Clinician Connect

Improving Aboriginal health through culture and innovation

By Dr Jean-Frédéric Levesque, Chief Executive, Agency for Clinical Innovation

31 Oct 2022 Reading time approximately

Dr Jean-Frédéric Levesque explores how culture and innovation are key to improving the delivery of culturally safe and responsive healthcare that meets the needs of Aboriginal communities.

The Agency for Clinical Innovation (ACI) recognises the importance of building a culturally responsive workforce that prioritises inclusion and celebrates cultural diversity. Increasingly, we are learning how to innovate through culture (not just learn about it), so that we are responsive to the needs and expectations of First Nations peoples.

Designing culturally-appropriate healthcare and improving health outcomes for Aboriginal people involves connecting with the community.

The ACI has made a commitment to embed, value and recognise Aboriginal culture, knowledge and history as integral to our core business.

Our journey started in 2013 to make a difference in closing the gap and to build meaningful sustainable initiatives in partnership with Aboriginal communities.

Framework for Working Effectively with Aboriginal People was our first step, outlining our commitment, and the principles and the strategies we would use to build our cultural responsiveness.

We developed a Cultural Competency Action Plan, our Aboriginal employment strategy and implemented Muurung Junyirri yarning circles. These helped ACI staff to learn how to incorporate the needs of Aboriginal communities from the inception of programs and projects.

These initiatives (and more) are driven by the ACI’s Aboriginal Cultural Capability Advocates. This group of dedicated staff with diverse backgrounds and experiences are passionate about building cultural capability across our organisation.

Our Aboriginal staff members play an integral role connecting us with the community, sharing personal insights and providing expertise on the history and needs of Aboriginal people. You can read more from these staff members in this issue of Clinician Connect.

We are also guided by our partnerships with key stakeholders, including the Centre for Aboriginal Health, peak Aboriginal organisations, such as the Aboriginal Health and Medical Research Council, Aboriginal people and communities.

Influencing change

ACI staff worked together to finish weaving a canoe, which was gifted to the Aboriginal Chronic Conditions Network.

Developing a culturally responsive workforce is having a positive influence in our work across the health system as we co-design new ways to deliver healthcare. The ACI’s Aboriginal Chronic Conditions Network and many of our clinical networks co-design and implement key initiatives that consider the unique needs of the Aboriginal community. This helps the system deliver culturally-safe, trauma-informed and patient-centred care.

All NSW Health staff undertake mandatory ‘Respecting the difference’ training to increase cultural competency and promote greater understanding of the processes and protocols for delivering health services to Aboriginal people. To build our capability further, the ACI has partnered with the Bangamalanaha Centre, Department of Education, to deliver in-depth training for staff to embed the 8 Aboriginal Ways of Learning (8 Ways) into our programs and projects.

This approach has informed many organisational initiatives, including the development of our strategic plan and projects specifically aimed at improving healthcare for Aboriginal communities.

How we are improving healthcare

My Rehab, My Journey – Gadjigadji (meaning regrowth) is a practical web-based resource that was co-designed with Aboriginal people. It improves the experience for Aboriginal people in the rehabilitation environment during a long stay in hospital following trauma or medical episode.

The resource supports clinicians and health staff to create a culturally safe environment for Aboriginal people in their ward. While this website was originally developed for rehabilitation wards, it is now being used in other areas of healthcare.

Finding Your Way was developed with Aboriginal people to support shared decision making between Aboriginal people and their health professional. The model was originally developed in rapid response to the need for a decision aid regarding COVID-19 vaccination. We are now exploring its use and implementation in other areas of healthcare. Read more about the project in this issue of Clinician Connect.

Other programs are using the 8 Ways approach to improve clinical care for diabetes, musculoskeletal conditions and chronic wounds (to name a few) in a culturally responsive way.

The ACI’s Centre for Healthcare Redesign has celebrated its first virtual cohort of participants undertaking the Graduate Certificate in Clinical Redesign who are specifically focused on improving Aboriginal healthcare through local redesign projects.

Our Co-design toolkit also provides a practical resource for health services to co-design with Aboriginal communities using the 8 Ways approach – innovating ‘through’ culture.

The ACI recently presented our experiences of using the 8 Ways approach to more than 600 health workers. This knowledge sharing across the system helps ensure we stay focused on improving health outcomes for Aboriginal communities.

Responding to feedback from Aboriginal people

The NSW Health Patient Reported Measures Aboriginal Health Working Group was established to ensure our Patient Reported Measures Program helps clinicians and services to seek and respond to feedback from Aboriginal patients and their families, in a culturally appropriate way.

The group includes representatives from across the health system, and from Aboriginal community members and health workers. A key focus involves measuring outcomes and experiences from Aboriginal people who are attending Aboriginal-led health programs to improve overall wellbeing.

The responses to feedback will be a valuable source of information for yarning circles and aligning overall care and wellbeing with the preferences of individuals and their communities.

What the future looks like

While we have come a long way, we must continue to leverage partnerships, work with the community and collectively explore different ways to deliver healthcare with, and for the benefit of, Aboriginal people. This may involve exploring ways to provide care outside of traditional settings, such as through virtual care, so that Aboriginal people can remain at home, on Country, if they prefer.

Our aim is to integrate Aboriginal voices into all levels of health service design and delivery. Cultural appropriateness needs to be central to how we prioritise our work and evaluate healthcare innovations.

Welcome to our new Executive Director

I am pleased to welcome Richard Cheney to the ACI as the new Executive Director of our CATALYST directorate (Care Across the Lifecycle and Society). Richard has held many roles in his 32 years working in health, including clinician, manager and most recently Executive Director of Allied Health and Innovation at Western NSW Local Health District.

Richard has previously been involved as Co-Chair of our Rural Health Network. His extensive experience includes leading virtual models of care in rural, remote and regional health. Read more about Richard in this issue of Clinician Connect.


  • Our Patient Reported Measures (PRMs) team are NSW Premier’s Awards finalists, in the Excellence in Digital Innovation category. At the time of the program’s inception, PRMs were in their infancy around the world. There was no precedent to follow regarding the scale, requirements and value being sought for NSW Health. Since then:
    • The Health Outcomes and Patient Experience (HOPE) IT platform has been launched to capture and use real-time patient feedback and data. HOPE continues to be scaled-up across NSW, in collaboration with eHealth NSW.
    • PRMs are being used by more than 500 clinicians and more than 11,000 patients in NSW.

    NSW Premier’s Award winners will be announced at a ceremony on 29 November.

  • Professor James Middleton has worked with the ACI as Clinical Director of the State Spinal Cord Injury Service since 2006. In addition to his many clinical roles in NSW, Professor Middleton is an active contributor to international meetings, work programs and research. He contributes extensively to the World Health Organization, supporting and developing best practice management for people with spinal cord injury (SCI) across the developing world.

    This year, Professor Middleton’s outstanding contribution to the prevention, treatment and research of SCI has been recognised with the International Spinal Cord Society Medal. I am pleased to celebrate this recognition of Professor Middleton and his willingness to persistently champion best practice care for people with SCI in NSW.

Read more articles from Clinician Connect.

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