Building on Hospital Success Stories Improving the Culture of Hospitals project Angela Clarke Deputy Director/Senior Lecturer Onemda, VicHealth Koori Health Unit, University of Melbourne John Willis Project Manager Improving the Culture of Hospitals project, LaTrobe University LIME III Conference University of Melbourne 4th December 2009

Project Partners Aboriginal Health Council South Australia Latrobe University (Victoria) Cooperative Research Centre for Aboriginal Health Onemda, VicHealth Koori Health Unit (University of Melbourne)

Aim of the Project To produce tools, processes and guidelines to assist hospitals, in collaboration with the Aboriginal community, to become more culturally appropriate places for Aboriginal people to receive treatment

Scope and focus Systematic case studies of hospitals (national) that have different levels of experience in actively making their services and surrounds more culturally sensitive to the needs of Aboriginal patients Experience of Aboriginal people used as the central reference point

Literature review Cultural sensitivity needs to take a system wide approach to be effective Systemic change is required not just training Continuous Quality Improvement (CQI) has been effective in improving health care for non- indigenous Australians CQI can be adapted to be culturally specific and requires involvement of Aboriginal staff and community There needs to be a cultural shift in the way hospitals approach quality

Phase III Implementation First wave of case studies – Exploratory Thorough nomination & selection process NACCHO affiliates Five case study sites selected St.Vincent’s (Melbourne) Royal Adelaide Hospital (SA) Maitland Hospital (Yorke and Lower North Health Services) Goulburn Valley Health (Shepparton) Royal Children’s Hospital (Melbourne)

Main issue - All hospitals are different 1. Relationship with Aboriginal community 2. State and federal policy environment 3. CEO/Board commitment and clinical champions 4. Policy & strategic environment within hospital 5. Structural support 6. Aboriginal workforce Learning's from Phase III

Phase IV Implementation Second wave of case studies - Interventional Geographical site selection was of primary importance Involved both jurisdictions and NACCHO affiliates Draft tools, guidelines and processes trialled Hospitals ‘ready for change’ were selected Five case study sites selected Royal Brisbane and Women’s Hospital (QLD) Campbelltown Hospital (NSW) Derby Hospital (WA) Mater Hospital (QLD) Katherine Hospital (NT) - Did not complete trial

Learning's from Phase IV The really valuable thing your initiative has done is to put us on a pathway to do a range of things…this is just the beginning for us and our rather small team has been energized by the possibilities. Made us put it on the agenda so that was very useful and positive.

Learning's from Phase IV Assisted hospital staff to improve their focus on the needs of ATSI people. Helped us think about building relationships with the communities in a strategic way not just in terms of developing an antenatal leaflet.

This Toolkit explicitly identifies consultation with ATSI communities which is often missed in other processes.’ Strategically useful…made it easier to sell the idea of cultural reform to some hospital staff…and in the region We need more resources like this that help us gather information from families and people…that help us say ‘tell us your story’ rather than rely on complaints procedures. Learning's from Phase IV

The Toolkit can help [for example] the discharge person to understand the social context of the patient…unless there is some work being done in the hospital about this then the discharge will fail. This is the key to making a difference..

Learning's from Phase IV Any feedback will be a massive, massive cultural shift… We knew we had to do something but we just didn’t know how.

Learning's from Phase IV The questions for each stage of the process document was really useful…and The one page of tips is really helpful…it clarified potential sticking points…and helped us not get stuck in the mud.

Learning's from Phase IV Aboriginal interviewees noted that the Framework and Toolkit could assist them to advocate for and respond to Aboriginal patients’ needs in a more systematic way. As one Aboriginal Liaison Officer explained: It was something I can actually do [at the hospital] to make things better instead of just being a taxi driver.

Learning's from Phase IV Hospital executive made this comment: We need EQuIP to include a standard that specifically refers to Aboriginal and Torres Strait Islander cultural sensitivity. It could be framed in a cultural way like ‘how well is the Aboriginal patient’s milieu taken into account in the provision of care’… and then links the Toolkit as a resource… to assist hospital staff to respond to the standard.

Learning's from Phase IV The Improving the Culture of Hospitals project has also been invaluable in identifying for our Aboriginal Liaison workers the range of initiatives we can engage in that may have an impact on the whole organization, demonstrating the strategic importance of their work; and that it has a broader impact than the very good one-on-one care they provide to individual patients and their families.

Training for Aboriginal staff Two staff selected from each trial site Competency units from Community Services Training Package (CHC02) Nationally recognised qualification Delivered by an RTO (Victorian Aboriginal Community Controlled Health Organisation (VACCHO)) Training resources Workbooks for each course developed, trialled and evaluated

Training for Aboriginal staff

Conclusion Australian Council of Healthcare Standards (ACHS) need assistance to develop Aboriginal specific standards Need to provide training for Aboriginal hospital staff regarding CQI Hospitals need ongoing support and assistance to implement toolkit Need to develop training for executives and other non- Aboriginal staff Toolkit to be seen as a ‘work in progress’ Long term case studies required

Quality improvement process PLAN Information Gathering PLAN Solution Planning DO STUDY ACT

“People don’t change because of policies, policies come out of change” Do you think you can influence policy changes in your workplace? Quality and Safety Unit staff member of a large metropolitan hospital