We built data set outlining number of Aboriginal and Torres Strait Islander peoples attending Queensland Children’s Hospital, reviewing their patient journey and experience, this highlighted the need for cultural safety, identity training and recruitment of Aboriginal and Torres Strait Islander staff to join team and develop QCH ED Health Equity Action Plan- MOB ED.
MOB ED CNC developed an Aboriginal and Torres Strait Islander model of care for ED, that begins for Aboriginal and Torres Strait Islander patient’s by identifying Indigenous descent at triage, to ensure that cultural safety can be delivered at the first touchpoint on the patient journey. Then the patient is directed to Aboriginal and Torres Strait Islander Health Workers within the ED for engagement and clinical assessment. MOB ED staff will have a Welcome, Wellbeing and Wayfinding yarn that supports co design of holistic healthcare by weaving into clinical care, culture and community, understanding the social and economic determinants that impact health, improving access, taking a trauma informed approach, working through barriers to receiving health care, and directing the multi-disciplinary team to deliver culturally safe clinical care. MOB ED paediatric nurses, follow up of all Aboriginal and Torres Strait Islander patients discharged from CHQ ED, prioritising those who did not wait, the nurses provide consultation for continuity of care, compassion, community connection and cultural safe care closer to home. MOB ED recognise, encourage and converse with patients/families who require additional community health supports to engage with moblink, our community partners, to highlight how this may benefit them and ensure continuity of care past the hospital doors.
In our model of care Aboriginal and Torres Strait Islander managers become models and mentors for non-Indigenous managers who value Aboriginal and Torres Strait Islander employees. Providing cultural mentoring for non-Indigenous managers who make strategic decisions around Aboriginal and Torres Strait Islander health is important. The Queensland Childrens Emergency Department has adopted a department wide approach, cultural safety in all ED services, continued learning and doing better is at the heart of MOB ED evolvement. MOB ED is embedded into ED services, data monitoring, administration, care given, acknowledging significant Indigenous dates, recruitment, orientation of doctors, nursing and administration staff, welcoming environment and wayfinding, ongoing education on racism and unconscious bias, policy, and practice. The expectation is if a patient identifies as Aboriginal and Torres Strait Islander a health equity action will be completed at each touchpoint on the patient journey.
Recruitment of Aboriginal and Torres Strait Islander staff, they bring a unique skill set, which comes from their lived cultural experiences and ways of being and doing, making them powerful advocates and agents of change to improve health outcomes. At the core lies their holistic and patient-centred focus, and family and cultural values, they deliver culturally responsive care and overcome barriers for clients accessing health services. Additionally, Aboriginal and Torres Strait Islander health professionals play a key role in providing education for non-Indigenous staff through demonstration of cultural safety when interacting with Aboriginal and Torres Strait Islander peoples. This has been essential to the goal of MOB ED to improve the capacity to provide culturally safe care by all members of the multidisciplinary team, even outside the rostered hours of the MOB ED Health Workers. The MOB ED team has worked closely with allies in the wider team to improve cultural competency of all staff through role modelling culturally safe care and targeted education. In turn, this has created a more culturally safe and inclusive workplace for Aboriginal and Torres Strait Islander staff and this workforce has increased within the department. Cultural safe recruitment practices have been adopted by QCH ED ensuring staff are connected and comfortable.
The MOB ED program places emphasis on culturally safe care beginning at the first interaction on presentation by families to QCH ED, the care pathway starts with all families being asked if they identify as Aboriginal and/or Torres Strait Islander by the triage nurse. This has shifted the question from being considered as an administrative process for data collection to being viewed as integral to the ongoing clinical care that is provided. This is then clearly documented in the electronic medical record to share the information with the treating team. This question is further incorporated into nursing and medical assessments with all streams of the multidisciplinary team challenged to add a health equity action at each touchpoint on the patient journey. Small steps such as this change in process have made incremental improvements in the understanding of health equity by all members of the QCH ED team who have the privilege of working alongside the MOB ED team as peers to provide the best possible care for patients. Improved identity of Aboriginal and Torres Strait Islander people to ensure,
• 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.
Building relationships our community partners- moblink (IUIH), Health Equity for Aboriginal and Torres strait islander peoples is everyone’s business. We have partnered with moblink to advocate for the co design and development of care models that meet the needs of children and young people and are delivered in partnership with families and their community. On an individual patient level there are numerous case examples where, through sharing their lived experiences, the MOB ED team have been able to develop rapport and trust from families who have previously struggled to access healthcare. Through partnerships with community-based organisations, such as the Institute for Urban Indigenous Health, families have been engaged in care closer to home and collaborative advocacy has occurred to improve outcomes for complex patients avoiding unnecessary hospital admissions. QCH ED now has a Paediatric Emergency Fellow who is working 0.5FTE in ED and 0.5FTE with IUIH further building the connection between the organisations.
The impact of the MOB ED program has had further reaching influence through the sharing of knowledge and strategy with the broader healthcare system to empower others to also improve the access to culturally appropriate and racism-free care. This has included presentations at Queensland Emergency Department Strategic Advisory Panel Forum 2023 (QEDSAP) and, in partnership with IUIH, at the SE Queensland Health Equity conference. MOB ED received the 2023 ACEM Foundation Al Spilman Award for Culturally Safe Emergency Departments, commending the commitment to cultural safety as an essential step in reducing current health disparities and inequities for Indigenous people.
