Nicky Of Oz

A series revealing practice management wizardry from Nicky’s health industry experience of 30+ years

Chapter 4 : Quality Improvement In Practice Management

Keeping yourself buoyant with managing a new or existing practice and introducing quality improvement.

Whether you are managing an existing practice, in the process of setting up a new practice or have had a new practice for a few weeks or months, there always seems to be a tendency to become “bogged” down in the day-to-day operations and not in the strategic direction of the practice. The problem with this is that you get to the stage where you are just going through the motions of working, you are bored or you are fed up. When you get like this you need to focus on projects.

The Practice Incentive Program (PIP) pays an incentive for Quality Improvement. This is primarily for improving the quality of care and clinical data of patients but it is also about developing new business plans to achieve this. At the moment PIP do not audit practices for this payment. You are required to have the PENCAT tool (Clinical Data Tool) and also send de-identified data to your PHN to receive the payment.

Setting up quarterly programs is good to keep the staff progressing and improve the quality of the clinical data and patient care. For example, it could be as simple as increasing allergies in the medical software i.e. 50% of patients have their allergies recorded and you want to increase that percentage to 80%. An idea would be to meet with the nursing staff and ask them how they are going to improve this.

You may be reading this and thinking “that’s a boring project” but there are several aspects of any quality improvement that not only improves data but also improves practice income.

For example, you may want to focus on patients who are visiting the practice the following week, and not only ask them to come in and see the nurse beforehand so they can update data but also do a care plan or health assessment if required. That also saves the patient from making another visit for a plan. Some fantastic tools can also help with this process. One product worth looking at is Cubiko. The software has scores of matrixes to identify patients who require care plans, health assessments etc. The software also has matrixes that pick up item numbers that should have been invoiced i.e. nurse items 10997 which can be billed if the nurse is part of the care plan.

A few ideas for clinical improvement data are found via this tooltip link*.

Another project could be purchasing a diagnostic medical tool. This could be skin cancer diagnostic equipment or equipment for diagnosing Peripheral Arterial Disease. There are item numbers you can charge for most diagnostic equipment.

For the new practice owner, there is the excitement of starting a new practice and then the deflation of the practice starting and maybe not making as much money or seeing as many patients as you thought you would. I have set up so many medical practices that I can tell when the owners are starting to get this, and it’s imperative to dust yourself off and refocus.

A new project could be organising your website, updating blogs and social media regularly. This is exceptionally important for any new or existing practice to keep patients engaged but also attracts new doctors to your practice. Potential candidates always look at websites for a medical practice. If it looks boring, unfinished or has old information, it is a sign that the practice has lost interest or is disorganised.

As highlighted in The 2021 Accenture Health and Life Sciences Experience survey:
‘Australians report relatively high satisfaction from their experiences with the healthcare system — but trouble navigating the complex system and the cost of services can lead to disengagement with the patient journey and cause delays in accessing care, potentially worsening health outcomes.’

Continually striving to improve systems and processes within your practice can create a point of difference that patients may come to appreciate.

To recap, don’t let yourself get bored. General practice is a business. You need to keep focused on projects, income and new ideas. You need to focus on your budget, a target or a goal. Setting up these every month, quarter or even annually can be fun for all staff. It gives staff a purpose for their position and then there is pride when staff have achieved something.

* The Quality Improvement Toolkit For General Practice Is Courtesy of Brisbane South PHN

What is ‘Nicky Of Oz’

Being a Practice Manager in General Practice is challenging, rewarding and frustrating all at the same time. Protocols are consistently changing along with Medicare item numbers and new initiatives which are thrown onto General Practice at the last minute. Don’t get me wrong, it is an exciting profession to be in and you are constantly learning. It also helps if you have a good sense of humour and thick skin.

I have been in the Australian health industry for over 30 years. I migrated from the UK and started working for an ENT surgeon in Sydney. He was also new to Australia and setting up a new practice. It was also the first time that computers were used in general practice. I can still remember going in for a typing test for my interview. I was tapping away and nothing was happening. Both the ENT surgeon and I were complaining about the typewriter as it was new and appeared to be broken already. It turned out that the typewriter was not plugged in. Those were the days. Plenty of laughs over the past 30 years and many friends and colleagues made.

The aim of this blog is to supply as much information as I can to you as it currently stands in 2022. I hope to retire in the next few years and have learnt so much. It is a shame to retire without passing on what I have learned. You will also read some funny stories – all anonymous of course, but refreshing and real. I hope you enjoy reading these blogs.

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