26/27 June 2008 - Brisbane

1. Cultural Security – The Next Step- WIPPresenter: Stephen SimpsonHospital: KHKey contact person for this project (Stephen Simpson; stephen.simpson@nt.gov.au) 26/27 June 2008 - Brisbane

2. Describe your Clinical Management Structure

3. Describe your Clinical Management Structure • Conventional and contemporary in it’s structure and style • Pyramidal management structure • Hierarchical in nature • A combination of Clinical program Networks and activity-based programs and structures • Significant distance between end-point service delivery and strategy flows and policy creation

4. KEY PROBLEM • Incomplete engagement with the end-point users of the health service impacting adversely on health dynamics– members of the local Aboriginal communities – Jawoyn, Walpri,Gurinji & Wardaman – Kriol language groups

5. AIM OF THIS INNOVATION • The practice of Indigenous Medicine has always been integral to Indigenous life and contains the understanding that emotional wellbeing is kindred to spiritual wellbeing and has a strong effect on physical wellbeing – a concept all too often lost in the medical management model • That said, we aim to improve engagement/interaction with Aboriginal users (identified key representatives) of the health service. We anticipate that this will in turn lead to improved health outcomes through enhanced understanding and systems of cultural security, and better interaction between DHCS-KH and the community (enhanced social-capital between these groups). • Health care models that encompass and form a respectful relationship with traditional ways, beliefs and traditional medicine practitioners, are proving successful in Central and Northwest Australia where traditional healers and contemporary medicine work alongside each other in respectful partnerships to improve the health and wellbeing of the communities they serve*. * SMSOAP Concept Brief – D. Tibby – 2006.TPCH. ** Historically has proven a difficult area to map and measure as key indicators for service delivery outcomes (complaints and user-satisfaction surveys) are of limited relevance/value at this point in time to this user-group

6. The Model TREATMENT: COMMUNITY: Assessment Engagement Treatment Assessment Followup Building Capacity proving successful in Central and Northwest Australia – (SMSOAP Concept Brief – D. Tibby – 2006.TPCH.)

7. KEY CHANGES IMPLEMENTED • This remains a WIP (especially in light of the AGI) – unfortunately the improvements are more anticipated and anecdotal at this stage • LHAC - Regular meetings –high attendance – aim to produce positive outcomes with ‘real’ (generated by the community) indicators • User-groups surveys will demonstrate greater satisfaction with the process • Review of clinical practice supported by a structure of cultural security. Identifying where clinical practice and culture intersect i.e. birth, death, consent, admission and discharge, and compliance issues areas of identified concern • Less complaints, less TOL, greater satisfaction etc

8. OUTCOMES SO FAR • Appreciation – feedback from the community that there is a ‘sense’ of respect (engendering trust) that will flow from the Health Advisory Committees • Innovation – smoking ceremonies in birth and death; ‘Sorry’ places – creation of open, comfortable places to greave - once again building positive relationships (which the provision of high quality health services are dependent on) between the Aboriginal Community and the organisation. • A closer appreciation of cultural influences impacting on admission, discharge and TOL – engaging with families on admission, greater use of AHW, ALO and interpreters initially – training of staff in speaking Kriol • A greater realisation that language and cultural differences impact significantly on our working lives

9. EVALUATION • A clear appreciation that there exists a need and desire to engage ‘meaningfully’ with those community groups from a NES- background • That currently there is a growing body of evidence to suggest that using revised models and terms of engagement with Aboriginal people is beginning to have a positive and significant impact on the health care continuum • Language and cultural differences impact significantly on health care - A greater realisation that a ‘cultural awareness’ is a beginning point only in the provision of safe care and that a key is the clear identification of where culture intersects with health care (cultural security) in high-risk situations and implementing strategies to address or mitigate adversity is paramount.