Elements that facilitated successful systems changes included capitalizing on environmental changes, ensuring participation and support at all organizational levels, using technology, establishing ongoing training and continuous quality improvement mechanisms and leveraging external funding and technical assistance.
This work involved developing skills and supports for identifying key stakeholders in the district and establishing ongoing partnerships.
With the wide engagement of service organisations we aim to establish mechanisms to a) provide ongoing support for services in implementing CQI and b) to continue our program of research on primary care quality improvement.
For example, our findings suggest that where equipment count practices are not well established, focused training, agreed procedures and ongoing support to implement these practices are needed if the use of checklists is to be meaningful.
And the Welsh Co-op's involvement in this project is part of the business's ongoing support of measures to re-establish environmental balance.
Establishing and maintaining a forum of mixed members required careful preparation and ongoing support.
Furthermore, to ensure sustainability of improvements, it is recommended that ongoing support and supervision is needed from an experienced facilitator in order to establish a culture of data driven monitoring and to foster greater ownership of programme performance.
However, he says, with help and ongoing support, "these patterns can be left behind and new patterns of healthy sexuality established".
Advisory groups were established, comprising the research team and key stakeholders and clinicians within each hospital department, who met frequently to ensure ongoing support for the study from the clinical teams and departments.
We're not doing ongoing support".
