Table 3.

Challenges and strengths of service approaches to QI activities identified in PHC services

	Challenges to QI	Strengths of service approaches to QI
PHC service 1	Coordination of multiple specialist visits (unrealistic expectations) IT system transitions Uncertainty about future service provision Staff shortage (IHWs) (especially male) Unclear ownership of QI Lack of space/rooms	Strong sense of team amongst workers Ethos of quality care and “keeping the door open” Recognition of importance of “working culture way” Links with community (through staff)
PHC service 2	Issues with patient flow – no-shows, waiting time and transport Rapid growth and diversification Communication challenges between external services/between Board and staff	Strong systems and active QI implementation Long term staff, strong teams and links with community Clients comfortable and perceive quality care Quality, holistic care provision
PHC service 3	Understanding of QI processes (QI as “scary words”) QI happening but not evidenced or measured Engaging patients to come in Managing referrals and visiting teams Busyness!	Ethos and values of quality care AHW led service Strong leadership and committed workforce Community outreach Effective use of IT systems Open communication
PHC service 4	Working across languages Lack of male AHPs Burden on AHPs - tension between cultural expectations & health service delivery Some people not attending clinic Limited understanding of audit and QI Ageing workforce	Culture-embedded care delivered by local Aboriginal staff Majority Aboriginal staff – valued AHP workforce Collaborative workforce Good community engagement
PHC service 5	Staff turnover/shortages and challenges recruiting and training AHPs Limited local cultural orientation for new staff Large complex clinical workload impacting on turnover and continuity of care Building trust with community/disconnect between clinic and community Remoteness and isolation Complex health service delivery arrangements	AHPs play an important role in care delivery Committed staff with relationships with community Strong links with AMSANT and support IT systems used to support care Support for staff training and upskilling
PHC service 6	Acute care demands “like constantly chasing your tail” Importance of peak body support Staff turnover and the “departure lounge” Lack of AHP and cross-cultural communication Links between community members and clinic staff	Resilient community Quality staff
PHC service 7	Perceived “top down” approach to QI and staff not feeling they had a say in QI Local staff feel they are always on call Not fully utilizing knowledge of local staff	Strong stable Aboriginal workforce, valued within service Receptive community Health systems support QI by all staff
PHC service 8	QI not yet embedded in the organizational culture Large clinical load Geographic isolation (incl. connectivity) Staff turnover; lack of AHP (especially males) Limited external support for QI	Strong shared motivation to improve health Support for QI from management