Working well: Tailoring a workforce development model to deliver sustained improvements in community controlled healthcare

Working Well: Tailoring a workforce development model to deliver sustained improvements in community-controlled healthcare

Project Aim

To develop evidence-informed, tailored workforce systems and processes to support sustained improvements in Aboriginal and Torres Strait Islander community-controlled primary healthcare service provision.

Objectives

To identify Indigenous primary healthcare workforce models in Canada, Australia, New Zealand and the United States (CANZUS nations) and their enabling conditions, strategies and impacts.
To map change in workforce characteristics against evidence-informed workforce management systems (2014-2017).
Informed by 1 and 2, to develop a transferable workforce model.

Project Team:

Project leaders: Associate Professor Janya McCalman, Centre for Indigenous Health Equity Research, Central Queensland University; Associate Professor Dr Roxanne Bainbridge, Senior Research Fellow, The Cairns Institute, James Cook University
Project partners:

Gurriny Yealamucka Health Service
James Cook University

Administering organisation: Central Queensland University
Project timeline: 1 January 2018—31 December 2018

Methodology

The research identified learnings from international Indigenous literature and filtered the results using collaborative quality improvement workshops. The research comprised three steps:

Systematic scoping review of the literature to determine the enabling conditions strategies and impacts of Indigenous primary healthcare service workforce models in Canada, Australia, New Zealand and the United States (CANZUS nations)
Mapping of annual growth and change in workforce and workforce systems since transition to community control.
Informed by 1 and 2, grounded theory analysis to develop a workforce model based on interviews/focus groups with staff and key/stakeholder groups to identify what worked well, what did not and how improvements could be made.

Project Findings

Systematic scoping review

The systematic scoping review of the literature found 28 studies that described or evaluated models and systems that support the sustainability, capacity or growth of the Indigenous primary healthcare workforce to provide effective care provision. No study reported a ‘one size fits all’ model of workforce development in Indigenous primary healthcare. Studies reported that enabling conditions for workforce development are:

Government funding and appropriate regulation
Support and advocacy by professional organisations
Community engagement
Primary healthcare leadership, supervision and support
Practitioner Indigeneity, motivation, power equality and wellbeing.

Strategies focused on enhancing recruitment and retention; strengthening roles, capacity and teamwork; and improving supervision, mentoring and support.

Only 12/28 studies were evaluations, and these studies were generally of weak quality. These studies reported impacts of improved workforce sustainability, workforce capacity, resourcing/growth and healthcare performance improvements. The review concluded that primary healthcare services can strengthen their workforce models by bringing together healthcare providers to consider how these strategies and enabling conditions can be improved to meet the healthcare and health needs of the local community. Improvement is also needed in the quality of evidence relating to particular strategies to guide practice.

Workforce mapping

The numbers of staff and mix of workforce skills required to maintain service delivery under Gurriny Yealamucka Health Service’s current model of care has grown considerably since the organisation’s transition of primary healthcare services to community control.

Overall, staff numbers increased by 71% from 44.5 FTE in 2013-14 to 61.5 FTE in 2014-15, 54 FTE in 2015-16 and 76.0 FTE in 2017-18. Gurriny has actively recruited local Yarrabah health professionals and operational staff. The proportion of local people employed has been maintained at high levels, with 58/76 (76%) positions filled by Indigenous people in 2017-18. The composition of the Gurriny workforce has also changed. The focus of additional positions has been in management, drivers, administrative/clerical, cleaning, health worker, medical, nursing, drug and alcohol worker, health promotion and health trainee positions.

The key conditions, or contextual factors that influenced Gurriny’s workforce development included macro societal-level factors such as broad political and economic systems, and health and social inequities experienced by Indigenous people in Australia and internationally.

As well, conditions operate at community, primary healthcare service, and individual levels. For example, the transition of primary healthcare services in Yarrabah to community control has led to significant organisational growth with a large increase in employment, including of local Yarrabah community members, and the provision of a wide array of comprehensive primary healthcare services and programs. These changes, while enabling, building and strengthening Gurriny and its workforce, have also brought challenges such as changes in the workforce culture and a degree of change fatigue, especially among local staff who have been with Gurriny throughout the transition process and beyond.

The core process for Gurriny’s workforce development was identified as growing a stable, capable and cohesive/collaborative workforce that is responsive to community health needs. Four key strategies or actions that are taken and could be extended to help strengthen this core process were identified as:

Strengthening workforce stability
Having strong leadership
Growing capacity
Working well together.

Each of these core strategies contain further sub-strategies that outlined the specific ways in which Gurriny supports its workforce well, and the ways this could be improved.

Project Outcomes

Knowledge	The tailored workforce model collaboratively developed in this research will provide knowledge to inform practice and advocacy for enhanced health workforce capability and systems to optimise sustained healthcare improvements in Australia’s largest discrete Indigenous community. The Gurriny demonstration project provides a blueprint of the enabling conditions and strategies required for a best practice workforce model for community-controlled health service across Australia.
Awareness	The interviews conducted with 17 Gurriny staff members from various positions in the organisation provided staff members’ perspectives on what working well is and what could work better to build a strong workforce. The issue of workforce remains a priority with Gurriny’s senior management team and board.
Skills	Gurriny found the report to be useful and considers it important to implement some of the recommendations. Workforce development and provision of primary healthcare services to Yarrabah will be enhanced.

Related resources:

Janya McCalman, Sandra Campbell, Crystal Jongen, Erika Langham, Kingsley Pearson, Ruth Fagan, Ann Sardesai, Roxanne Bainbridge (in press). Working Well: A systematic scoping review of the Indigenous primary healthcare workforce development literature, BMC Health Services Research.
Sandy Campbell, Crystal Jongen, Ruth Fagan, Roxanne Bainbridge, Janya McCalman (2019). Working Well: Tailoring a workforce development model to deliver sustained improvements in community-controlled health care. Project Report for Gurriny Yealamucka Health Service prepared by the Centre for Indigenous Health Equity Research, Central Queensland University.
Another paper will be developed from the report (pending approval from Gurriny’s senior management team) and submitted to a peer reviewed journal.
Policy Brief: Working Well: Tailoring a workforce development model to deliver sustained improvements in community-controlled health care. The story of Gurriny Yealamucka Health Service