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Building a Better Department, a Better System 31 Part B - Building a Better Department, a Better System

31 Part B - Building a Better Department, a Better Systemdigitallibrary.health.nt.gov.au/prodjspui/bitstream/10137/50/3... · Part B - Building a Better Department, a ... Building

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Page 1: 31 Part B - Building a Better Department, a Better Systemdigitallibrary.health.nt.gov.au/prodjspui/bitstream/10137/50/3... · Part B - Building a Better Department, a ... Building

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Part B - Building a BetterDepartment, a Better System

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The Banscott Review spoke clearly about the workforce, cultural, policy, management and evaluationchallenges confronting the Department. The Department continues to provide the bulk of health andfamily wellbeing services to Aboriginal people in the Northern Territory and increasingly plays asignificant and collaborative role in national Aboriginal health policy and action. However there is anactive and growing involvement of Aboriginal communities as local health and family wellbeingservice providers and increasingly over recent years as partners in the planning and development ofa health and family wellbeing system across the NT.

The environment in which Aboriginal health and family wellbeing services operate is clearlychanging. Those changes bring new challenges and opportunities and the Department needs tothink strategically about how it organises itself and contributes. The Department needs to takeseriously its strategic role both within and outside the public sector to build the knowledge, policies,programs and systems necessary to deliver sustainable achievements in Aboriginal health and familywellbeing. The delivery of effective, quality services within the environment of the Northern Territoryrequires the Department to do better.

This Framework for Action commits the Department to better policies, better targeting of services and resources, better support for staff and better monitoring and evaluation of effort. It also maps a course for the Department's implementation of Building Healthier Communities by identifying keyimprovements to services, systems and policy within the Northern Territory health and family wellbeing sector.

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Office of Aboriginal Health,Family and Social PolicyBased on the recommendations of Banscott and the commitments in Building Healthier Communitiesan Office of Aboriginal Health, Family and Social Policy has been established within the Department.The Office has a place on the Department's Executive and operates through two Branches that seek tobuild on Banscott, Building Healthier Communities and serve the critical areas of action outlined opposite.

The core domains of engagement for the Office are in influencing the Department’s:

Institutional settings

• Strategic engagement with community• Macro service delivery settings• Managing strategic partnerships• Accountability and performance

Central processes

• Policy• Budget priorities• Legislation and regulation

Value and Ethics

• Promotion of equity and efficiency • Cultural security• Program and administrative behaviour• Promotion of a balance between the responsibilities of individuals, family, communities and

socially in the development of Aboriginal health and family wellbeing.

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CEODepartment of Health and

Community Services

Assistant SecretaryOffice Aboriginal Health,Family and Social Policy

Director, Policy and Engagement Branch

Director, Population and Evaluation Branch

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Five Year Objectives

• Ensure that Departmental management and staff are clear about the goals for Aboriginal healthand wellbeing and about their Division's contribution to them including the explicit incorporation of Aboriginal objectives consistent with this Plan within strategic and business plans.

• Establish a proactive system that identifies and incorporates qualitative and quantative evidenceand research appropriately in policy and program settings.

• Cooperate to establish responsive policy platforms in key operational and strategic areas of Departmental activity.

• Establish a timely monitoring and evaluation regime for Departmental policy and activity,including feedback, which includes a focus on performance, organisational development,learning and growth towards higher goals.

• Promote improved quality of services through relevant staff development and education opportunities and secure effective management of change through appropriate staff support mechanisms.

• Secure collective organisational leadership, action and accountability.• Promote an informed balance between social, cultural, technical and bureaucratic pressures

and needs affecting the health and family development of Aboriginal people.• Improve the level of trust and cooperation between stakeholders by focusing on key goals and

public interest and engaging honestly.• Identify Aboriginal people's service delivery needs and expectations and incorporate these in

the planning, design, development and delivery of services and programs across the Territory.• Secure improved efficiency in the allocation and use of available resources.• Ensure the engagement of relevant unions in the implementation of the Plan through

appropriate and regular consultation.

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The introduction of core services will focus attention in each place thatservices are delivered. When people are required to travel away from thatplace, we need to make sure that pathways of care are aligned andappropriate; to do otherwise places the individual and system at risk.

Navigating entry to a health or family wellbeing service is challenging for many Aboriginal Territorians.When people need additional care the pathway from one point of service to another can alsointroduce risk and resistance. Whether transitions are managed well will have an important bearingon the outcomes.

The Department must provide a standard of service that ensures seamless care can be providedbetween the home; GP services; pharmacies and hospitals; rehabilitation; back to the home;perhaps into long term care; and finally into end of life care with minimum turmoil, stress and risk.

Studies have identified poor communication between sectors, lack of understanding of the level ofcare, insufficient support for carers, insufficient support for self or family management and inadequatestaff skills in working across the sector as driving systems failure. This has resulted in frequentreadmissions, people 'walking out', duplication of interventions, significant additional costs and greaterrisk to the individual's health and wellbeing. Many health and family wellbeing services sharecommon multi-disciplinary care processes leading some providers to look at developing commonmulti-disciplinary pathways, practice standards and protocols. These could include:

• Initial Contact• Service Coordination (Multidisciplinary) and Care Planning• Initial Needs Identification• Transition of care from one agency to another/Referral• Assessment (plus plans, service delivery, review and monitoring) • Discharge• Intake• Feedback (referral and assessment/re-assessment outcomes).

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Hospitals, Health Centres,Families, and In Between

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Five Year Objectives

• Establish access to care pathways that integrate role delineation and transition management between family, primary, secondary and tertiary health and family wellbeing services.

• Establish skills and systems development exercises and processes that link clinical, administrative and community leadership in support of identifying and pursuing opportunities to improve health services linkage and effective service integration including active patient/family involvement.

• Improve community information and knowledge of role delineation and the standards of care that they can expect from providers including the management of transition of care.

• Establish a monitoring regime that captures the failure of the system to properly manage entry,transitions and exits from the health and family wellbeing systems including feedback loops to appropriate Divisions.

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Aboriginal employment and career development is a health, social justice and service quality issue.

From the health/social justice perspective, evidence shows that there is an association between work,type of work and the security surrounding employment, and the prevalence of ill health and mortality.Further studies have shown that the impact of unemployment reaches beyond the lives of those withoutwork to touch whole families and future generations. Most would understand the impacts ofunemployment on the families of the unemployed but we are also now coming to understand theimpact that high rates of unemployment have on whole communities and society more broadly.

The employment of Aboriginal and Torres Strait Islander people can bring to the workplace diverse skills,knowledge, and cultural and social experience that enriches the context of services to Aboriginal andTorres Strait Islander people. It can improve the cultural security of services and sensitivity of staff, improveaccess and trust and promote improved quality of services.

Aboriginal people employed in the Department are concentrated in a few occupations and generallyat the lower levels and are under-represented in the industry generally. About 255 staff members haveidentified as Aboriginal or Torres Strait Islander. Improving both Aboriginal representation in the healthworkforce and ensuring that they have access to career and development opportunities is an essentialcomponent of building a different and better functioning Department. While predictions see the workingage population in other Australian States declining it will continue to grow in the NT over coming years.Aboriginal people are a growing proportion of the Territory's population, are younger and must be seenas a potential pool of Territory-based and Territory-loyal workers. It makes sense for the Department tomatch this potential with the creation of a workplace that is affirming of Aboriginal culture and values andwhich seeks to create targeted and general employment and career opportunities for Aboriginal people.

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Aboriginal Employmentand Career Development

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Five Year Objectives

• Increase Aboriginal representation in the health and community services workforce to 15% over the next three to five years.

• Broaden Aboriginal representation at all levels of the Department.

• In collaboration with unions, build workplaces that are culturally affirming through innovative and flexible workplace policy and practices.

• Establish an expanded range of development placements for Aboriginal staff including articulation with the Public Sector Management Program, Kigaruk,Executive Development Program and relevant tertiary programs.

• Build mechanisms that link workforce needs, developmentopportunities and Aboriginal community and staff aspirations.

• Establish an Aboriginal Career Development Fund to support career and professional development for Aboriginal staff.

• Conduct an Aboriginal Employment and Career Development Review and repeat it every three years.

• Identify those positions within the industry that require specific Aboriginal cultural skills, experiences and insights and actively recruit Aboriginal people to these positions.

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Government, and ultimately Territorians, have high expectations ofaccountability and performance and both will be looking for signs that thesector is both implementing this Framework for Action equitably and efficientlyand is producing results.

The current debate about the respective responsibility of government, individuals, families andcommunities within a civil society also adds a rich dimension to the question of accountability foroutcomes. Add to this the range of service providers contributing to outcomes and the complexity of the ask is more than apparent.

Within this mix of financial and outcome contribution are widespread calls for greater communityparticipation, creating the need for balanced but flexible systems able to meter effectiveparticipation and local decision-making on the one hand and the usefulness of systems of controland risk management on the other. The key task for the Department and the sector is how to respondto performance and accountability expectations in this complex and changing environment.

A number of essential elements need to be present in any accountability framework. We need to beclear about what it is we are striving to achieve; people need clear roles and responsibilities; andresponsible areas need to have the means to achieve effectively and efficiently. For the link betweenpublic expectations, government policy and program providers to be effective, a useful interfaceincorporating communication, collaboration, problem-solving, and mutually beneficial interactionmust be created. Such an approach will provide the basis on which Government and Territorians cansee and trust progress, making the Department accountable for the decisions it makes.

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Demonstrating Outcomes and Being Accountable

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Five Year Objectives

• Produce annually an Aboriginal health and family wellbeing business plan consistent with the objectives of this Framework for Action and make it publicly available.

• Produce an annual Departmental outcomes and accountability statement mapping business performance against the objectives of this Framework for Action.

• Establish Performance Agreements between the CEO and Division Heads requiring a demonstrable contribution to the implementation of this Framework for Action.

• Establish strategic governance across the programs within the Department in support of the Framework for Action.

• Agree and produce a comprehensive Framework for Action Report Card at the end of this initial five year period.

• Produce risk and impact assessment methodologies and tools that address financial and outcome management needs.

• Produce a regime of health economics and population analysis that contributes to optimal policy and program decision making.

• Produce a joint service and performance accountability matrix for public and community controlled sector providers.

• Convene an annual staff focus group to reflect on the Plan's implementation and progress.

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If we continue to learn and build the system's capabilities the likelihood is that we will deliver a better, more sustainable health and family wellbeingoutcome for Aboriginal Territorians.

Learning as we go means that the system will more effectively identify and reduce problems, increasethe choice of strategies available and shift the energy from narrow interests to agreed commonobjectives. Focusing on the exchange of knowledge and experience both of mistakes and successeswithout blame or competition provides a useful basis on which the health and family wellbeingsystem can expand and improve. Creating living knowledge, a practice where knowledge andexperience is recorded, evaluated, shared, modified and fed back into a continuous process of useand improvement is a critical concept if we are to learn as we go.

Creating networks at the local level or among communities of interest can lead to informed andconsistent expectations of service behaviour both among providers and Aboriginal communitieswhich in itself can contribute to greater levels of trust. Local networks where living knowledge isencouraged are less likely to crowd out local initiative by promoting and valuing coordination andcooperative behaviour over narrower self or group interests. The more inclusive the networks the morepositive and efficient the outcomes are likely to be.

Importantly, creating networks and learning as we go can reduce the cost of day-to-day affairs andof business more broadly. More cooperation and trust can reduce transaction costs not only forindividuals but for whole communities and this can lead to improved capacity from which the healthand family wellbeing system can expand the level and coverage of services to Territorians. Highquality stewardship - management that empowers, supports, reviews, communicates, encouragesparticipation while sanctioning those who undermine, and that offers incentives for betterperformance - is crucial to a modern health and family wellbeing system.

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Learning as We Go - Living Knowledge

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Five Year Objectives

• Establish Living Knowledge and Learning Networks (LKLN) in each major population centre involving NGO, community and Government providers and for the Department’s Executive.

• Establish a sound evaluation agenda for Aboriginal health and family wellbeing policies and programs and feed results into LKLNs.

• Establish an Aboriginal health and family wellbeing research/policy nexus within the Department promoting knowledge development and transfer.

• In collaboration with the Cooperative Research Centre for Aboriginal Health establish improved economic evaluation of policy and programs.

• Create a Living Knowledge and Lessons Database for Aboriginal health and family wellbeing in the NT accessible to public, community and NGO sector providers.

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Measuring Action and OutcomesMeasuring action is aimed at better monitoring. We need to be able to watchprogress, check results and provide feedback on the strategies we have chosen.Measuring outcomes will tell us how close we have come to the objectives weset ourselves.

In addition to helping us understand whether what we do produces the results we want, measuringaction and outcomes helps us determine the value or worth of our efforts - it is not just a technicalexercise but also a task of making value based judgements about whether the gains made aresufficient given the time, effort and money we have spent.

Many performance and statistical analyses have been produced over the past decades but slowprogress in changing the picture they present has left some asking: Does reporting and how we reportmake a difference? Evidence suggests that we should not try to measure everything but pick a smallnumber of sensitive indicators that are broadly indicative of change and that are useful in helping usdo still better. Some of the indicators will be relevant to a number of the components in the Frameworkfor Action.

Measuring the Department's performance is also important so that Government, Aboriginal people,Territorians and the Department itself can be encouraged and assured that its efforts are on track. It isoften the case that good work, progress and outcomes are left unnoticed because there is no systemthat captures and shares them. The Office of Aboriginal Health, Family and Social Policy will also workwith other parts of the Department and our research partners, the Cooperative Research Centre forAboriginal Health, Menzies School of Health Research and Charles Darwin University to develop aneffective process that leads to improvements in the effectiveness, efficiency, equity and quality of outactions and outcomes.

Lastly good performance measurement is not about catching people out, it is about helping them to do better.

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Five Year Objectives

• Establish a framework of performance measurement consistent with the Framework for Action and national obligations.

• Collect, collate and analyse data and information on performance and produce regular reports to Departmental management.

• Link analysis to the policy, budgetary and business planning of the Department.• Report annually to the Government on the implementation of this Framework for Action.

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Aboriginal Health and Families A Five Year Framework for Action