Learning from Action

1. Learning from Action Researching with Aboriginal Health Care Managers Judith Dwyer, Cindy Shannon and Shirley Godwin Funded by the Cooperative Research Centre for Aboriginal Health, conducted in partnership with QAIHC Resourced by La Trobe, Flinders and Queensland Unis

2. Shirley and Cindy Learning from Action

3. Outline and acknowledgements • Goals • Method • Findings • Discussion • Thanks to Lizzie Adams, Valerie Craigie, Bronwyn Fredericks, Sheryl Lawton, Mary Martin, Mark Moore, Janelle Murphy, Justin Saunders, Bronwyn Smith, Mick Gooda, Ian Anderson, David Legge, Christine Bright and many others Learning from Action

4. Project Goals • Work with senior managers of ACCHS’s to: • develop understanding of management challenges and practices in ACCHSs • to share and build knowledge and skills • to use this project as the basis for further research and development – learning approaches; management methods tailored to the needs of the Aboriginal health sector Research Learning Devel’t Learning from Action

5. Our approach • Rather than focus on ‘difference’, we investigated the challenges and strategies, aware of context • Intention to inform further applied research • And development of the sector • And provide participant-defined view of challenges in contested policy environment • As well as contribute to learning and development for participants Learning from Action

6. Overall Program • Worked with 13 senior managers in Queensland Aboriginal and Islander Health Services • 4 workshops (3 days, 2 days, 2 days, 3 days) • Learning set meetings • Formal teaching, seminars • Option for academic credit • Equivalent to 25% of a Grad. Cert. in HSM • Formal recognition of participation Learning from Action

7. Complying with ethical guidelines “..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..” Learning from Action

8. Learning Set method • At each meeting, each person presents a real, current management problem they are trying to solve • Everyone asks questions to clarify the problem, and offers suggestions about strategies • The person who owns the problem sums up, says what they’re going to do (each problem takes about 45 minutes) • Next meeting – each person gives an update on what happened, and brings a new problem or situation • We ran two sets of 6 members each • Two team members acted as facilitators • And two people took detailed notes on laptop computers Learning from Action

9. Seminars • Half-day or more each meeting • Topics determined by participants • Formal teaching and discussion/case studies on: • Managing money • Managing people • Managing organisational strategy • Managing systems and reading policy • Delivered by the team, plus two guest speakers • Mr Mick Gooda, CEO, CRCAH • Professor Ian Anderson, Head, Onemda (Uni of Melbourne) Learning from Action

10. Data • We had 37 stories from 13 participants • Our aim was to gather data about their management experiences, (rather than their opinions about management) and analyse, reflect on and discuss them with our co-researchers • We collected comparison data from a mainstream learning set at the same time • 21 stories from 6 participants Learning from Action

11. Analysing the data Learning from Action 37 stories in 9 groups (by primary problem)

12. ‘Theming’ • Each story gave rise to multiple themes • No stories can be told in the results – confidentiality • Structured summaries • issue, underlying factors, strategies, enablers, barriers • We used excel spread sheets to sort and manage data • And the process was iterative (develop, check, further develop categories as new data incorporated) Learning from Action

13. Validation • Story summary and ‘themes’ were returned to participants at the following workshop • We presented a collated cumulative summary of the themes at each workshop, for discussion and amendment/endorsement • The discussion was valuable • Sideline: I kept a journal, not consistently, and it was very useful as a reference Learning from Action

14. Nine groups of stories • Managing staff (8 stories) • Managing the organisation (6 stories) • Managing relations with Board (6 stories) • Working with external partners (5 stories) • Managing self in job (4 stories) • Managing finances and funding (3 stories) • Managing Aboriginal Health Worker roles (2 stories) • Managing non-Indigenous staff (2 stories) • Working with culture and race (1 story) Learning from Action

15. Managing staff 8 Managing the org 6 Managing Board 6 External partners 5 Managing self in job 4 Managing money 3 Managing AHW roles 2 Managing non-Indigenous staff 2 Working with culture 1 Managing staff 9 Org strategy/structure 4 [only 1 worked to a Board] External relationships 1 Managing job/career 5 Workforce 2 Comparison with mainstream set: main problem in each story This project Mainstream Set Learning from Action

16. Managers’ problems and actions 4 workshops 37 stories, sorted into 9 groups Strategies 97 management strategies in 11 categories Enablers 57 themes in 12 categories Barriers 81 themes in 13 categories Underlying factors 152 themes in 12 categories Consolidated results in 7 main categories Context or organisation factors Learning from Action

17. Results in 7 headings • Workforce and people management are major challenge • Organisations need infrastructure and systems • Community engagement is a strength but difficult to structure and manage well • Managers need better support • Being a ‘partner’ to the biggies is a challenge • Funding is complex and short-term • Working across cultures is difficult, racism gets in the way Learning from Action

18. Policy implications • Managers lack a system for support and development – career structure, staff development, mentoring etc • Size matters – critical mass for health care, and for organisational effectiveness • The sector needs infrastructure that matches its critical role in PHC (corporate support +quality+IT+service development capacity) • The services have grown and become more complex, and may have gotten out of sync with some of the methods used to implement the principle of community control. Learning from Action

19. After the Research: • QAIHC received funding from OATSIH to implement management executive training program • Partnered with Griffith University • 16 senior managers enrolled in the program • Training for 100 managers in Business Management was funded by OATSIH • The Overburden project took up the issue of funding and regulation of the sector • One Aboriginal researcher went on to study medicine Learning from Action

20. Conclusions • Learning sets work in this setting • We think they could be used more for development • And for research • Challenges for governments (stewardship, better funding and contracting) and for the sector (workforce, governance) Learning from Action