Intellectual Apartheid in Australian Healthcare Governance

My assessment of healthcare governance literature shows that Australia’s First Peoples’ cultural meanings of governance are invisible. For example, in Meredith Edward’s (2002) discussion of Australian public sector governance; in Braithwaite, Healy and Dwan’s (2005) Australian discussion paper about the governance of health safety and quality; in Donald Philippon and Jeffrey Braithwaite’s (2008) comparative review of Australian and Canadian systems of healthcare governance; in Lynne Bennington’s (2010) Australian review of corporate governance and healthcare literature; in Barbazza and Tello’s (2014) international review of health governance; and in Brown, Dickinson, and Kelaher’s (2018) Australian conceptual framework for governing the quality and safety of healthcare.

“Decades of intellectual thought influencing the trajectory of Australian healthcare governance has produced another Great Australian Silence about the voice of First Nations Peoples”

Dr Mark J Lock

In writing about the ‘main governance challenges facing the public sector over the next decade’ from her position in Canberra, Meredith Edwards failed to include any consideration of First Nations peoples. Braithwaite, Healy and Dwan’s (2005) discussion paper was ‘intended to stimulate debate on how to improve the governance of health care safety and quality in Australia’ but failed to draw on Healy’s extensive experience in working with Aboriginal communities. And the comparative review of Canadian and Australian healthcare governance systems – by Philipon and Braithwaite (2008) – First Nations peoples did not make it into the scope ‘to provide insights on future directions and to suggest what the two countries might learn from each other’.

“When the rights of First Nations peoples worldwide are hotly debated in the media, academic research, policy debates and in practice, governance intellectuals were culturally blind to those socio-political currents”

Dr Mark J Lock

Bennington’s (2010) review drawing ‘together the theoretical and empirical literature from both the corporate and healthcare governance literature’ failed to ‘draw-in’ and reference to First Nations peoples. In a targeted review of governance literature from ‘the work of international organizations in health governance’ – by Barbazza and Tello (2014) – not even the world’s First Nations peoples were mentioned. The work of Brown, Dickinson and Kelaher (2018) developed ‘a conceptual framework to guide empirical research examining the work of board and senior management in governing healthcare quality’ did not include First Nations Australians. Margaret Kelaher’s extensive research and publication track record about First Nations Australians was not considered in this conceptual framework.

“Intellectual apartheid excludes the cultural voice of First Nations Australians and renders us invisible and silent in the future governance of healthcare safety and quality”

Dr Mark J Lock

My definition of cultural safety and security is this: when cultural safety is evident at every point and pathway of the Australian healthcare system, then Australia’s First Peoples can trust that it is culturally secure for them, their families, and their communities (Lock, 2018). This means thinking about how culturally dangerous health service environments are enabled through corporate governance.

A recent example is the 2016 death of pregnant Wiradjuri woman Naomi Williams where the resulting coronial inquest found no individual staff member or particular circumstance was to blame (Grahame 2019), but implicated was a long history of distrust with the Tumut hospital and health services in the Murrumbidgee region of New South Wales. That history means the leadership and stewardship of healthcare governance, over many decades, resulted a culturally insecure system of care for Wiradjuri people.

“Intellectuals of healthcare governance fail to connect with the reality of First Peoples experiences of cultural danger, cultural insecurity and institutional racism”

Dr Mark J Lock

As a Ngiyampaa academic deeply affected by the stolen generations and history of growing up Koori in small town Australia, I vowed to ensure that the violation of human rights ‘on my watch such practices will not be allowed again’ (Lock 2012). That includes the ‘practice’ of academic writing and intellectualising. In the six healthcare governance documents published from 2002 to 2018 by professionals with hundreds of years of combined experience and knowledge of healthcare in Australia – there was not a single reference to First Nations Australians, no citation of media reports of racism and discrimination, and no reference to human rights of First Peoples. The Williams family, the wider Wiradjuri community, and First Nations Australians, want accountability for the continuing failures of healthcare services – it is time for governance academics to apologise for their intellectual apartheid in Australian healthcare governance.


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