Outreach is not the only way for hospitals to work with local Aboriginal and Torres Strait Islander communities.

It is critical that Indigenous people have a positive hospital experience and that cultural and other barriers to accessing hospitals are proactively addressed. This case study shows how one hospital is working towards this.

What's the problem with our hospitals?

Greater need

Aboriginal and Torres Strait Islander people’s hospitalisation rates are higher than their non-Indigenous peers due to poorer health. This includes for potentially preventable admissions — that might otherwise have been treated earlier in primary settings.

Barriers

Health authorities’ complicity in the forcible removal of the Stolen Generations is a recent memory for many. Thus, Aboriginal and Torres Strait Islander people can have mistrust towards hospitals. Despite greater need, Aboriginal and Torres Strait Islander people are less likely to receive a medical or surgical procedure while in hospital¹.

In a national 2012–13 survey, 27 per cent of Indigenous people reported access barriers in relation to hospitals, be they distance, language, cultural or other barriers².

Between July 2011 and June 2013, the Australian Health Ministers’ Advisory Council reported that 5 per cent of all hospitalised Aboriginal and Torres Strait Islander peoples left hospital against medical advice or were discharged at their own risk. This compares with 0.5 per cent for non-Indigenous people. It’s critical that our hospitals proactively work to address this situation.

Case study | St Vincent’s Hospital’s Aboriginal Health Unit

St Vincent’s is a large public hospital located in Fitzroy, Melbourne. It has more than 5000 staff and 880 beds. In 2016–17 St Vincent’s treated approximately 57,000 acute inpatients; Aboriginal patient data showed 1235 inpatients, 935 emergency presentations and 2528 outpatients^3.

St Vincent’s is part of the North Western Melbourne Primary Health Care Unit. Services include acute medical and surgical services, emergency care, aged care, diagnostics, rehabilitation, allied health, mental health, palliative care and residential care. It has a long history of working with its local Indigenous population and provides outreach to the Victorian Aboriginal Health Service (VAHS) – as discussed in another case study.

Aboriginal Hospital Liaison Officers (AHLOs)

St Vincent’s AHLO Program was established in 1982. AHLOs provide support to patients and their families during admission, inpatient stays, and upon discharge. They provide a culturally sensitive link between medical teams and patients. AHLOs work with and educate other staff in being culturally sensitive to Indigenous patient needs. St Vincent’s currently employs three AHLOs:

• One covers the Emergency Department, the Mental Health Unit’s Aboriginal inpatient beds, and Cardiac Services including cardiac patients in the Intensive Care Unit as well as other inpatient and outpatient units and Dialysis.
• A second covers designated general and specialist inpatient and outpatient units, Oncology, Cancer Tumour streams and Palliative Care.
• A Senior AHLO is responsible for partnerships and liaison with Aboriginal community organisations, for staff orientation, cultural engagement and staff training.

St Vincent’s established an Aboriginal and Torres Strait Islander staffed Aboriginal Health Unit under a dedicated manager at the end of 2015. This incorporated the existing AHLO Program. Further, at St Vincent’s an Aboriginal Health Care Coordinator in the Assessment Liaison & Early Referral Team (ALERT) works with patients presenting with complex needs and assists them to manage their needs in the community by connecting them to GPs and other health services, by advocacy, and by supporting their attendance at outpatient appointments. Completing the Unit, an Aboriginal Employment Officer is responsible for the recruitment and support of Aboriginal staff at St Vincent’s.

Working with prisoners

Aboriginal and Torres Strait Islander people are imprisoned at over 10 times the rate of other Australians. Working with Indigenous people in prison is critical to improving Indigenous health at a population level. The Unit provides services to Indigenous prisoners through a special ward located in the hospital. Unit staff liaise with the Aboriginal Health Clinician at Port Phillip prison about these patients.

The Principles in Action: What Makes the Aboriginal Health Unit Work?

Indigenous leadership

• The Aboriginal Health Unit was established in response to need identified by local Aboriginal and Torres Strait Islander communities and local Aboriginal Community Controlled Health Services (ACCHSs).
• All staff are Aboriginal and Torres Strait Islander, including the Unit manager.
• An Aboriginal Health Advisory Committee, includes representatives of local ACCHSs, community services, staff and heads of hospital departments.

Culturally safe

• AHLOs provide a culturally sensitive link between medical teams and patients.
• The Senior AHLO educates other hospital staff on how to work in culturally sensitive ways.
• The Unit’s Aboriginal Employment Officer supports the hospital to actively recruit Indigenous staff. This includes an Aboriginal cadetship program for nursed and allied health staff in training.
• The hospital hosts Aboriginal and Torres Strait Islander celebrations onsite and all staff are encouraged to participate. This includes Close the Gap Day, Sorry Day, NAIDOC Week, and Reconciliation Week.

Person-centred and family-orientated

• AHLOs provide an Indigenous person-centred hospital experience and involve families as appropriate.
• The Unit and the hospital’s Social Work Team have developed an Aboriginal and Torres Strait Islander Care planning tool to assess patient health and other priorities and communicate complex care needs to key stakeholders. The tool is completed with the patient and used by the Unit and Social Work Team to help ensure a patient’s needs are appropriately prioritised and holistically addressed in and out of hospital.

Sustainable and feasible

• Institutional culture – Aboriginal and Torres Strait Islander health is a core priority for St Vincent’s Health Australia, the hospital’s governing body. It has a Reconciliation Action Plan that drives Aboriginal health activities and includes Aboriginal employment targets.
• Funding – the Aboriginal Health Unit is primarily funded from core public hospital funding. St Vincent’s Private Hospital Melbourne, as part of the organisation’s Reconciliation Action Plan, funds one AHLO position and the part time Aboriginal health clinician at Port Phillip’s correctional services is funded by the Victorian Department of Justice. The cadetship program is funded by the Victorian Department of Health.

Integration and continuity of care

• The Aboriginal Health Care Coordinator works with patients presenting with complex needs and assists them to managing their health needs within the community. They do this by connecting patients to GPs and other health services, by advocacy, and by supporting their attendance at outpatient appointments.
• See Aboriginal & Torres Strait Islander Care Planning tool.

Quality and accountability

• The hospital collates data and regularly reports to the Aboriginal Health Advisory Committee on both Indigenous staff numbers and patient presentations. Because the committee has Indigenous community representation, this expands the hospital’s accountability to those communities.
• To proactively identify gaps, barriers and issues to address, AHLOs enter and analyse patient contact data at the end of each month, including data on discharges against medical advice and on patients who left without being seen.

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