Changes in Aboriginal Patient Experiences of Care in NSW Public Hospitals From 2014 To 2018: The NSW Patient Survey Program

IntroductionNew South Wales is home to more Aboriginal people than any other state or territory in Australia. While much is known about social and health status among these Aboriginal people, less is known about their experience of healthcare. Objectives and ApproachBHI produces independent reports and information about the performance of the NSW healthcare system. In collaboration with the NSW Ministry of Health Centre for Aboriginal Health, our report explored trends in Adult Admitted Patient Survey in public hospitals for a range of measures from 2014 to 2018 for Aboriginal and non-Aboriginal patients. Administrative survey data were used to establish a sample frame, send questionnaires to a random sample of patients within three months following discharge and assess representativeness of respondents. We used logistic regression models, adjusted for age, sex, education and language spoken at home, to estimate the change of experience over time for both populations. ResultsThere were 122,626 patients who shared their experiences each year from 2014 to 2018, among them, 4% identified themselves as Aboriginal. Aboriginal respondents in the survey were similar in age, sex, country of birth and stay type to the administrative sampling data. In 2018, 70% of Aboriginal patients said they would “speak highly” of their experience compared to 79% of non-Aboriginal patients. Across 51 measures, experience of care improved significantly for 39 measures among non-Aboriginal patients, and four among Aboriginal patients (privacy, experience with nurse, communication with patients). Conclusion / ImplicationsAboriginal patients have less positive experience of the hospital care in general and there has been little improvement in their experience in recent years. Identifying areas of less positive experiences where health professionals can play a role individually or in a team could minimise disparities in experience of care.

Cultural safety in hospitals: validating an empirical measurement tool to capture the Aboriginal patient experience

ObjectiveThe aim of the present study was to develop a scale to measure cultural safety in hospitals from an Aboriginal patient perspective. MethodsThe Cultural Safety Survey was designed to measure five key characteristics of cultural safety that contribute to positive hospital experiences among Aboriginal hospital patients. Investigators developed a range of different methods to assess the validity and reliability of the scale using a sample of 316 participants who had attended a New South Wales hospital in the past 12 months. Targeted recruitment was conducted at two hospital sites. Opportunistic recruitment took place through a local health district, discharge follow-up service and online via social media. ResultsThe Cultural Safety Survey Scale was a robust measurement tool that demonstrated a high level of content and construct validity. ConclusionThe Cultural Safety Survey Scale could be a useful tool for measuring cultural safety in hospitals from the Aboriginal patient perspective. What is known about the topic?There are increasing calls by governments around the world for health institutions to enhance the cultural safety of their services as one way of removing access barriers and increasing health equity. However, currently there are no critical indicators or systematic methods of measuring cultural safety from the patient perspective. What does this paper add?The cultural safety scale, an Australian first, presents the first empirically validated tool that measures cultural safety from the Aboriginal patient perspective. What are the implications for practitioners?This measurement model will allow hospitals to measure the cultural safety of their services and ascertain whether current efforts aimed to improve cultural safety are resulting in Aboriginal patients reporting more culturally safe experiences. Over time it is hoped that the tool will be used to benchmark performance and eventually be adopted as a performance measure for hospitals across New South Wales.

Coproducing Aboriginal patient journey mapping tools for improved quality and coordination of care

This paper describes the rationale and process for developing a set of Aboriginal patient journey mapping tools with Aboriginal patients, health professionals, support workers, educators and researchers in the Managing Two Worlds Together project between 2008 and 2015. Aboriginal patients and their families from rural and remote areas, and healthcare providers in urban, rural and remote settings, shared their perceptions of the barriers and enablers to quality care in interviews and focus groups, and individual patient journey case studies were documented. Data were thematically analysed. In the absence of suitable existing tools, a new analytical framework and mapping approach was developed. The utility of the tools in other settings was then tested with health professionals, and the tools were further modified for use in quality improvement in health and education settings in South Australia and the Northern Territory. A central set of patient journey mapping tools with flexible adaptations, a workbook, and five sets of case studies describing how staff adapted and used the tools at different sites are available for wider use.

An Opportunity for Healing and Holistic Care: Exploring the Roles of Health Care Providers Working Within Northern Canadian Aboriginal Communities

Purpose: The purpose of this qualitative study was exploring what the roles and challenges of health care providers working within Northern Canadian Aboriginal communities are and what resources can help support or impede their efforts in working toward addressing health inequities within these communities. Design: The qualitative research conducted was influenced by a postcolonial epistemology. The works of theorists Fanon on colonization and racial construction, Kristeva on semiotics and abjection, and Foucault on power/knowledge, governmentality, and biopower were used in providing a theoretical framework. Methods: Critical discourse analysis of 25 semistructured interviews with health care providers was used to gain a better understanding of their roles and challenges while working within Northern Canadian Aboriginal communities. Findings: Within this research study, three significant findings emerged from the data. First, the Aboriginal person’s identity was constructed in relation to the health care provider’s role of delivering essential health services. Second, health care providers were not treating the “ill” patient, but rather treating the patient for being “ill.” Third, health care providers were treating the Aboriginal person for being “Aboriginal” by separating the patient from his or her identity. The treatment involved reforming the Aboriginal patient from the condition of being “Aboriginal.”

Jumping to Conclusions: Things are Never What They Seem

A 46-year-old Aboriginal man presented with a massive pleural effusion. A diagnosis of sarcoidosis was established. To the author's knowledge, this is the first reported case of sarcoidosis in a North American Aboriginal patient.