CHCPOL002 Readings

Extract 1: Introduction

National Model Clinical Governance Framework

Clinical governance is a shared responsibility to ensure that all patients receive the best care. Good clinical governance allows the community and health service organisations to be confi-dent that systems are in place to deliver safe and high-quality health care, and continuously improve services.

Allied health practitioners including registered and non-registered professional groups, assis-tants, technicians, students and managers, work in multidisciplinary teams to optimise patient care by identifying and managing risks to patients, and working within safety and quality sys-tems with patients, carers and families.

Optimising patient care requires allied health practitioners to actively take part in safety and quality processes that support patient safety, including:

1. Participating in safety and quality processes that support good patient care
2. Reporting incidents and near misses when they occur
3. Analysing and addressing adverse events, including through peer review and clinical audit processes
4. Following through with open disclosure to patients and families
5. Appropriately escalating patient safety issues to managers.

Optimising patient care also requires active participation in quality improvement, including:

• Contributing to multidisciplinary teams to ensure that patients receive comprehensive care
• Partnering with patients, consumers, other allied health practitioners or clinicians and managers ensures that patients receive appropriate information and care
• Supervising junior members of the workforce who provide patient care
• Taking part in regular performance appraisals
• Participating in regular reviews of patients’ clinical outcomes to improve the delivery of care
• Engaging in critical reflection
• Identifying opportunities and taking action to improve care.

Members of an organisation’s governing body, its managers and allied health practitioners and other clinicians are together responsible for ensuring effective clinical governance in an organi-sation. Collectively, the governing body and the workforce share the common goal of optimis-ing patient care. To meet this goal, allied health practitioners should work together with members of the work force to identify and manage risks, and to meet their professional responsibilities related to optimis-ing patient care.

Fulfilling a role in clinical governance aligns with the obligations of allied health practitioners under their codes of conduct.

Everyone – from frontline allied health practitioners to managers and members of governing bodies, such as boards – are accountable to patients and the community for ensuring an effec-tive clinical governance framework is in place. This is important to deliver health services that are safe, effective, high quality and continuously improving.

Roles and Responsibilities of Allied Health Practitioners in Providing Clinical Governance

Governance, leadership and culture

• Actively take part in the development of an organisational culture that enables and pri-oritises patient safety and quality.
• Actively communicate the profession’s commitment to the delivery of safe, high-quality health care.
• Model professional conduct that is consistent with a commitment to safety and quality at all times.
• Embrace opportunities to learn about safety and quality theory and systems.
• Embrace opportunities to take part in the management of clinical services.
• Encourage, mentor and guide colleagues in the delivery of safe, high-quality care.
• Take part in all aspects of the development, implementation, evaluation and monitoring of governance processes.

Patient safety and quality systems

• Contribute to the design of systems for the delivery of safe, high-quality clinical care.
• Comply with relevant organisational policies and procedures when visiting and provid-ing care.
• Provide health care within the parameters of these systems.
• Communicate with allied health practitioners and other clinicians internally and in oth-er health service organisations to support good patient outcomes.
• Ensure contemporary knowledge about safe system design.
• Be alert for opportunities to improve systems.
• Ensure that identified opportunities for improvement are raised and reported appropri-ately.
• Educate junior clinicians about the importance of working within organisational systems for the delivery of clinical care.
• Take part in the design and implementation of systems in the health service organisa-tion for:
  • Quality improvement and measurement
  • Risk management
  • Incident management
  • Open disclosure
  • Feedback and complaints management
  • Complying with professional regulatory requirements and codes of conduct.

Clinical performance and effectiveness

• Maintain personal professional skills, competence and performance.
• Contribute to relevant organisational policies and procedures.
• Comply with professional regulatory requirements and codes of conduct.
• Monitor personal performance and engage in critical reflection.
• Supervise and manage the performance of junior clinicians.
• Ensure that specific performance concerns are reported appropriately.
• Work constructively in clinical teams.
• Contribute to an environment of cultural safety and responsiveness.
• Take part in the design and implementation of the organisations’ systems for:
  • Acknowledging and monitoring standards including through relationships with professional peers
  • Defining scope of clinical practice
  • Clinical education and training
  • Safety and quality education and training
  • Using evidence-based practice
  • Performance monitoring and management
  • Clinical review.

Safe environment for the delivery of care

• Contribute to the planning and development of activities relating to the environment of the health service organisation.
• Provide clinical care within the parameters of this environment.
• Be alert to and act on opportunities to improve the safety of the environment.
• Ensure that identified opportunities for improvement are raised and reported.

Partnering with Consumers

• Understand the evidence on consumer engagement, and its contribution to healthcare safety and quality.
• Understand how health literacy might affect the way a consumer gains access to, under-stands and uses health information.
• Support patients to have access to, and use, high- quality, easy-to- understand infor-mation about health care.
• Support patients to share decision-making about their own health care, to the extent that they choose.
• Work with consumer representative groups to ensure that systems of care are designed to aid consumer engagement in decision-making.
• Assist access of consumers to their own health information, as well as complaints and feedback systems.
• Implement and fully take part in the organisation’s open disclosure policy.

Resources

• National Model Clinical Governance Framework
• National Safety and Quality Health Service Standards
• Standards of practice for the relevant allied health profession State and territory, and organisational policies and procedures relating to conduct, risk, safety and open disclosure.

Questions?

For more information, please visit: safetyandquality.gov.au/standards/nsqhs-standards

You can also email the NSQHS Standards Advice Centre at: accredita-tion@safetyandquality.gov.au or call 1800 304 056.

Extract 1: Introduction

The WHS Act defines ‘health’ to include both physical and psychological health. This means that where the WHS Act imposes a duty in relation to ‘health’, PCBUs must manage risks to both physical and psychological health, so far as is reasonably practicable.

Figure 1: Continuum of psychological health

Psychological health occurs on a continuum of responses which workers may experience, with harm occurring at one end of this continuum – see Figure 1. An individual’s experience may move back and/or forward on this continuum over time. Experiences may include:

• psychological health - a state of wellbeing in which individuals realise their own poten-tial, can cope with the normal stresses of life, can work productively and are able to make a contribution to their community
• reacting in a normative way to negative work events which does not constitute harm
• struggling with exposure to psychosocial hazards, where changes can be made to
• prevent harm
• psychological injury, where harm is evident.¹

^{1 A psychological injury is a disorder or illness that includes a range of recognised cognitive, emotional, physical and behavioural symp-toms. These may be short term or occur over many months or years, can significantly affect how a person feels, thinks, behaves, interacts with others, and may impact their work performance.}

Risks to psychological health are known as psychosocial risks. Section 55B of the WHS Regula-tion defines psychosocial risk as a risk to the health and safety of a worker or other person from a psychosocial hazard.

1.1. What are Psychosocial Hazards?

WHS Regulation section 55A: Meaning of psychosocial hazard

A psychosocial hazard is a hazard that arises from, or relates to, the design or management of work, a work environment, plant at a workplace, or workplace interactions and behaviours and may cause psychological harm, whether or not the hazard may also cause physical harm. In severe cases exposure to psychosocial hazards can lead to death by suicide.

As shown in Figure 2, psychosocial hazards can create harm through a worker’s experience of a frequent, prolonged and/or severe stress response, where stress is defined as a person’s psycho-logical response (e.g. anxiety, tension) and physiological response (e.g. release of stress hor-mones, cardiovascular response) to work demands or threats.

Workers are likely to be exposed to a combination of psychosocial hazards; some hazards may always be present, while others only occasionally. Common psychosocial hazards that arise from, or are related to, work may include:

• high and/or low job de-mands
• low job control
• poor support
• low role clarity
• poor organisational change management
• low reward and recogni-tion
• poor organisational justice
• poor workplace relation-ships including interper-sonal conflict
• remote or isolated work
• poor environmental con-ditions
• traumatic events
• violence and aggression
• bullying
• harassment including sex-ual
• harassment.

Figure 2: Relationship between psychosocial hazards and injury outcomes

For further information see section 3.1.1 - common psychosocial hazards.

1.2. Who has a Health and Safety Duty in Relation to Psychosocial Jazards?

A person conducting a business or undertaking (PCBU)

WHS Regulation section 19; WHS Regulation Part 3.1 and Part 3.2, Division 11: Primary duty of care; managing risks to health and safety; psychosocial risks

A PCBU must ensure, so far as is reasonably practicable, the health and safety (including psycho-logical health) of workers:

• engaged, or caused to be engaged by the PCBU
• whose activities in carrying out work are influenced or directed by the PCBU while the workers are at work in the business or undertaking.

PCBUs must also ensure, so far as is reasonably practicable, that other persons (e.g. visitors, de-livery people, clients, patients and their families) are not put at risk from work carried out as part of the conduct of the business or undertaking.

This includes ensuring, so far as is reasonably practicable:

• the provision and maintenance of a work environment without risks to health and safety
• the provision and maintenance of safe systems of work
• the provision of adequate facilities
• the provision of information, training, instruction or supervision
• that the health of workers and the conditions at the workplace are monitored.

A PCBU’s duty includes ensuring the health and safety of workers and others from acts by third parties (e.g. patients or their family members, students in educational facilities, and members of the public in retail or hospitality establishments).

PCBUs must also manage psychosocial risks in accordance with Part 3.1 of the WHS Regulation. This includes eliminating psychosocial risks, so far as is reasonably practicable, or if it is not rea-sonably practicable to eliminate psychosocial risks, minimising psychosocial risk, so far as is rea-sonably practicable. Further information on specific regulatory requirements in relation to psy-chosocial risks is provided in section 3 of this Code.

A PCBU cannot transfer or delegate these duties to another person.

PCBU with management or control of workplaces

WHS Act section 27: Duty of PCBUs involving management or control of workplaces

A PCBU with management or control of a workplace must ensure, so far as is reasonably practi-cable, that the workplace, the means of entering/exiting the workplace, and anything arising from the workplace are without risks to the health and safety of any person.

Officers

WHS Act section 27: Duties of officers

An officer of a PCBU (e.g. company directors, senior managers or executives), must exercise due diligence to ensure PCBUs comply with duties under the WHS laws. This includes taking reason-able steps to:

• acquire and keep up-to-date knowledge of work health and safety matters associated with the operations of the business or undertaking (including matters related to psycho-logical health and psychosocial risks)
• gain an understanding of the nature of the operations of the business or undertaking and the psychosocial hazards associated with those operations
• ensure the PCBU has and uses appropriate resources and processes to eliminate or min-imise risks from psychosocial hazards
• ensure the PCBU has appropriate processes for receiving and considering information regarding incidents, hazards and risks and responding in a timely way to that information
• verify the provision and use of these resources and processes.

An officer’s duty is immediate, positive, and proactive, and is owed by each individual officer of a PCBU.

Further information on who is an officer and officer duties can be found in the Safe Work Aus-tralia guidance: The health and safety duty of an officer.

Workers

WHS Act section 28: Duties of workers

While at work, a worker must:

• take reasonable care for their own health and safety, including psychological health
• take reasonable care their acts or omissions do not adversely affect the health (includ-ing  psychological health) and safety of other persons
• comply, so far as the worker is reasonably able, with reasonable instructions given by a  PCBU
• cooperate with reasonable health and safety policies or procedures issued by a PCBU that have been notified to workers.

A worker is entitled to cease, or refuse to carry out work, if the worker has a reasonable con-cern that carrying out the work would expose them to a serious risk to their health or safety, emanating from an immediate or imminent exposure to a hazard (see WHS Act, section 84). A worker who has ceased work must notify the PCBU that they have ceased work and remain available to carry out suitable alternative work until it is safe for them to resume normal duties (see WHS Act sections, 86–87).

A person is a worker if the person carries out work in any capacity for a PCBU including work as an employee, a contractor or sub-contractor or their employees, a labour hire worker, an out-worker, an apprentice or trainee, a work experience student, or a volunteer (see WHS Act, sec-tion 7).

Other persons at the workplace

WHS Act section 29: Duties of other persons at the workplace

Other persons at the workplace (e.g., visitors, delivery people, customers, clients, and patients and their families) must:

• take reasonable care for their own health and safety
• take reasonable care not to adversely affect other people’s health and safety by
• exposing them to psychosocial hazards
• comply, so far as they are reasonably able, with reasonable instructions given by a
• PCBU to allow them to comply with the WHS Act.

1.3. What is Reasonably Practicable?

WHS Act section 29: What is reasonably practicable in ensuring health and safety

‘Reasonably practicable’, in relation to a PCBU’s duty to ensure health and safety, means that which is, or was at a particular time, reasonably able to be done to ensure health and safety, taking into account and weighing up all relevant matters including:

• the likelihood of the hazard or the risk concerned occurring
• the degree of harm that might result from the psychosocial hazard or risk
• the availability and suitability of ways to eliminate or minimise the risk
• what the person concerned knows, or ought reasonably to know, about the hazard or risk, and about the ways of eliminating or minimising the risk
• after assessing the extent of the risk and the available ways of eliminating or minimising the risk, the cost associated with available ways of eliminating or minimising the risk, including whether the cost is grossly disproportionate to the risk.

In practical terms, this means that all the relevant matters in relation to the hazard and its risk are taken into account and weighed up to achieve a balance that provides the highest level of protection that is possible and reasonable in the circumstances.

This Code informs what may be reasonably practicable in ensuring health and safety, particularly information which outlines:

• common psychosocial hazards
• metrics, data sources, and risk assessment measures/methods that can be used to  de-termine the likelihood of risk and the degree of harm that might result from  psychoso-cial hazards
• examples of risk control strategies.

Additionally, in determining what is reasonably practicable, PCBUs may need to consider their obligations under other legislation that requires or prohibits certain activities. Where legisla-tive duties interact, a PCBU must do what it is reasonably practicable while complying with other legislation and should take interacting legislation into account as part of their risk man-agement process.

The question of what is reasonably practicable is determined objectively (that is, by what a rea-sonable person in the position of the PCBU would do in the circumstances), not by reference to a PCBU’s capacity to pay or other individual circumstances. A PCBU cannot expose people to a lower level of protection simply because it is in a lesser financial position than another PCBU facing the same hazard or risk in similar circumstances.

Further information on what is ‘reasonably practicable’ is provided in the Safe Work Australia guide: How to determine what is reasonably practicable to meet a health and safety duty.

1.4. Other Legislation

While the scope of this Code is limited to duties under the WHS Act, there are several other laws that duty holders should be aware of that are relevant to psychosocial hazards and may also apply, e.g., industrial relations, criminal, anti-discrimination, human rights, privacy, and workers’ compensation laws (see Appendix 1).

The Queensland WHS regulator’s jurisdiction is not to enforce the legislation listed in Appendix 1 but to ensure risks to health and safety are being managed as required under the WHS Act.

Using the Australian Charter of Healthcare Rights in your health service

The Australian Charter of Healthcare Rights (the Charter) describes what consumers, or some-one they care for can expect when receiving health care. Everyone who works in a health ser-vice is responsible for upholding healthcare rights.

This fact sheet provides information about how to use the Charter in your health service.

Why is the Charter Important?

Healthcare rights are human rights. Australia has committed to international agreements that recognise everyone has the right to enjoy the best possible standard of physical and mental health.

There are seven healthcare rights in the Charter. These are: access, safety, respect, information, partnership, privacy and giving feedback.

Upholding healthcare rights helps ensure that people receive safe, high-quality and person-centred care. Using the Charter supports a shared understanding of healthcare rights between consumers, clinicians, health services and their workforce:

• For consumers understanding their rights can empower them to be actively involved in their health care, to ask questions if they need information or support, and to share feedback or concerns if their rights are not being upheld.
• For clinicians upholding healthcare rights is an ethical responsibility and is included in many practitioners’ codes of conduct. Clinicians also play an important role in support-ing consumers to understand their healthcare rights by helping consumers to under-stand information about their care and treatment options and involving them as part-ners in decisions about their care.
• For health services the Charter explains the responsibilities of an organisation in up-holding these rights and provides a framework for delivering person-centred care.

Do We Need to Use a Charter?

Yes. The Charter applies in all places where health care is provided. This includes public and private hospitals, day procedure facilities, general practices, specialist clinics, community health centres, dental clinics and allied health provider services.

National standards

The Charter is embedded within the:

• National Safety and Quality Health Service Standards (Action 2.03)
• National Safety and Quality Primary and Community Healthcare Standards (Action 2.02)
• National Safety and Quality Digital Mental Health Standards (Action 2.1).

These standards require health services to use a charter that is consistent with the Australian Charter of Healthcare Rights; and make it easily accessible for patients, consumers, carers and families.

Health services also need to support their workforce to apply the principles of the Charter un-der the Primary and Community Healthcare Standards.

Options for Using a Charter

Your health service can decide which charter of rights you use. You can:

1. Adopt the Australian Charter of Healthcare Rights
2. Review or develop a charter for your organisation. You will need to ensure that your charter includes the seven rights in the Australian Charter of Healthcare Rights and is consistent with
3. its principles.

Strategies to Support the Use of the Charter

Regardless of whether you decide to adopt the Australian Charter of Healthcare Rights, or de-velop your own, there are a range of strategies that can support its use. When planning your approach, consider the characteristics of your organisation, the services you deliver, the needs of your consumers and the diversity of the communities you serve.

Plan a whole-of-organisation approach

Upholding the rights in the Charter needs a coordinated effort across the whole organisation. The National Model Clinical Governance Framework can help with planning a whole-of-organisation approach.

A health service organisation’s clinical governance framework describes the safety and quality systems and processes that need to be in place to ensure the delivery of safe, high-quality health care. Including guidance about the role of Charter in the clinical governance framework, helps to communicate the agreed approach for the whole organisation in implementing the Charter.

Support consumer understanding of healthcare rights

Strategies include:

• Displaying information about the Charter, in places of high visibility such as at reception desks, waiting areas, consulting rooms or, on digital platforms such as on your website
• Sharing information about healthcare rights before or during an admission appointment or at the bedside (if in hospital). Ideally information should be shared as a discussion, as well as providing written information. It could be as simple as highlighting a consumer’s right to information about care and treatment options and how this is important for be-ing able to share decisions about their care
• Assisting consumers who need support to understand their rights by providing infor-mation that is accessible such as Easy Read, Auslan, Braille and audio-visual formats and access to interpreters and translations in community languages
• Providing opportunities for consumers to give feedback about their rights and letting them know it is welcome. This is an opportunity for staff to work with consumers to im-prove the way healthcare rights are upheld and care is delivered
• Seeking feedback from consumers about new ways the Charter could be promoted and used.

Promote workforce understanding of healthcare rights

Strategies include:

• Training your workforce about their responsibilities to uphold healthcare rights. For ex-ample, provide information at staff meetings and at orientation for new staff and ongo-ing education
• Ensuring your workforce has the right skills to provide care that aligns with the Charter. For example, skills are needed with shared decision making and knowledge of how health literacy influences a person’s ability to understand information and participate in decisions about their care
• Put in place resources, processes and training to assist administrative staff and clinicians to use alternative styles of communication when needed. For example, set up a process to identify ahead of an appointment if a person has alternative communication needs. This can assist staff to arrange support including use of interpreters, translation of key documents, access to easy read information and Auslan. These systems will assist con-sumers from diverse backgrounds, cognitive impairment, intellectual disability and oth-ers who have additional communication needs
• Incorporate healthcare rights training into your regular education calendar, including the role and importance of the Charter, shared decision making, health literacy, com-municating risks and benefits of treatment options, informed consent processes and how to manage feedback and complaints
• Having clear pathways for consumers to make a complaint and/or share feedback about their experience of care. The workforce should be trained on these pathways and share this information with consumers to guide them through the process of making a com-plaint and sharing feedback.

Embed the Charter into systems to guide health service planning and delivery

Strategies include:

• Incorporating the Charter into your processes, policies and codes of conduct. Consider how the rights in the Charter can be achieved through processes related to quality im-provement, risk management, incident management, open disclosure, informed con-sent, feedback and complaints
• Developing policies and procedures that outline how the rights in the Charter will be achieved
• Using the Charter as a reference point for the management of feedback and complaints.

Measure the impact of the Charter and its effect on consumer experience

Strategies include:

• Gathering information about the Charter in consumer experience surveys by including questions about whether they are aware of the Charter and whether their rights were upheld
• Plan ways to seek feedback about the Charter from diverse consumers including Aborig-inal and Torres Strait Islander peoples, culturally and linguistically diverse groups, LGBTQI+ groups, consumers with a lived experience of mental illness and disabilities
• Gathering information from your workforce by conducting surveys about their under-standing of, and attitude to, the Charter
• Monitoring complaints and feedback to identify where improvements to align with the Charter are needed
• Monitoring changes that are made to improve how healthcare rights are upheld and providing this feedback to consumers and staff.

Resources

The Charter is available as a:

• Poster
• Flyer
• Animation
• Guide for consumers
• Guide for people with cognitive
• impairment
• Auslan
• Audio recordings
• Braille
• Easy English
• Translations
• Digital signage.

Visit the Australian Commission on Safety and Quality in Health Care’s website to download the resources above.

Questions?

For more information about the Charter, please visit: www.safetyandquality.gov.au/consumers/working-your-healthcare-provider/australian-charter- healthcare-rights

You can also email us at partneringwithconsumers@safetyandquality.gov.au.

Standard Precautions: Section One

Generally, the greatest risks for transmission of infectious agents are:

• Hands
• Clothes
• Medical devices
• Client’s personal assistive technology
• Environmental surfaces.

Standard Precautions are infection prevention and control precautions applied to everyone, all the time, regardless of their perceived or confirmed infectious status to minimise the risk of spreading infectious agents.

Standard precautions consist of:

• Hand hygiene, as consistent with the 5 moments for hand hygiene
• The use of appropriate personal protective equipment (PPE)
• The safe use and disposal of sharps
• Routine environmental cleaning
• Reprocessing of reusable medical equipment and instruments
• Respiratory hygiene and cough etiquette
• Aseptic technique
• Waste management
• Appropriate handling of linen.

Standard precautions should be used at any time staff may be involved in the handling of:

• Blood (including dried blood)
• All other body substances, secretions and excretions (excluding sweat), regardless of whether they contain visible blood
• Non-intact skin and
• Mucous membranes.

Common tasks performed by Allied Health clinicians which may result in exposure to these sit-uations include:

• Assessment and treatment of clients who may vomit, have an episode of incontinence and/or cry
• Close assessment and treatment of clients with chronic respiratory conditions, excessive phonation and/or saliva control difficulties
• Assessment and treatment of clients with wounds
• Handling of client’s personal assistive technology such as glasses, wheelchairs, footwear, orthoses, prostheses, hearing aids, communication technology
• Assessment and treatment of clients who present with conditions that can be spread by contact, droplet and aerosol routes
• Handling and use of medical devices including shared client care equipment

Utilising shared clinic environments.

Examples of additional profession specific tasks regularly conducted which also require adher-ence to infection prevention and control procedures are outlined in Table 1 to demonstrate the high frequency with which these situations arise in day to day practice.

Table 1: Regularly conducted tasks requiring infection prevention and control procedures

Allied Health Profession	Commonly conducted tasks requiring infection prevention and control
Audiology	Vestibular and balance assessment Handling of hearing devices Observe ENT procedures, conduct standard practices in parallel with ENT or other surgery Ear mopping or tissue spears in presence of active discharge Cerumen management Procedures which elicit cough reflex
Radiography/Radiation Therapy/Mammography	Clients presenting with chemotherapy drips Clients presenting with colostomy bags Clients presenting with Percutaneous Endoscopic Gastrostomy tubes (PEG’s) Clients presenting with open wounds or erythematous skin Tattooing surface markers on clients Superficial x-ray treatment Brachytherapy treatment IV cannulation / PICC insertion Clients with MRSA, HIV, possible tuberculosis Treating prison inmates Treating and imaging Head and Neck Clients Emergency room/ operating theatre/ICU imaging Dental imaging Paediatric / neonate imaging
Occupational Therapy	Assessment and Treatment of clients with wounds (e.g. hand therapy, burns, pressure care) Functional and or activities of daily living assessment of clients Preparing food with clients Hands on facilitation or direct contact with clients during therapeutic activities Home visits When undertaking client transfers
Optometry	Tonometry, pachymetry Gonioscopy (or use of contact fundus lenses) Removal of foreign bodies Assessment of clients with ocular trauma Assessment of clients with infectious conjunctivitis Assessment of clients with microbial keratitis Lacrimal lavage, removal of eyelashes Expressions of glands and cysts Contact lens fitting Epithelial debridement Post-operative management
Orthoptics	Assessment, diagnosis and non-surgical management of eye disorders in adults and children Diagnostic testing and imaging including tonometry, ultrasonography (A & B Scans), angiography and ocular electrophysiology Assessment of clients with suspected conjunctivitis or other eye infections Assessment of clients following ocular trauma Post-operative care and management Set-up/surgical assisting of minor procedures (e.g. intravitreal injections, biopsies, chalazion drainage, eyelash electrolysis, corneal cross-linking) Contact lens fitting
Orthotics/Prosthetics	Assessment of clients with wounds and non-intact skin (e.g. post-surgical suture, pressure sore, blister, burns, emergency client presenting with dried blood) Handling of orthoses and prostheses used by clients with wounds and non-intact skin Assessments of clients requiring close contact to the client’s face (e.g. management of neck and facial burns, cranio-moulding helmets, spinal injury) Handling of orthoses relating to the neck and head (e.g. cervical orthoses, cervico-thoracic orthoses including halo thoracic orthoses, burns orthoses)
Podiatry	Wound care Nail care Debridement of corns/calluses Ingrown toenail procedures Verruca treatment Removal of foreign bodies Dermatological conditions assessment
Speech Pathology	Cough or gag reflex testing Endoscopic assessment of vocal function (flexible and/or rigid endoscopes) Flexible endoscopic evaluation of swallowing (FEES) Instrumental respiratory/aerodynamic function testing Multi-use of swallowing/feeding or communication assessment or intervention equipment (e.g. stethoscope, Western Aphasia Battery objects, Augmentative and Alternative Communication devices, toys and games used in therapy) Oro-motor function assessment or intervention (e.g. jaw and tongue strength testing Saliva management Speech pathologist-led laryngectomy care and management (e.g. voice prosthesis changes, stoma inspection) Swallowing or communication assessment or intervention (including non-verbal and speech) requiring contact (e.g. Facial-Oral Tract Therapy, PROMPT) Swallowing/feeding assessment or intervention, including the delivery of mouth care Swallowing/feeding or communication assessment or intervention with clients requiring: Non-invasive ventilation (NIV); High-flow nasal oxygen (HFNO); respiratory support via nasal cannulae; face mask Tracheostomy care and management Videofluoroscopic Swallowing Study (VFSS)

The following information assists you to implement the NHMRC guidelines in practice and to develop your local practice policies.

HAND HYGIENE

Effective hand hygiene is the single most important strategy in preventing healthcare associated infections.

IMPLEMENTATION

• Wash hands with soap and water if visibly soiled, use soap and water or an alcohol-based hand rub if hands are visibly clean
• Ensure alcohol-based hand rub meets the Therapeutic Goods Administration (TGA) re-quirements
• Know the correct technique:
  • Hand washing (40–60 sec): wet hands and apply soap; rub all surfaces; rinse hands and dry thoroughly with a single use item; use item to turn off faucet if required
  • Hand rubbing (20–30 sec): apply enough product to cover all areas of the hands; rub hands until dry (2)
• Conduct hand hygiene as often as required dependent upon tasks conducted (see Table 2 below)
• Performing routine hand hygiene in view of a client before and after any client contact is a demonstration of good infection prevention management (3)
• Educate and encourage your clients to conduct hand hygiene too.
• Ensure the following are considered and practiced in line with your practice policy to fa-cilitate effective hand hygiene:
  • Hand cream
  • Clothes
  • Jewellery
  • Artificial nails and/or nail polish
  • Any cuts and abrasions present (see NHMRC Guidelines page 33-35 for more in-formation on these areas).

When to conduct hand hygiene?

The 5 Moments of Hand Hygiene

• Before touching a client
• Before a procedure
• After a procedure or body substance exposure risk
• After touching a client
• After touching a client’s surroundings.

ALLIED HEALTH PRACTICE POINTS AND CONSIDERATIONS

Optometry Australia recommend that all areas where contact lenses may be inserted or re-moved should be fitted with hand basins as alcohol-based hand rubs are unsuitable for use in contact lens practice due to the risk of transferring undesirable aspects from the hands to the lens prior to eye insertion (4)

• Where possible hand basins should be fitted with elbow, foot or sensor-controlled taps to reduce the need for touching
• A designated hand washing sink that is not used for cleaning and/or reprocessing is re-quired (5)
• Hand washing facilities separate to client treatment areas for practice areas such as of-fices, workshops and storage areas should also be provided
• Podiatrists who perform any procedure that involves penetration of normally sterile tis-sues must perform surgical scrubbing techniques prior to doing so (6).

MORE INFORMATION

• National Hand Hygiene Initiative; Australian Commission on Safety and Quality in Health Care:
  • Covers aspects such as free online learning, brochures, posters, considerations for placement of basins and dispensers for positive influence and competency audit tools
• WHO: Hand Hygiene in outpatient and Home-based Care and long-term Care facilities [link in original no longer operating]
• Therapeutic Goods Administration; Hand Sanitiser information
• VIC Health: Hand hygiene (Arabic, Chinese, Italian, Malay, Vietnamese)

Table 2. Additional situations when Allied Health clinicians should conduct hand hygiene

Before

After

Starting/leaving work Eating/handling of food/drinks Using computer keyboard, tablet or mobile device in a clinical area Putting on gloves Handling invasive medical devices Entering/leaving clinical areas Touching or contacting a client, particularly immuno-compromised clients Moving from a contaminated to a clean body site of a client Immediately prior to conducting a clean/aseptic procedure Entering a client’s home Touching client’s assistive technology

Hands becoming visibly soiled Eating/handling of food/drinks Visiting the toilet Using a computer keyboard, tablet or mobile device in a clinical area Being in client-care areas during outbreaks of infection Removing gloves Handling laundry/equipment/waste Blowing/wiping/touching nose and mouth Smoking Touching a client and/or their personal items or items within their immediate vicinity – this includes any assistive technology the Allied Health clinicians and client are touching Touching blood, body fluids, secretions, excretions, non-intact skin and contaminated items, even if gloves are worn Leaving a client’s home Touching your own personal items such as phone, identity tag, keys

Extract 2: Scenario 1 – Community care

Scenario Context and Work Content

A large private sector organisation delivers health care and social services in the community to disabled adults and children, some with severe behavioural issues. Work activities occur largely in clients’ homes but can include transporting clients by vehicle to and from excursions to a park, shopping centre or other location, where members of the public are often present. Workers often work alone and are employed on a casual or contract basis. Minimal time is al-lowed for travel between clients, which forces workers to rush. Workers have received minimal training and lack knowledge of procedures or support available in the event of an emergency, including instances of client aggression. Workers have been injured by clients and do not report these incidents to the organisation. Workers are reluctant to raise concerns about the job with the organisation in case they lose work.

Psychosocial Hazards and Risks

High work demands:

• Role overload – workers have limited time to provide services and insufficient travel time between clients, causing them to rush.
• Workers are unable to take rest breaks due to inadequate time or support (being una-ble to leave clients unsupervised in public places).
• Workers experience high emotional and physical demands due to the nature of care provided (heavy lifting and responding to challenging behavioural issues).

Work-related violence and aggression:

• Workers have regular exposure to violent and aggressive behaviours from clients. These behaviours can be exacerbated by insufficient time to provide services

Isolated work:

• Work in people’s homes and in the community without co-workers and a lack of clari-ty/information regarding emergency response procedures (including responding to work-related violence and aggression, or remote work procedures).

Low job control:

• Workers’ employment is insecure (casual/ contractor) which adds to their fear of report-ing health and safety concerns to employer as they may risk reduced or no shifts.

Psychosocial Controls

The organisation, after consulting supervisors, workgroups and HSRs, takes the following steps to manage role overload, emotional demands, violence/aggression, isolated work and insecure work:

• Reviewing worker ratios and travel time in order to ensure sufficient workers rostered to complete work tasks.
• Implementing a risk assessment of each site location/community activity prior to service provision for a new client and/or new site location for care activity. Consideration is given to the client’s home environment and previous history when managing risks to workers. If risks are assessed as too high, service is refused until adaptations are made to minimise the risk.
• Policies are introduced and enforced to ensure where a client has been assessed as like-ly to exhibit violent or aggressive behaviours, two workers are allocated to provide care, or care is provided in a controlled environment.
• Regular reviews are conducted of work activities to ensure workload is manageable and additional support and training is provided as needed.
• Opportunities for regular communication/consultation are introduced to ensure work-ers are provided with up-to-date information and opportunities/avenues to connect with the organisation. Systems for professional supervision and debriefing are devel-oped and implemented.
• Workers receive information and training regarding work-related violence and aggres-sion and reporting of incidents, emergency response procedures, and support services available, with an increased focus on prevention and early intervention.
• Communication processes, equipment (mobile phones, duress alarms) and training are implemented to address risks associated with isolated work (including device monitor-ing to ensure appropriate and timely response to any emergency situations) .
• Employment agreements and entitlements are reviewed and adjusted where possible to enable more stable and secure employment opportunities.

Review and Improve

The organisation:

• Identifies and assesses risks and adequacy of controls through surveys/psychosocial risk assessment tools (e.g. People at Work psychosocial risk assessment survey), and continu-ally monitors and reviews other safety data (incident reporting, exposure to vio-lence/aggression, sickness absence, turnover etc.)
• Actively encourages reporting of incidents and health and safety concerns and ensures all reports are investigated in a timely manner, in accordance with procedures.
• Ensures workers are provided with information regarding incident investigations and complaints lodged, and opportunities for input during the investigation process regard-ing controls and safety issues. Workers are provided with support as needed including information about professional supervision options and other internal and external sup-port services available.
• Conducts regular monitoring and review of controls, clients’ needs and behaviours to ensure adequacy of controls.
• Delivers ongoing training to workers in relation to their role, activities performed and policies and procedures for managing risk to ensure competency remains current.
• Conducts a security review regarding worker safety while working in isolation, and emergency responses available to workers.

Extract 3: Examples of Control Measures for Psychosocial Hazards

The examples provided in the table below are not exhaustive and may be used to help inform risk management processes. Under the WHS Act psychosocial hazards that are a risk to psycho-logical health and safety must be eliminated so far as is reasonably practicable, or if that is not reasonably practicable, the risks must be minimised so far as is reasonably practicable in ac-cordance with the hierarchy of controls.

Focusing on higher level control measures that address work design will ensure the risk of harm is addressed at the source, as opposed to using measures that only reduce the impact of harm after it has occurred. In most cases a combination of controls will be needed to eliminate or minimise psychosocial risk. The examples in the table have generally been ordered from the highest level of controls to lowest. There are also additional controls at the end of this table that apply across all psychosocial hazards.

Situation	Example control measures
Psychosocial hazard: high and/or low job demands
Situations that may lead to high levels of time pressure and role overload include: allocating tasks to workers that are beyond their level of competence or capacity placing excessive expectations on new or exist-ing workers to learn new tasks quickly giving unreasonable deadlines for work tasks or being pressured to complete work tasks out-side of work hours or while on leave lack of resources required to complete tasks and projects, be it people, financial or physical resources absence of team members through illness or leave needing to quickly evaluate complex situations and make effective decisions under pressure, such as in medical or policing work. Situations that may lead to high levels of emotional demand include:   dealing with customer/client complaints or delivering bad news to customers, clients or co-workers engaging in performance conversations with underperforming work-ers or undertaking disciplinary processes providing support to customers, clients or co-workers that are emo-tionally distressed job requirements that specify workers can only express organisationally-approved emotions while at work (e.g. flight attendants being directed to always be happy and smiling while on duty). Situations that may lead to challenging work hours or shift work include: Note: work that involves challenging work hours or shift work is associ-ated with a greater risk of fatigue.   frequent night shifts or long shifts (over 12 hours) shifts patterns that are unpredictable regular or unplanned overtime shifts that provide inadequate time for sleep and recovery between periods of work workers being prevented from taking designated breaks from work tasks roles where there is an expectation of out of hours responsiveness and availability. Situations which may lead to low job demands include:   having little mental stimulation or problem solving in the work requiring workers to undertake repetitive tasks with little variety monotonous work, vigilance tasks, or sorting tasks (e.g. sorting irregu-lar fruit, monitoring CCTV cameras, stop/go machine operation) alloca-tion of tasks that are well below a worker’s level of competence or ca-pacity.	Time pressure, role overload Design the work to ensure manageable workloads with achiev-able performance standards. Implement self-check-in processes for customers/patients to reduce staff workloads. Rotate tasks and activities so that workers are not overex-posed to time pressured or excessively demanding work. Negotiate reasonable deadlines for completing tasks. Provide workers with sufficient time, resources, and appropri-ate equipment to perform the tasks assigned. Schedule regular breaks throughout the day and ensure that workers are taking breaks to get adequate rest and recovery. Monitor and manage workloads during periods of peak de-mand (e.g. end of financial year, seasonal peaks). Use this in-formation to plan and provide additional resources where re-quired. Ensure work tasks and cases are matched with the worker’s capability level. Ensure sufficient cover for workers who are on leave. Implement flexible working arrangement policies and practic-es. Implement workload reporting and review systems and schedule regular opportunities to review workloads with staff. Encourage work practices and systems that allow workers to disconnect from work outside of work hours. Emotional demands Where practicable, ensure workers are not required to approach difficult client situations on their own. Ensure there is sufficient supervision available. Implement systems to support workers when they are required to make difficult decisions or when there are negative consequences to decisions they have made (e.g. child safety workers). Provide workers/managers with safe spaces where they can have physical and psychological distance from events and/or debrief about emotionally demanding situations. Design work so it can be conducted in pairs or teams where practicable. Rotate work or activities to have adequate breaks from roles that involve exposure to emotional de-mands. Implement file flagging for potentially distressing files or cases to avoid inadvertent exposure to distress-ing content. Ensure there is a reporting system for exposure to distressing events and that managers or others check-in with affected workers following events. Where emotional demands are an unavoidable part of a worker’s role: ensure these are captured in a position description and that applicants are informed at the pre-selection stage monitor the psychological health through active supervision and provide training to managers/workers to understand and be alert to the early signs of mental health conditions/distress and how to offer support if identified provide training and practical support regarding how to diffuse difficult or confronting situations (e.g. conflict management skills) and implement escalation and supervisory support systems for staff. Challenging hours of work or shift work Ensure the roster provides for a continuous seven to eight hours sleep in each 24 hours. Implement systems to manage and limit overtime. Do not allow work to regularly exceed a 12-hour shift. Minimise safety-critical tasks during the early hours of the morning (2am to 6am). Ensure adequate work breaks and, where practicable, allow some flexibility in the timing of breaks, if pos-sible. Provide reasonable notice of shift rosters to allow workers to plan recovery activities. Ensure there is consultation about shift rosters with workers and provide communication and consulta-tion when designing or changing rosters. See more information in the Preventing and managing fatigue-related risk in the workplace guide availa-ble on the WorkSafe Queensland website. Low job demands Design work tasks and activities so workers aren’t overexposed to monotonous work. Implement processes to allow opportunities for job rotation to enable skill development and job varia-tion. Engage in career planning conversations with workers to identify work that provides them with a sense of meaning/purpose.
Psychosocial hazard: high and/or low job demands (cont.)
Situations that may lead to workers experiencing low levels of control include: workers not being involved in decisions that affect them or their cli-ents work that is tightly managed and controlled (e.g. machine or computer paced, scripted call centres with set breaks and rostering, work that requires permission before progressing with routine tasks) lack of formal and/or informal opportunities to learn and develop new skills where workers have little say in the way they do their work (e.g. when they can take a break from certain tasks or change tasks) excessive monitoring and scrutiny of low-level tasks insecure, precarious and contingent work arrangements (e.g. casual work, labour hire, fixed-term contracts, gig economy workers).	Where reasonably practicable, avoid insecure, precarious and contingent work arrangements (e.g. move long-term casual workers to permanent contracts, consult and provide advance notice of work arrange-ments). Consult workers when determining goals, objectives, work hours, performance indicators, work require-ments and deadlines. Facilitate discussion and input into what work tasks need to be achieved and how. Involve workers in decision-making processes and encourage suggestions for continuously improving work practices (e.g. in performance reviews, team meetings etc.). Implement processes to allow workers to have some control over workflow, customer queues, and task intake etc. Implement policies and practices for flexible working arrangements. Ensure systems are in place to provide adequate training to managers on strategies that empower work-ers rather than micro-managing.
Psychosocial hazard: poor support
Situations that may lead to workers experiencing low levels of control include: workers not being involved in decisions that affect them or their cli-ents work that is tightly managed and controlled (e.g. machine or computer paced, scripted call centres with set breaks and rostering, work that requires permission before progressing with routine tasks) lack of formal and/or informal opportunities to learn and develop new skills where workers have little say in the way they do their work (e.g. when they can take a break from certain tasks or change tasks) excessive monitoring and scrutiny of low-level tasks insecure, precarious and contingent work arrangements (e.g. casual work, labour hire, fixed-term contracts, gig economy workers).	Where reasonably practicable, avoid insecure, precarious and contingent work arrangements (e.g. move long-term casual workers to permanent contracts, consult and provide advance notice of work arrange-ments). Consult workers when determining goals, objectives, work hours, performance indicators, work require-ments and deadlines. Facilitate discussion and input into what work tasks need to be achieved and how. Involve workers in decision-making processes and encourage suggestions for continuously improving work practices (e.g. in performance reviews, team meetings etc.). Implement processes to allow workers to have some control over workflow, customer queues, and task intake etc. Implement policies and practices for flexible working arrangements. Ensure systems are in place to provide adequate training to managers on strategies that empower work-ers rather than micro-managing.
Psychosocial hazard: poor support
Situations that may lead to workers experiencing poor support include: workers who are not provided instrumental support to carry out the job (access to tools, resources, information, or coaching needed) workers who work in isolation or in geographically-dispersed teams where managers are required to manage large numbers of workers and it is difficult to provide adequate support to individuals workers who do not have time or opportunity within work hours to speak with their colleagues or managers (e.g. highly regimented work-places such as call centres, medical practices) working in fly-in/fly-out or drive-in/drive-out arrangements where workers are away from their usual social supports.	Supervisor support Establish clear reporting lines within teams so workers know where they can go for help with work prob-lems. Ensure supervisors are provided with sufficient resources and support to undertake their supervisory duties (e.g. ensure that supervisors have a manageable workload, and their span of control is not so great it prevents effective supervision). Assist workers with practical solutions for any task-related issues that arise (e.g. ensure adequate backfill-ing of roles or redistribution of work when workers are out of the office or away on leave). Provide leadership development that emphasises the importance of task and emotional support from leaders and supervisors and how to connect workers to professional mental health support when re-quired. Schedule and prioritise time for regular and open discussion between workers and supervisors about support needs (e.g. foster a culture of collaboration and support by discussing any pressures and chal-lenges within the work unit). Provide psychosocial advice to supervisors conducting disciplinary processes – particularly for the pur-pose of being aware of processes and support needed. Co-worker support Design work in such a way as to emphasise team collaboration rather than independent working and allow opportunities for incidental peer discussion about work tasks during the workday. Decrease factors within work roles that are likely to increase competition. Develop a team charter that emphasises expected behaviours. Structure reward and recognition programs around team achievements rather than individual achieve-ments. Develop a peer support network and/or a mentoring/buddy program for new starters. If responding to highly publicised issues (e.g. an incident picked up by the media or in social media), en-sure procedures are established to support workers involved or affected.
Psychosocial hazard: low role clarity/role conflict
Situations that may lead to workers experiencing low role clarity or role conflict include: where workers have multiple reporting lines and/or supervisors and competing demands associated with these being asked to undertake a specific task with no instructions or de-tailed information about requirements lack of clarity about what tasks need to be completed, their priority and deadlines changing position descriptions and/or areas of responsibility without consultation or discussion allocating the same task to two different workers, resulting in duplica-tion of effort.	Establish clear role expectations for individuals, including their role within their immediate work team and the broader organisation. Implement a comprehensive recruitment and induction process (define role purpose, reporting relation-ships and key duties, tasks, responsibilities, and role expectations). Avoid making workers accountable to more than one immediate supervisor to reduce potential conflict in work demands. Avoid placing inconsistent or incompatible demands on workers. Identify issues such as duplication, in-sufficient work instructions, errors, missed deadlines, and problems with work task allocation. Ensure roles are clearly understood via the provision of training and supervision, and a current role de-scription. Ensure that management structures and reporting lines are clearly defined. This can be supported by an organisational chart. Implement a timely performance feedback system.
Psychosocial hazard: poor organizational change management
Situations that may lead to poor organisational change management in-clude: failure to consider health and safety impacts during organisational changes, such as downsizing or relocations disorganisation and lack of planning in organisational change implementing changes without sufficient consultation and stakehold-er engagement failure to communicate key messages, updates, or reasons for change inadequate support provided to those affected during transition times.	Ensure there are systematic approaches for conceiving, planning, developing, implementing and evaluat-ing changes. Implement robust consultation and engagement practices (e.g. group information and/or feedback ses-sions) as part of change projects. Give workers the background and reasons behind changes and check understanding. Ensure the person communicating the change has the skills and authority to do so. Train managers or supervisors to support workers through periods of change. Ensure workers receive enough training for them to be confident and competent in new roles.
Psychosocial hazard: low reward and recognition
Situations that may lead to workers experiencing low recognition and reward include: the absence of positive feedback about work performance the absence of appropriate mechanisms and practices for regular performance discussions, performance planning and goal setting providing recognition or acknowledgement that is not meaningful, vague, or not attributed to specific situations.	Implement a performance review system that ensures workers are provided with positive and construc-tive advice for future performance, including opportunities for skill development. Recognise workers for their work outputs, but also for their ideas and behaviours. Ensure praise and recognition is built into leadership training. Provide supervisors and workers with a range of strategies to recognise others, understanding that people like to be acknowledged in different ways. Implement recognition programs that provide all workers with equal opportunity to be recognised for their contributions. Ensure that workers are being provided with feedback that is timely, practical and specific to their work tasks.
Psychosocial hazard: poor organisational justice
Situations that may lead to workers experiencing poor organisational justice include: inequitable or inconsistent application of procedures across workers or over time (e.g. reward and recognition, promotion or job rotations, opportunities for training or job assignments) unfair or inequitable distribution of resources (e.g. pay inequities, access to benefits) bias, impartiality [sic: this should be partiality], favouritism and nepo-tism workers or managers believing that rules do not apply to them and failing to follow agreed policies, guidelines and procedures.	Design fair procedures and implement procedures consistently over time and across all workers and work groups (e.g. a structured performance review and recruitment processes so all workers are reviewed and recruited using consistent processes). Apply processes and procedures (e.g. recruitment, performance management) in a transparent and con-sistent manner. To do this, ensure managers and supervisors are provided information and training. Ensure procedures are explained to workers in situations where the procedure will be applied to them (at the commencement of disciplinary procedures or complaint processes) Provide workers with a mechanism to manage complaints or appeal the result of a procedure. Where a worker may perceive unfair work practices, encourage them to access the appeal process. Review decisions to ensure that they are fair and free of bias. Train managers in how to have difficult conversations with their workers in a fair and just way. Foster a culture of transparency, openness, respect, fairness and equity. Provide support and communication mechanisms for all parties to complaints and those going through disciplinary or investigative procedures.
Psychosocial hazard: poor workplace relationships including interpersonal conflict
Situations that may lead to poor workplace relationships and interper-sonal conflict include: incivility (abrupt rude behaviour) or other inappropriate behaviour is demonstrated and/or tolerated by management and co-workers frequent or heightened task conflict between workers, supervisors, co-workers and clients or others discrimination or other unreasonable behaviours by co-workers, su-pervisors or clients a lack of fairness and equity in dealing with workplace issues or where performance issues are poorly managed unresolved issues or concerns regarding work tasks, processes, cus-tomers, interpersonal issues.	Identify and minimise work design issues that may negatively affect team communication (e.g. competi-tion or isolated work groups). Provide sufficient opportunities for workers to get to know each other and build positive relationships. Develop a code of conduct so that everyone is aware of appropriate work behaviours. Implement and maintain a system to manage inappropriate workplace behaviours in accordance with the Code of Conduct. Monitor the work environment for potential disagreements, factors or situations that may result in con-flict and address these promptly. Encourage respectful discussion and sharing of differing views and ideas among workers and within the team. Clarify team rules of communication or develop a team charter. Provide managers with the knowledge and skills to identify and manage conflict and respond to inappro-priate behaviour, including accessing third-party professional support when required.
Psychosocial hazard: remote or isolated work
Situations that may lead to increased risk in remote or isolated work include: limited access to communication devices or no regular contact with other workers or supervisors lengthy periods of isolation working away from social and family con-tacts, and support networks such as fly-in/fly-out or drive-in/drive-out arrangements excessive monitoring of workers working from home work in locations where there is difficulty in immediate rescue or at-tendance of emergency services work where violence or aggression from customers	Ensure emergency communication systems in place are suitable for the location. Ensure accommodation is lockable, with safe entry and exit, meets all relevant structural and stability re-quirements, and has all fittings, appliances and equipment in good condition. Use a buddy system, particularly where there is a risk of violence or misadventure, or risks to physical safety. Ensure workers are trained in, and carry out, situational risk assessments of the safety of their work loca-tion before commencing duties (e.g. when they are working in a client’s home or in the community). Ensure there is appropriate supervision/monitoring systems in place when workers are working in isola-tion, in the community, or away from the workplace such as: monitored CCTV and enhanced visibility schedule periodic visits by supervisors to visually observe workers and provide appropriate support and assistance procedures to maintain regular contact between workers and supervisors using suitable communica-tion devices automatic warning devices that raise the alarm in an emergency a ‘check-in’ at the beginning and ‘sign-off’ at the end of the working period use satellite tracking systems or devices. Design emergency response procedures in consideration of location and access to services available (e.g. relevant for medical emergencies and response time, consult with emergency services about possible rescue scenarios and what would be involved). Implement opportunities for regular organisational communication/consultation to ensure workers are provided with up-to-date information and opportunities/avenues to connect with the organisation regu-larly.
Psychosocial hazard: poor environmental conditions
Situations that may lead to workers experiencing stress due to poor environmental conditions include: excessive or irritating noise or vibration unmanaged biological or chemical hazards (e.g. health care workers with insufficient PPE) low, very bright or flickering lighting extremes of temperature or poor air quality.	Design and maintain plant, equipment and work environments to eliminate or minimise risks associated with stressful environmental hazards (e.g. stressful vibration, lighting, nuisance noise, thermal discomfort, poor air quality, biological or chemical hazards). Ensure appropriate PPE and resources are provided to workers. In addition to other control measures, utilise PPE to minimise residual risk (e.g. use face shields where workers are at risk of exposure to COVID-19 and spitting is a risk, or hearing protection if nuisance noise cannot be eliminated). Ensure workers are trained in work systems to manage risk associated with stressful environmental haz-ards. Ensure systems are in place for workers to report the presence of poor environment conditions that may create a stress response.
Psychosocial hazard: exposure to traumatic events
Situations that may lead to exposure to traumatic events include: working in certain areas or occupations (e.g. health care, community work, counselling, defence, funeral services, child protective services, correction officers, legal services, high risk work where injuries may occur). responding to emergencies (e.g. incidents requiring response by emergency service workers including police, emergency health work-ers, firefighters, ambulance officers and triple-zero call receivers) providing care to those experiencing a traumatic event, listening to, viewing or reading detailed descriptions of traumatic events experi-enced by others (e.g. rape crisis or child safety officers, lawyers or immigration officers, workplace incident investigators).	Rotate roles or activities to ensure adequate breaks from roles likely to involve exposure to traumatic events. Implement file flagging processes on potentially distressing files or cases to avoid inadvertent exposure to distressing content. Ensure procedures are in place to respond to critical incidents including practical support for workers, counselling/professional support services, appropriate information about available resources. Ensure systems are in place to regularly monitor workers’ exposure to traumatic events and workers’ psy-chological health. Where repeated high-risk exposure to distressing events is an unavoidable part of the role, consider additional risk controls including reducing workload to decrease exposure, increasing breaks and recovery time, or implementing periodic health assessments. Design procedures to support workers in response to exposure to traumatic events. Ensure managers are provided with adequate information, training and instruction in how to respond and manage reported exposure of workers, including how to identify early signs of distress or psychological injury and how to offer support if required. Ensure workers are provided with information on how to report exposure to traumatic events and other procedures in relation to support options available.
Psychosocial hazard: violence and aggression
Situations where a worker is subjected to violent or aggressive behav-iour include: scratching or hitting attacking with any type of weapon or substance (e.g. knives, guns, incidental weapons like keys, bats or rocks, or chemical agents such as hazardous chemicals or affects from use of drugs or alcohol) pushing, shoving, tripping or grabbing armed robbery sexual violence intentionally coughing or spitting on someone verbal abuse and threats including intimidation, insults, shouting, or swearing banging, kicking, throwing, or hitting objects online abuse or threats, including on social media. Workers in occupations most at risk of work-related violence and ag-gression include those who regularly work with the public or provide services to clients such as: doctors, nurses, ambulance officers welfare workers, personal carers waitstaff and housekeeping workers police officers, corrections officers, child safety officers teachers and teacher aides debt collectors front-office workers, call centre workers cashiers, retail and hospitality workers, salespeople, and security guards bus drivers, taxi drivers, couriers, cabin crew workers who work alone or in remote locations. Violence and aggression can also constitute criminal behaviours. See section 3.1.3 for factors that increase the risk of work-related vio-lence and aggression.	Physical work environment and security Ensure the building is secure, maintained and fit for purpose. Control access to work areas. Use secure service windows, CCTV, timer safes, and anti-jump screens where appropriate. Prevent access to dangerous or heavy implements or objects that could be thrown or used to injure someone. Increase visibility of who is coming into the premises/work area through access, lighting, positioning of furniture. Fit communication and fixed or personal duress alarm systems (e.g. personal duress alarms could be used in community services work where there is a risk of aggressive behaviour. Duress alarms should be attached to clothing but not worn around the neck). Use safe glass (e.g. laminated, toughened, or glass alternatives like Perspex), including in picture frames and mirrors. Provide a safe space for workers and others to retreat to in order to avoid violent or aggressive situations. Ensure vehicles are fit for purpose and well maintained (e.g. have central locking, tracking devices with GPS to allow drivers in distress to be located, lighting inside the vehicle to see passenger behaviour). Engage security consultants/professionals to conduct security assessments and/or provide security services. Work systems and procedures for: Empowering workers to restrict, refuse or suspend service if other people fail to comply with the expected standard of behaviour. Reducing frustration levels of clients (e.g. readily available assistance, alternatives to queues, or waiting areas with entertainment). Managing the handling of cash and valuable products (e.g. limit the amount of cash, valuables and drugs held on premises and store them securely, vary banking times, or utilise security personnel). Responsible service of alcohol. Communication with clients about violence and aggression control measures (e.g. signs at the workplace such as zero tolerance of aggression and violence, security cameras are in use, or holding limited cash on the premises). Safe opening and closing of the business. Assessing individual client needs (conditions, triggers, care requirements) and the provision of appropriately skilled workers. A trauma-informed approach and management plans for clients known to have a history of aggression and regular handover of information (with workers, other agencies, carers and service providers that includes safety components, in addition to clinical care plans). Identification systems such that workers and authorised visitors are clearly identified (minimisation). Working in remote or isolated locations (see risk controls for this hazard noted under ‘Remote or Isolated work’ in this table). Worker and manager training in: Violence prevention measures (including trauma-informed approaches, use and testing of communica-tion/alarm/duress systems, emergency drills etc) Positive behaviour expectations, de-escalation and emotional regulation Incident investigation and WHS risk management Monitoring the health of workers for managers and supervisors Work policy and procedures, including emergency response systems and reporting of incidents. See more information in the Preventing and responding to work-related violence guide, available on the WorkSafe Queensland site.
Psychosocial hazard: bullying
Examples of behaviour, whether intentional or unintentional, that may be work-related bullying if it is repeated, unreasonable and creates a risk to health and safety includes: abusive, insulting or offensive language or comments aggressive and intimidating conduct (verbal or physical) belittling or humiliating comments teasing or regularly making someone the brunt of practical jokes the making of vexatious allegations against a worker spreading rude, inaccurate, or malicious rumours about an individual responding to a complaint, report, or incident in a grossly unfair man-ner victimisation unjustified criticism or complaints unreasonably excluding someone from work-related activities setting unreasonable timelines or constantly changing deadlines setting tasks that are unreasonably below or beyond a person’s skill level using changes to work arrangements such as rosters and leave as a way to victimise completely ignoring or isolating an individual. See section 3.1.3 for factors that increase the risk of work-related bully-ing.	Empower workers to refuse or suspend service if other people fail to comply with the expected standard of behaviour. Design work to minimise psychosocial hazards that increase the risk of work-related bullying (see for ex-ample, risk controls noted under ‘Poor workplace relationships’, ‘work demands’, ‘poor support’, ‘low role clarity’, and ‘poor organisational justice’ in this table). Develop and implement a bullying policy (see example in Appendix 5). Communicate in-person and online behavioural expectations to all workers and clients via training and other methods, including role modelling of appropriate behaviours by leaders and line managers. Implement effective reporting processes, and actively monitor staff welfare through regular consultation. Encourage staff to report any inappropriate behaviour they witness towards themselves or others and address these reports in a timely and consistent way with feedback provided. Implement and maintain a system to manage inappropriate workplace behaviours in accordance with the Code of Conduct. See more information in the Preventing and responding to workplace bullying guide, available on the WorkSafe Queensland website.
Psychosocial hazard: harassment including sexual harassment
Factors that may increase the likelihood or risk of harassment include: particular cohorts of workers who are more vulnerable such as young workers, workers with a disability, Aboriginal and Torres Strait Islander workers, workers in insecure or precarious forms of employment, and workers on working visas low worker diversity (e.g. the workforce is dominated by one gender, age group, race or culture) power imbalances (e.g. workplaces where one gender holds most of the management and decision-making positions) workplaces organised according to a hierarchical structure (e.g. police and enforcement organisations, or medical or legal professions) workplace culture that supports or tolerates sexual harassment, including where lower level (but still harmful) forms of harassment are accepted (e.g. small acts of disrespect and inequality are ignored and reports of sexual harassment or inappropriate behaviours are not taken seriously) - this conduct can escalate to other forms of harassment, work-related bullying/violence and aggression use of alcohol in a work context, and attendance at conferences and social events as part of work duties (including overnight travel) workers are isolated (e.g. due to location, hours of work) in restrictive places like cars, working at residential premises, living in employer provided accommodation, working from remote locations with limited supervision, or have restricted access to help and support working from home, which may provide an opportunity for covert sexual harassment to occur online or through phone communication worker interactions with clients, customers or members of the public (either face to face or online) which may give rise to third party sexual harassment including work that involves a high level of contact or work in close proximity to customers or clients poor understanding among workplace leaders of the nature, drivers and impacts of sexual harassment.	Empower workers to refuse, restrict or suspend service if people fail to comply with the expected stand-ard of behaviour. Physical work environment and security Provide facilities that give privacy and security. Ensure the layout of the workplace provides good visibility of work areas and avoids restrictive movement. Ensure there are no areas where workers could become trapped, such as rooms with keyed locks. Provide communication systems like phones or duress alarms (and provide workers with information, instruction and training on how to use these). Ensure a safe working environment for workers during access and egress from the workplace, during trav-el, at client or customer premises and any other location where work is performed. Work systems and procedures for: Responsible service of alcohol policies at work and at work events. Standards of behaviour and procedures for what a worker should do if they experience or see harass-ment at work or work-related events or from third parties to the workplace (including sexual harassment).  Addressing reports of harassment consistently and in accordance with procedures, including the provi-sion of sufficient, appropriate and timely feedback to workers who have raised concerns. Avoiding sexualised uniforms and ensuring clothing is practical for the work undertaken. Regularly monitoring and reviewing work systems and practices, to evaluate effectiveness in minimising the likelihood of harassment occurring. Collecting de-identified details of all harassment complaints, including those that are not pursued, to help identify systemic issues. Effectively reporting and monitoring staff welfare through regular consultation. See more information in the Preventing workplace sexual harassment guide, available on the WorkSafe Queensland website.

While the table above provides examples of control measures specific to each psychosocial haz-ard, there are a number of control measures that apply across all psychosocial hazards. The list below provides example lower-level controls, which are common across all psychosocial haz-ards:

• Ensure there are workplace specific policies for any psychosocial hazards identified as creating risk in your workplace. For example, see the workplace bullying policy in Appendix 5. 
• Ensure there is training for leaders and line-managers about their role in the design and management of work and psychosocial hazards and in providing support, particularly if their workers have experienced demanding, distressing, or traumatic events or have been exposed to bullying, violence, aggression, or sexual harassment. 
• Build capability of workers by providing training relevant to any high-risk hazards identi-fied (e.g. conflict management skills, dealing with aggressive behaviour, high work de-mands, working alone or in remote locations, emotional competencies, or interpersonal skills). 
• Provide clear guidelines and expectations about respectful workplace behaviours and ensure leaders and line-managers model these behaviours. 
• Ensure professional psychological support is available to workers who are directly or in-directly exposed to traumatic events or other emotionally demanding work. 
• Provide clinical supervision in addition to managerial supervision to those who are ex-posed to work that has risks of occupational violence and traumatic events to manage risks of burnout and PTSD. 
• Create an environment in which workers feel comfortable raising concerns about any psychosocial hazards. 
• Provide clear guidelines and expectations on how to report psychosocial hazards or concerns in the workplace and respond in a timely, empathic, and effective manner to these concerns. 
• Ensure there are appropriate mechanisms to manage any poor performance of workers or supervisors. 
• Educate workers and managers about early warning signs of stress and fatigue and how to respond when they recognise them in themselves or others. 
• Managing the risk of psychosocial hazards at work Code of Practice 2022 Page 63 of 67
• Promote work-life balance and encourage workers to implement self-care practices, take annual leave regularly or to recover from periods of high demands.
• Provide and promote an employee assistance program for professional mental health support to workers who are experiencing high stress levels when they are exposed to psychosocial hazards (particularly exposure to trauma, bullying, violence and aggression or sexual harassment).
• Consult with workers to gain an understanding of specific requirements or reasonable adjustments in their working conditions to support individuals to perform their duties effectively (e.g. workers with a disability, recovering from injury, or neurodiverse indi-viduals).
• Develop and implement systems for professional supervision and debriefing.

Workplace Discrimination and Harassment Policy Template

Background to this Template

This template will help you create your own workplace discrimination and harassment policy. It covers topics relevant to the following Federal laws:

• Sex Discrimination Act 1984 (Cth)
• Racial Discrimination Act 1975 (Cth)
• Disability Discrimination Act 1992 (Cth)
• Age Discrimination Act 2004 (Cth)
• Australian Human Rights Commission Act 1986 (Cth).

Other Federal and state/territory laws may also apply to your workplace.

You may wish to customise, add or remove topics.

Read the instructions below to create your own document, and delete this page from your final version.

NOTE: DELETE THIS PAGE ONCE YOU COMPLETE THE TEMPLATE.

<Business name> Workplace Discrimination and Harassment Policy

1. 1. Scope
   • This policy applies to:
     • board members
     • all staff, including: managers and supervisors; full-time, part-time or casual, temporary or permanent staff; job candidates; student placements, apprentices, contractors, sub-contractors and volunteers
     • how <Business name> provides services to clients and how it interacts with other members of the public
     • all aspects of employment, recruitment and selection; conditions and benefits; training and promotion; task allocation; shifts; hours; leave arrangements; workload; equipment and transport
     • on-site, off-site or after hours work; work-related social functions; conferences – wher-ever and whenever staff may be as a result of their <Business name> duties
     • staff treatment of other staff, of clients, and of other members of the public encoun-tered in the course of their <Business name> duties.
2. Aims
   • [Guidance note (delete this later): This section could also directly quote from relevant parts of your business’s vision, mission or values.]
   • <Business name> is committed to providing a safe, flexible and respectful environment for staff and clients free from all forms of discrimination, bullying and sexual harassment. 
   • All <Business name> staff are required to treat others with dignity, courtesy and respect.
   • By effectively implementing our Workplace discrimination and harassment policy we will at-tract and retain talented staff and create a positive environment for staff.
3. Staff rights and responsibilities
   • All staff are entitled to:
     • recruitment and selection decisions based on merit and not affected by irrelevant per-sonal characteristics
     • work free from discrimination, bullying and sexual harassment
     • the right to raise issues or to make an enquiry or complaint in a reasonable and respect-ful manner without being victimised
     • reasonable flexibility in working arrangements, especially where needed to accommo-date their family responsibilities, disability, religious beliefs or culture.
     • All staff must:
     • follow the standards of behaviour outlined in this policy
     • offer support to people who experience discrimination, bullying or sexual harassment, including providing information about how to make a complaint
     • avoid gossip and respect the confidentiality of complaint resolution procedures
     • treat everyone with dignity, courtesy and respect.
   • 3.1. Additional responsibilities of managers and supervisors
     • Managers and supervisors must also:
     • model appropriate standards of behaviour
     • take steps to educate and make staff aware of their obligations under this policy and the law
     • intervene quickly and appropriately when they become aware of inappropriate behav-iour
     • act fairly to resolve issues and enforce workplace behavioural standards, making sure relevant parties are heard
     • help staff resolve complaints informally
     • refer formal complaints about breaches of this policy to the appropriate complaint han-dling officer for investigation
     • ensure staff who raise an issue or make a complaint are not victimised
     • ensure that recruitment decisions are based on merit and that no discriminatory re-quests for information are made
     • seriously consider requests for flexible work arrangements.
4. Unacceptable workplace conduct
   • Discrimination, bullying and sexual harassment are unacceptable at <Business name> and are unlawful under the following legislation:
     • Sex Discrimination Act 1984 (Cth)
     • Racial Discrimination Act 1975 (Cth)
     • Disability Discrimination Act 1992 (Cth)
     • Age Discrimination Act 2004 (Cth)
     • Australian Human Rights Commission Act 1986 (Cth). 
     • Staff (including managers) found to have engaged in such conduct might be counselled, warned or disciplined. Severe or repeated breaches can lead to formal discipline up to and including dismissal.
   • 4.1. Discrimination
     • Discrimination is treating, or proposing to treat, someone unfavourably because of a personal characteristic protected by the law, such as sex, age, race or disability.
     • Discrimination can occur:
     • Directly, when a person or group is treated less favourably than another person or group in a similar situation because of a personal characteristic protected by law (see list below).
     • For example, a worker is harassed and humiliated because of their race
     • or
     • A worker is refused promotion because they are ‘too old’
     • Indirectly, when an unreasonable requirement, condition or practice is imposed that has, or is likely to have, the effect of disadvantaging people with a personal characteristic protected by law (see list below).
     • For example, redundancy is decided based on people who have had a worker’s compen-sation claim rather than on merit.
     • Protected personal characteristics under Federal discrimination law include:
     • a disability, disease or injury, including work-related injury
     • parental status or status as a carer, for example, because they are responsible for caring for children or other family members
     • race, colour, descent, national origin, or ethnic background
     • age, whether young or old, or because of age in general
     • sex
     • industrial activity, including being a member of an industrial organisation like a trade union or taking part in industrial activity, or deciding not to join a union
     • religion
     • pregnancy and breastfeeding 
     • sexual orientation, intersex status or gender identity, including gay, lesbian, bisexual, transsexual, transgender, queer and heterosexual 
     • marital status, whether married, divorced, unmarried or in a de facto relationship or same sex relationship
     • political opinion 
     • social origin
     • medical record
     • an association with someone who has, or is assumed to have, one of these characteris-tics, such as being the parent of a child with a disability.
     • It is also against the law to treat someone unfavourably because you assume they have a per-sonal characteristic or may have it at some time in the future.
   • 4.2. Bullying
     • If someone is being bullied because of a personal characteristic protected by equal opportunity law, it is a form of discrimination.
     • Bullying can take many forms, including jokes, teasing, nicknames, emails, pictures, text mes-sages, social isolation or ignoring people, or unfair work practices.
     • Under Federal law, this behaviour does not have to be repeated to be discrimination – it may be a one-off event.
     • Behaviours that may constitute bullying include:
     • sarcasm and other forms of demeaning language
     • threats, abuse or shouting
     • coercion
     • isolation
     • inappropriate blaming
     • ganging up
     • constant unconstructive criticism
     • deliberately withholding information or equipment that a person needs to do their job or access their entitlements
     • unreasonable refusal of requests for leave, training or other workplace benefits.
     • Bullying is unacceptable in <Business name> and may also be against occupational health and safety law. 
   • 4.3. Sexual harassment
     • Sexual harassment is a specific and serious form of harassment. It is unwelcome sexual behav-iour, which could be expected to make a person feel offended, humiliated or intimidated. Sex-ual harassment can be physical, spoken or written. It can include:
     • comments about a person’s private life or the way they look
     • sexually suggestive behaviour, such as leering or staring
     • brushing up against someone, touching, fondling or hugging
     • sexually suggestive comments or jokes
     • displaying offensive screen savers, photos, calendars or objects
     • repeated unwanted requests to go out
     • requests for sex
     • sexually explicit posts on social networking sites
     • insults or taunts of a sexual nature
     • intrusive questions or statements about a person’s private life
     • sending sexually explicit emails or text messages
     • inappropriate advances on social networking sites
     • accessing sexually explicit internet sites
     • behaviour that may also be considered to be an offence under criminal law, such as physical assault, indecent exposure, sexual assault, stalking or obscene communications.
     • Just because someone does not object to inappropriate behaviour in the workplace at the time, it does not mean that they are consenting to the behaviour.
     • Sexual harassment is covered in the workplace when it happens at work, at work-related events, between people sharing the same workplace, or between colleagues outside of work.
     • All staff and volunteers have the same rights and responsibilities in relation to sexual harass-ment.
     • A single incident is enough to constitute sexual harassment – it doesn’t have to be repeated.
     • All incidents of sexual harassment – no matter how large or small or who is involved – require employers and managers to respond quickly and appropriately.
     • <Business name> recognises that comments and behaviour that do not offend one person can offend another. This policy requires all staff and volunteers to respect other people’s limits.
   • 4.4. Victimisation
     • Victimisation is subjecting or threatening to subject someone to a detriment because they have asserted their rights under equal opportunity law, made a complaint, helped someone else make a complaint, or refused to do something because it would be discrimination, sexual har-assment or victimisation. Victimisation is against the law.
     • It is also victimisation to threaten someone (such as a witness) who may be involved in investi-gating an equal opportunity concern or complaint.
     • Victimisation is a very serious breach of this policy and is likely (depending on the severity and circumstances) to result in formal discipline against the perpetrator.
     • <Business name> has a zero tolerance approach to victimisation. 
   • 4.5. Gossip
     • It is unacceptable for staff at <Business name> to talk with other staff members, clients or sup-pliers about any complaint of discrimination or harassment. 
     • Breaching the confidentiality of a formal complaint investigation or inappropriately disclosing personal information obtained in a professional role (for example, as a manager) is a serious breach of this policy and may lead to formal discipline.
5. Merit at <Business name>
   • All recruitment and job selection decisions at <Business name> will be based on merit – the skills and abilities of the candidate as measured against the inherent requirements of the posi-tion – regardless of personal characteristics.
   • It is unacceptable and may be against the law to ask job candidates questions, or to in any other way seek information, about their personal characteristics, unless this can be shown to be di-rectly relevant to a genuine requirement of the position.
6. Resolving issues at <Business name>
   • <Business name> strongly encourages any staff member who believes they have been discrimi-nated against, bullied, sexually harassed or victimised to take appropriate action by [Guidance note (delete this later): explain how to make a complaint and provide for an initial contact per-son]. 
   • Staff who do not feel safe or confident to take such action may seek assistance from [Guidance note (delete this later): list contacts.] for advice and support or action their behalf. 
   • 6.1. Employee assistance program
     • [Guidance note (delete this later): keep this section if relevant]
     • <Business name> staff are entitled to a certain amount of free, professional counselling from our employee assistance program. To access the employee assistance program, contact [Guid-ance note (delete this later): provide contact details to access this service.]
     • Employee assistance program counselling is confidential and nothing discussed with a counsel-lor will be communicated back to <Business name>. Employee assistance program counselling is available free to <Business name> staff regardless of whether the issue is related to a workplace problem or some other issue for the staff member.
7. Other relevant <Business name> policies
   • Staff, especially managers and supervisors, are encouraged to read this policy in conjunction with other relevant <Business name> policies, including [Guidance note (delete this later): list relevant policies.]
   • Workplace sexual harassment policy
   • Flexible work arrangements policy
   • Pregnancy and work procedure and policy
   • Occupational health and safety policy
   • Workplace complaint resolution policy and procedure
   • Discipline procedure
   • Mission, vision and values statements
   • Enterprise bargaining agreements [Guidance note (delete this later): list relevant agreements.]
   • Service agreement [Guidance note (delete this later): any document that outlines the rights of clients and customers to complain about the service they are receiving.]
8. 8. More information
   • If you have a query about this policy or need more information please contact [Guidance note (delete this later): list contacts].
9. Review details
   • This policy was adopted by <Business name> on [insert date]
   • This policy was last updated on [insert date]

I. About this Guide

This guide to plain English is for anyone who needs to communicate information to others and wants to do that as clearly as possible. It has been produced by 26TEN, a network of people and organisations working together to improve adult literacy and numeracy rates in Tasmania.

Writing and reading are a big part of how we communicate with each other. Many of us regular-ly send and receive important information through:

• emails
• letters
• signs
• job applications
• contracts
• reports
• policies
• instructions
• forms
• brochures
• websites
• newsletters
• speeches
• file notes for colleagues.

Plain English is a style of communication that studies have shown makes information easier to understand.²

The guide brings together a set of plain English tips. The main section covers how to write and present information clearly. Towards the end is an index, a handy summary, examples of clearer words and phrases to use, checklists to help review documents and forms, and a list of extra resources.

While the guide is based on English grammar, you don’t need to be an expert in grammar to be able to use it and write and speak in plain English.³

Literacy and Numeracy in Tasmania

One in every two Tasmanian adults has difficulties with the literacy and numeracy tasks that are part of everyday life – things like filling in forms, reading bills and bank statements, understand-ing safety signs at work, adding up at the supermarket, and reading instructions on everything from machinery to medications.

Not all adults with literacy and numeracy difficulties are the same. Some may be better at numbers than spelling and some may be better at reading than writing. Some can read short pieces of writing, but find it hard to understand longer or detailed documents. Literacy and numeracy skills are like muscles. We need to use and update them regularly or they weaken.

The literacy and numeracy skills expected by society are changing all the time. Some of us may have left school confident about our skills, but changes in our workplaces and everyday life since then place new pressures on them.

^{2 For various studies, see these online resources, www.plainlanguage.gov/whyPL/benefits/grotsky.cfm,
www.plainlanguage.gov/whyPL/benefits/bottomline.cfm, www.wordcentre.co.uk/page57.htm. Also see this book Writ-ing for Dollars, Writing to Please by Joseph Kimble, Carolina Academic Press, 2012.
3  If you would like to understand grammar better, there are good guides and courses available. See the extra resources in Appendix 5 or contact 26TEN for other suggestions.
4  Adult Literacy in Tasmania, 2006, Australian Bureau of Statistics, published in 2008.} 

Writing and Presenting Information Clearly

Being able to understand and act on a document the first time you read it is something we can all appreciate, no matter what our level of literacy. Just as important is spoken communication. Information that isn’t presented clearly creates confusion. This can lead to missed opportuni-ties, or mistakes and complaints that take time to sort out.

The 26TEN network wants to see plain English become the communication style of choice throughout Tasmania. We encourage you to become familiar with the guide, use it often and share it with others.

II. What is Plain English?

Plain English is a way of presenting information that helps someone understand it the first time they read or hear it. It allows them to get the information they need, understand it easily and act if they need to.

When you use plain English you:

• write in clear language
• give relevant information in the right order
• help people find information quickly.

Plain English – Before and After

To see the difference made by plain English, have a look at these ‘before’ and ‘after’ examples. Sometimes people think plain English ‘dumbs down’ complex information, but this isn’t so. Plain English English is about communicating to your reader or listener in language they understand, wheth-er they are specialists, colleagues or members of the public.

Most people do not want to have to read material more than once to understand the message and decide what to do next. While complex language is sometimes necessary, most of the time plain English is more suitable.

What are the Benefits of Plain English?

• Plain English saves time and money, and avoids misunderstandings.
• It increases the chances that everyone will understand your message, including adults who have difficulty reading.
• It makes it easier for people to make informed judgements, including about their rights and responsibilities.
• The clarity it brings means people are more likely to use services. They will also feel more confident in the people providing them, which can mean fewer mistakes, com-plaints and unnecessary queries.
• Instructions in plain English are easier for staff to understand and follow.
• Clearly presented information shows respect and consideration for your reader, which can help build better relationships.

The Plain English Movement

Plain English is known in some places as plain language. There are plain language movements in many parts of the world, including the UK, USA, Canada, New Zealand, Portugal, Mexico and the European Commission.

A simplified form of plain English known as Easy English is also being used more and more. Help-ful for people with intellectual disabilities, low literacy or where English is not their first lan-guage, it uses images and icons to support text, large font sizes and lots of white space on the page.⁵

^{5  For more information about Easy English, see www.volunteer.vic.gov.au/toolkit-for-volunteer-organisations/manage-your-organisation/marketing-and-communications/using-plain-language-and-easy-english}

Getting Started with Plain English

As you start to work more and more with plain English, remember that just because it’s easy to read doesn’t mean it’s always easy to write. It takes time and practice to do it well – but the rewards are great.

III. Steps from Start to Finish

Here we have set out five steps that will take you from staring at a blank page to having a well-informed reader.

1. Think about your reader
2. Organise your information
3. Write your content
4. Check what you have written
5. Design and produce your document

Under each step are tips to help you improve written and spoken information. They are guide-lines, not rules, and not all them will apply to every reader or every document. But using even some of them will take you a long way towards making your information more understandable.

Step 1: Think About Your Reader

Know who you are writing for and why

No matter what type of document you’re writing, from a short email to a long report, it’s im-portant first to be clear about your reader.

• Who are you writing this document for?
• Why are you writing it?
• What action do you want them to take? Is there something you want them to do, think or feel as a result of reading or hearing it?
• Is there more than one reader or group of readers? If so, do you need to write separate documents?

For longer documents, you might find it useful to write a brief plan before you start.

Write for your reader

The first step in writing and speaking in plain English is to put yourself in your reader’s shoes. Keep their interests in mind and ask the following questions when writing your document.

• How familiar are they with the words and terms you are likely to use?
• What subjects can you assume they understand?
• How will they read the document? Will they read it straight through or skip through to the sections that interest them?
• Will they need any background information?
• Do you need to explain any details they may not be familiar with?

Step 2: Organise Your Information

Use plenty of signposts

Table of contents: In a long document, a table of contents helps people to find the information they are particularly interested in.

Introductory paragraph: If a section of a document is very long, it is a good idea to include an introductory paragraph that summarises the contents.

Headings: Headings and sub-headings help people to work their way around a page. They also make the text less intimidating.

Dot-point lists: Use dot-points to break down complex text into lists. This guide includes plenty of examples of dot-points.

Use clear paragraphs

Limit each paragraph to one idea or topic. Try to keep their length between two and five sen-tences. Leave some white space between each paragraph and avoid continuing a paragraph over a page.

Keep documents as short as possible

Long documents can be hard work to read. Make sure every sentence you have written needs to be there. Often as you edit your work, you will see ways to tighten up the writing and pre-sent points more clearly. It’s important to allow time for this. The tips on editing in Step 4 can help with this (see page 17).

Step 3: Write Your Content

Be personal

Use ‘you’, ‘we’ and ‘I’ in your documents. This will help you to imagine your reader and make the tone of your material warmer. It’s easier for readers to engage with information when you address them directly.

Use everyday words

There’s nothing wrong with long words, but there’s no need to use them when short words will do. If you do need to use specialised language or jargon, make sure you explain what it means. At the back of this guide you’ll find suggestions for shorter words to replace long ones (see pag-es 31–34).

Also watch out for buzzwords – words and phrases that become fashionable for a while – as they can put readers off. Some examples are ‘24/7’ ‘going forward’ and ‘driving change’. If you find yourself using buzzwords, pause and work out what you’re really trying to say.

Keep sentences short

Long sentences, like long documents, can be hard work for your reader. While there are no strict rules about sentence length, try to keep sentences to an average of 15 to 20 words. You can vary the length with a mix of shorter and longer sentences, but try not to go over 25 words. Break up sentences with full stops rather than semi-colons, as people are more familiar with full stops.

Use the active voice

When we talk about the active voice, we mean the way the action word – the verb – is used in a sentence. Most sentences have three main parts: a subject, a verb and an object.

The subject is who or what is doing the action. The verb is the action. The object is who or what the action is being done to. An example is ‘Jane wrote the report.’ ‘Jane’ is the subject, ‘wrote’ is the verb, and ‘the report’ is the object.

The opposite of the active voice is the passive voice. This is when the object comes first and the subject last. The sentence above written in the passive voice would be ‘The report was written by Jane’.

The active voice is clearer and livelier and comes across as more personal and direct. You also usually need fewer words to say the same thing, as in these examples.

Before After

Sentences in the passive voice are written in this order: object – verb – subject

For example:

Sentences in the active voice are written in this order: subject – verb – object

For example:

It will be done by us. We will do it. The match was won by Tasmania. Tasmania won the match. A decision on your application will be made by the panel. The panel will decide on your application. The building plans were approved by the Council. The Council approved the building plans.

Most sentences will have other words as well, but the subject, verb and object are nearly al-ways there.⁶

Know when to use the passive voice

The passive voice puts a bit of distance between the person giving the information and the per-son receiving it. Sometimes it is appropriate to use it, such as when the active voice seems too harsh.

For example, ‘We will close your account if you do not pay us today.’ This is active, but it may be the wrong tone to use. In this case, you might prefer to use the passive voice and write, ‘This account will be closed if it is not paid today.’

The passive voice is also useful when you don’t know who the subject of the sentence is, or they aren’t important to the topic, or you don’t want to focus on them.

Because the passive voice can slow down your reader, you should use it only occasionally.

Avoid using nouns made from verbs

Nouns made from verbs are known as ‘nominalisations’. Avoid these and instead try to make actions direct and strong. Some examples include ‘consider’ rather than ‘consideration, ‘estab-lish’ rather than ‘establishment’ and ‘discuss’ rather than ‘discussion’.

Before After We gave consideration to four options. We considered four options. The retail company is working on the establishment of a new market. The retail company is establishing a new market. They will have a discussion about the new building tomorrow. They will discuss the new building tomorrow.

^{6  There are some exceptions. If you are interested in this topic, you can find out more from grammar guides. See the Extra Resources section in Appendix 5.}

Remove unnecessary words and phrases

Watch out for wording that bogs down your message, such as:

• Wordy phrases – using more words than you need to say something.
• Noun strings – groups of nouns joined together.
• Tautologies – two words that mean the same thing.
• Double negatives – two negative words where a single word will have the same effect.

Wordy phrases
Only use as many words as you need to get your message across clearly. Here are some exam-ples, and you’ll find more towards the end of this guide (see pages 31–34).

Before After in advance of before owing to the fact that because in the event that if

Noun strings
The words in bold make up a noun string, also known as a noun stack. To fix these, sometimes you will need to make the sentence a little longer.

Before After This year the company is working on organisational employee capabilities. This year the company is working on improving the skills of staff in the organisation.

Tautologies

Before After new innovation innovation

Double negatives

Before After less unhealthy option healthier option

Be consistent
Be consistent with any terms you use in your documents. For example, if you call something a review, use this term throughout your document. It can confuse your readers if you use the words evaluation, audit or study for the same thing.

Be specific
Rather than use abstract ideas, help your reader connect with something they know. Some-times small details can give a better picture of what you are writing about. Again, keep in mind your reader and what knowledge of the subject they already have.

Before After in advance of Before

Spell out acronyms

Acronyms are words formed from the first letters of other words. If you are using them in your document, spell them out the first time with the acronym in brackets, for example, Australian Research Council (ARC) or United Kingdom (UK).

Sometimes well-known organisations and businesses become better known by their acronym than their whole name. Examples include CSIRO (Commonwealth Scientific and Industrial Re-search Organisation), TasCOSS (Tasmanian Council of Social Services) and the RACT (Royal Auto-mobile Club of Tasmania).

When deciding which form to use, think about your reader and what will make sense to them. If you are using a lot of acronyms, it can be helpful to list their short and long forms in alphabet-ical order on a separate page.

Use questions and answers

Questions and answers are a good way to get information across or emphasise certain facts. They also mean people can go straight to the area that particularly interests them. Having a list of Frequently Asked Questions, or FAQs, is a common way of doing this.

An example of a FAQs list

Q. What does FAQs mean?

A. It is the abbreviation for Fre-quently Asked Questions.

Q. When might you use FAQs?

A. When you want to make in-formation easy to find or when you want to emphasise certain facts.

Q. How long should a FAQs list be?

A. There are no rules, but longer than two pages can be hard work for your reader.

Step 4: Check What You Have Written

Edit carefully

There are three main stages of editing. The first two, structural editing and copyediting, are about improving the writing. The third one, proofreading, is about fixing errors (commonly known as ‘typos’) and tidying up the document.⁷

Structural (or substantive) editing
Here you are looking at the overall structure and shape of the document.

• Is the information set out in a logical order your reader can easily follow?
• Is everything your reader needs to know there?
• Does it include information your reader doesn’t need? If so, can you cut that?

Copyediting
Here you are looking at the sentences and words.

• Are your sentences as clear and direct as they can be?
• Have you used everyday words that your reader would be familiar with?
• Are all the words and phrases as concise as they can be?
• Have you been consistent in how you have spelt words and used terms?
• Is what you have written accurate?

Proofreading
This is about doing a final check for any errors or typos.

• Are all the words, names, addresses, emails and websites spelt right?
• Are all the numbers, including phone numbers, correct?
• Is the layout alright? Are the page breaks in the right place? Is everything that needs to be in the document in the right place?

Small pieces of writing, like short emails or file notes for colleagues, might need only proof-reading. When proofreading larger documents, it is best to do this some time after you have finished writing it – at least an hour later or preferably 24 hours later. This way, you will see it with fresh eyes and be more likely to notice errors. If possible, ask someone else to proofread it too.

^{7 Summary based on Style Manual: for Authors, Editors and Printers, 6th edition, 2002, Commonwealth of Australia, pp. 256–261.}

Use a house style guide

Most organisations have terms and phrases that they use often. It is useful to have a ‘house style guide’ where these are documented, so that everyone can easily check them. The guide can also include any useful writing or layout standards. Your house style can deal with specific points like these below.

A simple way to set up a house style guide is to have a one page list of common words in alpha-betical order. This is useful when you are working on a single document or if your organisation is small. You can include words that may be spelt, capitalised or hyphenated differently, such as ageing or aging, state government or State Government, and part-time or part time.

Examples of what you can include in a house style guide

Your organisation’s name: How do you spell it? Do you use things like ‘Incorporated’ or ‘Pty Ltd’?

Job titles: Do they have capital letters? Are they up to date?

Acronyms: When do you use the acronym for your organisation, for example, RACT for Roy-al Automobile Club of Tasmania? What other acronyms do you use?

Jargon: What jargon will everyone you are writing for understand? What standard explana-tions will help those people who are unlikely to understand the jargon?

Test Your Document with Readers

You should test your document to see that people will understand it quickly and easily. Even if it is an internal memo for a small number of staff, it is still worth asking people for their opin-ion.

People who know nothing about your area are sometimes the best at spotting unclear text. It is also worth testing your document with some of the people who are likely to use it.

Testing saves you money, time and energy in answering questions or in printing corrections lat-er.

Use Readability Tools as a Guide Only

Readability tools are designed to give an idea of how difficult a piece of writing is to read. They measure syllables per word, words per sentence and sentences per paragraph, then work out the average and provide a rating. Some computers come with this already installed. There are also plain English software programs you can buy that assess extra aspects like unusual words, abbreviations, and clunky writing. Some also offer suggestions for how to simplify, cut and re-write.

Treat them as broad guides only, as they do not consider the content of your document, your reader’s needs or whether your document helps your reader find information quickly. People are the best judge of any document.

Systemic inclusion starts with robust policies. A full suite of inclusive company policies is a must for creating a culture of equity and belonging. The business case is clear — businesses that pro-actively address diversity and inclusion in their policy-making are coming out on top, both in terms of financial performance and employee engagement and retention.

In addition, the growing focus across many industries on ensuring diversity and equality within their supply chains means having clear policies in place is a must for business success. Increas-ingly, client standards and tender processes request these policies and assurance of the ethical operation of their suppliers.

We know that no two organisations are the same so each will need a different suite of diversity policies, tailored to their unique business. As a starting point, we’ve put together our top 10 policies that will provide the foundations for an inclusive workplace and culture.

This is not an exhaustive list and the specific policies your organisation needs might differ de-pending on scale, industry and sector. However, ensuring your recruitment policy is inclusive at its core and enables you to attract and hire the best talent – absolutely is. The key is that eve-ryone is considered in creation and application of policy, and that even with processes that might not seem to have direct people-impact, that DE&I is considered through an analysis of those who might benefit and those that might be disadvantaged.

Diversity and Inclusion Policy

A diversity and Inclusion policy is a fundamental policy critical to employee engagement. The policy should state the organisation’s commitment to ensuring an equitable, diverse and inclu-sive workplace. The policy should also include the process for making complaints of discrimina-tion in the workplace, and how the company will monitor and assess the effectiveness of the policy and working best practices.The diversity and inclusion policy should also cover the support and provisions made available for disabled individuals.

Recruitment and Selection Policy

This policy should detail the steps the business is taking to ensure an unbiased recruitment and selection process. A good process will be designed to be transparent, consistent and evident of proactive support, and be explicit in its intentions to create a diverse and inclusive workplace.

The process itself should include clearly defined and inclusive job descriptions, assessing where you advertise the role with different groups in mind, the application process, and how the company will make reasonable adjustments in the interview process. Shortlisting and interview-ing should be consistent with steps taken to mitigate the opportunity for bias; name-blank CVs, diverse panels and interview scoring can all support this.

In the end, the business case for hiring and retaining diverse talent is clear and a robust, inclu-sive recruitment and selection policy will only help you get there.

Flexible Working Policy

As a result of the COVID-19 pandemic, flexible working has increased globally. Many organisa-tions previously sceptical have been surprised by the clear benefits, not only for their employ-ees, but also to the bottom line via heightened engagement and productivity. The ‘new way of working’ is here to stay, and many employees will now simply expect a degree of flexibility in their working patterns. In addition, adopting an effective Flexible Working Policy can help those with family and personal needs thrive without the constraints of fixed working hours and an ability to work away from the office.

A clear and transparent flexible working policy is crucial to ensuring expectations are aligned between the business and employees, and there is a clear process for requesting it.

Work-Life Policy

A Work-Life Policy should encompass parental, shared parental, adoption, surrogacy and family-friendly leave, and support employees who are transitioning.

Several companies have also recently begun to introduce new policy addressing pregnancy loss, offering additional support for employees who have experienced miscarriages.

Code of Conduct

The Code of Conduct should essentially set out how the organisation expects its employees to behave in the workplace. This should include complying with requirements such as health and safety and environmental laws. The policy should detail the standards of professionalism ex-pected such as appearance/dress code, corruption and anti-bribery, employee benefits and an expectation of open and honest communication from all.

Should an employee be in breach of the organisation’s Code of Conduct, it is important to en-sure a robust Disciplinary and Grievance Policy that has the right EDI clauses is in place.

Dignity at Work/Bullying, Harassment and Discrimination Policy

These policies must be crystal clear in setting out the organisation’s values and its requirements under the Equality Act 2010. And although a policy can’t cover every aspect of unwanted be-haviour, it needs to clarify what sexual harassment is and that it could constitute gross miscon-duct.

Leaders and HR managers must ensure that policies communicate the right things, and that there is a formal procedure in place should anyone have a complaint. This means following up with anyone who flags misconduct and keeping them informed of how you are tackling the complaint. Looking the other way does not help anyone.

Disability and Reasonable Adjustments Policy

A disability and reasonable adjustments policy should detail how the organisation will make ad-justments to ensure adequate support and accessibility for the disabled. This could mean mak-ing adaptations to the workplace, purchasing specialised equipment, flexible working arrange-ments and additional support. There is no absolute definition of what is reasonable, but organi-sations should consider whether an adjustment is effective, practical and affordable.

The policy should also consider hidden disabilities, learning disabilities and reasonable adjust-ments and support needed for affected individuals.

Trans-Inclusion Policy

A trans-inclusion Policy should detail the company’s commitment to the equality of transgender and gender non-conforming people in the workplace, free from discrimination or harassment. The policy should set out its intent and the organisation’s responsibilities to ensuring these, as well as the rights of the individual. It should include guidance and support on those transition-ing, the process of updating personal details, and the process for reporting discriminatory be-haviour.

A trans-inclusion policy should consider transgender people at all times, not just those are tran-sitioning, and may also cover support available for those with a family member who is transi-tioning.

Whistleblowing Policy

A Whistleblowing Policy should provide a definition of whistleblowing and relevant examples. It should capture how employees can raise and resolve serious issues and concerns, and outline how the organisation will respond and the process for handling the concerns flagged.

Whistle-blowers are protected by law and if an employer dismisses or unfairly treats the em-ployee, the matter can be brought to a tribunal.

Mental Health, Wellbeing & Menopause Policy & Inclusion Policy

This policy should communicate the importance of mental wellbeing, how the organisation en-sures a safe workplace and its commitment to staff wellbeing.

It is helpful to include details of the resources and support available to employees, whether this be on-demand counselling, contact details for appropriate helplines and associations, or mental health first aiders in the business they can speak to.

It is also important to consider specific menopause policies to support women managing the symptoms of the menopause in the workplace. This should address flexible and hybrid working, training for managers, guidance on where to source additional healthcare information and providing feedback.

Extract 1: Cultural Responsiveness and Cultural Safety

Cultural Safety

Cultural safety represents a key philosophical shift from providing a service regardless of differ-ence to care that takes account of peoples’ unique needs. It requires all people to undertake an ongoing process of self-reflection and cultural self-awareness and an acknowledgement of how these impact on interactions with others and service delivery.

It is well recognised that people who live or work within a culture other than their own, need to recognise that their own beliefs and behaviours (i.e. ‘culture’) will have an impact upon their treatment and care of, or service provision to, their clientele.

Cultural safety is central to Aboriginal and Torres Strait Islander people and their relationships with the health system. Cultural safety describes a state, where people are enabled and feel they can access health care that suits their needs, are able to challenge personal or institution-al racism levels (when they experience it), establish trust in services and expect effective, qual-ity care.

Cultural safety is a philosophy of practice that is about how a person does something, not what they do, in order to not engage in unsafe cultural practice that ‘… diminish-es, demeans or disempowers the cultural identity and wellbeing of an individual’ Nursing Council of New Zealand, 2011, p 7

The process of seeking cultural safety, like most forms of study and development, is lifelong and it is the receiver of services who determines whether the service is culturally safe or not. Cul-tural safety is experienced by Aboriginal and Torres Strait Islander peoples when individual cul-tural ways of being, preferences and strengths are identified and included in policies, processes, planning, delivery, monitoring and evaluation.

Critically, cultural safety does not necessarily require the study of any culture other than one’s own: it is essentially about being open-minded and flexible in attitudes towards others. Identi-fying what makes others different is simple – however, understanding our own culture and its influence on how we think, feel and behave is much more complex, and often goes unques-tioned.

If cultural safety describes the state we are aiming to reach – safe, accessible, person-oriented and informed care – cultural responsiveness is the practice to enable it.

Cultural Responsiveness

Cultural responsiveness has cultural safety at its core. Cultural responsiveness is what is needed to transform systems; how individual health practitioners work to deliver and maintain cultural-ly safe and effective care. It is innately transformative and must incorporate knowledge (know-ing), self-knowledge and behaviour (being) and action (doing). It is about the approaches we take in engaging with people and how we act to embed what we learn in practice. This requires genuine dialogue to improve practice and health outcomes – it is how we achieve, maintain and govern cultural safety.

Cultural responsiveness is a term that has origins in Canada and North America and is a relative of the earlier work of transcultural nursing and the later work of cultural competency (Federa-tion of Saskatchewan Indian Nations, 2013). However, IAHA has listened, discussed, debated and shaped cultural responsiveness as strengths-based, action-orientated approaches that enable Aboriginal and Torres Strait Islander people to experience cultural safety. It is a negotiated pro-cess of what constitutes culturally safe health care as decided by the recipient of that care. It is about the centrality of culture and how that shapes each individual, their worldviews, values, beliefs, attitudes, and interactions with others. It requires strengths-based approaches and rec-ognises that if culture is not factored into health care and treatment, the quality and probable impact of that care and treatment is likely to be diminished.

The emphasis on 'action' in cultural responsiveness cannot be overstated: it is not enough to be well motivated or understand the need for change. Many of the architects and agents of poli-cies designed to ‘improve’ Aboriginal and Torres Strait Islander health and wellbeing will have understood the symptoms and extent of disadvantage they sought to address. The inadequacy of many approaches is rooted in assumption, notions of cultural superiority and often, well-meaning but culturally self-referenced approaches. Cultural responsiveness goes beyond know-ing change is needed, to enabling safe approaches that deliver genuine impact.

Responsibility to ensure Aboriginal and Torres Strait Islander people receive culturally safe and responsive care sits in many connected spheres: with education providers, service providers and organisations, and health professionals. Each must be capable of responding to the needs of Aboriginal and Torres Strait Islander people. Systems, organisations and individuals are at differ-ent stages in their journeys to develop these capabilities. Cultural responsiveness places the onus onto the individual, organisation and system to respond appropriately to the unique at-tributes of the people, families and communities with whom they work. Supporting Indigenous leadership and working in partnership is essential.

We support the development of capabilities in cultural safety and responsiveness for all Austral-ians, both non-Indigenous and Aboriginal and Torres Strait Islander people. IAHA sees the de-velopment of high-level capabilities in cultural responsiveness as a lifelong cycle of reflection, learning and action as we base our relationships on dialogue, communication, power sharing and negotiation.

Changing The Narrative

Historically in Australia, governance arrangements have been imposed on Aboriginal and Torres Strait Islander groups according to the agenda, priorities and values of governments and churches. This historical approach to governance and development has consistently been inad-equate to meet the needs of Aboriginal and Torres Strait Islander peoples (Reconciliation Aus-tralia, 2014).

Nation (re)-building refers to the processes by which an Indigenous nation enhances its own foundational capacity for effective self-governance and for self-determined community and economic development (Jorgensen, 2007). All Australians working with Aboriginal and Torres Strait Islander communities have a role to know, understand, respect and support a different approach to service delivery from a standard approach (imposed by governments) to a nation building dialogue now and in years to come.

The achievement of Aboriginal and Torres Strait Islander health equity and justice requires leadership and for organisations to have governance structures that promote nation-building approaches and processes that are courageous, honest and able to meet complex issues such as personal and institutional racism.

For Indigenous peoples to participate in Australian society as equals, IT requires that we be able to live our lives free from assumptions by others about what is best for us. It requires recognition of our values, culture and traditions so that they can co-exist with those of mainstream society. It requires respecting our difference and celebrating it within the diversity of the nation. Dr William Jonas, Aboriginal and Torres Strait Is-lander, Social Justice Commissioner, 1999-2004

The following table summarises the differences between a nation building approach and the standard approach to decision making, governance and development.

Standard Approach (Imposed for years by governments)	Nation Building Approach (Attempted by many Indigenous nations today)
The agenda is set by non-Indigenous governments	The agenda is set by the Indigenous nations
Decision making is short-term and nonstrategic: the quick fix	Decision making is long term and strategic
Indigenous nations manage government programs	Indigenous nations self-govern
Accountability is to external funders	Accountability is to the nation
Development is primarily treated as an economic problem	Economic, social and cultural factors shape development
Indigenous culture is treated as an obstacle to development	Indigenous culture is treasured and is an asset

Extract 2: An IAHA Cultural Responsiveness Capability Framework

The IAHA Cultural Responsiveness Framework aims to support all Australians working with Abo-riginal and Torres Strait Islander individuals, families and communities to acquire relevant skills and knowledge, and develop capabilities that are essential for successful partnerships and ac-tion.

This capability framework is focused on providing clear and thorough responses to our core question:

This question aligns with Indigenous pedagogy (Martin & Mirraboopa 2003), Bloom’s⁸ taxonomy of educational objectives and more recently international models of Relational Leadership (Uhl-Bien, 2006: Komives, Lucas, & McMahon, 2013):

To create real and lasting change at the systemic level, the question must be answered at the organisational and personal level. This places individuals and organisations as the critical driv-ers in creating culturally safe and responsive systems.

The individual level refers to the process by which health and wellbeing leaders, administrators and practitioners learn to become culturally responsive. It requires education and training, crit-ical reflection, awareness of personal cultures, differences in power and privilege and the his-torical and contemporary inequalities that emerge in and from social and therapeutic relation-ships.

Considerations at the organisation level require reform of the cultural and historical factors af-fecting the governance, policies and procedures of services and organisations. It requires re-spect for, and inclusion of, Aboriginal and Torres Strait Islander self-determination, cultures and cultural practices, education and training, critical reflection at an organisational level and awareness of the history of non-Indigenous institutional control over Aboriginal and Torres Strait Islander people’s lives and contemporary consequences.

^{8 1 Bloom’s taxonomy (1956) is a model that has been used for decades to write learning outcomes. It describes levels of achievement that can be attained across the domains of learning: skills (psychomotor), behaviours (affective) or knowledge (cognitive).
9  Relational Leadership is defined as a relational process of people together attempting to accomplish change or make a difference to benefit the common good.}

An Introduction to the Capabilities

Our framework is comprised of six key interconnected capabilities.

There is no particular place to start (or continue) your cultural responsiveness journey. You or your organisation will probably already have some of these capabilities or part thereof. They are often developed or further developed concurrently. For example, our self-awareness continues to develop as we are practising inclusive engagement or leadership. Capability in responsibility and accountability can be developed or further developed at the same time as we are develop-ing capability in proactivity and respect for the centrality of cultures. The interrelatedness of the capabilities along with the needs and opportunities that arise to develop them makes each of our cultural responsiveness journeys unique. Understanding strengths and opportunities for development is critical to building cultural responsiveness. They are:

Respect for the centrality of cultures is focused on:

• respecting and valuing Aboriginal and Torres Strait Islander cultures
• valuing the unique cultural lens that Aboriginal and Torres Strait Islander workforce bring to organisations
• understanding and respecting diversity of Aboriginal and Torres Strait Islander peoples and communities
• understanding dominant cultures and privilege that impacts on Aboriginal and Torres Strait Islander people.

Self-awareness is focused on:

• understanding our own cultures and impact on others
• understanding our own assumptions, beliefs and attitudes and their impact on others
• being open to changing behaviours and practices
• challenging our own assumptions, beliefs and attitudes that contribute to personal and institutional racism.

Proactivity is focused on:

• taking responsibility for our own capability development in cultural responsiveness
• addressing all forms of racism
• taking strengths-based and nation building approaches to practice
• transforming practice through personal and organisational initiatives and innovations.

Inclusive engagement is focused on:

• appreciating and implementing processes for Aboriginal and Torres Strait Islander self-determination and leadership
• developing respectful communication and engagement strategies that are a cultural match with communities
• encouraging community development solutions
• establishing respectful and equal partnerships in decision making.

Leadership is focused on:

• leading by example – vision and values in cultural responsiveness are visible to others
• inspiring others in cultural responsiveness and cultivating a shared vision
• using strengths-based, solution-focused approaches to demonstrate leadership that transforms governance, accountability and relationships that include Aboriginal and Torres Strait Islander people
• influencing change and transformation in building culturally responsive practice and en-vironments.

Responsibility and accountability is focused on:

• setting and achieving shared goals and targets in cultural responsiveness
• embedding cultural responsiveness in organisational goals and targets
• having accountability to Aboriginal and Torres Strait Islander individuals, families and communities
• understanding and working within a social justice and rights-based framework.

Examples Of Culturally Responsive Practice

Associate Professor Joanna Zubrzycki, Social Work, Australian Catholic University: Embedding Cultural Responsiveness in Social Work Curriculum

Joanna Zubrzycki is an experienced social worker, academic and curriculum developer who has worked at the Australian Catholic University since 1995. Joanna teaches the Social Work pro-gram at ACU and has been involved in national projects around Indigenous curriculum. Joanna is an active supporter of the IAHA Cultural Responsiveness Framework and has participated in IAHA Cultural Responsiveness workshops.

“We used cultural responsiveness in a number of areas in developing a framework. Our aim was to move social work away from the notion of cultural competence which has got that sense of ‘I’ve made it’ and ‘I can do it’, but I think really limiting in practice” said Joanna.

“We now embed the IAHA Cultural Responsiveness Framework really solidly in our field educa-tion program and our teaching. We teach a standalone Aboriginal and Torres Strait Islander So-cial Work unit to all of our Bachelor of Social Work students.”

This is showing to also have a positive effect on field education supervisors to engage in cultur-ally responsive practice. For example, a student identified there were no practice guidelines or policies on working with Aboriginal and Torres Strait Islander peoples in their placement alt-hough they had Aboriginal and Torres Strait Islander clients. This prompted her to have deep conversations with the Social Work supervisor who has said she'll take it up with senior man-agement.

“[The IAHA Cultural Responsiveness Framework] just keeps reinforcing our understanding about being self-aware and understanding what we want to see in our students we have to demon-strate ourselves. We have to be those role models of the framework to help bring it to life

“This is a problem in many areas of higher education and why the IAHA cultural responsiveness training is so important, unless you give your colleagues that capacity development, then they don’t know what it is to role model culturally responsive practice to our students.”

To develop staff capacity in Cultural Responsiveness the ACU have engaged in IAHA Cultural Re-sponsiveness Training for staff across the Health Science faculty at ACU. Together, the staff prac-tice cultural responsiveness in continuing to learn, share and reflect on culturally responsive practice.

“At the moment we get together about every 6 weeks to support each other’s teachings and work in the area. Some people are still very new to teaching CR work like exercise science who are very new to the Cultural Responsiveness practice, so it’s a lot of mentoring and looking at opportunities to share resources and to bring in stakeholders or people who are doing work in that space. “The network is great because the training triggered this, so if we hadn’t completed the IAHA Cultural Responsiveness Training it would not have happened. We are also working with Aborig-inal and Torres Strait Islander colleagues gathering all the material that people are using for their teaching and putting it into a central database” said Joanna.

The Australian Catholic University Health Science Faculty are an excellent example of walking the talk. Not only have they embedded the cultural responsiveness framework into their cur-riculum, they have also worked to build and embed cultural responsiveness practice in their staff.

Shaun Solomon: Mount Isa Centre for Rural and Remote Health

Shaun Solomon, a Birri and Ewamian man and cultural trainer, has utilised the IAHA Cultural Re-sponsiveness Framework to support his practice at the Mount Isa Centre for Rural and Remote Health (MICCRH). MICCRH is a key education provider both locally in Mount Isa and increasingly via distance delivery. MICCRH’s focus is on the training, development and support of the rural and remote health workforce and the management of key health issues in the rural and remote setting.

“The usefulness of the framework its general enough but also specific enough to think through all those stakeholders involved in that type of work. I move across different groups, so when I work with students I consider their situation and their knowledge and where they are at. I then think about what this means working in the North West, and, what are the cultural and social realities communities, families, client experiences and how all those things are related? The framework guides that thinking through to the application” says Shaun.

Shaun has utilised the IAHA Cultural Responsiveness Framework to support allied health teams working in Mount Isa and with communities in the Gulf region. Shaun referred to the IAHA Cul-tural Responsiveness Framework as a practical way to support allied health professionals in re-sponding to the diverse cultural and social factors of the different communities.

“Part of what I have drawn from the IAHA Framework, in particular, is the first capability of cen-trality of culture. It’s been useful in working out some strategies and contents that health pro-fessionals need to be mindful of working in community and understanding the different cultural and social factors.

“Key activities that health professionals engage in includes, culture mapping (who the tribes are and Traditional Owner’s groups in the communities), mud maps that identify significant local places and what meaning they have to the families. These activities meant that health profes-sionals going into community had to engage with community members. Health professionals were asked to reflect on what that all meant. This work was influenced by the IAHA Cultural Responsiveness Framework” says Shaun.

Shaun says the feedback from participants has been positive. “The consensus was that it was helpful and that they hadn’t thought about it. Once they’d been on the ground in those com-munities it was clearer for them to make that connection to culture. They thought about their practice how they create a repour, how they asses and evaluate, how they consult all those things. It also highlighted some of their own biases and assumptions” said Shaun.

Tahnee Elliott: Yawarawarka, Occupational Therapist

“I think for me personally it has been a good reflection tool for me to understand where peo-ple are on their journey to being culturally responsive and where I need to facilitate from my perspective. I supervise University students and I find it’s a good tool for me to reflect on where they are at.”

Andrew Harvey, CEO Western NSW PHN

"Aboriginal Health and Cultural safety are key priorities for Western NSW Primary Health Net-work (WNSW PHN). Our staff recently participated in a Cultural Responsiveness workshop deliv-ered by Indigenous Allied Health Australia (IAHA). The workshop was valuable for me personally in improving my understanding of the things I need to change and do to be culturally respon-sive, and our team in our cultural safety journey. I found the strengths-based approach very helpful and am pleased to recommend the IAHA workshop”.

Lin Oke: Cultural Responsiveness Mentoring

IAHA Associate Member and Occupational Therapist, Lin Oke, has a developed strong mentoring relationship with Tirritpa Ritchie, a Kaurna man and Occupational Therapist from Adelaide, South Australia to support her journey in cultural responsiveness.

Lin has found the Cultural Responsiveness training and framework has enabled her to start thinking critically about her own cultural identity.

“I think the biggest challenge for me is getting it in your head that cultural consideration and to reflect and acknowledge your own culture to start with. I find that incredibly challenging, I think that there are such incredible variations in the white Australia populations idea of what our culture is, it’s such a personalised family thing” says Lin.

Through her mentoring relationship with Tirritpa, Lin has learnt the importance of listening in her culturally responsive practice.

“One of the things I’ve learned from Tirritpa is listening to the silence, you know, what's not being said?"