Respect is central: a critical review of implementation frameworks for continuous quality improvement in Aboriginal and Torres Strait Islander primary health care services

Redman-Maclaren, Michelle, Turner, Nalita Nungarrayi, Taylor, Judy, Laycock, Alison, Vine, Kristina, Thompson, Quitaysha, Larkins, Sarah, Carlisle, Karen, Thompson, Sandra, Bailie, Ross, and Matthews, Veronica (2021) Respect is central: a critical review of implementation frameworks for continuous quality improvement in Aboriginal and Torres Strait Islander primary health care services. Frontiers in Public Health, 9. 630611.

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Abstract

Background: Primary health care (PHC) services are complex systems, shaped by an interplay of factors at individual, organisational and broader system levels. For Aboriginal and Torres Strait Islander PHC services, closer relationships with the people they serve, local knowledge of community, and cultural awareness are critical. Continuous quality improvement (CQI) has proven to be an effective process for identification of priority issues in health care delivery and for instigating the design, implementation and evaluation of improvement interventions in these settings. However, wide-scale variation in care quality persists partly due to the mismatch between CQI interventions and context.

Methods: This critical review of implementation frameworks for CQI in Aboriginal and Torres Strait Islander primary health care was conducted in two phases: (1) a review of primary published implementation frameworks used in PHC contexts, and (2) a comparison of key features of these frameworks with quality concepts identified by high-improving Aboriginal and Torres Strait Islander PHC services in remote Australia.

Results: We found nine primary implementation frameworks previously used in PHC contexts guiding interventions within and between macro (broader contextual) level; meso (health service) level; and micro (community and inter-personal) level systems. There was commonality between these frameworks and key quality concepts in Aboriginal and Torres Strait Islander PHC. However, none of the frameworks covered all concepts with rare consideration of communities driving health improvement, two-way learning (integrating cultural knowledge into healthcare provision), and caring staff—engendering trusting relationships with community enacted through respect.

Conclusion: Respect, as a secret essence, privileges the importance of culture, and is an essential element of CQI implementation frameworks for positive change in Aboriginal and Torres Strait Islander PHC services. It is essential to work with communities to design workforce models that grow a caring stable workforce to ensure improvements in quality of care that are effective for their context.

Item ID: 68816
Item Type: Article (Research - C1)
ISSN: 2296-2565
Keywords: implementation frameworks, continuous quality improvement, Aboriginal and Torres Strait Islander, primary health care, community health, Indigenous
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Copyright Information: © 2021 Redman-MacLaren, Turner, Taylor, Laycock, Vine, Thompson, Larkins, Carlisle, Thompson, Bailie and Matthews. 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) and the copyright owner(s) 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: National Health and Medical Research Council (NHMRC)
Projects and Grants: NHMRC Leveraging Effective Ambulatory Practises (LEAP) (Grant number:1148660), NHMRC Strengthening Systems For Indigenous Health Care Equity (CRE-STRIDE) (Grant Number: 1170882)
Date Deposited: 27 Jul 2021 23:08
FoR Codes: 45 INDIGENOUS STUDIES > 4504 Aboriginal and Torres Strait Islander health and wellbeing > 450409 Aboriginal and Torres Strait Islander health services @ 100%
SEO Codes: 21 INDIGENOUS > 2103 Aboriginal and Torres Strait Islander health > 210303 Aboriginal and Torres Strait Islander health system performance @ 100%
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