situation of strong state branches and strong regional groups, as it is at grassroots level that we reach our members,” she said.
Three years ago after my husband, Dr Bill Cadzow, died, I felt the need to contribute my writing and media liaison skills pro bono to end-of-life choice organisations such as Dying with Dignity Victoria, as Bill did not have the comfort of choice. I am now assisting similar organisations in several states.
There was a lot of discussion around the topic including the critical importance of the national program being able to reach all states. Both Mr McPherson and Mrs Sullivan acknowledged the importance of Head Office and its role, its invaluable support and many achievements.
To all my AAPM friends, I say thank you for your friendship, warmth, and fellowship over 25 years. It is not goodbye but simply a change in our relationship.
This motion was passed and will go to the National Board for further discussion.
AAPM now on Instagram Instagram is an online mobile photo-sharing, video-sharing, and social networking service that enables its users to take pictures and videos, and share them either publicly or privately on the app, as well as through a variety of other social networking platforms, such as Facebook, Twitter and LinkedIn. AAPM is delighted to announce our presence on Instagram. You will need to have the Instagram app installed on your mobile device and follow us on @aapm1979. 6 | Issue 4 – 2016
National conference “Have your say” For the first time at the conference there was a session where members had the opportunity to “have their say”. This was a well-attended session where members could have their say and the Board was able to respond and some of the issues raised included: • More information and education on interpreting the MBS and also on billing patients outside the MBS • National advocacy on behalf of general practice and of members • Interest in the addition of masterclasses at a higher level to the education programs offered.
National conference a real hit Congratulations to the Melbourne conference team, led by Maggie McPherson, on presenting such an exciting and educationally valuable conference. Pictured above from Left to Right: Peter Wallis, Jo Werda, Tracy Clarke, Linda Osman, Maggie McPherson, Nadine Smith, Cathy Hermans, Brett McPherson. Missing from photo were David Osman and Cheree McNeight.
Pharmacy applications and PBS stationery orders over the holidays Medicare has advised that Section 90 pharmacy applications and PBS stationery orders will not be processed over the Christmas holiday period.
For full details, see www.humanservices.gov.au/ health-professionals/news/pharmacy-applicationsand-pbs-stationery-orders-over-holidays.
Medical practices can apply for stage one of Health Care Homes Medical practices in selected regions around Australia can apply for stage one of Health Care Homes. Health Care Homes is a major reform of primary health care and aims to reshape the management of chronic and complex conditions by placing patients at the centre of care with general practice and Aboriginal community controlled health services (ACCHS). Stage one will be rolled out in selected regions from July 2017. Health Care Homes aims to deliver more flexible care for people with chronic and complex conditions.
Section 90 pharmacy applications submitted between 23 December 2016 and 2 January 2017 will not be assessed until Tuesday 3 January 2017, and there will be no PBS stationery orders dispatched during this time.
Practices will be given a monthly bundled payment
To receive your PBS stationery before the Christmas closure, you must place an order by:
organisations in the selected regions may apply
Personalised stationery orders must be in by midNovember, while standard non-personalised stationery must be in by 1-9 December, depending on your area.
for delivery of effective care to patients with chronic and complex health conditions. Accredited general practices and ACCHS to participate in the voluntary trials. More information on the application process is available on the Tenders and Grant page on the Department of Health website. 7 | Issue 4 â€“ 2016
Our new Board At the AGM, several members of our Board retired from the position, as a result of changes in the length of time possible for some to serve in the role. See the AAPM website (www.aapm.org.au/About-AAPM/National-Board) for additional information on the new Board.
L to R: Gillian Leach (AAPM CEO), Richard Evans, Jackie Beer, Danny Haydon, Cecily Igglesden, Brett McPherson, Cathy Baynie, Fiona Wong. Inset: Gary Smith
Danny Haydon BAppSc (OT), MHlthServMgt, FAAPM Danny is manager of Practice Management Services at Brentnalls SA, a highly respected accounting and business advisory firm. He provides a range of practice management consulting services in medical and allied health services, including practice assessments and business planning. He also assists practices to plan for the future and implement strategies for improved financial performance, new models of service delivery, effective management of human resources, and expanded infrastructure. Danny is also a director of the Northern Health Network in Adelaide. He has been president of AAPM since October 2014.
Vice-President Cathy Baynie RN, CPM, FAAPM Cathy has managed both semi-rural and urban practices. Whilst continuing to manage a multi-disciplinary practice and a specialist practice in Sydney’s north, she is the 8 | Issue 4 – 2016
practice management advisor to the NSW Australian Medical Association, an accreditation surveyor, a trainer and assessor with UNE Partnerships, and consultant to practices around the nation on governance and practice management issues.
Secretary Fiona Wong
Dip Pract Mgt, MAAPM, CPM Originally from Tasmania, Fiona started out in the credit union industry before moving to Perth where she began her health industry career in 1996 with a combined physiotherapy, podiatry and massage practice. She then worked for various specialist practices as well as for an accounting firm before settling in her current role as practice manager of a busy multilocation, multi-doctor ophthalmology and neurology practice where she has been for the past 10 years. Fiona is in her second term on the board as WA’s representative and is encouraged by the growth and the professionalism that AAPM has achieved during this time. In her spare time Fiona and a team of friends named Purple Hearts participate in charity walks and
host social events to raise money for research into all women’s cancers which is donated to the Harry Perkins Institute of Medical Research in WA.
committees, current and previous directors and the head office team. With continued growth and increased membership, I believe that AAPM will continue to build and extend the excellent services and advocacy currently available to members, and I in conjunction with them look forward to being part of the process.
MMgt, BCom, FIPA, FIFA, FAAPM, FFin, DipPracMgmt, Cdec
Jackie was a career banker for 20 years before turning to practice management. She is currently a practice manager on the outskirts of Bundaberg at an accredited general practice and Aboriginal health service. Jackie is the immediate past president of the AAPM Qld Branch and continues to serve as a AAPM Qld committee member.
Non-Executive Directors Richard Evans
DipBus, BA (IR), M CreativeWrtg, FAICD, FAIM Richard has over 30 years’ experience in business leadership, industry advocacy, policy advocacy and government relations, achieving strategic outcomes and revenue growth results. He is former executive director of several major national member associations. He has also served as executive director of six state headquartered member associations in highly regulated sectors. Additionally, he served as federal politician in the Australian parliament, including chairing and providing evidence to parliamentary inquiries and influencing policy and legislative changes. “In my view health policy in Australia is way too focused on clinical care. Of course it is important, but there are many other aspects of health service that fall outside of clinical work; yet it seems the clinicians have the overwhelming advocacy influence on all policy, which frankly could be driven by self-interest. Practice managers play a significant role in policy as they are the engine (hub) of any practice. They deal with the clinicians, the patients, the compliance, and the other stakeholders, but there is very little recognition for their role. My role as your independent director is to help your very competent leaders and senior executives of AAPM to increase their advocacy profile and thus AAPM’s influence in health policy. Gillian Leach has made significant leaps into the complex and mysterious world of politics and I look forward to supporting her.”
Cecily Igglesden Dip Pract Mgt, MAAPM Cecily is practice manager of Prospect Medical Centre, a large multi-disciplinary practice in northern Tasmania, where she has worked since 2001. She has significant management experience in the areas of disability, child care and health. “I am very honoured to be on the board of an organisation that represents such committed and passionate professionals. AAPM’s growth is testament to the hard work and dedication of its members, state
CPM, FAAPM, GradDipBus, FETC (Oxford), Life Member AAPM Brett has over 25 years’ health management experience and currently manages a multi-award winning Melbourne CBD GP practice, where adopting “Quality as a Business Strategy” and embracing e-Health through IT innovation has provided significant benefits to patients, practice services and overall practice efficiency and profitability. Brett received the 2014 Improvement Foundation Quality Improvement Award. He sits on a number of government and professional advisory groups and is a former AAPM national president. Having spent more than 10 years managing radiology practices, the last five of those in a corporate environment, Brett believes that all managers need to take leave/ time away from their position if they are to perform effectively. “You get engulfed by the practice, your work and sometimes your own belief that the practice can’t survive without you. You need to get away, clear the mind and enjoy some ‘me’ time. Not surprisingly, the practice will survive. Negotiate an extra week or two leave as part of your contract and you and your practice will notice the difference.” So now Brett and his wife Maggie travel regularly and share their passion for good food and rugby.
Gary Smith JP, CPM, FAAPM, MAICD, SFCDA, Life Member AAPM Gary has been practice manager for over 30 years of a large multi-disciplinary practice in western Sydney. His career has been extensive in the management of healthcare facilities and the provision of health services. He takes a keen interest and involvement in health reform in Australia. He provides advice to the federal government on the management of health reform and is a member of various advisory groups on behalf of AAPM. He is a former AAPM national president. “The delivery of healthcare is a business, and as such is subject to the same market factors, risks, constraints as other service industries, which require sound business principles and techniques to survive and thrive. This is all part of the practice manager’s role. “I would like to ensure that the professional development of our members is continually progressing, including refining their skill sets and knowledge. Because of the changing working environment in which managers work, I wish to ensure that we at AAPM are a centre of influence with government and peak bodies, ensuring that we are representing our members in the decision-making process.” 9 | Issue 4 – 2016
aapm 2016 conference crown melbourne
welcome reception at melbourne zoo conference partners
10 | Issue 4 â€“ 2016
aapm 2016 conference crown melbourne
11 | Issue 4 â€“ 2016
Applies to all healthcare practices
Core principles: All by Wendy Slight Practice Manager, Newlands Medical Centre, Wellington, NZ
non-Australian Fellow Hello from across the Tasman. I am Wendy Slight, practice manager of Newlands Medical Centre, Wellington, NZ and I am honoured to have recently become the first non-Australian to be accepted as a Fellow of AAPM.
Constantly learning My career in practice management started in 1999 at a small practice, and I have been at the larger Newlands Medical Centre for the past six years. Our enrolled patient population of 9,300 patients has a diverse ethnic and socioeconomic profile. I am fortunate to work alongside a dedicated, proactive and passionate team, consisting of three GP owners, six associate GPs, eight registered nurses, two primary care assistants, and six reception/administration staff. We also have a range of allied health professionals who offer clinics from our medical centre, including midwife, massage therapist, physiotherapist, podiatrist, and counsellor. Five years ago we moved into a purpose-refitted centre in what was once an old pub, doubling our floor space to increase our capacity, and last year completed a further extension. When I first started in 1999 it would be fair to say I knew very little about being a practice manager. I’d worked a variety of roles for an insurance and financial provider to the medical profession which gave me a comprehensive administrative foundation. Fortunately, a group of local managers took me under their wings, and they remain friends to this day. They took me along to PMAANZ (AAPM’s NZ equivalent) and this has been my saviour, providing a significant portion of my education, through monthly meetings, annual conferences, and invaluable collegiality. Along the way I completed a NZ Institute of Management Diploma in Management through the Open Polytechnic of NZ (distance learning). I am also a keen reader and love to learn, so I tend to take every opportunity that comes my way to keep learning. I am currently one of two primary care placements on a leadership 12 | Issue 4 – 2016
program being run by our secondary care district health board.
My relationship with AAPM In 2012 I was one of seven Wellington managers sponsored to attend the AAPM conference in Brisbane. This was one of those “pivotal” moments for me, and was the start of my relationship with AAPM. Exposure to the calibre of speakers in Brisbane and since, both in Adelaide and Hobart, has left lasting impressions on me and has shaped the manager that I now am. The weekly AAPM e-news and the AAPM journal often both contain gems that are just as relevant to us here in NZ. In 2014 I had the pleasure of being one of the convenors of the AAPM/PMAANZ Joint Education Symposium held in Wellington, that saw around 40 AAPM members cross the Tasman for two days of shared learning. I firmly believe that our roles as practice managers have more similarities than differences, and this was confirmed for me during the symposium. We all deal with HR, finance, compliance, etc. – it is just the particulars of the legislation that differ. As I see it the main differences are in our government structure and funding. During that symposium I formed and cemented friendships with AAPM colleagues, thereby widening my support crew. I am looking forward to renewing them in Melbourne.
Embracing change There have been significant changes in primary health in NZ since I started, with more on the horizon. I have had to learn to love change, and am grateful for some of the AAPM conference speakers, such as Dr Jason Fox, who have inspired me to take the leap of faith and not be held back by the self-doubt that comes from operating outside our comfort zone. Believe me when I say I used to be one of the most changeaverse people on the planet! Most significantly since I started, our funding system has completely changed from a fee-forservice model to a capitated model under which
we receive bulk funding based on the demographic profile of our enrolled patient base. The accuracy of our patient register is therefore crucial as it directly determines a significant portion of our funding (in our case at NMC, 54% of our income comes from capitation). Primary care networks (ours is Compass Health) also negotiate contracts with the district health board on our behalf for various health projects. For the past three years we have been bulk-funded for our long-term condition care which has meant that we design what the service provision looks like, including which type of clinician provides the care, as long as we meet the Ministry’s health performance milestones. For us, a significant portion of our long-term condition care is provided by our nurses in autonomous clinics. I am aware that bulk-funding is also under discussion, and pilots are underway, in Australia. Models of care in NZ are also in the spotlight, and this is where significant change is happening around me. NZ is facing the global issue of an ageing clinical workforce and an ageing patient population with more complex health needs. In essence, more patients living longer needing more care, with fewer clinicians to provide it. In an effort to find ways to work smarter with the resources available, our practice is one of an initial group of six taking part in a Healthcare Home pilot in the Wellington region. It is early days but we are already introducing Lean principles; clinical phone triage; closer integration with secondary care and community-based services; better use of technology, e.g. the patient portal; and reviewing our team members’ roles to ensure we “have the right people in the right seats on the bus”. It is an incredibly exciting, and busy, time to be a PM!
A career and a commitment For me, being a PM isn’t just a job, rather it is a career and a commitment. Working with the forward-thinking team at Newlands, I have had to change and grow. I have had to become more business focused, to learn to love change and innovation, and to keep learning. Much of my role, now that we are a Healthcare Home, is involved in a steep learning curve of change and project management. Professional development and peer support is key, which brings me back to Fellowship. Throughout my career I have been a member of our NZ association (PMAANZ) and in 2012 I joined AAPM as well. The support, collegiality, and professional development opportunities available through both of these organisations have shaped my development. Being accepted as a fellow of AAPM means, for me: • A n ongoing commitment to nurturing the relationship between our two organisations • A commitment to sharing the similarities and investigating the differences in how we do things • An ongoing commitment to my professional development • A commitment to helping to develop colleagues new to practice management • An acknowledgment of my professional journey. I look forward to contributing to AAPM in any way possible from “over the ditch”. If you would like to know about how things are done over here please don’t hesitate to get in touch and I’ll do my best to help. Again, I am honoured to have attained Fellowship. Wendy Slight email@example.com www.newlandsmedical.co.nz 13 | Issue 4 – 2016
Practice manager of the year
Western Australia Western Australia’s PMOY is Louise Turner, Operations Manager at Panaceum Medical, located in Geraldton in the mid-west of the state. Congratulations Louise.
My practice We haven’t let our remote location impede attempting to be a market leader in what we do. We are a part of a multidisciplinary practice, including allied health, industrial health and rehabilitation gym. The section that I am responsible for is the central hub of 18 GPs half of whom practise obstetrics or anaesthetics in the local hospitals. We have worked hard on getting strong foundations, and take part in constant quality improvement, never letting any stone left unturned. As a result we have forged a clinic that is working toward making healthcare easy for patient and practitioner, and empowering both. We are proud of what we have achieved so far but there is always so much more that we want to do to refine the practice and help all of our customers. We have a very skilled bunch of nurses, support staff and GPs who strive towards being better, and that is what makes our clinic different. In recognition of the fact that we have a good thing going, we have started to expand on our core business into practice consultancy, to assist other practices take crucial steps forward in becoming an efficient functional modern practice with a diversified income.
What sets us apart I was nominated for the award by my CEO and directors, and it was a surprise to me. I have worked for the Panaceum Group for four years, two years in a small practice of four GPs and the last two years in the super clinic of 18 GPs and nursing staff. It has been a ridiculously busy four years but in retrospect I would not have done it any other way. The smaller practice taught me so much, as I had to effectively rebuild it from bottom up, including a whole new policy and procedure manual, new doctors and new staff. I learnt nearly every aspect of every role, and with the help of my administrators and nursing team we took a fresh look at every process to find leaks or potential risk. The result was many hours of work and long days but it prepared me for walking into a very different practice two years later. My appetite for never accepting “the way it is” followed me, and we brought in major technological innovations to assist with patient flow, including online booking, new websites, check-in kiosks, and new branding. We also developed systems for industrial health and workers’ compensation to offer to our local business above and beyond services, which went on to be something we wanted to offer other practices around 14 | Issue 4 – 2016
Australia. The most important tool in the box, though, is good staff. I believe that good team culture trumps any policy or strategic plan! I have worked with my team to find out their strengths and weaknesses, give them a structure to work within and build trust. The eventual aim is to do myself out of a job, and then I will know I have succeeded!
What the award means to me and my practice This award means all of our hard work has been recognised! We have not stopped running for what feels like four years straight, pushing the practice sometimes kicking and screaming into the modern practice that we have now. It shows that you can spearhead innovation and create a stir from a regional city and you can overcome the constraint of location. This award has allowed me to reflect on the amount that I have learnt over the past four years, and given me some degree of assurance that I am on the right road. I think every practice manager at some point in their career (or at multiple points) wonders whether they have made the right decisions for their practice or whether they are pushing in the right direction, as they don’t have a moment to take stock and check. This award has given me a moment to take stock of achievements so far, and given me the push to keep on driving.
Advice for other practice managers Take ownership, never stop testing and asking why, and never accept normal! Build your team up with the knowledge you gain as it will pay dividends in the end. Good team culture trumps everything. Get that right and everything else is easy. For yourself, find a mentor (or two or three) who will help push you outside your comfort zone, as it helps you grow. Modern practice management is overwhelming. You can’t become an expert in every field so build up a network of experts in those key areas to help you on your way.
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Practice manager of the year
Queensland Congratulations to Anthea Blower, Queenslandâ€™s PMOY. Anthea manages Hope Island and Homeworld Helensvale Medical Centres, large, well-respected, doctorowned family general practices on the northern Gold Coast.
My practice Covering all aspects of general practice, the practices offer a diverse group of 21 dedicated GPs to deliver the highest quality care and service to their patients. We provide a team approach to care, patients are respected as partners in the management of their health and wellbeing. The practices are AGPAL accredited. As a testament to our commitment to quality care and continuous improvement, Hope Island Medical Centre won AGPAL Practice of the Year in 2012 and Homeworld Helensvale Medical Centre was a finalist in the 2016 Practice of the Year awards. Both practices are accredited training practices for GP registrars and medical and nursing students, from Griffith and Bond Universities. All of our doctors have a keen interest in preventative medicine and the practices provide the full range of comprehensive primary care services, incorporating visiting allied health and specialist services. There are currently five registered nurses, two enrolled nurses, a team of fifteen reception/administration staff and nine visiting allied health and specialist service providers. Together the teams participate in both internal and external quality improvement activities, having previously been involved with innovative Australian Primary Care Collaborative (APCC), Gold Coast Primary Health Network (GCPHN) and Gold Coast Hospital and Health Service(GCHHS) pilot programs that enhance best practice patient care, cement comprehensive policies and procedures and enrich service delivery models.
What sets us apart Managing such a large team of health professionals across two 16 | Issue 4 â€“ 2016
practice locations requires flexible and responsive leadership and team-building skills which have resulted in a highly successful business that delivers our patients a high standard of service and quality. In the past year I led the team through an external customised staff development program which improved the cohesiveness of the team through enhanced communication strategies based on situational leadership principles. I instigated, with collaboration from the team, our core principles. Our Vision, Mission and Method are based on service to our patients and to each other. Our best investment is in the people of the organisation. By using tailored human resource management skills, I invest my time and energy to support and draw out the best in each individual, which has led to a very enthusiastic, positive and productive practice culture. Business planning focuses on risk reduction, measuring and monitoring, ensuring sufficient resources, efficient processes, legal compliance and quality assurance while maximising income for the practice and its contracted GPs. I successfully obtained a $20,000 innovation grant to run a general practice-based, nurse-led activity tackling obesity. Maintaining our core commitment to the patient as central to all that we do, all business plans must pass the gold standard of being the right thing to do for our patients. As current administrator of the GCPHN practice managers email network, I aim to improve the quality of general practice, particularly through the influence and profile of exceptional practice management. I regularly facilitate and present training and networking sessions for general
practice, through educational events delivered by the GCPHN and I was one of three Gold Coast practice managers who were engaged as consultants for the development and implementation of the Gold Coast Integrated Care (GCIC) Project, an initiative of the Gold Coast Hospital and Health Service (GCHHS). The initiative aims to reduce avoidable hospital admissions through enhanced communication and integration of hospital and general practice care. I am continually pro-active in my introduction of protocols to ensure best practice. I have introduced a range of initiatives to enhance the business development and service delivery options for patients. These have included patient services, such as updated website and patient waiting room electronic displays, incorporation of My Health Record (PCHER) activities and capabilities, all new e-health policies and procedures, online bookings and SMS confirmations. I have also overseen expanded use of HPOS to check service eligibility, implementation of new infection control guidelines and implementation of Telehealth services to a local residential aged care facility.
I have had many years of leading practice teams through clinical quality improvement activities that enhance the systems that result in quality patient care. Utilising change management processes that allow the teams to Plan, Do, Study and Act, I have in collaboration with our teams fine-tuned practice patient management processes. I enjoy trolling through practice population data and delight in the incremental improvements I find in there (Clinical Audit Tool-CAT). A little friendly competition between the doctors and practices acts as an additional driver when I present data at GP clinical meetings. I am very proactive and passionate about ensuring that policies and processes within the practice ensure a maximum income stream, by a thorough knowledge of MBS item numbers and Medicare compliance. No matter what effort it takes, my passion for doing it â€œthe right wayâ€? ensures consistency and compliance across the diversity of practice systems.
What the award means to me and my practice In Queensland, the state PM award is named in honour of the late Sue-Ellen Toms. This inspirational and innovative practice manager was an effective leader whose warm style endeared her to many. Her skill and commitment to practice management raised the profile of our profession and she was the embodiment of our values and core principles.
practice 24 years ago as a medical receptionist and I never saw myself in the company of the previous extraordinary award recipients. I am amazed and privileged. I truly believe that this award reflects the commitment and dedication of our entire practice team. I could not do what I do without their support.
Advice for other practice managers Practice managers tend to be people who give entirely and constantly of themselves. They work tirelessly and can struggle to maintain a healthy work-life balance. We know that nothing will change unless we make a change. I made a commitment to myself at the start of 2016 that this year I was going to make more time
for me. Then I had an unexpected injury in May. A severed Achilles tendon put me out of action for a few weeks (but allowed me time to actually complete and submit the nomination for PMOY). Practice managers know all too well, that it never rains, but it pours. It was while recovering from surgery, we lost a server and recovery from that was far from smooth. I was, however, so proud of my team and the systems we had developed. The team stepped up. They drew on their training and they followed the protocols, not skipping a beat in continuing and recovering practice operations. The test of best PMs is how their practices survive without them. My advice is to ensure your workload, skills and knowledge is shared. Make time for yourself and time for your team to shine.
To be nominated initially, so generously by our practice principal, Dr Andrew Weissenberger, and our team was delightful. To be awarded the state title was an overwhelming surprise and a humbling honour. I started my career in general 17 | Issue 4 â€“ 2016
Practice manager of the year
New South Wales/ACT Congratulations to NSW/ACT PMOY Heather Farlow. Here she describes her practice, Bondi Road Doctors, and what the award means to her and to her practice.
My practice Bondi Road Doctors is a family boutique-style practice. With the principal, Dr Gillian Deakin, we have set up a unique practice to provide comprehensive care to our many patients in the local community. It is our mission to ensure this is maintained by building a highly successful team, and providing exceptional care to our patients. More recently, I have been given the opportunity to work alongside the principals of East Sydney Doctors as their practice manager. This practice has a large team of doctors whose expertise is in general and family medicine, sexual health and HIV medicine, and healthy lifestyle medicine. It is an exciting and challenging diverse role working between the two practices, which are both very different but very similar in the sense that the culture is focused on delivering good patient care.
What sets us apart I have worked at Bondi Road Doctors since 2002 and, in that time, not only have I grown in my role, but I have developed a passion for practice management. This passion has helped with the growth of the practice. I have developed an environment in which our patients feel comfortable. They know they are going to get good continued quality care from our doctors. It’s that doctorpatient relationship which is an important part of our practice’s culture, optimizing the patients’ health journey. An important part of my role is that of providing continued support to our great team of people. I am also responsible for the financial management of both practices, which is a role in itself. I am fortunate to have great working relationships with the principals of both practices, which is vital to my role as their manager. Managing a practice and leading a team, although it is a hard role, for me it’s an extremely rewarding one. The role is a varied one, and no day is the same as the other. As long as the patients are cared for, the staff are happy, then I’m happy!
What the award means to me and my practice It is an absolute honour to have won this award, to be given recognition for the huge role of practice manager, to have my team support and show that they admire and are grateful for my continued support. I’m extremely humbled and flattered by their nomination. To also be recognised by a great professional organization as AAPM is an honour 18 | Issue 4 – 2016
and provides me with further confidence and enthusiasm to be involved in promoting our wonderful profession.
Advice for other practice managers Get more involved! Network with your peers to help give you a broader knowledge base. Attend as many professional development events and workshop days that you possible can. The relationships and friendships you will develop and gain along the way will also be an invaluable part of your professional journey. If you haven’t already, it is a must to complete a certificate or diploma in practice management. The knowledge and skills you will learn from this will prove invaluable to your role. We never stop learning. The more knowledge we gain, the more we can develop our skill sets. And this not only helps the way we deliver our services to our patients, but also helps our team members. Remember, always laugh when you can. It’s cheap medicine.
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Fellowships, scholarships & awards
Fellowship – the gold level of achievement Our Association has six new Fellows. Six people who have reached the pinnacle of educational achievement for AAPM members. Fellow status recognises members who have met required levels of knowledge, skill and abilities. It assists employers in identifying people who meet nationally recognised standards, and provides formal recognition of those who meet these standards. Our new Fellows are (L to R) Jackie Beer (Qld), Fiona Brabender (SA), Tracy Clarke (Vic), Margaret McPherson (Vic), Catherine Ryan (NSW), and Wendy Slight (NZ). Wendy is our first non-Australian Fellow (see page 12).
National Practice Manager of the Year Congratulations to National Practice Manager of the Year Deb Stidwell from Victoria, who received her award at the national conference. Other state finalists were Anthea Blower (Qld), Heather Farlow (NSW/ ACT), Vicki Linden (SA/NT), and Louise Turner (WA). All well deserve the accolades they have earned.
managers with a wide range of business responsibilities in the practice environment, or the UNE Partnerships Certificate IV in Business, which is suitable for those responsible for operational management of a medical practice. Winners this year are Jodie Boyce (NSW), Gail Lloyd (NSW), Rachael Hatzopoulos (Vic), Annette Ah Shay (Qld), and Elli Lazarov (WA).
In the last issue of the Practice Manager, we introduced Deb and Vicki. In this issue, we have Anthea, Heather, and Louise.
L to R: Jodie Boyce, Marianna Kelly (Avant), Rachael Hatzopoulos, Adam Golabek (Avant head of partnerships), Gail Lloyd, Colleen Sullivan (AAPM and UNE Partnerships), Jan Chaffey (AAPM). Annette Ah Shay and Elli Lazarov were not at the conference and hence were missing from this photo. Congratulations to all scholarship winners.
Colleen Sullivan Scholarship
The purpose of these scholarships is to foster and promote continuing training and professional development for AAPM members.
The Colleen Sullivan Scholarship recognises Colleen’s
The scholarships provide for up to five enrolments in either the UNE Partnerships Diploma of Professional Practice Leadership, which is suitable for experienced practice
Diploma of Professional Practice Leadership, and is suitable
20 | Issue 4 – 2016
long-time contribution to education and assistance to AAPM members. It provides for enrolment in the UNE Partnerships for experienced practice managers with a wide range of business responsibilities in the practice environment.
Congratulations to this year’s winner, Jennifer Lang, from Indooroopilly Family Practice in Brisbane. Here she tells us what the scholarship means to her. “I knew I wanted to become a practice manager but still maintain a hands-on role as a general practice nurse. Two years ago, I was fortunate to land a position which combines both. Since taking on the additional role of practice manager I have acquired a lot of new skills and knowledge, and an appreciation of the bigger picture of the role of general practice in the Australian healthcare system. I was aware that there is so much more to learn in practice management so applied for the scholarship to learn what I don’t know. “Being awarded this scholarship will give me a higher level of knowledge and skills to enable me to improve the practice as a business, for its employees, and most importantly for our patients. Without the support of this scholarship I would not have been able to start so soon, and my eagerness for this knowledge would have had to wait. I am very humbled and grateful to AAPM and Avant for providing me with this opportunity.”
MedicalDirector/AAPM Indigenous Scholarship The purpose of this scholarship is to foster and promote continuing training and professional development to indigenous health workers, supporting a pathway to practice management. The scholarship provides the course fees for an enrolment in the UNE Partnerships Professional Development Program for an online course. This year’s recipient is Natalie Dunk-Andrews, from Theodore Medical in Qld. Her practice provides a comprehensive rural general practice including surgery, anaesthetics and obstetrics. Also available on site is a wide range of diagnostic services including x-ray, ultrasound, hearing, heart and breathing tests. This is the only private practice in Theodore, and services the townships of Theodore, Cracow and surrounding areas. Practice principal is Dr Bruce Chater, who is also a medical superintendent at Theodore Hospital. “This scholarship means a great deal to me and will allow me to continue to develop my professional capabilities
as a practice manager, whilst supporting my local community, Natalie said. “I will be able to ensure that I am providing my community with the most current advancements in general practice and also a safe and welcoming workplace. As an RN and diabetes educator, this diploma will be a great progression in my health career, and allow for this small rural community to have access to a progressive and engaging general practice. As a member of the local indigenous community I feel privileged and honoured to have been awarded this opportunity and I look forward to evolving as a valued member of my healthcare organisation and community. “In the words of Steve Jobs, ‘Your work is going to fill a large part of your life, and the only way to be truly satisfied is to do what you believe is great work. And the only way to do great work is to love what you do. If you haven’t found it yet, keep looking. Don’t settle. As with all matters of the heart, you’ll know when you find it’,” Natalie added.
UNE Partnerships Indigenous Scholarships UNE Partnerships, in recognition of its long-standing partnership with AAPM and as part of a new Aboriginal and Torres Strait Islander engagement strategy, is proud to offer a full scholarship in the Diploma of Professional Practice Leadership to two deserving recipients. Congratulations to Chantal Draper, assistant clinic manager at Carbal Medical Services, Toowong Qld, and to Theresa Symes, practice manager at ATSICHS (Aboriginal & Torres Strait Islander Community Health Services), Woolloongabba Qld. UNE Partnerships is committed to the provision of structured, high-quality, industry-relevant training to support your practice with study areas, including practice management, medical reception and medical practice assisting. The practical, accredited, nationally recognised qualifications can be directly applied to the workplace and provide articulation into higher qualifications to enable a structured career path.
MSD Practice Management Award for Excellence in Chronic Disease Management Chronic disease management covers many complex disease areas within general practice. The award, worth approximately $2,000 is used to further the recipient’s career in practice management in any way that contributes to enhancing patient outcomes; for example, attending a relevant conference, visiting a general practice in another country such as New Zealand, or other relevant educational experience as approved by AAPM. The award acknowledges work which has achieved outstanding improvements in 21 | Issue 4 – 2016
patient outcome. To enter for next year, see the AAPM website or contact Head Office. This year’s recipient is Jeannine Armstrong, manager of Harding St Medical Centre in Coburg, Victoria. “We at Harding Street were very excited and proud to receive this award,” said Jeannine. “It is recognition of our hard work and dedication applied to chronic disease management of our patients. We continually strive to improve patient outcomes and better patient care. This award is a testimony to the hard work, effort and diligence of all staff in the practice, not only the GPs and the nurses but all reception and management staff. The fact that the patients are continually engaging in chronic disease management and willingness to return for regular recalls reinforces the need for chronic disease management to be an integral part of general practice.”
Barbara Meredith Award This award honours Barbara Meredith, wife of Professor Geoffrey Meredith, a key educator in practice management in Australia. There are two awards – for successful completion at an exceptional standard of the UNE Partnership Diploma of Professional Practice Management and the UNE Partnerships Certificate IV in Practice Management. Recipient of the Diploma award is Kim Fryer, with an excellence award in this category to Catherine Scardilli, Cindy Leeson, and Inna Kosogovska. Recipient of the Certificate IV award is Rachael Hatzopoulos, with an excellence award to Deb Hanley. L to R: Li Y, Anne Davis (UNEP), Colleen Sullivan (UNEP) Rachael Hatzopoulos, Ehab Mostokly
To find out more, head over to the Fellowship webpage – www.aapm.org.au/Membership/Fellowship-of-AAPM
22 | Issue 4 – 2016
THE PRACTICE MANAGER:
A change agent for healthcare practices – new resource available Private healthcare practice in Australia has evolved considerably over recent decades and the pace of change is continually increasing. External forces and changes in practitioner preferences are resulting in a shift away from smaller practitioner-owned practices to larger corporately run practices. An increasing number of these practices include multidisciplinary care models, with doctors working in a team alongside nurses, allied health professionals, and pharmacists. This transformation of the healthcare practice has necessitated the need for the role of the practice manager to evolve. The new breed of practice manager is now running large multidisciplinary practices and responsible for a range of activities, including scheduling and billing, practice accreditation and compliance, financial and technology management, human resource and risk management. A significant driver of change has been government reform, and given the government’s future agenda we are likely to see an acceleration of change for practices. These reforms and the pressures they may create will test the viability and resilience of many practices. In light of these changes, our question to practice managers and the industry more generally is “how is your practice going to manage these changes?” and “who in your practice is taking responsibility for driving the changes necessary to navigate this successfully?” Avant and AAPM see great opportunities for practice managers to take a leading role in the transition of healthcare practices to their proposed future state under the range of changes proposed by government, such as Health Care Homes and changes to the MBS, as well as changes in technology that will have an impact on the way
The discussion paper developed jointly by AAPM and Avant,
medicine is delivered.
The practice manager: A change agent for healthcare
We believe professional practice managers are ideally placed to be positive change agents in practices and an important government interface. There are significant opportunities for the profession to influence policy and practice and for individuals to influence both strategy and delivery systems.
practices, aims to stimulate discussion and action on the role of the practice manager in the transformation of healthcare practice in Australia. Download your copy from the AAPM website under News. 23 | Issue 4 – 2016
Applies to all healthcare practices
Risk Advisory • Avant Mutual Group Limited ABN 58 123 154 898 Website www.avant.org.au Freecall 1800 128 268 Freefax 1800 228 268 memberservices@ avant.org.au www.avant.org.au
Core principles: Human resource management, Risk management, Business and clinical operations
Effective communication in employment by Sonya Black, Avant Special Counsel Employment Communicating effectively with medical practitioners, support staff and allied health practitioners is an essential part of a healthy work environment and good patient care. Individual differences in skills, understanding and temperament can make communication a challenge at the best of times. When you add in potentially sensitive issues, then extra care is needed. This article provides guidance on negotiating difficult situations with supervisors to avoid workplace disputes or resolve them if they do occur.
When a workplace discussion becomes difficult Common situations that could lead to a difficult discussion between a practice manager and his or her supervisor include: • a patient or staff complaint • a performance management discussion • disagreement about a business plan • fatigue issues • u nreliable scheduling of regular meetings resulting in limited opportunity for feedback on performance • a n expectation on the practice manager to work after-hours • t erms and conditions of employment, such as leave entitlements or an entitlement to paid overtime • inappropriate communication with staff • failure to meet key performance indicators • failure to present timely management reports. These situations are almost always difficult. Sometimes they can lead to conflict, particularly if there is a dispute about the content of the discussion. Before you speak with your supervisor, you should attempt to understand the underlying issues so that you can clearly articulate them. Mentally remove yourself from the situation 24 | Issue 4 – 2016
before you respond. Attempt to assess the situation objectively. Above all, you should show respect for the person with whom you are having the difficult discussion.
Preferred strategy Collaboration is the preferred strategy to manage difficult discussions. While each discussion is different, there are some approaches that we would generally recommend: 1. P repare for the discussion. If you are the one who has requested the discussion, carefully think through what you want to say and the outcome you are looking for. If you are responding to issues raised by your supervisor, it is useful to ask what the discussion is about in advance so you can prepare to the extent possible. Practice the discussion in your mind or with a friend if that would help. 2. T ime and place – choose an appropriate time where the other party is more amenable to listening and there are as few time pressures as possible. Choose a neutral venue for the discussion. 3. Listen carefully. Assume there are things about the situation that you don’t understand. 4. F ocus on the issues not the personalities. Do not lay blame. 5. C learly articulate the problem and be specific. Provide examples or ask for specific examples to clarify the other person’s concerns. 6. U se “I think” or “I feel” statements that present the situation as your view and are not inviting argument. 7. Demonstrate your understanding of the other person’s feelings and listen respectfully to their viewpoint. 8. C onsider whether it is best to respond immediately. It may be best to take some
time to reflect on the concerns so that you can provide a calmer and more measured response at a later time. 9. D on’t burn your bridges. Show respect at all times. Respect on both sides is most likely to lead to a negotiated outcome, and to ensure you can continue to work with this person now or at another point in your career. 10. Aim to negotiate a “win-win” solution. Acknowledge, emphasise and record any areas of agreement. Focus on shared viewpoints as a way of building common ground. This is the basis of your final agreement.
Healthy workplace – dealing with disputes It’s best to try to resolve disputes early and as informally as possible; however sometimes a more formal dispute resolution process needs to be followed.
Conflict Informal resolution Discuss the issue directly with the person concerned in order to resolve the conflict. You may wish to consider taking a support person to the discussion (bearing in mind that this may escalate the situation).
Formal resolution This may include a range of things such as: •
escalating the dispute to a higher level of management
participating in mediation
instituting an investigation into a complaint.
Dispute resolution processes are called by a number of names, including “grievance procedure” or “complaint process”.
Making a complaint to an external body such as the
In general, private medical practices/businesses have dispute resolution mechanisms in a contract of employment, award or enterprise agreement, or employment policy. Practice managers should familiarise themselves with the dispute resolution mechanisms. Dispute resolution mechanisms generally contain a number of different procedures that a practice manager may opt to use – informal, formal, or external.
sector doctors), a discrimination tribunal, etc.
Fair Work Ombudsman or the Fair Work Commission a State Industrial Relations Commission (for public
Learn more: Avant Learning Centre Read • How to negotiate difficult situations with your supervisor • What to do when requested to attend an employment meeting
Patient surveys for practice accreditation don’t need to be stressful. Practice accreditation can be stressful and occupy valuable time. Insync’s affordable and easy-to-use Patient Satisfaction Instrument® (PSI) is approved under RACGP’s 4th edition standards, so it makes perfect sense to engage us to coordinate the patient feedback component of your accreditation. We assist with the patient feedback process which includes providing surveys, analysing patient responses and supplying a report based on this analysis. This allows you to implement quality improvement activities within your practice. Insync is a leader in healthcare patient experience and engagement research. We’ve been delivering patient satisfaction surveys for over 20 years.d
To nd out more, contact our PSI Research Consultants on 1800 143 733, email us at firstname.lastname@example.org or visit us at insyncsurveys.com.au/psi
Melbourne Level 7, 91 William St Melbourne VIC 3000 Ph 03 9909 9209 Sydney Level 20, 15 Castlereagh Street Sydney NSW 2060 Ph 02 8081 2000
25 | Issue 4 – 2016
Applies to all healthcare practices
Core principle: Information management update update Miroslav Doncevic is managing director of Digital Medical Systems, a company which has been providing ITC solutions and support to medical practice in Australia since 1990.
To be or not to be, that is the question Apologies to Shakespeare for mauling Hamlet’s famous soliloquy; however my borrowing from Hamlet serves to highlight the question as to the merits or not of updating software, as the answer may not be as clear cut as it may seem at first. (For our discussion here software is categorised as either; 1) system software, or 2) application software. (See Text Box 1.) You see, there are complications. Even the very best of software is not perfect when released to users, has flaws (also called “bugs”), vulnerabilities, does not live in closed systems where everything is totally controlled, is subject to factors not planned for by the programmers, including interacting with other software in the particular environment, including the internet and not least, the actions of users. The complexity of a typical IT system in medical practice is surprising – from system software, to application software (clinical software, practice management software, pathology and radiology download software, secure messaging software, internet software, etc). It is indeed a complex eco system that needs to be in harmony to fulfil its purpose to the users. Previous articles in the Practice Manager have stressed the need for regular updating or “patching” of software, especially security patching.1 A good resource with advice for “online safety and security” is the Australian Government website staysmartonline.gov.au2 which recommends that, “Regularly updating software and operating systems is necessary to fix these vulnerabilities and keep your internet enabled devices as secure as possible.”3 Hence the need for regularly updating software. (See also Text Box 24.) If we accept as a given that computer systems software needs to be regularly updated, you may be asking which kind of software needs to be updated? Staysmartonline5 recommends that: “The most important things to keep updated are: • o perating systems, for example Windows, Windows Phone, Mac OS, iOS • virus scanners and security software • browsers, for example Internet Explorer, Firefox, Chrome
26 | Issue 4 – 2016
• w eb plugins, for example Adobe Flash, Reader, Skype, Apple Quicktime, iTunes, Java, ActiveX • some other types of applications, for example Microsoft Office.” The how and when and by whom of updating software is where it gets interesting. Some software has automatic updating features built in, while other software requires a manual update, or a manual update is advised due to the nature of the software itself or a particular update. Automatic updates are not always recommended as conflicts with existing and other software may emerge or the update may fail and cause other issues, such as locking up the computer upon reboot. Further, updates are prioritised such as High Priority or Critical or Important, some updates are labelled Recommended, whilst other updates are considered Optional and in fact may not be applicable to your software systems. Updates for security vulnerabilities are also prioritised, as in for example Microsoft’s Severity Rating System.6 Updating practice software can be complex and, with the potential for problems to arise as well as requiring significant time, often after hours, can seem daunting. Here I think that the medical maxim “first do no harm” is a good principle, as the reason for applying software updates is to ensure security, reliability and continuity of practice IT systems so the practice can deliver continuity of healthcare and not break the system. Before any update is carried out, full backups must be performed, so that if the update causes any problems the system software or application software will be able to be rolled back to the exact state just before the update. The question of who will manage updates in your practice also needs to be considered. Do you have a capable and trained person inhouse or do you outsource management of software updates to a professional IT Managed Service Provider (MSP) with medical software experience and expertise? MSPs use Remote Monitoring and Management (RMM) software tools to monitor patch status remotely, have access to knowledge base information from software developer databases to help determine which patches may cause problems, and if
A vulnerability whose exploitation could allow code execution without user interaction. These scenarios include self-propagating malware (e.g., network worms), or unavoidable common use scenarios where code execution occurs without warnings or prompts. This could mean browsing to a web page or opening email. Microsoft recommends that customers apply Critical updates immediately.
A vulnerability whose exploitation could result in compromise of the confidentiality, integrity, or availability of user data, or of the integrity or availability of processing resources. These scenarios include common use scenarios where client is compromised with warnings or prompts regardless of the prompt’s provenance, quality, or usability. Sequences of user actions that do not generate prompts or warnings are also covered. Microsoft recommends that customers apply Important updates at the earliest opportunity.
Impact of the vulnerability is mitigated to a significant degree by factors such as authentication requirements or applicability only to non-default configurations. Microsoft recommends that customers consider applying the security update.
Impact of the vulnerability is comprehensively mitigated by the characteristics of the affected component. Microsoft recommends that customers evaluate whether to apply the security update to the affected systems.
so, roll back or disable these patches until a new version is released, install high priority patches as they are released by the software vendor, ensure that critical servers reboot correctly, monitor the results and troubleshoot and fix any issues caused by the update. However you choose to do it, updating or patching software is essential. Apply with caution.
References 1. For example, Practice IT Security Update 2016, Practice Manager 2016(3):20 2. https://www.staysmartonline.gov.au/, accessed October 2016 3. https://www.staysmartonline.gov.au/computers/updatesoftware, accessed October 2016 4. https://security.illinois.edu/content/updates-and-patches, accessed October 2016 5. Op. cit, https://www.staysmartonline.gov.au/computers/updatesoftware, accessed October 2016 6. https://technet.microsoft.com/en-us/security/gg309177.aspx, accessed October 2016
Basic software types
(Text Box 1)
1. SYSTEMS SOFTWARE includes: a) “firmware” or machine code that controls the basic operations of hardware systems (includes BIOS (Basic Input / Output System). Not seen or accessed by users. b) device “drivers” or hardware control software that takes instructions from the Operating System to control computer hardware components or peripheral devices; for example, printer drivers. Not usually seen or accessed by users, except when drivers need to be reloaded or updated for the device to work c) Operating System (OS) software provides the “platform” for application software and the OS controls the firmware and device drivers, and is the intermediary software layer between the lower level BIOS, and other firmware and device drivers and application software. Examples include Microsoft Windows, MAC OSX, UNIX, LINUX. OS software is seen and used directly by users for many functions. 2. APPLICATION SOFTWARE is software that users directly interact with and use for specific tasks, such as word processing, email, desktop publishing, accounting, database and of course, clinical and practice management software, etc. 3. DEVELOPMENT SOFTWARE, or programming language software is used by computer programmers to write all the types of software above, examples include C, C++, Visual Basic, JAVA, etc. Unless you are a programmer you won’t see or use this kind of software.
Updates and Patches4
(Text Box 2)
What Are Updates? Software updates, occasionally referred to as patches, are released for a variety of reasons. Sometimes the patch will upgrade a piece of software to the latest version with new features in the software. Sometimes an update will improve an application’s stability. And sometimes an update is issued to fix a bug or security hole within the program. It is this last type of update that is the most important when it comes to computer security. Why Patch At All? Security researchers have shown that installing system and software updates is the best defense against the most common viruses and malware online, particularly for computers running Windows. Software makers often release updates to address specific security threats that have come to their attention. By downloading and installing the system and software updates, you patch the vulnerabilities that virus writers rely on to infect your computer. 27 | Issue 4 – 2016
Specialised health service initiative: demonstrate your commitment to quality while enhancing patient confidence Patient-centred care is a hot topic in the Australian healthcare system at present, and one which will likely lead the future direction of healthcare provision. Patient-centred care revolves around healthcare that is respectful of, and responsive to, the preferences, needs and values of patients and consumers.1 For you as an Australian healthcare provider, it is important that your specialised health service considers how you can enhance your patient care experience, demonstrating your commitment to patient-centred care. Although your service has grown into a successful business, accreditation provides an opportunity for your specialised health service to formally demonstrate to patients and consumers that your team is taking the initiative to provide, and continuously improve, its high standard of care, safety and service quality.
Your innovative solution Quality Innovation Performance Limited (QIP), Australia’s leading not-for-profit health and community service accreditation provider, has worked with numerous healthcare providers over many years to develop a streamlined accreditation program that best meets the needs of a diverse range of healthcare providers. QIP’s Specialised Health Service Accreditation Program is assessed against the National Safety and Quality Health Service (NSQHS) Standards, developed by the Australian Commission on Safety and Quality in Health Care. The NSQHS Standards aim to drive the implementation of safety and quality systems, improve the quality of healthcare in Australia and provide a nationally consistent statement about the level of care consumers can expect from health service organisations. This contemporary accreditation program is responsive to the needs of specialised healthcare providers and supports a sound evidence-based approach to accreditation. It focuses on the first six of the ten NSQHS Standards highlighted by the Commission as applicable to specialised and allied healthcare providers. With numerous specialised healthcare providers already awarded QIP accreditation across Australia, your service can be assured that engagement in the program is a positive step towards improved safety and quality, with outcomes benefiting your service team, the profession, and most importantly patients and consumers. Accreditation with QIP can also provide a pointof-difference over non-accredited services.
Enhancing patient confidence and more Patients and consumers are central to your business and will have even greater focus as the Australian healthcare system evolves. It is, therefore, essential that your patients and consumers have confidence and trust in the care and service they expect and receive when choosing to engage with your service. Accreditation against the NSQHS Standards demonstrates to patients and the community that your health service is committed to a national level of safety and quality. This is measured by independent review of your service’s systems and processes by QIP, which includes areas such as management of risk (clinical, professional, 28 | Issue 4 – 2016
reputational and business continuity planning), patient safety, infection control and the service environment. Your team’s commitment to continuous quality improvement across the entire service also supports them to develop, feel part of, and contribute to a quality and patient-centred culture, ultimately strengthening the care and service delivered.
Streamlined processes and complimentary support With over 20 years’ accreditation experience, QIP has refined the accreditation process to a sixstep cycle, which assists your specialised service to optimise the time and effort allocated to achieve accreditation. To ensure your team feels confident when preparing for each stage of the accreditation process, QIP offers a range of complimentary resources and services to personally support you on your accreditation and quality improvement journey. These include: • Access to AccreditationPro, QIP’s user-friendly webbased self-assessment tool • Support from QIP on the NSQHS Standards applicable to specialised health services, and guidance on documentary evidence required to comply with these Standards • Access to resources and templates through QIP’s online resource library, QbAY, and • Access to a dedicated QIP client liaison officer, who will assist you throughout the accreditation process.
Achieving accreditation – recognition of your commitment Once your service has met the relevant NSQHS Standards requirements (with no areas of non-compliance), your specialised health service will be formally awarded accreditation by QIP. The award of accreditation is an achievement your entire team should be proud of, and one you are encouraged to share with your patients, consumers, and the wider community. QIP provides a range of marketing collateral to assist you in promoting your accredited status, allowing you to highlight your health service’s achievement and commitment to continuous quality improvement to better support patient-centred outcomes.
Contact QIP For more information, or to start working towards recognition as a QIP-accredited specialised health service, contact a member of the QIP national development team via… p 1300 888 329
Reference 1. Australian Commission on Safety and Quality in Health Care
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HARDWARE AND SOFTWARE SALES 29 | Issue 4 – 2016
Applies to all healthcare practices
Core principle: Human resource management by Greg Mowbray Greg Mowbray is a leadership speaker, author, mentor and consultant. He is the author of Road Rules for Leadership. Contact him at greg@ gregmowbray.com.
Who’s the leader of your practice? The unique challenge of medical practices For the last 15 years I have been a business consultant and have worked with a wide range of organisations, small, medium and large, publicly owned and private, for profit and not for profit. Organisations from a wide range of industry sectors – transport and logistics, manufacturing and finance, disability and community, telecommunications and health. Almost all of the organisations that I have worked with have many things in common, including the problems that they face. Medical practices, though, have a unique characteristic that presents certain challenges and requires a somewhat different approach in order for them to operate optimally. At the risk at being politically incorrect I can highlight this difference by recounting the old joke “what is the difference between God and a doctor? God knows he’s not a doctor.” Clichéd? Bad taste? Perhaps. But most people will get my drift. Doctors are the owners of the practice, although, in my view, they are not necessarily the leaders of a practice, and nor should they be. Medical practices work best when there is clarity of structure, roles and expectations and there is recognition of the different strengths that individuals bring to the organisation. Several years ago I was asked by a specialist medical practice to make an assessment of their business and to provide some recommendations for improvement. My methodology in a case like this is simple. Visit, get to know the people and ask a lot of questions. Questions like, “why do you do that?” The answer in this case came back almost every time as “that’s the way Dr X likes it done.” Probing a little further, I’d ask, “OK, but do you think that is the best way to do it?” I soon realized that if Dr X wants it done a certain way, then that’s what happens. You could argue that if Dr X owns the practice and Dr X wants something done a certain way, then Dr X is entitled to have it done that way. I
30 | Issue 4 – 2016
would counter-argue that Dr X is undoubtedly an excellent doctor, but does his or her expertise cover running a successful business, one that provides first-class patient care, exceptional customer service, efficient and productive systems and procedures, a happy and effective work environment, and a sustainably profitable bottom line? The key to achieving this lofty goal is acknowledging that a successful practice is a team environment, where all players bring different strengths, and together they work towards success. One of the more difficult tasks I face as a business consultant is to have a conversation with a business owner where I tell them what they need to hear, not what they want to hear. I see it as my duty to deliver this vital, if not welcomed, news. On a number of occasions I have sat with doctors and told them that my opinion is, despite owning the practice, they are not the leader of the practice. The term I have used is that they are the “rainmaker”. They provide the essential service that generates the revenue, but it is the practice manager who provides the framework around them that holds it all together. I remember one doctor’s face as I delivered this news. It looked as if no one had ever had the audacity to speak such words. To their credit, they took a deep breath and said “OK, what should we do?”.
Practice success There are three things that organisations must get right in order to succeed. These are strategy, structure, and culture. The saying goes, “culture eats strategy and structure for breakfast”, but more about this later. For a practice to be successful the owner and the manager must invest time and effort to be on the same page about these three imperatives. Otherwise it will be like you are fighting with one hand tied behind your back or spinning on a hamster wheel – lots of effort, but not much movement.
Strategy This has the reputation of being a complex area, but it need not be. I use a simple methodology for strategic planning that works with everything from publicly listed companies right down to micro businesses. It definitely works with medical practices. It involves asking three questions: 1. Where are we now? 2. Where do we want to be? 3. How are we going to get there? I use tools such as a SWOT analysis (strengths, weaknesses, opportunities, threats) to help an organisation establish where it currently sits. Projecting a vision of where it wants to be in the future is a little more challenging. Asking questions about size of revenue and profit, geographical location, services to be offered, and the kind of a culture wanted helps with defining the end result for a practice. The “how are we going to get there” question is answered by an action plan that includes priorities, responsibilities, and resources. Many think that a strategic plan should be a thick, impressive-looking document. Not me. I distil the plan down to one page, so that everyone can see it, understand it, and be a part of it.
Structure This not only refers to having a clear organisation structure in graphic form (which you should have), but also making sure that everyone’s roles are defined and shared. This should involve the doctor, manager, and all other staff. In my experience, when an organisation is small it can get by as everyone seems to cover everyone’s back and somehow things get done. As an organisation grows this becomes a
major challenge and inevitably things will slip through the cracks. Having position descriptions is a good thing, but make sure they are up to date and reflect what is actually needed from each position. More importantly, make sure there are frequent and meaningful discussions about expectations of performance.
Culture The current culture of your practice is the result of an accumulation of things, good and bad, since it began. Changing it can’t happen over night. But understand that if it is not good then it will diminish the importance of both strategy and structure. Your efforts in these two areas will be futile if your culture isn’t strong and positive. The first step in changing a culture is to acknowledge its current state. Work on a vision of what you would like it to be, then close the gaps. Easier said than done!
A tip for practice managers Think of a one man band – a busker playing guitar, drums, harmonica, cymbals – all at the same time using various body parts and movements. A novelty to look at initially, but not very enjoyable. Now think of a symphony orchestra. What a sound! The experience it produces is almost magical. So many parts working so beautifully together, all under the guidance of one person – the conductor. Which one are you? The key to your success and that of your practice is that you, yes you, work towards achieving clarity of structure, roles and expectations and that there is recognition of the different strengths that individuals bring to the organisation.
31 | Issue 4 – 2016
Applies to all healthcare practices
Core principle: Human resource management
What is leadership? by David Wenban Managing Director, Australian Health Industry Group
This article is based on David’s presentation to our national conference.
Over 500,000 books and articles have been written on leadership. Three of these are: 1. The ancient Chinese military general and author of The Art of War, Sun Tzu, described a leader as one who “cultivates the moral law, and strictly adheres to proper methods and discipline”. 2. The nineteenth-century historian Thomas Carlyle believed leaders were born and not made. 3. The English philosopher Herbert Spencer argued that leaders were the result of the society in which they lived. Each book, article, or research report details a wide variety of leadership skills, styles, characteristics, and types. It’s clear that there is no single definition of leadership, because what works for one leader may not necessarily work for another, depending on the circumstances and personality type. However, most people agree that a leader must be able to inspire their team.
This process demands that you become more capable, committed, connected to yourself and to your team than you were yesterday. As a leader you need to build, maintain, and use relationships that both influence people to attain your strategy and vision and also increase the capacity and skill sets of each of those individuals. One normally utilises qualities that Mattone would refer to as the “outer core” – these are the observable behaviours and qualities that people can see. The types of behaviour that we might associate with your outer core include your capacity for the following: A. ambition/results focus
American author John Mattone suggested leaders have two distinct “layers” – the “inner core” and the “outer core”.
B. critical thinking
The inner core is essentially the beliefs, values and references that make up your individual character. Character to the business leader is important because, in times of great uncertainty, past performance is no true indicator of future performance. When experience falls away, all you are left with is character.
E. emotional leadership
Often when describing leaders we hear terms such as passionate, visionary, charismatic, motivational, and encouraging. Leaders should consider a far simpler term or quality – that of ambition. Ambition creates hard work, determination, and an unconditional desire to achieve. The first challenge for any leader, according to Betsy Myers in Take the lead: Motivate, inspire, and bring out the best in yourself and everyone around you, is the need to “know their behaviour and the impact it has on the people around them, and to be able to effectively lead themselves”. It is a journey that requires you to challenge yourself to admit that you may not be as good as you could be, and aspire each day to improve as a person and leader. 32 | Issue 4 – 2016
Implicit in this need to continuously improve is the need to confront the basic premise that the leader has the opportunity to either accept or reject feedback. A choice to reject feedback is, in fact, a choice to reject the opportunity to improve and be successful.
C. decision making D. strategic thinking F. communication G. talent leadership and fostering H. team leadership I. how you go about change. These create an important message about you, and set the tone for your people and your leadership.
Three fundamental processes Leadership is a three-step process: 1. Establishing direction – with a vision for the future along with strategies for producing the changes needed to achieve that vision; 2. Aligning people – communicate the direction to all employees and create coalitions that understand the vision and are committed to achieving it; and importantly the need for 3. Motivating and inspiring people to follow you, where you encourage people to move in the right direction by appealing to their basic human needs, values, and emotions.
Leaders look to create three essential characteristics in their teams:
3. Know your people
1. Capability – the “can do” mentality
5. Follow through on commitments
2. Commitment – the “will do” mentality
6. Reward the doers (and transition the non-doers)
3. Connectedness – “must do” mentality.
7. Expand people’s capacities.
At the same time, staff require the following attitudes:
The leader needs to understand and include in their methods any changes in the external environment and how “work” as a concept changes.
The way we organise work will change from a predominantly role-based focus to tasks, where those project roles will be of varying length, where the person is less concerned about their title than their role, and remuneration will most likely be tied to the completion of that project rather than to the hours they work.
3. a need to look for opportunity – by asking “what’s new”
The average length of time in retirement will change markedly, and the leader will need to learn to use older people in project roles. The traditional three phases of life (education, work, retirement) will change. Many will retrain, change careers, and retire more than once before they leave the workforce permanently.
7. a focus on working collaboratively not individually.
4. Set clear goals and priorities
2. a n expectation to follow through on commitments (through transparent reporting and outcomes) 4. an emphasis on having the right people in the right roles 5. clear priorities within the business 6. a need to develop a capacity to ask incisive questions, to learn, to teach to understand; and
In doing so the leader keeps, as their focus for execution, the following: • execution is about discipline and perseverance • execution is the leader’s priority
This creates two unique considerations for the leader:
• they will get the behaviour that they exhibit and tolerate
• h ow they can assist the employee to develop and acquire intangible assets (networks, altered skills, etc.) and what they will require in this changed model; and
• t hey will get the right people in the right place and job; and • they will succeed.
• ask how or where robotics will challenge an industry. Other changes include generational disparity and declining birth rates.
Developing strategies The strategies a leader will need to implement such changes are important. Less than 10% of strategies are formulated and executed effectively. In 70% of cases the real problem isn’t bad strategy, it’s bad execution, according to the seminal work of Larry Bossidy and Ram Charan, Execution: The discipline of getting things done. According to Kaplan in The execution premium: Linking strategy to operations for competitive advantage, developing strategy is a six-step process: 1. D evelop the strategy – includes mission, values, vision and strategic analysis. 2. T ranslate the strategy – strategy map, including measures and targets, initiate portfolios, capital and resource plans. 3. Align the organisation – business units, support units and employees. 4. P lan operations – key process improvements, sales planning, resource capacity plans and budgets 5. Monitor and learn – strategy reviews, operating reviews.
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6. T est and adapt – analyse profit, strategy corrections, new and emerging strategy. To execute strategies, leaders require the following skills: 1. K now yourself (and challenge yourself to get better day by day)
2. Know your business 33 | Issue 4 – 2016
Primary Dental’s transformation to digital patient engagement by Michelle Aquilina, Chief of Dentistry at Primary Health Care
As Chief of Dentistry at Primary Healthcare, responsible for 140 practitioners across 57 dental centres, it’s my responsibility to ensure we continue to meet the needs of our patients and ensure we have a successful, sustainable business. Despite 90% of patients wanting to use digital channels to manage their healthcare, and 72% of patients want to book, change or cancel their appointments digitally, yet just 3% of Australian healthcare practitioners currently take appointments online.
• Agility and flexibility • An expert in their field • A shared value proposition to the end customer • An understanding of patient needs • Best practice process and tools • A mutual understanding on clear objectives • Open lines of communication • The ability to launch and manage all 57 practices together • Trust and mutual respect. After many meetings and due diligence, 1stAvailable was appointed to the task. They had booked over 4.5 million patient appointments, developed solutions for over 4000 clients including private practices, pharmacies, corporates, hospitals and government clients, and their integrated with over 30 different practice management systems. This solution has allowed our dental centres to be more patient focused, enhanced the patient experience, promoted a more patient-centric culture, and we have become more effective in the work we do.
Patient needs and their demands are changing rapidly in the digital space and the impact of the internet for accessing healthcare has shifted the landscape significantly. Understanding this need was the first step in validating our customer needs. This was achieved through customer feedback and research. The next step was to collate the information and formulate a strategic plan, thus our E Roadmap was developed, a 12-month staged plan, with the first move providing 24/7 patient access. With every business decision, patients are always at the core. I ask myself constantly “is this what the patient wants, is this what the patient needs” – that is, we must create a customer-centric culture. We must continuously look for ways to improve the patient experience and drive successful business outcomes. Online appointments have opened another portal of opportunity not only for patients but also for our business, so that we can: • Impress our patients with ease of access • Ensure staff can spend less time on the phone and more time building relationships • Ensure 24/7 controlled access to our services • Achieve significantly increased bookings. Strategically aligning our business with a provider who shared a common value in patient care and someone who could deliver over and above was paramount in our decision. With a growing number of companies offering online appointments in Australia, a comparison was conducted on a range of criteria that included:
34 | Issue 4 – 2016
Since the launch of online bookings, the feedback speaks for itself: • “They have a new online booking system and it’s super easy to use, picking your dentist, day and time.” • “The new online booking system is exactly what is needed. It makes it so much easier to book an appointment with the dentist in my own time.” • “Great dentist and the new online booking system makes it easier and more efficient to book an appointment.” This coincides with business statistics in driving significantly improved outcomes, including a 40% increase in patients returning to our practices, over 50% of all appointments booked online are new patients, and 60% of all appointments booked since July were placed online – making way for healthcare professionals and employees to spend more time building relationships. We will continue our digital engagement journey with 1stAvailable, the first step being instant online appointments and our custombranded “book now” function achieved. Our plans are to further enhance services to continually improve the customer experience and introduce 1stAvailable’s Patient Clipboard App, the Patient Check-in App & Kiosk, easyRECALLS and easyFEEDBACK. For me, engaging with 1stAvailable to enhance our digital patient engagement was the right decision for our business. For more information give the team a call or visit www.1stavailable.com.au/ aapm.
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35 | Issue 4 â€“ 2016
Applies to general practice
Core principles: Information management, Business and clinical operations
by Tracey Johnson CEO, Inala Primary Care Ltd Churchill Fellow
Is it an IT revolution or evolution?
Every day the majority of Australian adults use their phones, tablets, computers and, increasingly, portable devices to communicate, connect and coordinate. We have learnt to use software to ensure the apps, favourites and music we love are shared across multiple platforms. We even trust the cloud to store our most treasured memories in the form of photos. So what is instore for healthcare? I suggest the change will be evolutionary. Healthcare simply needs to adopt to practices which other sectors and even our personal lives have adapted to long ago. The impact of embracing a few things at the same time, however, has the potential to be revolutionary for our practices. More than six years ago our practice started using i-Pads to support home visits. Nearly two years ago some of our doctors started using laptops to enter patient data at bedsides using remote access. All of this came at the request of our clinical team, involved very minimal expense and has been constrained only by the speed of mobile connectivity. In May we were surprised and delighted to find our clinic awarded Practice of the Year by AGPAL/QIP. We have become so accustomed to our technology-based business systems that to us they no longer feel that unusual. Just like our mobile phone, we occasionally surprise ourselves with how we can utilise another technology capability to address a problem. Therefore, the returns we are getting from our investment keep mounting.To remind ourselves that technology is always able to offer more than we can use, we try to frame problem-solving discussions with questions like how could we do this paperless, how can we generate this without creating another register or point of data entry? Such questions push us back to the capability of our systems and usually save us many staff hours in rolling out the resultant solutions. We have learnt to take the time to think through the 36 | Issue 4 â€“ 2016
technology possibilities before we add on reception hours or nursing hours.
Becoming a technologybased practice Becoming a technology-based practice began with a decision to be a fully digital practice. That was nine years ago. Initially, we were surprised by how clunky the systems were. We were frustrated that data in one software program could not be drawn out and drilled into, let alone linked to data in another system. Like most general practices we were short staffed and facing an effective Medicare freeze even before it became official government policy. Our patients were becoming more and more complex. Our team members were demanding work flexibility, with increasing numbers working part-time. Together we decided we needed to use systems which enabled people to make work more satisfying, drive quality and improve the patient experience. We moved from being a digital practice to a technology-led practice.
We started with key numbers needed for monitoring each week We started small by asking ourselves what the key numbers were that we needed to monitor each week. We were not satisfied that gross revenue or revenue by doctor or even
patient count gave us any meaningful insight into where our team could improve … but we knew we needed to include those numbers somewhere. We adopted some new accounting software which was cloud based so we could extract more data feeds and comparative analysis against our, by then, more detailed budget forecasts. Aftermany iterations we cemented a practice dashboard which draws information from our accounting, practice management, telephone, registrar training and other systems and makes the data visual. Raw numbers provide limited information. We rely on visual depictions of trends, comparisons between groups, ratios, percentages, charts, colours and lines to help us understand what is going on. Over time we started sharing this data beyond the leadership group. Now other team members routinely whether we could get some data which will… Of course, this means you need to value your data – patient and management related, and everything in between. Our people are becoming more reliant on data to make decisions about changes to clinical practice, staffing numbers and whether something is really even a problem or not.
The next step The next step was to start downloading information useful for accreditation and even PIP payments into our weekly dashboard. We knew way ahead of time that we had achieved the number of uploads required for the e-PIP. We can generate lists for our doctors and then monitor their progress in providing results back to their patients and managing different disease types. We are a teaching practice. We knew that every doctor had favourite sites, fact sheets and guidelines. We worked to establish an intranet and an area within the intranet where all our medical team could share their favourite tools. This has saved hours inducting our new medical staff and ensures everyone uses the most up-to-date information when caring for patients. It also stimulates debate amongst the clinicians about which tools and guidelines to include on the intranet so that clinical protocols and changes become more quickly shared. We made our Practice Manual electronic, disseminated and responsive. Through our intranet anyone could search for the answer to questions as diverse as approval paths for taking leave to how to archive the temperature feed from our vaccine fridge. Different teams converted
thousands of personal or team work flows into policies, procedures and templates which everyone could critique and learn from. When it came to accreditation, we had so many more routine ways of working than were required under the standards and such consistency of approach that we had few “count down to D day moments”. We run a number of specialist chronic disease services at our practice. We have been able to draw atomic data out of patient records by matching appointments types to required data and sending that to secure intranet pages accessed by staff of certain clinics. They simply cut and paste this data into letters back to GPs referring patients to those services. This has saved hours in manually entering data. Our letters back to our shared care team have so much organised detail and specificity that referring GPs tell us they always know what we need them to do.
We are able to repurpose existing solutions to a healthcare context We are actively looking at apps we can include in patient care cycles, self-care initiatives which may be possible under the Healthcare Home funding model and the world of mobile health. Most significantly, this journey is directed by people who are attempting to answer real world problems. We are not IT gurus. We do not see ourselves as an IT company. We have been fortunate in being able to re-purpose existing solutions to a healthcare context or stretch existing software to meet our challenges. We know this journey will never end and basic technological literacy is a requirement for all. We also know that we need in-house technology expertise to keep pushing the boundaries and have been prepared to invest in that. The spare “brain power” our systems have created or the insights our data and processes have delivered means our team has come together and is more trusting of decisions made. We are far from robots dictated to by a machine. We are people serving other people who have realised inexpensive technology serves us in remarkable ways. With nearly one in five Australians now registered for a My Health Record, the perception will grow that healthcare is technology enabled. Let’s be part of that revolution and evolve our practices to ensure the data anyone needs is where it needs to be.
37 | Issue 4 – 2016
programs to help you and your practice support patients with chronic conditions Chronic conditions are one of the biggest health challenges for Australia and the healthcare system. This challenge has been recognised by the Australian government, which has stated that as many as one-in-five Australians now live with two or more chronic health conditions. CareComplete is being rolled out nationally to provide general practice with an extended support system to help patients with chronic and complex conditions. These programs aim to empower patients to take positive steps towards improving their health and quality of life while keeping GPs at the centre of their care. The programs are available to eligible patients who are Medibank members, and we are also working with governments, Primary Health Networks and other private health insurers to extend the program further.
About CareComplete CareComplete comprises three programs: CareFirst: a six-month behaviour change program for patients who have been diagnosed with a chronic condition in one of five disease areas. CarePoint: a two-year program for chronically ill patients, to help them navigate the healthcare system and stay as healthy as possible so they can manage their condition at home and avoid hospital admissions. CareTransition: a 30-day hospital discharge support program that guides patients in transitioning from hospital to home, and managing their recovery to prevent readmission. Dr Julie Phillips, National Medical Director, Population Health Delivery Networks, Medibank said “CareComplete
focuses on improving the outcomes for Australians living with chronic conditions. At the same time the programs aim to support general practice, keep patients out of hospital and take pressure off the healthcare system.” “Through the initial pilots and rollout of the programs we have enrolled over 5,500 patients and have already worked with more than 1,400 GP clinics and 2,600 GPs to deliver CareComplete,” she said.
Benefits for your practice CareComplete helps build the capacity of your practice to provide evidence-based chronic disease management services and improved outcomes for patients. Participation in the programs not only benefits enrolled patients, but also the entire practice with additional funding and resources provided to assist you to implement the programs.
Benefits • Saves GP time • Improves outcomes for patients • Provides another revenue stream • No long-term commitment • Meets privacy regulations
For example, the CarePoint program is delivered within the current primary care clinical practice without disrupting existing workflow and processes. The program includes a dedicated care coordinator who works with you and your practice staff to help patients navigate the complexities of the healthcare system and access the support and resources they require. CareFirst is also delivered within the current primary care clinical practice. Recognising the important role that practice nurses play in the primary care setting, the CareFirst program provides nurses with training in chronic disease management, healthy lifestyle coaching and behaviour change methodologies. “For existing practice nurses, full training is provided free of charge for those who wish to participate in the CareFirst program and practice nurses have access to ongoing support from the CareComplete team during the delivery of the program,” Dr Phillips said.
Find out more To learn how CareComplete programs can help you and your practice, please call 1300 650 742 or visit carecomplete.com.au.
38 | Issue 4 – 2016
39 | Issue 4 â€“ 2016
Avant Practice Medical Indemnity. By doctors, for doctors.
Hip & Knee Clinic @ Sydney Olympic Park
With Avant, you’re well protected.
Dr Paul Della Torre Avant member
But what about your practice?
The Professional Indemnity you have with Avant is second to none. In fact, many doctors think it‘s the only cover they need. But if you’re a practice owner, it may not cover the actions of your staff or claims against the practice, so you could still be at risk. To ensure you have the extra cover you need as both a
practice owner and employer, Avant has developed a Practice Medical Indemnity policy that seamlessly integrates with your personal indemnity. Ask Avant about the cover you need today.
Find out more: 1800 128 268 avant.org.au/practices *IMPORTANT: The Practice Medical Indemnity Policy is issued by Avant Insurance Limited, ABN 82 003 707 471, AFSL 238 765. This policy is available at www.avant.org.au or by contacting us on 1800 128 268. Practices need to consider other forms of insurance including directors’ and officers’ liability, public and products liability, property and business interruption insurance, and workers compensation and you contact your insurance broker for more information. 40should | Issue 4 – 2016
Quarterly journal from the Association of Practice Management