Respect Is Central: A Critical Review of Implementation Frameworks for Continuous Quality Improvement in Aboriginal and Torres Strait Islander Primary Health Care Services

Background: Primary health care (PHC) services are complex systems, shaped by an interplay of factors at individual, organisational and broader system levels. For Aboriginal Torres Strait Islander PHC services, closer relationships with the people they serve, local knowledge community, cultural awareness critical. Continuous quality improvement (CQI) has proven to be effective process for identification priority issues in delivery instigating design, implementation evaluation interventions these settings. However, wide-scale variation persists partly due mismatch between CQI context. Methods: This critical review frameworks primary was conducted two phases: (1) a published used contexts, (2) comparison key features concepts identified high-improving remote Australia. Results: We found nine previously contexts guiding within macro (broader contextual) level; meso (health service) micro (community inter-personal) level systems. There commonality PHC. none covered all rare consideration communities driving improvement, two-way learning (integrating into healthcare provision), caring staff—engendering trusting community enacted through respect. Conclusion: Respect, as secret essence, privileges importance culture, is essential element positive change services. It work design workforce models that grow stable ensure improvements their