The Aboriginal Voice Integration and Diffusion in Public Health Collaboratives (AVID-PHC) study is concerned with Aboriginal voices in the governance processes

Aboriginal Voice Integration and
Diffusion in Public Health Collaboratives

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The Aboriginal Voice Integration and Diffusion in Public Health Collaboratives (AVID-PHC) study is concerned with Aboriginal voices in the governance processes of public health collaboratives in the Hunter New England Local Health District.

The research is a study of the 'integration principle' as stated in the National Indigenous Reform Agreement where within the Six Service Delivery Principles for Services for Indigenous Australians, the Integration Principle is stated as 'There should be collaboration between and within Governments at all levels and their agencies to effectively coordinate programs and services.'

As a research question it is restated as how does the integration of Aboriginal voices in governance processes of public health collaboratives influence equity of access in service delivery? In other words how is your 'voice' taken-up and spread throughout knowledge gathering processes? It answers the questions where is my voice, what happens to what I say, and how does my message make it to decision makers?

The Australian Research Council awarded $736,000 to Dr Mark J Lock and Associate Professor Peter O'Mara to investigate the research question over the next three years (2014-2017).​ Which is just as well because it involves the 53 communities encompassed within the administrative boundaries of NSW Health's Hunter New England Local Health District. This geographical spans from Morisset to Bogabilla (North to South) and from Piliga to Harrington (East to West). Dr Lock has developed a methodology based on the perspective that the key integrative structures are committees - that is different stakeholders get together to discuss the health of the population of which Aboriginal people are at a substantial disadvantage compared to non-Aboriginal people. So there are lots of committees in each of these 53 communities. The research methodology conducts a 'committee' census to find all of the committees which potentially affect the health of Aboriginal people. And because health is not only the physical wellbeing of the individual, but the social, cultural and emotional wellbeing of the whole community...that means there are tons of committees in different social policy sectors!

The question is then how are all of these committees inter-connected? (Because integration implies connectivity). Committee members often sit on more than one committee and in social network terms they are 'interlocks' or 'knowledge brokers' or 'gatekeepers' or 'strategic bridges'. This is important because a committee member with multiple memberships has the potential for more influence (as well as overload) in terms of their 'voice' diffusion. That is it is about who you know AND who else you know. Therefore, in terms of method, as the committees are indentified so are the committee members (plus their profile information) and their organisations. For example look at the NSW Agency for Clinical Innovation or the Aboriginal Health and Medical Research Council. As the committee information is collected it becomes apparent that all of the committees are inter-connected (through interlocks) to one another - and helps (but does not totally answer) the question of 'integration' - because all Aboriginal 'voices' (embodied as committee members) can then be visually identified in this committee interlock network. Much like looking at a road map to see where to stop for food and fuel, an interlock network can show where one might stop to fuel-up on Aboriginal 'voices'.

The AVID study will develop an enormous committee interlock network map which can be viewed at the AVID study webpage (under construction). However, that is merely the starting point of the study. It may be all well and good to show points on a map, but how quickly can a message get from one point to the next (one committee to the next)?. For example, when the National Aboriginal and Torres Strait Islander Nutrition Strategy and Action Plan (NATSINSAP) was formulated by a working party (which is also a committee), this working party was effectively a sub-sub-sub-sub committee of the ultimate decision makers - the Australian Health Ministers' Advisory Council (AHMAC). Dr Lock's concern is to study the processes of each of the committees in order to assess their efficacy for Aboriginal voice diffusion.

Each and every formally constituted committee has governance documents such as terms of references, allocated membership categories, frequency of meetings, funding, activities, and over-arching policy documents. For example, the NSW Parliament meets these criteria as does the Gayinyaga Aboriginal Community Consultative Committee in Armidale. The AVID methodology involves collecting this information for each and every committee identified in the committee census. The analysis of the committee processes focusses on how their governance processes produce and reproduce enablers of Aboriginal voice diffusion.

However, whilst committee interlock networks (integration part 1) and committee processes (diffusion part 1) are important, they do not reveal how the routine, ordinary or mundane workings of committees are significant for Aboriginal voice diffusion. That is, routine committee processes are the tabling of minutes, distribution of agendas, discussion of items, movements of actions, and voting for activities. All quite 'ordinary' and 'routine' but they are significant because, for example, when the Australian people voted for the Abbott Liberal Government the result was to change the administrative and funding landscape in Aboriginal affairs. Dr Lock argues that these processes are significant for each and every committee. Further, that because each and every committee is inter-connected, then the 'routine' processes cohere into an institutional process. It is quite difficult to study institutional processes using network maps and policy documents as theses sources do not reveal how committees work everyday. The AVID study will interview about 300 committee members to find out about the machinations of committee processes and the implications for Aboriginal voice diffusion.

Interviews will reveal the nuances of committee process, the detail necessary to understand the committee interlocks and the committee governance processes. But it is quite important to interview a range of committee members because they occupty different governance processes. In the NSW health system it is quite common to see large organisations with a Board of Directors (the strategic direction of the organisation), a clinicians committee (health professionals) and a community advisory group (for external stakeholders to advise the Board). For example take a look at the Agency for Clinical Innovation​, which states that the Consumer Council 'advises the board on consumer enagement and provides a focus for consumer involvement across all ACI networks'. The links are evident where information from the Consumer Council affects the Board's decisions and the clinician networks. The AVID study will inteview committee members who sit within each of these governance structures (Board, clinician and community).

This is leading to a building of a comprehensive understanding of integration and diffusion in public health collaboratives. Oh wait, what is a collaborative? Basically a bunch of organisations in a formal working relationship to address an area of need. The need in Aboriginal health is called Close the Gap and to this end their are collaborations at varios levels from the Commonwealth and State governments in the Overarching Bilateral Indigenous Plans, to the NSW State Goverment's OCHRE Aboriginal Affairs plan​, to the Narrabri Shire's Community Strategic Plan. Collaborations exist in many forms and thus it is necessary to gain an understanding of what participants think of the meaning and nature of collaboration. The AVID study will deploy an online survey of collaboration, the answers to a range of questions are aggregated and modeled (confirmatory factor analysis) to determine not only the dimensions of collaboration, but strenghts of each dimension. This will help to answer the question what is meant by the statement 'good collaboration'?

Collaboration is a way to conceptualise people and their organisations working together (as stated in the integration principle) and integration is a way to conceptualise how governance processes work together. But why? It's about improving service delivery to Aboriginal people in order to raise health outcomes. When we walk into a 'service' (hospital, general practice, dentist, etc.) our information is collected and reported to the government in order to assess patterns of service use. The National Health Performance Authority​ reports service use statistics by Aboriginality for each medicare locals area. The AVID study will compare and contrast these indicators with the information collected in order to see if there is a relationship between Aboriginal voice integration and diffusion in public health collaboratives and service delivery indictors. Finally, at the end of the AVID study the analysis is driving towards providing a performance indicator framework for AVID.