title: Re-orienting a remote acute care model towards a primary health care approach: key enablers.
abstract: BACKGROUND
  The objective of this study was to identify the key enablers of change in re-orienting a remote acute care model to comprehensive primary healthcare delivery. The setting of the study was a 12-bed hospital in Fitzroy Crossing, Western Australia.
  
  
  METHODS
  Individual key informant, in-depth interviews were completed with five of six identified senior leaders involved in the development of the Fitzroy Valley Health Partnership. Interviews were recorded and transcripts were thematically analysed by two investigators for shared views about the enabling factors strengthening primary healthcare delivery in a remote region of Australia.
  
  
  RESULTS
  Participants described theestablishment of a culturally relevant primary healthcare service, using a community-driven, 'bottom up' approach characterised by extensive community participation. The formal partnership across the government and community controlled health services was essential, both to enable change to occur and to provide sustainability in the longer term. A hierarchy of major themes emerged. These included community participation, community readiness and desire for self-determination; linkages in the form of a government community controlled health service partnership; leadership; adequate infrastructure; enhanced workforce supply; supportive policy; and primary healthcare funding.
  
  
  CONCLUSIONS
  The strong united leadership shown by the community and the health service enabled barriers to be overcome and it maximised the opportunities provided by government policy changes. The concurrent alignment around a common vision enabled implementation of change. The key principle learnt from this study is the importance of community and health service relationships and local leadership around a shared vision for the re-orientation of community health services.
authors.affiliation: Kimberley Population Health Unit, Broome, Western Australia, Australia. vicki.carroll@health.wa.gov.au.
authors.forename: Vicki
authors.initials: V
authors.lastname: Carroll
authors.affiliation: Kimberley Population Health Unit, Broome, Western Australia, Australia. carole.reeve@flinders.edu.au.
authors.forename: Carole A
authors.initials: CA
authors.lastname: Reeve
authors.affiliation: School of Rural Health, Monash University, Bendigo, Victoria, Australia. john.humphreys@monash.edu.
authors.forename: John S
authors.initials: JS
authors.lastname: Humphreys
authors.affiliation: Centre for Remote Health, Alice Springs, Northern Territory, Australia. john.wakerman@flinders.edu.au.
authors.forename: John
authors.initials: J
authors.lastname: Wakerman
authors.affiliation: Nindilingarri Cultural Health Services, Fitzroy Crossing, Western Australia, Australia. maureencarter@nindilingarri.org.au.
authors.forename: Maureen
authors.initials: M
authors.lastname: Carter
mesh_terms: D018672:Community Health Planning / Q000191:economics / Q000379:methods*; D003256:Community Participation; D003191:Comprehensive Health Care; D003695:Delivery of Health Care; D006075:Governing Board; D006078:Government Programs; D018166:Health Care Reform; D006743:Hospital Bed Capacity, under 100; D006801:Humans; D007373:Interinstitutional Relations; D007407:Interviews as Topic; D007857:Leadership; D017146:Models, Organizational; D009936:Organizational Innovation; D011320:Primary Health Care; D036301:Qualitative Research; D019035:Rural Health Services / Q000458:organization & administration; D014904:Western Australia; D000078329:Workforce
keywords: Allied Health; Australia/Pacific; Community Participation; Community-Controlled Health Services; Consumer perspectives; Cross-cultural Safety; Determinants of Health; Evidence-based Care; Health Service reform; Human Rights and Ethics; Indigenous Health Worker; Maternal and Child Health; Medical; Nursing; Primary Health Care; Public Health; Researcher