Academic journal article Australian Health Review

A Case Study in the Use of Evidence in a Changing Political Context: An Aboriginal and Torres Strait Islander Health Service Re-Examines Practice Models, Governance and Financing

Academic journal article Australian Health Review

A Case Study in the Use of Evidence in a Changing Political Context: An Aboriginal and Torres Strait Islander Health Service Re-Examines Practice Models, Governance and Financing

Article excerpt

Setting

Recent political changes at federal and state levels have reintroduced a degree of uncertainty to the policy direction, resourcing and delivery of Aboriginal and Torres Strait Islander health services in Australia. Since being elected in September 2013, the Liberal-National Federal Government has split policy and funding responsibilities across two departments, with strategic policy functions relocated into the Department of Prime Minister and Cabinet.1 This notably includes responsibility for the health performance framework, health expendi-ture analysis and life expectancy modelling. The Office for Aboriginal and Torres Strait Islander Health (OATSIH) has been dissolved, with the Department of Health retaining responsibility for the funding of health services under the newly created Indigenous Health Service Delivery Division. Following a review, Medicare Locals will be replaced by Primary Health Networks from 1 July 2015,2'3 At a state level, the Queensland Government continues to implement reforms and funding cuts, with implications for service delivery and the health workforce. Through the process of determining contestability, the Queensland Government intends to test the market in order to determine whether the current Aboriginal community controlled health organisation (ACCHO) providers deliver health services most competitively, with the option of opening up the delivery of health services to Aboriginal and Torres Strait Islanders to other providers if this is not the case.4 Within Queensland Health, there has been a review of the Indigenous workforce and their roles, with questions around optimal integration of these staff into programs. All these come at a time when new service delivery models, such as the Institute for Urban Indigenous Health (IUIH) Model of Care, are already evolving, driven by the Closing the Gap commitment, mainstream health developments and reforms initiated within ACCHOs in response to these changes.

Objectives

This case study examines the use of evidence in a recently established organisation, namely the IUIH (a partnership between the Aboriginal and Torres Strait Islander Community Health Service Brisbane, Kalwun Health Service, Yulu-Burri-Ba Aboriginal Corporation for Community Health and Kambu Medical Centre), in negotiating these uncertain times. Created in late 2008 in response to Closing the Gap,5,6 the IUIH is an innovative community controlled regional body leading planning, development and coordination for Aboriginal and Torres Strait Islander health services in south-east Queensland. This event-based analysis is structured around the observation of a quarterly management meeting of the IUIH held in October 2013, and explores how the IUIH uses a range of evidence to respond to the challenges faced by the sector through a regional vision, shared systems and processes, and self-regulation.

Setting, participants and methods

With the informed consent of participants, three independent researchers from the University of Queensland and the University of New South Wales observed, recorded and analysed the issues covered at a routine quarterly meeting of the IUIH. Day 1 consisted of a senior management team meeting, which focused on strategic planning and governance reforms. Day 2 consisted of the lead clinicians group meeting and focused on: clinical reforms; presenting and discussing data; and shared learning learning concerning best practice, technologies and performance frameworks. We examined conversation and debate, language and discourse and the materials presented. The case study is part of a broader research project examining the uptake of research evidence in Indigenous health policy and therefore focused on the use of evidence by the IUIH.

Ethics approval

The 'Uptake of evidence to policy: the Indigenous burden of disease case study' (Project no. 201001442) has National Health and Medical Research Council ethics approval.

Outcomes

In terms of the use of evidence, three distinct but interconnected processes were discernible at the meeting: (1) identifying evidence for change; (2) exploring and reframing this evidence; and (3) applying the evidence at different levels of policy and practice. …

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