A quality improvement collaborative to build improvement capacity in regional primary care support organisations

Strong primary care is foundational for effective, efficient health systems but remains variable in health systems around the world. Increasing quality improvement capacity in primary care support organisations has potential to improve primary care and health systems. This project worked with staff from primary healthcare support organisations with the aim of improving by 20% the confidence and competence scores of participants seeking to implement a quality improvement activity. The Breakthrough Collaborative approach was used to design a programme of learning workshops, action periods, data feedback and local support. Improvement measures included confidence in quality improvement (self-rated) and competence in quality improvement (using the validated Quality Improvement Knowledge Assessment Tool). Participants were required to submit quality improvement plans and run local quality improvement projects. The programme was run three times with improvements made between each cycle. Overall, 50 teams consisting of 173 regional staff took part. They engaged a total of 341 front-line primary care services such as general practices, Aboriginal medical services and pharmacies. In the first cycle, there was no improvement in measured regional staff knowledge and skills. In response, the learning workshops were changed to increase didactic teaching and supported practice of fundamental quality improvement skills. Regional organisational leaders were consulted to decrease the turnover in participants during each collaborative cycle. In the final cohort, a 38% improvement in knowledge and skills was recorded. All teams submitted quality improvement plans and ran local workshops indicating good engagement. This programme addresses a key need for health systems that is shared around the world: the improvement of primary care. It demonstrates using the Breakthrough Collaborative methodology to increase quality improvement capacity in the sector. After initial challenges, repeated cycles recorded greater than 30% improvement in the measured competence of participants in quality improvement activities.