Supporting Aboriginal and Torres Strait Islander health

Ensuring Aboriginal and Torres Strait Islander people have access to efficient, effective and appropriate health care remains a challenge for the Australian health system. Health service organisations must ensure that service provision is equitable, and that the specific and unique needs of Aboriginal and Torres Strait Islander people drive the level and range of the care that can be accessed by them.

While the current healthcare system does a good job of addressing the needs of a majority of Australians, Aboriginal and Torres Strait Islander people continue to have disproportionately poor health outcomes. The health disparities and treatment inequities between non-Indigenous Australians and Aboriginal and Torres Strait Islander people require a refocusing of health care to better address the unique needs of each patient.

The Australian Commission on Safety and Quality in Health Care plays an important role in ensuring that health service organisations across Australia provide safe and high-quality health care. The Commission has been considering the issue of variation in health care and health outcomes between Aboriginal and Torres Strait Islander people and other Australians. As a result, the National Safety and Quality Health Service (NSQHS) Standards, which are an important tool in supporting Australian health services to deliver safe, high-quality care for patients, now contain specific actions that address the health needs of Aboriginal and Torres Strait Islander people.

The Commission released the NSQHS Standards (second edition) in November 2017. The second edition of the NSQHS Standards addresses gaps identified in the first edition, including Aboriginal and Torres Strait Islander health. There are six actions focused specifically on Aboriginal and Torres Strait Islander health in the second edition. The implementation of these actions will help embed awareness of the specific needs of Aboriginal and Torres Strait Islander people and orientate the health system to provide more culturally appropriate care.

The six Aboriginal and Torres Strait Islander-specific actions are in the standards for:

• Clinical Governance
• Partnering with Consumers
• Comprehensive Care.

Research by the Commission in 2015–16 suggests that these six actions cover the key areas that Aboriginal and Torres Strait Islander people and health service representatives believe can improve the quality of care and health outcomes for Aboriginal and Torres Strait Islander people. It is intended that through successful implementation of these six actions, Aboriginal and Torres Strait Islander people will feel more confident and safe in accessing the Australian healthcare system, and that the system will be better equipped to respond appropriately to their needs.

To successfully implement the six actions, health service organisations are required to:

• establish meaningful and ongoing relationships with local Aboriginal and Torres Strait Islander communities, organisations and groups to better understand the needs of Aboriginal and Torres Strait Islander people and involve them in determining their own health priorities (Action 2.13);
• ensure that the governing body addresses the needs and health priorities of Aboriginal and Torres Strait Islander people when planning the health service organisation’s priorities (Action 1.2);
• develop and implement strategies to address the needs and priorities of Aboriginal and Torres Strait Islander people in the health service organisation’s catchment, including adequately resourcing strategies and evaluating reports of their outcomes (Action 1.4);
• support the workforce to better understand the needs of Aboriginal and Torres Strait Islander people and improve their cultural competency (Action 1.21);
• create an environment where Aboriginal and Torres Strait Islander people feel safe, comfortable and welcome (Action 1.33);
• establish systems that accurately record Aboriginal and Torres Strait Islander status and use this information routinely to improve the quality of care for Aboriginal and Torres Strait Islander patients (Action 5.8).

To support health service organisations to implement these six actions, the Commission has produced the NSQHS Standards User Guide for Aboriginal and Torres Strait Islander Health. Developed in collaboration with the Wardliparingga Aboriginal Research Unit of the South Australian Health and Medical Research Institute, the guide provides health service organisations with practical strategies to help organisations improve the quality of care and health outcomes for Aboriginal and Torres Strait Islander people.

The guide also provides practical examples of health service organisations across Australia implementing strategies that would meet the six Aboriginal and Torres Strait Islander actions. They include:

• South Western Sydney Local Health District, which has developed formal partnerships with Aboriginal and Torres Strait Islander community organisations through MOUs agreeing on specific service initiatives including outreach, drug and alcohol, specialist and speech therapy services;
• St Vincent’s Hospital in Melbourne, which has addressed the specific health needs of Aboriginal and Torres Strait Islander patients by developing and implementing specific clinical and clerical guidelines for the care Aboriginal and Torres Strait Islander patients;
• Bairnsdale Regional Health Service, which implemented new processes to improve identification of Aboriginal and Torres Strait Islander patients including ‘asking the question’ training for the workforce and stickers used for identifying health records of Aboriginal and Torres Strait Islander patients.

The safety and quality of care for Aboriginal and Torres Strait Islander people will only be improved when everyone who works in the healthcare system recognises that we are all responsible for providing equitable care — it is not solely the responsibility of Aboriginal and Torres Strait Islander units, employees or services.¹

Health service organisations will be assessed to the second edition of the NSQHS Standards from January 2019. The NSQHS Standards (2nd ed) and the NSQHS Standards User Guide for Aboriginal and Torres Strait Islander Health resources are on our website — https://www.safetyandquality.gov.au/second-edition.

Margaret Banks, BSc, Grad Dip (Physio), MHA, Grad Cert Management, Dip AICD, FACHM.

*Margaret Banks has worked as the National Standards Program Director with the Australian Commission on Safety and Quality in Health Care since July 2006. In this time she has worked with stakeholders, consumers and jurisdictions to develop and implement the National Safety and Quality Health Service Standards and a program of systematic accreditation reform across the Australian health system.

Prior to this appointment she worked with the Department of Health and Ageing, the Australian Health Workforce Advisory Committee and the NSW Health Department on matters relating to workforce. She has also worked as a physiotherapist for nine years in both Australia and Papua New Guinea, and held an Adjunct Professorship with the University of Technology Sydney.

¹National Aboriginal and Torres Strait Islander Health Standing Committee of the Australian Health Ministers’ Advisory Council. Cultural respect framework 2016–2026 for Aboriginal and Torres Strait Islander health. Canberra: AHMAC; 2016.

Top image credit: ©stock.adobe.com/au/sebastianbourges