A Path to Connected Care
Reshaping healthcare commissioning through Aboriginal wisdom and community-led approaches
In late February, the Aboriginal Health Council of South Australia (AHCSA) and Rebbeck ran the first in a series of planned events in South Australia. This gathering brought together leaders from Aboriginal Community Controlled Health Organisations (ACCHOs), SA Health, and other partner organisations – all committed to advancing Aboriginal commissioning and strengthening self-determination for Aboriginal communities.
Under the leadership of Tanya McGregor (AHCSA’s CEO) and Aboriginal leaders across the state, we began a journey of mutual discovery. Together, we examined how deep cultural knowledge and community-led insights can help us move beyond conventional, top-down approaches to commissioning that are too often used by Australian commissioners.
ACCHOs have long embraced a holistic view oriented around social, emotional, and spiritual wellbeing with strong connections to culture, kinship and communities. Our collaborative sessions explored ways to integrate these community insights into commissioning frameworks, creating a path where inclusive, strengths-based approaches lead to better health outcomes.
This article captures insights from our initial gathering and outlines how a dynamic, relational and collaborative commissioning approach can reshape healthcare delivery.
Image credit sebastianbourges
From a Colonial Construct to a Cultural Interface
Commissioning, at its core, is a colonial construct. This was part of our discussion in our most recent Commissioning Excellence Foundations course (CEF): the formal frameworks of contracts, punitive clauses and rigid reporting requirements trace back to a history steeped in top-down authority.
In our opening session, I noted that if these “coercive” strategies were used at home, we would call them domestic violence—yet in organisational contexts, it’s simply “how we do business.”
This contradiction became even clearer after our Adelaide sessions with around 20 Aboriginal and Non-Aboriginal leaders from the ACCHO sector and SA Health. They reminded us that colonisation is not just historical—it’s a living reality that continues to echo through generations. These echoes manifest as the systemic racism and inequities we see in our healthcare and social systems today.
“Colonisation is not just a historical footnote but a living reality, echoing down the generations.”
Why does this matter for commissioning? Because we cannot address problems we do not acknowledge. Part of our role as commissioners—especially in Primary Health Networks (PHNs)—is to reconcile these historical legacies with a vision for a more inclusive, relational and community-driven approach. At Rebbeck, this perspective informs our work in assessing health commissioning maturity with organisations across Australia.
Reflections from Adelaide: Strengths-Based Co-Design
Our Adelaide discussions revealed that Aboriginal communities hold deep expertise in fostering social and emotional wellbeing. Their cultural and communal practices—rooted in 65,000 years of knowledge—show us that healthcare isn’t merely about “fixing what’s broken” but about nurturing connections to Country, culture and each other.
During our PHN CEF session, I emphasised that if we can design services that work for Aboriginal and Torres Strait Islander communities, those services will likely work for everyone. The strength lies in co-design, where we systematically involve communities in:
- Planning healthcare services
- Delivering care in culturally appropriate ways
- Evaluating outcomes using meaningful measures
Instead of arriving with predetermined solutions, co-design recognises that Aboriginal cultural knowledge carries sophisticated models of social and emotional wellbeing—something often overlooked in Western medicine’s focus on clinical metrics. This approach aligns with Rebbeck’s methodology for improving healthcare services through co-design.
The Power of Storytelling: Linking Evidence, Culture and Outcomes
A recurring theme in our sessions was storytelling as a form of evidence-based practice. Aboriginal peoples have refined narrative methods for millennia, passing down vital information from generation to generation. While we often think of “data” and “evidence” in terms of graphs and spreadsheets, the most effective logic models are rooted in stories that illuminate the “why,” “how,” and “what next.”
“Storytelling is essentially science,” I noted during the session.
“The best logic models are rooted in stories that illuminate the ‘why,’ ‘how,’ and ‘what next.'”
The best commissioning—and the most effective health services—tell a clear story of:
- A person in need
- Meeting a guide (the service provider)
- Working through challenges together
- Finding a path to improved wellbeing
This story-based approach supports the plan/do/review cycle (or as I prefer, the “commissioning corkscrew”). Each iteration adds another layer of knowledge and improvement, allowing continuous service refinement. Aboriginal cultures demonstrate how powerful a narrative framework can be in driving genuine, sustained change.
Moving from Transactional to Relational
A significant insight from our discussions was the need to move beyond transactional relationships. Whether participants came from Southeastern NSW PHN, Gold Coast PHN or Adelaide PHN, many described the burden of:
- Siloed contracts
- Disjointed funding models
- A sense that “we keep papering over the cracks”
A relational mindset begins with respect—treating providers, consumers and communities as partners, not mere line items in procurement documents. We can no longer use cursory consultation to justify decisions already made. Meaningful engagement means involving communities earlier, creating space for genuine co-design, and measuring outcomes in ways that matter to the people we serve.
Collaborative Commissioning in Action: A Case Study
To illustrate these principles, one participant described “Link my Care,” a collaborative initiative between New South Wales Health and Coordinare (the Southeastern NSW PHN). This project aims to integrate primary and acute care for better health outcomes.
In discussing how Link my Care might adopt a strengths-based lens, participants highlighted three essential elements:
| Element | Application |
| Elder Engagement | Involving Aboriginal Elders to shape service design from the outset |
| Open Dialogue | Facilitating meaningful conversations between local communities and clinical staff |
| Shared Learning | Ensuring communities see the tangible impact of their input through data and stories |
While this example continues to evolve, it serves as a model for how commissioning activities might proceed—prioritising partnership, embedding cultural expertise, and continuously refining based on community-driven feedback. This collaborative approach to service design is central to Rebbeck’s methodology for crafting strategies to improve health outcomes.
A Call to Action: Centring Aboriginal Knowledge
Commissioners must shift from “contracts and compliance” to “co-creation and connectedness.” Aboriginal perspectives aren’t peripheral—they’re essential to designing services that work for all Australians.
Practical steps forward:
- Engage early: Begin meaningful conversations during the needs assessment phase, not when tenders are already written
- Share the power: Explore funding models that encourage collaboration, reduce punitive measures, and allow flexibility to address local needs
- Use storytelling as evidence: Gather and share stories—both successes and challenges—to build an authentic evidence base
- Adopt a Continuous Learning approach: View commissioning as an ongoing learning process where each iteration brings us closer to equitable, culturally relevant care
Building a Connected Future
As we concluded our first day of the Commissioning Excellence Foundations Course, I felt optimistic yet mindful of the significant work ahead. The intersection of colonial frameworks and Aboriginal cultural strengths holds tremendous potential for positive change.
By shifting from punitive contracting to relationships founded on trust, reciprocity and cultural respect, our healthcare systems can evolve into something more holistic and equitable—reflecting the principles Aboriginal communities have practised for thousands of years.
On a personal level, I am reminded of why I keep returning to these conversations: because the answers to many of our most pressing health challenges already exist, woven into the fabric of Aboriginal communities and cultures.
Our task is to listen, learn, and allow that knowledge to guide every step of our commissioning journey.
“When we approach Aboriginal and Torres Strait Islander communities with a strengths-based lens, we recognise they have always held the blueprint for true wellbeing.”
Working with Rebbeck
At Rebbeck, we’re committed to supporting commissioners in developing culturally appropriate, strengths-based approaches to healthcare design and delivery. Our expertise in commissioning excellence is built on practical experience working with health organisations across Australia, Canada, UK and New Zealand.
We offer:
- Commissioning capability building and education
- Commissioning maturity assessments
- Co-design facilitation and support
- Development of culturally appropriate commissioning frameworks
To learn more about how Rebbeck can support your organisation’s commissioning journey, contact our team.
This article was written by Jay Rebbeck, Managing Director of Rebbeck. Jay has over 20 years of experience working with health and public service organisations to improve commissioning practices and outcomes.
Featured image – credit scyther
