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