support systems for indigenous primary health care services alister thorpe, kate silburn #, ian...

Support Systems for Indigenous Primary Health Care Services

Alister Thorpe, Kate Silburn#, Ian Anderson

23 March 2010

#La Trobe University

The ‘Support Systems’ Project

• Corporate support for community controlled Aboriginal health organisations identified as a research priority area by the CRCAH.

• Cooperative Research Centre for Aboriginal Health, Primary Healthcare, Heath Systems & Workforce Program

• Two related projects:– Quality standards in Aboriginal & Torres Strait Islander health

project – The ‘Overburden Project’ - funding and regulation of PHC services

for Aboriginal & Torres Strait Islander people

The ‘Support Systems’ Project

• To identify corporate support needs

• To find out how organisations got support for corporate functions

• Document case studies of organised support structures

• Develop some resources for organisations

• Recommendations about what needs to happen now.

Context• Corporations world-wide looking for ways to ‘unlock

value’ – maximise use of resources through collaboration

• Many ACCHOs have significant challenges– The broader environment

• Complex funding & policy arrangements• Constant change and ‘reform’

– Organisational factors• Location and size• Often in transition • Difficult to obtain funding for corporate functions

– Workforce availability & retention– Community capacity & expectations

Corporate functions• Where might support be required?

– Many areas –eg: governance, human resource management, finances, legal, IT

• Within each area, what can be obtained externally & what needs to be done internally?– Human resources

• IR advice, specialist HR advice (eg PDs)• VS Employment decisions

• Four main types of support– ‘Foundational aspects’ – required on regular basis for basic ongoing

functioning of an organisation – eg aspects of finance, HR– Expert skills required infrequently but in an ongoing way (eg IR)– One-off changes affecting a whole sector (eg changes to legislation)– One off organisational/systems changes (eg IT systems)

Existing ways of getting corporate support

Affiliate / Peak Body support

AffiliateMember ACCHO

Member ACCHO

Member ACCHO

Member ACCHO

Member ACCHO

Existing ways of getting corporate support

Affiliate Brokerage

AffiliatePrivate Service Provider

Brokerage

Brokerage

MemberACCHO

MemberACCHO

MemberACCHO

Existing ways of getting corporate support

Centrally provided support

ACCHO

ACCHO

ACCHO ACCHO

ACCHO

Corporate Support

Existing ways of getting corporate support

Peer Support Network

ACCHO

ACCHO

ACCHO

ACCHO

ACCHO

ACCHO

Existing ways of getting corporate support

Direct Support

Including:

Government

Affiliates

Funding bodies

Private provider

Larger ACCHO

Mainstream org

ACCHO

Existing ways of getting corporate support

Joint outsourcing to the private sector

$$Private Service Provider

Organisation A

Organisation C

Organisation B

Ways of getting corporate support

Government funded facilitator / consultant

Facilitator / Consultant

Government Agency $$

ACCHO

ACCHO

ACCHO

Corporate support structures – advantages

• Economies of scale, resource sharing/pooling and maximising value for each dollar spent

• Reduced duplication of effort – sharing and standardising policies & protocols– developing joint responses to issues of common

concern

• Building capacity for increased revenue generation

• Supporting smaller or transitioning organisations & those with difficulties

Corporate support structures – advantages

• Developing capacity in a network to facilitate change & improve effectiveness

• Facilitating development of ‘good’ or possibly common business practices across services

• Facilitating access to high quality, timely, specialist advice

• Coordinating aspects of employment/ workforce organisation

• Enabling services to focus on their ‘core business’ (service provision)

Corporate support structures – challenges & potential risks/issues

• Agreeing on what the model will look like, the corporate functions that will be included & making choices about resource use

• Significant time, resources & skill required to set up & maintain support structures

• Concern about diminished community and/or organisational ownership (and less localised services)

• Divisions between different organisations with different agendas

• Ensuring mutual/equitable benefit to all participants

• Might be seen as opportunity to reduce funding

• Ensuring local capacity is built

• Members opting out

Themes from case studies

• Support for idea of services having access to good quality corporate support

• There is no one support structure that ‘fits all’ –the process for developing structures, for decision making within the structure & for ensuring support can be tailored to the needs of services are more important

• Balance between ‘bottom up’ and ‘top down’ – or what can be shared & what must be locally determined

Some features of successful models

• Developed to respond to need• Principles

– Supporting self determination & community control– Strengthening capacity of organisations

• Leadership (vision, change) – political, organisational, operational• Governance structures & negotiated agreements• Good communication processes• Careful planning – for establishing & reviewing the support structure

to take account of changing services, changing practices• Capacity building approach• Highly skilled and responsive staff • Integration - corporate functions and service delivery functions

Some issues

• Potential for support provider role to undermine original role of organisation (peak body, health service)

• Potential for purpose to change without revision of structure – this could create conflict

• Relationship based – how to build stable structures that take this into account?

Next steps

• Case studies completed

• National workshop 21 & 21 June in Melbourne– Gaps in knowledge– Develop tools– Develop a corporate support map – what might need to

occur at different levels– Recommendations/ suggestions about how to get there

• Newsletter – link will go out in CRCAH e bulletin