Table 1 Summary of factors influencing performance of six remote Northern Territory health centres in delivering services to clients with acute rheumatic fever/rheumatic heart disease (ARF/RHD)
Determinants of relatively good performance | Determinants of relatively poor performance |
|---|---|
• Clear allocation of responsibility for rheumatic heart disease (RHD) care among health centre staff • Good regional management – commitment to continuous quality improvement (CQI), resourcing for CQI • Effective feedback and management action in response to feedback from CQI process • Good Aboriginal health worker involvement in health centre operations • Good outreach arrangements – including drivers, Aboriginal health workers • Public health-oriented chronic disease support from regional level to health centres • Staff stability and continuity, including availability of experienced general practitioner | • Client flows in health centres do not direct ARF/RHD clients to staff responsible for RHD care • Lack of clear allocation of responsibility for RHD care • Lack of effective outreach services • Changes and inefficiencies in clinical information systems • Lack of regular/stable staffing, including general practitioner service • Health centre management turnover, unstable management structure • Larger number of clients, complexities of urban environment |