25th August 2020

Calling out culturally dangerous governance

By DrMJLock

Overcoming culturally dangerous corporate governance in four points:

  1. Understand that governance is power. Power is put into practice through governance by invisible people on secret committees making rule and resource allocation decisions. Ask: Are Aboriginal people involved in corporate committees?
  2. Reflect on all aspects of corporate governance where power is enacted. Every organisational policy, strategy, committee, role, and activity are points of power. Ask: Is Aboriginal cultural voice evident at governance “power points”?
  3. Investigate by research, evaluation and consultation how power can be redistributed. Think about how the “power points” are connected as pathways into a fabric of organisational philosophy. Ask: Are Aboriginal perspectives communicated in all those pathways?
  4. Embed culturally safe performance criteria throughout all corporate reporting systems. This drives transparency and accountability throughout all levels of an organisation. Ask: Are cultural safety indicators being met?

Case Study – AHPRA Cultural Safety Training

The Australian Health Practitioner Regulation Agency (AHPRA) has committed to wide ranging reforms to enable cultural safety in its national boards and, through them, in Australian health professions. See the AHPRA website and the article below for detailed information.

Reference: An opinion piece in CROAKEY about cultural safety training for the national boards of the Australian Health Practitioner Regulation Agency.

1. The power wielded by AHPRA is culturally dangerous by design

Why? It is constituted by and operates through the Authority of the National Law as developed and authorised through Australian Governments who operate according to the Australian Constitution 1901 which was designed to excluded First Nations people. The debates about the Australian Constitution 1901 are fierce and ongoing about ‘recognition‘ or ‘treaty‘. As it stands, I am absent from the Constitution, I do not see myself in Australian laws, and this institutional silence means I feel diminished, demeaned and devalued. (Governance is power).

The phrase “legally invisible” means that the Australian Constitution 1901 is a culturally dangerous barrel holding national law apples designed to exclude First Nations peoples’ cultural voice.

Mark Lock

2. Reflect on the “power points” of corporate governance

The AHPRA has a Reconciliation Action Plan 2018/2019 (the ‘Reflect’ stage) and in it are some nifty diagrams showing the ‘structures’ of governance which are within the ‘barrel’ of the Australian Constitution 1901. The AHPRA RAP has many laudable activities: cultural awareness, employment, diversity, NAIDOC events, protocols, and members on the national boards. Great! How’s it going? No public facing report on measurement, monitoring or evaluation (which is standard practice). Key message: reflecting on power means to publicly disclose knowledge to First Nations citizens (see Principle 6 ‘Respect the rights of security holders‘ in ASX Corporate Governance Council 2019 Corporate Governance Principles and Recommendations 4th Edition).

“Power Points” of corporate governance – where are First Nations Peoples?

3. Investigate power redistribution

The AHPRA Reconciliation Action Plan 2018/2019 is ultimately “overseen” by the Agency Management Committee of all-female executives (n=6) of which none (at 3/08/2020) are First Nations peoples and all are ministerial appointed (i.e. are politically acceptable to the political party of the day). There is no mention in the RAP of ‘reflecting’ on the membership of this decision making committee. Further, this committee authorises “secret governance”. What follows below is a summary of the kind of rigorous investigation that is needed by a Ngiyampaa citizen to find out what is happening on this topic.

1) Tenders to develop and deliver cultural safety training to AHPRA national boards were called for in 2018 (https://www.ahpra.gov.au/News/2018-09-03-cultural-safety.aspx)

2) It was 10 months before the successful suppliers were announced (https://www.ahpra.gov.au/News/2019-07-25-Cultural-safety-training-provider-announced.aspx): ‘PricewaterhouseCoopers Indigenous Consulting Pty Limited (PwC’s Indigenous Consulting) in partnership with Griffith University First Peoples Health Unit will deliver cultural safety training for Australia‚Äôs regulators of registered health practitioners.’

3) It is now 12 months later and there is no transparency about the development of the training. I did find a presentation about the project to the NACCHO Member’s conference in 2019 (https://www.slideshare.net/NACCHOpresentations/ahpra-cultural-safety-project?from_action=save).

4) Why is the development of cultural safety training secret? One aspect is that a private consulting firm (Price Waterhouse Coppers Indigenous) wants to protect the $$$ it makes from developing the product. This also applies to the Griffith University which wants to protect is business income and intellectual property. I also see a degree of professional and academic arrogance about the need for public transparency and accountability.

5) Governance for cultural safety: Time to change secrecy norms. I have followed the development of cultural safety for Australian Health Practitioner Regulation Agency – Ahpra, written about the development of definitions and tried to keep up-to-date with current developments. However, it’s time to call it for what it is: culturally dangerous governance.

Culturally dangerous governance is defined as corporate governance that diminishes, demeans and devalues the cultural safety of First Nations peoples through the secrecy of the philosophical and intellectual development of cultural safety activities.

Mark Lock, 2020

7) Protagonists may say that there are First Nations Peoples overseeing the project – those employed by PWC and Griffith University – and that First Nations Peoples are also monitoring the project through AHPRA’s Aboriginal and Torres Strait Islander Health Strategy Group. Great! A step forward and I also applaud the accessibility of information about their activities through the Communiques. Though there hasn’t been a communique in 2020 and none of the 2019 communiques provide detail about the cultural safety training.

8) As an Aboriginal citizen it has been impossible for me to find out the details (yes, details, not just a media release) of just what is happening! Price Waterhouse Coopers Indigenous PwC Australia and Griffith University’s First Peoples’ Health Unit have apparently done lots of work – but what? how? who with? what have they found? what is the model of training? what research informed the model? how were Aboriginal communities engaged (not just health professional associations)? how could I be involved? how have they operationalised cultural safety into a training curriculum? have they undertaken ethics applications?

Cultural safety training about us, without us!

Um, so what? A core aspect of cultural safety is “power” especially reflecting on power differentials (as noted in the AHPRA definition of cultural safety). This is usually spoken about at the interaction between clinicians and patients. My argument is that analysing power differentials also occurs in corporate governance. This is where many meetings take place, committees are formed, and decisions about money and activities are made, and an Australian/Western cultural norm is to keep these secret from citizens. That is, stewards and leaders in healthcare make decisions about us, without us. Unfortunately, the development of APHRA cultural safety training is showing the hallmarks of secret governance.

If cultural safety is determined by First Nations individuals, families and communities (as noted in the AHPRA definition of cultural safety) that means I need access to information to judge the cultural safety of what is being said about me, without me! Right?

4. Absence of cultural safety indicators for governance

The article that stimulated this analysis states that “there is no place for racism in healthcare” and I also add that there is no place for culturally dangerous governance. The perpetuation of racism in healthcare is also rooted in secret governance mechanisms, so these organisations needs to reflect on the power that they hold and think about cultural safety indicators of governance, such as:

  • publish a detailed 12 month report of activities
  • publish their methodology for the project
  • publish the membership and minutes for the steering committee for the project
  • develop and publish a public community engagement plan, and
  • regularly communicate to Aboriginal citizens in the public domain about the cultural safety training program.

Advocacy: Open Letter to AHPRA

Dear AHPRA, I write to you to a highlight some disturbing signs about your governance of cultural safety training. The details of my critique are contained in this publicly available blog and I hope that you can respond in kind through AHPRA’s social media and website. My concern is the secrecy of the governance of cultural safety training and how that secrecy runs counter to transparency and accountability to citizen stakeholders.

As a stakeholder in the Australian healthcare system, I am concerned about how little detail I can find out about the AHPRA cultural safety training project, details of which I’ve listed above, and wondered if you would be so kind as to provide some information? Please don’t hesitate to post your reply on to my Facebook Group ‘Cultural Safety and Security‘ Sincerely, Dr Mark J Lock.