learning from action researching with aboriginal health care managers judith dwyer, cindy shannon...
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Learning from Learning from ActionAction
Researching with Aboriginal Health Researching with Aboriginal Health Care ManagersCare Managers
Judith Dwyer, Cindy Shannon and Judith Dwyer, Cindy Shannon and Shirley Godwin Shirley Godwin
Funded by the Cooperative Research Centre Funded by the Cooperative Research Centre for Aboriginal Health, conducted in for Aboriginal Health, conducted in
partnership with QAIHCpartnership with QAIHCResourced by La Trobe, Flinders and Resourced by La Trobe, Flinders and
Queensland UnisQueensland Unis
2Learning from Action
Shirley and CindyShirley and Cindy
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Outline and Outline and acknowledgementsacknowledgements
GoalsGoals MethodMethod FindingsFindings DiscussionDiscussion
Thanks to Lizzie Adams, Valerie Craigie, Thanks to Lizzie Adams, Valerie Craigie, Bronwyn Fredericks, Sheryl Lawton, Mary Bronwyn Fredericks, Sheryl Lawton, Mary Martin, Mark Moore, Janelle Murphy, Martin, Mark Moore, Janelle Murphy, Justin Saunders, Bronwyn Smith, Mick Justin Saunders, Bronwyn Smith, Mick Gooda, Ian Anderson, David Legge, Gooda, Ian Anderson, David Legge, Christine Bright and many othersChristine Bright and many others
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Project GoalsProject Goals
Work with senior managers of Work with senior managers of ACCHS’s to:ACCHS’s to: develop understanding of management develop understanding of management
challenges and practices in ACCHSschallenges and practices in ACCHSs to share and build knowledge and skillsto share and build knowledge and skills to use this project as the basis for further to use this project as the basis for further
research and development – learning research and development – learning approaches; management methods approaches; management methods tailored to the needs of the Aboriginal tailored to the needs of the Aboriginal health sectorhealth sector
Research
Learning
Devel’t
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Our approachOur approach
Rather than focus on ‘difference’, we Rather than focus on ‘difference’, we investigated the challenges and strategies, investigated the challenges and strategies, aware of contextaware of context
Intention to inform further applied researchIntention to inform further applied research And development of the sectorAnd development of the sector
And provide participant-defined view of And provide participant-defined view of challenges in contested policy environmentchallenges in contested policy environment
As well as contribute to learning and As well as contribute to learning and development for participantsdevelopment for participants
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Overall ProgramOverall Program
Worked with 13 senior managers in Worked with 13 senior managers in Queensland Aboriginal and Islander Health Queensland Aboriginal and Islander Health ServicesServices
4 workshops (3 days, 2 days, 2 days, 3 days)4 workshops (3 days, 2 days, 2 days, 3 days) Learning set meetings Learning set meetings Formal teaching, seminarsFormal teaching, seminars Option for academic credit Option for academic credit
Equivalent to 25% of a Grad. Cert. in HSM Equivalent to 25% of a Grad. Cert. in HSM Formal recognition of participationFormal recognition of participation
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Complying with ethical Complying with ethical guidelinesguidelines
“..ensuring that research outcomes include equitable benefits of value to Aboriginal communities or individuals”
Benefits are defined as “…enhancement of capacities, opportunities or outcomes that advance interests …”
“.. beyond the project, eg through skills and knowledge or broader social, economic or political strategies..”
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Learning Set methodLearning Set method At each meeting, each person presents a real, At each meeting, each person presents a real,
current management problem they are trying to current management problem they are trying to solvesolve
Everyone asks questions to clarify the problem, and Everyone asks questions to clarify the problem, and offers suggestions about strategiesoffers suggestions about strategies
The person who owns the problem sums up, says The person who owns the problem sums up, says what they’re going to do (each problem takes about what they’re going to do (each problem takes about 45 minutes)45 minutes)
Next meeting – each person gives an update on what Next meeting – each person gives an update on what happened, and brings a new problem or situationhappened, and brings a new problem or situation
We ran two sets of 6 members eachWe ran two sets of 6 members each Two team members acted as facilitatorsTwo team members acted as facilitators And two people took detailed notes on laptop And two people took detailed notes on laptop
computerscomputers
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SeminarsSeminars Half-day or more each meetingHalf-day or more each meeting Topics determined by participantsTopics determined by participants Formal teaching and discussion/case studies Formal teaching and discussion/case studies
on:on: Managing moneyManaging money Managing peopleManaging people Managing organisational strategyManaging organisational strategy Managing systems and reading policyManaging systems and reading policy
Delivered by the team, plus two guest speakersDelivered by the team, plus two guest speakers Mr Mick Gooda, CEO, CRCAHMr Mick Gooda, CEO, CRCAH Professor Ian Anderson, Head, Onemda (Uni of Professor Ian Anderson, Head, Onemda (Uni of
Melbourne)Melbourne)
10Learning from Action
Data Data
We had 37 stories from 13 participantsWe had 37 stories from 13 participants Our aim was to gather data about their Our aim was to gather data about their
management experiencesmanagement experiences, (rather than , (rather than their their opinions about managementopinions about management) and ) and analyse, reflect on and discuss them with analyse, reflect on and discuss them with our co-researchersour co-researchers
We collected comparison data from a We collected comparison data from a mainstream learning set at the same time mainstream learning set at the same time 21 stories from 6 participants21 stories from 6 participants
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Analysing the dataAnalysing the data
37 stories in 9 groups (by primary problem)
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‘‘Theming’Theming’
Each story gave rise to multiple themesEach story gave rise to multiple themes No stories can be told in the results – No stories can be told in the results –
confidentiality confidentiality Structured summariesStructured summaries
issue, underlying factors, strategies, enablers, barriersissue, underlying factors, strategies, enablers, barriers We used excel spread sheets to sort and manage We used excel spread sheets to sort and manage
datadata And the process was iterative (develop, check, And the process was iterative (develop, check,
further develop categories as new data further develop categories as new data incorporated)incorporated)
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ValidationValidation
Story summary and ‘themes’ were Story summary and ‘themes’ were returned to participants at the following returned to participants at the following workshopworkshop
We presented a collated cumulative We presented a collated cumulative summary of the themes at each workshop, summary of the themes at each workshop, for discussion and for discussion and amendment/endorsementamendment/endorsement The discussion was valuableThe discussion was valuable
Sideline: I kept a journal, not consistently, Sideline: I kept a journal, not consistently, and it was very useful as a referenceand it was very useful as a reference
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Nine groups of storiesNine groups of stories Managing staff (8 stories)Managing staff (8 stories) Managing the organisation (6 stories)Managing the organisation (6 stories) Managing relations with Board (6 stories)Managing relations with Board (6 stories) Working with external partners (5 stories)Working with external partners (5 stories) Managing self in job (4 stories)Managing self in job (4 stories) Managing finances and funding (3 stories)Managing finances and funding (3 stories) Managing Aboriginal Health Worker roles Managing Aboriginal Health Worker roles
(2 stories)(2 stories) Managing non-Indigenous staff (2 stories)Managing non-Indigenous staff (2 stories) Working with culture and race (1 story)Working with culture and race (1 story)
15Learning from Action
Comparison with Comparison with mainstream set: main mainstream set: main problem in each storyproblem in each story
Managing staff Managing staff 88
Managing the org Managing the org 66
Managing Board Managing Board 66 External partners External partners
55 Managing self in job Managing self in job 44 Managing moneyManaging money 33 Managing AHW roles Managing AHW roles 22 Managing non-Indigenous Managing non-Indigenous
staffstaff 2 2 Working with cultureWorking with culture 11
Managing staff Managing staff 99
Org strategy/structureOrg strategy/structure 44 [only 1 worked to a [only 1 worked to a
Board]Board] External relationshipsExternal relationships 11 Managing job/careerManaging job/career 55
WorkforceWorkforce 22
This project Mainstream Set
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4 workshops
37 stories, sorted into 9 groups
Underlying factors152 themes in 12 categories
Enablers57 themes in 12 categories
Barriers81 themes in 13 categories
Managers’ problems and actions
Context or organisation factors
Consolidated results in 7 main categories
Strategies97 management strategies in 11 categories
17Learning from Action
Results in 7 headingsResults in 7 headings
Workforce and people management are major Workforce and people management are major challengechallenge
Organisations need infrastructure and systemsOrganisations need infrastructure and systems Community engagement is a strength but Community engagement is a strength but
difficult to structure and manage welldifficult to structure and manage well Managers need better supportManagers need better support Being a ‘partner’ to the biggies is a challengeBeing a ‘partner’ to the biggies is a challenge Funding is complex and short-termFunding is complex and short-term Working across cultures is difficult, racism gets Working across cultures is difficult, racism gets
in the wayin the way
18Learning from Action
Policy implicationsPolicy implications Managers lack a system for support and Managers lack a system for support and
development – career structure, staff development – career structure, staff development, mentoring etcdevelopment, mentoring etc
Size matters – critical mass for health care, and Size matters – critical mass for health care, and for organisational effectivenessfor organisational effectiveness
The sector needs infrastructure that matches its The sector needs infrastructure that matches its critical role in PHC (corporate support critical role in PHC (corporate support +quality+IT+service development capacity)+quality+IT+service development capacity)
The services have grown and become more The services have grown and become more complex, and may have gotten out of sync with complex, and may have gotten out of sync with some of the methods used to implement the some of the methods used to implement the principle of community control.principle of community control.
19Learning from Action
After the Research:After the Research:
QAIHC received funding from OATSIH to QAIHC received funding from OATSIH to implement management executive training implement management executive training programprogram Partnered with Griffith University Partnered with Griffith University 16 senior managers enrolled in the program16 senior managers enrolled in the program
Training for 100 managers in Business Training for 100 managers in Business Management was funded by OATSIHManagement was funded by OATSIH
The Overburden project took up the issue of The Overburden project took up the issue of funding and regulation of the sectorfunding and regulation of the sector
One Aboriginal researcher went on to study One Aboriginal researcher went on to study medicinemedicine
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ConclusionsConclusions
Learning sets work in this settingLearning sets work in this setting We think they could be used more for We think they could be used more for
developmentdevelopment And for researchAnd for research
Challenges for governments Challenges for governments (stewardship, better funding and (stewardship, better funding and contracting) and for the sector contracting) and for the sector (workforce, governance)(workforce, governance)