While the concepts and principles of continuous quality improvement (CQI) in health care are universal, specific approaches have been developed in response to the principles and characteristics of primary health care (PHC). This book provides an accessible contemporary guide on implementing CQI in PHC settings, with guidance for health services and their staff, policymakers, researchers, funders and support organisations. It draws together two decades of practical experience and established leadership in this field to position our work in Aboriginal and Torres Strait Islander health in Australia in an international context. The applied research described is based on participatory principles and engagement with community-based organisations and different levels of government. True to this approach, many of the people involved in the CQI work have generously reviewed chapters and had input as the book was developed.
We firmly believe that “continuous quality improvement is everybody’s business” and have intentionally written for a diverse audience. We recognise that different parts of the book will be of greater or lesser interest according to the context in which you work, your role and experience in the PHC system, or your area of study, research or teaching. There are four interlinked parts.
Part I identifies core concepts underpinning PHC and CQI. It explains why CQI is necessary in PHC and how CQI approaches in PHC differ from approaches used in other parts of the health system. Three chapters provide a foundation for understanding the PHC system context, CQI tools, processes and contemporary perspectives presented in parts II to IV.
Part II provides guidance for implementing CQI in PHC, with information of greatest relevance for health service providers and those developing CQI policy and support. The five chapters explain how to generate, present and analyse CQI data and how to adapt CQI tools and techniques to improve care quality in PHC settings. We introduce a CQI cycle that acknowledges the complexity of improving comprehensive PHC and steps readers through its application. Practical examples or stories from the field illustrate each phase: for example, how to present data for analysis; how to understand and address variation in care quality; and how to use systems thinking and local knowledge to interpret data and to plan improvement strategies. Some key CQI resources are recommended. The final chapter in Part II focuses on ways to embed an organisational culture of CQI.
Part III shares what has been learnt from applying the CQI approach described in parts I and II. Use of this CQI approach over two decades has produced data on clinical performance and change over time in a wide range of Australian Aboriginal and Torres Strait Islander PHC services, thus providing a strong evidence base for its use. Ten chapters demonstrate the successes and challenges experienced in implementing CQI for important clinical conditions, such as diabetes, or life stages, such as child health, with reference to the determinants that affect care and outcomes. Each chapter provides internationally relevant background, information about recommended care, CQI findings, and key messages for improving the quality of PHC. Implications for improving care in Aboriginal and Torres Strait Islander settings are included for Australian readers. The lessons offered in Part III may be particularly relevant for health service providers, policymakers and communities implementing CQI in low- and middle-income countries and in settings where healthcare inequity persists between population groups.
Part IV discusses the wide-scale application of CQI and contemporary collaborative approaches to PHC research, with a focus on strengthening systems to improve PHC equity. In these three chapters, we describe some approaches for engaging stakeholders at different levels of the health system and across sectors in CQI. We also outline the principles and methodologies informing culturally safe, strengths-based and transformative CQI research in Indigenous PHC settings and describe strategies for strengthening links between communities and health services. Several innovative evaluations are included. The examples presented in these chapters are complex interventions or strategies implemented within complex systems, offering transferable lessons for quality improvement work in a range of systems, services and communities. Researchers and policymakers who may be commissioning research or developing CQI policies and plans may find these chapters useful.
Throughout chapters, shaded boxes are used to highlight important messages.
Over the past two decades, through the many individuals, PHC teams, services and communities involved in this CQI work, we have learnt a lot about implementing quality improvement in PHC settings. There is much more to learn if we are to transform systems to achieve more equitable people-centred care and meet the healthcare challenges of the future.