AUTHOR=Bailie Jodie , Laycock Alison , Matthews Veronica , Bailie Ross 

TITLE=System-Level Action Required for Wide-Scale Improvement in Quality of Primary Health Care: Synthesis of Feedback from an Interactive Process to Promote Dissemination and Use of Aggregated Quality of Care Data

JOURNAL=Frontiers in Public Health

VOLUME=Volume 4 - 2016

YEAR=2016

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2016.00086

DOI=10.3389/fpubh.2016.00086

ISSN=2296-2565

ABSTRACT=Introduction
There is an enduring gap between recommended practice and care that is actually delivered; and there is wide variation between primary healthcare (PHC) centres in delivery of care. Where aspects of care are not being done well across a range of PHC centres, this is likely due to inadequacies in the broader system. This paper aims to describe stakeholders’ perceptions of the barriers and enablers to addressing gaps in Australian Aboriginal and Torres Strait Islander chronic illness care and child health, and to identify key drivers for improvement.

Methods
This paper draws on data collected as part of a large scale continuous quality improvement project in Australian Indigenous PHC settings. We undertook a qualitative assessment of stakeholder feedback on the main barriers and enablers to addressing gaps in care for Aboriginal and Torres Strait Islander children and in chronic illness care. Themes on barriers and enablers were further analysed to develop a ‘driver diagram’, an improvement tool used to locate barriers and enablers within causal pathways, (as primary and secondary drivers), enabling them to be targeted by tailored interventions.  

Results
We identified five primary drivers and eleven secondary drivers of high quality care, and associated strategies that have potential for wide-scale implementation to address barriers and enablers for improving care. Perceived barriers to addressing gaps in care included both health system and staff attributes. Primary drivers were: staff capability to deliver high quality care; availability and use of clinical information systems and decision support tools; embedding of quality improvement processes and data driven decision making; appropriate and effective recruitment and retention of staff; and community capacity, engagement and mobilisation for health. Suggested strategies included mechanisms for increasing clinical supervision and support, staff retention, reorientation of service delivery, use of information systems and community health literacy.

Conclusions
The findings identify areas of focus for development of barrier driven, tailored interventions to improve health outcomes. They reinforce the importance of system-level action to improve health centre performance and health outcomes, and of developing strategies to address system-wide challenges that can be adapted to local contexts.