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 change10,11
  • 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

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.