This paper explores how the Australian health sector might improve opportunities for career development for Aboriginal and Torres Strait Islander workers. It considers the current evidence surrounding career development in the health sector, along with Aboriginal and Torres Strait Islander worker experiences, to develop a usable conceptual framework for change.
The following framework is explicitly designed to provide a practical diagnostic tool for stakeholders (policy makers, health organisations and workers) to consider, analyse and identify challenges to career formation across a wide range of diverse health care service settings.
The conceptual framework presented herein nominates five key drivers or agents of change in the production of career opportunities for Aboriginal and Torres Strait Islander workers in the health sector:
professional association interventions.
The analogy of ‘shifting gears’ is used to identify and explain the key factors (agents) involved in driving career formation, and describe the level of interconnectedness between these drivers. In this context,the analogy is instructive because it demonstrates that gears must work together simultaneously in order to create motion. As one gear turns, the others within the system move as well in response to the pressure being applied.
In the health sector, and particularly the Aboriginal and Torres Strait Islander health sector/s, policy is identified in this analysis as the largest and most influential of all the drivers or gears. Policy frameworks are pivotal to almost every aspect of health care delivery including the funding, direction and focus of delivery efforts, and the structures that govern practice guidelines for key disciplines. Policy frameworks also shape employer decision-making processes surrounding patient and practitioner engagement, the legal parameters for patient care and how funding is disbursed.
The ability of the health system to maintain high-quality standards of patient care emerges directly from the sector’s ability to source, recognise, retain and reward appropriately skilled labour—in this instance, Aboriginal and Torres Strait Islander workers in health. A range of skill development policies and program initiatives have emerged at federal, state and local levels of government, each designed to maintain a supply of appropriately skilled Aboriginal and Torres Strait Islander workers for the health sector. Specifically, a number of sector-wide initiatives have previously been identified by policy makers as essential:
increasing the foundation levels of education for Australia’s First People
lifting the job-specific education and training of Aboriginal and Torres Strait Islander workers within the health sector
enticing new workers into the sector
increasing the resilience of workers through the provision of additional supports (e.g., mentoring).
This paper argues that while these kinds of initiatives are important, it must also be recognised that they all present a somewhat skewed response to career development. While this paper does not discount theimportance of skill development policy, and other supply-side focused efforts, this paper also asserts that skill development is not synonymous with career development. In other words, systemic-level challenges to career development require systemic-level responses. Innovative and effective responses to the challenges faced by Aboriginal and Torres Strait Islander workers in health can, therefore, only emerge from a more detailed examination of the demand-side factors underpinning career formation and development.
A key finding to emerge from this paper highlights that the working conditions and service delivery practices associated with contemporary health settings present diverse challenges for the formation and development of career. The multiple disadvantages faced by many Aboriginal and Torres Strait Islander people in the labour market means that these workers in the health sector are particularly vulnerable to the threats to career development that have emerged in the health sector over the past 20 years.