Realigning competencies with te Tiriti
A new study examines regulated health professions’ competency documents and their compliance with te Tiriti.
Dr Heather Came, lead author of the study and Head of the Department of Public Health at AUT, says this analysis of competency documents has highlighted the various ways that different professional groups have incorporated te Tiriti in their practice.
“Unfortunately, the majority of health professions are not meeting their obligations as a Crown Tiriti partner. It is not a stretch to posit that this is a contributing factor to the poor health outcomes and racism that Māori experience when seeking healthcare,” says Came.
“Health professionals occupy intimate spaces in Māori lives, whether they are promoting good health, protecting communities and individuals from poor health, or caring for the sick. It is vital that the work of health professionals is aligned with the health aspirations of Māori as outlined in te Tiriti.”
New Zealand currently has 18 regulated health professions. Each has a competency document that defines the core values and beliefs of that profession, as well as the competencies, behaviours, knowledge, and skills required to practise. Practitioners are also required to be registered with the relevant health authority and hold an Annual Practising Certificate (APC).
These professional groups are chiropractors, dental practitioners, dieticians, medical practitioners, medical radiation technologists, medical technicians, midwives, nurses, occupational therapists, optometrists and opticians, osteopaths, paramedics, pharmacists, physiotherapists, podiatrists, psychologists, psychotherapists, and social workers.
Professional competency frameworks are a key tool for aligning the workforce with the needs of the population. These competencies also shape tertiary education across any number of health-related programmes.
A te Tiriti-compliant health sector requires legislation, policy, competency documents, standards, codes of ethics, and supplementary documents to explicitly uphold te Tiriti.
“With a major review of the health sector underway, it is timely to review professional competency documents to determine whether they are compliant with te Tiriti,” says Came.
Researchers examined the competency documents of 17 regulated health professions in New Zealand, using an adapted criterion of Critical te Tiriti Analysis (CTA). Paramedics were not included in the analysis, as their reclassification under this heading was relatively recent.
By mapping the content of each competency document, they were able to assess the level of engagement with the five domains (preamble and four articles) of te Tiriti and assign an overall mark out of 15.
The competency documents most closely aligned with te Tiriti related to nurses (12/15), pharmacists (10/15), and social workers (10/15). Those with the lowest compliance related to chiropractors (1/15), osteopaths (0/15), and optometrists or opticians (0/15).
The results showed considerable variation in the quality of the competency documents reviewed. There was diverse use of the terms ‘te Tiriti’, ‘the Treaty’ and ‘Treaty principles’. And the competency documents for dentists and optometrists made no mention of any of these terms. Overall, 15 competency documents mentioned only the Treaty or arguably non te Tiriti-compliant Treaty principles.
All reviewed professions, except osteopaths and social workers, had separate cultural competencies where references to te Tiriti or the Treaty may have been more prolific.
“The decision to only use core competency documents in our analysis may not reflect well on those professions that handle te Tiriti or the Treaty differently. However, we argue that the rightful position of te Tiriti in health is at the core, not on the periphery,” says Came.
“The WAI 2575 report gave the health sector a collective ‘D grade’ for our failure to perform in relation to Māori health. To deliver health services effectively, health practitioners need to have the necessary clinical, cultural, and political skills to engage effectively with whānau,” says Came.
This study, published in the New Zealand Medical Journal, offers specific ideas for te Tiriti competencies that could be refined and integrated into core competency documents.
The article was co-authored by Associate Professor Jacquie Kidd (AUT School Clinical Sciences), Deborah Heke (AUT Taupua Waiora Centre for Māori Health Research), and Professor Tim McCreanor (Te Rōpū Whāriki, Massey University).