This chapter addresses three questions about health systems: What is a health system? What are health systems for? What functions should a health system perform? A health system can be understood as an interconnected set of structural relationships between two components: a population and a set of providers. A health system includes the resources, actors and institutions related to the financing, regulation and provision of activities, whose primary intent is to improve or maintain health. Health systems include personal health services, hybrid health services and population health services. The defining purpose of the health system is to improve health, both the average level and its distribution across individuals. Two other intrinsic goals of the health system should be responsiveness to the legitimate expectations of the population, and fairness in financial contribution. Health systems must perform five basic functions: financing, provision, resource development, systemic integration and the meta-function of stewardship.

This chapter offers an historical examination of Aboriginal and Torres Strait Islander healthcare from a nursing viewpoint. It considers how the current shape of Aboriginal and Torres Strait Islander health has been formed by actions taken since European colonisation. It discusses the status of Aboriginal and Torres Strait Islander health during different historical periods, including what is known about the pre-invasion health system and health service provision during the periods of initial contact, separation and protection. Finally, the chapter discusses the rise of the Aboriginal and Torres Strait Islander community-controlled health system and contemporary choices for Aboriginal and Torres Strait Islander people in the delivery of healthcare and health outcomes. It further discusses the approach taken by all Australian governments of working with Aboriginal and Torres Strait Islander people, communities and organisations to implement the new National Agreement on Closing the Gap at the national, state and territory, and local levels. Each section of this chapter is framed within the prism of nursing, exploring the role of nursing in health systems and the delivery of healthcare.

This chapter examines how medical workplaces – as material places and as institutions - protect or undermine the physical and emotional lives of the doctors who work there. Workplaces include hospitals, ambulatory clinics, locum settings, and precarious workplaces such as international humanitarian medical work, and newer, non-material workplaces such as telemedicine. Dominance and sexual harassment can occur in the interstices of all these workplaces, and sometimes in the full view of others.

Sexual harassment not only harms survivors; it also has impacts on the team, the organisation and the profession. Harms can include changes in the way teams and individuals interact, which can have a direct impact on the quality of patient care. It can mean survivors and witnesses are less able to be empathic and interpersonally aware, as they are focussed on defensive and protective behaviours. Sexual harassment by a senior colleague changes the way survivors and bystanders see their profession, and this can cause long-lasting harm in their own practice. Many survivors leave or change their workplace, causing workforce deficits and loss of experience and skills. Those survivors who live with intersectional disprivilege provide critical diversity in teams that need to manage a breadth of patient experience. Unfortunately, they are at higher risk of sexual harassment, and so are more likely to leave, restricting the profession’s capacity to respond to community needs across the breadth of the population. The cost is a drop in the capacity of the organisation to provide quality care.

This chapter defines sexual harassment and its key targets and perpetrators to argue that their attitudes and beliefs are the anthesis of medical values and principles – to do not harm. It identifies the costs to the organisations of this sexual harassment and abuse. Adopting a preventative medicine framework we extend the scale and focus of prior work to consider evidence-based SHA interventions. We aim to advance current understanding about SHA and its detection, deterrence and amelioration within the health workforce through a multi-level and multi-stage SHA prevention strategy that collectively impacts up- and down-stream changes for this workforce and their workplaces. We outline five levels at which awareness raising, education and intervention is required – to include primordial, primary, secondary, tertiary, and quaternary.

This chapter describes the role of medical regulators including the history of the International Association of Medical Regulatory Authorities (IAMRA). It highlights the common key processes of medical regulation agencies internationally and the standards of practice that are relevant to sexual harassment and abuse of doctors by doctors.

Examples of regulatory standards specifically relevant to sexual harassment and abuse of are drawn from the regulatory frameworks of several different countries illustrating the range which varies from specifically condemning sexual harassment to more generic requirements for good behaviour, productive and respectful collegiality and being aware of power imbalances.

In the final section the author documents typical regulatory processes that occur on receipt of a complaint of sexual harassment or abuse by a doctor as well as the range of responses that may occur if an adverse finding is made against a doctor. The advantage of involving medical regulators is that it allows communication about concern regarding perpetrators found to have failed the standard between jurisdictions and between specific clinical settings.

This chapter discusses the role of men in abuse of doctors by doctors. The chapter considers the role of men at all levels including victim, bystander, perpetrator, employer or those within the regulatory and legal systems. The chapter helps us to understand and look beneath the obvious drawing on the evidence of men’s roles at all levels. It also speaks to the potential of men to positively influence for change and prevention of abuse, as well as drawing our attention to possible risks of abuse occurring. It raises our awareness of the ‘not so innocent bystander’ and the significant potential of engaging bystanders, colleagues, and system leaders into positive action.

This chapter introduces the potential legal consequences of occupational sexual harm of medical practitioners by medical practitioners, and outlines some of the reasons for non-reporting in the criminal context. The challenges of reporting of sexual harm in the workplace are discussed and followed by three illustrative case studies from Australia one from a criminal court, one from a civil court and one case brought by the Medical Board to the Administrative Appeals Tribunal. The chapter concludes with the recognition that complex structural and cultural environments exist which deter some victims from pursuing legal redress and can inadvertently harm those who do pursue it. Solutions are not simple or easy and, irrespective of the prevalence of occupational sexual harm, pursuit of legal claims is likely to remain low due to the personal and professional risks a complainant endures.

This chapter draws from work and social-cognitive psychology, which is concerned with understanding people at work, and specifically the social and individual cognitive dimensions to these serious misconducts. It offers a distinct perspective on sexual harm, by focusing on three interconnected elements: the individual, the specific types of behaviours, and the environment. Understanding these distinct elements and how they combine, alongside insight into different inhibitors is critical not only understanding why these events occur, but also why they persist. This lens highlights the role of power and its abuse by elites, and why others may be reluctant to challenge and raise their concerns. It also reveals why a professional, undertaking morally praiseworthy activities may paradoxically be more at risk from the distorting cognitive processes of moral licensing. Psychology offers new perspectives into these phenomena and more critically into upstream preventative responses, to show why remediative sanctions may not be so simple here.

The framework of human rights has permeated international discourse and has evolved into standards that are replicated at international, regional, and domestic levels. This chapter utilises the human rights framework to explore the value it may offer in addressing the issue of abuse between medical practitioners. Beginning with a brief description of the overarching instruments from which the modern understanding of human rights stem, the chapter progresses to look at the specific human rights instruments at an international, regional, and domestic level. This analysis concludes the human rights framework offers little to an individual in terms of timely redress, however, the value of this approach lies in collective advocacy. Utilising a common language, global criteria, and data, human rights act as a point of agitation which can assist in exposing archaic notions around appropriate workplace behaviours and transforming rights into enshrined legislative materials with the full protection of the law. The human rights framework should be pursued alongside a more responsive methodology, such as though legal options and mechanisms, until such a time as neither are required.

Critical to successful engagement in any organisation is an understanding of the important elements affecting good communication. There are many dimensions to the study of communication in the 21st century, both generally and in health service settings, in the 21st century. This chapter considers the foundational concepts, with references to help students discover more about communication in organisational, social and cultural settings. Many believe that even the definition of communication is worth questioning. As a notion it is so discursive and diverse that any definition other than the simplest becomes so complex as to cease being useful.

Intense debate surrounds the differences between the roles, functions and even the differences between leaders and managers. Leadership is not wholly different from management; indeed, it is a component of management and a responsibility of management, especially of senior managers. Effective managers need to be effective leaders, and the most effective leaders are also good managers.