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									Public Lecture Notes
Associate Professor Gary Robinson
School for Social and Policy Research
Charles Darwin University
Darwin NT 0909
Tel 89466893

Gary Robinson is a Co-Director of the School for Social and Policy Research. He
is a social anthropologist who has been active in research relating to Aboriginal
youth, families and children in the NT for some twenty years. He has evaluated
major health service initiatives and continues with research and publication in the
field of health and community services development. He is now engaged with the
development of early intervention strategies to support families and children in
remote and urban Aboriginal communities.




The Manufacture of Crisis: Aboriginal Societies, Social Policy and Social
Change




The thesis we will explore here is that governments manufacture crisis. They do
so, both as a necessity of political action in the public domain, and as a
consequence or effect of their own interventions.


This is not to say, that in the routinely reported crises of Aboriginal affairs, there
are not real crises, nor real difficulties in need of response. There are. Equally,
the argument does not express the voice of passive entitlement that routinely
blames government for every social woe or unfulfilled want. However, if
communities, individuals, organizations must take responsibility for themselves, it
is also true that crises of intervention derive from the retreat of government from
it own responsibility to engage effectively.




                                                                                         1
Crisis talk and the scandal of failure and neglect, particularly in Aboriginal Affairs
are part of the business of politics. Suicides in an Aboriginal community lead to
the sacking of a regional council and a process to rebuild it under political
supervision. The discovery of petrol sniffing, of community violence, child abuse
or child neglect by a new minister provides the opportunity to dramatically expose
the inadequacies of State and Territory policies and for the rules of the game to
be rewritten. There is a new sheriff in town who demands accountability. Acts are
rewritten, funds flow under new conditions. Outcomes will be policed.


Crisis talk provides leadership with the opportunity to dramatize its claims, to
overturn settled boundaries and responsibilities, kick down doors, overturn poor
governance, move things along. Until things do improve, intervening leaders
have a point that is hard to refute.


Crisis is an engine of change; it is productive and destructive. The manufacture
of crisis is an instrument of Aboriginal policy, which draws on apparent evidence
of dysfunction, failure, the failure of Aboriginal people to improve, the failure of
those tasked with facilitating improvement to get results. Failure is as helpful to
the cause of governance as is success. Like success, its periodicity, indeed, its
predictability meshes with political opportunity.


The inability to analyse the effects of its own actions is a fact of government
policy. In the struggles for legitimacy dominating Aboriginal affairs, government
sees dysfunction and failure as characteristics of the world out there: of
communities and of the agencies funded to make things happen, not as products
of its own action.


Let’s think about representation of a dramatic recent example:
A year or two back, the prime minister visited Wadeye with great fanfare to
proclaim the good news of the COAG Trial, the funding of government, the
actions to improve the lot of people there. Little more than a year later, there are



                                                                                       2
tales of gang warfare, wanton destructiveness and intimidation, Evil Warriors at
war, families taking flight into the bush, houses destroyed and vandalised. The
new Minister visits, demands accountability, makes new promises, but with strict
conditions. Nowhere have I seen an analysis which explores the link between the
two: the comparatively well-funded COAG Trial (with housing improvement a key
aim) and the community violence and destruction. It seems that the well-
intentioned actions of government are exonerated from any part in this apparent
failure of the community to progress. To be sure, tough action is no doubt
warranted in response to this kind of problem, but so is some kind of analysis of
its determinants.


In a television interview, Terry Bullimore, the CEO of Thamarrur Council referred
to the gangs as the agents of organized interests within the community. The fact
is that any intensification of intervention driven by expanded funding
accompanied by political attention by significant government figures – no less
than the PM himself - destabilizes organized community interests to some extent,
creating increased rivalry and sometimes destructive competition. This may be
diffuse, disorganized, the destructiveness and violence sporadic, targeting
persons or contentious property; it may be between so-called gangs or groups of
countrymen; it maybe between brothers in a single family, or between fathers
and sons. Intergenerational tension is heightened by external political interest
and the influx of resources, setting relations of patronage on edge. The
manufacture of crisis at Wadeye has therefore only partly to do with the recent
political response to failure of community development and governance. It
undoubtedly also has to do with how patterns of internal tension are activated by
pressures towards change arising from the outside.


Of this we can be certain: government intervention becomes enmeshed in the
conditions causing difficulty within the communities in complex ways.




                                                                                    3
The manufacture of crisis reflects the structural condition of policy formation in
the Australian state as applied to Aboriginal people. As part of the routine
business of policy-reformation, it sits at the top of deeper determinants of social
change and barriers to change and development at the community level, in
respect of which the conditions of success are not known, and are not primarily in
the hands of government.


The Welfare Economy: From social rights to social outcomes?
Policy in Australian Aboriginal Affairs is – on the surface – now less concerned
with indigenous rights and is increasingly driven by a pragmatic orientation to
social outcomes, driven by the engines of the “new welfare”, that is, service-led
community development based on “mutual obligation” or “shared responsibility”.


Essentially the same things are argued by Aboriginal leaders and by government
policy makers alike, in a kind of points-scoring in matters of accountability. The
effort of leaders to hold governments accountable for their own performance, and
the policy shift away from “rights” to “obligation” and “outcome” lead in the same
direction: extending possibilities for Aboriginal development at the margins of the
state through the mechanism of “partnership” between funder, organization and
“community”. Outcomes are increasingly defined by a growing list of national
benchmarks and indicators, the COAG indicators, literacy benchmarks,
epidemiological comparisons. If the indicators are not shifting then more money
is needed. Money will only be given if there is attention to the outcomes. This is a
circular discourse of outcomes, failure to perform and responsibility.


If the new language of legitimacy in Aboriginal Affairs emphasizes mutual
obligation and the pursuit of ‘outcomes’ rather than realization of social ‘rights’,
the reality is that outcomes are in some respects more elusive than rights, and
are rarely if ever attainable during the time frame of political commitment of
resources. In this paradoxical discourse, Aboriginal societies may be
communities, but they are societies no longer; as communities, they are outputs



                                                                                       4
of the state, at best residual societies increasingly defined, not by distinctive
cultures, social processes and institutions, but by the form of partnership with
government justified largely by the need for intervention to deal with symptoms of
lack, dysfunction and social failure. This produces a kind of vacuum in the
analysis of the social determinants of difficulty and strength, and paradoxically, in
the analysis of the effects of government interventions in the communities
concerned and the determinants of their success or failure.


Two Tiers of the Welfare Economy: Trials and Strategic Programs
Two important strings to the Commonwealth bow in the drive to achieve
improved social outcomes - that is, two major strands of Commonwealth
intervention - have become clearer since the abolition of ATSIC. These include
big trials and initiatives, on the one hand, and Commonwealth strategic programs
which fund the patchwork of interventions e.g. in child and family welfare, mental
health, suicide prevention, and so on.


Big trials include the COAG Trials, the Coordinated Care Trials (CCTs), the
Primary Health Care Access Program (PHCAP), initiatives to produce regional
systems of governance by amalgamation of community councils, rollouts of
former trials, (the NT Health Zones based on the CCTs and PHCAP), all aiming
at improved organizational capacity, leadership and governance as the divers of
key social and organizational outcomes.


Strategic Programs in health and social welfare (including mainstream programs
with some indigenous specific targeting, such as the Stronger Families and
Communities strategy of FACSIA) produce a patchwork of interventions in a
short term, grant-funded welfare economy. In this intervention patchwork,
government is used to endemic failure or at best low-level success. Funders
manage risks through scrutiny of funds-recipients’ governance and delivery
capacities. There is often little ability to pitch the strategy much beyond what is




                                                                                      5
already there in terms of capacity to achieve outcomes through specific
interventions.


The short term grants economy provides grist to the mill of community
organization. Whether grants foster meaningful engagement with processes in
indigenous communities depends to significant degree on the capacity of that
organization. The grant-funded interventions do not disrupt established practice,
but tend to be inserted in spaces alongside mainstream and other services.


By contrast, big trials may aim at more ambitious and complex outcomes, but
typically absorb the greater part of effort in holding the organization afloat. In the
big trials, or in big rollouts following a trial, governments take on the task of
significant organization-building in order to produce a higher level of enduring
capacity: they in turn must manage a higher level of risk of failure to generate
outcomes, albeit often starting with diffuse or poorly enunciated goals. Such trial
partnerships are inevitably based on unsustainable relations between partners,
so that governance arrangements almost inevitably encounter difficult transitions
to ongoing operation after the trial phase. They create the conditions for a
political accountability crisis – a failure of partnership attributed to failure to
deliver outcomes, or, more often, to inadequate governance or lack of fiscal
accountability. This was the case with the failure of the Tiwi Health Board in 2003
and it is to that case that we will turn our attention now.


Tiwi Coordinated Care Trial:
The Aboriginal Coordinated Care Trials were a joint Commonwealth-Territory
government initiative originating from COAG proposals for the reform of health
care in Australia in about 1995 (Office of the Commission for Audit, 1995). Two
trials were established in the NT, one at Katherine, the Katherine West CCT, a
large region between the town of Katherine and the Western Australian border,
and the Tiwi CCT on Bathurst and Melville Islands, just to the North of Darwin in
the Arafura Sea. These trials were based on a complex, multi-directional



                                                                                         6
partnership between the Commonwealth and NT governments and local
community organizations: organizations which had to be built in order to play
their roles (Robinson, d'Abbs et al. 2003). High quality input from some of the
ablest people in NT DHCS contributed to the establishment of the trial.


                              The NT CCTs
                                  after Robinson, d’Abbs et al 2000

          Absence of community                                        Aboriginal community
          participation &                  1. Formation of            participation in planning,
          representation: no               the Tiwi and               allocation, management
          mandate for active               Katherine West             and agency
          community development            Health Boards.             coordination.




          Departmental allocation of                                  Changed allocation;
          priorities without               2. Funds pool              community-based
          population/community             & increased                services, development
          perspective; weak                funds.                     of human resources and
          management & controls.                                      infrastructure.




          Inadequate coordination of                                  Improved quality of
          care; no population              3. Care                    care; access; stronger
          perspective/strategy;            Coordination:              focus on prevention;
          limited preventive care;         (care plans & IT           improved technical and
          poor infrastructure.             infrastructure)            professional capacity.




Figure 1: The NT CCTs


The Aboriginal trials consisted of three main elements:
   Community Control: devolution of responsibility for management of funds and
   services and for development of health services to representative Aboriginal
   Area Health Boards.
   Cash-out: creation of a funds pool based on a cashing-out of MBS and PBS
   averages for the trial population (adding over $1m p.a. to existing funds for
   services to the Tiwi population) all existing Comm. and NT grants, and



                                                                                                   7
   funding equivalent to historical funding of health and related services by the
   THS. Total pooled funds represented some 142% of funds previously
   available for services to the Tiwi population (Robinson & Bailie, 2000: 48).
   Care Coordination: implementation of a system of population health care
   based on computerized care plans for individual case management.
   Population care plans scheduled the delivery of preventive screening and
   other clinical services for all population age groups. Standard health problem
   care plans scheduled services according to diagnosis and included plans for
   chronic illnesses such as diabetes, renal disease and respiratory diseases, as
   well as failure to thrive and chronic ear disease for infants and children.


The Tiwi CCT ran from December 1997 until December 1999, a full 25 months
and was extended for a “transition year” until December 2000. The financial and
legal arrangements of the trial were continued as the major stakeholders sought
to negotiate future permanent funding arrangements. The Tiwi Health Board had
incurred significant over-expenditure by 2000-2001. In 2002, arrangements were
made to restructure operations to reduce expenditure and to repay debt. There
was a failure to agree on funding arrangements which would enable the Board to
operate with post-restructure funding levels and the Board went into voluntary
liquidation in late 2003.


The NT Minister for Health and Community Services attributed the collapse of the
Tiwi Health Board entirely to the Board’s mismanagement. This is of course mere
political defense, but one which a good many in government, including some
associated with the CCT have accepted. Although there was an internal critical
appraisal of the Department’s performance, no objective assessment has seen
the light of day. There is no evidence that the Commonwealth entertained any
soul-searching about its role. It appeared that mechanisms limiting accountability
for achieving an outcome within the Commonwealth bureaucracy were too well
established by the time the final acts played out.




                                                                                    8
Make no mistake, this was a significant failure of government at both NT and
Commonwealth levels. It was a breakdown of the processes underpinning a
“partnership” between governments, a community and its leaders. It is certainly
arguable that the community-based organization – THB’s CEO and senior
management - failed to develop adequate strategies to deal with government,
particularly in post-trial conditions. Further, it clearly did not adequately deal with
the internal pressures driving expenditure and allocation, and allowed itself to
become locked into a strategy which the Commonwealth and NTG would not
allow to succeed.


There may have been mechanisms to achieve a circuit-breaker between the
adversarial interaction between the Board’s management and government in
2003 – for example, shedding the THB’s CEO and acceding to further substantial
cuts. However, there was by then a lack of leadership, a lack of capacity to take
risks on the part of government. The risk-taking and creativity of personnel within
the bureaucracies under conditions of clear political support for the trial at the
beginning found no equivalent during the later stages. In the last instance, apart
from the Tiwi themselves, it was the NT Government that had the biggest stake
in the Tiwi CCT, and it was the NT Government which was unable to act
effectively on its interest. In the absence of political leadership, and the
incapacity to generate a political crisis which could impact the Commonwealth,
the strategy of minimum risk was to let the Board fall on its sword, the
accountants take over and the departmental managers go back to managing
what was left. On the Board’s side, it was assumed that the transition to a new
funding agreement which would allow it to continue to operate was essentially a
political decision.


Anecdotally, the demise of the THB has been interpreted as: 1) a case of
financial mismanagement, thus of incompetence of Board and its administration;
2) a failure by government personnel to “take on” the CEO of the Board and to




                                                                                          9
intervene before it was too late; 3) a failure of the CEO’s strategies and an
expression of his temperament, and variations on these themes.


Although they certainly have some relevance to understanding the political and
managerial processes, the focus on individual actors and their responsibilities,
anecdotal accounts or a blow by blow account of the breakdown do not bring us
closer to any analysis of the structure of the CCT and its interaction with the Tiwi
social domain, nor of the social and political dynamics of “community control”
which was central to the trial. It is as much here as in financial management that
the lessons need to be learned if the government is to go beyond its occasional
declarations of intent to restore Tiwi control of the service.


CCT Outcomes and performance.
Although identifying the over-expenditure and raising other issues relating to
health centre management, the evaluation of the Tiwi CCT (Robinson 2001) had
concluded that the Tiwi Health Board was generally successful in the main
objectives of the trial:
   The funds pool concept had enabled the Health Board to reshape services
   development and had supported the development of an organizational
   structure with the capacity to manage and coordinate services within a
   framework of "community control" exercised through the Board. All three
   health centres were taken over by the Board well before the end of the Trial,
   with NT DHCS becoming responsible mainly for provision of a range of
   specialized clinical and public health services under contract.
   The CCT laid the foundations for an expansion of preventive community
   based services which responded to community priorities and allowed the
   formulation of locally based interventions to support or promote improved
   public health.
   Finally, the evaluation recorded a statistically significant trend towards
   improvement in the pattern of delivery of clinical services as prescribed by the




                                                                                   10
   care plan protocols, including in areas of chronic illness care. General clinical
   standards, resources and infrastructure were improved.


The Tiwi CCT had therefore confirmed that there was the potential to develop a
highly effective Tiwi health service under Tiwi leadership. Particularly in the
growth of community based programs, there was a rapid expansion of Tiwi
employment, and rapid growth in the scale of the organization, which at one point
employed over one hundred persons in full time and another one hundred in part
time work. The rapidity of growth of the organization, and its organizational and
technical complexity - greater by far than any other organization ever located on
the Islands - produced significant strains, not least the financial ones that led to
the collapse.


The drivers of development in the Tiwi CCT can be put under two broad
headings:
   1. Expectations which were part of the trial framework itself
   2. Expectations based on needs and demands generated in the Tiwi domain


Trial Framework
During the formative processes of CCT establishment, the Board had convened
exhaustive processes to identify key priorities in the community, not only in terms
of health care, but in terms of prevention extending into a range of community
issues. In 1997, it developed a “big hit list” targeting concerns about families,
parenting, youth issues including self harm and substance misuse, child
wellbeing, etc. This impressive process was repeated in a more political mode
with a cast of external stakeholder representatives, including personnel from key
DHCS divisions, the Commonwealth and others, aiming to coincide with signing
of the funding agreement. These developmental processes set up a powerful
expectation that the THB would move significantly beyond routine health service
management and development and significantly engage the communities in




                                                                                       11
preventive strategies in response to pubic health and social needs within the
community.


There was during 1999 an inquiry into a series of suicides by young Tiwi at
Nguiu, the first in what has become a serious epidemic. It was put to the Board,
and the Board itself felt that this was a major public health crisis to which it must
respond. There was very strong concern (and not only on the islands) about
youth generally. There were a range of other initiatives, in which the Board was
either asked to take a leading role or felt it had to, as part of its responsibility – for
example management of Commonwealth funded aged care facilities on the
islands. In summary, there was significant demand to respond to major public
health concerns through the development of community-based programs, either
funded by THB with the assistance of special purpose grants under various
Commonwealth programs.


Throughout 1998 until early in 1999, THB management had been reluctant to
spend much money at all. There were too many unknowns about its liabilities. It
had hesitantly taken on a public health package designed by DHCS to give it a
start in this area. This would be expensive enough. However, early in 1999, the
Board was urged by its government partners to start spending money: if the
funds pool remained unexpended within the time frame of the trial, this would be
a most serious political risk to the success of the trial. No one was thinking at that
stage that there might be adverse consequences to a rapid growth in the Board’s
commitments.


Within six months of the interdepartmental meeting in which it was warned of the
that under-expenditure was a serious political risk, the CEO announced that the
Board would be over-expended in the following year, clearly at that stage of the
view that it could achieve the appropriate restraints thereafter. The evaluation
documented the many other pressures on expenditure which contributed to the
outcome.



                                                                                       12
Tiwi Social Processes
The social processes underpinning the rapid growth of the Board need to be
understood at a number of levels. On the Tiwi Islands, there was:
   1. A relatively high level of articulation of social and community needs,
      leading to potentials for rapidly expandable intervention and community
      action
   2. Powerful, authoritative leadership able to grasp opportunity
   3. A drive to improve Tiwi participation and levels of competence and
      leadership within the organization: could Tiwi participation maintain pace
      with the growth of (externally sourced) expertise?


The following figure indicates that the authority generated through community
representation in the Board’s governance rests on organized interests within the
community and its processes (a balance of collective and individual interests
which are partly organized and partly disorganized), and that these in turn shape
the opportunity structures through which individuals and groups access
resources through jobs and services and other means mediated by the Board.


The Tiwi situation was not only amenable to rapid growth and articulation of
demands on the Board: the driving forces also included resource competition
within leadership itself. This drove powerful demands that there be equal
extension of all services to all parts of the Tiwi community and often had the
effect of stretching the Board’s commitments.




                                                                                 13
                                                          Tiwi Health Board

 Authority


 Organized interests

 Resource competition


 Opportunity structures


             Demand for participation, jobs, money….

Figure 2: Human Resources in THB and in the Tiwi social domain


The community services and preventive agendas also had a powerful
momentum: these were areas enabling engagement of a community voice in
articulation of local needs, and also allowed for increased Tiwi employment albeit
to a significant degree on a CDEP-subsidized basis. When the axe was to fall
further down the track, many of those areas to be cut were those responding
most directly to expressed community preference, were areas with numbers of
Tiwi employed including some in leadership roles. This hardened the Board’s
resolve not to budge in the later stages of negotiation with government and
accept further significant cuts before the collapse.


To simplify the assessment, the rapid growth of the Tiwi CCT, and thus, to a
certain extent, its eventual failure were also symptoms of success. Under
perceived pressure to get “runs on the board”, very powerful Tiwi leadership
combined with a combative and forceful CEO meant that for a time the Board
was able to base its strategies on driving hard against the ultimately political
limits to the funding model set by its trial partners.




                                                                                   14
In the early days of formation of the two CCTs, the Tiwi CCT was always cited as
having all of the advantages compared with KWCCT: relative cultural
homogeneity, powerful leadership and infrastructure able to support community
control. On the one hand, the Tiwi CCT was where all of the early evidence of the
success of the CCTs was to be found and broadcast: on the other, it was often
said among the departmental managers and project leaders, that people needed
to stop trumpeting the achievements of the Tiwi CCT, because this
overshadowed the slower pace of development of the KW CCT, which lacked
precisely these advantages and capacities. It now appears that some of the
apparent disadvantages of KW (among other factors) were protective.


This theme would need further exploration, but it appears that the Government
partners have been able to succeed with the CCT model and subsequent
variants in settings of relative underdevelopment of infrastructure and capacity,
where the available political processes were easier to contain and to some extent
needed to be set up fro the CCT and sustained by ongoing tutelage and
nurturance, and where the potentials for response to articulated community need
could only grow at a much slower pace than was the case on the Tiwi islands.
The organizational learning derived from the collapse of the Tiwi CCT by the NT
bureaucracy was no doubt substantial in terms of its management of risk through
reduced expectations concerning pace and scope of development for similar
initiatives. However, this has been inevitably linked to a reduced willingness to
take risks and innovate.


Organizational Complexity and Community Control: Internal impacts of
intensified intervention.
If time permits, I would like to examine a little more closely the issue of Tiwi
participation in the community controlled health service.


The evaluation of Tiwi participation in terms of capacity building involves the
objectification of system rationality according to some measure of the



                                                                                    15
'development of social or human capital'. Organizational capacity is partly
measured by professional and technical capacity; it is also partly - and only partly
- measured by the creation of conditions for Tiwi participation either through use
of existing Tiwi skills or through transfer of skills and responsibilities to Tiwi
persons. According to these criteria, the achievement of Tiwi capacity is the
greater if it can be achieved despite or in conjunction with technical complexity,
efficiency, and 'evidenced' appropriateness of roles occupied by Tiwi. This kind of
analysis is the program-logical and evaluative response to the normative
principle of self-determination consistent with the rationality of the health service
system.


The Final Local Evaluation Report (Robinson & Bailie, 2000: 88) represented the
issue of Tiwi capacity in the diagram below as a contribution to the internal
dialogue on the theme of Tiwi participation within the Board. The boxes represent
the three foci of capacity building which are to be sustained by processes of
communication and decision-making within the organization. The achievement of
capacity in the organization occurs when individuals are able to use sufficiently
robust organizational processes to assert specific managerial, community and
professional interests in order to develop their specialized contributions to
capacity and, eventually, outcomes. The boxes representing interests in the
organization do not necessarily coincide with groups or individuals and their
location within the organization; for example, a Tiwi person who is able to
perform as a manager/coordinator represents both enhancement of Tiwi Interests
and of Managerial Capacity; or when Tiwi and non-Tiwi staff are able to work
together effectively to build a program which responds to identified community
needs, this is a development of both Tiwi capacity and professional capacity
within the organization and an expression of both Tiwi and Professional interests.




                                                                                     16
Figure 3: Structural interests in Tiwi health services



          Tiwi
       Community                                          Managerial
       Interests &                                       Interests and
      Tiwi Capacity                                        Capacity


                                      organizational
                                        processes




                                     Professional
                                     Interests and
                                       Capacity



These three sets of interests are as it were 'structural interests' as in Alford's
model. The Tiwi interest may be partly repressed, as is the community interest in
Alford's model; however, in addition to the effective barriers generated by
professional-technical and managerial discourse, it is also unrealized because of
mechanisms within the Tiwi domain. What terms might community interests
express themselves in? What problems do members of the community see as
requiring a solution not met by the existing frameworks? Are these expectations
or interests at all compatible with the organizational mandate of an 'empowered'
leadership? What mechanisms within the community itself constrain possibilities
for participation, access to and use of services, for response to opportunities to
assert control and exert responsibility for it?


As indicated, rapid organizational growth and problem solving is something to
which the Tiwi committed themselves without perhaps fully knowing the scale of
the challenge or all of its consequences - these were powerful challenges given
the mix of highly technical health care objectives and $2m in additional funds
which had to be expended within a short period of time.


                                                                                     17
The Tiwi leadership grasped the opportunity of the CCT - and took on the political
challenges (e.g. against the lingering influence of the Church at Nguiu) in
asserting control. However, the Board members could not make it happen
without entering into a reciprocal and partly asymmetrical dependence on
external agents, managers and health professionals to a degree which had not
existed under the old system of relationships. Of the up to 200 persons working
full and part time, most of the key managerial positions were of necessity non-
Tiwi persons and indeed non-Aboriginal persons. The internal division of
functions between professional, managerial, “political” or “cultural” expertise, and
the complexity of technical and qualitative “cultural” issues at stake in much
decision-making at all levels was far more complex than was the case for any
other organization on the islands.


Strains on Tiwi capacity to participate and to exert authoritative control were
generated by the dynamics of the developing system. These strains intensified
with growth of complexity and scale - and with increasing community demands,
expectations and cynicism at failure to measure up.


Regulation of the system requires inputs which tax professional, organizational,
financial, even interpersonal understandings of Tiwi members; they also strain
established cultural codes of practice between Tiwi participants who face the
differentiation of their personal interests as an effect of system demands and
opportunities. Tiwi interests which drive the leadership are not simply those
relating to the 'core business' of health. Considerable resources are at stake,
both material resources which can be made available to communities, and
prestige for successful leadership.


Demands on Tiwi arose at all levels. Senior Tiwi accepted managerial roles
which in turn become points of strain as these roles proved unclear in terms of
what was demanded of them, given that in some cases functional authority



                                                                                  18
resided with nominally more junior non-Tiwi program managers. Senior AHWs
were asked to adopt a more strongly representative role within the organization
and to take responsibility for planning and strategy and to respond to the Board's
requirements for increased accountability; questions of accountability of AHWs
became more acute as the organization sought to reform work practices and rein
in areas of expenditure and inefficiency. Nurses under pressure to commit to
higher 'productivity', who might previously have shielded AHWs, were
increasingly inclined to insist that they be held independently accountable for
their output. At least in part, tensions associated with nursing EBA negotiations
reflected the inability to increase the level of responsibility of Tiwi AHWs in the
clinical setting to an equivalent degree to demands made on nurses, some of
whom felt that they bore a disproportionate share of the burden of responsibility
for success of the CCT system of Coordinated Care.


The system's demands became a kind of challenge to which both Tiwi and non-
Tiwi had to respond in different ways. In some cases the result was leadership
instability with for a time frequent changes of leadership of the Board. In other
cases powerful tensions focused on the role of non-Tiwi personnel. The
responses to demands and pressures were complex and variable. One effect
was to reduce Tiwi responsiveness to opportunity; new recruitment, for example,
had been largely limited to the community worker level; recruitment in clinical
services for a time at least was increasingly drawing on non-Tiwi AHWs.




                                                                                      19
Figure 4: Pressures on Tiwi participation with intensified organizational demands


                High quality, accountability, performance expectations




Performance pressure increases:




                                         Low
Thus there was a tendency to reduce high quality input by Tiwi based on high
levels of responsibility and to increase numbers of those providing “low” quality
input or inputs based on cultural or local knowledge which are not consolidated in
a formal way. The tendency to reduce Tiwi input relative to non-Tiwi input occurs
at the expense of consolidating higher skills among Tiwi, increasing the diversity
of working relationships and the quality of relationships and learning through
them.


It seems that the pool of employable Tiwi above a certain level is not
automatically or immediately expandable. In other words, without countervailing
influences, the tendency of the intensification of organizational complexity and of
demands on Tiwi personnel is to reduce Tiwi input, relative to non-Tiwi input and
responsibility, relatively, if not absolutely. The tendency to expel Tiwi labor and
replace it with non-Tiwi labor (despite absolute growth in numbers employed) has
been powerfully experienced in other developments on the Islands (and in many
Aboriginal organizations in mainland contexts). Tensions between cultural
insiders and outsiders then become more acute - often at first between Tiwi
insiders and non-Tiwi Aboriginal “outsiders” recruited in on the basis of their
literacy, skills or health qualifications.



                                                                                      20
The intensification of demands for Tiwi participation caused by the CCT, called
into stark relief the general lack of progression of Tiwi in formal education and
non-traditional employment. Paradoxically, the more the Tiwi leadership attempt
to expand its organizational capacity to assert Tiwi ownership and control of
community development, (through the THB, the Tiwi Islands Regional Assembly,
later TILG, the Training Board, TITEB, etc.) the more acutely is this problem
thrust on them, and the more do tensions associated with expansion of non-Tiwi
employment and authority within the Tiwi domain increase.


During the transition year, the Tiwi Health Board had become increasingly
concerned about the inability of Tiwi to take confident responsibility within the
organization, managerially and professionally. It was perplexed by the increasing
dependence on outside experts. One senior Board member asked: 'Why is it that
we always fall back, why can't we take responsibility; why do we always hand it
to white people?' It was not apparent to the Board how young people could be
encouraged to seek employment. It requested that management develop a
strategic plan for advancement of Tiwi within the organization based on training,
mentorship and other strategies. However, there were to be no designated Tiwi
positions: occupancy of positions and access to training are to be linked to
performance; those who undertake Board-funded training must be prepared to
accept increased responsibility in return.


This was an important part of the challenge the Board had taken on. This was
also a kind of organizational learning that was substantially discontinued in the
health service domain with the end of the CCT experiment. However, there is no
short term fix, nor easy solution. It is not without significance that one of the latest
projects of the Tiwi leadership, specifically of the Tiwi Education Board, is to
establish a partnership with governments and private sector funders to establish
a Tiwi College on Melville Island as the hub of a redevelopment of Tiwi
secondary education generally.



                                                                                     21
Outcomes and the long haul
The crisis which saw the end of the Tiwi Health Board and the CCT was not
about failure to deliver health or social outcomes – as the crisis rhetoric of
intervening governments implies in many cases. There was little or no apparent
discussion of outcomes at all in any consideration of the merits of survival of the
Board, if anything a “talking down” of its (and the NT government’s own)
achievements. It was not simply a product of poor governance or incompetence
of a community organization, as some government figures have suggested. It
was based on the inability of government to sustain its own commitment to the
objectives of the trial beyond the specific impasse which had emerged between
partners, and a failure to find the organizational mechanisms and interventions to
make that possible. It is by no means clear that the structures which had evolved
under the Tiwi CCT were the most desirable and effective. It is possible that
some of the government’s assumptions about the benefits of the CCT structure
had changed along with its medium term developmental priorities. Against the
backdrop of funding levels across the remote Territory, the Tiwi islands appeared
to be the best funded region. In terms of funding for services, there nothing to be
gained in terms of Territory wide objectives by continuing to support the Tiwi
Board itself.


The consequences of failure of the CCT partnership have been felt directly and
indirectly in subsequent years:
        1. politically, the NTG bureaucracy – and some ministers – lack
            confidence in their ability to contain the processes set in motion with
            any demand for community control;
        2. the resilience of Tiwi leadership would almost certainly allow it to
            grasp another opportunity; however, there is a new awareness of the
            complexity of the task and of the potential for failure, so that
        3. the level of trust required of non-Tiwi leadership and management in
            an organization of this scale may be difficult to achieve - the specific



                                                                                   22
           mix of leadership, expert knowledge and internal constraints required
           of the organization can not be confidently known.
        4. there is an awareness that these opportunities arise within
           government, but that government can not be trusted to see them
           through; strong community leadership and decision-making power are
           not enough.


The NT CCTs were the outcomes of a complex and ambitious partnership
between two tiers of government and the respective community organizations.
Despite the breakdown of the Tiwi trial, there were important outcomes – in terms
of the general resources and standards of management attained by routine
health services compared with what had existed before, in terms of some
research and development outcomes, and – to be generous - perhaps in terms of
some kinds of organizational learning in government.


The benefits of big trials are partly in the degree to which they empower
innovators in communities and in government to leap across existing structures
and create new processes and objectives for practice and organization. The
major risks of big trials are in the withdrawal of government from its own
commitment to outcomes, masked behind the fictions or at least half truths of
crisis management and organizational failure.


Against this experience of the risks of partnership to achieve complex
organizational and social outcomes it must be asked: are the prospects for
achieving improved outcomes through partnership any better in the current policy
environment?


Shared Responsibility: Outcomes, Policy Incoherence and Evidence
The Commonwealth Government has elaborated its notion of mutual obligation in
the Aboriginal domain around the mechanism of Shared Responsibility
Agreements (SRAs), by which the Commonwealth agrees to fund initiatives in



                                                                                 23
return for an explicit commitment to agreed actions or outcomes. In a sense this
heralds much more flexible direct engagement between Commonwealth funders
across departments and community organizations. What are the prospects for
success of partnerships under these conditions?


Leaving aside the entitlements-based critique of the shared responsibility
strategy, the shift to SRAs as the basis for indigenous policy coordination can be
seen as rational if one assumes that there is some Aboriginal infrastructure and
organizational capacity able to make use of the processes. SRAs bypass state
and territory governments where necessary, engage them where possible and
could in theory harness program funding regimes closer to community processes
and structures to open new lines of development inside and outside of
established service delivery practice. Program funding is potentially backed by
stronger agreements about outcomes. Strong communities and regions
potentially get stronger funding agreements with the Commonwealth on a longer
term basis. Weaker communities can possibly get a “leg up”, if they can make
visible something like “leadership”, “initiative” in response to their “dysfunction”,
“disadvantage” or “under-development”.


In moving to this model, the Commonwealth in a sense has to style itself as
closer to the community than state and territory service providers, and as
shaping priorities by directly engaging in community consultation, albeit
sometimes through intermediaries. The general claim that Canberra is closer to
the community may well be spurious. However, the claim is strategic and highly
significant in the federal context. The process may have the capacity to disrupt
established state practice and/or to nudge along by incentive state/territory
government agencies in part by locking in matching contributions with funding
conditions and in part by giving innovators in local bureaucracies opportunities to
contribute to change. Achieving this sort of outcome presupposes some capacity,
not only on the part of the community partner, but on the part of the government
itself: this capacity, talent or skill, whether organizational, professional, or based



                                                                                        24
on local knowledge, can certainly not be taken for granted. The Tiwi experience
makes this clear.


The SRA model suggests that a government interested in a community-level
strategy for achieving outcomes might invest in more systematic gathering of
evidence in order to support sustainable high quality interventions and, yes
rigorously test ways to get those outcomes. However, the reality is otherwise and
the current prospects for underpinning activity with formal evidence rather than
practitioner, field officer or bureaucratic say-so are poor. The Commonwealth’s
capacity to identify the links between funded activity and expected outcome is
highly limited. As is well known, the underlying assumptions rest predominantly
on a crude manipulation of access to resources in return for taken for granted
goods (“no school no pool”, or “funding of a resource in return for action on nose-
blowing or face-washing”). In many cases, there is no logical or causal
connection between the action to be funded and the outcome sought: often
enough, reductions in complex social problems are presumed to flow from
interventions to which there is no evidence of a connection at all (air conditioners
reduce domestic violence). Too often they merely state the problem: “we will give
you money for a new school if you can get the students to attend.” The spectacle
of Minister Brough sitting outside a graffiti-daubed outstation house not far from
Wadeye and telling its elderly owner something to the effect of, “I will give you
money for new houses, but you have to get the rocks off the roof and keep them
clean”, is a public, partial dramatization of the new logic of outcomes-driven
policy, of its capacity to define little more than superficial outcomes. Its role in
these terms is trivial compared with its political role as a lever of policy change,
political roof-clearing, as it were, and of low-order whip-cracking in terms of
governance and control.


In fact, the shift towards shared responsibility has been a shift towards policy
incoherence. The process of indigenous policy coordination lacks even the level
of coherence achieved under strategic programs. The nation is dotted by projects



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with an extraordinary range of objectives some with extremely loose links
between project and anticipated outcomes. SRAs may be one-to-one negotiation
between a government and a single community organization or may involve
multi-directional partnerships including commitments from state/territory
governments and other participants. For the SRAs to actually redirect community
capacity towards improved social outcomes, there would need to be much higher
regard for evidence about the determinants of existing difficulty in specific social
contexts, about the effective change mechanisms associated with specific
interventions, about how best to engage with the community context and what
the possibilities for engaging in real organizational growth and development are.


The terrain discussed is now clearly being opened up to flurries of
entrepreneurship of wildly varying quality, using SRAs to broker funding from
strategic programs and other sources. Organizations bring in consultants,
interventions are brought in, franchised interventions bought; organizations
needing runs on the board let tenders, so that all manner of problems – many of
them serious, intractable and complex - are found fundable solutions. In this new
landscape, not only community organizations, but state and territory
governments will continue to fail to support original research & development; at
the community level, there will be little coherence and sustainability to these
developments.


Where to get the knowledge needed to support the potentially opened up policy
economy of shared responsibility and to achieve something like effectiveness in
the short term grants economy does not appear to have been fully thought
through in government, despite some steps. This knowledge is almost entirely
lacking in the bureaucracy, and indeed, it can be argued, is structurally
impossible to produce there. Partnerships, not only between tiers and sectors of
government and community interests, but between these and the research sector
are needed in order to found these on strong research and development,
including training and education.



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As we have seen, boosting the functional capacity of community organizations to
operate in remote indigenous social and cultural contexts is a complex process.


       1.      It means investment in longer term processes – without loss of
       attention to outcomes - than are within the scope of the SRA process,
       2.      There is a fundamental mismatch between the grants economy
       through which innovation is expected to occur, and the requirements for
       longer term capacity built on higher levels of engagement with place,
       people and values.
       3.      Longer term investments in significant new organizational capacity
       are subject to the manufactured crisis: strong community organizations
       are needed to form strong partnerships.


Governments need to swear off the habits of crisis intervention and crisis
management and the externalization of blame for failure to achieve
organizational, social and other outcomes. Irrespective of the need for tough
decision-making concerning organisations, governance and financial
management, government can only support more differentiated objectives if it is
prepared to test its assumptions against evidence of the determinants of
developmental processes and intervention outcomes in specific social settings.
This is more complex and demanding than the average partnership achievable in
the current policy landscape.




References
Robinson, G., Bailie, R., Togni, S. & S. Kondalsamy-Chennakesavan (2001). Tiwi CCT
Transition Year Evaluation. Darwin, CNAAR, NTU.

Robinson, G., P. d'Abbs, et al. (2003). "Aboriginal Participation in Health Service
Delivery: Coordinated Care Trials in the Northern Territory of Australia." International
Journal of Healthcare Technology and Management 5(2).




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