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  1. 1

    Mark Lock

    Just a follow-up comment. The AGPAL and QIP responses are unsupported by any publicly available evidence. As private companies any information they provide to the ACSQHC on the cultural competency of their staff is covered by corporate confidentiality protection. Therefore, it is impossible for Aboriginal citizens to judge the ‘safety’ of accrediting agencies – and it is Aboriginal citizens who should determine if an organisation is ‘culturally safe’ (a key principle of cultural safety). Therefore, how are Aboriginal citizens to trust if healthcare organisations are safe if the accreditors’ competency is non-disclosed? Furthermore, the ACSQHC awards accreditation to accreditation agencies and the information they provide to the ACSQHC is also corporate-in-confidence. A conflict of interest then becomes apparent. Accreditors assess healthcare organisations who receive accreditation from ACSQHC who also accredit the accreditors. All information provided is corporate-in-confidence, that provided from accreditors to ACSQHC, from healthcare organisations to accreditors, and from healthcare organisations to ACSQHC. Within this triangle of relationships (healthcare organisations, accreditors, and ACSQHC), the c-suite decision makers are non-Aboriginal, and they have agreed that Aboriginal citizens are locked-out of reviewing information and their decisions which goes against the governance principles of transparency and accountability to stakeholders and thus contradicts the second standard (partnering with consumers) of the NSQHS Standards 2nd Ed. This reveals the greatest contradiction of requiring healthcare organisations to partner with consumers but the accreditors and the ACSQHC are not subject to the standards they wish others to abide by. These challenges are faced by the AHPRA in the pursuit of culturally safe health professional accreditation – the challenge is to focus inward to the corporate governance of the organisation because cultural safety should be more than clinician and patient interactions but also extend to how the interactions between people in governance and administration influence the cultural safety of an organisation.

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  2. 2

    Mark Lock

    Thanks to the Australian Medical Council for providing a response to this Croakey health post. The AMC shows (being transparent and accountable) that it is working hard to improve its governance processes so that cultural voice is included in medical accreditation.

    I’ll make a fuller assessment in due course but just for today I will highlight that this information from their post could be provided on the AMC’s website: a formal report of these activities to Australian Aboriginal citizens who may access the website, and transparency about the membership, terms of reference, activities, and decisions of the committees ( AMC Indigenous Planning Advisory Group, Aboriginal, Torres Strait Islander and Māori Strategy Group, AMC Standing Committees, or AMC Strategic Plan). Therefore, I cannot ‘see’ the ‘how’ the AMC processes flow through the organization and its accreditation processes.

    As an external auditor, I would like evidence and justification for the effectiveness of these processes for improving cultural safety through medical accreditation. One of the main points in the Croakey post is that accrediting organisations (e.g. AMC) are self-regulated and not subject to external and independent oversight – who assess the accreditors?

    This is philosophically important because cultural safety implies a separation of power between Western-derived mainstream colonial structures and Australia’s First Peoples and…here the argument is complicated and I don’t propose answers at this point…this could be put in practice through formal partnerships with, e.g. NACCHO Aboriginal Health Australia (who have an excellent paper on cultural safety training). As it stands, the AMC has ‘internal’ processes and engages professional Aboriginal ‘experts’ (not community representative organisations) such as members of the Australian Indigenous Doctors’ Association and The Leaders in Indigenous Medical Education (LIME) Network. I am not arguing if this is right, wrong, or otherwise. I’m arguing that these arguments need to be discussed through critical, theoretical, and research processes that are transparent and accountable to Aboriginal citizens.
    #AFPcultural_safety #CSPHRA

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