Leveraging quality improvement through use of the Systems Assessment Tool in Indigenous primary health care services: a mixed methods study

Abstract

BackgroundAssessment of the quality of primary health care health delivery systems is a vital part of continuous quality improvement (CQI) processes. The Systems Assessment Tool (SAT) was designed to support Indigenous PHC services in assessing and improving their health care systems. It was based on the Assessment of Chronic Illness Care scale, and on practical experience with applying systems assessments in quality improvement in Indigenous primary health care. We describe the development and application of the SAT, report on a survey to assess the utility of the SAT and review the use of the SAT in other CQI research programs.MethodsThe mixed methods approach involved a review of documents and internal reports relating to experience with use of the SAT since its development in 2002 and a survey of key informants on their experience with using the SAT.ResultsThe paper drew from documents and internal reports to describe the SAT development and application in primary health care services from 2002 to 2014. Survey feedback highlighted the benefit to the whole primary health care team from participating in the SAT, bringing to light issues that might not emerge with separate individual tool completion. A majority of respondents reported changes in their health centres as a result of using the SAT. Good organisational and management support assisted with ensuring allocation of time and resources for SAT conduct. Respondents identified the importance of having a skilled, external facilitator.ConclusionsOriginally designed as a measurement tool, the SAT rapidly evolved to become an important development tool, assisting teams in learning about primary health care system functioning, applying best practice and contributing to team strengthening. It is valued by primary health care centres as a lever in implementing improvements to strengthen centre delivery systems, and has potential for further adaptation and wider application in Australia and internationally.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1810-y) contains supplementary material, which is available to authorized users.

Emerging evidence of the value of health assessments for Aboriginal and Torres Strait Islander people in the primary healthcare setting

“…anaemia and child neurodevelopment if they had received an Indigenous-specific health assessment than those children who received acute care (2466 client records of children aged 3-59 months, from 109 Indigenous PHC centres, 2012-14) (Strobel et al 2018). These findings are consistent with other Australian research that has found Indigenous-specific health assessments to be useful for identifying new health issues, including chronic disease risk factors for individuals and for service populations (Miller et al 2002;Spurling et al 2009;Coleman et al 2011;Bailie et al 2013;Dutton et al 2016).…”

“…The audit protocol included sampling guidelines that would assist in generating a sample likely to reflect the general population of clients. A structured process to assess the organisational systems of the PHC centre was also conducted using the Systems Assessment Tool (Cunningham et al 2016).…”

Rural and remote health research: Does the investment match the need?

“…Indeed, the significant proportion of rural research that is about Indigenous health is appropriate and very welcome. High‐quality, rurally focussed and located research helps to build the rural health sector's capacity and has been demonstrated to bring positive health service and cost outcomes 13, 14. Research that improves rural service delivery and that addresses the underlying causes of poor health can make a critical contribution to the reduction of rural health inequality, a key aim of the Australian Government.…”

Exploring Systems That Support Good Clinical Care in Indigenous Primary Health-care Services: A Retrospective Analysis of Longitudinal Systems Assessment Tool Data from High-Improving Services

“…Qualitative data provide valuable insights into reasons why SAT scores changed and the strategies put in place which may have influenced the change. Recent work conducted by Cunningham et al (18), on the application of SAT data in PHC services, found that respondents reported changes in their health services as a result of using the SAT tool and valued the tool as a lever in implementing improvement. Indeed, Schierhout et al (23) also found potential causal linkages between CQI activities and outcomes that were achieved.…”

“…It was designed to assess systems across multiple areas of care and to be delivered in group setting. Scores are reached by consensus with prompts provided to increase standardization and reproducibility in scoring [(18), see also Table 1]. In some health services, an external facilitator is brought in to assist with the process.…”