National Standards

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Action 2.13: Working in partnership

Building effective and ongoing relationships with Aboriginal and Torres Strait Islander communities, organisations and groups that represent or service this population.

What does this mean for health service organisations?

The intent of this action is to build effective and ongoing relationships with Aboriginal and Torres Strait Islander communities, organisations and groups that represent or service this population. This will enable the health service organisation to identify priorities, understand cultural beliefs and practices, and involve Aboriginal and Torres Strait Islander people in determining their own health priorities.

When Aboriginal and Torres Strait Islander people are marginalised and not engaged in decision-making, the result is ineffective use of resources, both human and financial, with limited improvement in outcomes.

For the health service organisation to move beyond tokenistic relationships and towards working in true partnership requires meaningful engagement and understanding, with a commitment to building mutually beneficial relationships. There is evidence across Australia that Aboriginal and Torres Strait Islander people have limited access to appropriate services.⁷The health service organisation should work in partnership with communities to improve access to care, especially for individuals who need to access available services but do not currently do so. To better understand Aboriginal and Torres Strait Islander communities and build effective relationships, health service organisations could work with Aboriginal community controlled health services, Aboriginal Land Council or other Aboriginal and Torres Strait Islander groups that are working effectively with local communities.

Working in partnership with Aboriginal and Torres Strait Islander communities to bring about change is likely to succeed if the following cultural principles are understood and observed:

Gaining trust and building relationships is central to Aboriginal and Torres Strait Islander life; therefore, this should be the starting point for partnerships
More can be achieved when relationships and partnerships are equitable and built on mutual benefit
Relationships will be more respectful if efforts are made to identify the right community individuals and groups to approach, and enquiries about key leaders and points of contact in the community are routine
Aboriginal and Torres Strait Islander communities are diverse, and this diversity needs to be adequately represented⁸
Community responsibilities and obligations that have an impact on the community’s and individuals’ ability to participate need to be understood, and strategies should be implemented to minimise the burden on individuals, community organisations and the community more broadly
Communication strategies need to be clear and interactive to enable culturally appropriate ways of working and sharing understandings
English may be a third, fourth or even fifth language for an Aboriginal or Torres Strait Islander person
Relationships that are respectful of culture should:
- have clear and interactive communication to enable shared understandings
- adhere to cultural protocols (for example, considerations of gender)
- respect Aboriginal and Torres Strait Islander knowledge
Time and resources should be invested to ensure that relationships are effective and sustainable
Partnerships can be strengthened when they are developed at all levels of the organisation and include decision-making bodies.

What are the benefits of taking action?

Benefits for the health service organisation include:

Reduced institutionalised racism⁹, which can lead to improved patient outcomes
Relationships that will lead to a better understanding of the specific needs of the community
Greater ability to meet the needs of the Aboriginal and Torres Strait Islander community through access to appropriate services and programs
Increased meaningful engagement of the community
Increased input and participation by Aboriginal and Torres Strait Islander people in the governance and use of the health service organisation
Increased support for Aboriginal and Torres Strait Islander members of the workforce, particularly around cultural brokerage to link groups of people from different cultures to bring about change^10,11
Improved communication between the health service organisation and the community
Improved capacity to plan and deliver services
More efficient services and better use of resources
Improved performance of the safety and quality system in meeting the healthcare needs of Aboriginal and Torres Strait Islander people.

Benefits for the Aboriginal and Torres Strait Islander community include:

Improved communication between the health service organisation and the community
A better understanding of hospital systems and processes¹²
Improved health literacy and compliance with treatment programs and care plans
Increased self-determination of communities
Through Aboriginal and Torres Strait Islander leaders, inclusion of Aboriginal and Torres Strait Islander perspectives in the health service organisation
Less fear of, and a greater sense of connection to, the health service organisation
Improved access to appropriate services and programs that meet the needs of individuals and the community
Improved health outcomes and reduced health disparities between Aboriginal and Torres Strait Islander Australians and other Australians.^13,14

Key tasks

Identify Aboriginal and Torres Strait Islander communities within the organisation’s catchment, and the relevant cultural protocols to guide building of partnerships
Identify key contacts, elders and opinion leaders in the Aboriginal and Torres Strait Islander communities and health services and make contact with them
Establish and implement mechanisms for forming and maintaining partnerships with Aboriginal and Torres Strait Islander communities and representative organisations.

Suggested strategies

Understand the Aboriginal and Torres Strait Islander population in the organisation’s catchment and referral system

Gain an understanding of the Aboriginal and Torres Strait Islander population within the organisation’s catchment by:

Engaging in discussions with Aboriginal and Torres Strait Islander liaison services and relevant employees in the health service organisation, and key Aboriginal and Torres Strait Islander health organisations
Analysing health service organisation data and publicly available national, state and territory datasets and reports – these include administrative data and clinical datasets; data on organisation performance; and demographic data, including from the Australian Bureau of Statistics and the Australian Commission on Safety and Quality in Health Care’s Australian Atlas of Healthcare Variation
Reviewing key Aboriginal and Torres Strait Islander performance measures for the organisation, such as collection of information on Indigenous status, discharge against medical advice, unplanned readmission, unplanned emergency department re-presentation to a health service within 48 hours, and patients who did not wait
Understanding how Aboriginal and Torres Strait Islander people use available services.

Successful implementation of this strategy will be supported by, or rely on, the following actions:

Action 1.10b - The health service organisation uses clinical and other data collections to support risk assessments.

Action 1.13c - The health service organisation uses information from the feedback and complaints processes to improve safety and quality systems.

Action 1.15b - The health service organisation identifies groups of patients using [the organisation’s] services who are at higher risk of harm.

Establish partnerships with Aboriginal and Torres Strait Islander groups, services and organisations within the catchment

The approach, which may differ for each community and health service organisation, may include:

Taking advice on the appropriate process for initiating and maintaining relationships and partnerships from:
- the organisation’s Aboriginal and Torres Strait Islander workforce
- key community representatives, and the key Aboriginal and Torres Strait Islander health organisations
As a starting point, strengthening and building on any existing partnerships; consider:
- Aboriginal and Torres Strait Islander community controlled health services, and state or territory–funded primary health services
- Aboriginal and Torres Strait Islander–focused services within Primary Health Networks
- the Aboriginal and Torres Strait Islander directorate within the health service organisation
- specific maternal health, aged care, mental health, and drug and alcohol services
- community and homelands councils
- elders groups
- social support groups
- other organisations successfully servicing Aboriginal and Torres Strait Islander communities.

Successful implementation of this strategy will be supported by, or rely on, the following actions:

Action 2.8 - The health service organisation uses communication mechanisms that are tailored to the diversity of the consumers who use its services and, where relevant, the local communities.

Action 2.11a - The health service organisation involves consumers in partnerships in the governance of, and to design, measure and evaluate, health care.

Hold forums and discussion groups to engage Aboriginal and Torres Strait Islander people

Forums and discussion groups should involve broad representation of Aboriginal and Torres Strait Islander communities from a diverse range of age groups, gender groups and regions. Consider:

Appropriate timing, location and transport needs so that meetings can be attended
Engaging an existing group such as a men’s, women’s or granny’s group to convene a workshop
Ensuring that individuals participating feel safe and respected
Repeating consultations to enable long-term engagement
Providing and inviting feedback to develop trust and mutual respect.

Successful implementation of this strategy will be supported by, or rely on, the following actions:

Action 2.9 - Where information for patients, carers, families and consumers about health and health services is developed internally, the organisation involves consumers in its development and review.

Action 2.11b - The health service organisation has processes so that the consumers involved in partnerships reflect the diversity of consumers who use the service or, where relevant, the local communities.

Agree on the structure, mechanisms and responsibilities of partnerships

The structures and mechanisms of partnerships, and the responsibilities of all partners involved should focus on supporting ongoing, sustainable and mutually beneficial relationships and effective communication. This could be achieved by:

Developing a set of principles for working in partnership that cover issues such as reciprocity (that is, the Aboriginal or Torres Strait Islander community involved gains value from the partnership arrangements), communication, involvement, and sharing of knowledge
Formalising partnerships in a way that is appropriate for both the health service organisation and partnering organisations; this may be through an Aboriginal and Torres Strait Islander health strategy, a memorandum of understanding, a letter of agreement, formal representation in governance structures, or regular meetings that have defined reporting processes
Providing adequate financial remuneration for community spokespeople or elders who regularly participate in partnership roles
Mentoring younger Aboriginal and Torres Strait Islander people to participate on committees or working groups to build capacity and skills.

Community spokespeople, elders, and Aboriginal and Torres Strait Islander organisations are in demand by many organisations and may already be heavily committed. When inviting participation, consider the support mechanisms that community representatives may need to facilitate participation.

Successful implementation of this strategy will be supported by, or rely on, the following action:

Action 2.12 - The health service organisation provides orientation, support and education to consumers who are partnering in the governance, design, measurement and evaluation of the organisation.

Ensure representation of Aboriginal and Torres Strait Islander communities on the health service organisation’s decision-making bodies

Aboriginal and Torres Strait Islander people should be represented on the governing body, committees and groups that are responsible for advising on and overseeing the health service organisation – specifically, strategies and processes that have an impact on Aboriginal and Torres Strait Islander people. Note that:

Representation should be informed through community consultation and should recognise the diversity of the organisation’s catchment
Any committees or groups focusing on advising on or overseeing matters specific to Aboriginal and Torres Strait Islander communities should have significant Aboriginal and Torres Strait Islander representation.

Successful implementation of this strategy will be supported by or rely on the following action:

Action 2.11b - The health service organisation has processes so that the consumers involved in these partnerships reflect the diversity of consumers who use the service or, where relevant, the local communities.

Examples of supporting evidence

Reports or summary descriptions of the Aboriginal and Torres Strait Islander patient population and communities
Documentation from consultation processes, committees and meetings relating to the engagement of the Aboriginal and Torres Strait Islander community
Documentation on consultation with Aboriginal and Torres Strait Islander communities
Evidence-based clinical guidelines and decision support tools which have been co-designed in partnership with Aboriginal and Torres Strait Islander people
Membership of Aboriginal and Torres Strait Islander people on the organisation’s governing body, clinical governance committee or consumer advisory committee
Memorandum of understanding or other documentation of formal partnerships with local Aboriginal and Torres Strait Islander health service providers and community groups
Safety and quality action plans that incorporate Aboriginal and Torres Strait Islander communities’ strengths-based approach and key principles of the United Nations Declaration on the Rights of Indigenous Peoples.

References

7. Australian Health Ministers’ Advisory Council. Aboriginal and Torres Strait Islander Health Performance Framework 2017: report. Canberra: AHMAC; 2017.

8. Stewart J, Allan J. Building relationships with Aboriginal people: a cultural mapping toolbox. Aust Soc Work 2013;66:118–29.

9. Hunt J. Engagement with Indigenous communities in key sectors. Canberra: Australian Institute of Health and Welfare, and Australian Institute of Family Studies; 2013. (Resource Sheet No. 23.)

10. Liaw ST, Wade V, Lau P, Hassan I, Furler J. Safe and effective cultural mentorship in general practice. Aust Fam Physician 2016;45:431–6.

11. Jezewski MA. Culture brokering in migrant farmworker health care. West J Nurs Res 1990;12(4):497–513.

12. Howitt R, Colyer C, Hammer MR, Havnen O, Huchendorf K, Hubert C. Organisational capacity for engaging with Indigenous Australians. Geogr Res 2014;52:250–62.

13. Durey A, McEvoy S, Swift-Otero V, Taylor K, Katzenellenbogen J, Bessarab D. Improving healthcare for Aboriginal Australians through effective engagement between community and health services. BMC Health Serv Res 2016;16:224.

14. Kirkham R. Obligation and compromise: Aboriginal Maternal Infant Care Workers successes, challenges and partnerships [thesis]. Adelaide: University of Adelaide; 2014.