Exploring systems that support good clinical care in Indigenous primary health care services: a retrospective analysis of longitudinal Systems Assessment Tool data from high improving services

Woods, Cindy, Carlisle, Karen, Larkins, Sarah, Thompson, Sandra Claire, Tsey, Komla, Matthews, Veronica, and Bailie, Ross (2017) Exploring systems that support good clinical care in Indigenous primary health care services: a retrospective analysis of longitudinal Systems Assessment Tool data from high improving services. Frontiers in Public Health, 5. 45. pp. 1-17.

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Abstract

Background: Continuous Quality Improvement is a process for raising the quality of primary health care (PHC) across Indigenous PHC services. In addition to clinical auditing using plan, do, study, and act cycles, engaging staff in a process of reflecting on systems to support quality care is vital. The One21seventy Systems Assessment Tool (SAT) supports staff to assess systems performance in terms of five key components. This study examines quantitative and qualitative SAT data from five high-improving Indigenous PHC services in northern Australia to understand the systems used to support quality care.

Methods: High-improving services selected for the study were determined by calculating quality of care indices for Indigenous health services participating in the Audit and Best Practice in Chronic Disease National Research Partnership. Services that reported continuing high improvement in quality of care delivered across two or more audit tools in three or more audits were selected for the study. Precollected SAT data (from annual team SAT meetings) are presented longitudinally using radar plots for quantitative scores for each component, and content analysis is used to describe strengths and weaknesses of performance in each systems’ component.

Results: High-improving services were able to demonstrate strong processes for assessing system performance and consistent improvement in systems to support quality care across components. Key strengths in the quality support systems included adequate and orientated workforce, appropriate health system supports, and engagement with other organizations and community, while the weaknesses included lack of service infrastructure, recruitment, retention, and support for staff and additional costs. Qualitative data revealed clear voices from health service staff expressing concerns with performance, and subsequent SAT data provided evidence of changes made to address concerns.

Conclusion: Learning from the processes and strengths of high-improving services may be useful as we work with services striving to improve the quality of care provided in other areas.Methods: High improving services selected for the study were determined by calculating quality of care indices for Indigenous health services participating in the ABCD National Research Partnership. Services that reported continuing high improvement in quality of care delivered across two or more audit tools in three or more audits were selected for the study. Pre-collected SAT data (from annual team SAT meetings) is presented longitudinally using radar plots for quantitative scores for each component and content analysis is used to describe strengths and weaknesses of performance in each systems component. Results: High improving services were able to demonstrate strong processes for assessing system performance and consistent improvement in systems to support quality care across components. Key strengths in the quality support systems included adequate and orientated workforce, appropriate health system supports and engagement with other organisations and community while the weaknesses included lack of service infrastructure, recruitment, retention and support for staff and additional costs. Qualitative data revealed clear voices from health service staff expressing concerns with performance and subsequent SAT data provided evidence of changes made to address concerns. Conclusion: Learning from the processes and strengths of high-improving services may be useful as we work with services striving to improve the quality of care provided in other areas.

Item ID: 47638
Item Type: Article (Research - C1)
ISSN: 2296-2565
Keywords: quality improvement, Indigenous health, primary health services, primary health Care, systems improvement
Additional Information:

Copyright © 2017 Woods, Carlisle, Larkins, Thompson, Tsey, Matthews and Bailie. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

Funders: Australian National Health and Medical Research Council (NHMRC)
Projects and Grants: NHMRC ID 1062377
Date Deposited: 19 Jun 2017 00:08
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111717 Primary Health Care @ 100%
SEO Codes: 92 HEALTH > 9205 Specific Population Health (excl. Indigenous Health) > 920506 Rural Health @ 50%
92 HEALTH > 9203 Indigenous Health > 920303 Aboriginal and Torres Strait Islander Health - Health System Performance (incl. Effectiveness of Interventions) @ 50%
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