ISQUA16-2476IMPROVING THE SAFETY AND QUALITY OF HEALTH CARE FOR ABORIGINAL AND TORRES STRAIT ISLANDER PEOPLE USING THE AUSTRALIAN NATIONAL SAFETY AND QUALITY HEALTH SERVICE STANDARDS

Abstract

Objectives: To identify actions to improve the care of Aboriginal people accessing mainstream hospital services, using the National Safety and Quality Health Service (NSQHS) Standards as a lever for driving change: and to describe strategies to be incorporated into future NSQHS Standards to address the safety and quality needs of Aboriginal people. Method(s): During 2015 a multi-method approach was adopted. This involved a literature review of evidence-based strategies to improve the safety and quality of care for Aboriginal people. This was followed by consultation with stakeholders, using interviews, focus groups and an online survey. Each consultation process asked about the common factors that resulted in poor health outcomes for Aboriginal people and what good care would look like to identify the common safety and quality gaps in care faced by Aboriginal people. Finally, the safety and quality issues were mapped to the NSQHS Standards to identify gaps in Standards and opportunities for change. Result(s): The literature review identified limited evidence of theoretic, applied or trialled interventions to improve care. The factors found to improve care for Aboriginal people were: the cultural competency of a health service, the health service establishing partnerships with local Aboriginal communities; flexible service delivery models and increased employment of Aboriginal health providers. Twenty-five consultation sessions with over 200 Aboriginal and non-Aboriginal people providing a comprehensive list of safety and quality issues, including: not identifying Aboriginal people at presentation leading to poor monitoring of care and outcomes; limited cultural competency of health services; inadequate communication with family and carers; poor communication of clinical information at transitions of care; unco-ordinated care post discharge; low levels of participation in the health workforce by Aboriginal people; and racial bias. The online survey resulted in 876 responses, of which Aboriginal respondents comprised 20%. The top four areas where respondents believed organisations should take action were improving communication with patient and carers (70%); considering social and geographic factors in planning for discharge (53%); addressing issues of patient trust in mainstream health services (52%); and improving the cultural competency of staff (52%). Areas for improvement in future Standards were identified: setting and implementing goals for Aboriginal consumers; identifying Aboriginal people in clinical records systems; environments that recognised the importance of cultural beliefs and practices; improving the cultural competency of the workforce; effective communication particularly at discharge; and, the provision of comprehensive care. Conclusion(s): Australia's Aboriginal people have major differences in health outcomes when compared to the wider community. There are disparities not only for health status, health outcomes and the social determinants of health, but are also in the way that people access and use health services. Improving the health of Aboriginal people is a national priority. Understanding the factors that limit improvements in care for Aboriginal people provides an opportunity to develop standards to drive change throughout the health system. As a result of this project, six Aboriginal specific actions are to be included in version 2 of the Australian NSQHS Standards. While not specifically naming Aboriginal people, there are over 60 additional actions where guidance could identify specific strategies to improve the healthcare experience of Aboriginal consumers accessing care in mainstream health services.