About this Presentation
Atrial Fibrillation is a significant risk factor for strokes and early detection is key to prevention. This presentation reveals how TOC has helped play a role in finding the solution to low testing rates with preliminary pilot study results showing over 100% improvement yielding a potential for saving several hundred lives each year in Australia.
What Will You Learn
To help you get the most value from this session, we’ve highlighted a few key points. These takeaways capture the main ideas and practical insights from the presentation, making it easier for you to review, reflect, and apply what you’ve learned.
Dr. Katrina Giskes, Professor Ben Freedman, and Andrew Kay show how TOC can be applied to a healthcare challenge where the constraint was not medical knowledge, but the screening process itself. Atrial fibrillation is a major stroke risk, yet the presentation reports that only about 11% of Australian GPs regularly screened for AF, while meaningful population impact would require screening a much larger share of people over 65.
Andrew Kay’s TOC contribution helped reframe the problem around flow and burden. Rather than asking busy GPs to perform more screening themselves, the team developed the idea of patient self-screening in the medical-practice waiting room, designed to overcome time constraints while increasing the number of patients screened. The solution had to achieve high uptake, be low cost, support timely review of results, and place minimal additional burden on GPs and staff.
The project shows TOC being used both to design the solution and to make it executable. The team applied the questions of change, built consensus around the problem and direction of the solution, mapped practice workflows, worked backwards from the goal, and then used Critical Chain Project Management and EXEPRON to structure the research and implementation project. The implementation itself required coordinated development of screening hardware, software integration with patient medical records, and staff training.
The early results demonstrate why this case matters. Across three medical practices in the pilot from August 2020 to March 2021, 825 patients self-screened and 37 possible cases of atrial fibrillation were identified—4.5% of those screened. The presenters concluded that integrating self-screening with practice software and workflow appeared to produce substantially higher screening rates than standard general practice and therefore had the potential to contribute to greater stroke reduction.
Instructor(s)
Dr. Katrina Giskes
Dr Katrina Giskes is a rural GP and Research Fellow at the University of Notre Dame/Heart Research Institute. She is working on a project examining atrial fibrillation screening using opportunistic self-screening stations in general practice (AF SELF SMART). Dr Giskes completed her medical training at the University of Sydney (2015). Prior to her medical studies, Dr Giskes trained as a Dietitian/Nutritionist and worked as a research fellow in public health for 10+ years in Australia and internationally. Her PhD (completed in 2003) was the first population-based study in Australia to document socioeconomic inequalities in diet. She was awarded an NHMRC Sidney Sax international post-doctoral fellowship (2004-2008) and worked on various projects relating to socioeconomic health inequalities at Erasmus University in the Netherlands. She has also lectured in research methods and Nutrition and Dietetics, and has supervised a number of PhD students to completion. Dr Giskes is keen to apply her research skills in the primary care setting to develop screening opportunities and systems to detect asymptomatic atrial fibrillation in older adults, and thereby reduce the incidence of avoidable strokes.
Dr. Ben Freedman OAM
Professor Ben Freedman is currently Deputy Director of Research Strategy, Heart Research Institute/Charles Perkins Centre and Group Leader of the Heart Rhythm and Stroke Prevention Group. He is a professor of Cardiology at The University of Sydney and former head of Department of Cardiology Concord Hospital. He is also an adjunct professor in the School of Public Health & Preventive Medicine at Monash University, and Honorary Professorial Fellow at the University of Melbourne. He was Deputy Dean of Sydney Medical School, The University of Sydney's Medical Faculty, for 9 years from 2003 to 2012, and received the Faculty's inaugural Distinguished Service Award in 2012. He also heads Vascular Biology at ANZAC Research Institute on the Concord Hospital Campus. In 2011, he was awarded the Order of Australia Medal for service to medicine as a clinician, educator, and researcher. His research interests are broad but now focus on atrial fibrillation (AF): his group's work on screening was nominated as a finalist in the Australian Innovation Award in 2013. With five others, he formed the AF-SCREEN International Collaboration, which now has over 130 members from 33 countries, including many of the foremost names in AF research. He has authored over 180 publications and a number of book chapters.
Andrew Kay
ANDREW KAY, TOCPC™ , Founder/Owner TOC3 Pty Ltd & Director of TOC for Education Australia
Recognized in Australia as a leading TOC Practitioner, Andrew is the founder of an independent boutique TOC consulting firm TOC3 Pty Limited based in Sydney, serving the Asia Pacific.
With a TOC career spanning nearly 20 years, Andrew has delivered and helped deliver over 85 successful TOC implementations across a multitude of industry sectors in Australia, New Zealand, Singapore, Indonesia, Japan and the USA. Andrew brings a depth of TOC knowledge and implementation experience in guiding organizations to systematically and rapidly achieve their goals Andrew is proficient in all TOC application solution areas including the Logical Thinking Process Tools. He specializes in rapid and visual implementation methods.
Andrew partners with world-class practitioners and is actively engaged in the International TOC Community. He has commenced sharing his experiences and insights through several case studies at TOCICO and other international TOC Conferences.
Andrew is also the Director of TOC for Education Australia working to introduce the TOCFE thinking tools to schools and communities and wishes he could do more.
Andrew is passionate about TOC and what it can deliver to the world.
Before his TOC career, Andrew served as a scientific-systems based professional in strategic planning for Sydney City and the Blue Mountains Region. A pioneer in Integrated Local Government Geographic Information Systems, Andrew held senior management roles in Government Corporate Strategy and Business Planning and later for 5 years, in the private sector with Business Improvement Consulting with clients such as The Sydney Opera House, Phillips, Canberra Hospital, A V Jennings, and Perrigrin Semi-Conductor. In between he helped establish and run Australia's first micro-finance operation based on the Nobel Prize-winning Grameen Bank of Bangladesh.
Andrew holds a BSc Hons in Applied Science (dual major/Magna Cum Laude) from the University NSW, a post-graduate MBA from Macquarie University, and he is certified by TOCICO, and is a qualified Jonah+ and CCPM IC3PM instructor.