The eCollaborative: using a quality improvement collaborative to implement the National eHealth Record System in Australian primary care practices.

QUALITY PROBLEM: The new national patient-controlled electronic health record is an important quality improvement, and there was a pressing need to pilot its use in Australian primary care practices. Implementation of electronic health records in other countries has met with mixed success. INITIAL ASSESSMENT: New work was required in general practices participating in the national electronic health record. National implementers needed to engage with small private general practices to test the changes before general introduction. CHOICE OF SOLUTION: The National E-health Transition Authority contracted the Improvement Foundation Australia to conduct a quality improvement collaborative based on 9 years of experience with the Australian Primary Care Collaborative Program. IMPLEMENTATION: Aims, measures and change ideas were addressed in a collaborative programme of workshops and supported activity periods. Data quality measures and numbers of health summaries uploaded were collected monthly. Challenges such as the delay in implementation of the electronic health summary were met. EVALUATION: Fifty-six practices participated. Nine hundred and twenty-nine patients registered to participate, and 650 shared health summaries were uploaded. Five hundred and nineteen patient views occurred. Four hundred and twenty-one plan/do/study/act cycles were submitted by participating practices. LESSONS LEARNED: The collaborative methodology was adapted for implementing innovation and proved useful for engaging with multiple small practices, facilitating low-risk testing of processes, sharing ideas among participants, development of clinical champions and development of resources to support wider use. Email discussion between participants and system designers facilitated improvements. Data quality was a key challenge for this innovation, and quality measures chosen require development. Patient participants were partners in improvement.

Appointment zen - shaping demand and matching capacity.

BACKGROUND: Ten years of experience with hundreds of general practices in the Australian Primary Care Collaboratives program has provided many lessons for improving practice appointment systems. OBJECTIVE: In this article, we describe how general practitioners can, by actively managing our appointment systems, reduce waiting times and delays, improve patient care, improve our quality of life and improve practice financial viability. DISCUSSION: Demand is finite and predictable. We can shape our demand by influencing when, why and for whom people make appointments. We can change our daily appointment numbers and our team capacity to match our reshaped demand. Contingency plans for expected and unexpected drops in capacity can prevent appointment backlogs. Embedding and monitoring our demand and capacity management can help ensure smooth flow of patients through the practice with good care and improved staff and patient satisfaction.

Co-design of the Spinal Cord Injury Health Maintenance Tool to Support Self-Management: A Mixed-Methods Approach.

Background: There is a lack of consumer-friendly tools to empower and support people living with spinal cord injury (SCI) to self-manage complex health needs in community. This article describes the co-design process of the new SCI Health Maintenance Tool (SCI-HMT). Methods: Co-design of the SCI-HMT using a mixed-methods approach included a rapid review, e-Delphi surveys with range of multidisciplinary health care professionals (n = 62), interviews of participants with SCI (n = 18) and general practitioners (n = 4), focus groups (n = 3 with 7, 4, and 4 participants with SCI, respectively), design workshops with stakeholders (n = 11, 8), and end-user testing (n = 41). Results: The SCI-HMT (healthmaintenancetool.com) was developed based on participatory research with data synthesis from multiple sources. Five priority health maintenance issues for bladder, bowel, skin, pain, and autonomic dysreflexia were originally covered. Best practice recommendations, red flag conditions, referrals, and clinical pathways were agreed on through an e-Delphi technique. Qualitative analysis identified six broad key concepts for self-management, including early symptom recognition, role of SCI peers, knowledge sharing with primary care, general practitioners as gatekeepers, and shared decision-making and highlighted a need to place much stronger emphasis on mental health and well-being. Design workshops and end-user testing provided key insights about user experience, functionality, and content for the SCI-HMT. Conclusion: The co-design process engaging end users, including people with SCI and general practitioners, enabled a shared understanding of the problem and identification of important needs and how to meet them. Informed by this process, the SCI-HMT is a freely accessible resource supporting SCI self-management, shared decision-making, and early problem identification.

Appointments 101--how to shape a more effective appointment system.

BACKGROUND: Maximising the effectiveness of your appointment system in general practice has the potential to connect patients and clinicians for timely care and create a sustainable working environment. OBJECTIVE: This article shares lessons from the Australian Primary Care Collaboratives program that can help individual practices to shape their appointment system to their needs in order to improve both access and patient care. DISCUSSION: Five common appointment strategies have emerged through the work of the Australian Primary Care Collaboratives: open access, book on the day, supersaturate, carve out and advanced access systems. All these systems have advantages and disadvantages and may suit different practices depending on their contexts and populations. It is helpful to measure how effective the current practice approach is in dealing with delay and delivering satisfaction. Specific approaches such as 'appointment golf' and 'jeopardy doctor' may help improve system functioning. Practices should make intentional choices about their appointment system to meet the needs of their patients, staff and clinicians.

Appointments - getting it right.

BACKGROUND: Only 36% of sick Australians report being able to get an appointment on the day they need it, which is poor by international standards. This delay in care may impact on practice team morale, practice profitability and patient care. The Australian Primary Care Collaboratives Program aims to find better ways to provide primary healthcare services to patients through shared learning, peer support, training, education and support systems. OBJECTIVE: This article shares lessons from the Australian Primary Care Collaboratives Program that can help practices improve appointment scheduling. We describe steps to improving control of your practice scheduling - and your life - by measuring your practice demand, capacity and delay. DISCUSSION: Demand for appointments is finite, predictable and can be shaped. Delay is waste and the enemy of good healthcare. Where delay can be eliminated it should be. By measuring practice demand and capacity, improvements can be designed which will result in reduction in measured delay and patient unmet needs, and increased patient satisfaction.

Ten tips for becoming a Time Lord

BACKGROUND: There is evidence that extended waiting is the most important cause of patient dissatisfaction with a visit to their general practice. While waiting is sometimes unavoidable in primary care, sometimes its causes are systemic and modifiable. Our experience is that some doctors rarely run late and yet seem to meet their patients' needs. We call these colleagues 'Time Lords'. OBJECTIVE: The aim of this article is to revise and share tips to help others become Time Lords. DISCUSSION: We describe four tips that depend on good preparation. A further six involve maximising the value of consulting time. Waiting is sometimes unavoidable in general practice. Our patients accept this and so must we. However, we can do much to improve our patients' satisfaction by taking waiting as seriously as they do and minimising it.