National Standards

Logo

Action 1.2: Addressing health needs of Aboriginal and Torres Strait Islander people

The governing body has ultimate responsibility for the safety and quality of a health service organisation. Setting priorities for the health service organisation, including priorities for its Aboriginal and Torres Strait Islander consumers, is one way a governing body can direct effort and resources to improve care.

What does this mean for health service organisations?

To do this effectively, the governing body needs regular reporting on:

Key areas of concern for the Aboriginal and Torres Strait Islander community
The diversity and risks of care for Aboriginal and Torres Strait Islander communities
The organisation’s safety and quality performance for Aboriginal and Torres Strait Islander people compared with non-Indigenous patients; some of this information can be obtained from clinical and administrative data systems
Rates of complaints and incidents for Aboriginal and Torres Strait Islander people compared with non-Indigenous patients
The comparative performance of the organisation against peer organisations.

To have the greatest effect, the governing body needs to engage with community priorities when setting directions, targets, indicators and timelines; ensure that sufficient resources are provided; and routinely monitor progress.

Safety and quality priorities should, whenever possible, align with the Closing the Gap priorities.¹⁸

What are the benefits of taking action?

Benefits for the health service organisation include:

Greater ability to meet the healthcare needs of Aboriginal and Torres Strait Islander people
Focusing all employees on Aboriginal and Torres Strait Islander priorities that need to be addressed
Demonstration of alignment with national, state or territory, and local priorities, policies and strategies
Effective use of resources because Aboriginal and Torres Strait Islander individuals and communities are more likely to engage and participate in the processes of care
Demonstration of a commitment to the engagement of Aboriginal and Torres Strait Islander people, which has flow-on effects of greater support and cooperation on future projects
Reduced institutionalised racism.⁹

Benefits for the Aboriginal and Torres Strait Islander community include:

Health care that meets the needs of Aboriginal and Torres Strait Islander people
Improved outcomes and experiences of patients and families¹⁹
A feeling of being valued and engaged for individuals and communities that contribute or benefit
A reduction in the number of Aboriginal and Torres Strait Islander people experiencing hospitals as sites of trauma²⁰
Aboriginal and Torres Strait Islander people seeing their advice informing the processes of health service organisations
Addressing of health matters of significance to the community
Growing trust in the health service organisation’s commitment to addressing Aboriginal and Torres Strait Islander health priorities.

Key tasks

In collaboration with Aboriginal and Torres Strait Islander communities, determine the priorities for the organisation to meet the needs of Aboriginal and Torres Strait Islander people in the organisation’s catchment
Endorse performance indicators, and monitoring, reporting and evaluation processes
Oversee resource allocation to achieve the priorities
Prioritise ongoing care that is trauma-informed.²⁰

Suggested strategies

Set safety and quality priorities

Conduct a needs assessment and gap analysis. For all of the Aboriginal and Torres Strait Islander population and communities in the organisation’s catchment, determine:

The demographic and health profile of those who have used the organisation’s services
The services that are accessed.

Of groups not engaging with the health service organisation, determine the burden of disease of those people who are typically difficult to reach or engage.

Consider:

The needs identified by Aboriginal and Torres Strait Islander communities
Feedback and recommendations from consultations with Aboriginal community controlled health services²¹
Current organisational performance against key safety and quality measures for Aboriginal and Torres Strait Islander patients.

Recommend to the governing body priority areas to be addressed, including timelines, targets, deliverables, and accountabilities for success.

Consider the needs of Aboriginal and Torres Strait Islander people in strategic planning, including for capital works, workforce, information technology and operational strategic plans.

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

Action 1.1c - The governing body sets priorities and strategic directions for safe and high-quality clinical care, and ensures that these are communicated effectively to the workforce and the community.

Action 1.1e - The governing body ensures that roles and responsibilities are clearly defined for the governing body, management, clinicians and the workforce.

Promote Aboriginal and Torres Strait Islander representation in governance structures

Invite Aboriginal and Torres Strait Islander communities to determine how the community is represented, to maximise their contribution while ensuring that individuals are not overburdened.

Establish formal reporting channels from relevant advisory groups to Aboriginal and Torres Strait Islander representatives and the community.

Ensure that Aboriginal and Torres Strait Islander communities are involved in identifying priorities, targets, strategies and indicators of success through the governance process and monitoring system.

Establish formal and routine reporting to the executive and governing body on Aboriginal and Torres Strait Islander engagement, service use and issues, by all sections of the health service organisation.

Remunerate Aboriginal and Torres Strait Islander people participating in consultations or advisory groups in line with the organisation’s policy for payment of consumers.

Ensure that representation of Aboriginal and Torres Strait Islander communities reflects the diversity of the population in the organisation’s catchment.⁹

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

Action 2.11a - The health service organisation when designing, measuring and evaluating health care, establishes governance models which involve Aboriginal and Torres Strait Islander people in a partnership process.

Develop and maintain strategic action plans

Develop a strategic action plan, or a suite of plans, to improve the health of Aboriginal and Torres Strait Islander people. Plans may include Aboriginal health, cultural competence, reconciliation and Aboriginal employment plans, along with other health service plans, and actions for improvement of safety and quality.

Ensure that the plan:

Documents the health service organisation’s commitment to implementing and measuring practical, long-term, sustainable actions that will have a mutual benefit for the health service organisation and for Aboriginal and Torres Strait Islander community members within the organisation’s catchment²²
Aligns with, and complements, existing national and state or territory health plans and frameworks, whenever possible.

Examples of strategies include:

National, state and territory plans and frameworks for Aboriginal health and wellbeing
Aboriginal and Torres Strait Islander workforce strategies
Cultural competency strategies or frameworks
Aboriginal and Torres Strait Islander identification policies and guidelines.

Use Aboriginal and Torres Strait Islander Health Impact Statements and Declarations across the health service organisation

Implement requirements for an Aboriginal and Torres Strait Islander health impact statement and declaration when developing and implementing policies (including service guidelines, procedures and protocols), strategies, programs, capital works, information technology, and financial and workforce planning.

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

Action 1.5 The health service organisation considers the safety and quality of health care for patients in business decision-making.

Align quality and safety priorities at the national, state and territory, local, and Aboriginal and Torres Strait Islander community levels

Identify relevant national, state or territory, and local safety and quality priorities, based on the needs identified by local Aboriginal and Torres Strait Islander communities.

Review the health service organisation’s performance data against indicators that are reported at national, state or territory, and local levels (including data on patients who are discharged against medical advice, take their own leave or are absent without leave).

Examples of supporting evidence

Minutes of meetings, plans or strategies relating to development, endorsement or implementation of Aboriginal and Torres Strait Islander priorities overseen by the governing body, which deal with specific needs of the local community
Documented targets and performance indicators for Aboriginal and Torres Strait Islander health outcomes of the health service organisation that are endorsed by, and reported to, the governing body
Policies, procedures, protocols or project plans endorsed by the governing body that deal with the specific needs of Aboriginal and Torres Strait Islander people
Records of consultations with Aboriginal and Torres Strait Islander communities relating to the development of priorities, targets and performance indicators
Membership and terms of reference for the governing body or relevant advisory and consultative committees that include Aboriginal and Torres Strait Islander community representatives.

References

9. Hunt J. Engagement with Indigenous communities in key sectors. Canberra: Australian Institute of Health and Welfare, and Australian Institute of Family Studies; 2013. (Resource Sheet No. 23.)

18. Council of Australian Governments. National Indigenous Reform Agreement (Closing the Gap). Canberra: Council of Australian Governments; 2012.

19. Marmot M, Friel S, Bell R, Houweling TAJ, Taylor S. Closing the gap in a generation: health equity through action on the social determinants of health. Lancet 2008;372:1661–9.

20. Dudgeon P, Milroy H, Walker R. Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice. 2nd ed. Canberra: Australian Government Department of the Prime Minister and Cabinet; 2014 (accessed Mar 2017).

21. National Aboriginal Community Controlled Health Organisation. Constitution for the National Aboriginal Community Controlled Health Organisation. Canberra: NACCHO; 2011 (accessed Mar 2017).

22. Reconciliation Australia. What is the RAP program? Canberra: Reconciliation Australia; 2016 [cited 2016 Aug 19].