National Standards

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Action 1.33: Welcoming environments

What does this mean for health service organisations?

In Australia, Country and language groups among Aboriginal and Torres Strait Islander people are diverse.¹Therefore, clinicians and health service organisations need to be aware of, and sensitive to, the complexity of Aboriginal and Torres Strait Islander cultural beliefs and practices. Australia’s first peoples live within a kinship network and have done so since before colonisation. The kinship network is an interconnected, structured social system in which each person’s role is determined and defined, and comes with clear obligations and responsibilities. If community protocols for kinship networks are not adhered to, cultural fragmentation can and does occur.

Many Aboriginal and Torres Strait Islander people find health service organisations – including primary healthcare centres, hospitals and day surgeries – unwelcoming.^37,41Negative experiences can lead to reluctance to access services, disengagement with clinicians and care in these settings, and high rates of discharge against medical advice. These, in turn, affect health and wellbeing.⁴⁸

A welcoming environment in a health service organisation is about creating a place where Aboriginal and Torres Strait Islander people feel safe, comfortable, accepted, and confident that they will be respected, will be listened to and will receive high-quality care. Welcoming spaces enable Aboriginal and Torres Strait Islander individuals, families and employees to uphold their cultural practices and beliefs.⁴⁹

The physical, emotional and relational aspects of spaces are all critical components of creating welcoming environments⁴⁹:

Physical – design, layout and appearance
Emotional – the feeling of being supported and cared for within the health service organisation
Relational – the quality of relationships developed with the workforce and other consumers.

Creating a welcoming environment requires a culturally competent workforce providing culturally safe care.

What are the benefits of taking action?

Benefits for the health service organisation include:

Redress of historical associations of institutions, including the impact of past policies, practices and treatments such as segregation and seclusion, and a perception that hospitals are a place where people go to die
Improved efficiency of services and use of resources
Improved performance of the system in meeting the healthcare needs of Aboriginal and Torres Strait Islander people
More productive and meaningful collaboration and partnerships with Aboriginal and Torres Strait Islander communities.

Benefits for the Aboriginal and Torres Strait Islander community include:

Improved access to healthcare services that meet the needs and circumstances of Aboriginal and Torres Strait Islander people
An increased feeling of safety and engagement with the health service organisation
Improved health outcomes and equality.

Key tasks

Work in partnership with local Aboriginal and Torres Strait Islander people to identify strategies to create and maintain a welcoming environment
Implement and monitor the effectiveness of the strategies
Involve local Aboriginal and Torres Strait Islander people in evaluation of the environment
Consider the impact on Aboriginal and Torres Strait Islander people as part of planning for capital works programs and prioritise projects that have significant benefits for Aboriginal and Torres Strait Islander people.

Suggested strategies

Work in partnership with local Aboriginal and Torres Strait Islander communities to identify ways to create a welcoming environment

Seek input from the Aboriginal and Torres Strait Islander community on strategies to create and maintain a welcoming environment.

Involve the Aboriginal and Torres Strait Islander workforce and community members in the design and creation of a welcoming environment.

Successful implementation of this strategy will be supported by, or rely on, the following action:

Action 1.29a - The health service organisation maximises safety and quality of care through the design of the environment.

Obtain Aboriginal and Torres Strait Islander input on infrastructure design, landscaping, furnishings and use of spaces

Seek input from Aboriginal and Torres Strait Islander people on the design of infrastructure, landscapes and spaces in the health service organisation. Consider:

Engaging local Aboriginal and Torres Strait Islander artists or art groups
Displaying Aboriginal and Torres Strait Islander artwork and maps
Designating spaces for women and men
Providing easy access to outdoor spaces and fresh air during hospital stays
Installing a map of languages of Aboriginal and Torres Strait Islander people across Australia in the reception area and in clinic rooms
Positioning the Aboriginal and Torres Strait Islander liaison unit at the entrance to the service
Creating gender-specific wards, or specific clinic days for women and men
Providing clear signage in local Aboriginal and Torres Strait Islander languages.

Successful implementation of this strategy will be supported by, or rely on, the following action:

Action 2.11a The health service organisation involves consumers in partnerships in the governance of, and to design, measure and evaluate, health care.

Create and sustain comfortable and friendly spaces for Aboriginal and Torres Strait Islander people with art, visual aids and resources

Screen NITV (National Indigenous Television) and/or advertisements for Aboriginal and Torres Strait Islander health studies.

Translate written materials and posters into local Aboriginal and Torres Strait Islander languages, or adapt written materials for local use. The health service organisation should seek endorsement from the Aboriginal and Torres Strait Islander workforce or partner organisations for these resources.

Consider the role of traditional practices in the provision of care

Respond to the cultural needs, obligations and responsibilities of employees, patients and their families

Allocate time to listen to Aboriginal and Torres Strait Islander patients, their families and the Aboriginal and Torres Strait Islander workforce about their specific cultural needs.

Consider:

Spaces where a large family gathering can wait when visiting
Spaces for ceremony, such as smoking ceremonies
Flexible visiting arrangements
Integration of traditional foods into the catering menu, allowing these foods to be brought in, or establishing bush gardens on site.

Successful implementation of this strategy will be supported by, or rely on, the following action:

Action 1.32 - The health service organisation admitting patients overnight has processes that allow flexible visiting arrangements to meet the patients’ needs, when it is safe to do so.

Celebrate significant events on the Aboriginal and Torres Strait Islander health calendar

Celebrate or participate in important events on the Aboriginal and Torres Strait Islander cultural calendar, such as NAIDOC (National Aborigines and Islanders Day Observance Committee) Week, Sorry Day, National Apology Day, Mabo Day, Close the Gap Day and Reconciliation Week. Events and participation can be determined in partnership with Aboriginal and Torres Strait Islander organisations.

Participate in cultural activities with local Aboriginal and Torres Strait Islander communities.

Encourage community engagement

Develop resources on what to expect when visiting the facility

Support carers’, family members’ and escorts’ needs

Support family members and escorts by:

Enabling flexible visiting arrangements
Providing information and support to find suitable accommodation
Providing and coordinating transport
Providing information and support to help with access to social services
Providing access to a private space for family meetings.

Assign members of the workforce to coordinate links between patients’ family members and escorts, and primary care services.

Provide access to interpreters

Review models of care

Examples of supporting evidence

Documentation of community consultation relating to creation of a welcoming environment
Policies, procedures or protocols on cultural diversity that cover the needs of Aboriginal and Torres Strait Islander patients and their families
Signs and plaques acknowledging traditional custodians
Statement of recognition, such as a plaque; printed words on glass doors and pavement; or artwork telling the story of place, traditional ownership, individuals or significant events
Flying of the Aboriginal and Torres Strait Islander flags, and a policy on half-mast days, including the death of a community member
Evidence of celebrating important events in the Aboriginal and Torres Strait Islander cultural calendar
Information brochures that outline what to expect when visiting the organisation, and the services available to support Aboriginal and Torres Strait Islander patients and families
Documentation of services that are tailored to meet the needs of Aboriginal and Torres Strait Islander people
Use of Aboriginal and Torres Strait Islander names (developed in partnership) for wards and meeting rooms
Survey results and reports on consumer satisfaction with the organisation’s actions to meet the needs of Aboriginal and Torres Strait Islander communities
Availability of Aboriginal and Torres Strait Islander liaison officer(s) or health worker(s), including in emergency departments
Evidence that Aboriginal and/or Torres Strait Islander people are involved in the development and implementation of the strategies, and that their views are sought routinely, particularly when the effectiveness of welcoming strategies are evaluated.

References

1. National 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.

37. Bainbridge R, McCalman J, Clifford A, Tsey K. Cultural competency in the delivery of health services for Indigenous people. Issues Paper No. 13 produced for the Closing the Gap Clearinghouse. Canberra: Australian Institute of Health and Welfare, and Melbourne: Australian Institute of Family Studies; 2015.

41. Dwyer J, Willis E, Kelly J. Hospitals caring for rural Aboriginal patients: holding response and denial. Aust Health Rev 2014;38:546–51.

48. Durey A, Wynaden D, Thompson SC, Davidson PM, Bessarab D, Katzenellenbogen JM. Owning solutions: a collaborative model to improve quality in hospital care for Aboriginal Australians. Nurs Inq 2012;19:144–52.

49. Davy C, Cass A, Brady J, DeVries J, Fewquandie B, Ingram S, et al. Facilitating engagement through strong relationships between primary healthcare and Aboriginal and Torres Strait Islander peoples. Aust N Z J Public Health 2016;40:535–41.