The Indigenous Allied Health Australia 2017 conference was focused on the integration of care, culture, connection and collaboration in the delivery of allied health care to Aboriginal and Torres Strait Islander patients across the Australian healthcare system. We spoke to workplace training facilitator Duane Vickery who presented at the conference on using these elements to get the best out of our workforce in order to provide better patient care.

Reasons for developing our leadership skills in a cultural context are one and the same according to Duane, who presents the concept of leadership not as an instructive role but instead as an adaptive role, responsive to the needs and backgrounds of those you are supporting.

This relies on embracing the adaptive leadership theory, which is a practical method of learning. It uses the individual’s technical (knowledge and skills) and adaptive (relationships, attitudes, behaviours) resources to build a foundation of learning, experimenting and then designing interventions to the challenges encountered.
 
Duane explains the four-step process that adaptive learners must progress through in order to understand what it is to lead cultural responsiveness in a clinical setting.

1. Cultural Awareness – being able and willing to recognise cultural differences; being aware of one’s own culture; and accepting the cultural differences within a population.
2. Cultural Sensitivity – going beyond acknowledging cultural difference to respecting the other parties’ background, knowledge and customs, which may be uniquely different within their culture.
3. Cultural Competence – having the attitude and knowledge how to empower one’s clients in regard to their own culture; and adapting one’s delivery of services to meet the differing needs of the population (by way of social, cultural and linguistic customs or norms).
4. Cultural Safety – having a health delivery system that understands the power differential between cultures; has the barriers removed from policy, procedure and practices; and services are client-centred so that behaviours of service providers are in response to the actions of the patient. We want to treat our patients with respect so they not just feel safe for that visit, but for return visits, and when talking to family and friends about the health service.

Things as simple as gaining trust through learning how the locals say ‘hello’, or the respectful way of introducing yourself can be a big step forward in gaining your patient’s trust, and it can mean that patient who was forced to see you by their GP will actually come back and you will end up building a relationship with them. And quite possibly their family too.

Inspiring a shift to cultural adaptiveness in a practice, be it a small privately-owned clinic or a large-scale publicly-funded institution takes action from the inside and not just talk. He has seen some response to his training with Private Health Networks moving away from Key Performance Indicators as a measurement and more towards Quality of Life indexes. That’s why Duane believes it needs to be the leaders implementing this change, of which mentoring is an important part.

Mentoring can be a formal or informal relationship for a short or long-term period which is oriented to achieve clearly defined goals, either for a broader vision or life purpose. Both parties benefit from the relationship – as it should be focused on supporting the person, their career and support for their individual growth. This is where cultural sensitivity and growth through self-reflection can be beneficial for even the more traditionally ‘experienced’ mentor, who can learn from the mentee – each have the responsibility to bring their knowledge and experiences to the relationship.

“It’s easy to be seduced into a place where you as the mentor are giving them [the mentee] all the answers, but you have to ask yourself – ‘am I building capacity or dependency?’. I don’t want to give them all the answers, I want to teach them to think for themselves, to navigate with curiosity,” Duane says.

This is where having an understanding of the adaptive leadership theory is important for mentors to be able to provide guidance and non-judgemental support to their mentee, and to help them clarify their own goals and be true to their own experiences and background.

Everyone has a different experience and different background – black, white, woman, disabled, queer, old, young, immigrant – and we can all benefit from this kind of thinking.

It’s really quite simple, Duane says. We have a diverse base of patients already, we just need to trust our guts as clinicians in building our awareness of sensitivity for the individual.

“It’s not all about the clinician’s own outcome. What do I as the practitioner need to do to adjust to make the relationship more effective? I need to do the work! To look at the patient’s background, our difference, and my own cultural bias.”

“By being adaptive we improve the diversity of our industry, and with this comes emotional intelligence as we care for people.”

The Indigenous Allied Health Association has a Mentoring Program workbook and webinar that is accessible on their website.

Duane is Managing Director of Education Training & Management Perspectives Pty Ltd (ETMP), a consultancy company specialising in leadership development and governance facilitation, education, training and research. He is an adjunct lecturer in Multicultural Studies at Avondale College, NSW and is a former Director of Worawa Aboriginal College in Victoria.