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Issue 1 – 2013

www.aapm.org.au

Sydney Convention & Exhibition Centre –

venue of our national conference September 25-28

Welcome EBO S – new

Working togeth er to

A APM Gold Pa

promote profes sional

r tner development fo r practice mana gers

In this issue

8

Our Board

10

Patient-centred medical home

14

Salary survey: Practice management core responsibilities

18

Continuing professional development – What’s the point?


Your association AAPM Board President Carolyn Ingram P 0411 725 899 E carolyn@scobyco.com.au

Secretary Fiona Wong P 0412 155 865 E fiona.wong@idrs.com.au

Non-Executive Directors Linda Osman P 0405 516 331 E osmanlinda@gmail.com

Vice-president Debra Smith P 0412 802 096 E da.smith@internode.on.net

Treasurer Brett McPherson P 0418 131 873 E brettm@collinsstmedicalcentre.com.au

Marina Fulcher P 0417 438 895 E marina.braeside@gmail.com

Gary Smith P 0408 234 944 E gsmith@tindale.com.au Chief Executive Officer Gillian Leach

Contacts Queensland Contact Qld Secretariat (Fran de Klerk) P (07) 3103 5152 F (07) 3112 6838 E qld@aapm.org.au New South Wales/ACT Contact NSW/ACT Secretariat (Anna Sullivan) P 1800 196 679 F (03) 9329 2524 E nsw@aapm.org.au Victoria Contact Vic Secretariat P 1300 651 334 F 1300 651 335 E vic@aapm.org.au Tasmania Contact Tas Secretariat P 1800 196 000 F (03) 9329 2524 E tas@aapm.org.au

Head Office Level 1, 60 Lothian Street, North Melbourne, Vic 3051 P 1800 196 000 F (03) 9329 2524 E headoffice@aapm.org.au

South Australia/Northern Territory Contact Kim Monu P (08) 8342 4548 F (08) 8342 4548 E sa@aapm.org.au Western Australia Contact WA Secretariat P 1800 196 000 F (03) 9329 2524 E wa@aapm.org.au International For information on Institute of Healthcare Management 18-21 Morley Street, London SE1 7QZ P +44 20 7460 7623 F +44 20 7460 7655 E enquiries@ihm.org.uk W www.ihm.org.uk The Medical Group Management Association

in the United States has a vast range of courses ranging from one day to several months. A complete list of activities can be obtained from MGMA

P (303) 397 7875 W www.mgma.com

Editorial/Advertising Marilyn Bitomsky P (07) 3371 3057 E journal@aapm.org.au

AAPM Life Members Life Membership is bestowed on members who have made an extraordinary contribution to the Association. Jan Chaffey Desmond Higgs Gary Smith Barbara Madew Colleen Sullivan Louise Tindal Anthony Walch

contents Your association

Salary survey: Practice management

Our board members, contacts

2

core responsibilities

14

President’s message

3

Online learning

16

From the CEO’s desk

4

Continuing professional development

18

Checklist for developing policies

20

Newsbites

Cover photo: The venue for this year’s national conference, Sydney Convention and Exhibition Centre – Darling Harbour. Photo provided by Sydney Convention and Exhibition Centre

2 | Issue 1 – 2013

Latest news and events

6

AAPM members’ needs survey

7

Our Board

8

Patient-centred medical home

10

The checklist: administrator’s delight or clinician’s nightmare

12

What is the biggest favour you can do for your team?

21

Retrospectoscope 23 Medical assisting

24

Member benefits

26


A message from the president AAPM began the year by looking back. We reflected on the achievements of the Association over the past five years and were pleasantly reminded of our momentous milestones. Here are a few of the major ones: 2007/08: National office established 2009:

AAPM House purchased Constitution established

2010:

New website developed Annual national conferences

2011:

National finance account

2012:

New CEO, new finance officer

The AAPM Board also started the year with a strategic planning session with state branch presidents and treasurers looking at the future direction of AAPM. It is a strong belief of mine that a shared strategy is an achievable one and, with the assistance of our volunteers around Australia, I am very excited and confident that the year ahead will be filled with many successes. Thank you to all those who attended the strategic session and very soon you will receive information about the outcomes from these meetings. AAPM is at the forefront of healthcare knowledge and achieving early release of information to members is a high priority. An advantage of AAPM membership is the existence of clear, established lines of communication between many government bodies and other healthcare associations. The email alerts demystifying ePIP and answering your many questions surrounding this issue is testament to the collective knowledge your professional Association can draw upon. Just recently the AAPM Head Office launched the e-seminar program and I encourage members and non-members from all sectors of healthcare to take part in these very valuable sessions. This is especially the case for rural and remote workers in the field of healthcare management who struggle with minimal resources, including travel time, to attend a face-to-face event. I had the privilege of attending a meeting with Tanya Plibersek MP, Federal Minister for Health this week, where we discussed the growing workforce in the field of healthcare management and the need for the government to support those working in this field. This is particularly

prevalent with the current legislative changes needing to be implemented across all sectors of healthcare but particularly with those working in general practice. I look forward to further communication from the minister and her support for the AAPM CPM program advancing the standing and careers of those in this field. Since the introduction of social media – Facebook and LinkedIn in particular – and its effectiveness in delivering a quick message and communicating with people all over the world AAPM felt that our members needed to feel a connection with their Association via these means. If you haven’t discovered it yet, search for AAPM on Facebook and like us. We have also established a LinkedIn page so join the group and start your discussion. This is a fabulous environment for you to post questions and give other members of this healthcare management community the ability to share their experiences with you. Like and join today! Lastly, I encourage you all to visit the AAPM website for information on our national conference. This is shaping up to be an educational event not to be missed. This year AAPM is partnering with QIP (Quality in Practice) and the opportunities afforded to those who attend are endless. The provisional program is currently available. Go to www.aapm.org.au and follow the links. I wish you a very prosperous start to 2013.

Carolyn Ingram FAAPM National President

3 | Issue 1 – 2013


From the desk of the CEO president, Brett McPherson, represents us on the PIP Advisory Group where they are reviewing the priorities and effectiveness of the current PIP incentives for eHealth, IHI, cervical screening, diabetes, asthma, teaching, ACAI (aged care), and QPI (quality prescribing), and examining the progress of after hours service provision.

Welcome to the first edition of the Practice Manager for 2013. The AAPM Board and management have had a very active start to the year, with a forum for all state treasurers and presidents, a planning workshop for the Board and state presidents, plus a number of meetings with key partners. The president’s report outlines a number of initiatives developed from these workshops.

We are also a member of the RACGP GP Advocacy & Support group where we are contributing to the discussion on the concept of patient primary care home and the associated issues, including voluntary patient registration, simplifying chronic disease management compliance, the focus on preventive health and utilization of technology to improve efficiency and clinical outcomes.

One of the key roles of the AAPM Board and management is national advocacy on behalf of our members. This is a benefit which is often not highly visible to the majority of members but can have a big impact on their personal work and their careers. AAPM was invited to meet with the Minister for Health in January. Our president, Carolyn Ingram, and I raised a number of issues with the minister including professional recognition of the role practice managers play not only in managing healthcare practices but also in implementing health reform initiatives. AAPM provides support for practice managers in all healthcare disciplines including all allied health professions, dentistry, the range of medical specialists as well as general practice.

QuAlITY – Does it make a Carolyn Ingram and I recently met difference?

Gary Smith, National Board director, represents AAPM on the Medicare Stakeholders Consultative Group where a wide range of Medicare issues are discussed. Most recently, there was considerable discussion on the Medicare Assignment of Benefits Forms as the manual forms have been withdrawn and practices had to download these from the web and print them off as required. The group was able to reach a compromise for 25-28 SEPTEMBER 2013 practices like allied health and after SYdnEY hours services.

with the CEO of the Australian Dental Gary also represents us on the Medicare Association to further cement our The Australian Association of Practice Managers (AAPM) and Stake Holder Engagement Compliance partnership with that organisation and Working Group which does a lot of work Quality in Practice (QIP) proudly present the first International to ensure we meet the needs of our reviewing documentation on compliance members who Care manage dental practices. Health Conference. to the Medical Benefits Schedule for public release. Medicare is appreciative Practice managers are represented that AAPM to send by AAPM on a wide range of national Experience the journey with the AAPM and continues QIP teams on out these compliance/information documents to committees. Our immediate past

25 – 28 September 2013 at the Sydney Convention and Exhibition Centre to learn about Quality – Does it make a difference?

Learn from leading International speakers and Australian experts. The program

Your invitation to join AAPM and QIP

AAPM and QIP are bringing together opinion leaders and

The delivery of modern health care is becoming more

experts from Australia, USA and Europe, to focus on the core elements of quality in health care and address whether quality makes a difference.

integrated across professions.

QuAlITY – Does it make a difference?

The International Health Care Conference streams will focus on: – A to Z of Accreditation: Practical Strategies – Achieving Safety: Aspiring to Quality – Integrated Primary Health Care – Kaizen: The Art of Quality

Whether you work in a specialist or general practice, diagnostic imaging, dentistry, physiotherapy, community health, allied health, a hospital setting, Medicare Local or are interested in quality health care – you will benefit from

25-28 SEPTEMBER 2013 SYdnEY attending the International Health Care Conference.

– Technology & Innovation – The Evolving Role of Practice Management

The Australian Association of Practice Managers (AAPM) and the conference. Quality in Practice (QIP) proudly present the first International Health Care Conference. Workshops and master classes will be run prior to

REgISTRATIonS oPEn In EARlY 2013. SAvE ThE dATE.

www.cdesign.com.au/aapmqip2013

Experience the journey with the AAPM and QIP teams on

4 | Issue 25 1 – 2013 – 28

September 2013 at the Sydney Convention and Exhibition

Centre to learn about Quality – Does it make a difference?

its members. AAPM is highly respected on this very important working group. In addition, Gary participates on the Health Professional Online Services (HPOS) Working Group, advising Medicare Australia on doing business online though the HPOS portal. AAPM continues to be strongly involved in assisting members with the implementation of e-health. Resources have been placed on the AAPM website for your access and a number of “mythbuster” alerts were emailed to members in general practice to assist them in meeting the ePIP requirements by February 1. Your views and ideas on national issues are always appreciated and will be forwarded to the appropriate committee for consideration. The AAPM Certified Practice Manager qualification launched at the national conference last year is now open for application. This has had a fantastic reception from members with many applications already received. The AAPM CPM qualification provides ready recognition of a practice manager’s skills and experience. More information on this qualification can be read in this issue of the Practice Manager. AAPM regularly reviews the benefits provided for members. A summary is provided in this journal and also on the AAPM website. Join AAPM on Facebook and Linked In to keep up to date with benefits, events and ideas. All members are invited to join our state committees and working parties. One of the most valuable benefits of joining the committee is the opportunity to build your personal network with like-minded practice managers. Please contact AAPM Head Office if you need more information. Best wishes for a successful 2013.

Gillian Leach Chief Executive Officer


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news bites

Promoting a professional ethical relationship between doctors and industry In December, the AMA released its revised Position Statement on Medical Practitioners’ Relationships with Industry.

“Doctors have a responsibility to ensure that their interaction with industry is consistent with their patients and towards society at large.

The AMA Position Statement on Medical Practitioners’ Relationships with Industry 2012 provides guidance to doctors on maintaining ethical relationships with industries including the pharmaceutical industry, medical device and technology industry, other healthcare product suppliers, healthcare facilities, medical services such as pathology and radiology, and other health services such as pharmacy and physiotherapy.

“Doctors must safeguard their clinical independence and professional integrity from the influence of third parties, including industry.

“The history of health care in Australia has been marked by close collaboration between doctors and industry,” AMA President Steve Hambleton said. This collaboration has extended to research and education, and it has contributed beneficially to the quality of health care that Australians receive.

“It is important to recognise potential conflicts of interest and develop processes to deal with them.” The Position Statement covers the following areas: • Medical education; • Managing real and potential conflicts of interest; • Industry-sponsored research involving human participants, including participation in postmarketing surveillance studies; • Meetings and activities organised independent of industry; • Meetings and activities organised by industry;

• Hospitality and entertainment; • Use of professional status to promote industry interests; • Remuneration for services; • Product samples; • Dispensing and related issues; and • Relationships involving industry representatives. The AMA Position Statement on Medical Practitioners’ Relationships with Industry 2012 is at https://ama. com.au/node/5421

International conferences MGMA annual conference Oct. 6-9, 2013, San Diego See www.mgma.com/upcomingevents/ for the latest information on this and other MGMA events. For IHM events, see www.ihm.org. uk/calendar/

RACGP develops practice policy templates to support general practices meet ePIP requirements The RACGP has developed a range of practice policy templates for general practices to adapt to their individual practice needs when registering and complying with the requirements for the eHealth Practice Incentive Program (ePIP). The newly released practice policy templates cover secure messaging delivery, clinical coding terminologies and the electronic transfer of prescriptions – three components of the ePIP eligibility criteria. Of the five ePIP requirements, the first four were due on 1 February 2013, with the fifth requirement taking effect from 1 May 2013. ePIP requirements: 1. Integrating Healthcare Identifiers into electronic practice records 2. Secure messaging capability* 3. Data records and clinical coding* 6 | Issue 1 – 2013

4. Electronic transfer of prescriptions** 5. Personally Controlled Electronic Health Record (PCEHR) System*** RACGP President Liz Marles said the College has developed user-friendly templates focusing on assisting practices in meeting requirements. The College advises practices to utilise the templates that have been released, but mark them for review by the practice no later than June 2013, when the second edition and final CISS is released. Practices should note that the RACGP is reviewing its computer and information security standards (CISS) and workbook, with a planned release in June 2013. This review will include additional information to support GPs and their practice teams develop policies that relate to participation with the PCEHR and ePIP.

Until the release of the second edition of CISS, the current edition of the CISS (2011) is still best practice in providing guidance in information and security protection. “The College has made it a priority to provide practical support to our members in this time of national health reform in information technology. In addition to the practice policy templates, an ePIP eligibility checklist to be read in conjunction with the ePIP Incentive Guidelines is available on our website,” Dr Marles said. To access and download the practice policy templates, visit www.racgp. org.au/your-practice/e-health/ ehealthrecords/epip/. * practice policy required by 1 February 2013 to meet ePIP eligibility criteria. ** practice policy encouraged by 1 February 2013 to meet ePIP eligibility criteria. *** practice policy required by 1 May 2013 to meet ePIP eligibility criteria.


Applies to all healthcare practices

AAPM members’ needs study by Dianna McDonald, UltraFeedback

www.ultrafeedback.com Ph: +61 3 9819 2086 Freecall 1800 143 733

The third AAPM Member’s Needs Survey was conducted in August last year by independent health research organisation, UltraFeedback. The survey was conducted using an online questionnaire and all members were invited to participate. Feedback was received from over 400 respondents, representing approximately one-third of all members. Survey results reveal that, as a group, practice managers are highly qualified (8 out of 10 hold a formal qualification, e.g. a degree or diploma) and feel well resourced and supported to do their job. All are leaders in their practice team, with approximately 9 out of 10 holding purchasing power and the authority to hire staff. (One-third had no limit to their purchasing power while, at the other end of the spectrum, 8% had no purchasing power.) Survey feedback continues to show a good level of support within practices for professional development and training; however, about half of respondents didn’t agree with having to pay for their own professional development. Training courses were seen as somewhat costly, particularly for those in rural areas who had to fund travel and accommodation to attend and a common theme emerged. More webinars and online forums were suggested by some respondents as a possible solution to supporting cost-effective, time-efficient training and networking needs of those in regional and rural areas. “there’s not a lot of training in regional areas… it’s mostly city or coastal” “It would be great to see more webinars etc as I am in a rural setting and not able to attend any of the dinners, social events and training days.” Overall, however, scores on satisfaction with the AAPMs national training activities remain high and have even improved slightly, with courses run by the AAPM scoring higher that training activities run by other similar organisations.

Training needs Although practice managers felt highly skilled in the areas of client service and staff management they nevertheless nominated customer service, HR management and staff development as the most important areas for professional education. The perceived importance of customer service training has increased since the previous survey, thus reflecting an attitude of continual improvement and increasing focus upon serving patients and their needs. Other training areas that practice managers felt were increasingly important included financial management, medicolegal, OH&S and privacy.

IT/software Most practice managers (9 out of 10) felt that the IT software they use met their needs; however,

results also showed that uniformity of software programs across the industry is low, with fewer than half of respondents using any one program. This lack of uniformity may be problematic when looking to implement across-the-board strategies that involve IT or training programs that utilize a particular software program.

Awareness of AAPM’s role and performance remains high Awareness of the role and services of the AAPM remains high, with 98% agreeing that the organisation represented the interest of practice managers, and the same proportion believing that the AAPM was a reputable organisation. Most (96%) felt the organisation was responsive to national issues affecting practice managers and believed the organisation was regarded as having an experienced Board of Directors (95%). Scores relating to the performance of the APPM were high, with members feeling very positive about the valuable resources provided by the AAPM, including education and training. This was reflected in the following comments from survey participants: “Joining the AAPM has enabled me to have access to very valuable support and information that has really helped me in my role.” “AAPM offers a comprehensive resource base.” In relation to publications, the Practice Manager, Pulse+IT and the AAPM email newsletter all received high satisfaction scores of greater than 4 out of 5. Satisfaction with AAPM’s national conferences also rated highly, as indicated by the following comment: “The yearly national conferences are the best I’ve ever been to in my career” – as did the AAPM’s work in promoting and advancing ethical behaviour and promoting and advancing advocacy of practice management (all scoring more than 4 out of 5). Approximately 1 in 10 (13%), however, felt that the AAPM’s support with technology issues could be improved. The key needs of members were identified as: • access to quality outputs and support to meet professional development needs, • up-to-date information about the industry; and • opportunities for networking. Feedback indicates that the AAPM is continuing to rate well in these key areas. When members were asked their view of the top priorities for the AAPM over the next year, the three most commonly cited areas were: • Industry-specific education (GP, specialist, allied health) • An online forum for practice management issues • More networking. 7 | Issue 1 – 2013


President

Carolyn Ingram BA, Grad Dip Teach, Dip Prac Man, FAAPM, AIMM, MAICD

Carolyn has been involved in the business of healthcare practice management for over 10 years. She has established successful small businesses in the widely contested field of aesthetic medicine and remains a director of these companies today. Carolyn has a real grounding and experience in small business enterprises, marketing, innovation, corporate governance, and strategic planning. Research in the areas of healthcare innovation and practice management have become something of a passion for her as she continually strives for excellence in this field. Carolyn regularly participates as a guest speaker at both national and international conferences on practice management principles and innovation in healthcare. She enjoys building business relationships and forging strong bonds with others participating and working in the healthcare industry. Carolyn is a Fellow of AAPM. She became a member of the AAPM national editorial committee for the Practice Manager in 2007, is a long-standing member of the AAPM Queensland Branch committee, past state president, and is the current AAPM Queensland vice-president.

Vice-president

Debra Smith CPM, FAAPM, Dip Prac Man, Cert. IV in Workplace Training & Assessment, JP

With a background in nursing, a work colleague (who was an AAPM member) introduced Debra to practice management in 1997 and suggested that she undertake the Cert IV in Practice Management. She then went on to manage the general practice she was currently working at and furthered her studies by undertaking the Diploma in Practice Management. She completed the Fellowship Program in 2005, becoming the first credentialled Fellow of the Association. She has experience in management of both general and specialist practices. Debra manages a large private general practice on the Central Coast of NSW. She has been a NSW branch member since 2000, serving as both vice-president and secretary. She has served on the National Board since 2006. She is an accreditation surveyor with General Practice Accreditation Limited (GPA). 8 | Issue 2 – 2012

Her enthusiasm and passion for practice management was instrumental in the inauguration of the NSW Practice Manager of the Year Award in 2009, which has now become an annual state event across all states and a national event. She presents on a variety of topics for various organisations via her own consultancy business. On a personal note Debra is married with two adult children both of whom are married, and an elderly Maltese named Ike. She is now the proud grandmother of two beautiful grandsons and plans to spend lots and lots of time with them. In her spare time she likes to watch videos, go to the movies, take her dog to the beach and travel.

Secretary

Fiona Wong Dip Prac Man

Fiona is in her second year on the Board, having been on the WA Branch committee for the past five years. Originally from Tasmania, Fiona started out in the credit union industry before moving to Perth where she commenced her health industry career in 1996 with a combined physiotherapy, podiatry and massage practice that amongst other clients treated the Perth Wildcats NBL basketball team and the Australian hockey teams. She then worked for various specialist practices as well as for an accounting firm before settling in her current role as practice manager of a busy third generation, multi-doctor ophthalmology practice, newly branded, Western Eye. The practice was already an AAPM member which gave Fiona her initial opportunities to attend the many local seminars for the first time. Quickly realising the rewards and benefits of being a member Fiona then joined the AAPM WA Branch committee to be able to contribute professionally to the Association.

Treasurer

Brett McPherson CPM, FAAPM, Post Grad Dip – Business, FETC (Oxford)

2013 will be Brett’s 21st year as a member of AAPM. For 18 of those years he has been a member of a state Branch committee (Vic and Tas), 13 years have been as a director of AAPM and nine of those years in


Our Board Members executive positions (three years as president, three years as vice-president, four years treasurer and one year secretary – for twp years combined VP/treasurer). Brett grew up and was educated in Brisbane. After qualifying as a radiographer he moved to Launceston where he worked as a radiographer. Brett completed his Graduate Diploma of Business – Professional Management at the University of Tasmania and during that time he also travelled to the UK where he completed a postgraduate teaching qualification at Oxford. Upon return to Launceston he took up the offer to manage a private radiology practice and he continued to manage that practice for nearly 15 years. Following corporatisation of the practice and move to Melbourne he left the group to take up a position as a practice manager for a private general practice. During 2012, Brett took up a new role as business manager at an award-winning Melbourne CBD general practice and one of his main aims is to create initiatives that better utilise IT technology to improve the quality, efficiency and accessibility for patients and their healthcare. Outside of AAPM, Brett enjoys cooking (Thai and Indian) and is an avid rugby union supporter; having played and coached at various levels for many years, he (and his wife, Maggie) are members of the Melbourne Rebels.

Non-Executive Directors Linda Osman FAAPM, Dip Prac Man, Cert. IV in Workplace Training & Assessment

Linda has been working in practice management for over 25 years including work in a varied range of disciplines from general practice, specialist practice and Aboriginal health and medical imaging. Linda is also an accreditation surveyor for AGPAL and is currently working for the South Yarra and Richmond Medical Centre’s and progressive group practice in inner Melbourne She currently leads the AAPM National Indigenous Taskforce, which launched the Walking Alongside Mentoring Program at the AAPM national conference in 2012, an achievement of which she is extremely proud. Initially becoming involved with AAPM in 1995 Linda has been the Victorian president, vice-president, national secretary and national vice-president, and convenor for the AAPM national conference in 2009 hosted in Melbourne.

Her involvement at the national level has extended to being part of the working party for AAPM’s Practice Manual The Guide, participating on the Internal Business Committee and more recently the CPM program. Linda was awarded the AAPM Meritorious Award in 2009 for her involvement at both a state and national level. She is currently the Victorian representative of the National Board.

Gary Smith JP, FAAPM, SFCDA, MAICD, Life Member AAPM

Gary has been around the AAPM scene both at a NSW state and national level for a long time, some may say too long. After he stood down from the national presidency in 2001, his secretary was asked in an interview “what are you going to do with having him back in the office?”. Her reply was “ if anyone wants him anywhere, ring me and I will ensure he is there”. He continues to be actively involved in “spreading the word” for AAPM with his vast representation on numerous Boards, advisory groups and working parties. He currently holds directorships on AGPAL, UNEPartnerships, and General Practice Workforce Tasmania, and is chair of QIP. For his sins the NSW government has appointed him to the Local Health District Board of Governance.

QuAlITY –

GaryDoes is a surveyor foraAGPAL and an SEPTEMBER ISQua international it make 25-28 2013 surveyor, where he accredits accrediting organisations, SYdnEY difference? standards, and surveyor training programs. This takes him to The Australian Association of Practice Managers (AAPM) and all parts of the world. Quality in Practice (QIP) proudly present the first International

He isHealth a LifeCare Member and a Fellow of AAPM. Gary’s mantra is Conference. “the knowledge he has gained is not for him to keep”. Experience the journey with the AAPM and QIP teams on 25 – 28 September 2013 at the Sydney Convention and Exhibition Centre to learn about Quality – Does it make a difference?

Learn from leading International speakers and Australian experts. The program

Your invitation to join AAPM and QIP

AAPM and QIP are bringing together opinion leaders and experts from Australia, USA and Europe, to focus on the core elements of quality in health care and address whether quality makes a difference.

The delivery of modern health care is becoming more integrated across professions.

QuAlITY – Does it make a difference?

The International Health Care Conference streams will focus on: – A to Z of Accreditation: Practical Strategies – Achieving Safety: Aspiring to Quality – Integrated Primary Health Care – Kaizen: The Art of Quality – Technology & Innovation – The Evolving Role of Practice Management

Whether you work in a specialist or general practice, diagnostic imaging, dentistry, physiotherapy, community health, allied health, a hospital setting, Medicare Local or are interested in quality health care – you will benefit from attending the International Health Care Conference.

25-28 SEPTEMBER 2013 SYdnEY

The Australian Association of Practice Managers (AAPM) and Quality in Practice (QIP) proudly present the first International Health Care Conference.

Workshops and master classes will be run prior to the conference.

REgISTRATIonS oPEn In EARlY 2013. SAvE ThE dATE.

www.cdesign.com.au/aapmqip2013

Experience the journey with the AAPM and QIP teams on 25 – 28 September 2013 at the Sydney Convention and Exhibition 9 | Issue 1 – 2013 Centre to learn about Quality – Does it make a difference?

Learn from leading International speakers and Australian experts.


Applies to all healthcare practices

Core principles: Human resource management,

Business and clinical operations by Professor Claire Jackson, Director, Centres for Primary Care Reform Research Excellence, and Professor in Primary Care Research, University of Queensland; Immediate Past-President, Royal Australian College of General Practitioners

What is this “patient-centered medical home”? I greatly enjoyed presenting at the AAPM national conference last year and meeting and discussing healthcare reform with many delegates. This article provides a little more detail around one of the topics much discussed and its implications for Australian practice management. The Patient-Centered Medical Home was a concept developed in the USA in 2007. An initiative launched by the American Academy of Family Physicians (AAFP), American Academy of Paediatrics (AAP), American College of Physicians (ACP), and American Osteopathic Association (AOA), it describes a new primary care model to better meet the needs of contemporary communities. Early evidence has shown improved quality benchmarks, patient experience, systems of care and service use, and a significant reduction in avoidable hospital admissions, emergency department use and overall care costs. It is of growing interest internationally. The Patient-Centered Medical Home (PCMH) is characterised by seven key elements: • each patient has an ongoing relationship with a personal physician trained to provide first contact, continuous and comprehensive care • the personal physician leads a team of individuals who collectively take responsibility for the ongoing care of each patient • the personal physician is responsible for providing all the patient’s healthcare needs or arranging care with other qualified professionals • care is coordinated across all elements of the healthcare system and community, facilitated by registries, information technology, and health information exchange • quality and safety is ensured through care planning, evidence-based clinical decision tools, performance measurement and improvement, patient feedback, and effective IT • enhanced access to care is available through systems such as open scheduling, expanded hours and new options for e-communication • payment appropriately recognises the added value provided to patients with a PCMH. Much resonates with the future vision for primary care in our country based on key policy documentation and political rhetoric. Additionally, it sounds a lot like the College’s “Quality General Practice of the Future”.

10 | Issue 1 – 2013

However, the RACGP identifies additional important elements in their paper including teaching, leadership, and innovative models of shared-care (particularly with the secondary sector) in building the future capacity and impact of the Australian primary care sector.

What’s important at the practice level? A key element in the PCMH approach to healthcare is the commitment to ongoing quality improvement and effective systems management – particularly use of patient registers, recall, practice population tracking, support and performance measurement. Our UQ Centre for Research Excellence in this area is now working hard with AAPM to explore these key elements in relation to quality improvement at the Australian practice level. We have identified a number of critical areas which form the basic foundation to high-quality clinical management, namely: • a patient-centred and community focused care approach; • the ability of the practice to manage constant change; • communication strategies both internal and external to the practice; • the use of information and information technology • a culture of ongoing performance improvement • practice leadership; and finally • effective clinical and organisational governance. These elements now form the basis of a quick and simple improvement tool, developed with AAPM in 2012, to assist Australian general practices and primary healthcare clinics assess and improve their systems for quality practice care. In April 2013 we will be embarking on trial of this tool with practices nationally. If you would like to contribute to the refinement of an approach to quality improvement which is proven internationally, appropriate and relevant to Australian primary care, and included as relevant to your QI and CPD program, please contact us at l.crossland1@uq.edu.au. Practice management is being internationally recognised for the key role it plays in high quality patient outcomes – let’s build its impact Down Under as well!


11 | Issue 1 – 2013


Avant Risk Advisory • Avant Mutual Group Limited ABN 58 123 154 898 Website www.avant.org.au Freecall 1800 128 268 Freefax 1800 228 268 memberservices@ avant.org.au www.avant.org.au

Applies to all healthcare practices

Core principle: Risk management

The checklist… administrator’s delight or clinician’s nightmare? by Dianne Preen – Avant Senior Manager, Risk Advisory Service, and Marianna Kelly – Avant, Medico-legal Risk Advisor Conducting safety checks is not new to hospital environments; however, the three-phase surgical safety checklist (the checklist) has been developed only in recent years. An initiative of the World Health Organisation (WHO), its use is gaining ground in Australia driven by both clinicians and, more recently, hospital administrators. However, despite international research showing how using the checklist can reduce major complications deaths and infections rates, some clinical teams here remain resistant. The checklist requires a number of steps and specific stages of the surgical procedure. 1. The “sign-in”. The first phase occurs before a patient is anaesthetised and is known as the sign-in. The patient must confirm his/ her identity, the exact surgical site, consent, and the procedure. The team must check allergies, discuss the risk of aspiration and significant blood loss and carry out anaesthetic safety check. 2. The “time-out”. The second phase occurs before the first incision is made. During the time-out or “surgical pause” operating team members must introduce themselves by name and role. The surgeon and anaesthetist must then confirm the name of the patient, the procedure, discuss anticipated critical events and the need for antibiotics and confirm that any relevant imaging is available and displayed. 3. The “sign-out”. The third phase or sign-out takes place after the operation but before the patient leaves theatre. Performed by the nursing team, all instruments, sponges and needles must be accounted for, equipment checked, specimen labels checked. The surgeon, anaesthetist, and nursing staff then talk about any key concerns around recovery management. WHO also recommends that surgical teams include a “checklist co-ordinator” to be

12 | Issue 1 – 2013

responsible for confirming that each member of the team has completed their required tasks before an operation begins. The checklist was piloted in 2007-2008 in eight hospitals in different parts of the world. Those piloting the scheme encountered widespread resistance from operating teams based on the time the checklist takes to carry out and the social component – the requirement for teams to introduce themselves during the time out. Dr Atul Gawande, an American surgeon and journalist was director of WHO’s efforts to reduce surgical deaths in 2007 and was directly involved in the development of the checklist and the pilot program. He is widely published on the subject of reducing error, improving safety, and increasing efficiency in surgery. His third book, The Checklist Manifesto: How to Get Things Right,1 which reached The New York Times hardcover nonfiction bestseller list in 2010, Dr Gawande provides us with insights into the WHO project and why, after much consideration, a checklist became the tool of choice. His narrative takes us from aviation to the building industry, with examples of how a simple checklist can bring about improvements in a world of increasing complexity. A surgeon himself, Dr Gawande discusses resistance by his surgical colleagues to the checklist and how an orthopedic surgeon was won over during the testing phase when the checklist helped the team recognise that the knee prosthesis on hand was the wrong size for the patient. In Avant’s experience, adverse surgical events that have led to litigation or complaints often have two common themes: • inadequate communication, and • departure from usual practice. Avant’s risk advisors have been fortunate to see first hand where an adaptation of the checklist has been successfully introduced. What made these situations different was:


• The implementation was championed and driven by the clinicians. • There was flexibility to allow customisation of the checklist to the needs of the users. • There was buy-in from all parties. • The checklist was enlarged and displayed in the operating theatre. A number of organisations including the Royal Australasian College of Surgeons and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists have given their strong support to an adaptation of the checklist.2 Why then are some clinicians opposed to the checklist and why are some healthcare facilities failing in their endeavours to introduce it? The reasons are multifactorial but a few worthy of consideration are: • The checklist is a tool to aid surgical outcomes. Its use and implementation needs to be driven by clinicians and not be imposed by administrators as a box-ticking exercise. • It requires “buy-in” and commitment from the entire surgical team; it is everyone’s business, not just something for the nurses. • Flexibility is required to allow operating teams to modify it to fit local practice. • The question remains, must there be documentary evidence that it was done? Isn’t the ”doing” enough when the original intent of the checklist was to embrace a culture of teamwork and discipline? Avant risk advisors often meet Avant members who have read and are familiar with Dr Gawande’s books and articles. He makes a persuasive case for the use of checklists in medicine and his writings can provide valuable insights for those who doubt their efficacy. The use of checklists should not be confined to the operating theatre. They can: • help reduce the wrong lesion being removed in private practice • ensure discharge criteria is checked and documented prior to a patient discharge from day surgery • reduce the likelihood of medication misadventure • have application as a tool for dental procedures • act as a compliance tool in other business applications • assist with daily tasks. The following is just one example of the many situations where a checklist can be of benefit. The need for some form of communication tool was recognized after surveying ICU residents and nurses at Johns Hopkins following patient rounds. They were asked whether they understood the daily tasks and therapies dedicated to their patients. Only 10% answered yes to this question. With input from all ICU care team members, a daily goals sheet was developed. This hybrid checklist prompts the care team to identify the work needed to get the patient to the next level of care, which includes assessing the patient’s greatest

safety risk, the care plan, and the communication plan. It also covers issues of pain management, medication changes, other care processes, and whether someone has kept the family informed about their loved one’s care. The beauty of the daily goals sheet is the ability to modify it to meet the needs of any inpatient unit or medical care facility. For example, one ICU has modified the form to list goal 1, goal 2, and so on, while a separate ICU in the same hospital has initiated a checklist of specific therapies. Not surprisingly, the Daily Goals Sheet is now being used in hundreds of ICUs around the world.3 The checklist is just a piece of paper unless used correctly. Communication and respect is an integral part to ensure the successful use of checklists and good teamwork.

References 1. Atul Gawande. The Checklist Manifesto. Henry Holt and Company, LLC, 2010. 2. ANZ Journal of Surgery 2010. For more information view the video How to do the WHO Surgical Safety Checklist [Adapted for England and Wales]. www.youtube.com/watch?v=CsNpfMldtyk 3. www.learnicu.org/Quality_and_Safety/Patient_Safety/Pages/Effective_ Communication.aspx

13 | Issue 1 – 2013


Applies to all healthcare practices

Core principles: Financial management, Human

resource management, Business and clinical operations by Colleen Sullivan and Professor Geoff Meredith

Salary survey: Practice management core responsibilities This is our final article on the 2011 AAPM National Salary Survey of Practice Managers and it is worth reminding readers of the value and importance of this survey and to encourage everyone to participate in the 2013 AAPM National Salary Survey. The first survey was conducted by AAPM in 2005 and this was a ground-breaking exercise. At that time and today there has been no other national survey of healthcare practice managers. The AAPM survey focuses not only on salaries but also on where they practice, the type of practice, services offered, IT, staffing, responsibilities, qualifications and other relevant information. The survey has been conducted biennially since 2005 and we now have established professional data that has both authenticity and validity. We would like to encourage everyone to participate in the 2013 AAPM National Salary Survey. Outcomes from the AAPM National Survey of Practice Managers discussed in this article could be seen as critical to the impact of practice managers on the practice and the image of the practice and have an influence on where practice managers place their priorities in terms of work experience. As noted in previous articles, the outcomes reported in this article could serve as a basis for discussion within the practice amongst staff and amongst clinicians. Perhaps this is worth thinking about as a means of maximising the benefit of this survey for your practice. The first part of this report focuses on practice managers’ average time allocation over nine areas, ranging from financial management through to compliance requirements. Any practice manager who has not given serious thought to how time is allocated should make this a high priority and one that can lead to decisions on use of time and outcomes from time.

Practice Management Core Responsibilities Average Time Allocation Financial management 22% HRM 18% Planning and marketing 5% Information management 8% Risk management 5% Governance and organisation 4% Business and clinical operations 13% Professional responsibility 6% IR and compliance 19% 14 | Issue 1 – 2013

Core Responsibilities: Note: Responses recorded below include only tasks where more than 80% of respondents indicated involvement. 1. 2. 3. 4. 5.

Financial management tasks Establishment/review fees 93% Patient accounting procedures 80% HRM tasks Interview and induction 93% Job description 93% Practice manual 93% Contract/workplace agreements 89% Award compliance 89% Staff training programs 89% Compliance employee law & awards 87% Employee appraisal and evaluation 82% Planning and marketing tasks Nil at 80% - highest involvement 66% 61% Information management tasks Database management 87% Information systems installation 80% Risk management tasks Practice history and record keeping 93% Patient/staff confidential policies 91% Conflict resolution and grievance procedures 86% Legal compliance 84% 6. Governance and organisational tasks Nil at 80% - highest 76% 7. Business and clinical tasks Staff development and team building 92% Staff analysis and scheduling 86% Patient communication systems 83% Monitoring licences 80% 8. Professional responsibility tasks Develop interpersonal skills 87% Professional networking 85%

The major part of the report focuses on core responsibilities – AAPM has identified eight areas representing core responsibilities for practice managers and it is a question of to what extent managers are becoming involved with these areas. As noted below, the comments in this report are limited to a discussion on those tasks which appear to be accepted by more than 80% of respondents. In many cases, some areas of responsibility were involved by only 40% or 50% of those responding – this is disappointing indeed and perhaps it should have been reflected in the article; however if we take a positive view, then the fact that we focus here on those tasks in each of the eight core responsibility areas which have attracted the


attention of practice managers, and this perhaps is a good starting point.

Average time allocation The variation in time allocation was significant – for example, managers reported that some 4% of their time was allocated to governance and organisation matters, 5% to risk management and planning and marketing, while at the other extreme, 22% of time was allocated to financial management. Whether this is justified or not depends very much on the practice, its systems, and the extent to which it relies on professional assistance on financial matters. Tasks linked to HRM attracted a high proportion of respondents. There is no doubt that tasks associated with HRM in the practice are very important and it is to be expected therefore that the majority of practice managers would become directly involved in such tasks as interview programs, job descriptions, developing a practice manual, dealing with award compliance, training and appraisal and evaluation. In terms of application of ideas from the survey to your own practice, it is important to consider whether you are involved with all these tasks with HRM and the extent of your involvement in terms of time allocation. The most disappointing outcomes of the survey in terms of core responsibilities were the responses by practice managers to planning and marketing tasks and also governance and organisational tasks. In these two areas, at no stage were 80% of practice managers involved. The involvement tended to be about 60% or even lower than 60%. The challenge for practice managers here is therefore whether they should be involved in such planning exercises as producing marketing tools, evaluating plans, looking at customer relations, and so on. This would be the basis for discussion or perhaps workshops presented by external specialists may help in developing an approach by a practice manager to these two areas.

Information management tasks were a mixture, with a high proportion of respondents involved in database management and maintenance and also involved in system development and purchasing. Other areas of information management did not attract such a high proportion of practice managers. It may be argued that the future professional practice will rely heavily on electronic methods and perhaps therefore this is an area which could be given some attention by practice managers. A core responsibility dealing with risk management was also a “mixed bag”, with some areas attracting more than 80% and 90% of respondents whereas other areas attracted only 60% of participants in the survey. Again this is an area where practice managers could firstly attend programs or workshops offered by external specialists on aspects of risk for the practice and then decide to what extent they should become involved in such programs and tasks or arrange for others to take on the responsibility for the practice. Finally, there is a very high response to the core responsibilities associated with clinical tasks and also business tasks, particularly where they relate to staffing, and also a reasonable response to core responsibilities associated with professional development. In this whole area of core responsibilities, there is a need for practice managers to review the eight areas nominated by AAPM and to review the content of each of the eight areas and determine to what extent they can allocate time to these areas. This could be seen as an important aspect of the professional development of practice managers. Readers of these articles will have had the chance to review the contents and perhaps have made some decisions in their own practice. The AAPM survey for 2013 will soon be ready for distribution and we hope an increasing number of practice managers will participate in the program.

A must-have resource for your practice To order your Salary Survey 4th Edition CD complete all details and post, fax or email your order to:

Fax: (03) 9329 2524 Email: headoffice@aapm.org.au

AAPM Head Office Post: Level 1, 60 Lothian Street, North Melbourne VIC 3051

PLEASE PRINT AAPM Membership No:

Name:

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Please supply_______ (insert number required) CD(s) at: $55.00 Individual member (participants to 2011 survey)

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Payment options (Please tick): Please debit my credit card MasterCard Cardholder’s name Card number

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Direct Deposit Account Name: AAPM Ltd BSB: 063-114 Account No: 10119934 Note: To avoid disappointment and delay in receiving your order, please use your AAPM membership number as your reference or your last name and initial if you are not a member or the name of your organisation.

I enclose a cheque payable to AAPM Ltd – Drawer________________________________________________________________ Note: Your order will not be dispatched until the cheque has cleared.

15 | Issue 1 – 2013


Applies to all healthcare practices

Core principles: All by Helen Kenny, AAPM Head Office

Online Learning The introduction of online learning to the AAPM website allows you, our members, to access a range of education programs that you can complete at your own pace and in the convenience of your office or home. Members are invited to take part in our online learning program, which currently provides four instructive and interactive modules to complete, with more to come. “The inclusion of the online learning area on the AAPM website will be a valuable complement to the professional development events provided by AAPM state branches and nationally,” said AAPM Immediate Past President, Brett McPherson. “We are confident our members will find these modules informative and that they will assist with educating them on a range of management areas including the recent advancements in the eHealth area.” The AAPM Informed Financial Consent module will support practices to deliver quality services in providing financial information to patients who are having an operation or procedure in hospital. Zedmed, a market leader in providing medical software and services, is delighted to provide the following three learning modules: Practice Management Essentials - by Zedmed • Clinical Module - Results and reporting • Office Module - Reporting, recalls and security • Insurance Module - Powered by MLC On satisfactory completion of each module, AAPM members will receive five continuing professional development (CPD) points. AAPM is proud to support you in pursuing continuing professional development by

16 | Issue 1 – 2013

ensuring our members are at the forefront of excellence in practice management in today’s changing healthcare industry environment. For further information about this exciting resource, please contact AAPM Head Office. Phone 1800 196 000 or email headoffice@ aapm.org.au.


GPE

ON TI

T

NVEN O C

mining for gold

2013 11-12 September | Crown Perth, WA You’re invited to participate! Submit an abstract before 30 March to present your initiative or approach to registrar training at the General Practice Education and Training (GPET) Convention.

2013

in general General Practice in

All practice managers are invited to participate as a delegate, paper Education or workshop presenter at the 2013 GPET Convention.

practiceConvention, Perth GPET education

The GPET Convention will bring together over five hundred registrars, prevocational doctors, educators, supervisors, training providers, academics, cultural mentors and key medical education organisations from all over Australia. Join them to discuss critical issues in GP training, share your knowledge and showcase your programs and ideas. The Call for Abstracts is now open, visit

www.onqconferences.com.au/gpet2013/home.php

to download the ‘How to write an abstract guide’ and submit your research paper or workshop abstract online.

Australian Government General Practice Education and Training Limited

17 | Issue 1 – 2013


Applies to all healthcare practices

Core principles: All by Marina Fulcher CPM FAAPM

Continuing professional development – What’s the point? As professionals working in an environment of continual change such as healthcare, we must keep up to date to work effectively in our roles. To support this, AAPM developed eight core areas of responsibility that define the competencies for healthcare practice management. These principles largely cover the areas where we need to ensure knowledge is current.

Related Reading

Publications & • Articles in AAPM journals Presentations – 30 points

1. Financial management

• Articles in professional journals – 20 points

2. Human resources management

• Published professional papers – up to 50 points on assessment by AAPM

3. Planning and marketing 4. Information management 5. Risk management

• Professional presentations/teaching – 20 points per individual activity and up to 50 points per year on assessment by AAPM

6. Governance and organisational dynamics 7. Business and clinical operations 8. Professional responsibility There are a range of different ways for keeping skills and knowledge current: reading industry journals, such as this one, attending education workshops, e-seminars or webinars, completing courses or going to conferences. These activities all support your continuing professional development and by keeping a record, you are able to demonstrate effectively that you are staying at the forefront of knowledge.

Note: Each article can only be included once for CPD purposes. CONTRIBUTION POINTS Contribution to AAPM

20 points per year of service on state committees or national taskforces Or 40 points per year of service on the National AAPM Board

Activities

5 points per activity with a maximum of 20 points over 3 years for:

EDUCATION POINTS Education

AAPM courses, seminars and e-learning modules; UNEP/AAPM courses: 5 points = 1 hour of management related learning (minimum 1 hour) Other courses and study modules, seminars and online modules: Formal 2 points = 1 hour of management related learning (minimum 1 hour)

Conferences

AAPM national conference =100 points Day attendance = 30 points per day Other business or health related conferences = 50 points (max) Day attendance = 15 points per day

18 | Issue 1 – 2013

10 points for annual subscription to AAPM’s journal, the Practice Manager. 5 points for other business and healthcare management journal subscriptions per year.

• Participation on committees or working parties that represent, promote or contribute to practice management throughout the healthcare industry • Surveying for practice accreditation As an AAPM member you will be entitled to claim Continuing Professional Development (CPD) points for these and other activities. Whilst a “Member” of AAPM is not required to obtain a particular number of CPD points to continue to be a member of the Association,


AAPM recommends that all Members attain a minimum of 100 CPD points each triennium to remain current with professional practice. As the table below shows, to maintain your membership status as a Certified Practice Manager (CPM) or Fellow and the entitlement to use the relevant

Fellow Postnominal: FAAPM CPM 300 CPD points per triennium

postnominal, you are required to obtain a minimum number

• Points must be gained in at least 3 different areas with a minimum of 70% and a maximum of 90% being for formal education or conferences. • A Certified Practice Manager Certificate will be issued for maintaining 200 CPD points every 3 years • Certified Practice Managers who fail to maintain the prescribed level of CPD will no longer be eligible to hold Fellowship status.

• A Fellowship Certificate will be issued for maintaining 300 CPD Points every 3 years. • Fellows who fail to maintain the prescribed level of CPD will no longer be eligible to hold Fellowship status.

of CPD points over a three-year period. Certified Practice Manager Postnominal: CPM 200 CPD points per triennium

• Points must be gained in at least 3 different areas with a minimum of 70% and a maximum of 90% being for formal education or conferences.

Apart from education, another way to earn points is through contribution to AAPM. The Association relies upon members who volunteer their time to serve on State Branch Committees, National Taskforce Groups and the AAPM Board of Directors. Our members also represent the Association in a range of ways at a local, state, national and government level throughout the healthcare industry and this contribution is also recognised with CPD points. The My AAPM page on the AAPM web site allows you to record activity for CPD to make it very easy for you to keep track of your points.

UK managers facing a difficult year together all of the players, new and old, to focus on the delivery of better patient care. Managing waste cuts across both priorities.

“Transportation waste: picking

She quotes Don Berwick (2011) in saying that improving care and reducing waste are the same thing. “Thus, any task that does not add value from the perspective of the consumer (i.e., the patient) is the definition of waste.

community.

“A commitment to focus on patients and improve quality by eliminating waste should be central to all management decisions.”

to. Supply chain management has

What is waste?

being ignored as the reforms gather

“Waste of time: found everywhere in healthcare waiting for appointments, waiting for test results; waiting for people, services to be provided. Patients often see for themselves when people or equipment are idle.

pace, remain disjointed, promote

“This often inhibits effective decision making and thus is having a detrimental effect on good patient care.”

“Defects generate waste – delays in repairs or corrections; causing harm to patients, leading to complaints and distractions from the main event.

management, patient care will

She said the “new” skill set includes, in first place, commercial business acumen – work within budget and be more productive; with a close second of relational leadership that will bring

“Inefficient systems waste time, resources and money: LEAN has played a big part in making systems more productive, but there is a long way to go.

As the NHS reforms steamroller into 2013, there is still a skill set deficit for the managers who will need to work in the new and complex landscape, according to Susan Hodgetts, Institute of Healthcare Management chief executive. “Traditional” NHS managers freely admit that the skills they have worked with for years are no longer relevant for today’s demands and shifts of power and control. “The biggest complaint I hear is about the uncertainty around who is in control. Edicts are delivered that show a gross lack of understanding about service, process and management and are focussed exclusively around cost. Ironically the commands that are given are often ultimately more expensive and certainly not patient centric.

up, putting down, moving items or people unnecessarily, hospital visits that could be seen to in the

“Repetition and duplication: how many times does a patient have to repeat information? “Over buying, having more than you need and paying more that you have improved in recent years but there is a long way to go. “There is a danger of the above

confusion and fail to support those at the coalface who need to be trusted to make the right decisions, but who also need the right skills. “By paying attention to waste improve and there will be more resources available to enable continuous improvement. It is not rocket science. “This is a journey not a race. But if you don’t know where you are going, you will end up somewhere else.” 19 | Issue 1 – 2013


Applies to all healthcare practices

Core principles: All by Anna-Maria Gibb, MyPracticeManual email: admin@ mypracticemanual.com.au phone: 1300 96 86 36

Checklist for developing policies Policies and procedures form a critical part of the management of a practice. Time invested in creating practical, relevant policies can provides many benefits. Policies are a set of rules and principles that guide practice personnel standards of behaviour and performance. They describe the organisation’s stance on particular subjects and in response to specific situations. They may be imposed from outside – e.g., legislation, Standards, and/or originate from within the practice to determine specific management outcomes. Policies are the rules or principles that the organisation adheres to. It is the “what” and “why” actions are followed. From these policies, procedures – the “how” – are developed. Before starting out developing your organisation’s policies, consider: 1. Why is the policy relevant? What problem are you attempting to resolve; how will the policy make life easier and benefit both the staff and your patients. 2. Make sure the policy is realistic and delivers actual benefits – how will it improve services, reduce risk, minimise costs? 3. It can be hard to know where to start – make the most of the excellent resources that are available from a range of organisations, including industry-based associations, government departments and consultants. 4. To increase ownership by practice staff of new policies, it is important to consult with and involve those likely to be impacted in the development and implementation of the new policies.

5. Given that change is constant, polices should be living documents that can be reviewed and adapted to changing circumstances, as well as being discussed and improved. Other advantages of comprehensive polices include: 1. Ensuring uniform and consistent decisionmaking and operational procedures 2. Saving time and money when new problems or processes can be addressed through existing policies 3. Setting a framework for delegation of decision-making within the practice 4. Assisting in assessing performance and establishing accountability 5. Clarifying functions and responsibilities 6. Demonstrating commitment to fair and equal treatment 7. Communicating information to new staff and forming a significant part of a successful induction. A well-run practice will have policies relating to: • Code of conduct • Recruitment, induction and training • Internet and email usage • Workplace health and safety • Complaints handling • Infection control, sterilisation and cleaning • Privacy • Patient communication. Recognising the benefits of relevant, welldeveloped policies and getting the whole practice involved will increase the chances of the policies being followed and adding value to the your practice.

International keynote speakers at our 2013 national conference

Sister Mary Jean Ryan FSM, Board chairperson of SSM Health Care in the United States, led the USA healthcare quality movement and was one of the first executives to recognise the benefits of continuous quality improvement. Sir John Oldham, National clinical lead for quality and productivity for the UK Department of Health, is internationally known for his leadership in quality through the implementation of largescale projects in primary care, including the Primary Care Collaborative. He is currently responsible for improving how the national health service deals with long-term conditions and urgent care, two of the most costly and complex problems facing the service. 20 | Issue 1 – 2013


UNE Partnerships Pty Ltd T: 1800 288 622 E: practicemgt@unep.edu.au W: www. practicemanagement.edu.au

Applies to all healthcare practices

Core principle: Human resource management

What is the biggest favour you can do for your team right now? Need to do more with less, or looking for a few extra hours each day? Then aim to have high-quality decisions made by the right people in your practice. Try this approach.

Analyse Identify low-value or repetitive tasks then either: • Outsource/Delegate • Automate • Re-design  • Eliminate Remember that what a senior or experienced person considers “humdrum” will actually challenge and develop a junior staff member’s skills. Any task which is not inherently “valuable” or beneficial can be eliminated altogether.

Meetings • Don’t accept that “all meetings take an hour”. Set agendas, keep discussion on-point and respect time.

• Start by stating your desired outcome (e.g. “to make a decision about ‘x’”, rather than saying – in effect – “to get everyone to accept my preferred option”).

Empower staff Trying to solve every problem yourself only creates dependency on you. Instead, remove roadblocks and provide insight which empowers staff to back their own judgement.

Create the void Encourage staff to come to you with recommendations not problems. Discuss or enquire into their assumptions and thought process. You’ll add value as a sounding board: your insights and knowledge may help improve their decision, so share that, if needed, during the discussion.

discover skills for your practice

Training by distance and workshops

• Certificate III in Business Administration (Medical) • Certificate IV in Professional Practice Management • Diploma of Professional Practice Management leadership • service • support Call to discuss funding & study options 1800 288 622 • www.practicemanagement.edu.au

U N E P a r t n e r s h i p s P t y L t d – T h e E d u c a t i o n & T r a i n i n g C o m p a n y o f t h e U n i v e r s i t y o f N e w E21 n g| Issue l a n1d– 2013


QualITy – Does it make a difference?

The Australian Association of Practice Managers Ltd (AAPM) and Quality in Practice (QIP) are partnering to host a joint International Health Care Conference. Australia’s largest health care conference is a must-attend event in 2013. The conference delivers an action-packed program focusing on improving safety and quality in primary health care and professional development. Whether you are a practice manager, practice nurse, general practitioner, Medicare Local staff or are interested in quality health care – you will benefit from attending the International Health Care Conference.

Registration opens in March 2013 www.cdesign.com.au/aapmqip2013 22 | Issue 1 – 2013

The International Health Care Conference

25-28 SEPTEMBER 2013 SydnEy

The lively program will include a great debate on whether quality impacts the provision of health care. Stimulating plenary sessions, hands-on workshops and interactive sessions with international leaders and national experts are not to be missed. Experts in primary health care and practice management will not only present at the conference but will also be delegates. Join your peers and discuss how we can improve through professional development and apply quality every day in practice. The International Health Care program has been developed in consultation with key health organisations to ensure the sessions offer valuable learning for all health professionals. Conference streams include: – Achieving safety: aspiring to quality – A to Z of accreditation: practical strategies – Technology and innovation – Integrated primary health care – The evolving role of Practice Management, and – Kaizen: the art of quality. Workshops and master classes will be run prior to the conference. A trade exhibition will be open throughout the conference so you can learn about the latest technologies and advancements in health care.


Retrospectoscope: Our history as seen through the Practice Manager

E-mail: what is it? by Marilyn Bitomsky, Editor, the Practice Manager

Asking such a question seems almost unbelievable today, but that is exactly what we did in an article in our journal in 1996. And we weren’t alone. The world has come a long way since that time, and so too has AAPM. Our great strides forward were never more evident than at the national conference, which is covered elsewhere in this issue of the Practice Manager. But back to 1996. Here’s some of what we published. Electronic mail, or e-mail, is just another method of posting mail. The two major differentiators are speed and cost. E-mail can be sent from one side of the world to the other in about 15 seconds. It can be one paragraph long or 20 pages long. It can have documents such as spreadsheets or minutes of meetings attached to it. In fact you can move a computer file from one location to another in next to no time. E-mail also has a number of special features which reduce the time you would normally spend performing a task.

“The world has come a long way since that time, and so too has AAPM.” For instance, if you belong to a committee or group and want to communicate the same message to all the members of the group, you don’t need to type and send individual e-mails. You can set up a nickname facility so that you produce the message only once and it is sent to everyone in one swift action. When you receive a message via e-mail, you also have the added bonus of being able to reply, forward on, or redirect the message just be clicking on a button.

What about the cost? To send e-mail you need a modem installed in your computer. The modem connects you to a telephone line – your communication access.

Take any complex communication task you perform today and convert your actions from manual to electronic.

The cost of a telephone call is approximately 24 cents, so to send an e-mail message, it is going to cost you at least the cost of a telephone call.

You will actually save up to 90% of your time performing it electronically.

On top of this, you have the charge associated with your service provider. 23 | Issue 1 – 2013


by Julie Deeks, Manager Special Projects, Metro North Brisbane Medicare Local

Applies to all healthcare practices

Core principle: Human resource management,

Business and clinical operations

Medical assisting –

METRO NORTH BRISBANE

designed by doctors and tailored for the medical practice environment Medical assistants (MAs) are multi-skilled health team members, able to perform administrative tasks and front desk duties as well as a wide range of treatment room procedures. MAs perform delegated clinical tasks within the supervising practitioner’s scope of practice consistent with national and state legislation, the medical centre’s protocols and the Medical Assistant’s education, training and experience. Medical assistants undergo one year of formal training to obtain the Certificate IV in Medical Practice Assisting. In 2003 GPpartners, Australia’s largest Division of General Practice recognized a gap in training for general practice staff based on feedback received by practice liaison officers who visited the division’s 220 practices on a routine basis. General practitioners reported being overwhelmed by patient demand, unable to recruit doctors and nurses in sufficient numbers and practice nurses reported the desire to participate in higher level patient services but unable to find time to do so with the constant burden of lower level tasks. A survey at that time also showed many practices using staff not formally trained to perform clinical duties.

GPpartners designed the medical assisting course with the direct input and widespread consultation processes with medical, nursing and general practice related groups who saw a need for a medical assistant role tailored to the Australian medical practice environment. In many practices, the MA role already existed but lacked formal recognition and standardised training. In 2005 the course was adopted into the National Health Training Package, giving the qualification national recognition. The medical assisting qualification was seen as an important workforce advance by government departments and by medical indemnity companies. The Certificate IV in Medical Practice Assisting is a unique course offered by Metro North Brisbane Medicare Local as the Queensland campus for Healthfirst Training Australia (HFTA). HFTA offers the course out of Adelaide. The primary healthcare workforce shortage has been challenging to practice owners and managers for many years and evident right across Australia. With nurse shortages predicted to worsen, recognition of the MA role as an integral part of the healthcare team in a medical practice is essential in increasing the MA workforce in Australia. There is much happening in the MA field, including development of a quality assurance framework for medical assistants, forming an association of medical assistants, offering CPD opportunities and of course increasing the MA workforce Australia wide.

Medical assisting originated in the USA, with the first association for medical assistants formed in 1955. The role is well recognised and utilised in the USA, with medical assistants taking an active role in assisting the medical practitioner with patients pre- and post-consultation. Many countries have introduced “medical assistant” roles to supplement the medical and nursing workforce. These roles are called by a range of names from healthcare assistant in the UK, to clinical assistant in parts of Europe to medical assistant in other European countries and the USA. 24 | Issue 1 – 2013

If you are a practice manager and faced with the many challenges of maintaining workforce efficiency in your practice, up skilling existing administration staff to become medical assistants may provide a solution. Offering training as a medical assistant also provides professional development incentives and higher education pathways such as nursing. Currently MNBML is able to offer funding to eligible students. The course is also suited to Australian Apprenticeship pathways. Medical assisting is a workforce innovation that will no doubt have a significant impact on the future shape of Australian general practice. Please contact Julie Deeks on julie.deeks@ mnbml.com.au or 3630 7341 if you would like more information or go to our website www. mnbml.com.au.


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member benefits Discounts and other financial benefits Advantage Plus Card Accor Gift Cards

Accor brands include: Sofitel, Pullman, Novotel, Mercure and Ibis Hotels www.accorhotels.com

Away on Business 10% discount off the best unrestricted public rate of accommodation on the day.

www.guildgroup.com.au/ practicemanager Phone 1800 810 213

Practices can purchase our national employment template kit.

Discounted daily base rates Reduced insurance excess

www.avis.com.au Phone 136 333

Time & Attendance, HR & Payroll Services www.clockon.com.au Phone 02 4344 9444

www.kissites.com.au/AAPM Phone 1800 770 214

Australia’s leading VoIP Company www.engin.com.au/business Phone 1300 157 169

Rentals must be booked using the AAPM Avis Worldwide Discount number, and booked through the link on the AAPM website.

Specialising in web sites and custom business-driven applications such as Data and Workflow Management, Intranets and Business Logic implementations, Creative Intersection offer AAPM members a discount on a variety of great packages. With a system utilising leading edge technology, Engin can help you save up to 50% on your phone bills. Other benefits include: • Free line rental for the first 3 months • Save money on fixed line and call costs

GlobalArk provide a fully automated secure offsite back-up service to protect your data.

www.globalark.net

www.healthandlife.com.au Phone 1800 077 222

ClockOn offer a fully integrated system providing payroll, time and attendance, rostering, human resources, industrial relations and payroll requirements. ClockOn offers AAPM members a 7.5% Special Discount on the software fee and professional services.

AAPM members receive a 15% discount off this service.

Guild provides members with customised Practice Management professional indemnity insurance especially for your business.

www.mediprotect.com.au Phone 1800 177 163

Free initial & no obligation advice

Free subscription to our Best Practice News Alert

AAPM members receive 10% discount from IMGA Mediprotect for Practice Manager Professional Indemnity Insurance & Business Insurance.

Discounts on a wide range of IT products.

IT Products www.powerbuy.com.au Phone 1300 955 523

Health IT Magazine www.pulseitmagazine.com.au

Members must use the link on the AAPM website to access these discounts. A “cash-back” claim must be submitted to Bold Blue after purchasing an eligible product.

Australia’s first and only Health IT magazine. As part of your membership, AAPM members receive up to 5 editions of this magazine each year.

AAPM members receive a discount on Qantas Club Corporate Membership. Representing a saving www.qantas.com.au/travel/airlines/ of over $220

qantas-club/global/en

Phone 1300 425 275

www.gr8hrsolutions.com.au Phone 1300 882 906

AAPM members receive a 5% discount by quoting their AAPM Membership number on the relevant Staff systems Software order form.

Travel Club Getaways is part of the

www.fctravelclub.com.au/welcome Flight Centre Group Phone 1300 592 813

26 | Issue 1 – 2013

www.practicemanagement.edu.au

AAPM members receive a discount on enrolment fees for UNEP courses.

Phone 1800 288 622

For the latest member benefits head to the website: www.aapm.org.au


27 | Issue 1 – 2013


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Product ratings are provided by SuperRatings and Rainmaker Information, and are only one factor to be considered when making a decision. See superratings.com.au and selectingsuper.com.au for more information. H.E.S.T. Australia Ltd. ABN 66 006 818 695 AFSL No. 235249 Trustee of Health Employees Superannuation Trust Australia (HESTA) ABN 64 971 749 321. Consider a Product Disclosure Statement before making a decision about HESTA products, call 1800 813 327 or visit hesta.com.au for copies.


The Practice Manager Issue 1 2013