The document summarizes a project between PwC's Indigenous Consulting, Griffith University First Peoples Health Unit, and AHPRA to design and deliver Aboriginal and Torres Strait Islander cultural safety training. The partnership aims to establish a consistent national approach to cultural safety learning using the NACCHO Cultural Safety Standards. Key aspects of the project include developing a cultural safety learning framework, training program, and evaluation framework to measure the impact on over 1,000 health practitioners. The partnership brings expertise in Indigenous health, cultural safety, and a national reach to help improve health outcomes for Aboriginal and Torres Strait Islander people.

3. Declaration
 Any opinions expressed in this presentation are my own
and may not be representative of those of Logan Hospital,
the Pharmaceutical Society of Australia or the National
Aboriginal Community Controlled Health Organisation
(NACCHO)
 Permission has been granted by the members of the
PSA/NACCHO Pharmacist Leadership Group to share
achievements and success to date – these are collective
efforts

4. PSA/ NACCHO Pharmacist
Leadership group
 Convened in 2017
 Collaboration between NACCHO and PSA and membership
of the group needs to be approved by both organisations
 Covers all states and territories of Australia
 Time is volunteered
 Members may be working within Aboriginal medical
services or have specialist knowledge in the provision of
pharmacuetical care and services to Aboriginal and Torres
Strait Islander people.

5. Problem:
Restricted access to medications
needed for optimal care
 Medications not listed on the Medications for Aboriginal and
Torres Strait Islanders on the PBS special list
 Eg. a multivitamin supplement with
the recommended amounts of both iodine and
folic acid to support a healthy pregnancy
 Traditionally, lack of a platform for individual pharmacists/
services to raise these issues to a suitable forum in a co-ordinated
way that will result in any meaningful action
 Formulation of a “wish list” with suggested indications and
evidence and convened a special meeting in Canberra to further
discuss prioritisation of applications through PBAC submissions

6. Other Achievements
 Cultural mentoring
 Knowledge sharing and problem solving
 Encouragement of working in collaboration within health service
environments
 Eg liaison with local hospitals
 Sharing of local hospital lists to align with imprest lists of AMS
 Advise on optimal individual patient medicines list
 Review and support of two pharmacy trials funded through the
6th Community Pharmacy Agreement: IPAC & IMeRSe Study

7. Case Study: Logan Hospital & the
Institute for Urban Indigenous Health

8. Building relationships
 Education opportunities
 Both IUIH and Logan Hospital Pharmacy staff
 Invited to general pharmacy meetings
 In house CPD opportunities of Indigenous health service
provision
 IUIH work experience
 Problem solving
 Avoiding shame and providing culturally appropriate healthcare
eg provision of meds when unable to afford
 Out of hours “CTG” medication supply arrangements
 Patient handover

9. Sharing resources
 For information about the local healthcare environment
 Brochures about clinic locations and phone numbers
 CTG medication brochure
 Very handy for patient’s newly diagnosed with medical
conditions requiring medication for the first time

10. Sharing information
 Local immunisation programs
 Shared with maternity and special care pharmacists and team
leaders RE: whooping cough vaccinations for pregnant mother
and partner
 Influenza (prev gap in National Immunisation Program 5-
15years)

11. Keys to Success
 Buy in from management
 Positive culture and acknowledgement of the importance of
delivering culturally safe care
 Acknowledgement of barriers that policy places and the real effect
this has on service provision and relationships with individuals &
the wider community
 - both immediate and chronic
 Cultural champions
 Utilisation of current Australian Health Care and Quality
Standards for hospitals aka “accreditation” as a driving factor of
why a culturally safe and appropriate service is a must

13. NACCHO/RACGP Partnership Project:
NACCHO Conference 5 November 2019
We are proud to acknowledge the traditional owners of lands and
waters across Australia and pay our respect to Elders past and present

14. “…increase awareness and use of the
National Guide, and to support patient
centred, high quality primary healthcare
for Aboriginal and Torres Strait Islander
people.”

15. Where we came from…
In 2000 National
Guide conceived by
A/Prof Sophia Couzos
and the late Dr Puggy
Hunter (on behalf of
NACCHO).

16. Phase Two;
• Access to high quality preventive healthcare
• 715 health check as a positive experience realising
positive health outcomes
• Clinicians having resources and information available to
support provision of culturally responsive, high quality
healthcare for Aboriginal and Torres Strait Islander
people (mainstream practices).

17. What we were asked to do
• Establish and roll out APCCs in ACCHSs and mainstream
general practices

18. What we did
• 1 face to face
• Webinars
• Establishment of # involved
• Measures requested
• Measures developed

19. What is next – the recommendations
Informed software vendors workshop
Informed 715 templates
Informed resource development

20. What we were asked to do
•Develop/review the three MBS Item 715 health
check templates

21. What we did
1. Infants and preschool 0-5 years
2. Primary school age 5-12 years
3. Adolescents and young people 12-24 years
4. Adults 25-49 years
5. Older people 50+ years

22. What is next - the recommendations
Making the templates available
Communicating when and where the templates can
be located
Support the MBS taskforce review to reflect the
provision of item 715 across 5 specific age groups

23. What we were asked to do
•Scope existing clinical software to understand the
capacity to undertake a good health check

24. Department of Health
DoH materials are
available for download at
www.health.gov.au/715-
health-check
For hard copies of
brochures and posters,
contact:
info@33creative.com.au

25. What we did
1. Two roundtables with vendors
2. Vendors report capacity to create fields to capture
data

26. What is next - the recommendations
• Co-design the workflow, user interface and technical
specifications for the MBS Item 715 health check:
• Define set of data requirements for an MBS Item 715 health
check
• Structured atomic data (enter once, use many times)
• Develop an agreed information model
• Define user interfaces
• Evaluate efficacy with clinicians and consumers.

27. What we were asked to do
• Develop resources for mainstream health services

28. What we did
•Webpage; housing templates, project documents &
resources:
• MBS Item 715 health check templates
• Good Practice Tables
• National Guide in HTML
• National Guide Check
• Updated RACGP Identification Audit

29. What is next - the recommendations
Review and test

30. Success measures
•Stakeholders
•Relationships
•Appetite for change
•Systematic process

31. Key messages
Patient-centred healthcare
•what is acceptable and valuable to
patients
•supports cultural safety in the
experience of accessing and receiving
healthcare

32. Key messages
Screening as a component of primary
healthcare:
• consistent messages
• health assessments as a part of
preventive healthcare

33. Key messages
Quality of the MBS Item 715 health
check:
• What is included (elements)
• The experience

34. Key messages
Workforce:
• the importance and value of MBS Item 715
health checks being offered by
multidisciplinary teams

35. Key messages
Ways of working: the value of respectful,
inclusive, collaborative co-design with
broad representation as the most effective
way of working

36. Any questions or comments?

37. Contact Details
The RACGP Aboriginal and Torres Strait
Islander Health Faculty
Phone: 03 8699 0576
Email: aboriginalhealth@racgp.org.au
https://www.racgp.org.au/cultural-safety

39. • November 2019
NACCHO Members’ Conference 2019
AHPRA Cultural Safety Project

40. • “Aboriginal Peoples are the owners of cultural knowledge and
custom. Only they are endorsed at local, state and national
levels through the process of validated community control and
community representative arrangements based on self-
determination to develop cultural safety standards.
• As the peak bodies in Aboriginal health, NACCHO and its
Affiliates are entrusted to represent the needs and interests of
Aboriginal health, and therefore have a responsibility to
ensure cultural integrity is upheld. This authority extends to
the development of national Cultural Safety Training
Standards.” (NACCHO Cultural Safety Training Standards, 2011)
ACKNOWLEDGEMENTS

41. • Today we wanted to talk through our approach to our this project and the partnership we have
developed to deliver for AHPRA.
Overview
AHPRA supports the 16 National Boards that are responsible for regulating the health professions. This means that 16 health
professions are regulated by nationally consistent legislation under the National Registration and Accreditation Scheme.
In June 2018, AHPRA released the Statement of Intent. A strategic priority of the Statement of Intent is to embed cultural
safety into the health system through consistent regulation with over 740 000 registered health practitioners across Australia.
In February 2017 AHPRA established the Aboriginal and Torres Strait Islander Strategy Group towards the development of an
Aboriginal and Torres Strait Islander Health Strategy for the National Registration and Accreditation Scheme.
In July 2019, AHPRA and the Aboriginal and Torres Strait Islander Health Strategy Group announced
PricewaterhouseCoopers Indigenous Consulting Pty Limited (PwC's Indigenous Consulting) in partnership with Griffith
University First Peoples Health Unit will design, deliver and evaluate Aboriginal and Torres Strait Islander Health and Cultural
Safety training to AHPRA, the National Boards and committees, with the ability to extend training to accreditation authorities.

42. • PIC and Griffith FPHU will design, develop and deliver a tailored Aboriginal and
Torres Strait Islander cultural safety learning and development framework (The
Framework). It is intended that this framework will be rolled out to a range of
AHPRA staff, their members and affiliates.
• A critical success factor for this roll out and being able to measure success and impact
is to have consistency in approach and understanding to cultural safety from an
Aboriginal Health context.
• The key deliverables of the project include:
• evaluation framework
• cultural safety learning and development framework (The Framework)
• cultural safety training package
• evaluation report
Overview - AHPRA Cultural Safety Training

43. •
•PIC and Griffith University understand the sector and environment of health professionals. We understand the
overarching context in which AHPRA’s Aboriginal and Torres Strait Islander cultural safety learning and development
framework. This framework is essential and can:
• Increasing health professionals cultural capability is to drive improved health outcomes and experiences for
Aboriginal and Torres Strait Islander people.
• Provide a consistent national approach to learning and development , allowing members to have a consistent
base level of knowledge
• Manage quality and risk of the implementation of the learning and development framework
• Develop an evidence base and insights for future planning for AHPRA but more broadly the needs within the
health sector
Good health care outcomes for Aboriginal and Torres Strait Islander peoples require health
professionals to be both clinically and culturally capable. (Aboriginal and Torres Strait Islander Health Curriculum Framework)

44. • This diagram outlines our five key elements of the project. Noting that the delivery aspect is delivered in two
parts the initial being a trial and the second part with learnings from the trial.
Overview – the Approach

45. Implementation of the training program
There will be 1,392 participants over 75 sessions across all capital cities.

46. The partnership - PwC’s Indigenous Consulting

48. •
•PwC’s Indigenous Consulting (PIC) and Griffith University’s First Peoples Health Unit (FPHU) partnership, are uniquely placed to deliver and
evaluate an evidence-based Aboriginal and Torres Strait Islander Health and Cultural Safety Learning Framework nationally.
The Partnership – the value we bring
Deep expertise in engaging and
working with a diverse range of Aboriginal
and Torres Strait Islander people and
communities
Leaders in designing curriculum
specialising in Aboriginal and Torres
Strait Islander health providing
professionally recognised qualifications
A consistent approach to cultural
safety across all AHPRA jurisdictions
Expertise in system changes for
organisations and individuals to
advancing cultural proficiency
National coverage with PIC having lead
facilitators that are based in each capital
city (with the exception of Tasmania)
Provision of a well-tested secure on-line
platform for learning materials to be
located

49. Cultural safety
Definition

50. Aboriginal and Torres Strait Islander Strategy Group

51. Cultural Safety defined for the National Registration
and Accreditation Scheme
Definition:
Cultural safety is determined by Aboriginal and Torres Strait
Islander individuals, families and communities.
Culturally safe practice is the ongoing critical reflection of health
practitioner knowledge, skills, attitudes, practising behaviours and
power differentials in delivering safe, accessible and responsive
healthcare free of racism.

52. • How to:
• To ensure culturally safe and respectful practice, health practitioners must:
a) Acknowledge colonisation and systemic racism, social,
cultural, behavioural and economic factors which impact individual and
community health;
b) Acknowledge and address individual racism, their own biases,
assumptions, stereotypes and prejudices and provide care that is holistic, free of
bias and racism;
c) Recognise the importance of self-determined decision-making, partnership
and collaboration in healthcare which is driven by the individual, family
and community;
d) Foster a safe working environment through leadership to support the rights
and dignity of Aboriginal and Torres Strait Islander people and colleagues.
Cultural Safety defined for the National Registration
and Accreditation Scheme

53. • Principles:
• The following principles inform the definition of cultural safety:
• Prioritising COAG’s goal to deliver healthcare free of racism supported by
the National Aboriginal and Torres Strait Islander Health Plan 2013-2023
• Improved health service provision supported by the Safety and Quality Health
Service Standards User Guide for Aboriginal and Torres Strait Islander Health
• Provision of a rights-based approach to healthcare supported by the United
Nations Declaration on the Rights of Indigenous Peoples
• Ongoing commitment to learning, education and training
Cultural Safety defined for the National Registration
and Accreditation Scheme

54. Applying the NACCHO Cultural
Safety Standards

55. •To achieve recognition of the NACCHO cultural safety
training standards as a national benchmark for quality
Aboriginal cultural safety training for the health
workforce and other relevant sectors.
NACCHO Cultural Safety Project Goal

56. • 1989, National Aboriginal Health Strategy (NAHS)
• 2009, February - “Services that are not Aboriginal community-controlled, by
definition, cannot deliver culturally appropriate primary health care. However,
services that are not Aboriginal community-controlled can be encouraged to
deliver healthcare that is actually secure. A definition and program prepared by
the ACCHS sector for the delivery of Aboriginal cultural safety training for
mainstream health services should be supported.”. (Towards a Primary Health
Care Strategy)
• 2010, August - NACCHO Board made a recommendation to proceed with the
Cultural Safety Standards Project to formalize this work
• 2011, NACCHO Cultural Safety Standards endorsed by the Board
NACCHO Cultural Safety Standards
Background

57. •Element 1 – Structure
• Standard 1.1: Program description
• Standard 1.2: Program length
• Standard 1.3: Learning objectives
NACCHO Cultural Safety Standards, 2011
Element 2 – Process
Standard 2.1: Welcome to Country or Acknowledgement of Country
Standard 2.2: Participant pre-knowledge and expectations
Standard 2.3: Evaluation and program development

58. •Element 3 – Program Delivery
• Standard 3.1: Learning environment
• Standard 3.2: Delivery strategies
• Standard 3.3: Critical self-reflection
• Standard 3.4: Range of program materials
NACCHO Cultural Safety Standards, 2011
Element 4 – Content
Standard 4.1: Aboriginal health profile
Standard 4.2: Aboriginal Community Controlled Health Services
Standard 4.3: Racism and its impact on health
Standard 4.4: Diversity of Australia’s first peoples
Standard 4.5: Localised content
Standard 4.6: Historical context

59. •Element 5 – Facilitation
• Standard 5.1: Facilitators
• Standard 5.2: Facilitator safety
• Standard 5.3: Experience in service provision to Aboriginal Peoples
• Standard 5.4: Managing a sensitive learning environment
• Standard 5.5: Cultural protocols
NACCHO Cultural Safety Standards, 2011

60. Creation of a micro credential
There are three key elements to the learning program. To be successful in obtaining a micro credential each participant must complete the
following three components

61.  Aligns with Indigenous Research Principles
 Privileging Indigenous voices
 Emancipatory Imperative
 Political integrity
 Indigenous led collaborative design
 Aboriginal and Torres Strait Islander Health and Cultural Safety Education
and Training Impact Assessment Tool (ATSIHCSETIAT).
 The short title for the new enhanced tool is the Ganngaleh nga
Yagaleh Tool which in Yugambeh language means education and
training
 Indigenous learners experience
Evaluation Framework

62. • “Aboriginal Peoples are the owners of cultural knowledge and custom.
Only they are endorsed at local, state and national levels through the
process of validated community control and community representative
arrangements based on self-determination to develop cultural safety
standards.
• As the peak bodies in Aboriginal health, NACCHO and its Affiliates are
entrusted to represent the needs and interests of Aboriginal health, and
therefore have a responsibility to ensure cultural integrity is upheld. This
authority extends to the development of national Cultural Safety
Training Standards.” (NACCHO Cultural Safety Training Standards, 2011)

63. • © 2019 PricewaterhouseCoopers Indigenous Consulting Pty Limited (PIC). All rights reserved.
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Each member firm is a separate legal entity. Please see www.pwc.com/structure for further details.
At PIC, our purpose is to improve the lives of Indigenous peoples and support self-determination through empowering Indigenous led models and solutions. With over 50 staff located in 8 offices across
Australia, we offer a full suite of consulting services, regularly collaborating with PwC and its extensive array of specialist business services. Find out more and tell us what matters to you by visiting us at
www.pwc.com.au/pic.
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