Career Pathways for the Aboriginal and Torres Strait Islander Health Workforce: NSW Workplace Case Studies Report: Career Pathways Project

Expanding and strengthening the Aboriginal and Torres Strait Islander health professional workforce is recognised as crucial for improving the health and wellbeing of Aboriginal and Torres Strait Islander communities. The Career Pathways Project is an Aboriginal-led research project funded by the Lowitja Institute. Its purpose is to provide insight and guidance to enhance the capacity of the health system to retain and support the development and careers of Aboriginal and Torres Strait Islander people in the health workforce. The national project has several components. This report presents the methods and findings of the workplace-based case studies conducted in New South Wales (NSW). The aim of the workplace-based case studies was to collect ground-level data from urban, regional, rural and remote regions of NSW. A series of 28 yarning circles and 6 interviews were held with Aboriginal health staff and their managers at both Aboriginal Community Controlled Health Organisations (ACCHOs) and Government health services (including Local Health Districts and a Primary Health Network). This allowed us to explore in depth the factors impacting on careers whilst using a solutions-focus to generate a range of potential strategies for enhancing career pathways. In total, 122 people including 83 staff (57 from ACCHOs and 26 from government organisations) and 39 managers (24 from ACCHOs and 15 from government organisations) from across NSW participated in either a yarning circle or an interview. The Aboriginal health workforce brings to the delivery of services cultural skills, knowledge and values that are uniquely Aboriginal, including vital communication skills and ways of conducting business. These are underpinned by personal experiences of living and working in community, and a lived understanding of what it is to be an Aboriginal person. Aboriginal people mostly want to work in health for reasons to do with community. Having a job, especially stable employment, is another factor. Aboriginal health service managers, whether they work in ACCHOs or government organisations, are interested in an applicant’s strengths and their potential to grow and be a leader. In recruiting they look for staff with a combination of cultural, personal and professional attributes. When it comes to Aboriginal people enjoying a career in the health sector, it seems that there are barriers all along the way. Financial pressures impact at every step. The project also identified important enablers. At the organisational level, career development starts with the ‘right’ governance and management structure and strategies, including a Workforce Development Strategy that includes specific goals and actions to enhance career development and ensure cultural safety. Cultural values must be at the forefront. All staff need to feel valued in the workplace and by the community and be appropriately rewarded. Aboriginal leadership is essential with Aboriginal people in the executive and senior and line management positions. The focus should be on providing opportunities through identified and targeted recruitment, nurturing staff, developing skills and strengthening culture. In this respect, ACCHOs are so much more than an Aboriginal organisation delivering health care; they are a place of opportunity bringing wellbeing to staff and community alike. Strategies to improve Aboriginal career pathways are necessary at multiple levels: within health services and organisations, across the health and education sectors, and in the community. Partnerships will be essential in moving forward

We Are working for our People: Growing and Strengthening the Aboriginal and Torres Strait Islander Health Workforce: Career Pathways Project Report

Expanding and strengthening the Aboriginal and Torres Strait Islander health professional workforce is recognised as crucial for improving the health and wellbeing of Aboriginal and Torres Strait Islander communities. The Career Pathways Project took a national perspective and aimed to provide insights and guidance to enhance the capacity of the health system to retain and support the development and careers of Aboriginal and Torres Strait Islander people in the health workforce. The research incorporated a mixed-methods design, gathering and synthesising qualitative and quantitative data from primary and secondary sources. The main research activities included a literature review, national stakeholder consultations and a survey of the workforce, secondary data analysis, individual career trajectory interviews, locally situated case studies (focus groups and interviews) and data synthesis. The Aboriginal and Torres Strait Islander health workforce is made up of individuals who are passionate about what they do and motivated by a commitment to improve the wellbeing and health of their communities. To fulfil this commitment, they are willing to embark on a lifelong journey of learning to address the issues they see facing their families and broader communities, even if this involves significant challenges, changes in career goals, isolation or working in a health system that is not always flexible or responsive to community needs. Aboriginal and Torres Strait Islander health professionals’ unique skill set, which comes from their lived cultural experiences and ways of being and doing, makes them powerful advocates and agents of change to improve health outcomes. A holistic model of health works for Aboriginal and Torres Strait Islander people and communities. The community-controlled sector works from a platform of respect and connection within comprehensive primary healthcare, which promotes a holistic approach and integrates the cultural and social determinants of health into the planning and delivery of health services. This model acknowledges and engages with community structures, allowing culture to guide service delivery strategies and enabling innovative approaches to care, and includes the participation of consumers, their families and broader communities in defining their healthcare needs. All sectors can benefit by considering this model of care in order to improve the health and wellbeing of their Aboriginal and Torres Strait Islander consumers and local communities, and their Indigenous health workforce. The Aboriginal and Torres Strait Islander health workforce delivers a holistic model of care services that is culturally informed and has its own networks and complexities. Without the dedication of the local Aboriginal and Torres Strait Islander health workforce in remote communities, it would be impossible to deliver effective local health promotion and healthcare services that reinforce positive community attitudes to health. Jobs and careers are restricted by funding strategies that constrain the types of services and employment contracts that can be offered and do not reflect local needs or collective decision-making processes. The Aboriginal and Torres Strait Islander health workforce brings an intuitive understanding of cultural safety and competence to an organisation. This understanding is often structurally embedded in the community-controlled sector’s way of operating but is not always reflected in the operational approach across all organisations in the health sector, where Aboriginal and Torres Strait Islander workers experience racism and often do not have the support of other Aboriginal and Torres Strait Islander peers and colleagues, or influence over management of services to Aboriginal and Torres Strait Islander consumers. In terms of career development, encouragement and support makes all the difference. Training and further studies may be stalled for Aboriginal and Torres Strait Islander health workforce members by organisational constraints and personal financial circumstances. Community ties to location or the absence of family support can make it difficult for individuals to participate in educational and professional development activities, such as university work placements and internships. The Aboriginal and Torres Strait Islander health workforce is boosted by individuals’ early experiences of the health system and the presence of role models and mentors, both in the community and in the workplace. Opportunities to enter the health workforce at a junior level or as a paid trainee are very influential. These experiences form the building blocks upon which further supported career progression can be built. Mentoring by respected managers and senior health professionals assists individuals to build their careers and helps the workforce as a whole to grow. The value that Aboriginal and Torres Strait Islander Health Workers bring to their positions is not reflected in some industrial awards. Lack of structured career pathways means that they are often restricted to low-paid roles in the health and community sectors, despite having multiple Vocational Education and Training (VET) and/or university qualifications. On the basis of these findings, the research team identified five contributing factors – or pillars of action – for successful careers. The pillars are: Leadership and self-determination, Cultural safety, Valuing cultural strengths, Investment in the workforce and workplace, and Education and training. General and specific strategies are suggested within each pillar. Many strategies are multifaceted and multilayered, require the engagement of one or more capacity-building pillars, and involve one or more key groups. These groups include workers, communities (such as families or health service organisations), peak community and professional organisations, training and education providers, and health systems (including funding bodies). Collaboration and partnership between jurisdictions, sectors, professional groups and communities is essential to retain, support and develop Aboriginal and Torres Strait Islander careers in the health workforce