A qualitative exploration of priorities for quality improvement amongst Aboriginal and Torres Strait Islander primary health care services

Carlisle, Karen, Matthews (Quandamooka), Veronica, Redman-MacLaren, Michelle, Vine, Kristina, Turner, Nalita Nungarrayi, Felton-Busch (Yangkaal/Gangalidda), Catrina, Taylor, Judy, Thompson, Sandra, Whaleboat (Meriam Le), Donald, Larkins, Sarah, and LEAP Learning Community, (2021) A qualitative exploration of priorities for quality improvement amongst Aboriginal and Torres Strait Islander primary health care services. BMC Health Services Research, 21. 431.

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Abstract

Background: Achieving quality improvement in primary care is a challenge worldwide, with substantial gaps between best practice and actual practice. Within the context of Australia, Aboriginal and Torres Strait Primary Health Care (PHC) services have great variation across settings, structures and context. Research has highlighted how these contextual differences can critically influence the success of Quality Improvement (QI) interventions and outcomes. Less understood is the interaction between local context and other factors, which may impact the implementation of QI interventions. This paper aims to explore the strengths and challenges in QI for Aboriginal and Torres Strait Islander PHC services and their priorities for improvement.

Methods: A multiple case study design was adopted, working with eight Aboriginal and Torres Strait Islander PHC services in Northern Territory, Queensland and Western Australia. Data were collected via a health service survey, semi-structured interviews with health service staff and service users and researcher observations, to explore QI and perceptions of care quality at the service level. Data reported here were analysed using an iterative thematic technique, within-case and across-case.

Results: A total of 135 interviews were conducted with health service staff, service users and community members. Participants emphasised the centrality of resilient community, committed workforce and valued Aboriginal and Torres Strait Islander team members in delivering care. A shared purpose around improving the health of community was a significant driver. Key challenges included staff turnover and shortages, a complex and overwhelming acute and chronic care workload, building relationships and trust between health services and the community. Service-suggested priority areas for improvement were categorised into five themes: i) cultural safety (community driving health and planning for culturally safe services); ii) community engagement (through clinical activities in the community); iii) shared ownership and a team approach around QI; iv) strengthening systems and consistent ways of doing things in the health service; and v) strengthening local workforce (and resources for a culturally safe workforce).

Conclusions: These findings advance understandings of relational, community and cultural factors which are identified priorities for the delivery of quality care in Aboriginal and Torres Strait Islander PHC services across varied contexts.

Item ID: 70891
Item Type: Article (Research - C1)
ISSN: 1472-6963
Keywords: Quality improvement, Primary health care, Aboriginal and Torres Strait Islander health
Copyright Information: © The Author(s). 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
Funders: National Health and Medical Research Council of Australia (NHMRC)
Projects and Grants: NHMRC Quality improvement in Indigenous primary health care: Leveraging Effective Ambulatory Practices (LEAP) 11486660
Date Deposited: 07 Dec 2021 23:53
FoR Codes: 42 HEALTH SCIENCES > 4203 Health services and systems > 420319 Primary health care @ 50%
42 HEALTH SCIENCES > 4203 Health services and systems > 420321 Rural and remote health services @ 50%
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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