ACEM - Aotearoa New Zealand: Manaaki Mana Strategy - Excellence in Emergency Care for Māori

The vision of this strategy is that emergency departments will provide excellent, culturally safe care to Māori, in an environment where Māori patients, whānau and staff feel valued, and where leaders actively seek to eliminate inequities.

HUTIA TE RITO O TE HARAKEKE,
KEI WHEA TE KŌMAKO E KŌ, KĪ MAI KĪ AHAU
HE AHA TE MEA NUI O TE AO, MĀKU E KĪ ATU
HE TĀNGATA, HE TĀNGATA, HE TĀNGATA

If the heart of harakeke was removed, where will the bellbird sing?
If I was asked, what was the most important thing in the world;
I would reply, It is people, it is people, it is people

In 2020, The Manaaki Mana rōpū were focused on preparing two documents, which are now ready for wider membership consultation.

Please read, reflect and feedback on our two draft documents that outline the way ACEM, its members and emergency departments can achieve Pae Ora - equity and excellence in emergency care for Māori and uphold te Tiriti o Waitangi (Treaty of Waitangi). These documents have been prepared by the Manaaki Mana rōpū (implementation group) as detailed stepwise guides to help us all grow our skills in four key domains:

Equity of emergency care outcomes
Culturally safe care
Anti-racist policies
Practices and upholders of te Tiriti.

ACEM will be undertaking a formal consultation process before these documents are endorsed by the ACEM board and we welcome any feedback.

He Ara Tiatia ki te Taumata o Pae Ora
Te Tiriti o Waitangi and the health and disability system

You can provide feedback on these documents here.

Te Rautaki Manaaki Mana: Excellence in Emergency Care for Māori (May 2019 - April 2022)

The Manaaki Mana Strategy was launched at the ACEM Winter Symposium in Rotorua on 1 May 2019. We are pleased to share the strategy with you:

ACEM is honoured to have been gifted the name Manaaki Mana for this strategy by Dame R. Naida Glavish, Ngāti Whātua me ngā Ngāti Hine. We thank Dame Naida for this generous gift.

Download Te Rautaki Manaaki Mana (PDF)
Last updated: 18 November 2020

Pae Ora: healthy futures for whānau

Goal	Actions	Priority	Responsibility	Status
1. ACEM’s vision for Manaaki Mana is clearly communicated to key stakeholders	1.1 Develop a set of ACEM Standards on Pae Ora for emergency departments in Aotearoa New Zealand. The standards will describe: What excellence in care looks like. How to measure equitable care.	Medium term	Policy and Strategic Partnerships	In Progress
2. Develop partnerships to progress shared Manaaki Mana goals	2.1 Contribute to Te Ohu Rata o Aotearoa New Zealand/Te ORA (Māori Medical Practitioners’ Association) medical colleges advisory group	Ongoing	MM Rōpu Policy and Strategic Partnerships	Ongoing
	2.2 Develop an engagement strategy to develop partnerships with key stakeholders	Short term	MM Rōpu	Ongoing
3. ACEM will advocate for embedding Manaaki Mana in EDs	3.1 Work with our stakeholders to influence Government policy and health reform	Medium term	MM Rōpu Policy and Strategic Partnerships	Ongoing
	3.2 Offer media training to Māori Fellows and trainees to be our public advocates	Short term	Marketing and Communications	In Progress
	3.3 Communicate opportunities to Māori Fellows and trainees to present at relevant conferences	Ongoing	Policy and Strategic Partnerships	Ongoing
	3.4 Scope holding a bi-annual hui with our partners and stakeholders to progress our vision for Pae Ora	Long term	MM Rōpu	Not started Delayed by COVID-19
4. Governance entities at ACEM represent our commitment to Manaaki Mana	4.1 Explore updating the ACEM Constitution to reflect a commitment to the principles of Te Tiriti o Waitangi and the United Nations Declaration on the Rights of Indigenous Peoples	Short term	MM Rōpu Office of the CEO	Complete
	4.2 Explore establishing a Te Reo Māori name for ACEM	Short term	MM Rōpu Office of the CEO	On Hold
	4.3 Consider the appointment of a strategic Te Ao Māori adviser to the ACEM Board, Council of Education and Council for Advocacy, Practice and Partnerships	Short term	Policy and Strategic Partnerships	Complete
	4.4 Review the Terms of Reference for the ACEM Aotearoa New Zealand Faculty to ensure Māori representation	Short term	New Zealand Office	Complete
5. ED staff understand Te Tiriti responsibilities and Manaaki Mana context	5.1 Develop a statement on giving effect to Te Tiriti o Waitangi in an emergency medicine context	Medium term	MM Rōpu	Not started
	5.2 Advocate to District Health Board executives and Directors of Emergency Medicine the value of regular Te Tiriti o Waitangi training for all ED staff	Long term	MM Rōpu Policy and Strategic Partnerships	Not started
6. ACEM’s senior office bearers understand the socio-political context within which the College operates in Aotearoa New Zealand	6.1 Provide Te Tiriti o Waitangi and tikanga training for ACEM’s Board, Council of Education, Council of Advocacy, Practice and Partnerships, and the ACEM Executive Leadership Team	Medium term Ongoing	Office of the CEO	On Hold due to COVID-19
7. Ensure appropriate oversight and implementation of the Manaaki Mana Strategy	7.1 Establish a Manaaki Mana Implementation Steering Group (Rōpu) to oversee the implementation of the Manaaki Mana Strategy	Short term	Policy and Strategic Partnerships	Complete
	7.2 Employ a project lead at the Aotearoa New Zealand office to support the implementation of the Manaaki Mana Strategy	Short term	Policy and Strategic Partnerships	Complete
8. Engage ACEM staff and members in understanding the significance of tikanga	8.1 Develop an acknowledgement/mihi to open all College meetings that recognises tangata whenua and a commitment to Te Tiriti o Waitangi	Short term	Policy and Strategic Partnerships	Complete
	8.2 Ensure ACEM email signatures and ACEM website recognise tangata whenua and a commitment to Te Tiriti o Waitangi	Short term	Corporate Services	Complete
	8.3 Ensure that a pōwhiri is conducted at appropriate College hui (e.g. Aotearoa New Zealand-based Annual Scientific Meetings, Winter Symposia and the annual Aotearoa New Zealand Faculty Conference)	Ongoing	Policy and Strategic Partnerships	Ongoing
9. Establish mechanisms to evaluate Pae Ora achievements	9.1 Support the delivery of a research project that creates a set of measures to provide an annual snapshot of Māori health outcomes in the ED	Long term	Policy and Strategic Partnerships	Not started
10. Advocate for research in emergency departments that is relevant, safe and responsive to Māori	10.1 Advocate for Emergency Department research and audits in Aotearoa New Zealand to include analysis of Māori health outcomes. Where inequities are uncovered, advocate for action plans to address inequities	Long term	MM Rōpu Policy and Strategic Partnerships	Not started
	10.2 Advocate for researchers to utilise Kaupapa Māori values, and to liaise with local Māori Health research services	Long term	MM Rōpu Policy and Strategic Partnerships	Not started

Mauri Ora: healthy individuals

Goal	Actions	Priority	Responsibility	Status
11. Weave aroha and manaakitanga practices into patient care	11.1 Run an ongoing advocacy campaign with supporting guidelines to encourage the everyday use of Te Reo in EDs: Encourage all Fellows and trainees working in Aotearoa New Zealand to practice pronunciation and use Te Reo with patients. Focus campaign on DEMs[1] and DEMTs[2] to promote the use of Te Reo and to support regular Te Reo study for ACEM trainees and Fellows.	Short term	MM Rōpu Policy and Strategic Partnerships Marketing and Comms	In progress
	11.2 Run an ongoing advocacy campaign with supporting guidelines to encourage best practice patient tikanga in the ED.	Medium term	MM Rōpu Policy and Strategic Partnerships Marketing and Comms	In progress
	11.3 Encourage DEMs and DEMTs to provide information to ED staff about Te Ao Māori views on health, healing and rongoā (traditional Māori healing practices)	Long term	MM Rōpu Policy and Strategic Partnerships Marketing and Comms	Not started
12. Create a kete of resources for all emergency medicine trainees and Fellows to support culturally safe care in EDs	12.1 Encourage EDs to review their practice based on the Ministry of Health’s Literacy Framework, and advocate to EDs the benefits of workforce development in good health literacy practice	Long term	MM Rōpu Policy and Strategic Partnerships Marketing and Comms	Not started
	12.2 Produce an e-learning resource for trainees, Specialist International Medical Graduates and Fellows: A culturally safe visit to the ED from the perspective of a Māori patient and their whānau. The resource will incorporate Māori history and Te Tiriti, understanding the impacts of colonisation and racism, understanding health inequities/equity vs equality, bias mitigation and self-reflection, asking patients if they identify as Māori and their iwi affiliations, and using Te Reo with patients and staff.	Medium term	MM Rōpu Policy and Strategic Partnerships Education and Training	In progress
13. Ensure all trainees and Fellows working in Aotearoa New Zealand are provided with regular Te Reo and tikanga training	13.1 Review ACEM’s Accreditation Standards for Training Sites to include provision of adequate time and resourcing for trainees and Fellows to attend Te Reo Māori and tikanga training	Long term	Education and Training	Not started
	13.2 Include a component on teaching Māori Health and Cultural Safety in ACEM DEMT Workshops	Medium term	Indigenous Health Committee Education and Training	In progress
	13.3 Continue to advocate to DEMTS for teaching sessions and events to be held around Waitangi Day, Te Wiki o Te Reo Māori and Matariki	Ongoing	Education and Training	Ongoing
	13.4 Partner with key stakeholders to ensure there are no barriers for trainees who wish to undertake ACEM’s Special Skills Placement in Aboriginal, Torres Strait Islander and Māori Health	Ongoing Long term	Education and Training	Pending
	13.4 Support the implementation of mandatory cultural competence and cultural safety activities in the ACEM CPD programme	Ongoing	Indigenous Health Committee	Ongoing
	13.5 Work with the organising committees of the Annual Scientific Meetings, Winter Symposia and Faculty Conferences to ensure that Māori Health and Cultural Safety content is prominent in programmes	Ongoing	MM Rōpu Policy and Strategic Partnerships	Ongoing
14. Ensure ACEM’s training programme has robust mechanisms in place to assess the cultural competence of trainees	14.1 Work with the Leaders in Indigenous Medical Education (LIME) Network to hold a workshop on embedding assessment in Māori health and cultural competency into the medical colleges’ training programmes	Medium term	MM Rōpu RAP Steering Group Indigenous Health Committee	In progress

[1] Directors of Emergency Medicine

[2] Directors of Emergency Medicine Training

Whānau Ora: healthy families

Goal	Actions	Priority	Responsibility	Status
15. Weave aroha and manaakitanga practices into Emergency Care	15.1 Encourage DEMs to establish a relationship with the DHB General Manager Māori Health and Māori Health Units to utilise their cultural expertise to support whānau and staff in the ED	Medium term	MM Rōpu Policy and Strategic Partnerships	Not started
16. Grow the Māori emergency medicine workforce to represent the communities they serve	16.1 Work with the ACEM Selection Subcommittee to consider including knowledge of Mātauranga Māori as a selection criteria for entry into FACEM Training in Aotearoa New Zealand	Medium term	MM Rōpu	In progress
	16.2 Establish targets for recruiting and retaining Māori doctors into the ACEM Training Programme	Short term	MM Rōpu Education and Training	Not started
	16.3 Host ACEM Foundation funded national hui or regional dinners to recruit house officers into emergency medicine	Short term	MM Rōpu Policy and Strategic Partnerships	Not started
	16.4 Establish a relationship with Te Oranga Māori Medical Students’ Association to explore how ACEM can promote emergency medicine as a specialty to its membership	Short term	MM Rōpu Policy and Strategic Partnerships	Not started
	16.5 Host ACEM Foundation funded dinners or events at the Auckland and Otago University medical school orientations for new students	Short term	MM Rōpu Policy and Strategic Partnerships	Not started
	16.6 Explore linking with Te Ohu Rata o Aotearoa New Zealand (Te ORA) (Māori Medical Practitioners’ Association) outreach work with high schools to engage with students to consider medicine/emergency medicine as a career	Short term	MM Rōpu Policy and Strategic Partnerships	Not started
	16.7 Explore how ACEM can use its website and social media to engage with students and doctors to promote emergency medicine as a career choice	Medium term		Pending
	16.8 Continue to sponsor the annual Te Ohu Rata o Aotearoa New Zealand/Te ORA (Māori Medical Practitioners’ Association) Hui-ā-Tau and the biannual Pacific Region Indigenous Doctors Congress (PRIDoC)	Ongoing	Policy and Strategic Partnerships	Ongoing
	16.9 Consider sponsorship of other conferences and grant opportunities that would increase the exposure of medical students and doctors to emergency medicine	Ongoing	Policy and Strategic Partnerships	Ongoing
17. Support and retain the Māori emergency medicine workforce	17.1 Collaborate with ACEM Māori trainees and Fellows to establish a support network	Ongoing	Policy and Strategic Partnerships	Ongoing
	17.2 Based on feedback from trainees and Fellows, establish a mentoring model for Māori trainees and Fellows within ACEM’s overarching mentoring programme	Long term	Education and Training	In progress
	17.3 Ensure Māori trainees have opportunities to attend relevant hui and conferences (e.g. Te ORA Hui-ā-Tau, PRIDoC, ACEM Annual Scientific Meeting and Winter Symposium), and are aware of grant, award and scholarship opportunities	Ongoing	Policy and Strategic Partnerships Marketing and Comms	Ongoing
	17.4 Consult with our current Māori trainees to understand how ACEM can best support them on their journey through the FACEM Training Programme, and implement their recommendations where practicable	Medium term	Education and Training	In progress
	17.5 Ensure ACEM staff in the Melbourne and Aotearoa New Zealand offices receive regular training in Te Reo Māori, Tikanga and Te Tiriti o Waitangi	Ongoing	People and Wellbeing	Ongoing
	17.6 Scope a Māori Leadership Pathway in Emergency Care for trainees and FACEMs in ACEM and more generally in medical education and advocacy	Long term	Education and Training	Not started

Wai Ora: healthy environments

We look forward to keeping you updated on our progress to implement the strategy.

Ehara taku toa i te toa takitahi
Engari he toa takitini.

Success is not the work of one,
It is the work of many.

Manaaki Mana: the journey

Three years ago, a hui was convened in Auckland with a large group of stakeholders from Aotearoa to discuss ways in which ACEM can work in partnership to achieve equity for Māori in Aotearoa New Zealand emergency departments.

The hui led to the establishment of a steering group to oversee the development of a strategy for ACEM.

A consultation was held with our stakeholders in March, seeking feedback on the strategy. Aku mihi nui kia koe (many thanks) to everyone who took the time to provide comment.

Equity for Māori Hui

A very successful hui (meeting) was held on 8 March 2018 in Auckland at Te Manukanuka o Hoturoa Marae. A broad range of stakeholders working in emergency departments, health research and other Colleges met to discuss ways in which ACEM can work in partnership to achieve equity for Māori in emergency departments.

A joint project between the Indigenous Health Committee and the Aotearoa New Zealand Faculty, the hui involved a formal pōwhiri, a range of speakers and robust and spirited workshop sessions.

The insights and input collated from the hui have informed the development of the College’s long term strategy. The ACEM Board has committed to the formation of a Steering Group to oversee this work.

Hui Speaker Presentations

David Tipene-Leach
Rhys Griffith-Jones
Elana Curtis
Tengaruru Wi-Neera
Marama Tauranga
Riki Nia Nia

ACEM acknowledges Māori as tangata whenua and Treaty of Waitangi partners in Aotearoa New Zealand.

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