National Standards

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Action 5.8: Identifying people of Aboriginal and/or Torres Strait Islander origin

Establish processes to accurately identify and record Aboriginal and Torres Strait Islander status.

What does this mean for health service organisations?

Improving identification rates of Aboriginal and Torres Strait Islander people in health service organisations has been prioritised as part of the Australian Government’s and all state and territory governments’ commitment to Closing the Gap though the Council of Australian Governments and the National Indigenous Reform Agreement.¹⁸

Incomplete and inaccurate identification of the Aboriginal and Torres Strait Islander population is commonplace in administrative and clinical information systems in health service organisations across Australia.⁵²

Health service organisations are required to establish processes to accurately identify and record Aboriginal and Torres Strait Islander status. These processes should ensure that all people, regardless of appearance and across all service areas, are asked whether they identify as being of Aboriginal and/or Torres Strait Islander origin.

This information should be routinely recorded in information systems, and should be consistent across administrative and clinical information systems. Best-practice collection of Aboriginal and Torres Strait Islander status requires that:

All clients, whether Aboriginal, Torres Strait Islander or non-Indigenous, have the right to self-report their Indigenous status, rather than have their status assumed and recorded on their behalf.⁵³

This right extends to non-Indigenous parents who wish to have the Aboriginal or Torres Strait Islander heritage of their child recognised.

An individual’s right not to identify as Aboriginal or Torres Strait Islander must be respected. Personal, historical, family or cultural reasons may influence an individual’s decision to identify, and these may vary over time.

Aboriginal and Torres Strait Islander people are more likely to identify as such if they are in a safe environment where they will not experience discrimination. Ensuring that health service organisations have a welcoming environment and a culturally competent workforce is critical.

Inaccurate recording of Aboriginal and Torres Strait Islander status can result in Aboriginal and Torres Strait Islander people being recorded as ‘non-Indigenous’ or ‘not stated’ within collection systems, which results in their exclusion from monitoring and analysis of service utilisation and health outcomes for Aboriginal and Torres Strait Islander patients. In turn, this may lead to under-reporting of the prevalence of disease and of service utilisation, and underplay inequalities in health. Importantly, this lack of detail can potentially lead to biased analysis and reporting of information that informs policy and practice.⁵³

What are the benefits of taking action?

Benefits for the health service organisation include:

Improved standards, more consistent practice, improved accuracy in recording status, and improvements in meeting the needs of Aboriginal and Torres Strait Islander people
Accurate data on Aboriginal and Torres Strait Islander people to inform policy, and service planning and development⁵⁴
Accurate monitoring of disparities in health care and outcomes used to inform actions to reduce these disparities
Accuracy of financial remuneration to organisations providing services to Aboriginal and Torres Strait Islander people through activity-based funding and service loadings.⁵⁴

Benefits for the Aboriginal and Torres Strait Islander community include:

Safe, high-quality and culturally appropriate clinical care
Understanding that self-identification is important to enable access to services in response to community health needs
Upholding of the rights of all Aboriginal and Torres Strait Islander people
Improved quality of services available to individual patients and their families by informing care requirements, including population-specific improvements in clinical decision-making.^55,56

Key tasks

Develop and implement policy, procedures and protocols on Aboriginal and Torres Strait Islander identification
Raise awareness with Aboriginal and Torres Strait Islander community members of the importance and benefits of recording Aboriginal and Torres Strait Islander status
Promote self-identification by creating environments in health service organisations that are welcoming and friendly for Aboriginal and Torres Strait Islander people, including:
- displaying Aboriginal or Torres Strait Islander arts in the service facilities
- making promotional materials such as posters and pamphlets readily available
Train and support the workforce to collect identification information in a culturally appropriate way
Implement monitoring and evaluation systems to monitor and measure improvements in accuracy and consistency of identification rates, practices and data quality
Develop or adapt user-friendly data collection systems that transmit data between administrative and clinical data systems.

Suggested strategies

Develop policy, business rules, procedures and protocols on Aboriginal and Torres Strait Islander identification processes to ensure that identification rates are improved through continuous quality improvement

Develop a policy, business rules, procedures and protocols on Aboriginal and Torres Strait Islander identification that incorporate:

Processes to ask all patients the standard question of whether they identify as being of Aboriginal and/ or Torres Strait Islander origin
Processes to transfer information – automatically, if possible, and manually otherwise – on Aboriginal and Torres Strait Islander status within and between administrative and clinical data systems
Training and support to enable members of the workforce to ask every patient about their Aboriginal and Torres Strait Islander status
Support to enable Aboriginal and Torres Strait Islander people to self-identify.

The policy, business rules, procedures and protocols should be developed in accordance with the National Best Practice Guidelines for Collecting Indigenous Status in Health Data Sets, and in partnership with Aboriginal and Torres Strait Islander community organisations and groups.⁵³

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

Action 1.15a - The health service organisation identifies the diversity of the consumers using its services.

Action 1.15b - The health service organisation identifies the groups of patients using its services who are at higher risk of harm.

Review all systems to ensure that the standard questions regarding Aboriginal and Torres Strait Islander status are consistently worded and coded

The wording and coding of the question regarding Aboriginal and Torres Strait Islander status should be standardised to the National Best Practice Guidelines for Collecting Indigenous Status in Health Data Sets and the Australian Bureau of Statistics Indigenous Status Standard, 2014.

In accordance with the national standard, Aboriginal and Torres Strait Islander status may be coded as:

‘No’
Either or both of ‘Yes, Aboriginal’ and ‘Yes, Torres Strait Islander’.

Ensure that the question is a mandatory field

Ensure that administrative and clinical information systems are streamlined and user friendly

Review patient intake procedures

Develop a prompt for the workforce to check for and follow up missing or incomplete fields throughout a patient’s admission

In some instances, the response to the question may be left blank or incomplete.⁵³This could occur if:

The client is capable of responding but declines to respond following prompting or follow-up
It is impossible for the question to be asked during the contact episode.

If this occurs, there should be automatic prompts within the administrative and clinical information systems to enable all members of the workforce to follow up.

If the code ‘Client is capable of responding but declines to respond following prompting/follow-up’ is applied, there should be specific culturally acceptable procedures to follow for approaching the individual.⁵³

Periodically provide regular clients with a copy of their personal details

Develop policies, business rules, procedures and protocols to provide regular clients with a copy of their personal details, including recorded Aboriginal and Torres Strait Islander status, for verification. Providing people with a copy of their personal details for verification can address concerns about patient confidentiality.⁵³

Personal details may include:

Name (and demographic information)
Date of birth
Address
Medical record number
Aboriginal and Torres Strait Islander status.

Introduce mechanisms for quick identification of Aboriginal and Torres Strait Islander people in systems

Provide training and support for the workforce on the importance and process of identification

Provide training and support to the frontline, administrative and clinical workforce on:

The importance of identification at an individual and systems level
How to routinely ask the question about identification and record the response in a way that is consistent with the national standard for identification
How to ask the question about identification in a way that is comfortable and culturally safe for both patients and the workforce
How to ask the question about identification as part of a series of demographic questions directed at providing better quality care.⁵³

Asking the question regarding identification routinely as part of a set of demographic questions – including name, date of birth and address – makes it a part of the systematic identification process, and removes any racial connotation.

Incorporate training into a cultural competency package.

Establish processes for the ongoing monitoring of workforce attitudes, performance and views to inform further training and support.

Develop resources in collaboration with Aboriginal and Torres Strait Islander people that explains and encourages people to self-identify

Develop or use nationally developed resources^53,55, including posters and brochures, to support people to identify as being of Aboriginal and/or Torres Strait Islander origin. These resources should include information on:

The importance of identification at an individual and systems level
How the question about identification can be asked as part of a series of demographic questions directed at providing better quality care
How all patients are asked the same series of questions.

Email ncatsis@abs.gov.au to request copies of Australian Bureau of Statistics resources.

Routinely review the effectiveness of the identification processes

Review the effectiveness of the identification processes. This includes conducting quality surveys and interviews with Aboriginal and Torres Strait Islander clients to determine accuracy of collection and develop estimates of the level of under-identification, and surveys of the workforce to understand their views and attitudes.⁵³

Report results to the governing body and management.

Monitor trends over time in the number and proportion of Aboriginal and Torres Strait Islander people identifying.⁵³

Examples of supporting evidence

Policies, procedures and protocols outlining processes for identification of Aboriginal and Torres Strait Islander patients, and recording of this information in administrative and clinical information systems
Observation of the admission system to demonstrate that the identification question is mandatory
Prompts in the admission and patient information systems to complete identification fields
A continuous quality improvement protocol to monitor and review processes to improve the rate of Aboriginal and Torres Strait Islander identification and recording
Results of audits of completed admission records
Communication materials to inform Aboriginal and/or Torres Strait Islander people and encourage them to self-identify
Orientation manuals and education resources on requesting Aboriginal and Torres Strait Islander status and records of attendance at training by the workforce
Orientation manuals, memos, newsletters or other communication material provided to the workforce on the importance of identifying Aboriginal and Torres Strait Islander patients
Evidence that information is shared between administrative and clinical information systems.

References

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

52. Steering Committee for the Review of Government Service Provision. Report on government services 2015: Indigenous compendium. Canberra: Productivity Commission; 2015.

53. Australian Institute of Health and Welfare. National best practice guidelines for collecting Indigenous status in health data sets. Canberra: AIHW; 2010.

54. Thompson SC, Woods JA, Katzenellenbogen JM. The quality of Indigenous identification in administrative health data in Australia: insights from studies using data linkage. BMC Med Inform Decis Mak 2012;12:133.

55. Australian Institute of Health and Welfare. Towards better Indigenous health data. Canberra: AIHW; 2013.

56. Kelaher M, Parry A, Day S, Paradies Y, Lawlor J, Solomon L. Improving the identification of Aboriginal and Torres Strait Islander people in mainstream general practice. Melbourne: Australian National University and The Lowitja Institute; 2010.