Introduction & Aim

This paper describes early adoption of the Australian Hospital Patient Experience Question Set (AHPEQS) and use of a real-time dashboard to drive improvements in patient experience at ward level.

Method/Change

In January 2018, Healthscope implemented the AHPEQS survey tool, developed by the Australian Commission on Safety and Quality in Health Care (ACSQHC), across their 43 hospitals nationwide. Healthscope was the first Australian healthcare provider to fully adopt and implement the AHPEQS across multiple sites.

In preparation for the national rollout of the AHPEQS across their facilities, Healthscope consulted with staff and patients, conducted a roadshow of education workshops at each hospital, procured a software platform with customised interactive dashboards, and designed procedure manuals for administration, analysis and interpretation of AHPEQS data.

Nurse Managers use the dashboard at ward level to view real-time quantitative and qualitative feedback from patients and make changes to improve patient experience. The survey and dashboard is a key component of Back to Bedside, Healthscope’s change management strategy targeting consistent person-centred care through system and behavioural change.

Outcomes

As of June 2019, the hospital group had received over 100,000 completed responses to the AHPEQS from patients. Over the past 2 years, the group has seen a rise in the core overall measure of over 10 points.

Establishment of a core patient experience indicator (overall rating of the quality of treatment and care), clearly communicated at all levels and reported through to Executive and Board, has been critical for the successful rollout of the AHPEQS. This core measure provides a patient evaluation of the integrated treatment and care provided by the hospital.

Although the survey tool is only 12 questions and therefore shorter than other instruments, one key advantage is the richness of data obtained from comments made by patients. This provides local managers with information that is key to making targeted quality improvements in integrated care, while the focus on overall rating provides the quantitative monitoring required for benchmarking over time and with peers.

Conclusion

The Australian Hospital Patient Experience Question Set is an effective survey tool for driving and communicating changes and continuous improvement in patient experience.

Introduction
The Health Quality & Safety Commission, a New Zealand crown agency charged with quality improvement across the health sector has recently begun to work in primary care and needed to build sector relationships and its own understanding of the complexity of primary care.
Beginning in February 2017, the Commission used co-creation to develop, implement, evaluate and improve Whakakotahi, te reo Māori for ‘to be as one’, the Commission’s primary care improvement programme. The Commission was guided by sector experts, the improvement teams and an external formative evaluation to enable rapid learning and adaptation.
Whakakotahi aims to improve health outcomes with a focus on Māori health gains, equity and consumer experience in primary care. The theory of change primary drivers are: partnering with Māori, integration, enhanced sector leadership and quality improvement capability, alongside consumer co-design and reduced harm and variation, supported by our use of data and knowledge. The collaborative methodology was adapted to meet the specific needs of our people and context. Key to this were primary care stakeholders and consumers, particularly Māori, Pacific peoples and/or those living in low socio-economic environments experiencing inequitable health outcomes.
Discussion
Whakakotahi is small-scale but expanding each year with an increasing focus on equity. In 2019 all participating teams serve low socio-economic populations. The eight teams include four Iwi and Māori providers, and a Pacific provider.
Whakakotahi teams are having a positive impact. Whakakotahi has built quality improvement capability in the sector alongside promising gains in health outcomes and narrowing of equity gaps. Relationships and partnerships have been built to form the base for an enduring programme of work in primary care. The challenge now is to progress to scale and spread while maintaining the key factors that have made Whakakotahi a success particularly for populations experiencing inequitable health outcomes.
The co-creation approach and small-scale incremental learning means that Whakakotahi has been able to ‘fail small’, learn and respond with agility to the needs of the sector. This led to the formation of new partnerships both within the sector and with central agencies that draw on existing expertise. This has been a key factor in maintaining the cultural safety of the Commission team and the participating primary care teams, while supporting Iwi, Māori and Pacific peoples’ approaches to improvement.
Conclusions
Partnerships and relationships are key; expertise exists within the system to improve the system. Whakakotahi has worked alongside primary care improvement teams and other agencies to seek improved health outcomes, equity, integration and consumer co-design. The teams’ diverse cultural contexts are teaching us new ways of working. This bottom-up approach, co-created with the sector as partners, has generated some early wins, but the challenge of scale-up and spread remains.
Lessons:
• Start small, build knowledge incrementally.
• Partner with those with cultural expertise and lived experience of care – especially those most affected by inequitable health outcomes.
• Ensure engagement, relationship building up front.
• Listen, learn, adapt, respond to local context.
• Share improvement stories in various fora and media for impact.

1. Data quality in general practice and its analysis has historically been poor across Australia, limiting its potential to improve patient care, provider experience and contribute to population health planning. Through partnerships between practices and support agencies the change required in general practice to realise these benefits of meaningful data usage may be met.
2. South Western Sydney PHN’s (SWSPHN) Quality Improvement in Primary Care program (QIPC) program utilises data extraction tools to generate concise reports compiled from individual practice data. By collaboratively designing these reports with practice teams and leading NGOs, data is presented in succinctly, highlighting areas of success and improvement for participating practices. SWSPHN facilitate planning workshops, in-practice training and links to referral pathways to support changes.
3. Working directly with frontline practice teams tailored solutions are developed in in partnership to overcome knowledge gaps and identify opportunities for process improvements. Through these improvements, data-led QI can improve patient care, provider experience and contribute to population health planning. The QIPC strategy works closely with providers to achieve sustainable changes of greatest impact then continues to monitor efficacy through continuous, quarterly feedback.
4. QIPC encompasses 220 computerised general practices within south western Sydney, reaching over 600 general practitioners, 270 practice nurses and 200 practice managers. Stakeholders include NGOs who provide education and support including Heart Foundation, Kidney Health Australia and Asthma Australia.
5. Built on smaller trials between 2015-17, QIPC launched in October 2017 following 3 months of intensive co-design with practice teams, 2 NGOs and PHN staff to develop a tiered practice engagement model and three varieties of meaningful reports with practice data. Data extraction software (PenCS) was installed in 130 sites by launch. 220 practices have participated as of June 2019 and 3 additional partnerships have formed, developing 4 additional reports. The first stakeholder review was completed in May of 2019 with Western Sydney University.
6. In 20 months, 20.4% increase in ethnicity recorded (>60,000 patient records), 14.2% increase in alcohol intake recording (>80,000) and a 7.5% increase in BMI recording (>50,000) was achieved. Additionally, 3,500 coded diabetes diagnosis and 1400 coded chronic kidney disease diagnoses made. Stakeholder feedback reported added value to clinicians and practice owners alike, and enhancements in patient care. Practice engagement and data has informed strategic direction for SWSPHN and stakeholders.
7. 81% of survey respondents report to have continued implementing changes initiated by QIPC; 66% of respondents report reviewing data-reports without PHN staff present. Long term sustainability is achievable with continued government support of PHNs and NGOs.
8. QIPC reports have been successfully adapted in 4 other PHN regions.
9. A well supported QI-program facilitated by PHNs, developed in collaboration with stakeholders can improve the quality of care provided to patients accessing general practice, achieve strategic objectives, inform population health planning and improve utilisation of general practice data.
10. Whilst the model is transferable, there may be benefits in localising resources to suit regional needs.
11. Early collaboration is key, continuous review of resources required, growth and dedicated lead is necessary

Theme: Evaluation, Monitoring and Quality Improvement

Innovation in Cancer Screening through Quality Improvement

Introduction
The Community-led Cancer Screening Project (CLCSP) funded by the Victorian Department of Health and Human Services is a three-year project being run in partnership with the North Western Melbourne Primary Health Network (NWMPHN), and two other Primary Health Networks in Victoria.

The project aims to increase participation in bowel, cervical and breast cancer screening programs by building capacity within primary care and through facilitated targeted community-led interventions. The project focuses on under-screened communities including Culturally and Linguistically Diverse (CALD), Aboriginal and Torres Strait Islanders and people experiencing socio-economic disadvantage.

This abstract focuses on the building capacity within primary care aspect of the project.

Practice change implemented
Evidence shows higher cancer screening participation rates with greater involvement of primary care1. This project works with general practices to understand the challenges and barriers to screening and to support practices to undertake activities to increase screening rates in these populations.

Aim and theory of change
Practices will undertake practice-based quality improvement (QI) activities using the Model for Improvement (MFI) methodology, which provides a framework for practices to develop, test and implement changes using Plan, Do, Study, Act (PDSA) cycles.

Practices will participate in three workshops that will provide clinical updates on cancer screening and the MFI methodology, and facilitate peer-to-peer learning. Practices receive in-practice support from NWMPHN staff throughout.

Using the MFI methodology practices implement changes to work towards increasing cancer screening rates. Through this process screening rates are increased, particularly for under-screened populations.

Targeted population and stakeholders
Brimbank and Wyndham Local Government Areas were selected to be the focus of this activity due to low screening rates. Specifically, the CALD community and people of low socio-economic status in Brimbank and the Aboriginal and Torres Strait Islander community in Wyndham.

Timeline
The activity commenced in May 2019 and will be implemented over 12 months.

Highlights
Development of a cancer screening QI toolkit in collaboration with participating PHNs
Practices recruited by a selection panel that included a GP and community member
Development of data reports
Completion of pre-activity confidence surveys – 23% participants not confident with cancer screening, 46% partially confident, 27% entirely confident

Sustainability
The activity aims to embed QI and develop clinical champions who can continue to support initiatives to improve cancer screening and mentor others.

Transferability
Practices will become confident in QI methodology that they can apply to other diseases/conditions. They are also provided the opportunity to share learnings with peers.

Conclusions
The MFI has been demonstrated to improve practice-level outcomes. We expect that using this methodology practices will see increased cancer screening rates in underscreened populations.

Further results available in November.

Discussions
Initially, participating practices are focusing on data cleansing, identifying eligible patients and actively recalling them. Further analysis of results available by November.

Lessons learned
The MFI is a well-accepted model for implementing change in general practice to achieve improvements such as improved cancer screening
Access to specialists is key to engaging practices

INTRODUCTION
Prescribing occurs at a rate of 85.5 prescriptions per 100 patient encounters in Australian general practices. When used appropriately medicines maintain health, manage chronic conditions and cure disease. However, medicine-related problems can lead to harm, unnecessary general practice visits and potential hospitalisation.
Evidence demonstrates that integrating pharmacists into the general practice team can reduce medicine-related problems through better medication management and coordination of care. Yet as of May 2018, only 42 pharmacists were working in Australian general practices.

PRACTICE CHANGE IMPLEMENTED
In 2018, North Western Melbourne Primary Health Network (NWMPHN) commissioned the Pharmaceutical Society of Australia (PSA) to deliver the project. Over 14-months, practice pharmacists provided medication services in three general practices within NWMPHN’s region.
The pharmacist worked as part of the practice team for 14 hours per week providing patient medication reviews, staff education and quality improvement.

AIM AND THEORY OF CHANGE
•Improve quality use of medications by patients and general practitioners (GPs).
•Optimise prescribing in general practice.
•Improve patient medication literacy and adherence.
•Identify the roles of practice pharmacists that are accepted by GPs, patients and pharmacists.

TARGETED POPULATION AND STAKEHOLDERS
The targeted population for this project was people on multiple medicines. Targeted stakeholders were general practice staff, patients and pharmacists.

TIMELINE
The project ran from January 2018 to May 2019.

HIGHLIGHTS
•Improved quality use of medications by patients via 402 patient education sessions.
•Optimised prescribing in general practice via pharmacist participation in 62 case-conferences.
•Improved patient medication literacy and adherence via the identification of adherence issues on 70 occasions.
Impact was demonstrated via the patient survey results:
•97% of patients agreed that being able to access a practice pharmacist was a valuable service.
•87% of patients agreed that after talking with the practice pharmacist they could better manage their health.
•92% of patients agreed that after talking with the practice pharmacist they felt reassured that their medicines were appropriate.

COMMENTS ON SUSTAINABILITY

Sustainability relies on the remuneration of the practice pharmacist.
Currently, practice pharmacists are remunerated through completing home medicine reviews or via pilots like this one.

In January 2020, a new Workforce Incentive Program (WIP) enabling allied health professionals working in general practice, including pharmacists, to be remunerated will be implemented. However, the WIP includes remuneration of practice nurses and therefore the uptake of practice pharmacists is likely to be low.

COMMENTS ON TRANSFERABILITY
The general practices were selected to inform the transferability of the project. They were an inner urban community health centre, an outer urban community health centre and a privately-run suburban clinic.

CONCLUSIONS
Key findings suggest integrating pharmacists into general practices:
•Is acceptable to practice staff and patients.
•Improves quality use of medications by patients and GPs.

DISCUSSION
The project demonstrated the value of practice pharmacists in multidisciplinary general practice teams and highlighted enablers to facilitate this process.

LESSIONS LEARNED
•Practices require a GP champion.
•At corporate practices, engagement is essential at all business levels.
•The pharmacist’s role varies depending on the needs of the practice, patient demographics, and GP special interests.