Development of a National CQI Framework for Aboriginal and Torres Strait Islander Primary Health Care

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2 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

3 Phase 1: May September 2014 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?

4 Project Team 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

5 Consultations Regional (hosted by Affiliates) Adelaide Cairns Perth Canberra National (hosted by NACCHO) Canberra

6 Full report cqi-framework-atsih

7 Stage 1 - Key principles 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: years

8 Stage 1 - Recommendations 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

9 Recommendations (cont.) 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

10 Project team Phase 2 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)

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12 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

13 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)

14 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

15 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.

16 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)

17 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

18 Core components

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20 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

21 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

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