There are a number of factors to consider before getting started:
- What other quality improvement projects has your hospital undertaken before? These projects might be known as clinical practice improvement projects, patient journey projects, LEAN thinking or redesigning care projects.
- How should you start a quality improvement project focused on Aboriginal health issues? What should you focus on first?
- Who needs to be involved?
- Do you need senior management support?
- Do you need to get approval from the Aboriginal community before you commence?
Any quality improvement projects you undertake should fall within a normal quality assurance exercise but if you have any concerns please seek an opinion from your hospital ethics committee.
Who should you involve?
It should be noted that changing hospital systems is significant work and requires a range of staff from across the organisation to be successful. In this area of Aboriginal cultural sensitivity the involvement of Aboriginal staff is crucial but they are unable to undertake this work alone.
The Aboriginal staff employed within your health service are a crucial starting point to providing guidance on how to go about any quality improvement project in this area. The most common Aboriginal staff role in Australian hospitals is the Aboriginal Hospital Liaison Officer also known as the Aboriginal Liaison Officer. For the remainder of this toolkit this role will be referred to as the Aboriginal Hospital Liaison Officer or AHLO. Other Aboriginal specific roles may include Aboriginal Family Support Worker or Aboriginal Education and Training Officer.
In the first instance, ask your AHLO how to approach the community and who to liaise with about quality improvement projects.
Senior management support is essential to Aboriginal health developments. To ensure a quality improvement project can be successfully undertaken and findings implemented, management need to be engaged at the early stages. One way to do this is to invite a senior staff member to lead any partnership/project meetings with the Aboriginal community.
The body or structures with responsibility for quality improvement in hospitals go by many different names.
The term Quality Improvement Committee (QIC) is a general term that is used to represent the formal body within the hospital that has responsibility for providing service improvement advice on major clinical governance matters to the hospital executive and Board.
Aboriginal health being one of the primary health issues facing Australia means that activities and changes aimed at improving Aboriginal health should be dealt with through the principal quality improvement body of hospitals.
As an initial step many hospitals create a team of staff to work on a specific Aboriginal project and connect to the QIC by inviting them to meetings etc. This is intended as a starting point only as the involvement of the main committee is crucial to ensure learnings are promulgated across the organisation.
Start with a project that is clearly defined, relatively short in timeframe and manageable by your current staff team. Avoid large, complex projects initially to allow the relationship between your hospital and the Aboriginal community to develop.
Always remember that hospitals are large, complex organisations with their own unique culture. The idea with this kind of quality improvement project is to break down this cultural barrier and bring about some flexibility and this will take time. Big organisations take time to change.
Start with one project and follow the process. Even if the project is not seen as successful there will nearly always be capacity gained through connection and relationship development with the community.
Aboriginal Health Quality Flow Diagram
The flow diagram provides a pictorial outline of what needs to be in place to ensure the successful implementation of a quality improvement approach to Aboriginal health in acute care organisations. The key component is senior management support for the process by directly supporting the Quality Improvement Committee to engage with Aboriginal quality improvement projects and also supporting Aboriginal Hospitals Liaison Officers (or other relevant Aboriginal staff) to assist with the process.
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