Table 2 Key findings from CRE-IQI publications and reports (n = 78) organized by agreement across synthesis methods

Unique findings

• There is wide variation in the quality of delivery of care between health services and jurisdictions, with a significant proportion of this variation explained by health centre factors rather than patient characteristics

• Multidisciplinary networks—such as ‘innovation platforms’—are effective in collective problem solving, building capacity and learning, and fostering system-wide learning and change

• There is a need for health centre capacity building in the use of CQI tools and processes and principles of patient-centred care

• Staff capacity for CQI and IT system use is low; CQI is not viewed as a core component of staffs’ work—this is linked to high staff turnover and a lack of leadership

• Trusting relationships between staff and clients and between Aboriginal and Torres Strait Islander staff and non-Indigenous staff support staff retention, and quality service delivery

• There are successful models of staff capacity building for CQI implementation in a variety of areas including: Health promotion, family wellbeing program, innovation platform, and programs for staff development and wellbeing

• CQI processes can improve the quality and use of client record systems

• Description of the Innovation Platform concept and its application to the CRE-IQI and Aboriginal and Torres Strait Islander Primary Healthcare. The innovation platform concept can be applied to the CRE-IQI an Aboriginal and Torres Strait Islander Primary Healthcare research network

• CQI tools are not fully used [50] because of a disconnect between the theory of doing CQI, and the realities of practice

• Remoteness, population size and governance structure types are not linked to ability to conduct CQI [51], but in our experience, organisational commitment, leadership, funding, and support to develop capacity are linked

• Good data (i.e., relevant, reliable) [52, 53] is crucial but must be part of a full cycle, at a whole-of-system level, to drive improvement

• CQI will be implemented/look different in each service. Each context is unique [53]

• Enablers of CQI are participatory and contextually relevant and responsive approaches [54, 55]

• Gaps in follow-up care exist across the full pathway of care [56] because systems are not fit for context; better referral systems are needed [57] and support to increase and retain Aboriginal and Torres Strait Islander staff

• Better referral systems and support is required to enable Aboriginal and Torres Strait Islander patients to navigate the health system [57]

• “Proper care” and standards of care need to be defined by Aboriginal and Torres Strait Islander people themselves [58]

• Navigating the healthcare system is problematic, and patients require more help [58]

• There is a need for documentation [59], assessment and support, and action in preventive health [60], health promotion and emotional well-being [61, 62], with health promotion and community-based initiatives that incorporate social determinants of health

• Diversity in learning and collaboration is supported by mechanisms that bring diverse groups together [27, 56, 63] to do monitoring [63] and collaboration in writing [64], and it enables dissemination of findings at different levels of the system [65]

• Ensure capacity strengthening and succession planning is embedded in research activities/programs [30, 64]

• Consistency in reporting of research and research approaches (including value and economic value) is important [64, 66]

Moderate agreement

Availability of IT data systems may drive high-quality care [50]

IT capacity and use in the context of CQI processes and quality data is poor [67,68,69] because IT systems and training aren’t specific to CQI

IT systems need to be dynamic to respond to needs, high-level/centralized, with increased focus on capacity building for use [56, 60, 70, 71]

Leadership for CQI is important [72, 73]. Local-level leadership identified as particularly important

Leadership for CQI is important [72, 73], and lack of leadership is a problem

Leadership for CQI is important [72, 73] and lack of leadership is a problem. Aboriginal and Torres Strait Islander leadership identified as critical

Studies have not yet explained variations in effectiveness observed across CQI studies [51]

Participant insights suggest variations are based on incomplete cycles of CQI, separation of data from improvement activities, and top-down selection of issues to study

Activities of the CRE-IQI supported its history of a collaboration research network and ways of working, and ongoing evaluation on its functioning

There is a need to improve community engagement in CQI and research to increase Indigenous ownership and empowerment, identify priority questions, support implementation and translation, and the credibility of findings

Strong agreement across synthesis methods

• Consecutive cycles of CQI improve care [46, 55, 61, 68, 74,75,76,77,78,79,80,81]

• Policy support enables CQI [82]

• There are variations in effectiveness of CQI on improving care [55, 61, 68, 76, 78, 79]

• CQI processes have been applied to a range of non-healthcare settings and for a variety of purposes [83, 84]

• Reliable, valid CQI tools and research have been developed and adapted to support changes to care for a range of issues [45, 46, 68,69,70, 72, 85,86,87,88]

• CQI processes and CQI tools have been successfully applied to other, non-clinical areas of care—including to address social determinants of health and health promotion—and are adaptable for context and content [45, 46]

• Multi-level leadership across an organization is needed to support CQI [73, 82, 89]

• Retaining staff is critical for skilled teams to engage in CQI [53, 72, 73, 89,90,91]

• Barriers to training and retention include heavy workloads and time pressures; with recommendations from Participatory Synthesis to decrease workloads and focus on hiring Aboriginal and Torres Strait Islander staff [58, 92]

• Whole-team, whole-organization support for CQI is an important enabler [73, 82, 89]

• Specialized CQI Facilitators support CQI processes, including promoting team dynamics, capacity building and effective use of CQI tools [45, 46, 93, 94]

• Having the right blend of staff, including Aboriginal and Torres Strait Islander and local workforces, is an important enabler of CQI [53, 57, 73, 90, 95, 96]

• Having Aboriginal and Torres Strait Islander staff, a stable workforce including Aboriginal workers and local workers, and having clear roles and responsibilities of staff are vital to providing care and engaging in CQI [53, 72, 73, 89,90,91, 96]

• Aboriginal and Torres Strait Islander staff and Aboriginal and Torres Strait Islander participation input are critical in driving the quality of care [53, 57, 73, 90, 95]

• Follow-up of abnormal results is a high priority for Primary Health Care [62, 71, 96]

• Importance of Aboriginal and Torres Strait Islander leadership and ownership of driving quality, CQI and CQI research [30, 97]