Advisory AS18/04: Advice on the applicability of Aboriginal and Torres Strait Islander specific actions

Advisory details

Purpose

To clarify the applicability of Aboriginal and Torres Strait Islander specific actions in the National Safety and Quality Health Service (NSQHS) Standards.

Issue

The NSQHS Standards include six defined actions that specifically address the needs of Aboriginal and Torres Strait Islander people. The implementation of these actions will support the provision of culturally appropriate care to Aboriginal and Torres Strait Islander people across the health system.

The Commission recommends that health service organisations implement all six actions. However, the Commission recognises that not all of these actions may be applicable for all health service organisations. The relevance of the actions depends on the risk profile of the organisation’s patient population.

States and territories have signed the National Indigenous Reform Agreement with the Commonwealth of Australia to work together to Close the Gap in Indigenous disadvantage. Close the Gap has set targets. Implementing the six Aboriginal and Torres Strait Islander specific actions in the NSQHS Standards is one mechanism for achieving these targets.
Therefore, all public health service organisations are required to implement the six Aboriginal and Torres Strait Islander specific actions. Please refer to Advisory AS18/01 for advice on whether your organisation type is eligible for not applicable status for these actions.

Requirements

Health service organisations must comply with the following two actions, with no exclusions:

• Action 1.21 – the health service organisation has strategies to improve the cultural awareness and cultural competency of the workforce to meet the needs of its Aboriginal and Torres Strait Islander patients
• Action 5.8 – the health service organisation has processes to routinely ask patients if they identify as being of Aboriginal and/or Torres Strait Islander origin, and to record this information in administrative and clinical information systems.

Health service organisations that provide services to Aboriginal and Torres Strait Islander people where the risk of harm is the same as for the organisation’s general patient population, and who are eligible to receive an exemption, may seek ‘not applicable’ status for the following actions:

• Action 1.2 – the governing body setting safety and quality priorities for Aboriginal and Torres Strait Islander people
• Action 1.4 – the health service organisation implementing strategies and monitoring safety and quality priorities for Aboriginal and Torres Strait Islander people
• Action 1.33 – the health service organisation demonstrating a welcoming environment
• Action 2.13 – partnering with the Aboriginal and Torres Strait Islander community.

Organisations seeking exemption for any of these actions must demonstrate that a comprehensive risk analysis has been undertaken that examines the:

• Risk profile of the organisation’s general patient population
• Risk profile of the organisation’s Aboriginal and Torres Strait Islander patient population.

The risk profile could be determined by comparing the following information on Aboriginal and Torres Strait Islander patients to non-Indigenous patients:

• Number and age profile of Aboriginal and Torres Strait Islander patients
• Diagnosis, procedures and rate of complications
• Length of stay
• Type, severity and rate of incidents
• Frequency of discharge against medical advice
• Feedback from Aboriginal and Torres Strait Islander patients

This data can could be collected from a range of resources, including:

• Clinical and administrative data sets
• Audit of patient records
• Incident management systems
• Feedback and complaints systems
• Demographic information on the organisation’s patient catchment
• Risk register

For all actions in the NSQHS Standards, the extent and scope of the strategies health service organisations implement should be determined by the risks to patient care. Where the number of Aboriginal and Torres Strait Islander patients are small when compared to the overall population, the strategies implemented by the health service organisation may be implemented over a longer period or focus on one or two key strategies.

Not applicable status for Actions 1.2, 1.4, 1.33 and 2.13 will only be granted where these risk profiles are in evidence.

Where not applicable status is granted, health service organisations will be required to continue to manage the specific risk of harm, and provide safe and high-quality care for all Aboriginal and Torres Strait Islander patients through the safety and quality improvement systems set out in the NSQHS Standards that relate to their whole patient population.

All acute health service organisations are required to submit an Attestation Statement annually, see Fact Sheet 7: Governing body attestation statement.

Organisations that are granted not applicable status for Action 1.2 may cross through or remove point two of the Attestation Statement and initial the change. In this way, the organisation is reporting its not applicable status has been confirmed for the named health service organisation or that they intend to apply for not applicable status ahead of their assessment.