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Six steps to protect your practice


Don’t be lulled into digital inaction


Positive workplaces and high performing teams

Join us in Canberra for the AAPM Conference

2018 – Issue 3 |

the practice manager

Avant Practice. By doctors, for doctors. Hip and Knee Clinic @Sydney Olympic Park

Avant offers protection, advice and support for you and your practice entity

Practitioner Indemnity to protect, defend and advise the individual doctors working in the practice.

Practice Medical Indemnity, and Business Insurance for the business of medicine, and Life Insurance to protect your investment in the practice.

As Australia’s largest doctor-owned mutual, every day we see the increasing complexities our members face in running a successful practice. Just knowing what insurances are required can be a challenge in itself.

PracticeHub, a practice management platform to reduce the complexity, risk and costs in running a practice.

a range of covers a practice needs. And since they’re all designed to work together, you can be confident that nothing overlaps or is overlooked.

We know, for example, that many practice owners assume their practitioner indemnity also covers their practice, which is often not the case.

To help further, we’ve also developed a range of support services – including the online practice management tool PracticeHub – to make managing today’s complex practice simpler, safer and more efficient.

To protect practice owners, Avant has designed a comprehensive suite of practice insurances that provide

It all adds up to better protection for your practice, your patients and you.

Contact Avant today 1800 128 268 IMPORTANT: Professional indemnity insurance and the Practice Medical Indemnity Policy available from Avant Mutual Group Limited ABN 58 123 154 898 (Avant Mutual) are issued by Avant Insurance Limited, ABN 82 003 707 471, AFSL 238 765 (Avant). Avant arranges Avant Business Insurance as agent of the insurer Allianz Australia Insurance Limited ABN 15 000 122 850, AFSL 234 708 (Allianz) and may receive a commission on each policy arranged. The information provided here is general advice only. You should consider the appropriateness of the advice having regard to your own objectives, financial situation and needs before deciding to purchase or continuing to hold a policy with us. For full details including the terms, conditions, and exclusions that apply, please read and consider the policy wording and PDS, which are available at or by contacting us on 1800 128 268. 2400.1 07/18 (0945)


Your Association A message from the President From the CEO’s desk News Bites Six steps to protect your practice based on common MLAS queries One of your practice’s most valuable assets… YOU! Who pays the wages, rent & other bills if the Doctor gets sick? Everything you’ve always wanted to know about ‘The Cloud’, but never asked My Health Record: in your patients’ hands 11 tips for SEO success for your practice National Cervical Screening Program and National Cancer Screening Register Don’t be lulled into Digital Inaction How to deal with a bad customer review AAPM National Salary Survey Practice performance monitoring take control! Positive workplaces and high performing teams an antidote to the winter work blues Community Nursing Hong Kong Thunder & Lighting and now a brighter sky? Cyber Security Update 2018 …“the price of data freedom is eternal vigilance” Practice Profile The Breast & Endocrine Centre, Gateshead

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Your Association AAPM Board President Cathy Baynie

Treasurer Jackie Beer

Vice-President David Osman

Chief Executive Officer Nicholas Voudouris

Secretary Fiona Wong

Non-Executive Directors Danny Haydon Cecily Igglesden Richard Evans James Downing

CONTACTS HEAD OFFICE Level 1, 60 Lothian Street, North Melbourne, VIC 3051 P 1800 196 000 F (03) 9329 2524 E VISIT THE WEBSITE LIKE US ON FACEBOOK FOLLOW US ON TWITTER @AAPM_National



IHM Institute of Healthcare Management 18-21 Morley Street, London SE1 7QZ P +44 20 7460 7623 | F +44 20 7460 7655 E | W

ark:media PO Box 824 Surfers Paradise, QLD 4217 P +61 7 5629 5300 E W

PMAANZ Practice Managers and Administrators Association of New Zealand

Managing Editor: Sue Guilfoyle Design Team: Andrew Crabb, Arlen Chidzey


No part of this publication may be reproduced, copied or duplicated without the written consent of AAPM.

The content of articles and advertisements contained in the Practice Manager Journal solely reflect the personal opinions of the authors or contributors and does not necessarily represent the official position of AAPM.

Thank you to our National Partners | 1


A message from the President Cathy Baynie

Welcome to the New CEO

National President

I would like to extend a very warm welcome to Nicholas who has hit the ground running at Head Office, spending his first weeks in the job meeting as many members as possible while attending all PMED days around the country. Nicholas brings to AAPM the combination of a strong business and education background. We look forward to working with Nicholas as AAPM seeks new directions and growth under his leadership. Head Office Staff I would like to acknowledge the dedicated work and “business as usual” approach from our Head Office staff as they have navigated the changing of the guard, ensuring that the business of AAPM in meeting the needs of our members and delivering on our education program has been seamless. A heartfelt thank you from the Board and AAPM community. Practice Manager of the Year Awards I am constantly in awe of the calibre and achievements of all our nominees and extend my congratulations to Elizabeth Jones NSW/ACT, Garry Hurst VIC, Jacky Genesin SA/NT, Darcy Inglis QLD, Jeni Anning WA and Tanya Barrett TAS, on achieving PMoY in their respective states.

The energy, enthusiasm and collective wisdom and skill that these volunteers bring to the table is a crucial component of our Association’s structure. Our State Committees are the ‘Brains Trust’ and your voice, particularly in feeding back your educational requirements. It is at this time of the year that State Planning days are held in conjunction with Head Office to develop the National Education Framework for the following year. This program has the flexibility to allow for individual State ‘flavour’ and needs. I encourage all our members to engage with your State Committees either through networking opportunities, at your education days or contact through Head Office. From within these committees our State leaders are chosen. I congratulate the following State Presidents for 2018/19 - Fiona Kolokas NSW/ACT, Brett Miller SA/ NT, Kerry Emery QLD, Claire Stocks WA, Margaret McPherson VIC and Leanne Cullen TAS. AAPM 2018 Conference Planning is well underway for this year’s conference in Canberra. The program has been structured to ensure choice across experience and disciplines with ample opportunity for networking. Please head to the new look AAPM website, check out the program and register.

State Committees It is at this time of the year that positions become available on all our State Committees. In 2016 the committee election process was changed to create a succession planning model that ensures the State Committees continue to work cohesively with Head Office on delivering the AAPM Strategic Plan.

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Cathy Baynie National President


From the CEO’s desk Nicholas Voudouris CEO

Just over a month ago I took up the role of CEO at AAPM following the retirement of Gillian Leach, and what a busy first month it’s been, meeting Fellows, Ambassadors, State committees and other members, attending Practice Management Education Days, and engaging with our partners and sponsors. I think of it as a “listening tour” and I’m looking forward to engaging with more of our members in the future as I continue to get to know AAPM.

On 16-19 October this year AAPM’s National Conference will be held in Canberra and the program has workshops, plenaries, masterclasses and other sessions covering topics ranging from Medicare items and audits through to digital health, case studies and information on developing your career path. Don’t miss the opportunity to connect with other practice managers at the conference and share approaches to overcoming the daily challenges faced in your practice.

A lot of change is taking place in the health sector and through our members, Board and staff, AAPM plays an increasingly important role as health reforms unfold. One of the biggest reforms to take place in Australian healthcare in decades is the government’s My Health Record (MHR) initiative, which is currently attracting a lot of media attention.

AAPM recognises the importance of continuing education for Practice Managers and the crucial role you play in improving the day-to-day management of your practice. We are proud to offer seven scholarships for practice management courses at the University of New England Partnerships. The successful recipients of the Avant and AAPM Scholarships, Colleen Sullivan Scholarship and MedicalDirector Aboriginal Health Service Scholarship will be announced at our conference and we look forward to congratulating them.

Now that the MHR opt-out period has commenced there is a strong focus in the media on privacy and security. Practice Managers will need to be well informed so they can effectively train their staff and can handle enquiries from patients about how MHR works. To that end AAPM has been assisting the Australian Digital Health Agency to deliver webinars for practice managers and also to distribute documents. This edition of The Practice Manager contains a piece on MHR by AAPM Life member, Marina Fulcher, and the AAPM website has a useful MHR overview that members can download. Watch our website for more opportunities to learn about MHR. Many members will have noticed that the AAPM website has had a make-over recently and once members get used to the new layout, I’m confident everyone will find the site much easier to navigate. With an updated design, several enhanced features and easier navigation, it will offer members and other site visitors a more user-friendly experience.

Congratulations to our State Practice Manager of the Year Award recipients – Elizbeth Jones NSW/ACT, Garry Hurst VIC, Jacky Genesin SA/NT, Darcy Inglis QLD, Jeni Anning WA and Tanya Barrett TAS. All state recipients will be finalists for the National Practice Manager of the Year Award which will be presented at our conference Gala Dinner. We wish all recipients the best of luck. I look forward to seeing you in Canberra in October!

Nicholas Voudouris CEO | 3


AAPM Preferred Recruitment Partner Offering

Members can now access a single point of contact to assist with all recruitment matters and be directed to the best recruitment adviser in their state. MConsulting Solutions offers AAPM members access to a one stop recruitment solution for their Practice, including access to a database of over 5 million Australian Resumes. Their service aims to ease the task of finding your next team member whilst delivering access to talent of the highest calibre.

AAPM has a partnership with recruitment firm, MConsulting Solutions, to offer members a dedicated, Australia-wide recruitment service.

This offer to members is for recruitment services across all roles ranging from Receptionist and Administration through to Practice/Business Manager. Roles requiring GP/Specialist qualifications would be welcomed but handled on a case by case basis. AAPM members also have access to a complimentary introductory consultation as part of this dedicated recruitment service. To learn more head to the members only recruitment page on the AAPM website.

Welcome to AAPM’s new CEO Welcome to our CEO, Nicholas Voudouris, who commenced early in July. Nicholas is an experienced CEO who has led both not-for-profit and commercial organisations, most recently Health Skills Australia. His career has included working for education providers, in both the VET and Higher Education sectors, a health-related membership organisation, and a range of health service providers. He has held a wide variety of leadership positions, including successfully leading boards, organisations, coalitions of organisations and professional groups.

Under Nicholas’s leadership, together with the existing team at Head Office and our State Committees, AAPM will continue to deliver on the goal of promoting excellence in health care management. We would like to congratulate Nicholas on his appointment and invite all members of AAPM to welcome him as we take this next step in our journey as the peak professional body for Practice Management in Australia.

Are you missing out on Government incentives?

New AAPM Website We are excited to have launched our new AAPM website! With an updated design, several enhanced features and easier navigation, it offers members and other site visitors a more user-friendly experience. Please be aware that, as passwords are not stored against member records in the database for security reasons, all members will have to reset their passwords to log in to the new site. You can use your existing password, but use the “Reset Password” function first to re-submit it. After you log in, you will see “My Membership” in the top menu. This will be where you go to find all the details and functions for your membership and to access member-only resources and the Member Forum. 4 |

Your practice can earn up to $4000 per employee through the Australian Apprenticeship Incentives Programme* Ask us how

1800 066 128

* Conditions apply | | RTO 6754

POWERING YOUR JOURNEY DRIVING CHANGE Australian Association of Practice Management



National Convention Centre, Canberra

16-19 October 2018

AAPM aims to ensure excellence in healthcare management for better patient outcomes. As the peak association supporting practice management, AAPM provides education, support, advice and advocacy for those involved in healthcare practice management.

Dike Drummond

Michael Greco

The AAPM National Conference offers a professional development opportunity which develops and reinforces the core principles of healthcare practice management.

There is still time to register to attend. Book NOW, online at:

Debbie Mayo-Smith

Shara Evans


Australian Association of Practice Management

Saroo Brierley



Marianna Kelly

Six steps to protect your practice based on common MLAS queries If you aren’t already familiar with the new privacy laws, read our article: or visit the Avant website: for more resources. 2. Understand Medicare requirements


vant’s Medico-Legal Advisory Service (MLAS) handled over 20,000 calls last year, advising members and practices on how to prevent or respond to adverse incidents. Available 24/7 in emergencies, Avant’s MLAS provides expert advice to help minimise the chance of a complaint or claim occurring. Based on common queries our MLAS have received, here are six steps to take to protect your practice. 1. Know your mandatory data breach requirements This year, new privacy laws came into effect on 22 February 2018, placing a legal obligation on doctors and practices within the private sector to notify individuals – and the Office of the Information Commissioner (OAIC) – if their information has been affected by a ‘notifiable data breach.’ A breach will need to be notified if a data breach is likely to result in serious harm and remedial action cannot be taken to prevent the likelihood of serious harm. To reduce the risk of a privacy breach in the first place, it’s important to take the following steps in your practice: • ensure you and your staff are aware of your privacy obligations • review and update your practice’s privacy policy outlining how information is collected, used and disclosed in your practice • review and update privacy and security procedures, including processes for managing staff authorisation, authentication and access to records • create a process for proactively detecting data breaches • create a detailed data breach response plan if a privacy or security breach is discovered • create a business continuity plan and disaster recovery plan, so that if there is a disruption to your systems you can continue to operate your practice.

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Medicare is paying closer attention to doctors’ activities. The Department of Health is increasing its Medicare and Professional Services Review compliance activity. Medicare audits have recently been conducted in relation to the billing of initial and subsequent consultation items by specialists and the use of overnight sleep study items by sleep physicians. Doctors are legally responsible for services billed to Medicare under their Medicare provider number or in their name. Doctors are also responsible for incorrect claims regardless of who does the billing or receives the benefit. To ensure services are billed correctly under Medicare, practices are advised to: • make sure the doctor under whose provider number services are to be billed, reviews and authorises the items claimed • use the full online version of the Medicare Benefits Schedule (MBS) to determine what services are billed and always refer to any explanatory notes. This is better than relying on abbreviated summaries of the MBS • review The Department of Health’s range of online resources which assist practices and doctors in understanding the MBS and billing services accurately. For example, item numbers for skin excision items and Chronic Disease Management plans. • be especially careful to ensure chronic disease management plans are billed appropriately – particularly in relation to the need to consult with contributing providers about the care they will provide in a Team Care Arrangement and the review of those arrangements. For more information on specialist referrals and initial consultations, refer to Avant’s article and decision-making flowchart: news/20150508-referrals-initial-consultations-and-medicare-compliance/

3. Know what is, and isn’t, advertising Many practices are unintentionally breaching national advertising laws through the use of testimonials and social media. In April 2017, the AHPRA outlined its approach to enforcing compliance with advertising standards in its Advertising compliance and enforcement strategy for the National Scheme. With a renewed focus on advertising compliance, and significant penalties for breaches, it is important to understand how you can promote your practice while staying within the law. Review AHPRA’s Guidelines for Advertising Regulated Health Services to understand your responsibilities. Some key tips include: • avoid using language or images which may mislead or cause a patient to have an unreasonable expectation of beneficial treatment • don’t use testimonials or repost positive comments from other social media platforms • set your website and other social media platform settings so that users are unable to leave comments. For more information on what you can and can’t advertise, read Avant’s article: 4. Use electronic communication appropriately Practices are increasingly embracing technology such as SMS or email to communicate with your patients. While this certainly has benefits, it’s important to keep in mind that electronic communications may be subject to cyber threats, privacy obligations and the Spam Act 2003 (Cth). If you are communicating with your patients via SMS, refer to Avant’s factsheet for tips and developing a SMS messaging policy. Visit: au/Resources/Public/20160113-factsheet-recommendations-when-usingsms-messaging/ Patients and organisations are increasingly requesting that information be sent to them via email. Your practice has an obligation to take reasonable steps to protect the privacy and security of information it holds including when it is transmitted or disclosed outside the organisation. The use of passwords or encryption can reduce the risk of a data breach, although there is no legal requirement that emails be encrypted or password protected. The Royal Australasian College of General Practitioners provides guidance on using email for practices to reduce the risk of interception of data and sending emails to incorrect addresses, including: • use of passwords • use of encryption • verification of the recipient’s email address • obtaining consent • use of secure messaging facilities between practices. You should have a policy and procedure in place to manage the electronic transmission of personal information, including the steps the practice will take to ensure the privacy and security of information transferred outside your practice is protected. 5. Know what patient information can be disclosed to third parties

Examples where legislation requires you to share health information without the patient’s express permission include: • public health requirements to report infectious diseases • summons or subpoenas to produce medical records to a court or tribunal • a police search warrant. Read our article: to find out the requirements for consent, your legal obligations and when you can refuse to provide medical records. 6. Update policies and processes for transition to the RACGP’s new practice standards In October 2017, the RACGP released the Standards for general practices (5th edition) (the Standards). In order to align with the Standards, GP practices will need to update their policies, procedures and processes. It is also important these changes have been communicated with the practice team to ensure the changes are understood and implemented in a timely manner. Read our article: for more information on the new modules and indicators covered in the Standards. If you have a PracticeHub subscription, you will notice that the updated policies and procedures were added to your site from 1 December, 2017. For more information on Avant’s online practice management platform, contact 1300 96 86 36 or It is important that all practices: • review the new Standards for general practices (5th edition) • review the new content and ensure they have procedures in place to ensure staff know how to comply with these changes • allocate the changes to the relevant roles in your practice for compliance sign-off. Practices undertaking accreditation over the next 12 months should check with their accreditation provider about the changeover date for assessment. Accreditation providers are also conducting webinars and workshops on the requirements for practices to meet the new Standards. FURTHER INFORMATION DOES YOUR PRACTICE HAVE THE PROTECTION IT NEEDS? Many practice owners assume their practitioner indemnity also covers their practice entity and their staff, which is sometimes not the case. To protect practice owners, Avant’s practice insurance offers your practice comprehensive protection and works hand-inhand with your Avant Practitioner Indemnity Insurance Policy. Avant’s Practice Medical Indemnity Insurance* covers the legal costs of defending your practice against allegations and complaints, and compensation for patient loss or injury. For added peace of mind, your policy also offers you and your staff unlimited access to Avant’s MLAS, which provides expert advice, 24/7 in emergencies. Visit: or call Avant today on 1800 128 268 to organise a quote. *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 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.

Practices and doctors can share a patient’s medical information with a third party if they have authority from the patient to do so or are required to by law. Carefully read the information request and the patient’s authority to ensure the correct documentation is shared and that it’s within the scope of the patient’s authority.

Kate Gillman, BA, LLB Head of Avant’s Medico-legal Advisory Service | 7

One of your practice’s most valuable assets…


Sydney, 2003: I had my first taste of ‘medical billing’. My mother, a single parent and specialist doctor, had done a wonderful job at raising my brother and me but with such work came long hours, regular on-call, a lengthy commute and the inevitable administrative burden that came with being a sole trader. I was in seventh grade, enjoying life and treated as an adult both at home and at school, so consequently was keen to play a ‘mature’ role and do my bit. I offered to assist with the running of her business (for a small stipend of course - that 1st generation iPod was certainly not going to buy itself!) She agreed and the complicated world of batches, no gap schemes, known gap schemes, BAS, referrals and the inevitable claim rejections was opened wide for me. Melbourne, 2013: I found myself a few years later with varied experience but no real clarity or vision of where I saw my future. In a five-year period I had worked in hospitality, travel and real estate, with each job-hop pursuing

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greater responsibility and more income. Looking back now, am I fitting the mould of the difficult (or perhaps just misunderstood) millennial… Job hopping, skim latte in one hand, iPhone in the other and pondering why I am just so special? Well, maybe so! But what is significant are the skills and experiences learnt on the journey: Hospitality taught me the backbone of good customer service and problem solving; Flight Centre and Webjet taught essential business skills and revealed what it takes to be in the ASX top 200; real estate taught me the value of relationships and really drove home that sales and commission are just not for me. I am all about service. My mother and I were both feeling the bleak monotony of life and there was a real hunger to tread our own path and make our own way. An opportunity presented itself in the form of a ‘business plan’ on a serviette in a wine bar... Why not open our own medical practice!

The business plan was sound and, in my mind, read as follows: • No boss • Long carefree lunches • Unlimited and unconditional leave • A licence to print money (medical is an essential service) • Complete independence which must lead to a happy and fulfilled life The reality was a lot of hard work, rewarding relationships with both patients and colleagues and the opportunity to make our lives our own. The venture was the most fulfilling business we have ever run, albeit, it was also the most challenging. As a 23-year-old male working solo in Bendigo, a city in rural Victoria, and having never been in charge of a practice before it was difficult to know where to start. We had a sound enough knowledge of generic business and billing but running a practice required more. If I was to sum it all up in one word it would be ‘isolating’. Being the fledgling leader of a practice, I was reluctant to blur the professional boundaries between practice manager, doctors, staff and patients. Having just moved to a new town, there were no social circles to speak of and, despite being my most frequently dialled number, even Medicare turned out to be not so sociable! The answer was threefold: • AAPM Membership - offers the development pathway, provides a framework, adds legitimacy • Diploma of Practice Management - with knowledge comes power and confidence • AAPM Networking - provides support, sounding board and reassurance I travelled to Gisborne for an AAPM breakfast meeting and networking. I am so grateful to Tracey Clarke, Deb Stidwell and other colleagues for welcoming me warmly and without judgement and providing me with a great sense of collegiate support. With that support came confidence. Key takeaway: Other practice managers are not frightening; we all face similar challenges and stresses and, even across specialities, there are others willing to help, collaborate and share. For those on Facebook, there are some helpful groups such as the Practice Managers Network, Practice Managers Network Queensland (PMNQ) or the Practice Managers Network Group. The Diploma of Practice Management was not only enjoyable to complete but equipped me with the essential knowledge required to succeed. It is possible to be effective without this, however, the formalised education provided a fast-track and, importantly, a formal qualification that allowed me to access Certified Practice Manager (CPM) status, and eventually Fellowship with the AAPM. Oh - and the grand total of long lunches and leave days in the practice ended up totalling nil! Cairns, 2015 - Present: An opportunity presented itself in Cairns. Upon arrival I was presented with a three doctor, single speciality clinic that has since become a multi-site, multi-specialty medical organisation, employing around 50 individuals and operating across Far North Queensland and more recently the Northern Territory and Papua New Guinea. I am honoured to be entrusted with and lead such a dynamic and fastgrowing organisation with forward thinking directors. Together we have created a mutually beneficial relationship. However, the journey from small

to medium sized business has not been without its challenges: • When does Practice Manager stop and business/ general manager/ CEO begin? • The relationship between board of directors and management easily becomes blurred, particularly if the board are working in and/or are owners of the business • A wider set of business skills are called upon, in addition to your specialist medical practice management knowledge, for example: contract law, tax law, employment law, accounting standards, enterprise grade IT ‘lingo’ and planning plus a greater regulatory and compliance burden. Practice Managers looking for a new challenge should not be afraid to broaden their scopes and knowledge and consider the value they can add to their current business or in related roles in hospitals, aged care or even as consultants. For me, Fellowship with the AAPM was a logical step in progressing both my own personal brand and moving our business forward, providing: • formalised on-the-job training and knowledge • prescribed further training and development • added legitimacy and status to my personal brand • added legitimacy and status to our practice • an opportunity for self-reflection and improvement In addition to Fellowship, I have found it useful to embrace opportunities with other institutions, including your local chamber of commerce, a University Business Degree - Core business skills, the CEO Institute - Leadership and Innovation and the Australian Institute of Company Directors (AICD) - Bridging the gap between managers and business directors/ owners. I encourage business owners to make funding available for the development of their staff, and for those self-funding, consider it an investment in your future. Track the value you bring to your practice. Document throughout the year the dollar value of tenders won, grants gained, increase in patient satisfaction scores or other metrics. Practice Managers who hold CPM or FAAPM status bring legitimacy and add value to both their personal brand and the brand of the practice. Value is your leverage for your performance appraisal or at the negotiating table when it comes to remuneration and your future career prospects.

KEY TAKEAWAY: Never stop learning. AAPM is what you make it, so use your membership and be involved. Consider your personal ‘brand’ and tread your own path - every journey is different. Most of all, do not forget to invest in one of your practice’s most valuable assets… YOU!

Darcy Inglis Fellow, AAPM | 9

Who pays the wages, rent & other bills if the Doctor gets sick? Business Expense Insurance...


s most Practices are reliant on a small number of practitioners to generate income, it’s worth asking the question:“If one or more of the main income producing practitioners is unable to work due to illness or injury for an extended period of time, how do we cover the fixed costs of the business?” At first glance, you may think that if a Doctor has Income Protection Insurance everything will be fine. Income Protection however typically covers around 75% of the individuals’ pre-disability income. While this money can help to cover everyday costs and household bills – would it stretch to cover business expenses like Rent, Salaries and Leasing costs for example? As alarming as it may sound, over 60% of Australians will be disabled for more than one month in their working life. Further, over 25% will be disabled for more than three months.

As a Practice Manager, it’s worth taking stock of what is being spent on the following: • Staff Salaries • Leasing Costs • Accounting • Advertising • Audit Fees • Cleaning And these are just some of the fixed costs that could be covered by the right Business Expense Insurance policy... Peter’s story Peter is an Orthopaedic Surgeon in partnership with another practitioner. They employ a Practice Manager and reception staff in rooms they rent close to a major Private Hospital. Unfortunately Peter has a serious accident on a family skiing holiday which leaves him with a broken arm and some broken fingers, as well as significant back injuries. Peter requires long-term rehabilitation before he can return to work – it could be as long as six months.

Thankfully, Peter has Business Expense Insurance – he can continue to pay his share of the employee costs and fixed expenses, and the cost of a Locum is covered so he doesn’t lose patients. If a Doctor in your practice couldn’t work, how would you keep up with the costs?

Business Expense Insurance provides a monthly benefit that can help to ensure fixed operating expenses are covered so they can focus on returning to peak health ... and to work.

FURTHER INFORMATION We can explain more about the different types of insurance, and help you tailor the right cover for your practice’s needs. Feel free to get in touch!

Brad Oldham Risk Insurance Cutcher & Neale

Hassle-free patient feedback for your accreditation Practice accreditation is stressful and occupies the valuable time of busy practice staff. Let us lighten the load and help you improve the service you provide your patients. We can co-ordinate and help you complete the patient feedback component of your practice accreditation. Insync’s survey tool and method are approved by RACGP. Insync is a leader in healthcare patient experience and engagement research. We’ve been delivering patient satisfaction surveys for over 20 years.

To find out more, contact our team on: 1800 143 733 10 |

By now you would have heard quite a lot about ‘the cloud’. Firstly, the cloud isn’t actually a physical thing. It is just a network of servers, and each server performs a different function. Some are used for storage, others can be for applications or services. The term ‘cloud computing’ has only entered the public sphere in the last 10 years, but, the concept has been in development for decades. Cloud computing describes the processes of sharing resources between devices to optimise performance. This means using a network of computers to store and process information, instead of just the one. Cloud computing as a term has been around since the early 2000s, but the concept of computing-as-a-service has been around for much, much longer -- as far back as the 1960s, when computer bureaus would allow companies to rent time on a mainframe, rather than have to buy one themselves. These ‘time-sharing’ services were largely overtaken by the rise of the PC which made owning a computer much more affordable, and then by the rise of corporate data centres where companies would store vast amounts of data. Cloud computing gained mainstream traction about ten years ago due to a number of factors,

but the key was the widespread uptake in persistent high-speed internet connections. The rise in smart mobile devices and Wi-Fi technology allowed people to be mobile and always on line. From this point, IT companies realised it is now safer and more efficient to store software and files online.

or thousands of users. However, anyone that uses common consumer products like iCloud or Google Drive have experienced cloud computing through cloud storage.

The modern notion of cloud computing has changed the way we interact with our devices. A laptop is now less like a standalone computer and more like a user terminal used to access data and files that are stored in the cloud.

When moving to the cloud, businesses are often motivated by finances. Previously, organisations would have to buy their own hardware and equipment, which depreciate over time. Now organisations are utilising the cloud, so they only pay for what they need. This model also allows organisations to quickly scale up or down depending on their need and budget.

By spreading the load across a number of very powerful servers, a user can run web-based applications with higher reliability and efficiency. The servers are also constantly updating, ensuring you have the most up to date software available. Another key feature of this technology is the reliability available, because if one server crashes there are multiple connected servers ready to take up the slack.

So, when you save something ‘in the cloud’, you are storing it in a physical place. That file is transferred from your device to a hard drive located on a physical server, or potentially multiple servers, potentially thousands of kilometres away. And by doing this, no matter what happens to your device, you will always be able to access this file by downloading it from the server to the device you are using.

The exact benefits will vary according to the type of cloud service being used but, fundamentally, using cloud services means companies not having to buy or maintain their own computing infrastructure. Cloud computing has proven to be very popular at the enterprise level, as IT managers are concerned with the stabilisation and reliability of large networks with hundreds

Jason Amato Marketing Manager Centorrino Technologies | 11

My Health Record: in your patients’ hands AAPM DIGITAL HEALTH CHAMPIONS The Australian Digital Health Agency (the Agency) and AAPM have joined forces to support the appointment of five AAPM members as digital champions to lead a My Health record expansion awareness program among AAPM members. This is timely given the My Health Record opt-out period began on 16 July and will finish on 15 November 2018. Cathy Baynie, AAPM National President has said, “There are significant potential benefits for practices that flow through with the adoption of digital health, improving efficiency of systems and business processes; therefore enabling enhanced access to care and better health outcomes as well as improved co-ordination and communication between providers.” The Agency’s aim is to learn from, and build on, the experience of practice managers in the front line and better support practices in realising the significant benefits of using digital health and the My Health Record. Expanding My Health Record This year, every person with a Medicare or Department of Veterans’ Affairs card will get a My Health Record unless they indicate they don’t want one during the opt out period. Through independent research, individuals have told the Agency their preferred way to receive information about My Health Record is from their trusted General Practitioner. It is likely that patients may come to your practice for advice about My Health Record Currently, more than 6 million Australians already have a My Health Record. During the opt-out period people who do not want to have a My Health Record may opt out by: • Going to • Calling the Helpline on 1800 723 471 • Contacting their Indigenous Health Service Toolkits have been distributed to practices that provide the information and resources they need to assist in answering their patients’ enquiries about My Health Record, including discussion of benefits such as: • In a medical emergency, healthcare providers connected to the My Health Record system can see their patient’s health information such as allergies, medicines and immunisations. This helps them to provide their patients with the best possible treatment and care. • When a healthcare provider uses a patient’s My Health Record, it means the patient has support to remember and repeat their medical story, such as their prescriptions or the names of tests they’ve had. My Health Record helps a patient to keep track of their children’s health, immunisations and any medical tests.

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Frequently asked questions 1. Following the opt out period, when will the Records be created? By the end of 2018. 2. What is in a My Health Record when it is created? • There is no health information in a person’s My Health Record when it is created. • Once the record is created, the individual can log on and upload information including personal notes, advanced care documentation, and medication and allergy information. º Once the record is created, health care providers can upload health information on allergies, medical conditions and treatments, medicine details, and test results. º The first time the record is used two years of Medicare and PBS data may be uploaded, unless the individual has chosen not to have this information in their record. 3. How do patients access their My Health Record? To access their My Health Record, individuals will need to use the myGov username and password that they will have created. If they don’t have a myGov account, they will need to create one to access their My Health Record online. Their myGov username and password are only known by them and should be kept secret. If they forget their login details, they will need to create a new account through myGov and link it to their My Health Record. If they forget their password they can create a new one online (after their identity is verified). If they don’t have internet access, they can call the My Health Record Helpline on 1800 723 471 to access their information. The Helpline will be able to tell them the documents that are in their My Health Record, but not the information each document contains. 4. Can patients choose not to have information loaded into their Record? • Individuals can tell their healthcare provider not to add specific tests and other medical information to their My Health Record. • Individuals can also restrict access to specific information in their My Health Record by applying a Limited Document Access Code (LDAC) to that specific document – or by applying a Record Access Code (RAC) to the entire record to control which healthcare provider organisations can see a record. • Additionally, any person can remove specific documents from their My Health Record.

The AAPM digital champions attended a workshop at the Agency offices in Brisbane at the end of June. L to R Genevieve Donnelly (Agency), Champions: Dene Creegan, Melinda Burgess, Jan Chaffey, Raelene Tully, Kim Passante and Marina Fulcher (Agency)

5. Can patients register for a My Health Record under a pseudonym? You may be eligible to have a My Health Record under a pseudonym. For information, including to see if you are eligible, please contact the My Health Record Help line: contact-us 6. Can patients see who has accessed their My Health Record? They are able to monitor who has accessed or updated their My Health Record through the access history. This feature shows information regarding: • Date and time the My Health Record was accessed • Organisation that accessed it • Circumstances surrounding access (for example: in an emergency) • Details of actions that occurred during access. The access history can be obtained either online or by calling the Helpline on 1800 723 471. 7. What is a My Health Record authorised representative? An authorised representative is a person who has applied to, and satisfied, the System Operator that they have parental or legal authority, or is otherwise appropriate, to act on behalf of an individual. An authorised representative must act in accordance with the will and preference of the person they represent. Authorised representatives can access, view and update the information in the individual’s My Health Record, as well as add/ remove other people as nominated representatives.

8. What is a My Health Record nominated representative? A Nominated Representative is a person that has been chosen by the individual to assist with managing an individual’s My Health Record. A Nominated Representative can access and view an individual’s My Health Record, and a Full Access Nominated Representative has the ability to access, view and update an individual’s My Health Record. Nominated representatives are required to act in accordance with the will and preferences of the person they represent. 9. Who has control over a child’s My Health Record? Authorised representatives (such as a parent or legal guardian) will have control of their children’s My Health Record from 0 to 14 years. After a child turns 14, they will be able to choose whether to manage their own My Health Record. If a child chooses not to take control of their My Health Record between 14 and 17, their Authorised Representative (which may or may not be a parent) can continue to manage their record until they turn 18. Once an individual turns 18, Authorised Representative(s) will automatically lose access to that My Health Record. If an individual still wants their parent(s) or guardian(s) to view information in their My Health Record after they turn 18, they will need to take control of their record and set them up as Nominated Representatives. Parents will not be able to view the MBS, PBS or Immunisation Register details of children aged over 14. | 13

My Health Record: in your patients’ hands The role of the Practice Manager As is often true when there are changes or new initiatives that impact upon the day-to-day delivery of patient care, the Practice Manager becomes the “go to” person; the person members of the care team look to for guidance and answers. This article and those in the past two issues of The Practice Manager have been aimed at providing readers with information to support them in successfully fulfilling the role of change champion. AAPM Digital Health Champions The five practice managers who were successful in their application to be appointed as AAPM Digital Health Champions are: • Dene Creegan, Seven Springs Medical Practice • Jan Chaffey, Camp Hill Healthcare • Kim Passante, Carbal Medical Service • Melina Burgess, Southern ENT • Raelene Tully, Murray Medical Centre. Your AAPM Digital Health Champions are working to implement and expand on the use of My Health Record in their practices and will be developing case studies that aim to support you from their lessons learned, as well as to further inform the work of the Agency. They are also developing Top Tips for Practice Managers based on their experiences. This and other information will be circulated to AAPM members over the coming weeks and months.

Marina Fulcher Life Member FAAPM CPM Senior Clinical Reference Lead Australian Digital Health Agency


Medical Media delivers an interesting blend of engaging content including: health messages news quizzes local advertisements national advertisements designed to educate and entertain your patients. W: 14 |

T: 02 9929 2763

Over 2,500 screens in medical practices throughout Australia

11 tips for SEO success for your practice L

ike many aspects of marketing, Search Engine Optimisation (SEO) is an area that many practices feel daunted by. You are probably familiar with the term SEO but may be unsure what it actually means and how to achieve it for your practice. Well you certainly aren’t alone! CEO of Reality Marketing, Leonie Arnebark who looks after the marketing requirements of a number of clients nationwide in the healthcare arena has complied some tips to help you get on top of SEO for your practice. What is SEO? Search Engine Optimisation (SEO) is the ongoing process of making sure your website performs as well as possible on specific search engine searches. The key distinction between paid and organic search marketing is that with search engine optimisation, you get the visitors you earn. Whereas with pay per click, you get the visitors you pay for. Why optimise your website? You have a great practice and you want people to be able to easily find it! Success is based on being top of search rankings. You need to be constantly optimising your website in order to achieve high rankings.

At the end of the day you want your website users to have an enjoyable experience when they visit your site and get what they need out of it. To improve your website’s user experience, you’ll want to focus on things like page load time, bounce rate, time on page, page views per visit, and how far a person scrolls down the page. Your website is a work in progress which needs to be continually updated and nurtured in order to achieve optimal results, so make it a central focus of your marketing activity and dedicate time and resources to keep it current, relevant and engaging for your target audience.


11 tips for SEO success for your practice: 1. Mobile responsive design Ensure your website is usable on multiple devices and screen resolutions and is completely mobile responsive. Check this before publishing to ensure your audience can find you easily using a mobile device. 2. Avoid typos and grammatical errors Google penalises typos so be sure to do a site audit and fix any technical errors or grammatical errors on your practice website. 3. Check site speed Check all pages are fast loading and working well in mobile responsive design. If your site is slow to load, try reducing the size of your images and also explore your hosting provider as this can contribute to speed. 4. Useful and up to date content Create high quality, original content that is useful and relevant for your audience. The right words in the right place can have a huge effect on how much traffic you get from the search engines. Ensure your content is up to date and accurate too. 5. Get your metatags and meta descriptions set up Meta descriptions are HTML attributes that concisely explain the contents of webpages. You’ve seen them before on Google’s search engine results pages (SERPs), where they’re commonly used as preview snippets. When writing your descriptions be sure to make it about your readers’, the more benefit and value you can build for them, the more likely they’ll be to click. Bonus tip: Ensure all images have alt tags as well

6. Create fresh content regularly Great content is important. But it’s only a piece of the puzzle. If you want to move up the ranks in Google, you need to be smart about it and be continually creating fresh content. A strategic system for creating content that wows your audience, gets you on the front page, and drives the traffic you need to enhance Search Engine Optimisation is key. 7. Use on page SEO and cross linking Utilise On-page SEO. This includes creating separate pages for each keyword or phrase i.e. don’t have a general services page, have separate pages that focus on each service. 8. SSL enabled Ensuring that your website is secure will also assist with google rankings. There is a clear SEO benefit to enabling-SSL on your website, and across all your content. 9. Third party listings and affiliate links Have your business listed on third-party websites, including business name, opening hours, URL, address, images and phone number. 10. Google my business Ensure your practices google my business account is up to date, has fresh images and lists accurate contact details, opening hours etc. 11. Drive through social media Linking to content from your social media platform i.e. blog articles is a contributing factor for SEO success.

Leonie Arnebark CEO, Reality Marketing | 15

National Cervical Screening Program and National Cancer Screening Register A

ustralian rates of cervical cancer incidence and death are among the lowest in the world, a success story reflecting the involvement by the healthcare sector since the introduction of the National Cervical Screening Program (NCSP) in 1991. This joint program of the Australian Government and state and territory governments has been implemented by a range of health professionals, including general practitioners, women’s health nurses, Aboriginal Health Workers, gynaecologists, gynaecological oncologists, cytologists and pathologists. From the beginning of the program two-yearly screening with a Pap test was offered for women aged 18 to 69 years and screening registers were held by states and territories. A review of the NCSP began in 2011 to provide Australian women, including those not HPV vaccinated, access to a cervical screening program that is based on current evidence and best practice. To build on and ensure its continuing success, the NCSP was renewed on 1 December 2017 with the Cervical Screening Test replacing the Pap test, based on recommendations of the Medical Services Advisory Committee. The Cervical Screening Test is a simple procedure to check the health of the cervix and detects human papillomavirus (HPV), a common virus that can cause changes to cells in the cervix, which in rare cases can develop into cervical cancer. By detecting a HPV infection, healthcare providers can monitor their patients earlier, and intervene if the infection causes changes to cells in the cervix.

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The National HPV Vaccination Program commenced for girls in 2007 and for boys in 2013 but women and other people with a cervix who have had the HPV vaccine should have regular Cervical Screening Tests as the vaccine protects against the types of HPV that cause about 70% of cervical cancers. It does not protect against all types of HPV. The Cervical Screening Test is expected to further reduce cervical cancer incidence and mortality rates by up to 30% when compared to the Pap test. Healthcare providers have an important role in educating their patients about the benefits of screening, including those who have never screened or are under screened, a group in which 80% per cent of cervical cancers occurs. For the most efficient transition to the new test regime, healthcare providers should ensure their patient reminder and recall system aligns with the new recommended commencement age for routine screening and new screening and clinical management intervals. The National Cancer Screening Register supports the renewed program from its commencement on 1 December 2017. The new Register will play an important role in supporting the continuing screening and care of patients, in conjunction with the role of healthcare providers in managing and educating their patients about the NCSP. The Register is a national electronic infrastructure for the collection, storage and reporting of cancer screening program data for the NCSP. The Register does not replace the relationship between the healthcare provider and

How the National Cancer Screening Register will support the NCSP • Inviting women to participate in routine screening. • Reminding women when they are due and overdue for cervical screening. • Providing a woman’s cervical screening history to laboratories to assist in the reporting of current test results. • Providing a ‘safety net’ for women who have positive test results and who have not attended further testing, by prompting them and their healthcare providers of the need to attend follow-up tests.

their patients but is designed to act as a safety net by holding patient details, test results, screening histories and providing follow up support. Past screening records held by state and territory registers have been migrated to the Register which gives healthcare providers access to a patient’s cervical screening history in one place. While healthcare providers should continue to contact the relevant pathology laboratory for recent test results, the information on the Register will allow providers to check the cervical screening history of their patients, regardless of who ordered previous tests and where in Australia the test was conducted. The Register also includes details of when a patient’s next screening test is due and results of all tests. Healthcare providers can contact the Register and after verifying their identity, can check a patient’s history, update a patient’s personal details and manage a patient’s participation in the program if required. People on the Register can also manage their participation. They can call the Register on 1800 627 701 to ask for their next screening date, which will be given verbally after proving their identity. A screening history can be posted to them. They may wish to nominate a healthcare provider for the cervical program and in those instances the provider will be advised when a person is overdue for follow up action. People may withdraw any request concerning their participation from the Register at any time. The Register will notify healthcare providers when it has not received information to indicate that a person who is at risk has been followed up. Participants will be contacted by the Register when there is no information to indicate they have had a requested follow up after a screening test. The Australian Government Department of Health is the custodian of the information in the Register and is bound by the Privacy Act 1988, including the Australian Privacy Principles, and the National Cancer Screening Register Act 2016 on how information is collected, recorded, used, stored and disclosed. No information is disclosed without the caller, including healthcare providers, being verified.

Changes for Healthcare Providers • A Cervical Screening Test will be conducted every five years for people with a normal test result. • Reminders should be sent every five years for patients aged between 25 to 74 years who have had a normal test result. • Patients who are turning 25 or are over 25 and have never had a Pap test should be encouraged to make an appointment for a Cervical Screening Test. • All women, including those under 25 years of age, who are currently under clinical management for a cervical abnormality should continue to be managed according to the recommendations on transitioning individuals in the 2016 Guidelines at: question:Transition_to_the_renewed_ National_Cervical_Screening_Program • A patient who at any age experiences abnormal vaginal bleeding (post coital, unexplained inter-menstrual or any post-menopausal bleeding), unexplained persistent unusual vaginal discharge, or unexplained persistent deep pain during sex, should discuss these symptoms with their healthcare provider as soon as possible.

Resources for Healthcare Providers

Ordering the Cervical Screening Test

Publications and resources about the National Cervical Screening Program are available from the NCSP website in a number of languages and are free of charge: screening/publishing.nsf/Content/resources-menu?OpenDocument&CAT EGORY=3Health+Professional+Resources-3&SUBMIT=Search

Details on how to correctly order the Cervical Screening Test are available here: the Pathology Test Guide for Cervical and Vaginal Testing http:// pathology-test-guide-cervical-vaginal-testing.

Online training modules

If you are unsure of a patient’s cervical screening history or status, please call the Contact Centre team on 1800 627 701 (between 8am and 6pm, Monday to Friday, in all Australian state and territory time zones) or visit the National Cancer Screening Register ncsr/en/healthcare-providers.html website.

Online training modules to help healthcare providers understand the Cervical Screening Test and Clinical Pathways are available on the NPS MedicineWise website This training will be recognised as continuing professional development hours with RACGP, ACRRM, ACN, ACM and APNA.

Contact the Register

This article has been prepared by the Australian Government Department of Health. | 17

Don’t be lulled into Digital Inaction In 2011, the world got to witness an incredible glimpse into where technology is heading. Like most of the big technology companies, IBM had been working on artificial intelligence and machine learning for years but in 2011 they decided to test it out in a very public way. They entered Watson, their new machine learning behemoth (it was the size of eight refrigerators), onto the US trivia game show Jeopardy. But Watson wasn’t to compete against just any ordinary contestants, it was pitted against the two greatest players the game had ever seen. Brad Ritter was the highest money earner of all time and Ken Jennings was the longest running undefeated champion.


or the contest to be referenced in an article like this you can already be fairly sure of the outcome, though you might be a little surprised at the margin. Watson won both games (plus the warm up match) accruing a combined total of $112,881 to Brad Rutter's $31,600 and Ken Jennings $28,800. It was a pivotal moment for the world’s awareness of machine learning, but what was really exciting was what Watson did next.

Risk aversion

After Jeopardy, IBM started looking for real world applications for Watson and the first job it took was in the healthcare industry. Specifically, Watson was fed a whole bunch of research and data on various types of cancer and then, using the same machine learning and natural language processing it used to win Jeopardy, it would mine this information to help doctors more accurately diagnose their patients’ conditions.

A lack of time

It is interesting then, that given healthcare was the go-to sector for demonstrating the value of machine learning, that in study after study the healthcare sector is seen as one of the laggards in terms of technology adoption. The question needs to be asked “What are the reasons why the healthcare sector has been slow to digitise?” and assuming there is validity in these reasons initially, are the reasons still valid now?

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There is no question that healthcare is a risk averse industry, and given that people’s lives are at stake, this is generally seen as a good thing. Research by Deloitte and the Sloan School of Business suggests that one of the prerequisites for being a digital leader is the willingness to take risks. For many healthcare providers a culture of risk taking when it comes to technology is the antithesis of everything else they do - every day.

Healthcare providers are also generally time poor. This is even more so in private practice where the time of practitioners is sold in half hourly increments and revenue is ultimately dependent on patient throughput (so much so that most healthcare practices are one of the only industries in the world where whole rooms are dedicated to making other people wait). Given that the business owner is often also the over stretched practitioner, it can be hard to get their attention for anything that isn’t directly related to client care. A lack of expertise There is little doubt that being a practitioner in almost any health or wellbeing related field requires a high level of expertise, often the result of half a decade or more of formal study. The challenge is that outside of client care, none of this expertise has much to do with technology.

Given that many practices run with a small number of support staff it is mostly impractical to have a dedicated IT expert available to help guide digitisation. So is this it?

practices doesn’t necessarily involve patient data at all. There are incredible opportunities to digitise back end processes that improve patient communication, marketing, appointment booking, payments and practice management without ever touching sensitive patient information.

Seemingly, the most legitimate of these concerns is that of risk aversion. Especially in medical practices, where people’s lives are on the line, it seems reasonable that at bare minimum there should be caution about the use of ‘unreliable’ technology. There is little doubt that this was a valid concern back in the 1990’s when organisations struggled with the blue screen of death and dial up internet, but it is perhaps less valid today.

The truth is that, although there are a significant number of opportunities for healthcare practices to improve both productivity and patient outcomes, many of them will not be identified and will never be pursued. We might justify that these are secondary concerns that are not core to patient outcomes but in failing to improve them, practices leave themselves at risk.

There are two challenges we face when assessing risk: the first is the propensity to overstate the risks of the future; the second is that we tend to underestimate the risks of the present. It is often a case of ‘it’s better the devil you know’. Improvements in technology over the last two decades means that in many ways our digital systems are more reliable than the paper based systems they aim to replace. Not only can patient information be backed up to offsite locations, it can also be easily searched and shared in real time to ensure that treating practitioners have the right information and patients receive the right care. It is also important to acknowledge that many of the opportunities for digitisation within healthcare

And herein lies the fundamental technology challenge for most practices today. It’s not that their healthcare professionals are competing against computers like Watson, it’s that healthcare practices are are already in competition with other practices that are using technology better than they do. The good news is that the return on investment of many digitisation projects is incredibly compelling. Within the Digital Champions Club, a technology improvement program I run for small and medium sized businesses, the hurdle rate for implementing a new project is generally 1000% return per annum ie. an organisation should expect to get back 10 x their initial outlay within the first year. But to find and deliver these projects, practices are going to need internal experts that intimately understand the needs of

the practice (rather than just rely on biased and often unreliable external experts). For the foreseeable future, technology is only heading in one direction and it is going to bring some big and exciting opportunities to the organisations that are ready. Being ready for the big things means having delivered on the small things already, as it is only through delivering on the small things that organisations develop the internal expertise and generate the returns that ensure time and other resources are available when they’re required. In the words of Bill Gates “We always overestimate the change that will occur in the next two years and underestimate the change that will occur in the next ten. Don't let yourself be lulled into inaction.”

FURTHER INFORMATION Simon Waller will be presenting at the 2018 AAPM Conference in Canberra

Simon Waller Founder, Digital Champions Club International Keynote Speaker | 19

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How to deal with a bad customer review What and Who has been leading the changes to health care?

Consumer Empowerment

In healthcare, the practitioner-patient relationship is shifting from service controlled whereby the doctor decides on the patient’s healthcare, to patient centred care, where the patient is empowered, to make decisions (1-4). This is a worldwide trend, among the contributions to this shift are increased individualism in western societies and governments/payers embracing free market principles to deliver more efficient outcomes (2). Australian Government is moving to modern healthcare design models that view patients as more than passive recipients of healthcare services and instead expect patients to manage their own care and be accomplished in assessing service quality (5).

Healthcare quality is difficult to evaluate as it is often a reflection of values and goals in the health system and the larger society in which it is embedded (9). Nonetheless, healthcare consumers have been empowered, not only through government policy, but through access to digital platforms, such as Online Rating Websites (ORWs), to evaluate existing and future providers. The patient becomes a consumer and free market forces work to drive efficiency through choice. Information symmetry, where all relevant information is known to all parties involved, is critical in any free market (10).

What happens when patients act like consumers?

ORWs are a form of public reporting that contributes to information symmetry, driven by the consumer of health services rather than the entities providing the service. They are internet-based social networking platforms that allow patients to discuss information and provide evaluations based on personal experiences (2). In recent years, patients have increasingly consulted ORWs to select their doctor (11). For example, a recent study (12) showed that 65% of ORW users had consulted a doctor based on the ratings shown on the websites. Another study by Rozenblum and Bates (13) stated that “customer ratings have the potential to become important differentiators among healthcare organisations and providers and may have major future effects on customer behaviour and decisions� (p.2). Arguably, evaluations made on ORWs are at odds with how doctors would prefer the quality of their service to be appraised.

Under a consumer model of healthcare, doctors are suppliers of a service who can be selected and evaluated based on consumer needs just like any other product or service. Sturgeon (2014) identified David Lees, an economist in the 1960s, as the first to argue that there was no fundamental difference between medical services and any other consumer service. However, this shifting landscape is especially challenging for doctors who argue that healthcare is complex and difficult to evaluate, and the consumer model is less applicable to healthcare (6). This discourse is based on a number of premises which include: patients are sick, thus influencing their ability to make objective choices or evaluations (7) and patients may not have the technical skill to evaluate the healthcare service and often rely on credence factors such as the cleanliness of the waiting room and staff friendliness (8).

What are Online Rating Websites (ORW)? | 21

Are ORWs growing?

Should you react to bad ratings?

The number of ORWs in operation is growing in popularity around the world (14, 15). In an ORW study, a search for healthcare online review sites in Boston USA found 33 such sites existed (16). In other countries, the number of such websites varies; there are eight physician rating websites in Germany and in the UK there are three dominant review sites, one being run by government (17). In Australia, there are a number of sites, the most prominent being run by an insurance company. Concerns have been expressed by the Australian Medical Association that such ownership will result in information asymmetry whereby the insurers own all the information (18). Private ownership of such ORWs creates a potential conflict of interest.

The strategy should be to anticipate ratings of any sort and make patient/ customer feedback an integral part of your practice through simple surveys using survey monkey or or more sophisticated systems such as that run by It is ultimately an individual matter to decide how you wish to respond and it is important to ensure you do so within the boundaries of your professional obligations. If you do get a bad rating, Ruanne Brell BA LLB (Hons), Senior Solicitor, Avant Law provides some useful options: • Don’t respond at all as this may escalate the matter • If you did want to respond to the post itself, a comment in very general terms is the best approach. This should be limited to something along the lines that you do not consider that the comments are accurate, and that any concerns regarding services provided should be addressed directly with the practice or its practitioners. It is important you do not inadvertently breach the patient’s confidentiality when responding. • Some websites allow reviews to be posted on pages which are not controlled by you, such as the Google Maps page. For these sites, other options include requesting a website operator to remove any offending comments, or asking the party making the comments to withdraw those comments and possibly publish or post a retraction. The author’s experience is that it may appear difficult to ask the reviewer, but not as difficult as dealing with the layers and blocking strategies used by Google. • The response of website owners asked to remove a comment varies but most will usually only remove it if they accept that it is defamatory, or otherwise breaches their specific terms of use. You should therefore read the applicable terms carefully and then, if appropriate, you can contact the site and ask them to take down the review on the basis that it is misleading and unfairly critical or untrue. In our experience, doctors have varying success with these types of requests, with some websites declining to remove negative comments on the basis that the patients are allowed to express their opinions. • If you can identify the person, it is always best to contact the person directly (rather than through comments on the review site) to make the request to remove and use it as an opportunity to address their concerns if possible. • If the actions taken are not acceptable to you, the remaining option is to consider instituting defamation proceedings. The law in this area is complex and it is advisable to obtain advice from a defamation lawyer as time limits apply to bringing a defamation action.

What are the benefits of an ORW for health professionals? The available research suggest reasons doctors could benefit from looking at ORWs. One reason is that they provide a real time invaluable source of measure of patient experience. A correlation of patient ratings has been found between a random survey of patients experience in UK hospitals and those of the ORWs for the same hospitals (19). Other benefits of ORWs include; rating sites are a fast and efficient way to gather information about quality of care (20), they are an economical way for doctors to hear the voice of patients to receive feedback (21-23) and ORWs represent an opportunity to correct information that is not under the control of the doctor (24). However, given the potential benefit of ORWs, the low prevalence of health practitioner ratings (4.4%) in Australia questions their current reliability as a sound indicator of patient satisfaction (25).

Renato Ulpiano Practice Manager, Ladybug House Melbourne/Gold Coast Doctoral Student - Research Topic “Adopting Health Practitioner Rating Websites: Assessing the influence of practitioners’ motivation and system perceptions.”

1. Calnan M. Consumerism and the provision of health care. British Journal of Healthcare Management. 2010;16(1):37-9 3p. 2. Fischer S, Emmert M. A Review of Scientific Evidence for Public Perspectives on Online Rating Websites of Healthcare Providers. Challenges and Opportunities in Health Care Management: Springer; 2015. p. 279-90. 3. Gabe J, Harley K, Calnan M. Healthcare choice: Discourses, perceptions, experiences and practices. Current Sociology. 2015;63(5):623-35. 4. Kekewich MA. Market liberalism in health care: A dysfunctional view of respecting “consumer” autonomy. Journal of Bioethical Inquiry. 2014;11(1):21-9. 5. Adams SA. Sourcing the crowd for health services improvement: The reflexive patient and “share-your-experience” websites. Social Science & Medicine. 2011;72(7):1069-76. 6. McDonald R, Mead N, Cheraghi-Sohi S, Bower P, Whalley D, Roland M. Governing the ethical consumer: identity, choice and the primary care medical encounter. Sociology of Health & Illness. 2007;29(3):430. 7. Berry LL, Bendapudi N. Health Care: A Fertile Field for Service Research. Journal of Service Research. 2007;10(2):111-22. 8. Corbin CL, Kelley SW, Schwartz RW. Concepts in service marketing for healthcare professionals. The American Journal of Surgery. 2001;181(1):1-7. 9. Donabedian A. Evaluating the quality of medical care. Milbank Quarterly. 2005;83(4):691-729.

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10. Faber M, Bosch M, Wollersheim H, Leatherman S, Grol R. Public Reporting in Health Care: How Do Consumers Use Quality-of-Care Information? A Systematic Review. Medical Care. 2009;47(1):1-8. 11. Patel S, Cain R, Neailey K, Hooberman L. General Practitioners’ Concerns About Online Patient Feedback: Findings From a Descriptive Exploratory Qualitative Study in England. Journal of Medical Internet Research. 2015;17(12):e276. 12. Emmert M, Meier F, Pisch F, Sander U. Physician choice making and characteristics associated with using physician-rating websites: cross-sectional study. J Med Internet Res. 2013;15. 13. Rozenblum R, Bates DW. Patient-centred healthcare, social media and the internet: the perfect storm? BMJ Quality & Safety. 2013:bmjqs-2012-001744. 14. Burkle CM, Keegan MT. Popularity of internet physician rating sites and their apparent influence on patients’ choices of physicians. BMC Health Services Research. 2015;15(1):1-7. 15. Gao GG, McCullough JS, Agarwal R, Jha AK. A changing landscape of physician quality reporting: analysis of patients’ online ratings of their physicians over a 5-year period. Journal of Medical Internet Research. 2012;14(1):e38. 16. Lagu T, Hannon NS, Rothberg MB, Lindenauer PK. Patients’ evaluations of health care providers in the era of social networking: an analysis of physician-rating websites. J GEN INTERN MED. 2010;25(9):942-6. 17. Emmert M, Sander U, Esslinger AS, Maryschok M, Schöffski O. Public Reporting in Germany: the Content of Physician Rating Websites. Methods of Information in Medicine. 2012;51(2):112-20.

18. Rollins A. Doctor Rating Website Could Hurt Patients. Australia Medicine. 2016. 19. Greaves F, Pape UJ, King D, Darzi A, Majeed A, Wachter RM, et al. Associations between Internet-based patient ratings and conventional surveys of patient experience in the English NHS: an observational study. BMJ Quality & Safety. 2012:bmjqs-2012-000906. 20. Verhoef LM, Van de Belt TH, Engelen LJ, Schoonhoven L, Kool RB. Social media and rating sites as tools to understanding quality of care: a scoping review. Journal of Medical Internet research. 2014;16(2). 21. Alemi F, Torii M, Clementz L, Aron DC. Feasibility of real-time satisfaction surveys through automated analysis of patients' unstructured comments and sentiments. Quality Management in Healthcare. 2012;21(1):9-19. 22. Emmert M, Meier F. An analysis of online evaluations on a physician rating website: evidence from a German public reporting instrument. J Med Internet Res. 2013;15. 23. Thielst CB. Social media: ubiquitous community and patient engagement. Frontiers of Health Services Management. 2011;28(2):3-14. 24. Mostaghimi A, Crotty BH, Landon BE. The availability and nature of physician information on the internet. J GEN INTERN MED. 2010;25(11):1152-6. 25. Atkinson S. Current status of online rating of Australian doctors. Australian Journal of Primary Health. 2014;20(3):222-3.


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AAPM National Salary Survey Annual Practice Fees and Salaries; AAPM Core Principles and Responsibilities This is the fourth report based on the 2017 AAPM National Survey of Practice Managers conducted on behalf of AAPM by Insync Surveys. In the previous reports I have focussed on factors that would influence salaries or salary ranges, employment conditions and benefits. In this report I also look at the connection between the annual practice fees and salaries. I will also look at the AAPM Core principles and the practice manager’s responsibilities to see how these are changing in the current environment of the delivery of healthcare. As I have said in the earlier reports, it is important for anybody reading this article to compare their own responsibilities, their own practice information with the figures that the respondents have reported. The material from this article will give you the opportunity to compare your specific information with actual data and could form the basis of very useful discussions with staff and with clinicians within the practice. The scope of the AAPM National Salary Survey is broad and we have expanded this at the request of practices. One of the interesting areas the AAPM National Salary Survey includes is to report the detail on Practice Annual Gross fees and the relationship to practice manager salaries. An important outcome from AAPM’s National Survey of Practice Managers in 2017, is the detail on average practice gross fees, average consulting fee for each patient consultation, billing methods, and experience of practice managers with specific health assessments, general practice management plans and nurse billing items. We have now been collecting data on these latter areas in the last four surveys and we are starting to get a picture of these services in general practice and also as new trends emerge it will give us the opportunity to gather data from their inception. As we stated after the 2015 survey, we have been encouraged to add other practice staff to our National Survey. In the 2017 National Salary Survey, this has become an important area of the survey and highlights the value of this research for individual practice managers, to practitioners, practice owners and all of healthcare. Average Practice Gross Fees As can be seen from the report, the range varies significantly from relatively small practices with annual gross fees of $500,000 to the other extreme

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of practices reporting more than $7 million per annum. Close to 53% of practices reported fees in the range from $1,000,000 - $3,000,000 and 28.1% of practices reported fees more than $3 million while 19.3% of practices reported fees under $1 million dollars per annum. It is important to relate these figures to other data collected in the complete National Salary Survey – for example, number of fee earners per practice and number of patients per day reported by practices. Annual Gross Practice Fees Under $500,000

2015 (%)

2017 (%)



$500,000 - $1,000,000



$1,000,001 - $2,000,000



$2,000,001 - $3,000,000



$3,000,001 - $4,000,000



$4,000,001 - $5,000,000



$5,000,001 - $6,000,000



$6,000,001 - $7,000,000



More than $7,000,000



Connection between average gross annual practice fees and salaries In all of the Salary Surveys we have conducted there have been reported links between the average gross annual practice fees and practice manager salaries. In the 2017 National Salary Survey, those practices with $500,000 or less in gross fees reported average practice management salaries of between $55,000 - $60,000 and if we go to practices reporting gross fees of between $500,000 and $1,000,000 the range is between $65,000- $70,000. The salaries in practices of $1,000,000 and less, has dropped. Practices with annual Gross fees of $1,000,000- $2,000,000; $2,000,000-$3,000,000 and $3,000,000 -$4,000,000 have remained the same. It is only in practices with gross annual fees greater than $6,000,000 that salaries have increased. It is interesting to see that except in the practices with the highest level of gross fees there has been very little change in salaries in the 2017 survey from the 2015 salary survey for the practice manager. As stated earlier, it is important to take into account the details relating to all of the other data collected in the 2017 National Salary Survey

Practice Annual Gross Fees

2015 Median Salary Range

2017 Median Salary Range

Under $500,000

$60,001 - $65,000

$55,001 - $60,000

$501,000 - $1,000,000

$70,001 - $75,000

$65,001 - $70,000

$1,000,001 - $2,000,000

$70,001 - $75,000

$70,001 - $75,000

$2,000,001 - $3,000,000

$75,001 - $80,000

$75,001 - $80,000

$3,000,001 - $4,000,000

$80,001 - $85,000

$80,001 - $85,000

$4,000,001 - $5,000,000

$85,001 - $90,000

$80,001 - $85,000

$5,000,001 - $6,000,000

$95,001 - $100,000

$85,001 - $90,000

More than $6,000,000

$90,001 - $95,000

$95,001 - $100,000

More than $7,000,000


$95,001 - $100,000

AAPM Core Principles and Responsibilities In each of the National Salary Surveys, participants have responded to indicate their involvement with the AAPM Core Principles and also the allocation of time for each of them. The report was able to break these down further to indicate the position of the participant as practice manager, business manager or general manager. The Core Responsibilities and Tasks provide summaries of the key responsibilities of staff including those relating to financial management, human resource management, planning and marketing, information management, risk management, governance and organisation, business and clinical operations, professional responsibilities and compliance. The world of healthcare is changing and the emphasis on risk and compliance is part of every aspect of healthcare practice. The role of the practice manager is important in all of the areas listed. In this section, most participants have indicated some increase in their involvement in the responsibilities of all areas. Financial management, Human Resources and Risk management continue to have the highest level of responsibility. Allocation of time for responsibilities Once again, one of the most interesting and challenging sections of this report continues to be the increase in the involvement and the allocation of time to Compliance in practices. This compliance includes Medicare, ATO, Legislative, Accreditation and PIP. This section also highlights the skills involved in managing a healthcare practice in today’s world.

The AAPM 2017 National Salary Survey is a major research project and from the survey we can see the key influences on salaries as well as all practice staff and practice development. These influences include: • Size of practice – fee earners, gross fees, patients per day, personnel • Type of practice • Location of practice • Responsibilities of position • Professional development • Qualifications The material from this article could form the basis of very useful discussions with staff and with clinicians within the practice. The first three areas of fees, fee per patient and billing policies are all linked and can be the basis for practice organisation discussions. The last three items on health assessment, management plans and nurse billing can also form the basis for an interesting discussion amongst staff and doctors within the practice. The final report looks at core responsibilities of practice managers – how time is allocated and what responsibilities are receiving due attention. The complete report of the AAPM 2017 National Salary Survey is available from the AAPM Shop.

Colleen Sullivan OAM, BA, FAAPM Life Member, MGMA Life Member | 25

Practice performance monitoring take control! I

n the busy-ness of day to day practice management, statistical data reporting is often relegated to the back seat and can be an ad-hoc activity if a streamlined and easy to use management system has not been developed. Using practice performance data is crucial to maintain a sense of control of how your practice is performing at any point in time as well as telling the historical story of the business. Practices collect an overwhelming amount of data which needs some structure and manipulation to be able to make sense of it all. Whilst health care practices are becoming more skilled at analysing clinical data to assist with service planning – for example to plan chronic disease services, this feature focuses on the use of practice service data to give accurate and timely insight into financial and service performance. Key Metrics There are some service indicators that will give your practice a good sense of performance. Monthly: • The number of patient attendances • Billings • Receipts • Any other data that is particularly relevant to your practice, for example, hours worked, total staff numbers and full time equivalent staff or other practice income/expenditure data Quarterly: • PIP, SIP & PNIP data; WPE, SWPE and income from each eligible program (as applicable to your type of practice) By summarising the above data for each practitioner, you will be able to calculate monthly and cumulative results. This allows you to track individual practitioner performance, average fees generated per patient, overall practice turn-over, year-to-date tracking and year-on-year performance (when using this consistently over a number of years). By including other metrics such as staffing hours and costs, you are able to calculate staffing costs per service provided, or staffing costs per hours of services delivered. The reporting options are vast! What do I do with all that information? The best way to manage large data sets is to use spreadsheets, Advanced use of spreadsheet functionality including use of Pivot Tables allows for easy manipulation and configuration of large data sets to drill down into important service information. If you have not undertaken some skill building in use of spreadsheets such as MS Excel, there are many online tutorials that will give you guidance on how to use spreadsheets for more than just adding up rows or columns! YouTube has many instructional videos on how to learn to use these advanced tools. They are well worth spending some time on. Visual representation of information is much easier to understand than raw data and numbers, and by including data graphs, you will be able to quickly understand complex data – and explain it to others! By making this a regular monthly activity you will ensure that your statistical reporting is always up to date.

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Once information is updated, analyse the results for the purpose of deciding what action, if any, needs to be taken. These reports will be able to spot trends in activity that are tangible and on which you can confidently base your decision making. It will also be possible to start benchmarking your practice’s services performance. These reports are, of course, important to share with your practice principals. What kinds of trends can be identified? Increase or decrease in; • patient attendances • billings • receipts (fees generated) • seasonal service trends • average fees per patient In conjunction with debtor reports, the differential between billings and receipts (indicating possible issues with fee collection) By comparing practitioners, identify: • billing patterns • opportunities to modify service activities For GP practices – Analyse your PIP/SIP Data By tracking quarterly PIP/SIP data, practices can gain a higher level of insight into performance than by only reviewing reports as they are issued. WPE/SWPE numbers tell you about your practice patient population. The WPE – whole patient equivalent, is a measure of service provided to a patient over a 12 month period. The SWPE – standardised whole patient equivalent, is a weighting applied to WPE to account for clinical complexity. This means that elderly, indigenous and patients with chronic conditions increase the SWPE and younger, healthier populations reduce the SWPE. The difference between WPE and SWPE is therefore a measure of clinical complexity of your patient base. PIP statements contain a wealth of information, however this is difficult to interpret if you don’t track the service outcomes and payments received (or missed out on). Again, spreadsheets are the answer to make better sense of the information.


Riwka Hagen Medical Business Services

Positive workplaces and high performing teams

an antidote to the winter work blues H

ave you ever noticed how everything seems to get that little bit harder when the winter months appear? The days are shorter, the temperature drops and, for many, cold and flu bugs zap your energy. All of these factors can impact your motivation, engagement and productivity which make it particularly hard to bounce out of bed in the mornings and go to work, especially if the workplace culture isn’t as encouraging as it could be. The correlation between a positive workplace culture and a high performing team is undeniable. Rather than finding work a struggle, exhausting and demotivating, employees in positive workplaces are more likely to enjoy work and have a sense of belonging, which in turn, positively impacts the organisation’s culture. Positive workplaces also create increased productivity, commitment and loyalty to the organisation, and the generation of unity amongst team members to give their best effort. So, as a leader, what steps can you take to develop and maintain a team environment where members want to go the extra mile? The answer to this question is really a case of ‘how long is a piece of string?’ as what works for one organisation may not necessarily work for another; however, to support your team to create, maintain and/or enhance a positive workplace culture, there are ten key areas for success:

1. Great teams start with great leadership Leaders are only as successful as their teams and the great ones know that with the right team dynamics, decisions and diverse personalities, everyone wins in the end. The words ‘leader’ and ‘manager’ are often used interchangeably but it is important to note the difference in their traits. Managers, particularly those who rely on control, aren’t always great leaders and leaders aren’t necessarily in management positions. Great leaders are primarily great team players with excellent communication skills who aren’t afraid to make difficult decisions, change course when necessary and lead by example. Successful leaders deliver on their promises, appreciate individual and team achievements, actively listen to team members and provide constructive and supportive feedback. These actions can help break down barriers, strengthen team unity and increase team member confidence. You should also be able to identify opportunities to motivate your team to get the best out of all staff, effectively manage egos and leverage off team member strengths, differences and skills to ensure organisational goals and objectives are achieved. 2. Know your team Great leaders take the time to know their staff. This goes beyond knowing what’s on an individual’s resume; it is learning about their characteristics, their strengths and weaknesses, how they like to work and what motivates them to go beyond what is expected of them. Simple ways to achieve this include engaging staff in conversations with open-ended questions, listening actively to their responses and taking an interest in both their professional drivers and personal passions which contribute to their individual personalities and work styles. These approaches to engage staff help them feel appreciated while also creating understanding which supports you to know exactly which buttons of motivation to push to ensure you get the best out of them.

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3. Have clear roles and responsibilities for staff All teams work better when each member knows the role they play, their responsibilities and how they contribute to the organisation’s overall objectives. Duplication of effort and confusion as to someone’s roles and responsibilities can increase frustration and stress, and potentially create conflict in teams. It is helpful to ensure that each team member has a clearly defined position description which outlines their role and responsibilities, allowing them to feel a sense of ownership and pride over their specific functions and contributions within the organisation. Position descriptions should be routinely reviewed and updated to reflect professional development and increased responsibility, providing an opportunity to set expectations and address areas that may be falling outside expected role responsibilities. Staff should also be provided with an overview of how their position interconnects with other team members to provide further clarity and guidance, which can act as a vital reference point if someone starts to veer off course. This mutual understanding showcases how the team is working together to achieve common goals. 4. Hire for the right reasons Building a successful team is about more than finding a group of people with the right mix of professional skills. Creating a high-performing and cohesive team is about finding staff who share the organisation’s vision, values and work philosophies. When hiring new staff ensure you consider a number of different elements that go beyond what is written on their resume as the best candidate may not be the best candidate on paper. There are so many questions that could be raised during an interview to discover if potential employees are a good fit for your team – do they have the same approach to patient relationships and care as you? What is their work ethic? How well do they function in a team environment and under stress? How do they respond to constructive feedback? What matters most to them in the workplace? Do they have long and short-term goals which align to the organisation?

Ultimately, all staff are there to ensure a positive experience for every patient that walks through your doors, a task made significantly easier with staff who are united. 5. Provide constant feedback As human nature indicates, most people prefer to deliver good news rather than bad which means many leaders are prone to only providing feedback when things go wrong or months after an incident at an annual performance review. The essence of effective feedback is simply great communication which should be a part of the everyday working environment. Developing a regular system of informal and proactive feedback can serve as a team’s greatest enabler for continuous improvement while also making more formal feedback sessions less stressful for both the leader and employee. Constant communication also allows you to check-in to ensure team members are on track, are clear as to their deliverables and have the opportunity to ask for support or assistance as required. 6. Acknowledge and reward Everyone likes to be acknowledged when they’ve done a good job and providing more proactive feedback allows this to happen naturally. Some leaders believe they shouldn’t reward staff for simply ‘doing their job’, however this negative attitude will be felt by your staff and will diminish team morale. Acknowledgement and reward doesn’t have to be in the form of financial benefits or with the presentation of gifts. It can be done by saying ‘thank you’, providing praise individually or acknowledging staff publicly, an opportunity for professional development, the flexibility to leave early one afternoon, going out for a team lunch or by offering a promotion to higher duties. Genuinely reassuring your team that you are paying attention to their efforts shows them they are appreciated and respected which goes a long way towards increasing productivity and building loyalty and trust. | 29

7. Celebrate success In today’s fast paced world it can be easy to move from one project or patient to the next without stopping to look at what has been achieved. Perhaps your team recently accomplished the implementation of a waiting room redesign, you came up with a quality improvement initiative to better communicate with patients or staff received positive responses to a patient satisfaction survey. Celebrating success goes beyond simply acknowledging the end goal, it allows you to take a step back and reflect on the accomplishment, effort and lessons learned throughout the entire journey. Taking the time to celebrate these ‘little wins’ is important as it increases staff motivation and morale. It is also said to release chemicals in our brain that give us a feeling of pride, happiness and that ‘feel good’ factor while creating drive toward achievement of the next goal. 8. Work with experts Have you ever had a patient who walked into their appointment having already diagnosed themselves after some basic online research? Would you blindly follow what they were telling you and treat them accordingly or would you use your expertise to ensure the patient received the best possible advice, treatment and outcome? The same is true when it comes to working with others in your extended team. You may be the healthcare professional but are you also an expert on HR, business planning, accounting, and marketing? Engaging those who are experts in their field rather than trying to do it all yourself will allow you and members of your immediate team to share knowledge and insights, leverage off each other’s skills and strengths, and consider other and varied perspectives. This collaborative team work will strengthen your team dynamics, outputs and relationships to enhance the power of your team and each individual within it.

While you can’t control the behaviours of others, you can control the way in which you recognise, respond to and address negativity, and how you channel your own positive emotions and strategies to contribute to creating a positive work environment. Organisations which consciously embed positivity within their culture are said to see results in less sick days, greater job satisfaction and outputs, increased creativity and innovation, and a sense of belonging and organisational loyalty. 10. Culture counts To work at their highest standard, people need to be aware of what they are working towards. Organisations with truly high performing teams have a crystal clear purpose at an organisational level as well as by department and even down to the individual. Engaging all members of staff in setting, or modifying, the organisation’s vision will ensure each member of the team has a sense of belonging and purpose in the work they are doing which, over time, becomes ingrained into the DNA of the organisation. While there are many ways to create a positive workplace culture and build a high performing team, the attributes of them are largely the same. These special ingredients are open communication and strong relationships, built as a result of shared goals and experiences. Workplaces, and leaders who lay the groundwork for a highly productive team that can communicate, cooperate and innovate in an atmosphere of mutual trust and respect will ensure their workplace is a positive place to be. This in turn has significant benefits to an organisation, ultimately lowering staff turnover and therefore costs, increasing levels of motivation, productivity, and overall employee satisfaction and enhancing company reputation as an employer of choice.

9. Accentuate the positive and tune out the negative As a leader, your team will follow the example you set. If you are positive, approachable and a team player who focuses on the tasks at hand, chances are the rest of the team will as well. Likewise, if your team hear you being negative about people and situations they will then think it is ok for them to do the same which can have a huge impact on the workplace culture. Even when things aren’t going as planned, remaining positive and focussed on your goals will allow you to more easily tune out the negative comments.

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Scott Keighley Chief Financial Officer AGPAL Group of Companies

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Want to know more? Visit the Avant stand at the conference on 16 -19 October or go to to book a demonstration and get a sneak preview now. Special offer to AAPM members ü Receive up to $300 off your first year’s subscription, if you purchase PracticeHub’s core product and the NEW Task Management module before 30 November 2018*; plus ü All AAPM members receive an ongoing discount of an additional $200 off your annual subscription fee**. Contact us to book a demonstration: 1300 96 86 36 The offer applies to the first years’ subscription cost of PracticeHub. The discount of $300.00 applies if the core PracticeHub module is purchased in conjunction with Task Management module, when purchased before 30 November 2018. The offer is only available to new PracticeHub customers. We reserve the right to change the offer conditions at any time. **The offer applies to the ongoing annual subscription cost, and excludes the initial set-up costs of PracticeHub. 2401 07/17 (1037) *

Community Nursing Hong Kong H

ong Kong, like Australia, is in the midst of an ageing crisis. High property costs have combined with increased numbers of dual income couples to undermine the traditional models of family care. Hong Kong has proportionally more aged people in the country than Australia. For that reason they are a great study in the challenges which will come to us. Delays in realising the impending growth in demand have limited the options available in Hong Kong. Positively, they have started to fund month long overseas study programs for nurses across the healthcare system. This approach is targeted at quickly identifying promising solutions, generating advocates and replicating successful models. Through such a direct investment in people and global scanning, Hong Kong stands to leapfrog many other jurisdictions. Healthcare in Hong Kong is delivered by both public and private care provision. The Hong Kong Hospital Authority provides publically funded services to eligible patients. This includes provision of residential aged care, respite and community nursing services aimed at supporting the elderly and those with complex chronic disease. They also operate general practice clinics which are sizeable campuses well distributed throughout the country. Notably, the government funded aged care institutions run by the Authority are the preferred solution for residential care in Hong Kong. They offer more space and are subject to standards which ensure better care.

were participating in the first organised study tour program funded by the Hong Kong Hospital Authority for community nurses to ever come to Australia. The focus of their visit was to explore models of end of life care planning, hospital avoidance, pain management and chronic disease care. Their program was developed by Inala Primary Care and included extensive time visiting services across Brisbane, the Gold Coast and Toowoomba. What were some of the lessons we learnt in hosting a team of dynamic, committed and predominantly post-graduate trained nurses? Community Nurses in Hong Kong play a valuable role bridging the worlds of hospital, aged care and general practice. We have few equivalent resources to support patients stay well in their homes or residential facilities. Even our domiciliary care sector is not a direct parallel to the Hong Kong Community Nurse. The capability and scope of practice of these nurses is considerable. They operate independently and case manage across the continuum of care. In the absence of much of the paperwork and reporting which accompanies so much of the aged and domiciliary care activity in Australia they have the ability to exercise professional judgement. The downside is that limited reporting mechanisms exist to highlight where the system is under pressure or unsafe.

Private sector aged and respite care is not subject to standards. This leads to desperately overcrowded facilities with unqualified staff doing their best for their patients and their owners. Often the profit motive of the owner wins out over the needs of patients and their families.

The nurses benefit from being able to access a single health record. This shared dataset means that hospitals, general practice, pathology providers and other care providers are operating with the same data, no matter where the patient accesses the health system. This saves time and makes care coordination considerably easier.

We learnt firsthand about these system deficiencies from five Community Nurses who visited Queensland between March and May this year. They

Being an arm of the hospital system, the nurses can leverage out patient and specialty services on behalf of patients. This speeds up access to

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the most necessary care. The disadvantage is that Community Nurses are a small group, neither part of the hospital nor part of the very large government run general practice clinics which operate throughout Hong Kong. This can lead to a lack of voice and influence. The lack of accreditation and standards in aged care related provision in Hong Kong leads to misfortune. The misgivings we may have about the time involved in conforming with regulations and standards is nothing in comparison to the real jeopardy the lack of accreditation creates for vulnerable patients.

being a Community Nurse. They reported the study tour model was a very efficient way of learning as it would save them from repeating mistakes made by others and really challenged so many of their assumptions. Looking at an overseas model of care, and indeed so many variants of that, really helped them stretch their knowledge in ways that reading or visiting other sites in Hong Kong never would have. Based on their enthusiasm and my own experience being part of overseas study tours, I would commend every Practice Manager to save some funds, lobby for support and get out to see what the world of health has to offer. It might just change your life!

The role of managers and performance measures came up in conversations with the Hong Kong nurses. They too struggle in a world dominated by clinicians. Any investment made in developing the people and systems to manage increasing and increasingly complex workloads has to compete with the priority to expand care. Lack of investment can create tension for everyone, reduce productivity and can even endanger patient safety. Finally, we were reminded of our obligations to provide staff with a safe working environment. Community nurses use public transport to get to their clients and the facilities they support. They bring with them the necessary equipment for the anticipated tasks. Pressure to visit a large caseload exacerbates stress. Difficulty filling available roles means it can be hard to take sick leave or respond to patients in crisis. Sadly, the frustration of family members with the quality of care provided by private agents, the shame associated with dementia and the lack of skills of other members of the care team means the nurses are frequently exposed to abuse and threats.

Tracey Johnson CEO, Inala Primary Care, Brisbane

Our community has growing expectation that care will come to them. Safely delivering models of care which enable our clinicians to have joy at work must be a priority. It will be a challenge as more care is co-designed and new models of care funded through emergent funding mechanisms. It is possible to develop models of care where nurses play a fundamental role in care coordination, care delivery and supervision of other contributors to care. However, the systems need to be built around them to make this role safe, efficient and value adding. At the very least, we need to keep striving for delivery of a mechanism which makes access to patient records possible across the health system. Our current opt out phase of the My Health Record needs to be just one of many significant milestones in Australia’s e-health journey. The role of managers as our teams become multi-site, peripatetic, virtual and increasingly involved in care coordination will rise. Current methods of visual management (ie watching what goes on), counting simple performance metrics and hoping for the best will not be enough. We will need systems, just as our team will to thrive in such environments. They will also need a culture which fairly acknowledges their contribution. These are key elements of every practice manager’s role. Surveys of capacity in this regard in the NHS have shown real weakness despite the NHS proactively investing in practice manager upskilling over the last decade. I wonder how we will fare? Food for thought as we continue to see more of our patients over 65 and needing increased levels of support and access to multidisciplinary teams. Of course, the biggest benefit noted by the nurses from their month long study tour? The time to think, observe the best and reflect on how their practice could change was found to re-energise their commitment to | 33

Thunder & Lighting and now a brighter sky?


round this time last year dark clouds were hanging over the Medical Deputising Service (MDS) industry, with the Commonwealth Government, the RACGP, the AMA and many GPs, deeply concerned with the purported ongoing misbehaviour of some highly entrepreneurial MDS. On the back of these concerns, on March 1st 2018, the Commonwealth enacted changes to the MBS related to after hours items and amended the Approved Medical Deputising Service Program, to reduce inappropriate Medicare expenditure and instigate a ban on direct to consumer advertising by MDS. The Protect Home Visits campaign, launched at the time by the National Association for Medical Deputising Services (NAMDS) in an attempt to block these after hours reforms, foretold of a perfect storm that would decimate the MDS sector. Their contention was, that due to the proposed reforms, that deputising services would be forced to close, emergency departments overrun and that the community would suffer as a consequence. Now that the thunder and lightning of such dramatic premonitions have cleared, it seems timely to provide the AAPM membership with an update as to how the MDS sector and the broader community has fared with the changes. Pleasingly, though some of the smaller and arguably purely volume based MDS have ceased operations, those long term genuine MDS with strong linkages with their General Practice clients, continue to provide comprehensive continuity of care to patients after hours. There have been no reports of ED departments being overrun, or patients being unable to access urgent care after hours when needed, whether this be through an MDS or through their own GP Practice. It should be noted however, that the changes have presented some challenges. There has been a reduction in income for doctors and a need for MDS to review their methods of recruiting and retaining workforce and the efficiencies of their operations. Likewise the changes have presented opportunities for those MDS that continue to place acting for and on behalf of their GP subscribers first and foremost. Now more than ever operating ethically and appropriately is essential for an MDS to continue operations and rebuild the trust that was lost in the sector, because of the misbehaviour of some. Another positive outcome for the deputising sector is the establishment of the GP Deputising Association (GPDA) Members of the Association have formed close and constructive relationships with all key stakeholders over the course of the after hours review and reform process. It is evident through this engagement, that there continues to be a determination to support genuine Medical Deputising Services, in the critical role they play in the community. So is the sky a brighter hue for deputising and those GPs and patients they support? Certainly in its passing, the storm of reform has cleared the air to a point where at least the positive deeds of legitimate MDS, may act to replace past memories of abuse and mistrust. In my mind, after some 20 years involvement in the industry, it was clear that action needed to be taken. I now look forward to those ongoing efforts necessary to sustain, what remains an essential and worthwhile service.

Nicolas Richardson General Manager DoctorDoctor Vice President GP Deputising Association | 35

Cyber Security Update 2018

…“the price of data freedom is eternal vigilance” C

yber security issues continue to remain at the forefront of media headlines with ever evolving variations.

The slightly good news first: Cybersecurity firm Malwarebytes Labs, ‘Cybercrime tactics and techniques: Q2 2018, reports in the an “overall lull in cybercrime” in the first two quarters of 2018, and that, “In nearly every malware category for both business and consumer detections, we saw a decrease in volume…” Our relative malaise was punctuated, however, with some interesting developments moving from Q1 to Q2. What threat actors lacked in quantity they made up for in quality. The Malwarebytes report further quantifies some significant decreases in the top 10 cyber threats, including a welcome 35% reduction of ransomware, but tempered by significant increases in other malware such as Backdoor (also known as a Trapdoor) -up by 109%. Back to the bad news: The latest 2018 Internet Security Threat Report 23 (ISTR) from cyber security vendor Symantec highlights a veritawble cybercriminal gold rush in so called coin mining, aka crypto jacking:

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“Cryptojacking Attacks Explode by 8,500 Percent Stealthy miners steal resources and increase vulnerability

A meteoric crypto currency market triggered a gold rush for cyber criminals. Detections of coin miners on endpoint computers increased by 8,500 percent in 2017, with Symantec logging 1.7 million in December alone. With only a couple lines of code, or delivered via browser, cyber criminals harness stolen processing power and cloud CPU usage to mine crypto currency. Coin mining slows devices and overheats batteries. For enterprises, coin miners put corporate networks at risk of shutdown and inflate cloud CPU usage, adding cost.”

Are your computer users complaining about unusual slowness of IT systems? Your practice computer systems processing resources (CPU) and the electricity required to run at peak loads may well be “borrowed” for coin mining / crypto jacking with any proceeds going to the hackers’ accounts.

Australia’s own MyHealth Record is in sharp focus at the time of writing (late July) with many concerns expressed in the media about data privacy and security as the opt-out period deadline of 15 October approaches. Some Federal politicians have publicly “opted-out” and many doctors have publicly expressed concerns. ABC online news headlined Prime Minister Malcolm Turnbull’s reassurances to Australians that all will be sorted:

Deployment of old favorites such as ransomware and worming malware seems to have morphed since the massive WannaCry and Petya/Not Petya ransomware malware attacks from 2017 that are still fresh in our memories. Recall that one third of the UK’s National health Service (NHS) IT systems were brought to a standstill. Even now, one year later, “lessons learned” reports detail the massive ransomware breach; “… the [WannaCry] outbreak had led to disruption at least 80 out of 236 hospital trusts in England, as well as 603 primary care and affiliate NHS organisations, resulting in infected systems, thousands of cancelled appointments and the diversion of A&E patients to other hospitals”.

Hmmm, reports that, “The My Health records site has been breached though numbers were small considering the millions of records involved - 11 people were affected by six breaches in 2016-17 according to a report by the Australian Information Commissioner”.

Furthermore, cites, “A devastating report from the National Audit Office into the impact of WannaCry concluded that Britain’s health service was woefully unprepared for a cyber-attack of such scale, despite being warned of a threat as far back as 2014. This included a failure to undertake basic IT security procedures, such as patching and updating computer software, and not establishing response plans for major cyber security incidents.” According to the UK National Audit Office (NAO) report ‘Investigation: WannaCry cyber attack and the NHS’, when WannaCry struck, most of the NHS computers were still using unpatched Microsoft Windows 7 operating systems and some NHS Trusts even had unsupported Microsoft Windows XP based systems in use. A footnote to the aftermath of WannaCry: All NHS organisations will upgrade to Windows 10 which features significantly more robust security tools.

Practice managers in Australia should not think of these attacks as an “overseas” or government database problem. IT audits that I have been asked to perform during 2018 have almost always revealed similarly unprepared systems; unpatched Windows Server and Windows 7 based PC systems, and alarmingly, even some healthcare sites with Windows XP systems in active usage. Windows XP of course has not been supported by Microsoft since April 2014. Practice managers are reminded that usage of Windows XP in 2018 is non-compliant with the Australian Privacy Principles “reasonable steps” test. Many computers also have out of date anti-malware programs or no anti-malware programs installed. Passwords are also found to be weak or ineffective. (“Dictionary word” passwords can be cracked in seconds so please don’t use “password”, “reception”, “admin”, doctor1, etc.)

My Health Record privacy concerns will be addressed, Malcolm Turnbull promises, amid ongoing criticism

On July 21 2018, news media reported a massive health data base breach in Singapore with headlines such as this one from ABC online:

Singapore health database hack steals personal information of 1.5 million people, including PM Hmmm, now that is a big data breach, could this happen in Australia? Here is a list of some recent hacks: • Media reports allege Chinese hackers compromise Australian National University’s computer network • Ticketmaster data breach includes Australians who purchased tickets between September 2017 and June 2018 • Nearly half of Australian companies hit by cybercrime, PwC global survey reveals (more from this report below)

In Australia, the 5 most common types of cyber attacks were: | 37

Since the Notifiable Data Breach scheme came into force on 22 February 2018, 55 data breaches have been reported to the OAIC in the first quarter of 2018. The OAIC notes that the top industry sector reporting breaches in this period is healthcare: “During the first quarter of 2018, the largest proportion of eligible data breaches reported to the OAIC was from health service providers, at 24 per cent.” (15 reported breaches out of 55 in the reporting period). The OAIC reports that, “over 73% of eligible data breaches reported involved the personal information of under 100 people”. It is worth highlighting the OAICs summary of findings and recommendations in the release notes: “The report shows that the main causes of data breaches are malicious or criminal attacks (142 notifications or 59 per cent), followed by human error (88 notifications or 36 per cent). The majority of malicious or criminal breaches reported were the result of compromised credentials, and the most common human error was sending emails containing personal information to the wrong recipient.” The risks of these types of data breaches can be greatly reduced by ensuring that staff responsible for handling personal information receive regular training. Entities should also implement strong password protection strategies, including raising staff awareness about the importance of protecting their credentials. The OAIC has worked with the Australian Cyber Security Centre (ACSC), the Australian Government’s lead agency on national cyber security, on the causes of cyber security related breaches. The ACSC has provided a guide to mitigation strategies aimed at protecting credentials.” Credentials are the keys to the safe: The OAIC highlights credential (or user name/password) theft as the most significant factor - at least 77% - in cyber incidents in the second Quarterly Report. The OAIC website further summarizes advice from the ACSC, that, “there are four ways in which credentials (user names and passwords) are typically stolen: 1. A user is tricked into entering their credentials into a page that mimics the legitimate site. 2. A brute force (automated trial-and-error) attack on username and password combinations could be performed against a service, if the service does not prevent such activity. 3. A service is compromised, and credentials are stolen from that system. These credentials could be used for that system, or the username and password combination will be tested against other high value sites like social media and email. 4. A user’s system may be compromised by malware that is designed to steal credentials.

Therefore, the ACSC advises that mitigations for users can include: 1.

Users who are affected by credential compromises should reset their passwords as soon as possible. 2. Do not use the same password across critical services (like banking and social media sites), and do not share a password for a critical service with a non-critical service. This mitigates the impact if credentials are stolen for one service, and particularly of a less secure service impacting a critical service. 3. Use a passphrase that is not based on simple dictionary words, or a combination of personal information. This mitigates the success of password guessing and simple brute forcing. 4. When changing a password, ensure that it does not follow a recognisable pattern. This mitigates intelligent brute forcing based on prior stolen credentials. 5. Use multi-factor authentication, such as an authentication code sent to your mobile, for critical services where offered. This mitigates the simple use of stolen credentials. [ also known as 2 Factor Authentication or 2FA] 6. Look out for unusual account activity or suspicious logins. This may help improve detection of when a service, like email, has been compromised, and will need a password reset. 7. Think carefully before entering credentials when asked. Ask if this is normal. Do not enter credentials into a form loaded from a link sent to you in email, chat or other means open to receiving communications from an unknown party. Even if the page looks like the service you are resetting, think twice. Use the method you would normally use to access that site, and reset the password from there. Be aware that your friends’ or other contacts’ accounts could be compromised and controlled by a third party to also send a link. 8. If you are aware some of your credentials have been compromised, try to identify a specific cause. Did you enter your credentials in an untrusted place? Did you recently reset your credentials? What were the credentials for? Have you used those credentials elsewhere? 9. Users should ensure their operating system, browser, and plugins are kept up-to-date with patches and fixes. 10. Users should enable anti-virus protections on their systems in order to help minimise the effects of malware that steals credentials. Advisory firm PwC’s 2018 Global Economic Crime & Fraud Survey: Australian Report looks at the trends in economic crime which includes fraud committed by internal threats, dubbed “frenemies” and by external threats, i.e. cybercrime. PwCs report shows that an alarming 64% of economic crime in Australia is now due to external cyber threats, with technology itself being the enabler; “external criminals are taking advantage of the dark web and readily available technologies to commit fraud and crime. And if these actors are part of an organised crime syndicate, they can also bring significant scale to their nefarious activities.” PwC advises business managers look at cybercrime in a new way;

“Think of it as the biggest competitor you never knew you had.” PwC urges business managers not to retreat from technology, instead, “they need to design, build, test and deploy with cyber in mind.” PwC asks the obvious question: “So what are organisations doing about cyber? Unfortunately, not enough to stay ahead of the threat. In Australia, almost half (48%) have not completed a cyber vulnerability assessment, while over one-third (36%) don’t have a cybersecurity plan in operation. Without these ‘basics’ in place, organisations will find themselves not only highly vulnerable to a successful cyber attack, but poorly prepared to respond when the inevitable happens.”

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Here are some easy actions to take: • as advised by PwC, review practice cyber security ‘basics’; • update practice computer users on cyber security awareness to minimize the human factor • (the Stay Smart Online Small Business Guide is a recommended good primer) • Keep credentials safe – implement 2 Factor Authentication for file servers, administrator logins • Backup, Backup, Backup – review the 3-2-1 Rule in last year’s Cyber Security Update]

Here is the list of the Essential Eight mitigation strategies from the Australian Cyber Security Centre: 1.

Application whitelisting

to control the execution of unauthorised software


Patching applications

to remediate known security vulnerabilities


Configuring Microsoft Office macro settings

to block untrusted macros


Application hardening

to protect against vulnerable functionality


Restricting administrative privileges

to limit powerful access to systems


Patching operating systems

to remediate known security vulnerabilities


Multi-factor authentication

to protect against risky activities and credential theft


Daily backups

to maintain the availability of critical data.

So, what are you going to do to mitigate against the tide of cyber threats? Please ensure that your practice implements the practical cyber advice above against the ever evolving dangers of cyber attacks, including credential theft and crypto jacking. Let’s not see your practice contribute to the OAIC’s Notifiable Data Breach reports…



Miroslav Doncevic Managing Director Digital Medical Systems

The uniform solution for small business… | 39

Practice Profile

The Breast & Endocrine Centre, Gateshead I

n 1988, Dr David Clark established The Breast Centre at Christo Road Private Hospital in Waratah. The vision was to provide a one-stop shop for patients with breast problems and The Centre provided specialist consultation, mammogram, ultrasound and cytology services. This meant patients were now able to have a diagnosis of their breast problem with only one appointment. With the closure of Christo Road Private Hospital in 2004, The Breast Centre moved to Lake Macquarie Specialist Medical Centre at Gateshead. When the Specialist Centre expanded in 2011, The Breast Centre moved to its new purpose-built rooms, which enabled Dr Clark to fulfil his vision of a comprehensive breast cancer clinic. The Centre is also the largest single practice for the management of breast cancer in the Hunter. We provide comprehensive services to women from a large rural and metropolitan region of NSW. Approximately 5500 patients with breast related problems are seen each year in our centre, with over 300 of those patients having newly diagnosed breast cancer. We endeavor to see all new patients within 24 hours of a referral. The essence of our centre is that all patients are treated and cared for equally, irrespective of their financial and social status. We meet many lovely, brave and scared people, and hope that the way we care for them helps to decrease their extremely high levels of anxiety. To be able to provide this service we require special people; from our handpicked highly dedicated, caring reception and nursing team, to our skilled Cytotechnicians, Radiographers and Ultrasonographers, who combine an expertise second to none with compassion and understanding for these very frightened people.

Physician, Medical and Radiation Oncologists, Physiotherapists, Nurses and a Research Trials Coordinator. After undergoing a multi-million dollar expansion, our services continued to broaden to also cater for patients with endocrine problems and kidney disease and this brought with it a name change to “The Breast & Endocrine Centre”. In July 2012, we were honoured to have Her Excellency, Ms Quentin Bryce AC CVO, Governor-General of the Commonwealth of Australia, officiate at the opening of the Centre. We welcomed the services of an Endocrinologist along with two diabetic educators to assist. In addition, two Nephrologists, who practice under the ‘Hunter Kidney Clinic’, joined our team and more recently a Paediatric Respiratory and Sleep Physician and a Dietitian. In conjunction with The Breast & Endocrine Centre, the Newcastle Breast Centre Research Association was also established to provide the opportunity for studies and trials into the treatment and management of breast cancer. The Centre would not be complete without our ongoing research, entirely funded by generous donations from our patients. As a multi-disciplinary diagnostic centre offering a wide range of specialists in the one location, we are dedicated to providing a ‘one-stop shop’ to help reduce the anxiety associated with waiting for results. Patient care is always our priority. As my 16 plus years with The Breast & Endocrine Centre continue to flourish, I am so proud to be part of this team. My role as Practice Manager provides me with the opportunity to think outside the box. No day is ever the same!

We have been very fortunate in obtaining a McGrath Breast Care Nurse who works very closely with the women and men experiencing a diagnosis of breast cancer. She has a deep understanding of the complex nature of breast cancer, including its impact on individuals and their families, and appreciates that ongoing support and information from diagnosis right through to treatment is vital for ensuring optimal treatment outcomes. Our centre provides a diverse range of services in the treatment and management of breast cancer. This includes Breast Surgeons, a Breast

40 |

Jodie Boyce Practice Manager

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The Practice Manager Journal Issue 3 2018  
The Practice Manager Journal Issue 3 2018