A new book, Primary health care and continuous quality improvement: An evidence-based guide, draws upon more than 20 years of research across the scope of clinical care in Aboriginal and Torres Strait Islander primary healthcare services, with stories from the field and practical tips backed by research evidence.
Below, the authors highlight five of their key points, concluding: “Highly relevant to Australia’s health sector – and to global efforts toward health equity – we offer this book as essential reading for policymakers, primary healthcare staff, funders, and researchers working to build stronger, fairer systems of care.”
Alison Laycock, Lynette O’Donoghue and Ross Bailie write:
Primary healthcare is the foundation of health systems worldwide, yet the quality of that care varies greatly between communities, facilities, and conditions.
In Australia, particularly in Aboriginal and Torres Strait Islander health settings, continuous quality improvement (CQI) has emerged as a structured, participatory, and evidence-based way to address these disparities.
Drawing on more than two decades of collaborative research with hundreds of community-controlled and government primary healthcare services, our new book, Primary health care and continuous quality improvement: An evidence-based guide, offers a comprehensive and practical guide to improving care.
Published by Sydney University Press, the book brings together frontline experience and collaborative research to show how CQI can support more equitable, accountable, and effective health systems. It situates this work in Australian Indigenous primary healthcare while offering international relevance.
The book emerges from a long history of research innovation and health reform, much of it rooted in the Northern Territory.
Dr Tarun Weeramanthri, a national leader in public health, writes in the foreword: “New approaches to healthcare are constantly needed in rural and remote Australia – to build on existing strengths, fill gaps and ensure access and quality.”
In such environments, where patient need is high and staff turnover and resource constraints are ongoing, CQI has become both a tool for improvement and a driver of innovation.
1. Primary healthcare as a foundation
As our book states, “Primary healthcare attends to the majority of a person’s health needs throughout their lifetime, including physical, mental and social wellbeing. Primary healthcare is people-centred rather than disease-centred.”
We explore how primary healthcare, when done well, empowers communities, improves equity, and becomes a central mechanism for responding to chronic illness, social determinants of health, and system complexity.
Primary healthcare’s community-based structure is one of its great strengths, and demands locally tailored approaches to improvement.
In the first section of the book, we lay out why CQI in primary healthcare differs from improvement strategies in hospitals or specialist services.
It explores how the social, structural and environmental determinants of health intersect with clinical practice, drawing on examples from Aboriginal and Torres Strait Islander communities.
2. Understanding variation in quality of care
Using evidence from over 20 years of implementation, we highlight how the quality of care differs markedly, not only between health services, but within them – across health conditions, patient groups, and types of care.
Through data gathered in Aboriginal and Torres Strait Islander primary healthcare settings, we provide a striking view of this variation, for example in diabetes management, child immunisation, cardiovascular screening, or maternal health.
These differences point to clear opportunities for improvement – and for targeted action that is ethical, collaborative, and systems-based.
3. Tools, data and a participatory approach
The practical heart of the book lies in how we guide CQI implementation in complex, real-world settings.
Readers are introduced to the cycle of continuous quality improvement and the tools that support it – from run charts and systems assessment tools to stakeholder mapping and goal setting frameworks.
We have adapted and tested the resources and tools in primary healthcare settings. The practical focus is clear: readers are equipped not just with theory, but with proven methods for implementation, reflection, and sustained improvement.
More than a technical manual, the book demonstrates how teams can use these methods to interpret local data, understand variation, and design improvement strategies with community engagement.
Co-designed approaches and Indigenous leadership are central throughout.
4. Case studies, evidence and impact
Primary health care and continuous quality improvement: An evidence-based guide provides illustrative data from over 20 years of research across the scope of clinical care in Aboriginal and Torres Strait Islander primary healthcare services, with stories from the field and practical tips backed by research evidence.
These case studies – spanning chronic disease, child health, maternal health, mental health, and preventive care – show not only what can be improved, but how.
This work builds on the Audit and Best Practice in Chronic Disease (ABCD) program and its successors.
Dr Tarun Weeramanthri observes that “it is the continuous in continuous quality improvement that is the hardest bit”.
Yet this sustained effort has shaped policy, service delivery, and research partnerships in Australia and internationally for over two decades.
5. A legacy of equity and leadership
The foundation for this work is Aboriginal and Torres Strait Islander leadership and community control.
As Professor Ian Anderson – a leading Aboriginal academic – writes in the second foreword: “These services were created from the 1970s through Aboriginal and Torres Strait Islander activism to address our people’s poor access to healthcare, and the racism they experienced when seeking care.”
Anderson reflects on the evolution of CQI research through initiatives like the Cooperative Research Centre for Aboriginal Health.
He notes: “It is exciting to see the ongoing evolution of this field of work, described in detail in this book, as it continues to impact and improve health services’ practice, thereby contributing to better health outcomes for Aboriginal and Torres Strait Islander peoples.”
Primary health care and continuous quality improvement: An evidence-based guide is a contribution grounded not only in data and method, but in story, service, and sustained collaboration.
It offers evidence, tools, and most importantly, a vision of how better care can be delivered – ethically, practically, and in genuine partnership.
Highly relevant to Australia’s health sector – and to global efforts toward health equity – we offer this book as essential reading for policymakers, primary healthcare staff, funders, and researchers working to build stronger, fairer systems of care.
As Weeramanthri reminds us, these improvements “may be modest initially, but such hard-won gains, sustained over time and built into a new base of primary care practice, will be worthwhile in the long run for a large number of patients”.
By bringing together practical experience, local and international evidence, and decades of collaborative research, we have created a comprehensive and accessible resource – available in print and open access online – for those involved in delivering, managing, or shaping primary healthcare.
Author details
Alison Laycock is a research fellow at the University Centre for Rural Health, University of Sydney. Alison has worked collaboratively with community, research and health service partners to develop quality improvement tools and training resources, and guides for health promotion practice and health research in Aboriginal and Torres Strait Islander primary health care settings.
Lynette O’Donoghue is a proud Yankunytjatjara and Warumungu-Warlpiri woman, and a research fellow at the University Centre for Rural Health, University of Sydney. She has contributed significantly to Indigenous leadership of the NHMRC-funded Centre for Research Excellence in Strengthening Systems for Indigenous Health Care Equity, advocating meaningful engagement of Aboriginal and Torres Strait Islander communities and services in the design, implementation and translation of research activities.
Ross Bailie is professor of rural health with the University of Sydney School of Public Health and the University Centre for Rural Health, based in Lismore, Northern NSW. Ross’s research has been centred on increasing availability of information for policy and service planning for Aboriginal and Torres Strait Islander health and for rural and remote communities.
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