Table 5 Themes and subthemes from interviews with health care managers, including illustrative statements as examples

1. Existing cultural training

Other than that (online cultural training), to be honest not really much else happens (Participant 5)

…that’s (online cultural training program) quite broad, it’s not particularly clinical… that’s just… generic for everybody (Participant 5)

We have cultural awareness training, which happens every month. That’s delivered by XXXX. (Participant 2)

2. About Clinical Yarning

The Clinical Yarning Concept

2a.

There is a big difference in the communication style between clinicians and Aboriginal patients and the information that Aboriginal people need (Participant 1)

It was something that was never heard of before to be honest. You know it doesn’t come through medical school, it doesn’t come through you know your junior doctor training or anything. So it’s completely new… So it’s something that we just don’t get any sort of exposure to. So yeah, no, I thought it was good, because I’ve never seen it before. (Participant 6)

Clinical Yarning training

2b.

…there’s been positive feedback. So, there’s nothing here that’s come back negative at all. So, they do feel that it was worthwhile and that they’re glad that they did it, yes. (Participant 2)

2c.

So, I think the practical component is a big emphasis on making them feel secure in the workplace and actually giving them those skills to actually defuse situations that they’re faced with, and how to communicate more effectively with the client. Because sometimes they’re taught about asking questions that are in a care plan, but there’s a way of asking those questions to people to get a better response. (Participant 4)

The staff who have done it really have found it very helpful, and practical actually for what we do with our clients. (Participant 5)

3. Future Implementation Considerations

Training options

3a.

ELearning gives options to our staff who are out in outer regions who can’t get in to town to do it. I think in this day and age we do need to have a few different options for training. (Participant 5)

3b.

One thing - good thing that computer training is very good at, is repeating the same information over and over again, and people can do it at their leisure, and then being able to do the practical stuff face to face. (Participant 3)

3c.

Yeah, look I’m in two mixed minds about that sort of half online half practical stuff. I mean a lot of our courses seem to be going down that way of doing, you know, some of I suppose the bookwork online and then reducing the face-to-face time. I think some people respond to it. Some people don’t respond to the online stuff. They don’t do it. They put it off and when they do they just click next, next, next, next, next and don’t bother actually reading it. (Participant 6)

Train-the-trainer model

3d.

The partnership model of facilitation (with an Aboriginal and clinical facilitator) works well. (it) benefits Aboriginal staff because it is not just them saying there is an issue… (it) increases the confidence of Aboriginal staff to talk up about issues (Participant 1)

The more we can do at home base the more I’d support it. So, to have a local person trained effectively to deliver this training to me would be beneficial, because the challenge we have is that we depend a lot with other training on people coming out… So, the more self-sufficient we can be at the workplace the better it works for us really (Participant 4)

3e.

I know you met [staff member] who’s our Aboriginal liaison officer. I know she’s very keen on cultural awareness training and any aspects of that…. So for somebody, for example, like her that is an Aboriginal person that’s talking about Aboriginal issues and part of her role is facilitating and educating Aboriginal people to come to their medical appointments and supporting them to do so - somebody like her would be a key component to have as a trainer to provide ongoing education to our new employees as part of their orientation to site. (Participant 4)

I mean we might be lucky, if you put it out there then you might find someone who is really keen and wants to take it on, but I wouldn’t count on that. (Participant 6)

Future Implementation Considerations

Opportunities

3 f.

We could introduce it at orientation level. Locums who come visit us all the time, you may have a shortened version that we could introduce to the locums at orientation. Bearing in mind that they are maybe here for a week or two weeks but we do need to have the first half a day for locums to be training. That could be slotted into something that is mandatory orientation. (Participant 2)

Implementing CY would be helped if mandated through regional executive or WACHS board… maybe as a KPI… this would add weight and reduce barriers (Participant 1)

3 g.

I think good engagement with the Aboriginal workers on the ground is really useful, because they’re the ones that will be promoting it in the service, and they’ll know, when you’re having that conversation, they’re able to draw on that when they’re having the corridor conversations, or the clinical reviews, as well, in that process. Some top-down support doesn’t hurt either, as well. (Participant 3)

[Senior manager] would be a good ally locally (Participant 1)

Challenges

3 h.

I think one of the main hurdles for us will be our transiency of staff because that’s something that we have to take into consideration; that whoever might be chosen to do it now we’ve always got to have good succession planning in place for those people should they choose to move on. (Participant 4)

I mean I think the problem you’re going to have once you go to the smaller sites is a problem we have here, is just getting the staff off the floor to attend. We’re lucky we’ve got slightly more staff so we have more staff off-duty who can come in. You go to [remote site] or somewhere like that where there’s only four or five docs, you’re basically going to have to deliver it almost one-on-one or one-on-two, because the other two will be working. Then try and get them when they’re not on days off and going away somewhere and all that. Logistically it just becomes challenging. (Participant 6)