provide actionable, recommendations to enhance the sustainability and continuous improvement of the CQI Strategy. 1.2 Audience In addition to the three partner organisations, the evaluation findings will be relevant to key stakeholders involved in the implementation of CQI in the NT, and other government and organisations with an interest in improving quality in the health sector. This includes the NT Aboriginal Health Forum (NT AHF), the key governance body representing the three partner organisations, and the CQI Steering Committee, the group charged with guiding the implementation of the CQI Strategy. We have prepared an accompanying summary report which will be used to disseminate findings and learnings of the evaluation to a wider audience. 1.3 The CQI Strategy Prior to the development of the CQI Strategy the level of uptake and capacity for CQI was inconsistent across the NT Aboriginal PHC sector. While some health services had the expertise and capacity to address CQI, others had little or no exposure to formal CQI. Funding for CQI was also inconsistent and was generally program-specific. The proposed CQI Strategy was agreed in April 2009. Its overall goal is to build a consistent approach to CQI across the NT Aboriginal PHC sector to support sustainable, long term service reform and improvement, with a focus on clinical CQI. The CQI Strategy is part of a wider suite of PHC reforms occurring in the NT Aboriginal PHC sector, including regionalisation and expansion of PHC services, and the introduction of the NT Aboriginal Health Key Performance Indicators (AHKPIs). The CQI Strategy includes four major components, each of which supports the development and implementation of the CQI model: Establishment of the CQI Steering Committee to guide the development of a sustainable and integrated CQI model, and to guide the implementation of that model within Health Service Delivery Areas (HSDAs). Engagement of two CQI Coordinators to provide expert leadership in implementing the CQI through training and support to CQI Facilitators in the HSDAs, as well as advice to the CQI Steering Committee on further development of the CQI model. Funding to support CQI Facilitators within HSDAs. Conducting a comprehensive quantitative and qualitative evaluation of the CQI Strategy. 1.4 Structure of this report The remainder of this report is structured as follows:
5.1 Summary of findings The key evaluation findings relating to barriers and enablers are: the current CQI Strategy governance structures are effective in supporting the operation of the Strategy, but there is a gap in higher level strategic oversight of the Strategy governance of the Strategy would be assisted by more active contract oversight is varying levels of support from management for CQI and this is reflected in the attitudes of their staff regular training to increase staff capacity in CQI has been provided under the Strategy. This training is valued by attendees the main barriers to training attendance are time and a lack of backfill staff the CQI Coordinator role is providing effective support to the CQI Facilitators; this could be enhanced by a complementary focus on supporting the strategic goals of the CQI Strategy the CQI Facilitator role has been critical to increasing CQI capacity and capability in the Aboriginal NT health sector recruitment and training processes for the CQI workforce were appropriate, but uncertainty of funding is a barrier the population based formula to determine placement of the CQI Facilitators could be reconsidered change management support has been provided through training and through the CQI workforce; further developing change management and communications would be beneficial patient information systems used by NT health services are suitable for the current CQI approach but may not support leading their own CQI processes the CQI approach in the NT needs to account for high staff turnover and use of temporary staff. Potential adjustments and improvements to the ongoing implementation of the CQI Strategy are outlined in Box 3 below. The formal recommendations from this evaluation are outlined in section 8. Box 3: Potential areas for improvement Clarify who the CQI Steering Committee reports to, and develop a process for identifying and elevating emerging issues. Clarify the role of regional managers in CQI activities and how they are expected to work with the CQI Facilitators and communicate the results of this discussion to the sector. Reconsider the distribution of the CQI Facilitators workforce, including consideration of the population served, the number of communities and health clinics, and the remoteness of these clinics. Include CQI as part of staff recruitment and performance appraisal processes and the orientation of new staff, including locum staff. Explore rolling out the PENCAT system, or a similar tool, across the NT health sector. Investigate including a CQI component as part of locum training and incentivising visiting GPs to come to the same clinic over time.