Working well: strategies to strengthen the workforce of the Indigenous primary healthcare sector

Jongen, Crystal; McCalman, Janya; Campbell, Sandra; Fagan, Ruth

doi:10.1186/s12913-019-4750-5

Cited by 36 publications

(40 citation statements)

References 27 publications

(64 reference statements)

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“…AHWs initiated interagency communication, facilitated communication, were often the conduit between other healthcare workers and patients, transported patients to and from appointments and provided one-on-one case management. This is consistent with previous research that reported ACCHOs are already implementing many important workforce development strategies that are having a positive impact on health service utilization and patient outcomes [ 30 ]. Our findings highlight that these approaches should be tailored to local needs and contexts.…”

Section: Discussionsupporting

confidence: 93%

Enablers and Barriers to Accessing Healthcare Services for Aboriginal People in New South Wales, Australia

Nolan-Isles

Macniven

Hunter

et al. 2021

IJERPH

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Background: Australia’s healthcare system is complex and fragmented which can create challenges in healthcare, particularly in rural and remote areas. Aboriginal people experience inequalities in healthcare treatment and outcomes. This study aimed to investigate barriers and enablers to accessing healthcare services for Aboriginal people living in regional and remote Australia. Methods: Semi-structured interviews were conducted with healthcare delivery staff and stakeholders recruited through snowball sampling. Three communities were selected for their high proportion of Aboriginal people and diverse regional and remote locations. Thematic analysis identified barriers and enablers. Results: Thirty-one interviews were conducted in the three communities (n = 5 coastal, n = 13 remote, and n = 13 border) and six themes identified: (1) Improved coordination of healthcare services; (2) Better communication between services and patients; (3) Trust in services and cultural safety; (4) Importance of prioritizing health services by Aboriginal people; (5) Importance of reliable, affordable and sustainable services; (6) Distance and transport availability. These themes were often present as both barriers and enablers to healthcare access for Aboriginal people. They were also present across the healthcare system and within all three communities. Conclusions: This study describes a pathway to better healthcare outcomes for Aboriginal Australians by providing insights into ways to improve access.

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Section: Discussionsupporting

confidence: 93%

Enablers and Barriers to Accessing Healthcare Services for Aboriginal People in New South Wales, Australia

Nolan-Isles

Macniven

Hunter

et al. 2021

IJERPH

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“…Through our case studies with cancer services around Australia, we observed that it "starts from the top"; if the commitment to Indigenous health and workforce is dependent on just one or two dedicated employees then efforts can diminish over time as supportive staff leave or get burnt out. This reflects findings by other studies, including Jongen et al [41] who found that strong leadership was essential for a strong and stable Indigenous primary health care workforce and the Mason Review of Health Workforce Programs, which states "Aboriginal and Torres Strait Islander leadership is recognised internationally as a key factor in the development and sustainability of programs aimed at increasing Aboriginal and Torres Strait Islander workforce capacity, and influencing the non-Aboriginal and Torres Strait Islander health workforce to provide culturally safe and appropriate services" [42].…”

Section: Discussionsupporting

confidence: 91%

“We’re very much part of the team here”: A culture of respect for Indigenous health workforce transforms Indigenous health care

et al. 2020

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Background Improving health outcomes for Indigenous people by strengthening the cultural safety of care is a vital challenge for the health sector, both in Australia and internationally. Although Indigenous people have long requested to have Indigenous practitioners involved in their health care, many health services report difficulties with recruiting and retaining Indigenous staff. This article describes Indigenous workforce policies and strategies from two Australian health services, as well as cancer-service specific strategies. Methods Services were identified as part of a national study designed to identify and assess innovative services for Indigenous cancer patients and their families. In-depth interviews were conducted in a small number of identified services. The interviews from two services, which stood out as particularly high performing, were analysed through the lens of Indigenous health workforce. Results Twenty-four hospital staff (Indigenous and non-Indigenous), five Indigenous people with cancer and three family members shared their views and experiences. Eight themes were identified from the way that the two services supported their Indigenous workforce: strong executive leadership, a proactive employment strategy, the Indigenous Health Unit, the Indigenous Liaison Officer, multidisciplinary team inclusion, professional development, work environment and a culture of respect. Participants reported two positive outcomes resulting from the active implementation of the eight workforce themes: ‘Improved Indigenous patient outcomes’ and ‘Improved staff outcomes’. Conclusions These two cancer services and their affiliated hospitals show how positive patient outcomes and a strong Indigenous health workforce can be achieved when a health service has strong leadership, commits to an inclusive and enabling culture, facilitates two-way learning and develops specific support structures appropriate for Indigenous staff. It is hoped that the strategies captured in this study will be used by health services and cancer services to inform their own policies and programs to support building their Indigenous workforce.

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“…Strengths of the PHC services identified by staff and community provide evidence of the immutable interconnection between culture, community and the delivery of quality care and builds on what we know about two way learning and community driving health [ 11 , 23 ]. Critical to a “strong” PHC service response to quality improvement was an integrated Aboriginal and Torres Strait Islander workforce that (teamwork) that were supported (through appropriate training, QI systems and leadership) and valued in their provision of quality care to the community [ 10 , 35 ]. These factors, including the esteem in which Aboriginal staff are held and the valuing of their input have also been identified as critical in high performing tertiary health services [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

“…Together with mechanisms to facilitate community engagement, these enable perseverance with participation in QI [ 6 , 8 ]. In contrast, some services show limited improvement (or sometimes none), due to a range of interwoven implementation, resourcing and community contextual factors, often the inverse of those underlying high performance [ 9 , 10 ]. To achieve Aboriginal and Torres Strait Islander population health impact, we need to understand how to strengthen the quality of care in PHC on a broad scale and broaden our discourse on quality as defined by the communities we serve [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

A qualitative exploration of priorities for quality improvement amongst Aboriginal and Torres Strait Islander primary health care services

Carlisle

Quandamooka

Redman-MacLaren

et al. 2021

BMC Health Serv Res

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Background Achieving quality improvement in primary care is a challenge worldwide, with substantial gaps between best practice and actual practice. Within the context of Australia, Aboriginal and Torres Strait Primary Health Care (PHC) services have great variation across settings, structures and context. Research has highlighted how these contextual differences can critically influence the success of Quality Improvement (QI) interventions and outcomes. Less understood is the interaction between local context and other factors, which may impact the implementation of QI interventions. This paper aims to explore the strengths and challenges in QI for Aboriginal and Torres Strait Islander PHC services and their priorities for improvement. Methods A multiple case study design was adopted, working with eight Aboriginal and Torres Strait Islander PHC services in Northern Territory, Queensland and Western Australia. Data were collected via a health service survey, semi-structured interviews with health service staff and service users and researcher observations, to explore QI and perceptions of care quality at the service level. Data reported here were analysed using an iterative thematic technique, within-case and across-case. Results A total of 135 interviews were conducted with health service staff, service users and community members. Participants emphasised the centrality of resilient community, committed workforce and valued Aboriginal and Torres Strait Islander team members in delivering care. A shared purpose around improving the health of community was a significant driver. Key challenges included staff turnover and shortages, a complex and overwhelming acute and chronic care workload, building relationships and trust between health services and the community. Service-suggested priority areas for improvement were categorised into five themes: i) cultural safety (community driving health and planning for culturally safe services); ii) community engagement (through clinical activities in the community); iii) shared ownership and a team approach around QI; iv) strengthening systems and consistent ways of doing things in the health service; and v) strengthening local workforce (and resources for a culturally safe workforce). Conclusions These findings advance understandings of relational, community and cultural factors which are identified priorities for the delivery of quality care in Aboriginal and Torres Strait Islander PHC services across varied contexts.

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Working well: strategies to strengthen the workforce of the Indigenous primary healthcare sector

Cited by 36 publications

References 27 publications

Enablers and Barriers to Accessing Healthcare Services for Aboriginal People in New South Wales, Australia

Enablers and Barriers to Accessing Healthcare Services for Aboriginal People in New South Wales, Australia

“We’re very much part of the team here”: A culture of respect for Indigenous health workforce transforms Indigenous health care

A qualitative exploration of priorities for quality improvement amongst Aboriginal and Torres Strait Islander primary health care services

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