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Building better systems of care for Aboriginal and Torres Strait Islander people: findings from the Kanyini health systems assessment
BACKGROUND: Australian federal and jurisdictional governments are implementing ambitious policy initiatives intended to improve health care access and outcomes for Aboriginal and Torres Strait Islander people. In this qualitative study we explored Aboriginal Medical Service (AMS) staff views on fact...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2012
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3529689/ https://www.ncbi.nlm.nih.gov/pubmed/23102409 http://dx.doi.org/10.1186/1472-6963-12-369 |
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author | Peiris, David Brown, Alex Howard, Michael Rickards, Bernadette A Tonkin, Andrew Ring, Ian Hayman, Noel Cass, Alan |
author_facet | Peiris, David Brown, Alex Howard, Michael Rickards, Bernadette A Tonkin, Andrew Ring, Ian Hayman, Noel Cass, Alan |
author_sort | Peiris, David |
collection | PubMed |
description | BACKGROUND: Australian federal and jurisdictional governments are implementing ambitious policy initiatives intended to improve health care access and outcomes for Aboriginal and Torres Strait Islander people. In this qualitative study we explored Aboriginal Medical Service (AMS) staff views on factors needed to improve chronic care systems and assessed their relevance to the new policy environment. METHODS: Two theories informed the study: (1) ‘candidacy’, which explores “the ways in which people’s eligibility for care is jointly negotiated between individuals and health services”; and (2) kanyini or ‘holding’, a Central Australian philosophy which describes the principle and obligations of nurturing and protecting others. A structured health systems assessment, locally adapted from Chronic Care Model domains, was administered via group interviews with 37 health staff in six AMSs and one government Indigenous-led health service. Data were thematically analysed. RESULTS: Staff emphasised AMS health care was different to private general practices. Consistent with kanyini, community governance and leadership, community representation among staff, and commitment to community development were important organisational features to retain and nurture both staff and patients. This was undermined, however, by constant fear of government funding for AMSs being withheld. Staff resourcing, information systems and high-level leadership were perceived to be key drivers of health care quality. On-site specialist services, managed by AMS staff, were considered an enabling strategy to increase specialist access. Candidacy theory suggests the above factors influence whether a service is ‘tractable’ and ‘navigable’ to its users. Staff also described entrenched patient discrimination in hospitals and the need to expend considerable effort to reinstate care. This suggests that Aboriginal and Torres Strait Islander people are still constructed as ‘non-ideal users’ and are denied from being ‘held’ by hospital staff. CONCLUSIONS: Some new policy initiatives (workforce capacity strengthening, improving chronic care delivery systems and increasing specialist access) have potential to address barriers highlighted in this study. Few of these initiatives, however, capitalise on the unique mechanisms by which AMSs ‘hold’ their users and enhance their candidacy to health care. Kanyini and candidacy are promising and complementary theories for conceptualising health care access and provide a potential framework for improving systems of care. |
format | Online Article Text |
id | pubmed-3529689 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2012 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-35296892013-01-03 Building better systems of care for Aboriginal and Torres Strait Islander people: findings from the Kanyini health systems assessment Peiris, David Brown, Alex Howard, Michael Rickards, Bernadette A Tonkin, Andrew Ring, Ian Hayman, Noel Cass, Alan BMC Health Serv Res Research Article BACKGROUND: Australian federal and jurisdictional governments are implementing ambitious policy initiatives intended to improve health care access and outcomes for Aboriginal and Torres Strait Islander people. In this qualitative study we explored Aboriginal Medical Service (AMS) staff views on factors needed to improve chronic care systems and assessed their relevance to the new policy environment. METHODS: Two theories informed the study: (1) ‘candidacy’, which explores “the ways in which people’s eligibility for care is jointly negotiated between individuals and health services”; and (2) kanyini or ‘holding’, a Central Australian philosophy which describes the principle and obligations of nurturing and protecting others. A structured health systems assessment, locally adapted from Chronic Care Model domains, was administered via group interviews with 37 health staff in six AMSs and one government Indigenous-led health service. Data were thematically analysed. RESULTS: Staff emphasised AMS health care was different to private general practices. Consistent with kanyini, community governance and leadership, community representation among staff, and commitment to community development were important organisational features to retain and nurture both staff and patients. This was undermined, however, by constant fear of government funding for AMSs being withheld. Staff resourcing, information systems and high-level leadership were perceived to be key drivers of health care quality. On-site specialist services, managed by AMS staff, were considered an enabling strategy to increase specialist access. Candidacy theory suggests the above factors influence whether a service is ‘tractable’ and ‘navigable’ to its users. Staff also described entrenched patient discrimination in hospitals and the need to expend considerable effort to reinstate care. This suggests that Aboriginal and Torres Strait Islander people are still constructed as ‘non-ideal users’ and are denied from being ‘held’ by hospital staff. CONCLUSIONS: Some new policy initiatives (workforce capacity strengthening, improving chronic care delivery systems and increasing specialist access) have potential to address barriers highlighted in this study. Few of these initiatives, however, capitalise on the unique mechanisms by which AMSs ‘hold’ their users and enhance their candidacy to health care. Kanyini and candidacy are promising and complementary theories for conceptualising health care access and provide a potential framework for improving systems of care. BioMed Central 2012-10-28 /pmc/articles/PMC3529689/ /pubmed/23102409 http://dx.doi.org/10.1186/1472-6963-12-369 Text en Copyright ©2012 Peiris et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Research Article Peiris, David Brown, Alex Howard, Michael Rickards, Bernadette A Tonkin, Andrew Ring, Ian Hayman, Noel Cass, Alan Building better systems of care for Aboriginal and Torres Strait Islander people: findings from the Kanyini health systems assessment |
title | Building better systems of care for Aboriginal and Torres Strait Islander people: findings from the Kanyini health systems assessment |
title_full | Building better systems of care for Aboriginal and Torres Strait Islander people: findings from the Kanyini health systems assessment |
title_fullStr | Building better systems of care for Aboriginal and Torres Strait Islander people: findings from the Kanyini health systems assessment |
title_full_unstemmed | Building better systems of care for Aboriginal and Torres Strait Islander people: findings from the Kanyini health systems assessment |
title_short | Building better systems of care for Aboriginal and Torres Strait Islander people: findings from the Kanyini health systems assessment |
title_sort | building better systems of care for aboriginal and torres strait islander people: findings from the kanyini health systems assessment |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3529689/ https://www.ncbi.nlm.nih.gov/pubmed/23102409 http://dx.doi.org/10.1186/1472-6963-12-369 |
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