Unsafe Workplaces, Unsafe Care: Addressing Structural Violence in Regional NSW Health Services

This five-year, Aboriginal-led research project addresses structural violence and cultural unsafety in regional New South Wales for health services.

It aims to improve workplace conditions for Aboriginal and Torres Strait Islander health professionals and strengthen culturally safe care for communities.

Project summary

This project investigates structural violence and cultural safety within regional New South Wales health services and their impacts on Aboriginal and Torres Strait Islander health professionals, patients, families, and communities. Despite national commitments to cultural safety, many Aboriginal staff continue to experience racism, marginalisation, and a disproportionate 'colonial load', the ongoing expectation to provide unpaid cultural labour and manage workplace inequities.

Unsafe workplace environments contribute to burnout, distress, and workforce attrition, ultimately affecting the quality of patient care. The project responds by embedding cultural safety at a system level through Aboriginal-led governance and co-designed interventions.

Project details

Project period
5 years

Project funding
NHMRC  $1,699,075.69

Field of Research
Aboriginal Health, Nursing

Across four interconnected studies, the research will establish Cultural Governance Advisory Groups; develop and deliver cultural capability training for middle managers; implement a Community of Practice for Aboriginal health professionals; and assess the cost-effectiveness and equity impacts of these initiatives.

Delivered in partnership with regional health services and guided by Aboriginal leadership, the project will generate scalable, evidence-based solutions to improve workforce sustainability, strengthen cultural safety, and enhance health outcomes.

Project objectives

The project will deliver a validated Cultural Governance Framework, Community of Practice model, and evidence-based cultural capability interventions, alongside economic and equity analyses to support policy uptake and national scale-up.

We will also aim to:

  • reduce structural violence and cultural unsafety in regional health services
  • embed Aboriginal-led cultural governance and accountability mechanisms
  • strengthen cultural capability and leadership of middle managers
  • support Aboriginal and Torres Strait Islander health. professionals through a Community of Practice
  • reduce cultural load, burnout, and workforce attrition
  • improve quality and cultural safety of patient care
  • generate economic and equity evidence to inform policy and scale-up.

Project partners

  • Charles Sturt University
  • University of Technology Sydney
  • University of New South Wales
  • RMIT University
  • University of Canberra
  • Western NSW Local Health District
  • NSW Ambulance
  • Marathon Health

Our team

Research team

Professor Faye McMillan

University of Technology Sydney

Associate Professor Jessica Biles

Charles Sturt University

Dr Shanna Fealy

Charles Sturt University

Professor Rhonda Wilson

RMIT University

Associate Professor Brett Biles

University of New South Wales

Associate Professor Oliver Higgins

University of Canberra

Mr Troy Pietsch

Marathon Health

Dr Rashidul Alam Mahumud

University of Sydney

Mr Luke Marks

Senior Nursing Advisor and Adjunct Senior Lecturer

Associate researchers

Mandy Debenham

Associate Director, Aboriginal Health, NSW Ambulance

Simon McDonald

Spatial Analysis Officer, Charles Sturt University

Shirlena Gallagher

Manager, Aboriginal Quality Safety & Corporate Engagement at Western NSW Local Health District

Lesa Towers

Manager, Aboriginal Workforce Capability Development and Culture, Western NSW Local Health District

Rhys Callaghan

Head of Discipline (Under Graduate) First Nations Health, Charles Sturt University

In the media

Cultural safety and community wellbeing are forefront of $1.7 million First Nations research - Charles Sturt News

Get involved

Health services and organisations

If your organisation is interested in collaboration or participation, please email our research team.

unsafeworkunsafecare@csu.edu.au

Higher Degree by Research students

Email Associate Professor Jessica Biles about starting full time study in 2027. These are funded roles.

jbiles@csu.edu.au