title: Leveraging quality improvement through use of the Systems Assessment Tool in Indigenous primary health care services: a mixed methods study.
abstract: Assessment 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.
  
  
  
  The 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.
  
  
  
  The 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.
  
  
  
  Originally 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.
authors.affiliation: Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Spring Hill, Brisbane, Qld, Australia. frances.cunningham@menzies.edu.au.
authors.forename: Frances C
authors.initials: FC
authors.lastname: Cunningham
authors.affiliation: National Centre for Quality Improvement in Indigenous Primary Health Care, Menzies School of Health Research, Charles Darwin University, Spring Hill, Brisbane, Qld, Australia.
authors.forename: Sue
authors.initials: S
authors.lastname: Ferguson-Hill
authors.affiliation: Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Spring Hill, Brisbane, Qld, Australia.
authors.forename: Veronica
authors.initials: V
authors.lastname: Matthews
authors.affiliation: University Centre for Rural Health, University of Sydney, Sydney, Australia.
authors.forename: Ross
authors.initials: R
authors.lastname: Bailie
mesh_terms: D001315:Australia / Q000208:ethnology; D002908:Chronic Disease / Q000208:ethnology / Q000628:therapy*; D003695:Delivery of Health Care / Q000592:standards; D005260:Female; D006303:Health Services, Indigenous / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D008297:Male; D011320:Primary Health Care / Q000458:organization & administration / Q000592:standards*; D058996:Quality Improvement; D011787:Quality of Health Care / Q000592:standards*; D012720:Severity of Illness Index
keywords: Chronic disease; Data collection tool; Healthcare systems; Indigenous health; Organisational assessment; Primary health care; Quality improvement