The vision for He Kaupapa Oranga Tahi is to explore how we best generate sustainable, high quality, interprofessional clinical learning opportunities for our health tauira , while also providing accessible, low/no cost, quality health services to communities with high needs. To achieve this, we will continue engagement with community providers in the development of the proposed tauira-assisted health services. Our study investigating the feasibility of employing this teaching and learning approach is outlined in this report. Wintec is a subsidiary of Te Pūkenga, the newly formed implementation agency for the New Zealand Government Reform of Vocational Education. Consistent with Wintec values and mission, this innovative strategy generates opportunities for collaboration within Te Pūkenga, brings life to Wintec’s Tōia Mai framework, and builds on our existing success.
The kaupapa of this project advanced the following key objectives that sought to:
1. Determine the community need and explore community viewpoints and the feasibility of establishing culturally adept tauira-assisted health services to promote social wellbeing for communities in the Waikato Region.
2. Explore innovative ‘real world’ learning opportunities for Wintec tauira to learn industry-relevant skills in ways that are integrated into the cultural fabric of the communities we serve.
3. Identify opportunities and barriers to the development, implementation, and evaluation of a tauira-assisted health service involving Wintec tauira.
4. Enhance and extend opportunities for collaboration between two centres within Wintec: Centre for Sport Science and Human Performance and Centre for Health and Social Practice.
To address the key objectives of this enquiry, a mixed method study design was employed. First, we undertook a scoping review of the current literature on tauira-assisted health services in Aotearoa New Zealand. Secondly, we undertook an analysis of key Ministry of Health and ACC datasets to understand patterns of healthcare need in the community. Thirdly, we engaged in a three-fold consultation process with Wintec staff, other New Zealand education providers, and representatives from community-based organisations (Te Kōhao Health, K’aute Pasifika, and Rauawaawa Kaumātua Charitable Trust). Through collating and synthesising these data sources we have co-constructed a compelling case supporting the development of tauira-assisted health services.
The literature on tauira-assisted clinics in Aotearoa New Zealand demonstrated that such clinics offer students an opportunity to ‘give back’, to address healthcare gaps, and generate significant benefits across a range of learning and health domains. However, it was noted that establishing tauira-assisted clinics involves complex considerations, in particular curriculum design, ethical, financial and resource implications, and the most appropriate structure and educational model.
Ministry of Health and ACC data showed that the Huntly, Ngāruawāhia and Hamilton City communities have significant healthcare needs. Local rates of childhood immunisation could be improved, cancer represents a considerable healthcare burden, the number of claims made to ACC for accident or injuries may surprise, and mortality records reveal that many local deaths are from preventable causes. Especially notable is the prevalence of chronic conditions and significant health events, including the number of people living with diabetes, or with the potentially long-term effects of events such as stroke or heart attack. Clearly, addressing non-communicable diseases in our communities is critical.
Wintec staff expressed strongly that a tauira-assisted health service would need to be well resourced, and several mentioned logistics (such as finding an appropriate space and timetabling conflicts) as important considerations. Some staff noted the challenges of appropriate staffing, supervision, and workload. Authentic, ongoing consultation (with mana whenua, stakeholders, and the community) was mentioned by many staff as an essential prerequisite for success.
When comparing New Zealand tauira-assisted clinics which feature in the literature with those we identified via online searching, research networks, and snowball sampling we found more traditional and single-discipline clinics were less likely to have been written about. To widen our perspective, we reached out to kōrero with some of these clinics. Our discussions with providers confirmed an initial observation from the literature that clinics appeared to have limited levels of Māori consultation and involvement, including in the planning and operational phases. Representatives from clinics were universally positive about the opportunities and successes of clinics for tauira learning, but noted some important advice borne from their own experiences.
Our whakawhiti kōrero with community organisations improved our knowledge of local needs, and the opportunities for partnership in a tauira-assisted healthcare initiative. Those we talked to clearly valued existing relationships with Wintec and their prior/current experiences with tauira on placement. Their kōrero emphasised the benefits of tauira experiencing their services’ holistic, client-centred and culturally responsive models of care. They showed support for extending these relationships, which they saw as having potential benefits for their own organisations, Wintec and students. Despite these synergies and positive views, staff did note the challenges their organisations face relating to the structures and funding models they operate in, which do not necessarily align or reflect their models of care. Establishing and sustaining a tauira-assisted health initiative would require adequate resourcing, attention to client safety, align with organisation’s own goals and objectives and uphold their mana motuhake.
In drawing together the information from all these sources, seven key, evidence-based recommendations have been formulated. The recommendations support moving forward with the establishment of interprofessional clinical learning opportunities for our health tauira within the context of a tauira-assisted health service, specifically to:
1. Enhance tauira learning outcomes, develop a tauira-assisted health service designed to offer tauira sustainable, high quality learning experiences.
2. Build a culturally competent graduate workforce by ensuring any planned tauira-assisted health service delivers healthcare using culturally informed models of care and provides opportunities for engaging in Kaupapa Māori practices.
3. Contribute in local responses to community needs by developing a tauira-assisted health service in the Waikato Region.
4. Facilitate interprofessional education by ensuring the planned tauira-assisted health service is interprofessional by design.
5. Genuinely partner with Tangata Whenua/Hapori with a formalized governance model that explicitly outlines the partnership approach to developing a tauira-assisted health service.
6. Develop a financially viable option to undertake a pilot, while seeking funding options for a larger clinic by semester one 2023
7. Effectively pilot and evaluate a tauira-assisted health service, seek health provider status to enable capacity to conduct a pilot within the Waikato subsidiary of the Te Pūkenga network or in partnership with a local provider, capitalising on current resources and infrastructure