Please use this identifier to cite or link to this item: https://hdl.handle.net/2440/120517
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Type: Journal article
Title: 'At the grass roots level it's about sitting down and talking': exploring quality improvement through case studies with high-improving Aboriginal and Torres Strait Islander primary healthcare services
Author: Larkins, S.
Carlisle, K.
Turner, N.
Taylor, J.
Copley, K.
Cooney, S.
Wright, R.
Matthews, V.
Thompson, S.
Bailie, R.
Citation: BMJ Open, 2019; 9(5):e027568-1-e027568-15
Publisher: BMJ Publishing Group
Issue Date: 2019
ISSN: 2044-6055
2044-6055
Statement of
Responsibility: 
Sarah Larkins, Karen Carlisle, Nalita Turner, Judy Taylor, Kerry Copley, Sinon Cooney, Roderick Wright, Veronica Matthews, Sandra Thompson, Ross Bailie
Abstract: OBJECTIVES:Improving the quality of primary care is an important strategy to improve health outcomes. However, responses to continuous quality improvement (CQI) initiatives are variable, likely due in part to a mismatch between interventions and context. This project aimed to understand the successful implementation of CQI initiatives in Aboriginal and Torres Strait Islander health services in Australia through exploring the strategies used by 'high-improving' Indigenous primary healthcare (PHC) services. DESIGN, SETTINGS AND PARTICIPANTS:This strengths-based participatory observational study used a multiple case study method with six Indigenous PHC services in northern Australia that had improved their performance in CQI audits. Interviews with healthcare providers, service users and managers (n=134), documentary review and non-participant observation were used to explore implementation of CQI and the enablers of quality improvement in these contexts. RESULTS:Services approached the implementation of CQI differently according to their contexts. Common themes previously reported included CQI systems, teamwork, collaboration, a stable workforce and community engagement. Novel themes included embeddedness in the local historical and cultural contexts, two-way learning about CQI and the community 'driving' health improvement. These novel themes were implicit in the descriptions of stakeholders about why the services were improving. Embeddedness in the local historical and cultural context resulted in 'two-way' learning between communities and health system personnel. CONCLUSIONS:Practical interventions to strengthen responses to CQI in Indigenous PHC services require recruitment and support of an appropriate and well prepared workforce, training in leadership and joint decision-making, regional CQI collaboratives and workable mechanisms for genuine community engagement. A 'toolkit' of strategies for service support might address each of these components, although strategies need to be implemented through a two-way learning process and adapted to the historical and cultural community context. Such approaches have the potential to assist health service personnel strengthen the PHC provided to Indigenous communities.
Keywords: Aboriginal
continuous quality improvement
implementation
primary health care
quality of care
systems approach
Rights: © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http:// creativecommons. org/ licenses/ by- nc/ 4. 0/.
DOI: 10.1136/bmjopen-2018-027568
Grant ID: http://purl.org/au-research/grants/nhmrc/1078927
Appears in Collections:Aurora harvest 8
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