if annualreport final131112

IF AnnuAl RepoRt 2013

Chairman’s Report ........................................................ 3

Welcome from our CEO ................................................ 4

Our History .................................................................... 5

IF’s Journey ................................................................... 6

Sharing our work with others ........................................ 9

IF Improvement Award ................................................ 10

Collaborative Methodology ........................................... 11

Measuring for Improvement ........................................ 15

Technology at IF .......................................................... 16

Partnerships, Products & Programs ............................ 17

Our Leadership ........................................................... 20

Our People .................................................................. 22

Our Strategy for the Future .......................................... 25

Financials .................................................................... 26

Contents

IF will be a recognised leader in, and centre of excellence for, the design, development and delivery of quality improvement programs for health care and community services.

The aim of the Improvement Foundation is to lead the country in enabling and driving quality improvement in the primary health care sector.

IF empowers organisations, teams and individuals to improve the quality of their services, whether services are delivered directly to patients or delivered by supporting organisations to general practices or primary health care services.

We do this by:

• Designing and implementing large and small scale improvement programs that produce rapid improvements that benefit communities

• Developing individuals and teams through the transfer of skills and knowledge. This is achieved through their engagement with improvement programs and direct training and development courses

• Measuring. We accurately and reliably measure our program activity and allow the measurement system to be used broadly by others

• Encouraging knowledge, innovation and sharing by building networks from the ground up

• Providing a unique quality improvement portal which supports and assists the improvement of our primary and indigenous health sectors.

We are passionate about improvement work that transforms the lives of individuals and communities. Our values are the basis for what we do and how we do it:

• We only do work that we expect will make a real difference to individuals and communities

• We are committed to the transfer of skills for large scale improvement within communities

• We encourage innovation, creativity, continuous improvement and learning

• We value every individual’s contribution to the success of the team

• We provide an open, fair and supportive environment for our staff and for those who work with us

• We are committed to the responsible use of resources through a transparent way of working and the achievement of demonstrable results

• We demonstrate excellence, integrity, timeliness, accountability, accuracy and we are dependable.

ouR VIsIon ouR MIssIon ouR VAlues

ChAIRMAn’s RepoRt

On behalf of the Board and staff, welcome to our first annual report. Here we have the opportunity to recognise the IF journey, the people that have helped along the way, and the outcomes achieved over the past 12 months and since IF was formed in Australia.

The Improvement Foundation (Australia) was formed in November 2006 and commenced operations in Adelaide in January 2007. This was made possible by support from the Improvement Foundation (UK) and in particular, Sir John Oldham, the Chairman of the UK IF, at the time. Sir John’s guidance was inspirational in providing the foundations for the organisation in Australia. Ms Ruth Kennedy, who was CEO of IF (UK), has also provided strong and enduring support over many years, and continues to do so as one of our directors.

Dr Dale Ford and Ms Claire Caesar were fundamental in the formation of IF in Australia, and remain centrally involved in our strategic direction and operations today.

Since the formation of IF, our CEO Mr Colin Frick has been instrumental in providing management leadership to build a cohesive team. Our philosophy is to practice what we preach and to look constantly at how we can improve internally and externally. The staff have been active and willing participants in this process.

IF has touched many people and organisations over the years, in a variety of ways, from helping people to think differently about the way services are provided, to the actual quality of the services delivered, and ultimately improving outcomes for patients.

Our future lies in being recognised as an organisation where key stakeholders can come for information and services related to improving outcomes in health care. Our stakeholders include governments, associations, health care providers and any organisation that wants to make a difference to the health of the population. We want to assist our stakeholders in improving their policy and practice, which in turn leads to positive outcomes for patients.

Finally, I would like to acknowledge the Australian Government and the Department of Health for their continuing support, encouragement and belief in our efforts to improve health outcomes in Australia.

We encourage all readers of this Annual Report to look at ways we can work together for the mutual benefit of the population we serve.

David J Wright MBA, MHMS, B.Ed, Cert.Ed, Chairman

IF has touched many people and organisations over

the years, in a variety of ways, from helping

people to think differently about the way services

are provided, to the actual quality of the

services delivered, and ultimately improving

outcomes for patients.

The APCC Program is the first and largest quality

improvement program of its type in Australia

APCC Improving health

outcomes for more than:

patients with diabetes

320,000 &patients with coronary

heart disease

210,000APCC - A 55% improvement means that 35,000 more

people with diabetes have their blood sugar recorded within

recommended limits

55% = 35,000

APCC - An 85% improvement means that 34,000 more people

with diabetes now have their cholesterol recorded within

recommended targets

85% = 34,000

practicesand health services

85patients registered

to the PCEHR system

shared health summaries uploaded

4,500 1,700

Individual practices and health services in the

APCC Program

1,300primary health care

professionals trained to use quality improvement.

3,000

eCollaborative practices and health services - 2% of

total services registered, 37% of all Shared Health

Summary uploads to PCEHRregistered users

1,000

APCC - A 55% improvement means that 34,000 more people

with diabetes now have their blood pressure recorded within

recommended limits

55% = 34,000

Developed and implemented OCHREStreams. The first

national online reporting tool for Aboriginal and Torres Strait

Islander Health Services

3Improvement Foundation Annual Report 2012/20132

ouR hIstoRy

As this is IF’s first annual report, we have included a short introduction to our history, which in some ways, began before we did.

The 2003/04 Budget saw the announcement of the introduction of the National Primary Care Collaboratives (NPCC) Program in Australia. Collaborative Methodology had proved highly successful in the UK, delivered by the National Primary Care Development Team (NPDT), which later was renamed as the UK Improvement Foundation, and the federal government wished to drive similar improvements in primary health care in Australia.

Two Australian teams from Flinders Consulting trained in the UK with NPDT, and key staff from NPDT came to Australia to facilitate implementation and share considerable intellectual property. From 2004 to 2007 the National Primary Care Collaboratives (NPCC) quality improvement methodology was delivered through 43 Divisions of General Practice to 615 general practices, 630 FTE GPs and 370 additional practice team members.

November 2006 The Improvement Foundation (Australia) Ltd was established in Adelaide as a not-for-profit charity.

September 2007 The Improvement Foundation won the tender to implement the APCC Program.

From 2008, the Australian Primary Care Collaboratives (APCC) Program delivered four Collaborative ‘waves’ on the topics of diabetes, chronic heart disease and access and care redesign. As additional funding

was made available, further topics, including chronic obstructive pulmonary disease and prevention, and patient self-management were also developed and delivered

September 2009 Launched the IF Web Portal. Now named qiConnect, this secure web portal enabled users to upload and monitor their improvement measures, as well as navigate to a range of quality improvement tools, indicators, and resources. It marked the beginning of a key tool for Divisions, now known as Medicare Locals, to monitor their practices’ and health services’ participation and progress in quality improvement programs and initiatives.

July 2010 The Improvement Foundation and our partner OBS won the tender to develop a web based reporting tool (web portal) for the Department of Health and Ageing’s Office for Aboriginal and Torres Strait Islander Health (OATSIH).

The web portal, OCHREStreams, enables a single, fast, reliable, and efficient transmission of service data, and streamlined reporting from Aboriginal and Torres Strait Islander health services to the Department. It replaces the range of separate web-based and paper-based processes that services previously had to fill in to report on service activity and program performance.

July 2011 The Department of Health and Ageing granted IF a one year extension, to June 2012, to continue delivering the APCC Program.

September 2011 Improve Australia, an Australian not-for-profit organisation made up of a small

group of people involved with IF in Australia, takes over the membership of the Improvement Foundation (Australia) Ltd to make it a 100% Australian-owned organisation.

June 2012 By now, over 1,100 general practices, more than 90 Divisions of General Practice and approximately 2,300 general practice staff had participated in a Collaborative wave.

September 2012 IF was awarded a three year contract to deliver the APCC Program to 2015. This funding enables the Collaborative Program to be delivered to an additional 500 Australian general practices and health services, including allied health services. In addition it enables extensive training for Medicare Locals with support to embed continuous quality improvement into their work. IF will also be working closely with the Australian Medicare Local Alliance (AML Alliance) on the design and delivery of this phase of the Program.

December 2012 The eCollaboratives – 21st Century Patient Care and Self- Management wave began. This wave supported general practices and health services to improve outcomes for patients with chronic disease, improve patient self-management and be ready to use the Personally Controlled Electronic Health Record.

WelCoMe FRoM ouR Ceo

Welcome to the Improvement Foundation’s (IF) first annual report. As an organisation we have been, and continue to be, supported by a team of talented people committed to achieving our objectives.

Firstly, I’d like to recognise the key leaders and Board members, including Mr David Wright, our inaugural Chair, for their central role in establishing IF, and specifically David’s direction, leadership and support in growing our organisation.

I’d like to recognise the efforts of the small team of talented individuals who joined the newly formed IF and worked together in the successful 2007 bid for the Australian Primary Care Collaboratives (APCC) Program tender. Many of them are still working at IF today. The APCC is our flagship Program, and has played an important part in shaping our organisation and improving Australian primary health care.

Over time, we have developed our capability and expanded our services. We have enjoyed continued Commonwealth Government support for our quality improvement programs. These programs have expanded to include support for Aboriginal and Torres Strait Islander community controlled health services, and support for the implementation of Australia’s health reform, including the eHeath reform.

This work would not have been possible without the support we have received from many organisations, groups and individuals. These include IF’s Principal Clinical Advisor, Dr Dale Ford, the APCC

Program’s Clinical Advisor, Dr Tony Lembke, Expert Reference Panels and their Chairs; Australia’s leading researchers who provide us with the evidence to base our improvement work on, and key national organisations. There are simply too many people and organisations to recognise here; thank you everyone who has helped us over the years.

We have also had the privilege of working with many thousands of primary health care professionals. I am inspired by the professionalism and dedication these general practitioners, Aboriginal and Torres Strait Islander health workers, practice nurses and managers have shown to improving patient outcomes, which is clearly visible through their involvement in our programs.

Finally, our team. We have a wonderful team of people who work hard and strive to succeed. I’d like to thank each and every one of our hardworking team members, past and present, for their tireless and invaluable efforts.

Colin Frick Chief Executive Officer

I am inspired by the professionalism and

dedication these general practitioners, Aboriginal and Torres Strait Islander health

workers, practice nurses and managers

have shown to improving patient

outcomes, which is clearly visible through

their involvement in our programs.

54 Improvement Foundation Annual Report 2012/2013

IF’s jouRney: tRAnsFoRMIng pRIMARy CARe thRough quAlIty IMpRoVeMent

kidney disease, cancer screening and eHealth.

Intrinsic to the success of the APCC has been partnership with local practices, health services, and their support organisations. This began with Divisions and is now flowing through a close working relationship with Medicare Locals and the Australian Medicare Local Alliance.

Through the APCC IF has improved the care of hundreds of thousands of patients, empowered hundreds of primary care practices to improve the way they work and enhanced the effectiveness of Medicare Locals to engage with their practices and health services.

Laying the groundwork to support sustainable change

Throughout the life of the APCC, IF has been strategic in building essential infrastructure and relationships to support the national refocus of the health system on primary care. As well as improving direct patient care IF has built lasting and significant landscape features to support a primary care focussed health system.

Significant achievements include:

Data extraction tools

The Canning Tool and Pen Clinical Audit Tool were created and fostered to support the data collection required for measuring for improvement in the APCC. These tools have unlocked the greatest repository of clinical data in the health system and have now become essential supports to practices, Medicare Locals and governments to track improvements in health service delivery. They are opening up general practice and health service data to national improvement.

A continuous quality improvement culture

Concepts such as the model for improvement, PDSA cycles and measurement for improvement were virtually unknown in Australian general practice before 2004. They have become widely known and accepted in Australian primary care through the work of IF.

OCHREStreams

The success of the APCC Program led to IF building and managing of data reporting systems for Aboriginal and Torres Strait Islander Health

Services across Australia through the OCHREStreams data portal. Lessons learnt from this experience have in turn informed the design of IF’s national qiConnect portal for primary care data.

Aboriginal and Torres Strait Islander Health

Through the APCC Program, participants in the Closing the Gap wave focused on improving health outcomes for Aboriginal and Torres Strait Islander peoples. IF is now a preferred training provider to the National Aboriginal Community Controlled Health Organisation.

qiConnect

Through continuous improvement in data extraction, handling and reporting IF has developed and launched qiConnect, a national data portal with capacity for all primary care practices, health services and support organisations in Australia. qiConnect permits individual practices and health services to submit clinical data and monitor their own improvement. Secure, ethical aggregation of data enables regional, state and national views of clinical primary care outcome measures. Geographical information

Dr Andrew Knight, Clinical Advisor

Dr Andrew Knight is a Clinical Advisor at IF and has co-authored a number of articles, which have been published in a variety of peer reviewed medical journals over the past two years.

Since 2008, when IF began implementing its flagship quality improvement program, the APCC Program, IF has built its work to provide essential infrastructure and relationships that support a refocus, and transformation of the Australian primary health care sector.

IF’s journey: Transforming primary care through quality improvement

In the last three decades the rapid emergence of chronic disease and multimorbity as the leading burden of disease have increasingly strained finances and delivery systems around the world. Health budgets are ballooning in some countries and some predictions suggest they could overwhelm national budgets in the next few decades.

The work of health system researcher Barbara Starfield, and others, demonstrated that health systems which are centred on primary care can provide higher quality care with better outcomes at lower cost. The World Health Organisation in its landmark publication ‘Primary Health: Now More Than Ever’ outlined the urgent imperative to transform healthcare systems to be centred on primary care.

In Australia we face a unique set of advantages and challenges as we focus on primary care. While the Australian health system is recognised as one of the best in the world, the federal/state funding split creates fractures and perverse drivers. General practice has many strengths but is variable in quality. Levers for change are few and relatively ineffective. How are we to ensure general practice assumes and succeeds in its central role in achieving affordable, effective health care for all?

Can quality improvement collaboratives support the shift to a primary care centred health system?

The Improvement Foundation, through its core activity the Australian Primary Care Collaborative (APCC) Program, has contributed to a transformation of the primary healthcare system since 2004. The Improvement Foundation team has been there since the early, very challenging days. The APCC is now a widely accepted, highly valued, key element in improving primary care.

The APCC has since reached over 1300 individual practices and health services which care for hundreds of thousands of Australians living with chronic diseases. Each APCC wave has demonstrated important measurable improvements in front-line patient care.

There is now an extensive library of evidence-based improvement topics available to practices and regional primary health care organisations including access and care redesign, diabetes, coronary heart disease, COPD, patient self management, prevention of chronic disease, Aboriginal health, chronic

APCC has improved the care of hundreds of

thousands of patients

The APCC Program is the first and largest quality

improvement program of its type in Australia

Tools created to unlock the greatest repository of health

data in the health system

Building and managing of data reporting systems for Aboriginal and Torres Strait


APCC - A 55% improvement means that 34,000 more people

with diabetes now have their blood pressure recorded within

recommended limits

55% = 34,000For the first time a national picture of primary care data

is a realistic possibility


shARIng ouR WoRk WIth otheRs

Presenting at conferences

We recognises the value of showcasing our work and sharing our knowledge with others at Australian and international primary care conferences. Over time, our clinical staff and consultants have become sought after presenters at national and international conferences and other events.

In the media

IF recognises the importance of publishing information and results in the public sphere. This not only serves as a promotional tool for our programs, it’s also an important way for sharing success stories and innovative ideas for participants, identifying gaps in the primary care sector and addressing needs, in the hope that these will be replicated at other services.

In recent years, IF have focused on sharing and promoting our work, with an emphasis on medical media and peer–reviewed journal articles.

system overlays support health care planning across the whole health system for the first time. For the first time a national picture of primary care data is a realistic possibility.

eHealth

IF has had a pivotal role in trialling the national eHealth record system through two collaborative waves. As at 31 July 2013 participants of the eCollaboratives – 21st Century Patient Care and Self-Management Wave made up just 2% of all organisations registered to the Personally Controlled Electronic Health System, and had uploaded over 37% of the total number of Shared Health Summaries to the system.

Medicare Local partners

IF has provided advanced training in quality improvement to Medicare Local staff through customised Medicare Local programs. Quality improvement and the APCC are transforming from ’a project’ to being seen as a key tool for achieving all the strategic goals of the organisations. IF is working closely with the Australian Medicare Local Alliance to support Medicare Locals in achieving this continuous improvement culture.

Our clinical staff and consultants have

become sought after presenters at national

and international conferences and other events, both nationally

and abroad.

Looking to the future

Achieving improved health outcomes for Australians will require sustained investment in primary care. IF has embraced the opportunity to scale up and embed quality improvement through Medicare Locals in partnership with the Australian Medicare Local Alliance. As the Minister for Health said in 2012, “Some 1100 of Australia’s 7300 general practices have been engaged through the Collaboratives process. The idea is that by entrenching the work of the Collaboratives as core business for Medicare Locals, we can make it a focus across the primary health care system.”

Primary care is the answer. Improving general practice is the strategy. The Improvement Foundation has the tools, the people, the experience and the track record to play a key role in the transformation to a health system fit for the challenges of the 21st century.

Some 1100 of Australia’s 7300

general practices have been engaged through

the Collaboratives process. The idea is that by entrenching

the work of the Collaboratives as core business for Medicare Locals, we can make

it a focus across the primary health

care system.

eCollaborative practices and health services - 2% of

total services registered, 37% of all Shared Health

Summary uploads to PCEHR

Pivotal role in trialling the national eHealth

record system

QI and the APCC are now key tools for achieving organisational goals Dr Tony Lembke, APCC Clinical Director and eCollaborative Clinical Lead.


There is sound scientific evidence which tells us that current primary health care practices can be greatly improved, however, there is a gap between what we know and what we do. The Breakthrough Series Collaborative methodology was designed to help organisations close that evidence-practice gap by creating a structure in which teams can easily learn from each other and from recognised experts in selected topic areas.

Breakthrough Series Collaborative methodology, first developed in the USA by the Institute of Healthcare Improvement, has been applied to a wide range of management challenges. It was originally applied to healthcare systems in the USA, and has been adopted in other countries, including the UK, Scotland, Canada and New Zealand.

IF has adapted the Breakthrough Series Collaborative methodology and applied it as the framework for our Collaborative and other quality improvement programs.

Patient representation in quality improvement Collaboratives

We believe that when it comes to chronic disease management, patients are the experts as they live with their condition 24 hours a day. IF has developed a comprehensive and ambitious Patient Engagement Strategy for the meaningful involvement of patients in the design and delivery of health services. This is based on the commitment that involving patient representatives in improving the quality of care for all patients will support the development of a more patient-centred culture and will result in significantly improved health outcomes.

Since 2010, IF has involved patient representatives in Collaborative work. We have built on this experience to introduce an improved method of patient representation in future Collaborative Waves. This includes the involvement of a patient mentor to provide coaching and support to patients that participate in the Collaborative journey.

“I was diagnosed with Type 1 Diabetes at age 22 after my immune system overreacted to a post-operative infection. I’m very excited

to be a patient representative in the APCC Diabetes Prevention and Management Wave. I hope that sharing my experiences and journey will help to improve care for people with Type 1 Diabetes.” Karen, Patient Representative, Adelaide, SA

Australian Primary Care Collaboratives Program

The Australian Primary Care Collaboratives (APCC) Program is the first and largest quality improvement program of its type in Australia.

Since 2004, The APCC Program has helped more than 2,500 general practitioners (GPs) and primary health care providers work together to:

• Improve patient clinical outcomes• Reduce lifestyle risk factors• Help maintain good health for

those with chronic and complex conditions; and

• Promote a culture of quality improvement in primary health care.

In an APCC Collaborative, colleagues come together at a series of learning workshops. They hear from experts and their peers, exchange ideas, share experiences and learn about practical quality improvement skills.

IF IMpRoVeMent AWARd

In 2012, IF launched a new award to recognise the commitment individuals make towards quality improvement work. The Improvement Award was opened to primary health care employees across Australia who had been involved in quality improvement activities within their work place.

The 2012 Improvement Award was awarded to the team at Montague Farm Medical Centre, SA, who have worked together to devise effective ways to empower patients, increase productivity and decrease waiting times through their involvement in both the APCC Program and the eCollaborative – 21st Century Patient Care and Self-Management Wave.

As part of the award Montague Farm Medical Centre’s Practice Manager,

Mr Prashiba Thavarajadeva, was given the opportunity to attend the Institute for Healthcare Improvement (IHI) 24th Annual National Forum, in Orlando, USA to learn from quality improvement experts from around the world.

“We are just a local practice striving to improve the quality of our patient care. I found the conference very motivating with its focus on thinking more broadly, building teams and making connections - work that is already embedded in the culture of Montague Farm,” said Prashiba.

‘With 5,500 people attending the conference, all focused on making improvements in health care, it felt more like a movement than just a conference. The immense scope of the work being done worldwide, with

so many people working towards the same goals, inspired us with a new energy and enthusiasm for the work we are doing here in Montague Farm’, said Prashiba

Prashiba was presented with the award by Colin Frick, IF’s CEO who said “it was inspiring to see their success and such a diverse range of improvements across the practice”.

CollAboRAtIVe Methodology

primary health care professionals trained to

use quality improvement.

3,000

APCC Improving health

outcomes for more than:

patients with diabetes

320,000 &patients with coronary

heart disease

210,000Colin Frick ,IF CEO (left), with Prashiba Thavarajadeva (centre) and the Montague Farm Medical Centre Team.


Medicare Local Quality Improvement Partnership

The Medicare Local Quality Improvement Partnership, formerly named the Medicare Local National Wave, was introduced as a component of the APCC Program in 2012. This program has been custom-designed by IF, utilising the guidance of quality improvement and change management experts, and application experts from experienced Divisions of General Practice, and the first tranche of Medicare Locals.

The objective is to give Medicare Local teams the tools and skills to embed continuous quality improvement systems into all aspects of their organisation, and into their day-to-day work. The program includes supporting Medicare Local teams to develop a plan to support the improvement of chronic disease management and/or prevention, with flexibility to choose a topic that is a priority in their regions. Medicare Locals are supported to work with general practices, health services, and allied health providers as part of their plan to support these practices, services and providers to move towards best practice in the chosen

topic area. This approach also assists with strengthening the relationship that Medicare Locals have with health practitioners in their regions.

Methodology

Teams of three staff from participating Medicare Locals attend a series of three Quality Improvement Partnership workshops where they learn about the fundamental components of quality improvement and change management, and have a shared space to network, share ideas and learn from peers. In between workshops, IF Program Managers coach each team to develop a plan that addresses a local health priority. These priorities have included advanced care directives, after hours care, the use of eHealth to support chronic disease management, diabetes management, and many others.

IF is currently working with the Australian Medicare Local Alliance to deliver a further two Quality Improvement Partnerships so that all Medicare Locals can participate in a QIP by 2015.

“Being involved in the APCC Program has worked on a number of levels for us. It’s been great for team building at our Medicare Local. The work we did with our practices supports the strategic objectives of improving the patient journey, and we are now equipped with a QI tool that helps us to break down potentially overwhelming tasks or information into small chunks.” Vesna Thon, After Hours Liaison & Community Engagement Officer, Northern Adelaide Medicare Local, SA

In between workshops, participants are supported to apply what they’ve learnt to deliver measurable, systematic, and sustainable improvements in the care they provide to patients. The changes are made in small, bite sized chunks, using the proven quality improvement tool, the ‘Model for Improvement’.

“Once a practice has accurate records of who their patients are, and what conditions they’ve got, it helps the practice team to target specific patient groups for proactive or ongoing treatment,” Dr Dale Ford, Principal Clinical Advisor, IF.

Topics included in APCC Program waves over the years have included:

• Access and Care Redesign

• Diabetes

• Coronary Heart Disease

• Chronic Obstructive Pulmonary Disease

• Prevention and Management of Chronic Conditions, with a focus on diabetes

• Closing the Gap, which includes the above topics with a focus on the health of Aboriginal and Torres Strait Islander peoples

National Collaborative Waves

In December 2012, 16 Medicare Locals supporting 60 general practices and health services commenced a National Diabetes Prevention and Management Collaborative Wave which will carry through until April 2014.

May 2013 saw another National Diabetes Prevention and Management Collaborative Wave begin, with 18 Medicare Locals and 50 health services participating.

“The APCC Program has provided a change model that is benefitting everyone - our GPs, nurses, reception staff and our patients - what could be better than that?” Jackie Turner, Practice Nurse and Manager, Coliban Medical Centre, VIC

“The APCC Program has been instrumental in developing and enhancing General Practice processes of care which lead to better health outcomes for people living with chronic disease.” Professor Claire Jackson, President, Royal Australian College of General Practitioners, 2010.

This program utilises the guidance of quality

improvement and change management

experts, and application experts.

APCC - A 55% improvement means that 35,000 more

people with diabetes have their blood sugar recorded within

recommended limits

55% = 35,000

collaboratives participants presenting to their peers

at workshops

340Plan, Do, Study, Act

cycles recorded

35,000

APCC Workshop


MeAsuRIng FoR IMpRoVeMent

Behind the measures

Chronic diseases constitute the leading causes of mortality and morbidity in Australia.

When a person experiences ill health as a result of having a chronic disease, it can prevent them leading a full life. People with chronic disease may be limited in their ability to participate fully in the workforce or family life, and have serious complications.

For example, diabetes is the sixth leading cause of death in Australia and our fastest growing chronic disease, costing up to $6 billion a year.

There is clear evidence that if a person with Type 2 diabetes has their blood sugar level (HBA1c) well controlled that there is less chance of that person developing complications arising from the disease. Complications can include hospitalisation, amputations, vision problems, heart problems and impaired kidney function.

“Analysed data helps your health services create a profile of disease & morbidity which in turn can be used realistically to enable you to target areas of need & improvement within the practice & contribute to your community’s health in a meaningful way.” Dr Nick Stephens, Daisy Hill Medical Centre, QLD

Regular reporting of measures is a key feature of quality improvement activity. It helps organisations assess their progress, identify areas for improvement, and benchmark themselves against others. In IF’s quality improvement programs, it must be stressed that measures are reported for the purposes of tracking improvements in the topic areas. The measures are not a performance management tool.

Through the development of a robust measurement data set for the APCC Program, IF has worked with nationally recognised organisations such as the Royal Australian College of General Practitioners, the Heart Foundation, Diabetes Australia, and the Australian Lung Foundation.

Measures enable participants to track the health status, and improvements over time, for people with or at risk of chronic conditions such as diabetes and heart disease. At the start of the APCC Program, just 10 measures were collected. Over time, IF has increased this to 299 measures. Broken down, these measures contain more than 2,200 unique data elements.

The IF measurement set spans diabetes, coronary heart disease, chronic disease prevention, chronic obstructive pulmonary disease, Aboriginal and Torres Strait Islander status, and a range of other health status indicators that help health services track improvements over time for their patient population. The measures are consistent across the nation to allow for individual practice, regional and national level progress to be measured in each topic. There is a robust security system in place to aggregate data at the health service level to ensure that no individual identifiable patient details can be collected once the data leaves the health service.

The IF measures have been a catalyst for change within primary health care:

• IF has pioneered an innovative web based ‘measurement for improvement’ system, qiConnect so health services can track their improvement through a safe and secure web portal.

• Clinical software vendors are revising their programs to better align with the data collection requirements of the IF measures.

eCollaborative: 21st Century Patient Care and Self-Management Wave

In 2011, IF was contracted by the National E-Health Transition Authority (NEHTA) to deliver a quality improvement Collaborative to help Australian general practices adopt the soon-to-be developed Personally Controlled Electronic Health Record (PCEHR).

The eCollaborative Wave applied the Collaborative methodology of quality improvement to the challenge of improving outcomes for people living with chronic disease using technology - promoting better patient self-management and improved integration of patient care teams.

The first eCollaborative Wave was delivered between February and September 2012. As a direct result

of the work undertaken in this Collaborative, and the results achieved, IF was commissioned to deliver a second eCollaborative Wave, which commenced on 1 November 2012.

Efforts were directed at understanding the requirements of the PCEHR, establishing systems and work processes within participating practices and health services to support data quality and the accuracy of shared health summaries, engaging patients in the PCEHR system and developing systems to improve the integration of care across the team. Practices and health services in this program achieved outstanding results. They made up just 2% of the total services registered to the PCEHR system, and uploaded 37% of all shared health records as a 31 July 2013.

Cancer Screening Collaborative (The Cancer Institute NSW)

The Cancer Institute of NSW commissioned IF to develop a Cancer Screening Primary Care Collaborative (CSPCC) to support the NSW Cancer Plan to substantially improve cancer control throughout the state.

IF is currently working with The Cancer Institute of NSW to finalise the CSPCC Handbook, including its aims, change principles, ideas and measurements, along with examples, best practice guidelines and tools for change. These will all be made available to general practices involved in the CSPCC. IF continues to work with the Cancer Institute team to explore the best way to deliver the CSPCC program.

Building and managing of data reporting systems for Aboriginal and Torres Strait


Collecting 299 measures = 2224 unique data elements

299 APCC - An 85% improvement means that 34,000 more people

with diabetes now have their cholesterol recorded within

recommended targets

85% = 34,000

eCollaborative Workshop


pARtneRshIps, pRoduCts & pRogRAMsteChnology At IF

Partnering with NACCHO and State Affiliates to improve Aboriginal Health Outcomes

In late 2012 IF became a preferred training provider for National Aboriginal Community Controlled Health Organisation (NACCHO) and Aboriginal Community Controlled Health Organisation state (ACCHO) affiliates. IF continues to work with NACCHO in building a true partnership in the delivery of continuous quality improvement programs aimed at improving health for Aboriginal and Torres Strait Islander peoples across Australia.

Past years have seen IF working with the NACCHO and State and Territory Affiliates across a number of quality improvement programs including the APCC Program and OCHREStreams.

This work has been further enhanced by our strong working relationship with the Queensland ACCHO Affiliate, the Queensland Aboriginal and Islander Health Council (QAIHC).

Early discussions with QAIHC established a good understanding of how IF could support QAIHC programs through the development of a specific measurement set. The continuing strength of this working

relationship has seen QAIHC champion the development of a QAIHC specific site hosted on IF’s qiConnect (for more information on qiConnect, see over). Success with the QAIHC site led to the establishment of an additional Affiliate qiConnect site, for the Victorian Aboriginal Community Controlled Health Organisation (VACCHO).

IF continues to work closely with both QAIHC and VACCHO to engage health services across Queensland and Victoria to participate in the qiConnect CQI programs. These sites enable Affiliates to support health services through quality improvement programs and establish a good understanding of the effect these programs have on improving health outcomes.

“Our partnership with the Improvement Foundation is built on a shared recognition of the value of using data to assist in clinical CQI work. QAIHC, with the support of IF, has provided our member services a way to review their patient data via qiConnect. We have also established steps for making system changes at the practice level, resulting from participation in the IF Closing the Gap Collaborative, which has

IF is quickly becoming recognised as an Information Technology (IT) leader in primary care within Australia. Through our strategic and creative use of Microsoft SharePoint and other technologies, we have developed and built a number of online tools used for reporting, monitoring, managing and organising various data and information. These tools and projects all sit within the IF Web Portal and include:

• OCHREStreams

• qiConnect

• Customer Relationship Management System

• Geographic Information System

Secure infrastructure

The IF Web Portal, which houses each of the above projects, is hosted at a secure datacentre in Brisbane. The infrastructure environment is monitored, supported and managed by specialist personnel, and has a regular security update program, as well as daily offsite backups with replication to the alternative site. These security measures help to enable IF to run our QI programs in a highly secure and protected manner.

Through our strategic and creative use of

technologies, we have developed and built a number of online tools

used for reporting, monitoring, managing and organising various data and information.

IF is a preferred training provider to the National Aboriginal

Community Controlled Health Organisation

Developed and implemented OCHREStreams. The first

national online reporting tool for Aboriginal and Torres Strait


Aboriginal Medical Services are registered to submit

reports through OCHREStreams

320

eCollaborative Workshop


qiCommunity

Supported by the discussion forum on qiConnect, the qiCommunity provides a platform for previous, current and future participants of IF QI programs to engage in conversation and share ideas, challenges and resources.

Over the past financial year, the bulk of activity within the qiCommunity has revolved around the support of Medicare Locals during their transition from Divisions of General Practice. The qiCommunity meetings have provided a forum for Medicare Local staff to network and share their experiences, particularly in the early days of the transition. Participants have also shared and gained knowledge of quality improvement tools and techniques.

qiCommunity meetings have been held in New South Wales, Queensland and Victoria, covering topics such as e-Health, allied health engagement, and embedding quality improvement through service level support.

Quality improvement training

Over the past year IF has significantly expanded our suite of QI training products. Training has been designed and delivered for both face to face delivery and through the use of webinar technology. Webinar technology has enabled cost effective training to be delivered to a large number of participants without the need to take time off or travel long distances.

Pathways to eHealth

The Pathways to eHealth program consists of two online learning series, with the intended outcome that participants will become eHealth ready; by registering for the electronic practice incentive payment (ePIP) and by using the Personally Controlled Electronic Health Record (PCEHR) System.

Each webinar series comprises between five and seven short sessions, which are designed to provide practical examples and steps for services to make improvements in chronic disease management.

Quality improvement webinars

Remote Vocational Training Scheme

IF has been delivering quality improvement training to registrars in rural and remote areas through the Remote Vocational Training Scheme (RVTS). Twice a month, third-year registrars join a webinar to learn about quality improvement topics, such as building a practice team, the Model for Improvement, clinical audit tools and data quality.

It is an opportunity for a very diverse range of doctors from across Australia to come together and hear from some of the experts in the field of quality improvement.

Rural Health West, WA

Since May 2013, IF has been delivering a monthly QI webinar series for Rural Health West. Rural Health West supports a number of initiatives in Western Australia that aim to grow and retain the rural health workforce in the state. The aim is to use these sessions raise awareness of QI as a whole and assist practices toward accreditation.

Topics have included QI tools, and measuring for improvement. Future sessions will explore access to primary care and using QI to achieve better outcomes in chronic disease management.

resulted in improved quality of care for Aboriginal Communities across Queensland. QAIHC continues to lead CQI work for our Aboriginal and Islander Community Controlled Health Services and continues to work with IF in further improving systems, data collection and analysis”. Dr Katie Panaretto, Public Health Medical Officer (QAIHC).

qiConnect

“Thousands of primary health care organisations have trusted IF with the safe custodianship of their practice and health service level data. Access to good quality data is essential for the provision of good quality health care and improving health systems. Without access to these data we could not see so many positive outcomes, nor continue working with health professionals who are at the forefront of improving Australian health outcomes.” Colin Frick, CEO, Improvement Foundation

The 2012/13 financial year saw the development and launch of qiConnect. qiConnect is an innovative web portal that provides a gateway to the qiCommunity, as well as to an extensive range of quality improvement tools, services and

resources oriented towards general practices and Aboriginal and Torres Strait Islander health services, as well as the services that support them, such as NACCHO, the Affiliates and Medicare Locals. Any of the organisations that support services involved in our quality improvement programs can use qiConnect to benchmark improvements against the Medicare Local, State or Territory and national averages; generate reports from real-time graphs, analyse service data to track improvements, and identify areas where extra support may be required.

Medicare Local QI Sites

Medicare Local QI sites enable Medicare Locals to create custom program pages for local quality improvement activities. With a custom QI site in qiConnect, Medicare Locals can lead and coordinate their own quality improvement initiatives with health services in their region, leveraging the qiConnect functionality to engage their services via a private discussion space, share resources restricted to participants, track progress at a range of aggregations (health service, Medicare Local, national average)

and map health metrics against a backdrop of population health data.

GIS functionality

The inclusion of GIS (Geographic Information System) functionality is a new and exciting development within qiConnect. Within a quality improvement context, GIS can assist by highlighting potential issues and areas for improvement, as well as identifying eligible non-participating services situated in high need areas, for quality improvement initiatives focused on particular issues or chronic diseases. GIS is also a powerful tool for supporting Medicare Locals with reports, strategic planning and workforce planning. As IF learns more about how Medicare Locals are applying GIS technology within their regions over time, the functionality and range of information within GIS and qiConnect will expand.

“qiConnect allows users to turn data into knowledge. Data analysis enables users to identify issues, improve processes and make informed improvements. This ultimately leads to better patient health outcomes.” Corey McWhinnie, Primary Care Support Officer, Nepean-Blue Mountains Medicare Local

Over the past year IF has significantly

expanded our suite of QI training products.

Webinar technology has enabled cost

effective training to be delivered to a large number of participants

without the need to take time off or travel

long distances.

registered users

1,000 QI and the APCC are now key tools for achieving organisational goals

For the first time a national picture of primary care data

is a realistic possibility


Key Consultants

Enhancing IF’s wealth of knowledge and experience are our key consultants:

Dr Dale Ford, Principal Clinical Advisor and Chair, Chronic Kidney Disease Expert Reference Panel

Dale has considerable quality improvement experience specialising in the application of Collaboratives. He has been involved in the APCC Program since its inception, initially as its inaugural clinical chair. Dale has trained in the Collaborative methodology and quality improvement techniques in the UK and the US and has presented extensively throughout Australia, New Zealand, Asia, and Europe.

Dale has been a GP and owner in a Group Practice in the regional Victorian city of Hamilton for more than 25 years, where he had had appointments in General Medicine and Intensive Care at the local Health Service.

He has been the Chair and then Medical Director of Otway Division of General Practice, and is now on the Board of the Great South Coast Medicare Local. Dale helped set up the Regional GP Training Provider, Greater Green Triangle GP Education and Training, and is currently Chair of the merged Southern GP Training Ltd.

Dale’s other quality improvement positions include being a member of the Quality and Safety Commission’s Primary Care Committee, and a member of the APCC Quality Improvement Programs Advisory Group.

Dr Tony Lembke, Clinical Director for APCC and Clinical Lead for eCollaboratives

Originally a participant in the NPCC program in 2005, Tony has been Clinical Director for the APCC since 2007 and inaugural Clinical Lead for the eCollaboratives Program since 2011. Tony is Chair of the North Coast NSW Medicare Local and Chair of the General Practice Forum of the Australian Medicare Local Alliance. He has a strong interest in Health Information Management Information Technology, and has served on a number of national eHealth advisory groups, including as a National eHealth Transition Authority Clinical Lead. Tony is a member of the APCC Quality Improvement Programs Advisory Group.

Dr Andrew Knight, Clinical Advisor, Clinical Lead Medicare Local QI Partnerships, and Chair, Access and Care Redesign Expert Reference Panel,

Andrew has a long standing interest in quality improvement in general practice and is a clinical consultant to the APCC Program, as well as a leading author on several internationally and nationally published peer reviewed journal articles. Andrew was the first consultant to have successfully published IF’s collaborative achievements in an international journal, the British Medical Journal.

ouR leAdeRshIp

The Board

IF is governed by a Board of four members, with experience and expertise in primary care and quality improvement on both a national, and international scale.

David Wright, Chairman

David Wright has been Chair of the IF Board since 2006. He consults in health care internationally as an Advisor to the Bahrain Defence Force Royal Medical Services, and also as a registered international expert on health care quality improvement with the European Commission and the International Society for Quality in Healthcare (ISQua). During 2011 he supported the Economic Development Board of Bahrain as Director of Healthcare Reform on their 2030 Vision for the Kingdom.

Previously, David has been the CEO of the Royal Australian College of General Practitioners between 2003-2008.

David was also the inaugural CEO of the Australian General Practice Accreditation Limited between 1998 and 2003, and the inaugural Managing Director of Quality in Practice (QIP) between 2000 and 2003.

Ms Claire Caesar, Secretary

Claire helped to establish the Improvement Foundation in Australia in 2006 and continues to identify strategic opportunities for IF to extend its quality improvement work in the Australian and Asia-Pacific health and community services sectors.

Claire is also the Principal of a private consulting business and has extensive knowledge in government policy development, implementation and evaluation experience, with over ten years in the federal public sector.

Claire has worked in the health and community welfare field for more than two decades. During this time she has worked across the spectrum of government, non-government and community agencies, managed government budgets in excess of $386 million annually, and led initiatives to strategically reform primary health care and population health.

Ms Ruth Kennedy

The Chief Executive Officer for the Improvement Foundation, UK from 2006 to 2010, Ruth Kennedy has over 25 years of leadership and management experience in the National Health Service (NHS) UK, and within the private sector. From 2003 to 2006, Ruth was Chief Executive of NPDT (National Primary Care Development Team) which led the improvement of primary care in general practice across the UK. Ruth co-founded and established both the Improvement Foundation UK, and the Improvement Foundation Australia, in 2006.

Ms Rosey Batt

Rosey Batt founded Rosey Batt & Associates in 2001 with the vision of creating a highly professional legal firm that valued its clients and provided a family friendly environment for staff. The firm now employs five full time lawyers and a number of law clerks.

Rosey has had extensive commercial legal experience acting for publicly listed companies, small to medium enterprises and individuals. Her primary areas of practice are in business transactions, trade practices, commercialisation of business opportunities, resolving disputes, and intellectual property. She has extensive Board experience and currently sits on a number of Private and Public Sector Boards. She has also held the position of Chair and Deputy Chair on a number of Corporate Governance committees.

The Finance, Audit and Risk Management (FARM) Committee

Established by the Board in early 2010, the FARM Committee consists of three members; Mr Bruce Thomas, Chair, Mr John Mortimore and Mr David Wright.

The Committee meets on a quarterly basis and provides advice and recommendations to the Board. The responsibilities of the Committee are: Financial governance, external reporting & financial statement compliance, reviewing and recommending internal audits, risk management, external auditing.

Enhancing IF’s wealth of knowledge and

experience are our key consultants:

Dr Dale FordDr Tony Lembke

Dr Andrew Knight


training provider. No serious WHS incidents were reported in 2012/2013.

Work/life balance

Creating work/life balance for our staff includes providing flexible work policies to cater to each person’s family commitments, their health and wellness, and being able to leave work at a reasonable hour each day. IF have invested in IT infrastructure which affords all staff the advantage of working from home if required. These benefits are highly valued by staff and enables them to balance their work and home life commitments.

Creating an ‘EPIC’ place to work by Enhancing Performance & Improving Culture

As we’ve grown, IF has continued to maintain a strong organisational culture and an emphasis on work-life

IF also has expertise with geographical information systems (GIS). GIS is a system designed to capture, store, manipulate, analyse, manage and present all types of geographical data. GIS is an area of growth and opportunity for IF, and can provide significant benefits for our clients.

Staff tenure

IF has achieved an enviable balance of maintaining the wealth of experience that has accumulated over the numerous projects, programs and consultancy work within the organisation, whilst attracting new team members who contribute new skills, experiences and ideas to our work.

Investing in our people

To ensure we attract and retain our key people we take particular care in enhancing team members’ working lives through our organisational culture. There are a number of ways we do this.

Opportunities to advance

Job satisfaction is important to us. We provide our staff with professional development opportunities through in-house or subsidised accredited training. We also work with individuals to define and support their career paths and support our staff to demonstrate new skills and learning, either through promotion or with more responsibility.

Training opportunities

We provide staff with a mix of appropriate group and individually based in-house training, certified training by external providers, internal mentoring programs and sponsored social and sporting activities.

Keeping our people safe from harm

IF has a Work Health and Safety committee who have undertaken WHS training through an external

ouR people

Our people are our greatest asset. Our team of highly skilled staff come together from a diverse range of backgrounds, experiences and expertise. Each and every person, from our administration assistants through to our senior managers, contributes to a vibrant, professional and highly effective organisation.

IF was established in Adelaide in 2006 and in 2007 recruited a CEO and just five staff. To meet the growing demand for our services, IF now employ a total of 46 staff, with most located at our head office in Adelaide, four in Brisbane and one in Melbourne.

Key roles

Our Program Managers are key to our organisational success in delivering quality programs, projects and consultancy. The Program Manager team comprise staff that have:

• Significant practical experience of working in the health sector

• Hands on experience of quality improvement methodology, specifically the Collaborative methodology

• Practical experience working with data collection, analysis and interpretation

• Prince2 practitioner accreditation

• Training design and delivery skills.

Our Business Analysts provide fundamental support with the design, implementation and support of our programs. Their broad skill sets include:

• Experience in analysing the program or project needs and translating these into innovative technical solutions

• Working closely with the client to support the development of technical solutions

• Advanced Microsoft SharePoint technical skills and experience

• Significant system testing capabilities.

Our people are our greatest asset. Each

and every person, from our administration

assistants through to our senior managers,

contributes to a vibrant, professional and highly effective

organisation.

IF new office opening, November 2012

Gatti Triathalon Series, Adelaide, Jan 2013


ouR stRAtegy FoR the FutuRe

The environment in which we work; and our internal capabilities will shape what we do to achieve our goals. Twice a year, IF uses a whole of team approach to inform the strategy of the organisation. This ensures that the wealth of knowledge our team has is captured in a dynamic way to ensure our strategy remains relevant and on track.

In the years ahead IF will be focusing on:

• Delivering services to a wider range of clients to support quality improvement in the primary health sector. This means developing a greater range of products and services to meet the needs of this sector.

• Continuing to grow our capacity to work with health professionals to collect and feedback their general practice and health service data in a meaningful way, including having a greater

engagement with the allied health sector.

• Working with Medicare Locals and the Australian Medicare Local Alliance to build Australia’s capacity to support improvements in primary health care

• Continuing to provide and develop support for the adoption of Australia’s eHealth reform, and

• Maintaining and growing our talented staff.

IF currently has a strong engagement with the Aboriginal and Torres Strait Islander health sector and we will continue striving to support Aboriginal and Torres Strait Islander peoples to receive better health care. We plan to do this by working closely with the National Aboriginal Community Controlled Health Organisation, State and Territory Affiliates, Aboriginal and Torres Strait Islander Community Controlled Health Organisations, Medicare Locals and interested general practices.

at IF. To provide ongoing support to staff, IF has recently introduced the Employee Assistance Program, a confidential third party assistance and support service to help staff manage stress and other issues that may affect their roles, and ultimately, their wellbeing both inside and externally to IF.

Internal continuous quality improvement

Continuous quality improvement is at the heart of everything we do. We emphasise the need to evaluate and improve wherever possible through each of our training and collaborative programs.

balance. This has been evidenced by a number of corporate sponsored events and functions, internal training, professional development opportunities, and continuous support of various charities through fundraising initiatives and activities. This internal culture was formalised in 2009, through the development of the EPIC (Enhancing Performance & Improving Culture) team.

The EPIC model is based on five domains of learning: creative, mental, intellectual, physical and social.

To inform the EPIC team, an annual survey is conducted with staff. The Pulse Survey assesses the engagement and satisfaction of staff

In 2009, IF achieved the ISO 9001: 2008 accreditation and has successfully maintained this status.

A quality management system continues to drive our commitment to continuous improvement, and all our quality management and internal governance activities are underpinned by IF’s regular risk planning and review framework.

From Our Staff...

“People work towards getting a ‘yes’, and they are not afraid to raise a new idea”

Rachel Ambagtsheer, Principal Consultant, Population Health and Service Planning

“I’ve never seen teamwork as good as I have seen here at IF”

Cati Smith, Program Manager

“The energy and passion that exists within the organisation is great, coupled with a sense that you’re ultimately contributing towards improving the state of play in healthcare”

Donna Bridges, Senior Program Manager

“IF is the only organisation I’ve worked for that has such an overwhelmingly friendly working environment”

Matt Lewis, Technical Specialist

IF uses a whole of team approach to

inform the strategy of the organisation. This

ensures that the wealth of knowledge our team

has is captured in a dynamic way to ensure

our strategy remains relevant and on track.

We plan to continue delivering OCHREStreams, but recognise that the collection and reporting of data does not in itself achieve improvement. It takes hard work and local level innovation. We remain committed to working with frontline staff to achieve measureable improvements.

Project meeting 2013


FinancialsExtract from Improvement Foundation (Australia) Ltd Annual Account 2012-13


Statement of Comprehensive Income for the Year Ended 30 June 2013

12 months to 30 June 2013

Revenue from government and other grants 8,888,712

Project and workshop expenses (1,902,751)

Gross surplus 6,985,961

Other revenues 193,112

Marketing expense (125,654)

Occupancy expenses (342,927)

Administration expenses (2,562,111)

Depreciation expense (160,055)

Employee benefits expense (3,796,664)

Finance costs (348)

Surplus before income tax 191,314

Income tax expense -

Surplus for the year 191,314

Other comprehensive income -

Total comprehensive income 191,314

Attributable to the entity 191,314

30 June 2013 30 June 2012

Assets

Cash and cash equivalents 2,086,962 1,804,609

Trade and other receivables 1,551,527 1,279,597

Other assets - -

Total Current assets 3,638,489 3,084,206

Property, plant and equipment 555,674 245,532

Intangible assets 70,000 70,000

Total non-current assets 625,674 315,532

Total assets 4,264,163 3,399,738

Liabilities

Trade and other payables 1,879,784 1,784,955

Employee benefits 473,508 274,486

Other liabilities 379,260 -

Total current liabilities 2,732,552 2,059,441

Total liabilities 2,732,552 2,059,441

Net assets 1,531,611 1,340,297

Equity

Retained earnings 1,531,611 1,340,297

Total Equity 1,531,611 1,340,297



Retained earnings Total

Balance at 31 March 2012 1,722,784 1,722,784

Total comprehensive income (382,487) (382,487)

Balance at 30 June 2012 1,340,297 1,340,297

Total comprehensive income 191,314 191,314

Balance at 30 June 2013 1,531,611 1,531,611

Notes

Once IF became a wholly Australian owned company we changed financial years in 2012 from the United Kingdom March 31 end of financial year to the Australian 30 June end of financial year.

The data shown in this extract is taken from the Improvement Foundation (Australia) Ltd Annual Accounts for 2012-13.

28

Improvement Foundation

T +61 8 8422 7400 | F +61 8 8231 6690

E [email protected] | www.improve.org.au

Level 5, 19 Grenfell St Adelaide SA 5000

PO Box 3645 Rundle Mall SA 5000

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