Closing the (service) gap: exploring partnerships between Aboriginal and mainstream health services

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Abstract
Background. Although effective partnerships between Aboriginal and mainstream health services are critical to improve Aboriginal health outcomes, many factors can cause these partnerships to be tenuous and unproductive. Understanding the elements of best practice for successful partnerships is essential. Methods. A literature review was conducted in 2009 using keyword searches of electronic databases. Sourced literature was assessed for relevance regarding the benefits, challenges, lessons learnt and factors contributing to successful Aboriginal and mainstream partnerships. Key themes were collated. Results. Although there is much literature regarding general partnerships generally, few specifically examine Aboriginal and mainstream health service partnerships. Twenty-four sources were reviewed in detail. Benefits include broadening service capacity and improving the cultural security of healthcare. Challenges include the legacy of Australia’s colonial history, different approaches to servicing clients and resource limitations. Recommendations for success include workshopping tensions early, building trust and leadership. Conclusion. Although successful partnerships are crucial to optimise Aboriginal health outcomes, failed collaborations risk inflaming sensitive Aboriginal–non-Aboriginal relationships. Factors supporting successful partnerships remind us to develop genuine, trusting relationships that are tangibly linked to the Aboriginal community. Failure to invest in this relational process and push forward with ‘business as usual’ can ultimately have negative ramifications on client outcomes. What is known about the topic? Partnerships between different health services have long been recognised as beneficial for broadening service capacity and using resources more effectively to improve client care. The current policy climate particularly recognises partnerships between Aboriginal and mainstream services as offering multiple benefits for improving the cultural and clinical capacity of health service delivery to Aboriginal clients. Yet many challenges face these arrangements, including tensions stemming from historical and current race relations, different ways of working and ongoing Aboriginal disadvantage. What does this paper add? Although partnerships between Aboriginal and mainstream services are strongly advocated for, there is a paucity of research on the challenges in these arrangements and practical suggestions on how to make such partnerships genuinely successful. This paper analyses the results from research, case studies, reports and reviews to identify the factors that challenge and enhance partnerships between Aboriginal and mainstream health services. The collation of this information also enables indicators of best practice to be presented. What are the implications for practitioners? Although there are considerable challenges for Aboriginal and mainstream health services entering into partnerships, this paper offers health service practitioners and managers a summary of lessons learnt and a ‘checklist’ of best practice indicators to assist them in developing, implementing and sustaining a successful collaborative arrangement.