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Development of a National CQI Framework for Aboriginal and Torres Strait Islander
Primary Health Care
Michael Tynan, Lowitja Institute
Paul Ryan, Aboriginal Health Council of South Australia
To explore system wide national, regional and local enablers, barriers and linkages relevant to the development of a national CQI framework
Is there support for a national framework?
Phase 1: May – September 2014
The Lowitja Institute
National Aboriginal Community Controlled Health Organisation
State and Territory Affiliates
Menzies School of Health Research
Flinders University of South Australia
The University of Melbourne
Australian National University
Project Team
Regional (hosted by Affiliates)
Adelaide
Cairns
Perth
Canberra
National (hosted by NACCHO)
Canberra
Consultations
Full report http://www.health.gov.au/internet/main/publishing.nsf/content/cqi-framework-atsih
1. Build on past experience
2. Focus on strengthening enablers to CQI, not imposing specific models
3. Identify what cultural capability means for CQI
4. Led by the ACCHO sector, for the PHC system
5. Flexibility of use of CQI tools for local needs
6. Sustained commitment: 10–15 years
Stage 1 - Key principles
1. Develop a national CQI framework for Aboriginal and Torres Strait Islander PHC
2. Include high level implementation plan
3. Engage all key stakeholders in development
4. Monitor and evaluate implementation
5. Grow the ‘building blocks’ of effective CQI
6. Take a ‘systems approach’
7. Foster leadership and support networks
Stage 1 - Recommendations
8. Build the capacity of front line services
9. Enhance coordination and governance of clinical information systems to support CQI
10. Develop strategies for aligning CQI with accreditation, service governance, and national policies
11. Meet the needs of health services at differing levels of CQI development
Recommendations (cont.)
Lowitja Institute
National Aboriginal Community Controlled Health Organisation
State and Territory Affiliates
Menzies School of Health Research
Flinders University of South Australia
The University of Melbourne
Lead Researchers (Bev Sibthorpe and Karen Gardner)
Project team – Phase 2
Purpose of the framework
To foster commitment and a coordinated
approach to CQI in primary health care for
Aboriginal and Torres Strait Islander people,
wherever they seek care
Framework vision “For Aboriginal and Torres Strait Islander people everywhere to receive the highest attainable standard of primary health care.”
Covers 3 main PHC sectors:
Aboriginal community controlled sector
Private general practice
State/territory government services
Others? (RFDS, Corrections)
Framework aims For CQI in primary health care services delivering care to Aboriginal and Torres Strait Islander people this Framework aims to:
bring about universal uptake , embedding and sustainability;
achieve efficiencies in uptake, embedding and sustainability;
build capacity in services and sectors; and
build the evidence base and support translation of knowledge into practice
Framework content
Recognising central importance of cultural safety it provides guidance on effort and investment by identifying:
a definition of CQI
core components of CQI;
responsibilities at local, regional, state and national levels across the 3 main sectors; and
need to build evidence base and translate knowledge into practice.
Definition of CQI A structured organisational process for involving personnel in planning & executing a continuous stream of improvements to provide quality health care that meets or exceeds expectations (Sollecito & Johnson 2013)
Systematic data guided activities Iterative development and testing Designing with local conditions in mind Aiming to change routine work processes Multidisciplinary teams Specific predefined aims Set of specific changes Using evidence relevant to the problem Data feedback to implementers (Creating a culture of quality improvement)
(Rubenstein et al 2013)
Key concepts
Client and community centredness
Leadership (including Aboriginal and Torres Strait Islander leadership and career pathways)
Organisational culture for CQI
Team functioning
Systems thinking
Core components
Implementation effectiveness Need to have:
commitment and investment
knowledge base
drivers and incentives, organisational and professional
mechanisms for implementation of core components at four levels
high quality support for services
reasonable short, medium and long term results
High level implementation plan
Australian Government - $40 million over 3 years commencing July 2015
Good buy-in from general practice and state/territory health departments
Needs high level governmental endorsement
Implementation governance arrangements
Focus on the “Early “results” (1-2 years)
Weave in research/evaluation and knowledge translation