towards(an(aboriginal(health(plan(for(nsw( … · strategicdirec) onforthehealth ......

Towards an Aboriginal Health Plan for NSW Consulta)on Paper “the same challenges seen through new eyes”

Prepared by:

Dr Leigh Gassner & Steve Atkinson Reos Partners Melbourne Office 79 LiBle Oxford St Collingwood, 3066 Victoria

25 November 2011

Copyright © 2011 Reos Partners Pty Ltd. All rights reserved.


Contents

Introduc<on…………………….………………………………………………………………..……………………………………………..…… 3

Tackling Complex Problems…………………………………..………………..…………………………..…………………………..…… 5

Consulta<on Methodology and Process to Date…………………..…………………………..……………………………..…… 6

Summary Findings – Dialogue Interviews………..………………………………………………………………………………….… 7

Summary Findings – Regional Workshops………….………………………………………………………………………….….… 11

Building Blocks for the Future……………………………….……….………......…………………..……………….………….…..… 17

How do the building Blocks help?………………………………………………………………………..…………………………….. 21

Next Steps…………………………………………………………………………………………..………………………………………………. 29

2



Introduc<on

In collabora)ve partnership with the Aboriginal Health and Medical Research Council of NSW (AH&MRC), the NSW Ministry of Health, Centre for Aboriginal Health, (CAH) undertook a consulta)on and dialogue process across metropolitan and rural NSW. The consulta)ons were designed to inform the development of a 10 year Aboriginal Health Plan for NSW. It is an)cipated that the Aboriginal Health Plan will provide an overarching framework and set the strategic direc)on for the health system in NSW to meet the challenge of achieving sustainable equality in health outcomes for Aboriginal people.

The consulta)on process includes stakeholder interviews, regional workshops throughout NSW, a Ministerial Health and Wellbeing Forum, and wriBen submissions through the Centre for Aboriginal Health webpage to be launched shortly. The primary purpose of this dialogue process is to consult widely across a mul)-‐stakeholder popula)on connected to Aboriginal health to explore the diverse opinions and perspec)ves about how the current system is perceived and what is needed for the future.

The first phase of this consulta)on process involved thirty dialogue interviews conducted with key stakeholders across the health system in October 2011. The interviewees were asked to share “through their own eyes” their views about how they see the past and present situa)on of Aboriginal health in NSW, and its future. The interviews were followed up with a series of eight one-‐day workshops. The workshops extended the group of 30 interviewees to over 200 local decision-‐makers, leaders, and prac))oners across the metropolitan and rural regions of NSW during November 2011. The convening ques)on that formed the primary focus of the workshops was:

“How can we, together transform the way we work and collaborate to significantly improve health outcomes of Aboriginal people

across NSW over the next ten years?”

This ques)on was designed in a purposeful way. Firstly, it asks how “we together” can tackle this challenge, not how the challenge can be tackled separately or in compe))on. Secondly, it asks not what could be done to change the way we work and collaborate, but what could be done to “transform” it. Transform it permanently in the way a caterpillar transforms into a buBerfly – the buBerfly can’t then return to its original form. Thirdly, it includes a focus on both “working AND collabora)ng” – both were seen as difficult and necessary challenges to tackle. Finally, to significantly improve health outcomes of Aboriginal people over the next ten years requires us to both understand what “health outcomes” look like through the eyes of Aboriginal people, and that while ten years is not a long )me, it is long enough to start seeing significant changes in Aboriginal health outcomes – changes that in some cases are just not possible to observe in just 3-‐5 years.

3



Introduc<on

The consulta)on process was based on an underlying philosophy of Reos Partners for tackling “stuck problems” in complex social systems: a system that is able to look clearly at itself and its current reali)es, is more likely to be effec)ve in thinking together about its future. The primary purpose of the interviews and workshops was to dis)ll and collate the views from the ground up to help us “see” the collec)ve thinking of key leaders and decision makers from across health system. The consulta)ons enabled us to explore the breadth of views on both the current system, as well as dreams and aspira)ons of the ideal future. This was conducted in a way that regarded as “very different” and “very posi)ve” by almost all those in aBendance. As one of the Aboriginal women elders said, this approach provided us with a way to see our own insight and wisdom. That while much of the same problems seem to repeat over and again, it showed us, “the same challenges seen through new eyes”. This statement succinctly summed up the basis of the consulta)ons and the new possibili)es that emerged as a result.

Through exploring the convening ques)on, challenges, issues, opportuni)es and leverage points for ac)on emerged that have the poten)al to collec)vely form the basis of the ten year Aboriginal Health Plan for NSW.

This consulta)on report provides a summary of the collec)ve outcomes from the consulta)on process to date, as well as the proposed building blocks for how we can together transform the way we work and collaborate to significantly improve health outcomes of Aboriginal people across NSW over the next ten years.

“It is never enough just to tell people about some new insight. Rather, you have to get them to experience it in a way that evokes its power and possibility. Instead of pouring knowledge into people’s heads, you need to help them grind a new set of eyeglasses so they can see the world in a new way.”

John Seely Brown

4



Tackling Complex Problems

Tackling seemingly intractable problems in complex social systems require a specific set of approaches that extend beyond our more tradi)onal problem solving techniques. This does not mean our tradi)onal approaches are unimportant, but it means they will ohen benefit greatly from the inclusion of these addi)onal approaches designed specifically to tackle complexity.

There are three key types of complexity that are ohen present in social systems (from Adam Kahane, Reos Partners, 2002). From a number of perspec)ves it would appear to be the case that all three types of complexity are currently present in the health system in NSW.

These three types of complexity are:

Dynamic complexity: Cause and effect are far apart and interdependent -‐ the system needs to be approached as a connected whole, not in separated parts.

Social complexity: Actors have diverse perspec)ves and interests – an inclusive, par)cipa)ve, mul)-‐stakeholder approach needs to be applied to find sustainable solu)ons for all.

Genera)ve complexity: Future is unfamiliar and undetermined -‐ a reliance on present and past prac)ce is ohen not enough. The approach needs to be emergent -‐ involving discovery and innova)on to search for new solu)ons.

5



Consulta<on Methodology and Process to Date

Reos Partners undertook a dialogue process involving the Government, NGO sector and Aboriginal communi)es in a way that enabled these stakeholders to think differently together, to openly tease out issues in new ways, and to help shih the mindsets in a way that can collec)vely lead to new innova)ons and ideas to shih “stuck” systemic problems”. The process was designed to enable groups of system stakeholders to explore the current state side by side, to re-‐conceive what is possible, and to co-‐create new possibili)es for the future in ways that aim to build deeper awareness, deeper understanding, new insights, deeper trust, stronger rela)onships and ongoing inclusion. To enable the groups of system stakeholders there were two significant elements:

I. Mul<-‐stakeholder dialogue and consulta<on process was designed to bring to the surface both prevailing views and new insights whilst concurrently and progressively iden)fying, building upon and valida)ng the emerging themes and challenges. At the early part of this phase, the scope of the consulta)on doubled, ensuring there was adequate coverage across the State on this cri)cal issue. This first part of this phase involved over 30 dialogue interviews from a wide range of stakeholders from across the State. The interviews were subsequently synthesised into key themes that provided a framework for the eight regional workshops that followed, including Broken Hill, Coffs Harbour, Nowra, Dubbo, Wagga Wagga, Tamworth and Sydney (x2). Each workshop was comprised of a mul)-‐stakeholder group of local decision-‐makers from across the Health system. The Health and Wellbeing Forum is also included as an important component in this element.

II Report Findings involves analysis and repor)ng. Following the analysis and synthesis of the findings from the interviews and workshops, this consulta)on paper was developed as a high-‐level summary report of the outcomes to date. The second step will involve an extension of the consulta)on paper in the form of a final report detailing the full findings, challenges and insights emerging from the stakeholder groups including the Health and Wellbeing Forum and wriBen submissions.

6



Summary Findings – Dialogue Interviews

The thirty State-‐wide dialogue interviews enabled us to develop a rich source of themes that included views and perspec)ves on Aboriginal health in NSW. The purpose of the interviews was to elicit and help clarify the thinking of each interviewee on the topic of: How can we, together transform the way we work and collaborate to significantly improve health outcomes of Aboriginal people across NSW over the next ten years? Each interview included aspects of how the interviewees understand and saw from their perspec)ve the current situa)on in Aboriginal health, the core challenges and choices they and the sector are facing, and the possibili)es and leverage points they saw for future improvement and transforma)on. The interviewees were drawn from senior levels of government, AH&MRC Board members, local level managers and program co-‐ordinators in city, rural and regional NSW. In a sense it was a representa)ve slice through the health system.

Based on these interviews, a number of key themes emerged. These themes include, Workforce, Delivery Models, Funding, Connec<on, Respect, Leadership, Accountability, Measurement & Repor<ng, Outcomes and Time. Each of these themes are described in more detail below:

Workforce: This theme was predominant in the interviews. It includes the need to aBract and provide a pathway for Aboriginal people to work in the health system and for them to be con)nually supported to ensure reten)on accordingly the con)nual building of exper)se. The ability to build capability through proper educa)on was seen as cri)cal in ensuring the right mix of skills and capacity are available to support the health system providing the best service to the Aboriginal community. In par)cular the need for local Aboriginal people to be educated and work in their own communi)es is important for a sustainable workforce. The issue of Aboriginal workers being treated equally and with respect was seen as necessary yet not always obvious in the system. It was also apparent that Aboriginal health workers have a very different role to that of their non-‐Aboriginal counterparts in that it is difficult for them to “leave their work at work”. They are expected by their community to provide advice at any )me, even aher work hours. Another important whole of workforce issue relates to the mainstream services where cultural competency and cultural safety are paramount to ensuring a respeclul health system free of both personal and ins)tu)onalized racism. It was clear through the interviews that the prevailing antude in the health system should be one whereby each and every mainstream health worker is culturally competent in interac)ng with Aboriginal people entering the system, that is with respect and understanding, and indeed the whole system should be culturally safe for Aboriginal people seeking assistance. It must be added that the interviews clearly indicated that there was a lot more sincere effort required to achieve a mainstream system with cultural competency and cultural safety prevailing.

7




Delivery Models: Delivery models focused on the cri)cal factors which both impaired and enhanced good health service delivery within Aboriginal communi)es. This included the ques)on of Aboriginal health being seen in a wholis)c sense rather than being reduced to just a medical solu)on. The defini)on of Aboriginal health was ohen referred to in terms of the social, emo)onal and cultural well-‐being of the individual and the community, not just the medical solu)on which can be provided. It also included the focus of service delivery with a greater emphasis on primary health programs rather than over-‐emphasis on acute care. Access to the system and cultural safety in the system effected the ability of a service to deliver appropriate outcomes for Aboriginal people. The need to acknowledge the cultural, tradi)onal and historical influences on an Aboriginal person when they consider entering the system or not is significant and determines the effec)veness of the health system in achieving good outcomes.

Funding: The funding theme stretched across the depth and breadth of the system. It included the complex and difficult funding arrangements between the Commonwealth and State as well as acknowledgement at the local level that funds were not always efficiently and effec)vely used by local services. Both the Commonwealth and State funding arrangements and the lack of coordina)on of local resources contributed to fragmenta)on of service delivery as well as unproduc)ve compe))on for funds and mul)ple repor)ng and evalua)on regimes. A top-‐down approach to funding added to the concern that many local services believed that they knew what services and program needed funding but were not able to secure it under the current arrangements – they felt they were not listened to and while numerous programs were funded they may be irrelevant or peripheral to local community needs. The overwhelming concern rela)ng to the current funding structures was the sense of waste and duplica)on AND the misdirec)on that was occurring through the unintended consequences of fragmented and misaligned funding sources. It was felt that much more efficiency could be gained here.

Connec<on: Connec)on included the ability to link-‐up at all levels of the system to overcome fragmenta)on and enhance the co-‐ordina)on of resources and effort. Connec)on involved deeper and more meaningful rela)onships being built, beyond merely MoUs or similar. Connec)on also involved the need for genuine, honest consulta)on and involvement in decision making rather than just looking for superficial input. It was ohen ques)oned whether those who are being consulted were actually being listened to. Underpinning the whole concept of connec)on was the element of trust. If trust couldn’t be built with the community then the rela)onships would not be truly effec)ve and sustainable and health outcomes would suffer as a result.

8




Respect: This theme involved the respeclul treatment of Aboriginal people -‐ a sense of equality and inclusion, without the presence of racism – either on a personal level or ins)tu)onalised. Respect also involved Aboriginal people feeling safe that if they entered the health system their confiden)ality would be respected, their culture honoured and their children and families protected from being taken away by the authori)es. This is a living, present day fear felt by many Aboriginal people s)ll part of and connected to the Stolen Genera)on. The prevailing antudes and level of understanding, par)cularly by non-‐Aboriginal people in the system, directly effected the experience Aboriginal people had, and indeed whether they would enter the system at all to receive help. This theme seemed to be deeply embedded.

Leadership: The need for strong, consistent, accountable and honest leadership at all levels of the system was also acknowledged. Those consulted were eager to see leadership from the Ministerial level right through to the local level. There was a clear signal about the need for strong leadership at the local level which included leadership in building and sustaining partnerships and genuinely represen)ng the local communi)es. It was observed that when leadership was strong and working well, many other parts of the system started to work well also.

Accountability: Like leadership, accountability was viewed as vital from the Ministerial level down to the local level. Even though there was a feeling that accountability in government needed )ghtening, there was also a clear message that managers at a local level also needed to be kept accountable for delivering what was expected of them, par)cularly in joining up local services, ensuring funds reaching their intended purpose, and proac)vely advoca)ng for their community’s needs.

Measurement & Repor<ng: The measurement and repor)ng regimes were seen as complex, bureaucra)c and ohen unnecessary. Ohen repor)ng was seen as being done for repor)ng sake and what was measured and reported upon could not ohen seen as contribu)ng to the desired outcomes of providing an effec)ve health system to Aboriginal people. There was also perceived unfairness on what the Aboriginal health services had to report upon as against other non-‐Aboriginal services. Equally there were concerns that nothing was done with the repor)ng and ques)ons were asked about how the informa)on was used strategically to improve health outcomes.

9




Outcomes: Interviewees were asked what outcomes they had seen change in their )me in Aboriginal health. Many commented that nothing had really changed however others were able to see a change for the beBer if they looked at specific local programs or in some cases over long periods of )me. The general consensus was that if some posi)ve change had occurred it had ohen been unnecessarily difficult and slow. The interviewees were also asked to “set their sights” for the future and what would they see. The comments were varied but many felt that if the themes described in this report could be addressed the system could shih for the beBer.

Time: Time was seen in several ways. Firstly, it was felt that Aboriginal health services were asked to make a difference and achieve outcomes over a very short period of )me – based on short-‐term funding cycles rather than cycles needed to show genuine health improvements. It was generally believed that nothing sustainable could be reliably achieved over a three year period, par)cularly when the early part of this )meframe was needed for the program set up, recruitment etc. It was also felt that the )me it takes to make a difference was not understood or acknowledged by decision-‐makers (funders). Time was also perceived differently from an Aboriginal perspec)ve. Different world views collided on the issue of )me and this collision between policy makers and Aboriginal communi)es was not construc)ve in addressing health outcomes. Finally there was a genuine sense of urgency that )me was quickly running out and there is no )me to waste. People are hur)ng right now and need assistance and government and others have to move decisively and systemically.

10



Summary Findings – Regional Workshops

The eight regional workshops took place in Broken Hill, Coffs Harbour, Nowra, Dubbo, Wagga Wagga, Tamworth and Sydney (x2). The workshops were again focused on the convening ques)on: How can we, together transform the way we work and collaborate to significantly improve health outcomes of Aboriginal people across NSW over the next ten years?

The workshops included three key movements or elements over the course of the day. The first movement focused on slowing down to more deeply explore the current state and aBempt to “see” the system through the eyes of different stakeholders apart from ourselves. This involved a number of steps such as learning to see the current state in a new way, a gallery walk through the themes seen as most important in the region, an explora)on of the insight and ques)ons gained through exploring these themes, and an opportunity to iden)fy the key leverage point or biggest opportunity for making a transforma)onal shih in the current system towards the convening ques)on.

The second movement was different in nature and involved the concept of “retreat and reflect” – a stepping away from the noise and bustle to consider what is really needed of the people in the room as concerned individuals and as a group to transform the system. The process allowed a structured “pause” or break from the first movement before shihing gear into a space of co-‐crea)on and envisaging the future.

The third and final movement was focused on looking to the future and imagining what is possible to co-‐create. To shih into a crea)ve mindset, par)cipants were asked to paint a picture of what the health system would look like in ten years )me if the the convening ques)on had been successfully achieved. While not a natural ac)vity for those in government and healthcare, it was felt that a dream or imagina)on of the future was a vital step towards understanding what is needed. If we can’t imagine a desired future state, how can we get there? This exercise was then followed by a very prac)cal step of iden)fying and describing what immediate and long-‐term ac)ons needed to be taken at both the local and State levels to get things moving. These ac)ons were then priori)sed to further sharpen the focus of what needs to occur to help shih and transform the system.

While there was a lot of rich data that was extracted from the workshops, the following pages highlight some of the high-‐level themes and findings from the workshops.

11




The following diagram highlights the frequency of themes that emerged across the workshops, indica)ng where the areas of focus and concern lay from the stakeholders across the various regions:

12




The following diagram highlights the range and frequency of “leverage points” or key opportuni)es from across all workshops that were seen as cri)cal to address if the system was to shih:

13




Imagina)ons of the future. Some of the imagina)ons of the future are included below. Almost all groups were able to see sense of hope and aspira)on for a posi)ve future, provided that some key systemic fundamental issues were addressed:

14




Imagina)ons of the future:

15




Imagina)ons of the future:

16



Building Blocks for the Future

Through a thorough synthesis and analysis of the themes, quotes and comments emerging from around 200 key health decision makers and stakeholders via both the interviews and workshops, it appeared that a suite of core “building blocks” emerged that were essen)al to include in any aBempt to tackle the ques)on: How can we, together transform the way we work and collaborate to significantly improve health outcomes of Aboriginal people across NSW over the next ten years? and to effec)vely plan effec)vely for the future that is likely to unfold in unpredictable and unfamiliar ways.

The nature of these building blocks is that they are connected, not separate. That is, while they are few in number, all appear to be essen)al as part of a connected whole, which cannot effec)vely func)on with one or more of the parts missing.

The other feature of these building blocks is that by having them all in place and worked on simultaneously, almost all of the challenges presented in the interviews and workshops can in some way be addressed and fundamentally changed.

The following pages depict and describe the main elements of these building blocks for the future, as well as highlight the ways in which these building blocks help address many of the concerns and stumbling blocks currently genng in the way of improving Aboriginal health outcomes.

17




Our findings to date suggest that there are seven essen)al, integrated building blocks – all are needed as vital, inter-‐connected elements of the whole.

How can we together transform the way we work and collaborate to significantly improve the health outcomes of Aboriginal people across NSW

over the next 10 years? !

Unified/Integrated Planning & Funding

Framework !

Unified Vision & Definition of

Aboriginal Health !Critical Measures of Transformation!

Outcome reviews/needs & gaps

audits !(State & local)!

Joined-up local strategy and action planning!

Workforce – attract, develop,

sustain!

Making it happen: Joined-up local

action and service delivery !

18






Framework !







sustain !



•  Single, shared vision across triumvirate (Commonwealth, State, and AH&MRC);

•  Single clarity on the defini)on and concep)on of Aboriginal Health (see 1989 Na)onal Aboriginal Health Strategy -‐ physical, social, emo)onal, spiritual, cultural).

•  Unified planning/measurement/accountability framework; and

•  Integrated, “outcome focused” funding model based on BOTH State AND local strategy and genuine evidence (needs/gaps).

•  Carefully crahed, evidence-‐based, “outcome” measures and KPIs;

•  Transparent, consistent, lag/lead indicators;

•  Simple and powerful; • Measure both “what” and “how”.

•  Regular need and gap analyses at local levels;

•  Regular evidence-‐based reviews on achievement of Cri)cal Measures of Transforma)on.

•  Cri)cal input for local strategy and ac)on planning.

•  Reviews and local and State level – highlight strengths and gaps for sharing/learning.


19






Framework !

Shared Vision & Definition of






sustain !



•  Facilitated review of needs and gaps, delivery of measures and KPIs;

•  Iden)fy strengths to retain, share and build, and gaps to learn more about;

•  Planning for programs to start, stop and change as needed; •  Explore ways to innovate within a flexible but rigorous accountability framework.

• Whole workforce strategy developed and driven by the shared vision, planning and funding framework AND specific local needs (from client facing to execu)ve leadership);

Integrated focus on: •  Local workforce aBrac)on; •  Educa)on; • Measures of cultural safety and competency;

•  Con)nued growth; •  Career paths; •  Aboriginal people taking leadership posi)ons;

•  Accountabili)es, KPIs (both “what” and “how”); and

•  Sustainable succession plans.

•  Implementa)on of local strategy and ac)on plans; •  Built-‐in collabora)on, consulta)on, feedback, accountability; •  Implementa)on of innova)on ideas; •  Scale successes; •  Shared goals, measures and KPIs and performance mechanisms.


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•  Structured, in-built, genuine

dialogue, consultation,

collaboration & engagement;!

•  Deep local participa

tion;!

•  Aboriginal involvement in

decision-making;!

•  Build mutual trust and respect,

not “talk and tick

”.!

•  Innovative, co-ordinated,

collaborative approaches to

funding;!•  Reduced waste & duplication;!

•  Allow for best investment and

best ROI (eg. prevention, early

intervention etc.).!

•  Non-fragmented, non-isolated, non-competitive;!

•  Real partnerships;!•  Local co-ordination;!•  Rigour and accountability;!

•  True cross-agency planning and service delivery models.!

•  Single top-to-

bottom, botto

m-

to-top vision

and

focus.!

•  Clear KPIs, accountabilities (top to bottom, leader to worker);!

•  Regular follow-up;!

•  Behavioural measures – cultural competence;!

•  Transparent progress tracking – shared access;!

•  Concrete, reliable, evidence-based (not hunch-based) action and focus;;!

•  Information pathways - what, who, how? (health data, programs, outcomes etc).!

Recognition that:!• We are all here for the same reason –

to improve health;!

• We are repeatedly tackling the same

problems year after year, despite our

efforts to change – we’re in a

complex, “stuck” system;!

• We do not have a strong history of

embracing change or implementing

change in a sustainable way;!

• We need to learn alternative ways of

tackling complex, systemic problems,

and new principles and approaches of

working and collaborating to significantly improve system-wide

health outcomes.!

• More recognised qualifications;!•  Formal employment strategy;!•  Local Employment opportunities.!

•  Reduced bureaucracy;!•  Practical, targeted, consistent reporting and measurement.!

•  Deeper community understanding;!•  Accessible, safe, patient-centred care;!•  Clear patient pathways;!•  Increased acknowledgement, inclusion, cultural safety.!

•  Local innovation for local needs;!

•  In-built self-determination and self-reliance.!

•  Define cultural competence indicators;!•  Build and measure cultural competence and cultural safety.!

• We need substantive, transformational

change – we see

the same issues

coming up again and again…why?!

• Why are these issues still problems today?!

• Outcome/evidence driven NOT program/time/government driven;!

•  Redirect funds for best use, fill gaps, further reduce waste;!

•  Stop under-performance;!

•  Scale-up positive improvements.!

How do the Building Blocks Help?

The following pages summarise how the building blocks come together and tackle many of the issues consistently raised throughout the consulta)on process:

21






Framework !







sustain !



Recogni<on that:

• We are all here for the same reason – to improve health;

• We are repeatedly tackling the same problems year aher year, despite our best efforts to change – we’re in a complex, “stuck” system;

• We do not have a strong history of embracing change or implemen)ng change in a sustainable way;

• We need to learn alterna)ve ways of tackling complex, systemic problems, and new principles and approaches of working and collabora)ng to significantly improve system-‐wide health outcomes.

• We need substantive, transformational change – we see the same issues coming up again and again…why?!

• Why are these issues still problems today?!


How does this all come together?

22






Framework !







sustain !



•  Single top-to-bottom, bottom-to-top vision and focus!

•  Innovative, co-ordinated, collaborative approaches to funding;!

•  Reduced waste & duplication;!

•  Allow for best investment and best ROI (eg. prevention, early intervention etc.).!



•  System-wide leadership consistency;!

•  Together NOT separate; !•  In-built respect and honour of cultural difference;!

•  Long-term commitment.!

23






Framework !







sustain !



•  Clear KPIs, accountabilities (top to bottom, leader to worker);!

•  Regular follow-up;!•  Behavioural measures – cultural competence;!

•  Transparent progress tracking – shared access;!

•  Concrete, reliable, evidence-based (not hunch-based) action and focus;;!

•  Information pathways - what, who, how? (health data, programs, outcomes etc).!

•  Reduced bureaucracy;!

•  Practical, targeted, consistent reporting and measurement.!

•  Define cultural competence indicators;!

•  Build and measure cultural competence and cultural safety.!



24






Framework !







sustain !



• Outcome/evidence driven NOT program/time/government driven;!

•  Redirect funds for best use, fill gaps, further reduce waste;!

•  Stop under-performance;!

•  Scale-up positive improvements.!



25






Framework !







sustain !



•  Structured, in-built, genuine dialogue, consultation, collaboration & engagement;!

•  Deep local participation;!•  Aboriginal involvement in decision-making;!•  Build mutual trust and respect, not “talk and tick”.!

•  Local innovation for local needs;!

•  In-built self-determination and self-reliance.!



26






Framework !







sustain !



•  Deeper community understanding;!•  Accessible, safe, patient-centred care;!•  Clear patient pathways;!•  Increased acknowledgement, inclusion, cultural safety.!

• More recognised qualifications;!

•  Formal employment strategy;!

•  Local Employment opportunities.!

•  Leadership consistency;!•  Strengthening leadership capacity.!



27






Framework !

Shared Vision & Definition of






sustain !



What’s missing?

• What are the overall mechanisms and the container needed to hold these building blocks in a connected whole and deliver the outcomes needed?

Ques)ons s)ll to answer: • Who will lead and drive this?

• What are the governance and accountability processes around this?

•  How can this be “held” and supported to succeed over the next 10 years?

While the building blocks appear to represent the minimum number of elements that account for the greatest number of system blockers, inefficiencies and areas of dysfunc)on and waste, there are s)ll a number of ques)ons unanswered. Ques)ons rela)ng to the leadership, governance and suppor)ng the implementa)on of this over the next ten years, as well as broader ques)ons rela)ng to the linking-‐up and coming together of other areas that are important pre-‐determinants of health outcomes, including educa)on, housing and jus)ce.

•  All the issues are connected…

• What will drive the linking up of areas essen)al to good health and well-‐being – educa)on, housing, jus)ce etc.?

• What’s our aspira)on? • What can we do?

28



Next Steps

This paper describes the consulta)on process so far undertaken and the emerging results to this point. It describes how those working in the system perceive what is necessary to shih the health system to a point where the Aboriginal people can experience sensi)ve, responsive and sustainable health outcomes. The Health and Wellbeing Forum now provides an opportunity for senior managers and key decision makers in NSW Health and the AH&MRC to also now look at the system through a lens of open inquiry and bring their perspec)ve as to how the system can move beyond its “stuckness” and achieve the transforma)on necessary to significantly improve health outcomes of Aboriginal people in NSW over the next 10 years.

In a further demonstra)on of those in the system working and collabora)ng together to achieve the best outcome for Aboriginal health the Forum will bring a high-‐level and strategic perspec)ve to the emerging Building Blocks which will richly add to and complement the consulta)on process so far from the interviews and the workshops. Through input from the Forum more form and func)on can be brought to the Building Blocks as well as giving those aBending the )me to reflect on what they can do to drive the best outcomes with Aboriginal people across NSW.

As the next important step in the consulta)on process the Forum will assist Reos Partners in further developing this consulta)on paper in the form of a final report detailing the full findings, challenges and insights emerging from the interviews, stakeholder groups including the Health and Wellbeing Forum and wriBen submissions. This final consulta)on paper will provide the founda)on for the Discussion Paper leading to the NSW Aboriginal Health Plan.

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