Assessment Methodologies
-Achieving Accreditation
Dr Stephen Clark
Group Chief Executive Officer
Australian General Practice Accreditation Limited (AGPAL) and Quality Innovation Performance (QIP)
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Presentation overview
1. The AGPAL Group of Companies.
2. Australia’s health care system and health reform.
3. Standards and the importance of Standards in General Practice.
4. Components of a Standard – criterion, explanation and indicators.
5. AGPAL’s role in General Practice Accreditation and six step accreditation process.
5. AGPAL’s accreditation support resources.
About the AGPAL Group of Companies
• The AGPAL Group of Companies
– Australian General Practice Accreditation Limited (AGPAL)
– Quality Innovation Performance (QIP)
– QIP Consulting, and
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About AGPAL
• Australian General Practice Accreditation Limited (AGPAL) is a leading independent provider of
accreditation services for:
– General practices
– Medical deputising services
– After-hours services
– Aboriginal medical services, and
About AGPAL
• AGPAL was established in 1997
• AGPAL is a not-for-profit health promotion charity
• Accredits general practices against RACGP Standards for general practices 4th edition
• AGPAL is owned by the profession including:
– Peak Medical Groups
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About QIP
• Quality Innovation Performance (QIP) is
a certification and accreditation organisation dedicated to supporting health and community services.
• QIP is a not-for-profit health promotion charity
• As part of the AGPAL Group of Companies, QIP provides accreditation and assessment services for the entire continuum of care within Australia.
• QIP has developed accreditation programs that follow patients as they progress through the Australian health system.
The AGPAL Group of Companies
continuum of care model
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About Australia’s health care system
• Provided by both private and government institutions.
• Australian Federal Minister of Health administers
national health policies, elements of which are operated by state governments.
• National health reform has resulted in an expansion of accreditation and quality improvement services across community and health care services
with Australia.
• All primary and secondary health care organisations will eventually need to be accredited against the applicable National Safety and Quality Health
About Australia’s health care system
• The NSQHS Standards provide a
nationally consistent statement of the level of care consumers should be able to expect from health services.
• There are 10 NSQHS Standards
focusing on the areas that are essential to
drive the implementation and use of safety and quality systems.
• Profession specific standards, such as the RACGP Standards for general practices, are align
themselves to the applicable areas within the NSQHS Standards.
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About Australia’s health care system
• Medicare – universal health care scheme
publically funded. Providers of Practice Incentives Program and payments.
• Pharmaceutical Benefits Scheme – considerably subsidises a range of prescription medications.
Accreditation in Australia
• The Royal Australian College of General
Practitioners (RACGP) Standards for
general practices 4th edition.
• Standards developed by the profession for the profession.
• One of the pillars of safety and quality within the Australian health care system.
• Provide a template for quality care and risk management in Australian general practice.
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Accreditation in Australia
• The RACGP Standards are designed to ensure delivery of safe and high quality primary health care within Australia.
• Have evolved with the changing landscape.
• Provide a framework for continuing development.
Components of a Standard
The Standards made up of:• Five sections - Practice services, rights and needs of patients, safety, quality improvement and
education, practice management and physical factors;
• 15 Standards;
• 41 Criterion; and
• 140 Indicators.
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Components of a Standard
Criterion – describes key components of the Standard.
Example:
Criterion 1.3.1
Health promotion and preventative care
Our practice provides health promotion, illness prevention and preventative care and a reminder system based on patient need and best available evidence.
Components of a Standard
Explanation – provides a description and explanation of key aspects of the criterion.
Example:
Key points
• Practices need a systematic approach to health
promotion, preventive care and early detection and intervention
• Practices are encouraged to provide patients with information about health promotion
and illness prevention
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Components of a Standard
Example
Flagged Indicators – Mandatory
► A. Our practice has at least one dedicated
consulting/examination room for every member of our clinical team working in our practice at any time. Unflagged Indicators – Discretionary
H. Our practice waiting area caters for the specific needs of children.
AGPAL Accreditation Process
Registration Self-assessment Application Accreditation Survey Decision Continuous Quality ImprovementSix step process
1 2 3 4 5 6
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AGPAL Accreditation Process
• By registering with AGPAL, general practices gain unlimited access to accreditation support and resources to begin their quality improvement journey.
• Clients register for accreditation via the AGPAL website.
• AGPAL’s integrated IT systems populate with new client information and prompt our finance team to issue a registration invoice.
AGPAL Accreditation Process
• Prompts are sent to AGPAL’s Client Liaison Officers who then make contact with the new client.
• A unique client ID, username and password is
generated to allow new clients to access AGPAL’s:
– Online self-assessment tool, AccreditationPro, and
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AGPAL Accreditation Process
• Self-assessment is an internally led process whereby a general practice determines the
degree to which it meets the requirements of the RACGP Standards.
• AGPAL’s web-based self-assessment tool,
AccreditationPro, plays a unique role in guiding
general practices throughout the entire self-assessment process.
AGPAL Accreditation Process
• AccreditationPro, allows practices to work through
the evidence requirements of the RACGP
Standards, allowing them to input information and upload documents to indicate their compliance.
• Links to customisable templates, resources and requirement explanations are also provided.
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AGPAL Accreditation Process
• Saving the self-assessment as they go,
AccreditationPro allows practices to break down
the process, allocating specific Standards to specific members of the practice team.
• If a particular Standard requirement within the self-assessment is not met by the practice,
AccreditationPro allows for an action plan to be
created for practices to complete prior to submission of their self-assessment.
AGPAL Accreditation Process
• Prior to application for accreditation, practices
use AccreditationPro to check they have
completed all self-assessment requirements by ensuring all sections are marked as complete.
• To apply for accreditation, the practice submits its completed self-assessment to AGPAL. Submission of self-assessment is a paperless and fully
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AGPAL Accreditation Process
• Submission of the self-assessment indicates a practice is ready for the accreditation survey.
• When the self-assessment is submitted via
AccreditationPro, an automated alert is provided
to prompt AGPAL’s finance department to issue a client invoice.
• Accreditation planning commences on receipt of payment.
AGPAL Accreditation Process
• AGPAL’s survey teams are made up of a general practitioner and a co-surveyor, usually an
experienced practice nurse or practice manager.
• Surveyors use AGPAL’s online surveyor portal to demonstrate their availability for accreditation surveys and are allocated clients accordingly.
• Once allocated, the survey team reviews a
practice’s self-assessment by logging in to the AGPAL Surveyor version of
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AGPAL Accreditation Process
• This self-assessment review allows surveyors to identify any key areas of concern / clarification prior to conducting the on-site accreditation survey.
• The suvrey team liaises with the practice to
determine a mutually convenient accreditation on-site survey date.
• An on-site accreditation survey usually occurs three months before the practice’s
AGPAL Accreditation Process
• During an on-site accreditation survey, the AGPAL Surveyors will interview members of the practice team (e.g. GP, practice manager) and review
documentation (e.g. policies, educating and
training certificates) and practice equipment (e.g. vaccine fridge, medicine cabinet).
• While on-site, AGPAL Surveyors are able to log in
to AccreditationPro to directly enter their findings
against the RACGP Standard requirements.
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AGPAL Accreditation Process
• Prior to an accreditation decision being made, AGPAL Surveyors complete their accreditation report in AccreditationPro and submit their findings via this channel.
• A decision is made about a practice’s
accreditation status by an independent AGPAL Accreditation Decision Maker, taking into
consideration all available evidence contained within AccreditationPro.
AGPAL Accreditation Process
• If areas of non-compliance are identified practices are given a period of time, know as Natural
Justice, to rectify and provide evidence to demonstrate their compliance before a final accreditation decision is made.
• If a practice is awarded their accredited status, this is flagged within AGPAL’s IT systems and a Client Liaison Officer is then able to formally congratulate the practice team.
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Accreditation Survey
Common areas of non-compliance
• Criterion 3.1.2 Clinical risk management systems
• Standard 4.2 Management of health information
• Criterion 5.3.2 Vaccine potency
Accreditation Survey
Most highly compliant areas
Over 99% of AGPAL accredited practices are compliant with the following criterions.
• Criterion 1.4.2 Clinical autonomy for general practices
• Criterion 1.6.1 Engaging with other services
• Criterion 2.1.3 Presence of a third party
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AGPAL Accreditation Process
• Once accreditation has been achieved, the practice is identified as accredited on the AGPAL website
and provided with a number of marketing resources provided to promote their achievement to their
local community.
• Practices continue to implement quality
improvements throughout a three year cycle.
Evidence of continuous quality improvements and implementation processes formulate
part of the RACGP Standard requirements.
AGPAL’s Accreditation Resources
• AccreditationPro, AGPAL’s web-based self assessment tool • QbAY, AGPAL’s web-based library of resources and templates • AGPAL publications including Quality News magazine and
AGPAL Assist e-bulletin
• Ongoing general practice education and training
• Materials to help practices promote their accredited status • Dedicated AGPAL Client Liaison Team support
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Accreditation Resources
About AccreditationPro
• One of the first electronic self-assessment systems in Australia.
• Minimises time and effort in preparation and submission of the online self-assessment.
• Reduces the amount of paper work involved in the accreditation process.
• Guides health services through the self-assessment process. • Provides helpful prompts regarding required evidence.
• Produces a list of the team members who are likely to be interview during the self-assessment process.
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About AccreditationPro
• Automatically generates a self-assessment workbook with action plan.
• Links to extensive online resources and templates. • Provides a quality framework for the practice.
Financial Incentives
Practice Incentive Program (PIP)
• PIP is an Australian Government Department of Human Services program.
• PIP is aimed at supporting general practice activities that encourage continuing improvements and quality care,
enhance capacity and improve access to health outcomes for patients.
• To be eligible for PIP practices must be accredited or
registered for accreditation against the RACGP Standards. • Practices must apply for specific PIP payments, meeting
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Financial Incentives
Levels of PIP payments for general practice
• PIP payments are generally based on a measure of the practice size known as the Standardised Whole Patient Equivalent (SWPE) value.
• Taking the SWPE value into consideration and depending on the incentives a practice applies for, depends on the calculated amount of PIP funding received.
• For example, one of the offerings linked to the PIP Asthma Incentive is payment to GPs for each completed cycle of care for patients with moderate to severe asthma at a rate of $100 per patient per year. There are a number of
Benefits of AGPAL Accreditation
• Improved patient safety.• Effective risk management.
• Patient assurance that a high level of care is provided. • Building a culture of quality within the practice
environment.
• Developing staff skills and engaging the practice team in continuous quality improvement.
• Increased recognition from insurance providers. • Eligibility to access financial incentives such as the
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