A ‘True North Statement for Care’: charting the course to better care for all Australians

Rebecca K. Golley; Georgia Middleton; Michael T. Lawless; Lucy Anastasi; Alison L. Kitson; Raymond J. Chan

doi:10.1071/AH25063

RESEARCH ARTICLE

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A ‘True North Statement for Care’: charting the course to better care for all Australians

Rebecca K. Golley ^A ^* , Georgia Middleton

^A , Michael T. Lawless ^A , Lucy Anastasi ^A , Alison L. Kitson ^A ^# and Raymond J. Chan ^A ^#

+ Author Affiliations

- Author Affiliations

^A Flinders University, College of Nursing and Health Sciences, Caring Futures Institute, Tarntanya, Adelaide, SA, Australia.

^* Correspondence to: rebecca.golley@flinders.edu.au

^# These authors contributed equally to this paper.

Australian Health Review 49, AH25063 https://doi.org/10.1071/AH25063

Submitted: 17 March 2025 Accepted: 22 March 2025 Published: 9 April 2025

Abstract

Objective

To shift the narrative from ‘deficit dialogues’ in health and social care in Australia, we aimed to generate a series of consensus ‘ambition’ statements representing what peak care stakeholders in Australia want health and social care to look like in the future.

Methods

A multiphase co-design study with Australian ‘care’ stakeholders was undertaken. This consisted of a desk-based audit of Australian health and social care organisations (n = 9) and a pre-forum survey (n = 21 responses) (activity 1), the findings of which informed the national forum activities (activity 2, n = 31 organisations), which became the content for the Delphi survey (activity 3, n = 28 organisations).

Results

Through this process we distilled five ambition statements and 39 descriptors. These statements are our True North Statement for Better Care, providing a starting point to guide individual, organisation and system redesign across the life span. The statements require action at individual consumer, workforce and system level.

Conclusions

Creating the True North Statement for Better Care provides a united direction for heterogeneous groups to work together to improve care for consumers, their workforce and the systems they work in. This is an important initiative to change the way we value, talk about, do, own and research care. Further user testing is required to ensure the statements can be translated into action.

Keywords: care, care workforce, health services, person-centred, systems.

Introduction

Health, aged and social care systems worldwide face escalating demands to deliver efficient, safe, high-quality and humane care that meets the complex and diverse needs of individuals and communities.¹^–⁴ Existing systems were not designed to fulfil contemporary care objectives. There is an ingrained culture of conservatism and privileging of the biomedical model. Decision-makers, frontline professionals, communities and individuals are calling for transformative system and policy change to prioritise a human-centred approach.⁵^,⁶

Royal Commissions in Aged Care, Disability and The Early Years have illuminated the flaws in health, aged and social care systems, underscoring immediate need for reform to deliver better care.⁷^–⁹ Prior reform responses have been confined within existing structures and mental models. Despite efforts to shift towards an integrated biopsychosocial approach and a focus on person-centred care, our care systems do not yet have the capability to deliver high-quality, consistent, person-centred care that meets peoples’ fundamental care needs and expectations.¹⁰^,¹¹ Leaders know change is needed and that better systems will deliver better care and outcomes, but the ability to break out of bandaid or incremental change remains elusive.

Engaging with thought leaders in and consumers of care is essential for driving meaningful system change. There is, however, a lack of peer-reviewed literature exploring the future of care delivery at the individual, organisational and system level, priorities for reform, policy development and practice opportunities from the perspectives of policy, clinical leaders and key stakeholders. Creating a consensus on the future of care within health, social, aged and community contexts in Australia can bring about significant reform in health and care policy, benefiting providers and recipients of care. In other words, our mission is to generate new ways of discussing and tackling old problems.

Flinders Caring Futures Institute hosted the Care Ambition 2030 National Forum to co-design with stakeholders a ‘True North Statement’ to drive the future of care within our systems, processes and communities. This statement intends to be ambitious and future focused. By fostering a shared energy and ability to identify priorities together, this statement can underpin collective action to shape funding and political decisions. Together, we can chart our paths to deliver transformative change to enhance care systems and improve the care provision and experience of Australians for better health and wellbeing.

Methods

A multiphase co-design study with stakeholders generated a unified statement to drive the future of care (Fig. 1). This research was performed in accordance with the Declaration of Helsinki. Participants provided informed, written consent prior to the National Forum and Delphi survey. Ethics approval was granted by Flinders Human Research Ethics Committee (#5487).

Fig. 1.

Stakeholder activities to inform the generation of the Statement for Better Care.

Pre-forum survey

A desk-based audit was undertaken to scope definitions and strategic issues faced by Australian health and social care organisations. Nine national organisations were selected for comprehensive content analysis of their online pages and documents outlining strategic visions, issues and definitions regarding care. Organisations represented medicine, nursing, midwifery, allied health, pharmacy, aged care, carers and multicultural communities. One author (LA) extracted data and two authors (GM, ML) undertook content analysis to identify and theme the relevant content. A pre-forum survey was generated from these findings and sent to all individuals attending the National Forum. In the pre-forum survey, respondents identified their three core issues in care and what a successful transformation of care would look like. Twenty-one individuals responded, representing peak body organisations and professional societies, charity and advocacy groups, government departments and agencies, research centres and organisations in care (see Acknowledgements). GM and ML undertook qualitative content analysis of survey responses and generated three themes where care issues and transformations were most consistently identified; care system (integrated, equitable, patient-centred, sustainable), care workforce (skilled, valued, supported, collaborative) and care consumers (empowered, informed, respected). These themes were used to structure the forum activities.

National Forum

Care Ambition 2030 National Forum was held in September 2022 with representatives from 31 health, care and consumer organisations, including consumers, advocates, practitioners, chief executives and researchers (see Acknowledgements).

To facilitate thinking and information exchange, the World Café process was used.¹² The World Café method involves constructive conversation on designated topics through consecutive rounds, and recording key points through writing, drawing and mapping.¹² Our World Café involved 8–10 participants at tables with a topic area of care workforce, system or consumer and three rounds of conversation: (1) flaws in the Australian care system, (2) changes happening in care nationally and internationally and (3) ideas for the future of care in Australia. Participants then generated their most impactful statements for their designated table topic area, yielding 50 ‘ambition statements’ relevant to Australian care systems. Data from these activities were used to generate Delphi survey items.

Delphi survey

A modified Delphi survey was used to refine the ambition statements and generate descriptors to inform the True North Statement. The Delphi technique is an iterative, sequential process designed to obtain consensus from experts, termed ‘panellists’, through multiple survey rounds.¹³^,¹⁴ A traditional Delphi survey provides panellists with open-ended questions to generate ideas in Round 1.¹³ We modified this process and provided panellists with statements to rank in Round 1. Forum invitees were our expert panellists and were invited to participate in the Delphi survey. Consensus was set a priori at ≥79%.

Item generation for Delphi survey

Forum activity data were used to generate Delphi survey items. The World Café data, captured on butcher’s paper, was transcribed to an Microsoft Excel Spreadsheet¹⁵ for analysis. The ambition statement activity data were captured in Slido¹⁶ and transferred to a Microsoft Word Document¹⁷ for analysis.

GM and ML undertook thematic analysis of the ambition statements, categorising them according to their central theme. All statements fit within five main themes. The themed statements were brought to a team meeting where each team member independently generated one statement for each theme, representative of the original statements within that theme. This resulted in 25 statements with considerable overlap, further synthesised into five core statements. These statements were sense-checked against original statements to ensure representation of key ideas. The World Café data were synthesised against these five statements by GM and ML, and used to generate ‘descriptors’ against each statement by GM and RG. The descriptors represent the requirements for each ambition to be successful. These final ambition statements and descriptors were confirmed by the team before being finalised as Delphi survey items.

Round 1

Round 1 contained five ambition statements, each with five to seven descriptors. Panellists indicated their agreement with each ambition statement and the importance of each descriptor on a five-point Likert scale (strongly disagree to strongly agree). Panellists could provide alternative phrasing or add descriptors.

Round 2

Statements that reached consensus in the first round were not taken through to the second round. Statements and descriptors that had not reached consensus in Round 1, along with panellists’ additional descriptors, were presented in Round 2 as above.

Discussion and deliberation

Results from Round 2 were synthesised and final ambition statements and descriptors were confirmed through team discussion. This process ensured consistent phrasing and terminology. Through this process, descriptors were retermed ‘actions’.

Results

Thirty-four individuals participated in Round 1, and 29 in Round 2, representing 28 of the organisations invited to the forum (Fig. 2). Organisations included professional societies, bodies, organisations and boards, research centres, government departments or agencies, charity and advocacy groups, consumers, local health networks and service providers.

Fig. 2.

Flow chart of Delphi process to reach consensus on final statements.

Round 1

Of the five ambition statements presented in Round 1, all reached consensus agreement (± modifications). Of the 29 descriptors presented in Round 1, 23 reached consensus agreement (± modifications) and six did not meet consensus (± modifications). Statements and descriptors were refined based on open-ended participant responses. Descriptors that did not meet consensus were modified and carried into Round 2, along with 24 additional descriptors.

Round 2

Of the 30 descriptors presented in Round 2, 22 reached consensus agreement (± modifications) and eight did not. Descriptors were refined based on open-ended participant responses. This was the final Delphi round as we had achieved our study aim of co-designing a consensus True North Statement for the future of care in Australia. Supplementary Table S1 displays the ambition statements and descriptors presented for voting.

Final ambition statements and actions

Two Delphi rounds resulted in consensus agreement of five ambition statements and 45 descriptors for the future and focus of care for Australia. The descriptors were transformed into 39 actions, and the ambition statements were refined according to participant feedback and team discussion (Supplementary Table S2), with a final round of refinement to ensure the statements were accessible for a lay audience. Table 1 presents the final five ambition statements along with the 39 actions. See Fig. 3 for a graphic presentation.

Table 1.True North Statement and actions to deliver better care and caring for Australians.

Ambition Statement	Actions
1. A culture of care Consumers experience a culture of care where their health and wellbeing are taken care of in a holistic way, with their physical, mental, emotional, spiritual and cultural needs considered. People are seen as experts in their own health, and their friends and family who take care of them are recognised as important partners.	1.1. Create a culture of compassion, kindness and wellness, across health and social care settings that extends across the life course. 1.2. Adopt a strengths-based perspective that is focused on an individual’s or community’s ability, engagement and enablement as an antidote to exclusion, discrimination and stigma. 1.3. Facilitate connection and communication between health and social care workers and consumers and their chosen carers. 1.4. Respect the unique and diverse needs and experiences of consumers as part of person-responsive health and social care. 1.5. Privilege high-value, person-centred care that uses resources efficiently and achieves optimal results for every person. 1.6. Deliver policy, services, interventions and programs with compassion, kindness and empathy. 1.7. Position agency and self-determination as foundational in each person’s care. 1.8. Support health and social care education and literacy across all life stages for consumers, their chosen carers and their care networks. 1.9. Collect health and care data that are exchanged between health and social care partners and networks to support the provision of holistic and integrated care.
2. Consumer experience of health and social care A consumer experience of health and social care that empowers, informs and respects individuals, allowing them to easily and equitably access information and services. Consumers should be able to participate in their care according to their preferences, culture and values, provide feedback on their experiences and be involved in co-designing educational and system improvements supported by a comprehensive care team.	2.1. Acknowledge and respect chosen carers as part of the care team, where desired. 2.2. Empower consumers by providing navigation through the health and social care system. 2.3. Keep consumers informed through providing adequate health, care and digital literacy education and support. 2.4. Acknowledge and invest in consumers, and their family and friend carers, as advocates, experts and active participants in their own care in accordance to their preferences, culture and values. 2.5. Integrate consumers and family and friend carers in the design and delivery of healthcare training programs. 2.6. Measure and adequately act upon patient-reported health and care experiences and outcomes. 2.7. Share information with consumers and their family and friend carers through communicating in language, culture and context accessible ways to keep them informed.
3. A caring and cared for health and social care workforce A care workforce that is skilled, respected and supported, working to the highest standards. This includes ensuring fair compensation, providing career pathways, strong leadership and support systems.	3.1. Recognise and respect the multiple paid and unpaid workforces for their roles and responsibilities within the health and social care system. 3.2. Adequately fund and remunerate the paid health and social care workforce. 3.3. Facilitate the health and social care workforce to work at full scope of practice with appropriate mechanisms of support, supervision, education and credentialling to deliver excellence. 3.4. Build a culture of care through strong, values driven leadership, including open communication and active collaboration and supporting the health and wellbeing of the workforce. 3.5. Enable the health and social care workforce to innovate and move across the systems, sectors and models of care through purposeful education and training. 3.6. Develop career pathways that recognise and reward demonstrated capability, deliver higher qualifications and incorporate extensive hands-on care experience and leadership skills. 3.7. Support the health and social care workforce to deepen their expertise and interests through professional development opportunities to promote retention in the sector. 3.8. Diversify and optimise existing and new health and social care roles to create more capacity for care, establish clear boundaries and allow all care workers to work at full scope of practice. 3.9. Collect data against mutually agreed indicators to support work performance and ensure quality patient care.
4. Technology to support health and social care Technology used to support health and social care systems, to make them more effective and accessible while improving communication and collaboration between providers and consumers.	4.1. Integrate digital systems and technology in a way that facilitates efficient, effective, timely, relevant and safe exchange of information between consumers and care providers. 4.2. Ensure responsible use, lining and protection of consumer data when linking across infrastructures and systems. 4.3. Ensure that digital systems and technology are used to support data-informed and evidence-based change processes, such as quality improvement or service innovation. 4.4. Develop and implement accessible, comprehensive health and social care records that represent a consumer’s journey across the whole care system, that can be easily accessed by consumers to increase their control of their care journey. 4.5. Facilitate the human–technology interface through initiative, person-informed design, and empower consumer agency through increasing health and care literacy.
5. Learning health and care systems Care systems that meet the different needs of communities by providing care that is tailored, accessible and integrated. These systems should be designed together with the people that use them.	5.1. Design or reform health and social care systems to be responsive to the priorities and preferences of consumers. 5.2. Attend to the cultural, social and commercial determinants of health and wellbeing in the design and operation of health and social care systems. 5.3. Underpin all health and social care systems and models to be inclusive by emphasising the identified needs of priority groups. 5.4. Reduce inequities in access to health and social care services and resources to remove discrimination and stigma in provision of care. 5.5. Enhance access to health and social care by delivering services closer to home, with consumers and their chosen carers having easy and meaningful access to health and social care professionals. 5.6. Provide universal access to designated care workers or technology supports to assist people to navigate health and social care systems when needed. 5.7. Design or redesign an integrated, connected and coordinated health and social care system that connects acute and non-acute services so consumers have improved health and social care service availability, access, awareness and referral. 5.8. Co-design integrated health and social care systems with the influencers, users and beneficiaries of care, particularly consumers. 5.9. Integrate health and psychosocial research to support a holistic and consumer-informed approach to care.

Fig. 3.

Graphic representation of the True North Statement for Better Care for all Australians.

Discussion

The True North Statement for Better Care is a collective call to action driven by a purpose to create value for society. Through this study, the unifying True North Statement was co-designed with stakeholders across health and social care sectors to chart the reform needed within our systems, models of care and communities to deliver a culture of care. Creating the True North Statement for Better Care provides a starting point for a united direction of travel for heterogeneous groups to work together to improve care for consumers, their workforce and the systems they work in.¹⁸^–²²

The True North Statement and its ambitions focus on culture, lived experience, workforce, technology and the care ecosystem, setting clear areas for collective action. Shifting towards giving equal weight to compassion and wellness, consumers and supporting the workforce, in addition to current reform priorities, is fundamental. The ambitions articulated align with reasonable expectations but are not uniformly embedded across current care systems. Australia’s care landscape is being shaped by significant reform.⁷^,⁸ Common across current agendas are strategies aimed at improving access, affordability and quality of care standards, as well as addressing care workforce and funding models or shortages.⁷^,⁸^,²³^–²⁵ However, the care preferences of consumers and their care networks, a valued and appropriately renumerated workforce working to their full scope of practice, integrated continuity of care across sectors, integration of digital health and technology innovation and learning care systems informed by multiple evidence sources are largely implied.²⁶^–³⁰

Addressing Australia’s care shortcomings and aligning integrated multiple health and social care systems that work together as a ‘care eco-system’ that delivers on the overarching ambition of a culture of care, requires action at all levels. Viewing consumers as partners is vital for ensuring that person-centred care drives decision-making. Perspectives such as evidence-based care, risk or system efficiency or the biomedical model cannot be privileged over the care experience.³¹ People’s voices must be heard and used to drive change. Partnering with advocacy groups can amplify this effort, but change requires action from all sectors involved. Empowered and transformational leadership is crucial, particularly from the care workforce,³² who have voiced concerns regarding public respect, burn-out, limited agency and inadequate remuneration.¹⁰^,¹¹ The fundamental foundation of health and care systems also needs to shift. The call for values based health systems are a step in the right direction.³³ However, without a commitment to care and putting people at the centre of all decisions, there is a risk that the old becomes new. While consumers of care were involved in the development of these statements, further consultation with this key stakeholder group is a critical next step in this work.

Systems thinking and innovative policy planning are necessary to enact these actions nationwide.³⁴ The World Health Organization’s systems thinking framework offers a practical approach to strengthening health systems.³⁵ The framework encourages collaboration with diverse stakeholders in problem-solving, suggests ways to forecast health system’s responses to initiatives and stresses the importance of evaluation. Policies at different levels of government and jurisdiction should be informed by this framework including considerations for (i) service delivery, (ii) health workforce, (iii) health information systems, (iv) access to essential medicines and care, (v) financing and (vi) leadership/governance.³⁵ There are Australian examples emerging at both a state and clinical area level.³¹^,³⁶^–³⁸ It is intended that the generated True North Statement for Better Care developed in this study can be used as a starting point to foster a shared understanding, identify priorities, enhance care systems and chart our paths to deliver transformative change to improve the care provision and experience across health, ageing, early education and social care systems. Focused attention on these priorities from national research funding bodies is required to allocate research funding and prioritise solutions that can bring about care reforms called for by participants in this study.

The statements we refer to as our True North Statement for Better Care are a blueprint to guide individual, organisation and system redesign across the life span. The statements are sequential and require refinement and action at individual consumer, workforce and system levels. Engaging key stakeholders of care was an important first step to getting a heterogeneous group on the same page for a plan for the future of care. Next steps are to take these statements to on-the-ground care workforce and consumers for focus testing to ensure they are (a) reflective of their needs and (b) implementable within their contexts. Following this process, there are several practical applications of the statements and actions. For example, organisations that work in health or social care could use these statements to inform their strategic plans, research initiatives, education and guideline development. Organisational self-audits could be undertaken to identify current efforts and gaps in addressing and achieving the ambitions. The actions generated against each ambition could be changed into key performance indicators and objectives to track progress in achieving our True North Statement for Better Care across Australia. Timeframes could be set, and cost benefit analyses could be undertaken to evaluate whether organisations embracing the True North Statement for Better Care provide better health, care and wellbeing outcomes for their clients and staff. Multisector collaboration, partnership, inclusion and evaluation will be integral to realising the full impact of our True North Statement for Better Care. In the existing context of workforce burnout, rising costs, ageing and more complex care needs, this is an important initiative to change the way we value, talk about, do, own and research care.

Strengths and limitations

We achieved a high level of consensus across diverse health and social care organisations about what the future of care should look like. These statements embrace individual consumer, employee and system dimensions, which in turn support emerging research and policy shifts to addressing workforce shortages by looking at the psychosocial safety dimensions in the workplace. While this research has involved extensive stakeholder engagement, not all forum participants completed the Delphi surveys, and there was a need for interpretation to transform forum data into Delphi items. Furthermore, while consumers were involved in the co-design process, the statements and actions may not be appropriately articulated to enable their use and implementation. We suggest further market research with diverse consumer groups to ensure the findings from this work are relatable and actionable. These strengths and limitations contribute to the overall blueprint for actionable change and disruptive transformation of self-care, care and caring solutions in Australia.

Conclusion

This series of co-design activities has generated a True North Statement that can serve as a starting point for a shared action-focused vision to transform health and social care in Australia over the next decade. Through an inclusive consultation process with inter-sectorial stakeholders, five ambition statements have been developed to drive the future of care in the country. By actively working towards these ambitions and ensuring their integration across all health and social care systems through continued refinement and articulation, we have the opportunity to redefine the culture of care and use it to chart the future to improve outcomes for individuals, families and communities. This shared purpose will ensure that unique voices and perspectives, including those of consumers, will shape the narrative to inform policy and decision making that impacts care.

Supplementary material

Supplementary material is available online.

Data availability

The data that support this study cannot be publicly shared due to ethical or privacy reasons and may be shared upon reasonable request to the corresponding author if appropriate.

Conflicts of interest

The authors declare no conflicts of interest.

Declaration of funding

This research did not receive any specific funding.

Acknowledgements

We acknowledge Matthew Wright Simon for facilitating the National Forum, Dr (h.c.) Gill Hicks (AM, MBE) for providing the keynote at the pre-forum dinner, those who attended the Forum and generously shared their experiences and ideas, those who participated in the Delphi survey, the National Forum table hosts and facilitators from Flinders University (Assoc. Prof. Yvonne Parry, Prof. Lucy Chipchase, Prof. Robyn Clark, Prof. Julie Ratcliffe, Prof. Jennifer Tieman, Prof. Gill Harvey, Dr Jyoti Khadka, Assoc. Prof. Belinda Lange, Prof. Joanne Arciuli, Prof. Sally Robinson, Dr Nina Sivertsen, Dr Lauren Lines, Prof. Annette Briley, Dr Mattew Tieu) and Nikki Johnson and Anthea Schubert for providing support for the National Forum. We also acknowledge the following organisations for their contribution to this project: Adelaide Primary Health Network, Aged Care and Housing Group Incorporated (ACH Group), Australian College of Midwives, Australian College of Nursing, Australian Healthcare and Hospitals Association, Australian Nursing and Midwifery Federation, Australian Physiotherapy Association, Australasian Society for Exercise and Sports Science LTD, Brain Injury Australia, Central Adelaide Local Health Network, Cancer Council Australia, Carers Australia, Commission on Excellence and Innovation in Health, Department for Health and Wellbeing, Dietitians Australia, Flinders University Caring Futures Institute, Flinders University Research Centre for Palliative Care, Death and Dying, Health Translation SA, Maternal, Child and Family Health Nurses Australia, Minda Inc., National Disability Insurance Scheme, National Health and Medical Research Centre, NSW Health, Northern Adelaide Local Health Network, Nursing and Midwifery Board of Australia, Optometry Australia, Occupational Therapy Australia, Pharmaceutical Society of Australia, SA Department for Trade and Investment, SA Health, Society of Hospital Pharmacists of Australia and The Hospital Research Foundation Group.

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