1. Establish hospital Quality Improvement Committee (QIC) – Include Aboriginal community representatives
2. Engage the Aboriginal community and build relationships
3. Gather Aboriginal patient experience and information
Build and develop relationships with the Aboriginal community to give Aboriginal people a voice in the hospital CQI process.
1. When establishing an Aboriginal quality improvement committee it is important that the right people are involved. Consider carefully who should be invited. It is also important to clarify accountability of the group within the hospital committee system. Ideally, the committee would formally report to the hospital wide quality improvement committee (ie. as a subcommittee) but it may be a working group established to progress the change that is required with the Executive sponsor (senior manager) reporting to the hospital executive. This committee should also involve Aboriginal staff, ideally the ALO(s), and other staff as appropriate but should also consider inviting Aboriginal community members or staff from Aboriginal community organisations. Even though a lot of information is provided to the AQI officer by community members it is still important to have community members present to discuss directly with hospital staff.
2. The reason why a hospital should develop a relationship with the Aboriginal community in its local area is so they can hear directly from Aboriginal patients and their families about how they feel about the hospital and then hopefully do something about it. Developing a relationship sounds simple but often is a complex process and takes time. In the context of Aboriginal quality improvement it is also crucial to work with the Aboriginal community to explain how the continuous quality improvement process works within the hospital and why it is important for the Aboriginal community to be involved. The methods for this are not prescribed as this is a decision of the local community. It might occur, for example, through traditional community collection methods or it may occur through local Aboriginal organisations that collect quantitative data on Aboriginal experiences. This quote by an ALO emphasises the importance of the Aboriginal community in identifying issues of importance:
Hospitals and Aboriginal communities need to sit around a table and talk more about what the local health issues are and how they are going to be fixed. When we all work together a lot can be achieved but it is important that hospitals understand how the community works. Community control is essential in working together successfully and Aboriginal people know better than anyone how it should work to benefit our people. Being guided by the local Aboriginal community/organisations is important if hospitals want to contribute to our health and wellbeing (Jemmes Handy, Aboriginal Hospital Liaison Officer, Mildura Hospital).
3. Gathering information on Aboriginal patient experience of hospital care may involve consultation with community, patient surveys, patient journeys and so on. Although it is important to get Aboriginal patient and community feedback, it is also critical to look at hospital data. This data can be obtained from the relevant state government department but it is important in a CQI process to establish a regular collection and reporting of relevant data at the hospital level so that any improvement activities can be assessed over time to see if they are effective. This can also establish an awareness in the hospital that Aboriginal patient care can, in part, be assessed by the examination of hospital data, for example rates of ‘Left with Incomplete Treatment’/’Discharge Against Medical Advice’/’Incomplete Emergency Assessment’. Hospital data may also be gathered in the form of a cultural audit.
Questions to consider for this step
a) How should you go about working with local Aboriginal health organisations?
b) What is different about this feedback process compared to what already exists with ALO’s?
c) What resources would be useful to improve the connection between the hospital and the Aboriginal community?
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