In pursuit of the possible – how Yerin is backing community health with enterprise

Background

Yerin Eleanor Duncan Aboriginal Health Centre (Yerin) has been providing health care services to Aboriginal people living on Darkinjung land since 1993. In 2015, new CEO and former Jawun Emerging Leader Belinda Field came on board, and a period of significant growth began.

Between 2015 and end 2019, Yerin grew from 20 full time employees to 63, 75% of whom are Aboriginal. Expanding to meet growing community needs for health services, Yerin expanded from 20 programs to 31, and clinical patient numbers grew from 1,350 to 3,000.

Much of this growth was as a result of Belinda guiding the organisation to transition from an incorporated entity to a company limited by guarantee, with an increasingly enterprise-minded approach taken to meet specific and shifting community health needs. Yerin expanded from the provision of bulk billed GP services and block funded community programs, into fee for package services including NDIS, dental services and statutory foster care placement. Continuous improvement underpins Yerin’s drive to seek opportunities to sustain and grow.

Approach

Since 2012, 18 corporate and government employees have supported Yerin as Jawun secondees, applying skills in strategic planning, organisational change management and business development in order to support Yerin’s transition and growth. Secondee work has supported the transition to a new company structure, the establishment of Yerin’s NDIS business, and a feasibility analysis of ideas around flexibly meeting community needs through partnerships and revenue generation.

The majority of these secondees have been part of Yerin’s journey at a time when significant changes to the strategy and implementation model were being guided by Yerin CEO and local Aboriginal leader, Belinda Field. Belinda was a 2015 participant in the Jawun Emerging Leaders program, which aims to support leadership capability and confidence (as well as build networks and connections) for up and coming Indigenous leaders. Already a driven and influential leader, Belinda believes this program gave her the additional confidence required to step up and accept the offer of the CEO role in that same year.

At the heart of Yerin’s approach is the need to provide for its local community who seek accessible and culturally safe services or support which is of vital importance to Belinda, who grew up and raised her own family on the Central Coast. Belinda explains, “There’s not one Aboriginal person here that hasn’t experienced trauma either directly or vicariously.” She describes the essence of Yerin as a ‘trauma-informed practice coming from a lived experience’ – and calls out the skill of staff who respond with kindness when someone arrives troubled by their pain and trauma, and can defuse situations by understanding, not judging, often hand-in-hand with offering a cup of tea. For Belinda, it stems from a sense of community obligation and loyalty, something that is “so much more than a job.”

Yerin also seeks to respond to the specifics of local health needs of Aboriginal people on the Central Coast, including how these are changing with time. As Belinda sees it, “health is so unique to a region – rheumatic heart fever might be running rife in Central Australia but on the Central Coast we’ve only got two patients. Drugs and alcohol, mental health, sexual health and diabetes are some of the major issues here. You can’t have a one size fits all approach”. This means driving a hybrid model of government and non-government funding, where fee for package services make up an increasing percentage of Yerin’s revenue and enable it to adapt flexibly with its own resources in response to these needs.

In response to growing patient numbers, increasing the level of Medicare income has required the organisation to become more enterprise-minded. Doctors and medical staff prepare and submit projections, and there are strategies for covering gaps or piloting new approaches. In what Belinda calls a ‘paradigm shift’, this includes Yerin pitching its health and allied health services to government or larger service providers wanting to offer a culturally accessible solution to Aboriginal patients. Yerin offers services on a package cost basis, investing any margins back into the organisation.

As a registered NDIS provider since 2018, Yerin runs the Muru Bara (‘making pathways’) disability support program. Secondees from the Commonwealth Government, NSW Government and Westpac assisted in the feasibility assessment and planning of this program in recent years (including working on a future NDIS offering around delivery of supported independent living services). Yerin has also been running a dental service since late 2018, having agitated for this on the basis of the importance of dental and oral hygiene to overall health outcomes. This resulted in an MoU being signed with government where Yerin provides a community-controlled service on its premises, but with local health district staff. Previously, the primary dentistry option for Aboriginal people on the Central Coast was a two hour weekly clinic at Wyong Hospital.

Outcomes

Year on year, Yerin has provided increasing episodes of care, in an increasing number of areas, to a growing numbers of clients. In 2018 almost 4,000 patients received nearly 30,000 episodes of care. Muru Bara is linking a growing number of individuals to NDIS and helping them connect with culturally appropriate services. In its first year, the dental service saw nearly 1,000 patients – a huge increase from those who had prior to that presented at the Wyong Hospital clinic. Management and staff from other Aboriginal Medical Services have visited Yerin to learn from their model, which Belinda is proud to point out also has an employment and skills component – for example, rotating government dentists and dental hygienists are developing local staff skills and training people. Belinda has also forged a relationship with a local university who donated specialised dental chairs to support the initiative.

Yerin is currently looking at a five-year strategic plan with short, medium and long-term goals including a ‘hub and spoke model’ to enable expansion across the region. It continues to strive to integrate community perspectives, including through active outreach and social media that reaches several thousand Aboriginal people in Central Coast communities.

Today, Yerin is an empowerment model not only for community members but also for its staff, 75% of whom are Aboriginal. Belinda is proud of the professional leap many have taken, and describes a workplace where people are empowered and part of a cause: “We have Aboriginal staff aged from 19 to 64, all with unique experience. Some would never have thought they’d be senior practitioners, raising the bar, having a voice, changing the narrative.”

The partnership Yerin has with Jawun is a strong and continuing one, providing Yerin exposure to corporate and government skills and experience through secondments and Executive Visits (with much learning in the other direction too). This enables ways of working that align enterprise thinking with culturally appropriate service provision. Reflecting on that and her earlier experience as a Jawun Emerging Leaders participant, Belinda says: “The Jawun Emerging Leaders program, and exposure to people from the corporate sector who use a whole new language, that was very serendipitous”.

More recently Belinda has participated in Malparara, the inaugural leadership program under Jawun’s Stories of Female Leadership Network – a network that connects Indigenous, corporate and government female leaders together to drive change. Belinda saw that Malparara, “gave me the opportunity to consolidate the learnings from the Emerging Leaders course and build and stretch on these.”   

Next steps

Among other ideas, Yerin is looking at provision of culturally appropriate supports for Aboriginal children in out of home care, including therapy, counselling and mental health care. A business case has been developed for this cultural care plan, which could impact up to 600 Aboriginal children currently living in foster care on the Central Coast.

Belinda continues to drive the organisation onwards with entrepreneurial optimism and her deep sense of community duty. She sees this as her generation’s chance, both an opportunity and an obligation: We have a wave of people in my age group who’ve learnt from trailblazers before us. It’s about having the guts, holding the line, and setting standards”. There is no doubt Belinda knows how to bring people along with her, as she told a recent secondee, who was doubtful about the pace and vision of the work they were to support, “I would like you to start with the assumption that this is possible”.