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Yanagagi Numbadil Nurbul - Walking Together in Friendship

Western NSW Local Health District
Project Added:
31 October 2014
Last updated:
19 December 2014

Summary

Bathurst Health Service (BHS) was one of eight NSW Hospitals to participate in the Aboriginal Identification Hospital Quality Improvement Project (2013). 

This initiative has considered the needs of Aboriginal people as outlined in the NSW Health Impact Statement to ensure a significant focus on quality improvement and partnering with Aboriginal patients and community.

This project was a finalist in the Patients as Partners category of the 2014 NSW Health Awards. Download a poster from the 2014 NSW Health Awards.

Aboriginal Identification Working Party
Aboriginal Identification Working Party 

Aim

To improve the patient journey for Aboriginal people attending the emergency department (ED) and review why Aboriginal patients did not wait, left the ED at own risk and discharged against medical advice in the ED

Benefits

  • Improving patient outcomes for Aboriginal people.
  • Partnering with the Aboriginal community to develop trust, support and mutual respect leading to sustainable outcomes and improved care coordination.
  • Redesign and innovation “thinking outside the box” and “whole of system improvement.

Project status

Sustained: The project has been implemented, is sustained in standard business. 

Background

Aboriginal patients often did not wait or left the ED at their own risk and against medical advice. There is a direct correlation on Aboriginal identification and attendance in ED and on receiving appropriate care coordination and follow up care. 

Implementation 

A Local Steering Committee was established, consisting of multiple stakeholders including local Aboriginal community members.  

Partnering with the Aboriginal community and other key stakeholders has been the key to enabling sustainable outcomes, establishing community trust, respect and support as well as changing the way we do business.

Implementation included:

  • Process and structure effects included the adoption and implementation of the 'Improving culture in hospitals quality improvement framework'
  • Improved and new mechanisms for cultural leadership and governance at executive level
  • Improved and sustainable systems to increase and support Aboriginal workforce
  • Aboriginal primary health care worker roles were redesigned to include ED pathways to care, connecting care, 48 hour follow up
  • Regular 'environment scan', consumer/patient 'tag alongs' and use of a cultural audit tool
  • Regular targeted junior medical mfficer education including local cultural/working with Aboriginal patients and carer’s families - delivered in addition to 'Respecting the Difference' training
  • A cultural framework and integrity at Bathurst Hospital will include regular Aboriginal patient identification data education 'why we ask the question' and locally developed resources
  • A television link was established promoting Aboriginal Health Officers (AHO) in the ED waiting rooms.

NAIDOC Day celebration at Bathurst Health Service September 2014
NAIDOC Day celebration at Bathurst Health Service September 2014

Results

  • Before and after surveys demonstrate an increase in knowledge, confidence and skills of hospital staff in relation to Aboriginal culture and knowledge.
  • Increased number of people correctly identified in data systems and 35% reduction of did not waits/leaving ED against medical advice.
  • 84% improvement against the 90% state key performance indicator (KPI) target '48 hour follow up' as a result, prior to this there was zero reporting.
  • Improved care coordination for Aboriginal patients including 48 hour follow up of Aboriginal patients with chronic illnesses have increased from 0% compliance to 84%. 
  • Aboriginal customer satisfaction has increased.
  • AHO efficiency and productivity has now increased significantly through education and access to systems that allow information gathering and sharing between services.
  • Aboriginal community awareness of AHOs within facility resulted in Aboriginal patients requesting to see AHO on presentation and have developed referral pathways.
  • Hospital staff are more aware of AHOs due to displaying of posters advertising who they are and what services they provide and through additional cultural awareness training and education on the importance of asking about Aboriginal and Torres Strait Islander (ATSI) identification question for funding and linking to culturally safe and appropriate services.
  • 80% of staff surveyed after watching the cultural awareness training DVD were aware of the need to ask all patients presenting to ED if they were ATSI, 87% of staff who watched the DVD had an increased level of understanding of ATSI culture, beliefs and health needs. The project demonstrated 0.3% increase in number of ATSI patients presenting to ED.
  • Evaluation demonstrates increased customer confidence with service delivery efficiency and communication between the AHO, hosptial staff and the Aboriginal community.  

Partnerships

  • Aboriginal Identification in Hospitals Quality Improvement Project St Vincent’s Hospital Melbourne, NSW Ministry of Health
  • Bathurst Aboriginal Community representatives
  • Western Medicare Local
  • Arts Out West Coordinator 
  • Koori Interagency Group
  • Aboriginal Education Consultative Group
  • Bathurst Lands Council
  • Charles Sturt University Bathurst 

Lessons Learnt

  • Redesign and innovation 'thinking outside the box' does inform whole of system improvement.
  • Partnering with patients has set in place a process for the local Aboriginal community to identify gaps, solutions and identify opportunities to improve the Aboriginal patient journey.
  • Partnering with the Aboriginal community and other key stakeholders has been the key to enabling sustainable outcomes, gaining community trust, respect and support as well as changing the way we do business.
  • Learnings from this project will assist to guide district system priority for 'Closing the Gap' using the Improving cultures quality Improvement framework and the ACI’s Accelerated Implementation Methodology (AIM) training.
  • Learning’s from Bathurst will now guide future redesign and innovation planning in other Western Local Health District hospitals and small facilities specific to improving Aboriginal patient journey in Rural and Remote NSW.

Contact

Jackie Corliss
Primary Community and Allied Health Manager Bathurst
Western NSW Local Health District
Phone: 02 6330 5634
Email: Jackie.corliss@health.nsw.gov.au

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