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Towards quality improvement at scale in the New Zealand primary care setting

Primary care
05 June 2019

The Health Quality & Safety Commission is pleased to share the findings from consumer, health service and stakeholder engagement, to inform the future direction and priorities in our primary care programme.

The document, Towards quality improvement at scale in the New Zealand primary care setting, was prepared for us by Associate Professor Sue Wells, in her capacity as clinical advisor to the programme and a member of our primary care expert advisory group. It was commissioned to help us plan how to achieve quality improvement at scale in primary care. It will also help us understand the barriers and challenges, what the sector thinks our role should be, and where they see us adding the best value.

The document captures and summarises sector feedback according to key themes, which are to:

  • develop definitions of quality and quality improvement from tangata whenua, to reflect Aotearoa New Zealand perspectives
  • investigate the application of the ‘collective impact’ model, develop a shared vision for quality improvement and a national cross-agency unified charter and strategy
  • expand our knowledge management role
  • continue to build workforce capability
  • consider primary care collaboratives as a vehicle for addressing health outcomes, building intersectoral relationships, teamwork (across consumers and the health and social service workforce) and quality improvement capability building.

Overall, the document findings support the need for central agencies and the Commission to work much more collectively and create a national charter or framework for quality improvement with clear strategic initiatives. This would determine and clarify roles for different organisations.

The specific roles identified for the Commission are considered to be: leadership and strategic vision, knowledge management, building workforce capability, and leading or supporting quality improvement collaboratives.

Our work to date

The Commission’s primary care quality improvement work undertaken to date through Whakakotahi has been at a small scale; this has been a deliberate approach in response to sector feedback at the inception of the work.

By the end of our first three-year phase (May 2020), we will have supported 17 primary care-led projects with the key driver of building quality improvement capability in the primary care workforce. We will also have identified activities that show improved health outcomes, and which might be suitable for scale and spread.

In parallel with the third year of projects (being supported through 2019/20), we are considering the next phase of our programme, and its design/areas of focus; namely, how do we achieve scale and spread, maintaining a strong focus on three criteria that continue to drive our primary care agenda: equity, consumer engagement and integration?

The Commission also supports activities in primary care through its health quality intelligence work, with baseline measures and indicators that can be used to assess the quality of the health and disability system, in particular the Atlas of Healthcare Variation and the patient experience survey.

Actions underway

Several actions are already underway, and further reinforced by the findings of this document. They include the following:

  • The establishment by the Commission of our Māori health outcomes team. Its purpose is to help us play our part in the health and disability system to accelerate improved Māori health outcomes.
  • The establishment of a new leadership role by the Commission of a Director, Māori Health Outcomes to define the parameters of change required within our work that will spearhead action towards achieving Māori health equity and mobilise the organisation to think and act differently to move beyond the status quo. Other new dedicated Māori roles will be a Public Health Medicine Specialist (Māori) and a Quality Improvement Advisor (Māori).

One of the immediate priorities of this team, working with other Māori leaders in the sector, will be to develop definitions of quality and quality improvement for tangata whenua, to reflect Aotearoa New Zealand perspectives. This will build on the work we have already started through the Chief Advisor (Māori) in our national mental health and addictions quality improvement work programme.

Next steps

We will be working more closely, internally and externally, so the functions of intelligence, improvement, innovation and integration are addressed within one advisory group structure. This will help drive our primary care work in a more aligned way and provide more seamless engagement with the primary care sector.

We are establishing a new integrated advisory group (primary and community care), that will be chaired by Dr Nick Chamberlain, Chief Executive, Northland District Health Board. The first meeting of the group is in early July. The group will provide strategic leadership in helping us implement a plan of action in response to the findings in this document.


This document is timely, insightful and makes valuable recommendations on both the role of the Commission and other agencies. It will help us work better together to advance equitable health outcomes for all New Zealanders, and most importantly, to reduce inequities and advance Māori health outcomes.

We recognise that the Commission cannot do this alone but has a key strategic role in initiating new or supporting existing primary care quality improvement initiatives. We will facilitate collective action that aligns with sector health priorities, and ensure all of our workstreams are enacted within the frameworks of te Tiriti o Waitangi and He Korowai Oranga.

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