The Draft National Continuous Quality Improvement (CQI) Framework for Aboriginal and Torres Strait Islander Primary Health Care 2015-2025

During the 2014-2015 year NACCHO had an active role in supporting the development of the Commonwealth sponsored Draft National Continuous Quality Improvement (CQI) Framework for Aboriginal and Torres Strait Islander Primary Health Care 2015-2025.

NACCHO welcomed the prospect of this Australia wide, long term, multi service sector and inter- governmental reform enhancing the quality of service provision to Aboriginal and Torres Strait Islander People. Similarly NACCHO appreciated the open and consultative approach adopted by the Commonwealth Health Portfolio Ministers and their Department towards the Framework’s development and their intention to invest significant funds in the Sector for Framework implementation with a priority focus on Member Services.

The project arose from the Department of Health (DoH) commissioning, via open tender processes, the Lowitja Institute to prepare a nationally structured policy and program approach for enabling continuous quality improvement within Aboriginal and Torres Strait Islander primary health care services provision.

At the 30 June 2015 this project had occurred via two-stages. Stage 1 was a synthesis and analysis of International CQI activity and evidence. Stage 2 which was still in progress required the development of a recommended National CQI Framework.

The initiative reflected collaborative stakeholder participation in project management and advisory processes principally from NACCHO, all jurisdictional Affiliates, the Menzies School of Health Research, Flinders University of South Australia, The University of Melbourne, the Royal Australian College of General Practitioners (RACGP), the Australian College of Rural and Remote Medicine (ACRRM), the Australian Indigenous Doctors Association (AIDA), The National Aboriginal and Torres Strait Islander Health Standing Committee and DoH. NACCHO chaired the Stakeholder Advisory Committee.

During 2014-2015 NACCHO’s engagement with the Project occurred in two main ways.

Structural Content Development

NACCHO was an active participant in formulating the emerging Framework’s foundation of 15 core components to drive quality for Aboriginal and Torres Strait Islander primary health care. The project indicated four geographic levels of responsibility, being national, state and territory, regional and local, which could be applied for implementing the respective core components. This innovative design envisaged the core components being common to the three main Australian Service Sectors with delivery roles in the provision of Indigenous primary healthcare. These Sectors were the national ACCHO system, Private General Practice and State and Territory Government Auspiced Services. While the emerging structure encouraged inter-sectoral collaboration it was intended that each Sector would be responsible for its own implementation of the Framework.

The core components identified were: (C1) Cultural Safety and Competence,(C2) Government Policy, (C3) Coordination and Facilitation of Implementation of Core Components,(C4) Client and Community Participation,(C5) Organisational Partnerships,(C6) Professional Training,(C7) Access to CQI Skills,(C8) Clinical Data Infrastructure and Functionality for CQI, (C9) Managed CQI Networks, (C10) CQI Data Sharing and Sense-Making, (C11) Research and Knowledge Translation,(C12) Service Support, (C13) Clinical Governance,(C14) CQI Leads, and (C15) Plan-Do-Study- Act or PDSA cycles.

Strategic Review for Implementation

In the latter period of the draft Framework’s emerging format, NACCHO also undertook a strategic analysis of enabling issues surrounding the e ective implementation of the Framework within the ACCHO Sector. Significant issues identified included:

  1. how smooth client/patient referral pathways between the ACCHO Sector and the other partner Sectors of the Framework (especially the State and Territory public health care networks) could be best supported;
  2. how ACCHO Sector access to quality focused MBS generated services and revenues could be enhanced;
  3. how the ‘knowhow’ of the ACCHO Sector could be applied to support the other partner Sectors to enhance their cultural safety and competence; and
  4. how the long history of quality development in the ACCHO Sector could be more fully recognised as the starting and building-on points for the Framework’s long term implementation.

These issues and other aspects of the draft Framework were being consolidated into a NACCHO CQI Discussion Position Paper. The aim of the Position Paper was to provide a discussion basis for a Round Table consultation with Member Services and Affiliates with the intention of reaching an agreed understanding of how the Framework should be implemented in the ACCHO Sector.