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Table 3 Factors that enable or create a barrier to the normalisation of STRIVE sexual health CQI components

From: Perspectives of primary health care staff on the implementation of a sexual health quality improvement program: a qualitative study in remote aboriginal communities in Australia

STRIVE Component

Enabler

Barrier

Clinical data report

• Data specific to each clinic

• No clinic specific data pre STRIVE

• Clearly highlighted gaps and improvements

• Directly translatable into clinical activity

• Face-to-face delivery of reports

• High staff turnover decreased relevance of the data

• High staff turnover meant that some interviewees had no recall of the data reports

• Data quality was questioned

• Some interviewees felt the reports were difficult to interpret

• Clinic data overload (too much data)

• Competing clinical demands and a busy clinic

Systems Assessments Tool

• Tool aligned with existing CQI process

• Tool was familiar to interviewees

• Promoted reflective practice

• Clearly highlighted gaps and improvements

• All of staff involvement

• High staff turnover and yearly SAT meant that some interviewees had no recall of the tool

• Subjective nature of scoring system created less engagement

• Some clinic systems were unable to be altered by clinic based staff, therefore relevance of the tool was questioned

• Tool not understood easily by all

• Tool was very lengthy and felt to be repetitive

Action Plan setting

• Action plan translated the data and systems assessment into clinic specific goals

• Provided a clear framework

• Decreased manager workload

• High staff turnover meant some interviewees had no recall of the Action Plan

• Competing clinical demands decreased the workability of the action plan

• Limited engagement in the plan by some visiting sexual health support staff

STRIVE coordinator

• Clear understanding of difference in roles between STRIVE coordinator and existing regional sexual health support staff

• Regular face-to-face visits

• Continuity of STRIVE staff

• Created accountability

• Visiting support staff ‘fatigue’

Health Promotion funding

• Encouraged staff to conduct a health promotion activity

• Funding not tied to any formal reporting requirements

• Lack of clarity about the difference between STRIVE health promotion and STRIVE incentive based funding

• Interviewees questioned the value of health promotion

• Lack of resources (knowledge, staff, time) to utilise the funding

• Difficulties in accessing the funding

Clinic incentive payments

• Funding not tied to any formal reporting requirements

• Motivator for staff

• Lack of clarity about the difference between STRIVE health promotion and STRIVE incentive based funding

• Difficulties in accessing the funding

• Some interviewees felt ethical uncomfortable with incentivisation of their work