Table 4.

Suggested priority areas and strategies for improvement

1. Cultural safety– shared ownership and planning for culturally safe services (8 services) “we use culture, and balance with Balanda ways to health” •Strengthen cultural safety of the organisation – training for new staff (by local Elders) and learn language •More local Aboriginal and Torres Strait Islander staff in all kinds of roles within the service •Better understanding of local Aboriginal or Torres Strait Islander culture and building relationships •Listen to communities to gather ideas for change •Share ownership of CQI process with community (community driven health care) •Use more visual means to communicate with community e.g. photos to strengthen two-way communication

2. Community engagement (8 services) – take clinical activities out to community “sitting down with the community” •Increase outreach services and staff outreach roles – getting health out of the clinic into community • “Healthy clinic”/health camps in community for two-way learning •Strengthen linkages with other clinical/linked services in communities •Get involved in community events and through existing groups such as women’s groups •Engage those who don’t attend clinics, through home visits

3. Shared ownership and team approach around quality improvement (8 services) ”Probably just give us more - a bit more autonomy again. I remember the early years, we had that autonomy and you could do things that you saw in your particular community that might be of benefit rather than a general this is going to happen everywhere sort of thing.” •All staff involved and supported to have a say with local autonomy •Quality improvement is normal and systematised •Regular communication and meetings to workshop issues around workload and QI •Education and training around CQI to increase understanding of all staff •Mentor staff new to CQI processes •Leadership to support teamwork and engagement around shared vision

4. Strengthen systems and ways of doing things in the health service (8 services) Consistent “ways of doing things ….” “It requires a person to be able to take charge of it and action the recalls and [manage the] system. It’s so much more than just the software.. It’s about having … .staff to own it and run it.” •Build consistency and systems in face of changing staff •Improving patient flow and transport •Take control of referrals and external clinics e.g. visiting specialists •Strengthen use of IT systems •Joined up planning of services to meet needs

5. Strengthening local workforce (and resources) (5 services but strong intersection with cultural security and community engagement) “So from an organisation, we need to look at that, how we can change that ethos and have more health workers”. “Aboriginal Health Workers would “hold your hand and guide you through. They can be the element of change.” •More Aboriginal and Torres Strait Islander staff at all levels of service •Increase training and support for IHWs (esp. male) •Sustainable and flexible workforce models •Succession planning for workforce •More vehicles and office space, with health centres designed to be welcoming, new clinic