Cultural governance is vital for quality improvement in Aboriginal and Torres Strait Islander primary healthcare

<h2>Abstract</h2><h3>Purpose</h3> Considerable published work in continuous quality improvement (CQI) in First Nations primary healthcare indicates the importance of accessible data and a stable and prepared workforce. However, little has been published from a First Nations-led perspective about what factors are important in improving quality in care provided. <h3>Methods</h3> This participatory largely qualitative project involved a learning community with members from eight primary healthcare services serving First Nations communities, peak bodies, academics and other partners. It featured 140 interviews with health service staff, managers and community members. All data were collected, thematically analysed and interpreted by members of the learning community. <h3>Main findings</h3> Analysis of Leveraging Effective Ambulatory Practice (LEAP) project data from talking to community and health service providers and from learning community meetings revealed important facilitators of quality improvement, understandings of quality and some of the challenges encountered. A key principle that underpinned all themes was ‘working culture way', termed here as ‘our ways of working'. Other interwoven big ideas that participating services felt helped overcome challenges in implementing CQI included: workforce innovations to strengthen continuity and trust, accessible CQI data, cultural safety and place-based approaches, and making space for two-way learning with community. <h3>Principal conclusions</h3> Cultural governance of health services and quality improvement efforts are vital for success, and the centrality of cultural ways of working is paramount in these findings. In addition, these findings emphasise the importance of: i) recruitment, training on-Country and then support of a strong and valued Aboriginal and Torres Strait Islander health worker and practitioner workforce; ii) valuing the impact of this stable workforce in terms of relational continuity and trust (both directly and through supporting the stability and thus communication and trust of the non-Indigenous workforce); and iii) understanding how best to work with communities in addressing these issues.