Understanding uptake of continuous quality improvement in Indigenous primary health care: lessons from a multi-site case study of the Audit and Best Practice for Chronic Disease project | Gardner et al. Implementation Science 2010 5 21 http content 5 1 21 IMPLEMENTATION SCIENCE Implementation Science RESEARCH ARTICLE Open Access Understanding uptake of continuous quality improvement in Indigenous primary health care lessons from a multi-site case study of the Audit and Best Practice for Chronic Disease project Karen L Gardner 1 Michelle Dowden2 Samantha Togni2 and Ross Bailie2 Abstract Background Experimentation with continuous quality improvement CQI processes is well underway in Indigenous Australian primary health care. To date little research into how health organizations take up support and embed these complex innovations is available on which services can draw to inform implementation. In this paper we examine the practices and processes in the policy and organisational contexts and aim to explore the ways in which they interact to support and or hinder services participation in a large scale Indigenous primary health care CQI program. Methods We took a theory-driven approach drawing on literature on the theory and effectiveness of CQI systems and the Greenhalgh diffusion of innovation framework. Data included routinely collected regional and service profile data uptake of tools and progress through the first CQI cycle and data collected quarterly from hub coordinators on their perceptions of barriers and enablers. A total of 48 interviews were also conducted with key people involved in the development dissemination and implementation of the Audit and Best Practice for Chronic Disease ABCD project. We compiled the various data conducted thematic analyses and developed an in-depth narrative account of the processes of uptake and diffusion into services. Results Uptake of CQI was a complex and messy process that happened in fits and starts was often characterised by conflicts and tensions and was iterative reactive and transformational. Despite initial enthusiasm the mixed successes during the first cycle were .
