22 February The role health managers can play in creating culturally safe environments for Aboriginal people February 22, 2019 By ACHSM Admin challenges, health service delivery, indigenous, patients, public health, regional, remote, rural 0 Author: Isabelle Howard, 2nd year Intern The colonisation and historical events that have occurred in Australia have had and continue to have devastating impacts on Aboriginal people (Griffiths, Coleman, Lee, & Madden, 2016). Accessing healthcare can be particularly difficult for our First Nations people due to a deep mistrust and the institutional racism present in most hospitals (Sherwood, 2013). Statistics demonstrate that Aboriginal people present to the emergency department more frequently, are often sicker, are admitted to hospital for longer but are more likely to discharge themselves before their treatment is finished (Australian Government, 2014). This results in the cycle repeating itself, consequently costing the public health system more and ultimately resulting in poorer health outcomes for Aboriginal people. With all this said, health services are quick to blame Aboriginal people for their poor health and lack of engagement with the health system rather then reflect on their own health service and what could be done better (Durey, Wood, & Thompson, 2012). Literature suggests that increasing cultural awareness levels of an organisation starts with strong leadership, however, it is identifying and engaging these leaders that can be difficult (Westwood & Westwood, 2010; Parmenter & Trigger, 2018). Reducing institutional racism in health services needs to be both a top down and bottom up approach, so what can managers do to have an impact? Well here are some practical tips on how health managers at all levels can try create culturally safe environments for Aboriginal people: If you don’t know much about Aboriginal people and our shared history, do some reading. As a manager in a health service you have an obligation to understand the population groups you are delivering healthcare to. Find out who the Traditional Owners are of the land your health service resides on and start acknowledging them at all internal and external meetings. “Before I begin this meeting today, I would like to acknowledge the Traditional Owners of the land, and pay my respects to their Elders both past and present.” Consult with the local Aboriginal Community to find out what they want from your health service and what could be done differently. Listen deeply to what they have to say, implement the actions that come out of it, and always keep the communication channels open throughout the process. Build partnerships with your local Aboriginal Community Controlled Health Organisation. This builds a relationship between primary care and the acute setting, which can reduce ‘Discharges Against Medical Advice’ and ‘Did Not Attend ‘(DNA) rates. Find your organisation’s Reconciliation Action Plan (RAP) and read it. This will give you an idea of what your health service has committed to and what you can do within your team to achieve these goals. If your organisation doesn’t have a RAP, find out why not and start the conversation about creating one. Send your staff to cultural awareness training, particularly your clinical and frontline staff. This can improve identification rates and tackle unconscious bias within your workforce. Ask if you have Aboriginal Health Working Group within your organisation. If you do, ask to join it as this will increase your cultural awareness levels and allow you to understand the current difficulties Aboriginal people are facing at your health service. If you don’t have one, find out how to form one. Speak to your Aboriginal staff about it, and ask an executive to sponsor the group. Get your team involved in Aboriginal events such as Reconciliation week and NAIDOC week. Use the National Safety and Quality Health Service (NSQHS) Standards to get buy in from your executive team. The second edition of NSQHS has actions relating to Aboriginal and Torres Strait Islander patients that every health service will need to address. Ensure you have Aboriginal and Torres Strait Islander Flags out the front of your service, and an Acknowledgement plaque in your health service entrance. Get an Aboriginal representative on your board as well as an Aboriginal consumer on relevant committees. Encourage Aboriginal people to apply for jobs within your health service by having a statement on all position descriptions. Review policies and procedures to ensure you have an equitable process that supports Aboriginal people to apply for positions. Support Aboriginal businesses through procurement processes and policies. Health services are notoriously good at achieving goals that relate to compliance, however, improving the cultural safety levels of an organisation requires long-term commitment. Collaboration in this area is essential and everyone has a role to play within it, so regardless of your role pick something from this list and do it. Big or small, it will have an impact, start the conversation and begin the journey towards a culturally safe and inclusive health service. References Australian Government. (2018). 3.09 Discharge against medical advice | Aboriginal and Torres Strait Islander Health Performance Framework 2014 Report. Retrieved from https://www.pmc.gov.au/sites/default/files/publications/indigenous/Health-Performance-Framework-2014/tier-3-health-system-performance/309-discharge-against-medical-advice.html Durey, A., Wood, S., & Thompson, M. (2012). Time to bring down the twin towers in poor Aboriginal hospital care: Addressing institutional racism and misunderstandings in communication. Internal Medicine Journal, 42(1), 17-22. Griffiths, K., Coleman, C., Lee, V., & Madden, R. (2016). How colonisation determines social justice and indigenous health--a review of the literature.Journal of Population Research, 33(1), 9-30. doi:http://dx.doi.org.ez.library.latrobe.edu.au/10.1007/s12546-016-9164-1 Parmenter, J., & Trigger, D. (2018). Aboriginal cultural awareness training for mine employees: Good intentions, complicated outcomes. The Extractive Industries And Society, 5(2), 363-370. doi: 10.1016/j.exis.2017.12.005 Sherwood, J. (2013). Colonisation - It's bad for your health : The context of Aboriginal health. Contemporary Nurse, 46(1), 28-40. Westwood, B., & Westwood, G. (2010). Aboriginal cultural awareness training: policy v. accountability – failure in reality. 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