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Exercise & Sports Science Australia Submission to Australian

Commission on Safety and Quality in Health Care

Patient safety and quality improvement in primary care

Janette Frazer-Allen Standards Senior Advisory Exercise & Sports Science Australia Janette.Frazer-Allen@essa.org.au

Katie Lyndon Policy & Advisory Manager Exercise & Sports Science Australia Katie.Lyndon@essa.org.au

Anita Hobson-Powell Chief Executive Officer Exercise & Sports Science Australia Anita.Hobson-Powell@essa.org.au

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22 December 2017

Thank you for the opportunity to submit feedback to help inform the patient safety and quality

improvement in primary care project. Exercise & Sports Science Australia (ESSA) is a professional

association representing tertiary trained accredited exercise scientists, accredited sports scientists

and accredited exercise physiologists (AEPs). AEPs are recognised allied health professionals who

provide clinical exercise interventions aimed at primary and secondary prevention; managing sub-

acute and chronic disease or injury; and assist in restoring optimal physical function, health and

wellness.

1. The scope of primary care services as the focus for the Commission’s program of work.

The consultation paper defines primary care services as: ‘services provided by general practitioners, practice and community nurses, nurse practitioners, allied health professionals, midwives, pharmacists, dentists and Aboriginal and Torres Strait Islander health practitioners either, in the home, general or other private practice, community health services and local or non-government services’. Do you consider this to be an appropriate definition of primary care? Should this definition be amended? If so, what should be addressed in an alternative definition of primary care?

The proposed definition of primary care services is inclusive of a range of primary health service

providers and a range of health care settings. However, to be comprehensive, it is suggested that the

definition should be inclusive of health conditions, the purpose of the primary care services provided,

such as health promotion, disease prevention, health maintenance, health education and continuity

of care in the diagnosis and treatment of acute and chronic illness. In addition, consideration could

be given to the scope of delivery modalities to ensure that in addition to addressing the needs of

today, it also considers the direction of health service delivery of the future and the increasing use of

technology in delivery and monitoring of these services.

To be truly comprehensive of the primary care environment, the definition needs to be able to

incorporate all professions that provide services in a primary care setting to allow for evolution in

practice of primary care, as well as support patients to make informed choice about their care. To be

flexible enough to adapt to changes over time, rather than focusing on specific settings and

professions, the definition needs to provide for the recognition of the quality framework of health

care delivery and evidence base that contributes to health care knowledge to support a consumer

centred care approach to health care quality, safety and delivery.

The Australian Primary Health Care Research Institute (APHCRI) definition or the World Health

Organization (WHO) (1978) Declaration of Alma Ata provide for alternative definitions.

APHCRI definition: “Primary health care is socially appropriate, universally accessible, scientifically

sound first level care provided by health services and systems with a suitably trained workforce

comprised of multi-disciplinary teams supported by integrated referral systems in a way that: gives

priority to those most in need and addresses health inequalities; maximises community and individual

self-reliance, participation and control; and involves collaboration and partnership with other sectors

to promote public health. Comprehensive primary health care includes health promotion, illness

prevention, treatment and care of the sick, community development and advocacy and

rehabilitation.”

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World Health Organization (WHO) (1978) Declaration of Alma Ata: “Essential health care based on

practical, scientifically sound and socially acceptable methods and technology made universally

accessible to individuals and families in the community through their full participation and at a cost

that the community and country can afford to maintain at every stage of their development in the

spirit of self-reliance and self-determination. It forms an integral part both of the country’s health

system of which it is the central function and main focus, and the overall social and economic

development of the community. It is the first level of contact of individuals, the family and community

with the national health system bringing health care as close as possible to where people live and

work, and constitutes the first element of a continuing health care process.”

2. Safety and quality issues in Australian primary care services.

What are the safety and quality issues experienced by you, your primary care service or the primary care services you support? What strategies have been implemented to address these? Have these been evaluated? Have you noticed any changes in the quality of the service you receive or provide? What additional strategies, tools or resources should be developed and/or made available to make these strategies more effective?

ESSA is supportive of a nationally consistent or coordinated approach to patient safety and quality

improvement in primary care and the ACSQHC’s strategies that include:

A set of NSQHS standards for primary care services

Review of the practice level safety and quality indicators for primary care.

However, there are a number of safety and quality issues that affect the provision of Accredited

Exercise Physiology services. These can be broadly categorised as issues affecting the service delivery

and those affecting the system of care, see table 1. Both will need to be addressed in a nationally

consistent clinical governance approach to safety and quality in primary care.

Table 1 Primary care safety and quality issues for health care targeted exercise intervention strategies

Safety Quality

System of care Delivery of services in a variety of settings and modalities (traditional, non traditional and technological)

Lack of workforce quality supervision standards for trainee practitioners

Lack of clinical effectiveness data to drive quality clinical improvements

Lack of business support structures to support new and small businesses in establishing best business practices and processes

Service delivery Provision of services by non-accredited practitioners lacking in appropriate clinical expertise

Transition interface communications (step up/step down)

Provision of culturally appropriate care

Uncontrolled wearable and interactive technologies

Complexity of funding arrangements

Business practices heavily reliant on government funded services

Ineffectual referral pathways providing for mismatch between practitioner expertise, delivered service and consumer need

ESSA is committed to its members and the care they bring to clients through it quality improvement

strategies. This has resulted in ESSA embedding excellence as a key value in its strategic and

governance frameworks. ESSA’s commitment to excellence extends beyond its own borders acting as

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a national and international voice for timely access to best practice quality exercise interventions that

support improvements in health outcomes. In particular:

ESSA is a founding member of the alliance that established the National Alliance of Self

Regulating Health Professions (NASRHP) to provide a nationally consistent quality approach

for self-regulating health professions. Through its benchmark standards, NASRHP regulates

the quality of accreditation for self-regulating health professions to bridge the gap between

public expectation for quality practitioner accreditation and the Health Practitioner

Regulation National Law requirements. Having recently been established as an independent

body, the NASRHP is open to applications for membership from self-regulating allied health

professions. The ESSA CEO serves as the Chair of the NASRHP board.

ESSA’s professional standards for accreditation and course accreditation program,

independently and collectively provide for a nationally consistent approach to the quality of

practitioners entering exercise and sports science professions. In the past five years, ESSA has

reviewed its professional standards for accreditation and course accreditation frameworks

and has in place a structured review cycle to support ongoing quality improvement to ensure

the professional standards continue to evolve and maintain their relevance. In addition, ESSA

has developed scopes of practice as foundational documents to inform the public and other

stakeholders on what they can expect from their exercise and sports science professional.

ESSA has also developed a decision tree to support practitioners develop their individual scope

of practice in an evidence based and ethical manner. ESSA’s focused attention on improving

the quality framework, supports the provision of high quality practitioners who are qualified,

competent and safe in the services they provide. Developed primary care quality and safety

standards should measure these services and feedback into the quality improvement loop at

the education institution and professional body levels.

ESSA developed and has in place since 2013, a mandatory professional development for all

newly accredited AEPs to provide guidance on professional practice requirement in national

compensable schemes (Medicare and DVA). This professional development was developed

to address concerns raised by stakeholders in relation to professional practices and its

completion is linked to continuation of accreditation and has been associated with significant

improvements in practitioner compliance with scheme requirements.

We would agree with the consultation reports description of Australia’s primary health care as small

businesses in health as being accurate. We see this as contributing to some of the issues related to

safety and quality in the primary health setting. In particular, new practitioners who move to roles in

established organisations and larger health facilities experience the benefits of established mentoring,

human resource and quality and safety frameworks. In contrast, where new graduates establish

themselves as a sole trader or as part of a small business, they bear the burden of establishing these

frameworks for themselves. Hence, this burden falls on inexperienced health professionals with

limited support structures. Further, these sole or small business health practitioners may be practicing

across multiple locations and settings including as contractors to larger health facilities. We see this

as one of the key areas of value for the Commission in developing standards for safety and quality in

primary health care. Such initiatives could include:

a nationally developed and supported system for primary health safety and quality data

collection and mandated incident reporting

specific guidelines to guide implementation of primary care safety standards for different

professions or different areas of practice governance and responsibility, supplemented with

education resources

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linking of developed primary health care safety and quality standards to other government

funded strategies to increase targeted accessibility to appropriate primary care for

communities of need.

Any standards and tools developed by the Commission in relation to patient safety and quality

improvement in primary health care need to be able to accommodate and respond to the complexity

of service delivery in the primary health care setting. As one of the biggest factors in developing a set

of standards for primary care services is interoperability.

3. Developing a set of NSQHS Standards for primary care services other than general practices.

What are the barriers and enablers for implementation of these standards in primary care? How could the Commission address these? What support could other organisations provide for implementation? Which organisations need to be involved in this process?

The biggest benefit and biggest challenge in developing standards for primary care safety and quality

is probably the diversity of primary care. The second biggest challenge is likely to be predicting the

rate of change and impact of the technology revolution on health care delivery and consumer

expectation of health care. Consequently, a challenge for the Commission will be the development of

robust, flexible and adaptable standards that support a high level of interoperability with existing and

emerging systems in health care delivery, quality and safety to support a client centred health system.

In a broad sense, the barriers to implementing standards for primary care are those that have

prevented their development to date and influencing the health reform agenda. These include:

That most existing quality and safety frameworks are facilities based and input focused

whereas the primary health care quality and safety framework needs to be service focused

and outcome based to support interoperability and the diversity of primary health care

delivery. Whereas co-located facilities support a streamlined service process facilitating

systemised accreditation, primary health care delivery is more diverse and adaptable. It

delivers services through a variety of mediums and locations such as multidisciplinary

business, telehealth, gym, council pool, private homes, aged care facilities, workplaces,

outdoors.

The plethora of small business that service primary care. The small business model of service

delivery acts as spokes across multiple hub and spoke models of service delivery such as

PHN’s, Healthcare Homes, NDIS, My Aged Care providing for complexity to accreditation,

significant cost burden to individuals for accrediting. It may also lead to further skewing of

tendering effectiveness in favour of larger better resourced organisations. This may

potentially lead to a lack of diversity in service delivery, adaptability and an institutionalised

approach to care that exacerbates workforce gaps and undermines innovation, innovative

client centred care initiatives and health care reform effectiveness.

That in general, peak professional bodies are small not for profit organisations, have limited

resourcing to develop and implement educational and other resourcing to support

practitioner practice health reforms, and would be relying on the Commission to develop a

broad range of generic resourcing and educational material to support the implementation of

developed standards.

Potential industry/practitioner resistance to primary care quality and safety standards being

seen as an added of ‘red tape’ to professional practice. This may potentially lead to industry/

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practitioner resistance to the accreditation process (initial and ongoing) with the process

being seen as overwhelming and financially and labour input prohibitive. In particular,

infrastructure barriers such as technology infrastructure cost, validation and interoperability

may be prohibitive for small health business operators.

That there is no nationally consistent framework approach to support individualised scopes

of practice and competency development for practitioners that effectively balances safety,

quality and risk in a service delivery context. This could potentially undermine the service

quality and safety at the expense of increased adverse event outcomes. There is a need for

the protection of titles while allowing for flexible competence development to support

community health needs and workforce adaptability. For example, evidence suggests allied

health assistants (AHAs) play a crucial role within health and can improve quality of care and

safety for patients. An AHA is not an “autonomous practitioner and must work under the

overarching auspice and clinical oversight of the allied health practitioner”2. However, there

are many recorded barriers to effective use of AHAs, including:

o Lack of role clarity between an AHA and allied health professional

o Unrealistic expectations of AHA’s capacity/education and therefore what activities an

AHA can realistically undertake and what is within their scope

o Concerns that AHA maybe seen as a “cheaper” way of delivering services

ESSA acknowledges and supports the value of AHA roles within healthcare and encourages

the development of appropriate models of care for AEPs working with AHAs. However, the

variability in AHA workforce qualifications, training and skills can make delegation of an AEP’s

duties challenging.3 ESSA’s policy position on interprofessional practice between AEPs and

AHAs can be found here. Further, there is no consistent requirement for health practitioners

to have or maintain an industry associated accreditation that has the potential to undermine

the effectiveness of developed standards in delivering improvements in primary care.

Flow on reform effects. In particular digital reforms e.g. digital records management (privacy,

security, ownership and research use). The traditional approach to health care delivery has

seen the practitioner as the owner of the client record. However, with the advent of electronic

health records the concept of ownership is shifting in favour of the individual (at an identified

level) and the commonwealth (at a deidentified level).

Change resistance at a governance, institution, individual level that includes both practitioner

and the consumer. The paucity of primary care quality and safety information and the cost

effectiveness of alternative treatment options does little to support the uptake of alternative

treatment methodologies e.g. evidence based exercise interventions over conventional

pharmaceutical interventions, see Deloitte report – The value of accredited exercise

physiologists to consumers in Australia.

To account for the diversity of primary care, standards for safety and quality need to address service

delivery thresholds rather than systems processes; that is provide for an outcomes based approach

rather than an inputs based approach. Enablers to successful adoption of the standards for quality

and safety in primary care may include:

That existing frameworks of quality and safety are driving nationally consistent approaches

to:

Practitioner accreditation in self-regulating professions, see NASRHP Client safety Quality improvement

That technology and a consumer centred approaches to health care are driving greater

consumer collaboration in health care delivery and health outcomes

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Uptake of reforms is being driven by consumer demands as well as government drives for

efficiencies that include evolution to outcomes based funding across the whole of health

including primary care

The ACSQHC National Safety and Quality Health Service Standards and NHMRC Australian

Clinical Practice Guidelines provide for a nationally consistent approach to clinical care

Increasing recognition that a multidisciplinary approach that supports client centred care

requires synergies of education and standards to drive nationally consistent collaborative and

responsive healthcare workforce

To be universally accepted amongst allied health professionals and allied health professions, we would

recommend that:

The primary care safety and quality standards should:

Be simple, adaptive, universally accessible and well supported by educational and

implementation resources. In particular:

o elearning educational tutelage

o readily available, ready to use and adaptable templates and proformas

o example based guiding resources.

Provide for low cost interoperability (the ability to move information easily between

people, organisations and systems) to accommodate variety of practice orientations

and environments.

Be supported by extensive guidance to individuals and peak bodies on embedding

them in practice

Provide benchmarks for safety and quality in primary care that establish minimum

requirements, are oriented to a service delivery model rather than facility model and

with tiered guidance for their interpretation in terms of governance, facility, facility

interaction and individual level to allow for optimal interoperability. (The standards

framework needs to be adaptable to sole traders who provide services direct to the

public or under contract through a health service that may or may not have its own

accreditation as well as practitioners who practice as part of a small or large

multidisciplinary practices, with one or more regulated health service on a contractual

basis).

Accommodate the rapid change in technological delivery of health care generally and

primary health care in particular and in a cost effective manner.

There should be secured funding to:

support professional bodies new to this space develop resources to guide members

on embedding the safety and quality standards into routine clinical practice

support individual practitioners and individual businesses to adopt the standards in a

cost effective way.

reduce the burden of compliance to support sole traders and small health businesses

that do not have the same resource leveraging capability as larger facilities and

multidisciplinary clinics.

The standards should be well supported by a suite of guidance and educational material

directed and professional bodies, individual businesses and the practitioner including:

generic and independent learning resources to support peak professional bodies and

individual practitioners, understand, plan for and integrate the safety and quality

standards into routine clinical practice including:

o Information on framework

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o Accreditation period

o How intensive/what resource commitment is required for accreditation

o How will external reviews be conducted? e.g. surveys/site visits and how

would this work for multiple locations and where there is no physical location,

multiple locations including health care facilities (primary/tertiary)

o If working at a facility that has ACSQHC or other accreditation, what will be

required if contracted as a provider?

Note: As the peak professional body for allied health professionals, the Allied Health Professions

Australia (AHPA) could be commissioned or provide stakeholder support for the development of

such resources.

There should be a nationally consistent approach to primary care safety and quality data

collection and management. A nationally consistent approach needs to be supported by a

national database and minimum data set to overcome the current barrier of paucity of

evidence to evaluate current strategies and drive new strategies. It should integrate with

existing functions within other health care settings to support the measurement of healthcare

outcomes along the continuum of care and support integrated care in a multi-disciplinary

environment.

The database infrastructure should be provided and managed by government to allow for cost

effectiveness and provide for optimal and equitable interoperability to available systems.

The system should allow for capture of high quality data and analytics, the extraction of

deidentified local data, as well as comparison of deidentified data between comparable

services and primary health care environments.

From an operational perspective, the system should allow for pre-population with local

framework parameters for individual users.

The Commission could support such a system by:

Recommending that the Australian Government establish and manage a national

infrastructure database with secure practitioner access to provide for national

collection of primary care data that is cost effective for the individual practitioner and

primary health care business and provides a useful national resource for all

Australians.

Supporting digital workforce capability by developing and making readily available, on

demand online training.

Such a model would support a workforce equipped with hardware, software and digital literacy, as

well as integrating and aligning with other national digital health strategies.

To align with other national strategies and gain stakeholder by in, this project should integrate care to

reduce duplication and improve streamlining of services. In particular, stakeholder engagement

should be sought with Australian Digital Health Agency (ADHA), and Aboriginal and Torres Strait

Islander health organisations. In addition, implementation of developed safety and quality primary

care standards will require engagement with professional bodies representing the broad spectrum of

allied health professionals providing primary care. As the peak professional body for allied health

professionals Allied Health Professions Australia (AHPA) could be commissioned or provide

stakeholder support for the development of such resources. As the peak professional body for

Accredited Exercise Physiologists, ESSA could:

develop localised resources and facilitate the uptake of Commission developed resources to upskill

the AEP workforce as well as support this workforce to safety and quality standards into routine

clinical practice.

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identify clinical digital health champions and participate in network of same to support embedding

of digital health into routine clinical practice.

identify existing resources that could be integrated into/align with practice accreditation standards

framework.

Other stakeholders to engage may include:

Medicare, Department of Veterans’ Affairs (DVA), National Disability Insurance Scheme (NDIS), and

My Aged Care are or will be significant stakeholders to engage as they are significant funders of

primary health care services as well as collectors and custodians of health care data.

GP professional bodies (RACGP) and practitioners as they are a central hub to primary health care

delivery, often the main entry point to primary health care and often the interface between health

care step up, step down and a local network of allied health providers.

Allied health professional associations, who represent most allied health professionals and hence a

significant proportion of primary health care service providers. The project needs to engage a cross

representation of professions, provider types (small and large operators) and locations (major

metropolitan, regional, rural and remote). AHPA is the peak professional representatives for these

stakeholders.

NASRHP as the driver of a nationally consistent approach to the quality of self-regulating health

professionals

Consumers as the end user, data custodians and central recipient of the system provide the user

values and experience perspective. These stakeholders would benefit from example based

resources to support health literacy and health system literacy.

Education providers as the first point of contact and educators for the next generation of health

professionals and significant stakeholder in workforce accreditation and health education system

reforms. e.g. NRAS review of accreditation system

A holistic approach to stakeholder engagement is recommended to assist the Commission achieve its

objectives of supporting systems focused change that reorganising care delivery systems at an

organisational level to support improvement in the quality of primary care and ensure a sustainable,

efficient and effective primary care system into the future.

4. Reviewing the Commission’s practice-level safety and quality indicators for primary care.

What are the barriers and enablers for the review process, development and implementation of indicators in primary care? How could the Commission address these? Which organisations should be involved and what is their role?

To be complete and contemporary the national set of practice-level indicators of safety and quality in

primary health care should consider and be able to adequately accommodate the health care system

of the future and not just the health care system of today. In particular, a health care system that is

more client centred care, culturally inclusive, digitally and technologically based. The healthcare

system of the future is likely to:

be heavily technology focused incorporating: digital data collection, wearable technology,

interactive applications and consideration should be given to appropriate safe guards in

primary health care

be more user friendly incorporating service delivery convenient to the client/patient e.g. more

at home care

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provide for more integrated through greater use of multi-disciplinary team delivery, with

more integrated delivery across the continuum of care.

Consequently, it is suggested that consideration be given to the following and its incorporation into

the indicators list:

Access dimension:

Offer of alternate service provision option under the access dimension to measure facilitated

access e.g. through telehealth, provision of service at an alternate location (where possible

closer to home or for example through a mobile access service), using a culturally appropriate

practitioner

Appropriateness:

Specific ehealth indicators given that the My Health Record forms an integral part of the

Australian Governments digital health strategy and is a primary reservoir for primary care

data.

Opportunity to provide feedback in a form other than a standard patient experience

instrument

Patient assessment/perception of cultural appropriateness of care received

Patient assessment/perception of client centredness of care such as whether client values

were obtained and integrated into the care process

Cultural and linguistic diversity awareness/sensitivity measurement be time bound e.g. past

12 months/2 years to retain contemporary appropriateness

As the indicators are the measurement mechanism of service delivery, the barriers and enablers for

their review, development and implementation are primarily those identified for the development of

a set of standards. However, specific consideration needs to be given to technology as an enabler and

barrier for change and the anticipated effects it will have on health service provision over the next 5

to 10 years. The ADHA programs and initiatives including ‘test beds’ offer an opportunity to establish

system interoperability to test indicator appropriateness as well as a providing for a level of confidence

as a means of overcoming barriers to implementation and adoption. Specific stakeholders who can

attest to the appropriateness of the indicators include: the consumer, the healthcare professional and

the facility, as well as other stakeholder including funding stakeholders such as the government,

private health insurers and rebatable schemes.

5. Safety and quality improvement in primary care more generally.

What strategies are you, your primary care service or the primary care services you support, implementing to improve safety and quality of care? For example, do you have an incident or risk register in your service? What strategies, tools or resources to support improvements in safety and quality should be considered? What safety and quality strategies, tools and resources can be led by the Commission in a national approach? What safety and quality strategies, tools and resources can be led by professional support organisations? What are the barriers and enablers for implementation of these? How could the Commission support implementation of these? Which organisations need to be involved in the process and what is their role?

As discussed in response 2, ESSA’s quality and safety initiative revolve around ensuring the quality of

professionals (through knowledge, skills and professional competence) to promote trust and to ensure

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their ability to provide safe services. ESSA would support a national approach to establishing an

incident register. ESSA does however, consider risk as standard practice in all its operations and

organisational decision making.

The Commission can support primary care quality and safety more generally through development of

tools to support continuity of care and communication facilitation in a multidisciplinary care team

environment as well as provide guidance for adverse event reporting.

In a multi-disciplinary, client centred care environment, clinical handover through appropriate referral

is a point at which good collaboration is required, not just between professionals but also with the

patient and carers at the point the patient steps down to independent care, with a particular emphasis

on cultural appropriate communication and integration of client values into care. The Commission

could assist with educational resources and templates to guide communication and support

appropriate referral processes. To support appropriate referral, ESSA has in development a referral

pathway tool to support appropriate referral for clients seeking and receiving targeted exercise

interventions that will support the Adult Pre-exercise Screening System developed by Sports Medicine

Australia, Fitness Australia and ESSA that supports screening and appropriate referral for individuals

with risk factors for exercise due to existing health conditions.

Additionally, educational and guidance templates to support Root Cause Analysis (RCA),

establishment, assessment and reporting as a component of adverse event reporting as well as

complaints management would be useful from the perspective of the sole or small business health

care provider perspective. Existing resources favour larger organisations that have more resourcing.

Peak bodies could provide stakeholder input into resource development and support their adoption

through continuing professional development programs.

The barriers to development and implementation of safety and quality standards and indicators in a

primary health care environment generally include:

paucity of data that could be addressed over time through the establishment of a national

data reporting system

the diversity of services and service delivery in primary care across sole traders, small business

providers, institutions, in metropolitan, regional and remote settings

cost; both financial costs for infrastructure and logistical compliance safety and quality

monitoring and reporting.

As the peak professional body for allied health, AHPA could provide both stakeholder representation

and stakeholder engagement across arrange of allied health professions. Additional stakeholders

would include education institutions to ensure future graduates are properly equipped. The greatest

enabler for the potential costs of changing the system is the offset to health care costs generally

through improved patient outcomes.

6. Primary care consumers.

What are your biggest safety and quality concerns? What action would you like to see taken to address these concerns? Can you provide examples of a safe, high-quality primary care service that you have visited? What did they do to support safe, high-quality care? Does your primary care service support you to engage in your care? Are you supported to involve your family, carers and/or friends in your care? Does your primary care service support you to be involved in decisions about your treatment options? Are you supported to communicate your wishes and goals for treatment? When you visit

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primary care services, do you have an opportunity to provide feedback to the service on your experience of care? Does the primary care service keep consumers and patients informed about changes they make in response to feedback they receive?

From a consumer perspective, we would consider the current predominant arrangement of small

family practices with alignment with allied health professionals in the local area in a hub and spoke

model to facilitate seamless transition between providers and provided services to be optimal for the

consumer. Colocation of multiple services through a single facility while providing efficiencies of

service has the potential to institutionalise care that moulds the patient to the system rather than the

desired client centred approach. Standards that support optimal primary care to the consumer are

desirable.

Benefits to the consumer of primary care quality and safety improvements include:

improved care

greater direction of own care

reduced risk of systemic harm.

While, benefits to Government include:

terms of return on investment

potential to reduce patient care time

better integration of services

potential reduction in acute services cost off set by preventative service delivery.

Building in adequate communication points and communication exchange indicators in the care

continuum processes should help measure the client experience and inform quality improvement in

the client experience.

References

1. Deloitte Access Economics (2016). The value of accredited exercise physiologists to consumers

in Australia. Retrieved from: https://www.essa.org.au/wp-content/uploads/2016/04/Deloitte-

Value-of-AEP-to-Consumers.pdf

2 Occupational Therapy Australia (2015). Position paper: The role of allied health assistants in

supporting occuptional therapy practice. Retrieved from:

http://www.otaus.com.au/sitebuilder/advocacy/knowledge/asset/files/21/positionpaper-

theroleofahasinsupportingoccupationaltherapypractice%5Boctober2015%5D.pdf.

3. Exercise & Sports Science Australia (ESSA) (2016) Policy statement: Accredited Exercise

Physiologists working with allied health assistants. Retrieved from: https://www.essa.org.au/wp-

content/uploads/2016/06/Final-AHA-policyJune-2016.pdf