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IVALUE: Valuing Aboriginal Learning and Utilisation in Employment

Project Added:
20 April 2016
Last updated:
28 April 2016

IVALUE: Valuing Aboriginal Learning and Utilisation in Employment

Summary

The IVALUE initiative supported the implementation of new orientation and accountability processes to improve the way Orange and Cowra Community Health Services engage and utilise Aboriginal Health Workers ( AHWs ) to provide clinical services to Aboriginal clients accessing care.

View a poster from the Centre for Healthcare Redesign graduation, April 2016.

IVALUE poster

Aim

To have 50% of the qualified AHWs in Orange and Cowra Health Services achieving the AHW competencies by June 2016.

Benefits

  • Maximises workforce capacity and capability of qualified AHWs by improving the integration, utilisation and engagement of AHW skills to support local teams to better develop, implement and evaluate projects that meet community and service needs.
  • Increases clinical confidence and competence of AHWs , resulting in safer clinical service delivery.
  • Increases organisational capacity to meet all five strategic directions:
    1. Develop a coherent Western NSW system of care
    2. Support high performing primary health care
    3. Close the Aboriginal health gap
    4. Improve the patient experience
    5. Live within our means.
  • Reduces costs associated with staff turnover and low morale.
  • Reduces avoidable Aboriginal hospital admissions and re-admissions, as well as presentations and re-presentations to the emergency department.
  • Better connects clients to a culturally appropriate service.

Cover of the 2015 WNSWLHD AHW Forum
The IVALUE message was displayed on the front cover of the 2015 WNSWLHD AHW Forum compendium and provided to each participant attending the AHW Forum.

Background

WNSWLHD has invested in the development of an AHW workforce since 2007, with 95% of AHWs completing a Certificate IV in Aboriginal Primary Health Care (Practice). This allows AHWs to become an Aboriginal Health Practitioner and member of the Australian Health Practitioner Regulation Agency. However, the qualification has been applied inconsistently across WNSWLHD , resulting in confusion for management, supervisors and AHWs . It had also led to significant inefficiencies in the organisation, including:

  • a poor return on investment and reduced productivity of AHWs , due to a lack of understanding and application of the role and skills
  • poor engagement and participation of AHWs in community health teams, with many AHWs marginalised from actively participating as a member of multidisciplinary teams, leading to low morale and high AHW turnover
  • inconsistent expectations and accountability for the AHW role
  • reduced capacity to meet the health needs of the Aboriginal population and Close the Gap
  • culturally inappropriate and inaccessible services and poor patient experience that impact on patient safety and quality.

Implementation

  • Reviewed the AHW uniform and badges (in progress).
  • Improvements to the existing orientation processes at Orange and Cowra Health Services to incorporate information about the scope and purpose of the AHW role, as well as cultural information about the local Aboriginal community.
  • Developed an AHW work plan to better identify work tasks and projects that maximises the use clinical skills and integrates the role into the wider team.
  • Developed a short video clip explaining AHW role, to be displayed on the intranet (in progress).
  • Developed a monthly accountability report and meeting between the AHW and manager that is aligned with the WNSWLHD ’s ‘Living Well Together’ strategy.
  • Placed a photo and bio of AHWs in prominent areas, such as waiting rooms.
  • Added Closing the Gap and Aboriginal Health as a standing agenda item in team meetings.

Example of AHW photo and message displayed in waiting roomsExample of AHW photo and message displayed in waiting rooms.

Project status

  • Implementation - the initiative is being implemented, piloted or tested.

Key dates

  • Initiation: 6 April 2015
  • Diagnostics: 11 May 2015
  • Solution: 26 June 2015
  • Implementation and planning: 10 August 2015
  • Evaluation: 30 June 2016

Implementation sites

  • Orange Primary & Community Health Services, Orange Health Service, WNSWLHD
  • Cowra Community Health Services, Cowra Health Service, WNSWLHD
staff holding the IVALUE message to support the initiative
Staff holding the IVALUE message to support the initiative
staff holding the IVALUE message to support the initiative

Photos of local Aboriginal and non-Aboriginal staff holding the IVALUE message to support the initiative.

Results

Pre-evaluation measures were completed in June 2015 to measure baseline data. This included an online survey for all community health staff, semi-structured AHW interviews and structured Aboriginal client interviews, which revealed to following findings.

Community health staff online survey

  • No AHW competencies had been recently conducted to assess AHW capacity against the competency framework.
  • 41% of staff had a poor understanding of the AHW role.
  • 52% of staff thought there was poor integration of the AHW into the broader team.
  • 60% of staff had a poor understanding of the AHW registration and its practical application.
  • 31% of staff felt there was not the same expectation of AHW when compared to other staff within the team.
  • 65% of staff were willingness to embrace AHW clinical practice.

Aborignal Health Worker interviews

  • 50% of staff felt the AHW role was good to very good integration into the broader community health team.
  • 50% of staff reported that the registration changed the practical application of their role.
  • 100% of the AHWs reported that expectations of the AHW role was not similar to other staff within the community health team.

“They (Staff) only want us when they have a (difficult) Aboriginal client.”

Aboriginal Health Worker

“They (AHW) need to be available when I have an Aboriginal client.”

Community health staff member

Aboriginal client interviews

Results of the client survey revealed that whilst Aboriginal clients did not have a sophisticated understanding of the depth and breadth of the AHW role, they consistently stated that having the AHW involved in their care enhanced their patient experience and ensured the service was culturally appropriate and tailored to meet their individual needs.

“Sometimes it is hard for me to get from the car to community health. He will ring ahead and arrange for a wheelchair or a wheelie walker for me. He supports me in this class – seeing I am OK, if the seat is the right height, if I need a hand or some water”.

Aboriginal Client

Further evaluation

To measure the success of IVALUE a post evaluation will be conducted in June 2016, collecting the same measurements during diagnostics to support a pre and post evaluation framework. This will incorporate the following measures.

  • Online community health staff survey to identify how the service has utilised and integrated the AHW into the team.
  • Semi-structured interview with AHWs regarding the function and capacity of the role, engagement and utilisation in the team.
  • Self and peer assessment of the AHW against the AHW competencies.
  • Client interviews of Aboriginal people accessing the AHWs .

Lessons learnt

  • Creating a cultural shift in the way AHWs are perceived, used and incorporated into community health teams requires ongoing commitment and strategies aligned to the organisation's.
  • Engaging AHWs requires care and continuous reassurance that the changes will benefit their position.
  • To effectively change the way AHWs are used in community health teams requires leaders to ensure all staff have an understanding of why and commitment to changing practice and workplace culture.
  • Although a lean team was positive to make decisions quickly, though having additional staff or better delegation of tasks to the working party to support workloads when staff took leave would have been beneficial.

Contact

David Meharg
Manager, Orange Primary & Community Health Services
Western NSW Local Health District
Phone: 02 6369 3300
david.meharg@health.nsw.gov.au

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