NACCHO Summit Adelaide: Croakey Q and A interview with CEO Lisa Briggs

This is a good example of “the 3 C’s” as this event is not government funded but has been self-funded by our sector showing how NACCHO, affiliates and member services continue to support each other. The summit themes of governance, workforce and comprehensive primary health care will show the diversity amongst the membership. ” Lisa Briggs
As mentioned in the previous post, the Croakey Conference Reporting Service is covering the NACCHO Aboriginal Community Controlled Health Service Summit, which starts in Adelaide today on Twitter, check#NACCHOSummit).
In the conference preview below, Lisa Briggs, CEO of NACCHO, has an online chat with Croakey about the “bang for the buck” provided by the Aboriginal community controlled health sector.LisaBriggsPic1She also reveals her dream panel for ABC TV’s Q and A program, her enthusiasm for the power of social media, and her hopes that more young Aboriginal and Torres Strait Islander people will choose careers in health.Lisa is a Gunditjmara Aboriginal woman from the western district of Victoria, and an Aboriginal Health Worker who has worked in the health field for the past 25 years, mainly within the Aboriginal community controlled health sector.***Q: A Twitter campaign is pushing for the ABC program Q and A to have an all-Indigenous panel. Who is your dream Q and A panel?

Lisa Briggs:

Justin Mohamed, Chair of NACCHO – to highlight the importance of Aboriginal health and how the Aboriginal Community Controlled Health model is contributing to Closing the Gap.

Warren Mundine – who would Chair the Prime Minister’s Indigenous Advisory Council should the Coalition win the election.

Marion Scrymgour, CEO of our member service Wurli-Wurlinjang Health Service in Katherine. Marion understands the political and health system and would be able to provide another opinion and challenge ideas, as well as provide gender balance.

Shane Houston from Sydney University – his extensive knowledge of Aboriginal affairs is impressive and he would provide a sense of the vision and systematic changes required.

Professor Patrick Dodson – his extensive knowledge on current issues such as Constitutional reform and land rights.

Pat Turner – Former Deputy Secretary of the Prime Ministers Department – has extensive experience in government and Aboriginal affairs.

I wanted to put Marcia Langton and Noel Pearson in there too, as I think they all have something to contribute on how policy is being formed for Aboriginal people and the impacts that it has on us and our environments of urban, regional and remote…I think people expect Marcia, Noel and Warren to all be part of this should the Coalition win the election, so I thought what other Aboriginal leaders have equal experience but are not always heard and these are the ones I came up with my shortlist.


Q: You tweeted from a recent AHMRC meeting that the three C’s of the Aboriginal community control philosophy are “Community-initiated”, “Community-driven”, “Community-owned”. Could you explain why each of these C’s matter?

Lisa Briggs: It’s about self-determination of Aboriginal and Torres Strait Islander people and their fundamental right of being part of all processes that have impacts on us. Aboriginal Community Controlled Health Services are founded on this basis.

NACCHO has recently released the Aboriginal Community Controlled Health Services Report Card, which signifies that when Aboriginal health is in Aboriginal hands we can make a real difference to Closing the Gap.


Q: The NACCHO Summit aims to profile innovation and best practice in the community controlled sector. Can you give us one of your favourite examples of this?

Lisa Briggs: It wouldn’t be fair for me to pick one over the other. However, I can say this – how very pleased I am to see the Aboriginal Community Controlled Health Services put in so many conference abstracts to this weeks summit that will show innovation and best practice from all over the country. With over 300 delegates registered, over 85 presentations and over 100 speakers and exhibitors, it is going to be a great event.

This is a good example of “the 3 C’s” as this event is not government funded but has been self-funded by our sector showing how NACCHO, affiliates and member services continue to support each other. The summit themes of governance, workforce and comprehensive primary health care will show the diversity amongst the membership.

There will be common things we can all relate to, however it will be innovation at its best that the members can take back to their community organisations.


Q: What are the barriers within government & government policy to the community controlled sector achieving its potential?

Lisa Briggs: The barriers are to do with lack of action on the following:

• Engagement and cultural consultation processes with Aboriginal and Torres Strait Islander people

• Government understanding the role and importance of Aboriginal Community Controlled Health Services as part of the overall Australian health system

• Government Policies are piloted in Aboriginal and Torres Strait Islander communities before being rolled out nationally. Aboriginal specific policies such as the NT Intervention imply institutional racism, and then these policies affect the ideas of government workers and others

• Aboriginal history embedded into the Australian education system so that wider Australia can feel proud of it First Nations peoples

• Constitutional recognition that Australia’s first people are Aboriginal and Torres Strait Islander people who are rich in culture and knowledge – something all Australia should be proud of.


Q: What are the barriers within the community controlled sector to the sector achieving its potential?

Lisa Briggs:

• A lack of appropriate funding to enable the ACCHS to meet the needs of communities.

• Government policies that are not targeted to the needs of that community.

• Workforce recruitment, retention and capacity – particularly GPs, nurses and allied health workers.

• Lack of genuine partnerships.

• Lack of scholarships that support and meet the demand required for Aboriginal and Torres Strait Islander people to join the health workforce.


Q: What are the barriers within the wider health system to the community controlled sector achieving its potential?

Lisa Briggs:

• A lack of understanding of ACCHSs, their role and mechanism

• Lack of genuine partnerships

•  Lack of coordination

• Institutional racism

• Policies which impact access such as affordability, access,

• A lack of cultural understanding

• A lack of capacity to meet the needs of Aboriginal organisations and Aboriginal & Torres Strait Islander people.


Q: What are the barriers within Aboriginal and Torres Strait Islander communities to the community controlled sector achieving its potential?

Lisa Briggs: The Social and Cultural Determinants of Health are important, and these are a few underpinning examples:

•  Employment – meaningful career pathways

•  Education – meaningful and supported such as scholarships programs that enable participation, and being open to all age groups

•  Accessibility – having the means to be able to access services no matter where they are located and in an environment that meets their needs

•  Housing – having the same level of opportunity as other Australians to either purchase or rent.


Q: What are the enablers within government and government policy and the wider health system to the community controlled sector achieving its potential?

Lisa Briggs:

•  Genuine engagement and consultation and being heard and listened to.

•  Working alongside Aboriginal leadership at all levels for development, implementation and evaluation.

•  Genuine partnership, opportunity and investment in what works for Aboriginal and Torres Strait Islander people.

•  Close the Gap Statement of Intent is a good example of what can happen when this above process is followed. However, there is always room for improvement.


Q: What are the enablers within the sector to the community controlled sector achieving its potential?

Lisa Briggs:

•  Genuine engagement and consultation with local community members, and hearing their needs

•  Appropriately resourced to be able to meet the targeted needs of the local community

•  Funding mechanism that allows for innovation and investment

•  Appropriate workforce capacity and investment in new workforce innovation

•  Investing in Aboriginal leadership as part of professional development.


Q: You’ve been known to say that the community controlled sector offers “the best bang for the buck”. Can you quantify this?

Lisa Briggs: Aboriginal Community Controlled Health Services are not funded to the same level as other primary health care services across Australia.

However, they are the only services that demonstrate and are targeted towards health gains – not throughput.  This is why the Aboriginal Community Controlled Health Services Report Card is so significant, as we now have an evidence base that can be showcased.


Q: How would you advise community members to evaluate the quality of their community controlled service? What are the signs of a healthy service? And what are the signs of a service that needs support to improve?

Lisa Briggs: All of our Aboriginal Community Controlled Health Services are accredited and meet the Australian Standards and part of the process is to receive feedback from the clients you service to measure quality. This has now been embedded as custom and practice, and allows the ACCHS’s to work on a continuous quality improvement model.

A healthy service in my opinion is one that follows “the 3 Cs” (ie “Community-initiated”, “Community-driven”, “Community-owned”).

The issues that services face vary: it might be a small service needing more capacity and expansion, it might be a large service needed to review its strategic direction, it might be a young community needing guidance.


Q: In a recent speech on the social determinants of health, AMA president Dr Steve Hambleton acknowledged the impact of institutionalised racism. The vision of the new national plan for Aboriginal and Torres Strait Islander health (which recently had a positive wrap in The Lancet)  is for a health system free of racism.  For health services and health professionals that want to address this problem, how would you advise them?

Lisa Briggs: Engage with their local Aboriginal Community Controlled Health Service and learn about what the communities’ needs are, ask how they can assist in a genuine partnership and coordination model – it will take shape from there over a period of time.


Q: What is your vision for Aboriginal and Torres Strait Islander health in 10 years time?

Lisa Briggs: I believe if we currently keep tracking with our original health targets, then life expectancy should increase. However, some areas need urgent attention now, such as diabetes, renal disease and cancer.

We are moving into a world where everything will be more telecommunication-based with telehealth and ehealth. With workforce shortages and population growth, models of services will also need to adapt, to continue meeting the needs of the community.

Since we are a young population compared to the rest of Australia, I hope to see more of our young people complete their studies, and find their career pathway into the health system.

Economic constraints will create challenges and opportunities. The challenges include that NACCHO, affiliates and members are not funded at parity as the rest of the health system. A potential opportunity is that Government may choose to invest at a higher level or to buy more services from ACCHSs given the good value they provide.


Q: What is your vision for the community controlled sector in ten years time?

Lisa Briggs: Aboriginal Community Controlled Health Services are viable and sustainable, and their model of services adapts to suit the changing needs.  This vision is outlined by the NACCHO 10 point plan, which gives focus and direction to us, our affiliates and member services.


Q:  What is your top tip to those working in the community controlled sector for looking after their own health?

Lisa Briggs: Ensure that you have an annual health check, take regular holidays and spend quality time with the ones you love, take the time to sit back and reflect on how your contribution has made a difference  – you can’t look after other people if you don’t look after yourself!

It’s work and life balance.


Q: NACCHO (@NACCHOAustralia has over 4,000 followers) has been at the forefront of the health sector in using Twitter and other social media channels such as blogs to communicate with its stakeholders and to build influence. Would you like to see more people in the community controlled sector using social media as a health communications channel? If so, what might help them to get on board?

Lisa Briggs: This is absolutely essential, people need to be informed of the power and traction social media has – generally teaching people how to use social media or be involved is the key.

We are encouraging all our member services and staff to utilise social media and can provide them with information on establishing a corporate social media policy.  Once you start, you just can’t stop engaging with our community, partners, and stakeholders, sharing the issues and good news stories about the successes in our Aboriginal community controlled health sector.

• You can follow Lisa on Twitter at: @ NACCHO_CEO 

Keeping you up to date with Croakey news and developments

Some news about Croakey…

The Croakey Conference Reporting Service

I’m delighted to announce that the Croakey Conference Reporting Service will be in action at the following events:

The NACCHO Aboriginal Community Controlled Health Service Summit in Adelaide, August 20-22.
Adelaide-based journalist John Thompson-Mills (on Twitter – @jthompsonmills) will report from the Summit.
For those on Twitter, keep an eye on #NACCHOSummit. 

• An Australian Centre for Health Services Innovation forum, “Fixing Healthcare”, in Brisbane, August 29.
Mardi Chapman (@mardidiane), a health journalist and writer based in Brisbane, will cover the forum.
Check #12Bhealthfix.

• The 12th Australian Palliative Care Conference, in Canberra, 3-6 September.
Jennifer Doggett (@JenniferDoggett) will cover the conference.
Check #PallCareConf.


Announcing @WePublicHealth

@WePublicHealth is a new rotated Twitter account that is something of an experiment in public health/citizen journalism. Every week, a different person – including community members and public health professionals – will be asked to tweet-report and investigate public health matters.

Their focus might be local – for example, documenting the cost of fresh foods in remote communities via tweet-photos – national or global (for example, reporting from international conferences and events).


 Related articles

If the Federal Government really wants to improve Aboriginal and Torres Strait Islander health

Pictured above Selwyn Button, CEO of the Queensland Aboriginal and Islander Health Council (QAIHC),one of the key speakers at the NACCHO AGM members meeting 2012 in Brisbane where the theme was  “Our business,Our way- Governance”

In the article below, Selwyn  argues that the focus of government reporting requirements should shift to looking at outcomes rather than inputs He also argues that real health service improvement will be driven by communities themselves, rather than by government contracts.

The priority should be to build and develop “the capacity of our communities to ask the hard questions of their local organisations,” he says.

We acknowledge the continued support of Melissa Sweet CROAKEY


Our communities will drive health service reform better than input-focused government contracts

Selwyn Button writes:

Over the past 12 months, community controlled services across the country have entered into new contractual relationships with major funding bodies, predominantly the Federal Health Department, to support the improvement of health outcomes for Aboriginal and Torres Strait Islander people across the country.

Through this process we have seen significant new investment in community controlled service delivery, which is a welcome move, whilst also ensuring that organisations remain accountable to government for the resources they received through a range of new reporting measures, streamlined into a single agreement.

This was a major recommendation from the Overburden Report, compiled by Professor Judith Dwyer and her colleagues in 2009, that sought to make sense of complexities in funding arrangements for community controlled organisations, to support greater focus on service delivery as opposed to administration and compliance.

Finally, governments had started to listen to what their funded research was telling them.

What this new contract relationship should have created was an environment where community controlled health services could focus on doing what they do best – providing quality health care to our people. It would have been an ideal opportunity to also right the service-provider relationship – where Governments purchased quality health care outcomes not administrative outcomes.

Only months before the commencement of the 2011/2012 financial year, representatives from the Office of Aboriginal and Torres Strait Islander Health (OATSIH), which happens to be the major funder of primary health services across the country for our people, undertook a road show across the country to highlight and discuss impending changes to the contractual relationship between governments and community controlled services.

Workshops were held in every State and Territory capital city, with a view to ensuring that all stakeholders were aware of impending changes and outline how new contracts and explanatory handbooks would support improved understanding of demands on services and expectations from government. When establishing solid relationships between purchasers of services and providers of health care, it is important for both parties to understand each other’s needs and how to address concerns throughout the contract period.

Many of these workshops left participants more confused than before commencing, although left some glimmer of hope that there would be some joint work around the ongoing development and updating of the Funding Agreement Handbook, which would be used as a guide for both OATSIH and community controlled service staff.

Unfortunately, at this point and still today, there is no clear indication from OATSIH what they are seeking to purchase from community controlled services.

The contracts outline priority areas for program delivery, with a focus on inputs such as primary health care, social and emotional well-being, child and maternal health etc, without providing clear indication of what OATSIH want to achieve across all areas, other than to say it all contributes to the six Close the Gap National targets.

They don’t however provide solid links between health service outcomes and their known impact on clients’ health outcomes.

Consequently, we can only draw one conclusion from this confused contractual state: that governments do not yet truly understand what it is they want to purchase in terms of Indigenous health outcomes.

A focus on inputs rather than outputs

Community controlled services have and will continue to preach that comprehensive primary health care is needed for the health of our people.

Community controlled health service delivery commenced on the premise that to achieve the best health outcomes for our people, we need to provide comprehensive services, not just your average primary care services, and consequently there has been much attention across the sector to build and strengthen this approach over time, with great outcomes.

Furthermore, we can assume that the fundamental notion of a formidable purchaser/provider relationship is not a priority, as governments want to continue the notion of providing grant monies to community controlled organisations tied to a range of preventative measures that are not necessarily related to performance in health service provision.

Perhaps Governments are simply not ready to move to purchaser provider relationships where outcomes and not inputs are the contractual foundations.

How do we draw these conclusions?

Firstly, I am yet to hear complaints from any community controlled service across the country that is ever questioned by OATSIH in relation to a lack of health assessments completed over a quarterly reporting period.

Rather, much of these contractual discussions centre around questions concerning governance models, constitutional changes, budget expenditure against unreported items, employee fractions on projects and other related things. Is it that Government believes such matters are a better indication of performance by each service?

Again Government remain focussed on inputs and monitoring administrative functions of service providers rather than focussing on health outcomes delivered.

Don’t get me wrong, all of the aforementioned items are important in the broader scheme of running successful businesses, although these fundamental questions should be resolved at the time of developing and endorsing relevant annual Action Plans and related project budgets.

Building capacity of community controlled organisations to do this consistently will enable and inform successful new business models to support health outcomes, and we are already starting to see this happen in many areas.

This process is being developed and led by the sector itself, which is a clear demonstration of organisational maturity and growth to support outcomes for our people. The sector must and should continue to be responsible for internal reform and improvements, whilst also setting higher expectations for itself, rather than be dictated to by governments.

What I am advocating, though, is that quarterly discussions are better spent on performance outputs and outcomes that can lead to improved health benefits for clients.

This process is not what a purchaser/provider relationship should look like when governments are attempting to purchase quality health services to support outcomes for Aboriginal and Torres Strait Islander people.

Government push for control

The current contractual relationship enables and supports ongoing government manipulation of community controlled organisations in a manner they believe will benefit communities the most. Admittedly, there are circumstances across the country where this is required, although experiences tell us that community controlled services are already delivering the best health outcomes for their own people and this is not being supported to continue and strengthen.

More concerning with the current contractual arrangement is Government seeking to ensure they can run community controlled organisations from within their departments, again evidenced in the contractual focus on day-to-day operations and inputs.

What we need at this point is not for governments to assume and attempt to maintain total control over community organisations, nor do we wish for community controlled organisations to think that they can do as they please with no accountabilities to anyone, as this is not community controlled either.

Given the growth in organisational maturity and experience in health service delivery, community controlled services are seeking to assume responsibility as the major provider of health care to our own people.

Although with this responsibility comes greater accountability, but not just to government but our accountability must be to the communities we serve, through robust reporting and monitoring mechanisms that are designed to provide clients and community with relevant information and data to meet their needs.

Governments will continue to seek improved accountability through contractual relationships, although this needs to improve and give recognition to existing processes, like those already compulsory for organisations through clinical and organisational accreditation processes.

The development of relevant Action Plans and budgets for government and community are and still should be essential, although ongoing monitoring of performance can be better achieved through focussing upon health outputs and outcomes that will lead to fundamental change.

Reporting to communities

Additionally ensuring that all organisations are regularly reporting to their local communities will further drive transparency in organisations, consequently leading to improved outcomes that can be measured competently by both community and government.

This is the relationship we need to start building and developing: the capacity of our communities to ask the hard questions of their local organisations, which demands far greater weight and attention than that of governments.

In Queensland, these reforms have commenced and we are starting to see a dramatic shift in community interactions with their local community controlled service because of it.

We now need to see this spread across the country so that the people who need high quality health services the most, Aboriginal and Torres Strait Islander people, are demanding it from their local service and seeking to ensure it continues to improve and grow.

The challenge for governments in all of this is to determine what role they are seeking to play in supporting this reform process.

Are they still wanting to remain in an old grant provision mentality of providing resources to our services that are restricted by a range of reporting and compliance requirements?

Or do they seek to see fundamental change in health outcomes through new relationships that pay tribute to services that are providing high quality health care for our people and achieving relevant outcomes?

This shift requires significant attitudinal change by governments, reflected in the language they use, and demonstrated in contractual relationships that support and enable services to do their jobs, rather than restrict them into long-winded reporting regimes.

Then we will see real improvements and communities openly demanding further improvements from their local service.

• You can follow Selwyn Button on Twitter