Table 1 Core definitions and contributions of components of the partnership learning model

Comprehensive primary healthcare: An approach to PHC that aims to achieve equity in access to healthcare and other resources essential to health; reduced exposure to risk through changes in environmental and social determinants of health; improved participatory mechanisms, opportunities and political capabilities of marginalized population groups; increased inter-sectoral policy actions on the determinants of health; improved population health outcomes and greater health equity [20].

CPHC forms the operational base for the PLM through its focus on the needs and involvement of local communities, its inclusion of both patient-centered and population health approaches, and the recognition by the CPHC approach of the need to address the social determinants of health through co-ordinated, cross-sectoral action [21].

Integrated quality improvement: An interdisciplinary process designed to raise the standards of the care in order to maintain, restore and improve health outcomes of individuals and populations, and that includes the following key features:

SBRNs can draw on the combined effort of many participants from many levels of a health system, leveraging efficiencies of effort to meet priority challenges in a way that the usually more fragmented PHC sector can rarely achieve, and creating opportunities for large-scale ‘sense-making’ [42] and large scale change.

-The process is integrated into the core business of local organizations and the health system

IQI and SBRNs provide critical infrastructure, a systems focus, and an emphasis on generating and using data for ongoing improvement purposes. An IQI approach applied systematically but with sufficient flexibility to meet the needs of diverse stakeholders and contexts can provide a valuable source of data about the performance and state of system development of not only individual PHC services, but also collectively of services within a region or of the sector as a whole.

-Front line health workers, clinical leaders, managers and policy makers are engaged in QI processes

-QI processes and tools are used to address multiple enablers of good quality care

-Data on different enablers of performance are used to understand and inform system performance.

System-based research networks: Research Networks that include multiple practices or services, managers, policy makers and others at various levels of the system in collaborative research to enhance the potential to understand and overcome system barriers to achieving better quality of care and health outcomes.

SBPAR supports ongoing, adaptive strengthening of health systems and the application and refinement of QI tools and processes in a way that meets the diverse needs of a variety of PHC services and the needs of key stakeholders across various levels and sectors of the system. This approach mobilizes a force for change and improvement and encourages better measurement and evidence to inform ongoing improvement efforts.

System-based participatory research: an approach that includes clinicians, office support staff, representatives of health related organizations, managers, and policy makers as well as community members in guiding the research process so that studies more closely match the needs of all stakeholders through their engagement; development of research design, methods and protocols so that the study is more amenable to participants and fits well with the local context; recruitment of research participants; data collection and analysis; and translation of results from the study back into the community, clinical practice, management and policy making.

The SBPAR approach has a strong knowledge translation orientation, and has relevance to the broader system strengthening required to support local PHC functioning, the need for regional managers and policy makers to understand diversity of services and factors influencing performance, and the need for local service staff to contribute to understanding how systems function and how they may be improved. The SBPAR approach encourages effective flow of tacit and explicit knowledge in multiple directions between a range of stakeholders from a range of different levels of the health system. The PLM can be seen as an integrated model for knowledge translation, and as such, provides an ongoing mechanism for strengthening health systems with the aim of delivering large-scale health benefits.

Knowledge translation: refers to the effective use of two types of knowledge within and across a range of levels within the health system. Explicit knowledge refers to codified knowledge, such as that found in research papers, systematic reviews and best-practice guidelines. Tacit knowledge refers to non-codified and experience-based knowledge [11–15]. Knowledge translation refers to active engagement by researchers with policy and practice issues (as experienced by policy makers and practitioners) and with research information, and application of that information to real challenges by people with deep understanding of the challenges and the context within which the information needs to be applied.

Effective partnerships are essential to each of the core components of the model and to achieving synergies between these components. Partnerships are important to effective engagement between stakeholders at multiple levels of the system, between stakeholders within different levels of the system, and across jurisdictional boundaries.

Health systems strengthening: the process of building the overall capacity of a health system, by ensuring the ‘six building blocks’ of a health system - service delivery; health workforce; information; medical products, vaccines and technologies; financing; and leadership and governance - are strong and integrated [1].

Systems thinking enables synergies between key components of the PLM.

Systems thinking: the in-depth consideration of the linkages, relationships, interactions and behaviours among the elements that comprise a complex adaptive system – i.e. one that self-organizes, adapts and evolves with time [2].