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.
Highlights
Assessment of the quality of primary health care health delivery systems is a vital part of continuous quality improvement (CQI) processes
This paper describes the development and application of the Systems Assessment Tool (SAT), it assesses the utility of the tool based on the results of a 2014 survey of key informants involved in using the SAT in their health centres as part of their continuous quality improvement (CQI) processes, and it reviews the wider use of the SAT in other CQI research programs
The SAT was originally designed as a measurement tool, it rapidly evolved to become an important developmental tool, enabling team learning about primary health care (PHC) system functioning in relation to articulated best practice, and contributing to team strengthening
Summary
Assessment of the quality of primary health care health delivery systems is a vital part of continuous quality improvement (CQI) processes. As it is a priority to improve Indigenous health status through the effective delivery of primary health care (PHC) services [4], there is a need for good quality tools to assess the effectiveness of the PHC systems providing care to Indigenous people. Chee et al conceptualise health system strengthening as being “about permanently making the system function better, not just filling gaps or supporting the system to produce better short-term outcomes” [7]. This concept is fully supported in the World Health Organization (WHO) definition of health system strengthening: “improving [the] six health system building blocks and managing their interactions in ways that achieve more equitable and sustained improvements across health services and health outcomes” [5]. A review by Rule et al addressing the strengthening of PHC in low- and middle-income countries found no consistent approach for assessing the effectiveness of PHC delivery in those countries [9]
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