Professor Sarah Larkins has focused on improving equity in health care services in rural, remote and Indigenous populations since a medical education placement in the Northern Territory highlighted the tremendous inequities in health care access in the region.
Now living and working on Bindal and Wulgurukaba country in Townsville, Professor Larkins is a general practitioner and health systems researcher, and is currently the Dean of the College of Medicine and Dentistry at James Cook University.
This story is part of our 10 of the Best - thirteenth edition. 10 of the Best is an annual NHMRC publication, showcasing 10 NHMRC-funded health and medical research projects. See more 10 of the Best.
Professor Larkins and her co-investigators were awarded a NHMRC Project Grant in 2014 to better understand the healthcare services that had dramatically improved in performance in Continuous Quality Improvement (CQI) audits.
CQI is a quality management process that encourages team members to continuously evaluate whether there are any areas for improvement within their practice. CQI in primary healthcare is essential to improve processes, safety and patient care. Moreover, implementing CQI audits in rural and remote healthcare can be crucial in helping achieve equality in health and life expectancy for Aboriginal and Torres Strait Islander peoples.
Understanding the variability in response to CQI initiatives is an important component in lifting the quality of care overall and improving Indigenous health outcomes. Professor Larkins
The research project 'Lessons from the best to better the rest' formed participatory learning communities with six Aboriginal and Torres Strait Islander Primary Health Care Services in North Queensland, Northern Territory and Western Australia that had demonstrated high improvement in quality of care in response to CQI initiatives. Researchers worked with service providers, managers and service users to identify the 'secrets of success'. The project revealed that complex workforce, organisational and resourcing factors alongside the wider community context were the reasons why these centres had implemented CQI systems and processes better than others.
Professor Larkins praised the involvement of the service providers, managers and clients of the primary health care centres that took part in her project.
This collaborative co-designed work and subsequent learnings would simply not have been possible without the fantastic contributions of these services and communities. Professor Larkins
The results from this practical, on-the-ground manner of research have several mechanisms for potential impact on human health. Besides direct improvements in the quality of health care in and clinical best practice, the project also provided a better understanding of cultural appropriateness and other measures of accessibility and acceptability that are likely to deliver health gains to communities in rural and remote regions.
This program of research has delivered a range of process and outcome benefits that we are building on, with further work exploring how we can use these findings to help other "striving" services to improve their response to CQI activities. Professor Larkins
Professor Larkins used an active knowledge translation strategy within her project. Her team took a two-way learning approach by conducting face-to-face visits to discuss findings at every primary health care centre and producing one-page briefs on the implications of their findings for policymakers, health service providers and clients. The findings were widely disseminated at a variety of peer review conferences, with staff from three of the health care centres giving presentations about their involvement – a testament to the collaborative nature of this project.
Next steps
Professor Larkins is currently leading the 'Leveraging Effective Ambulatory Practices' (LEAP) project, which builds upon the findings of her program of research to further understand how to improve the quality of Indigenous primary health care services. Partnering with eight Aboriginal and Torres Strait Islander primary health care centres, Professor Larkins and her team have co-created a learning community to implement both peer-to-peer and technical support. She is also involved in a study, 'Women's action for Mums and Bubs (WOMB)', which aims to test the effectiveness of community women's groups to improve the quality of Aboriginal and Torres Strait Islander maternal and child health care outcomes.
Chief Investigator (CIA)
Professor Sarah Larkins
Institution
James Cook University
Title
Quality improvement in Aboriginal primary health care: lessons from the best to better the rest
Team members – CIs and Ais
Dr Veronica Matthews
Professor Ross Bailie
Professor Sandra Thompson
Ms Kerry Copley
Mr Dallas Leon
Professor Komla Tsey
Dr Elizabeth Moore
Dr Ruyomuro Kwedza
Ms Jeanette Ward
Dr Christine Connors
Professor Jacinta Elston
Associate Professor Catrina Felton-Busch
Dr Paul Burgess
Team members – Research team
Dr Cindy Woods
Dr Karen Carlisle
Ms Nalita Turner
Dr Michelle Redman-MacLaren
Associate Professor Judy Taylor
Ms Tania Patrao
Mr Maxwell Mitropolous
Ms Moana Tane
Grant information
$617,428
2014-2016
Project Grant
References
Edwards PJ et al. (2008) 'Maximizing your investment in EHR: Utilizing EHRs to inform continuous quality improvement', JHIM, 22(1):32-7.