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The journey through the health system is different for everyone and presents unique opportunities and challenges for the patient, carers, and health professionals. Journeys for Aboriginal and Torres Strait Islander patients may be complicated by travel from rural and remote communities, by inconsistent cultural safety measures and language barriers, and by the intersections between and within primary, acute and outpatient care.
In August 2018 the COAG Health Council Indigenous Roundtable made a commitment to “implement a Safe Patient Journey through the health care system”, and the value of understanding and improving the journey for Aboriginal and Torres Strait Islander patients is something that has been long recognised by the health sector. Facilitating this, the Cooperative Research Centre for Aboriginal Health and the Lowitja Institute funded, in partnership with SA Health, the three stage Managing Two Worlds Together project to investigate patient journeys for Australia’s First Peoples.
The project, led by Professor Judith Dwyer and Dr Janet Kelly at Flinders University, investigated what works well and what needs improvement in the health system for Aboriginal people who travel for hospital and specialist care from rural and remote areas of South Australia and the Northern Territory to city hospitals. The study enabled better understanding of complex patient journeys for Aboriginal people and produced practical tools that highlight the critical segments and gaps. The tools help to make the complex journey visible; organise the journey for analysis; and enable critical steps and gaps to be highlighted, providing a focus for targeted action.
Speaking about the work and how it has and continues to be applied in Australia and internationally, Dr Kelly highlights the role of Managing Two Worlds Together tools and case studies. “Adelaide Medical School and Nursing School use the patient journey mapping in undergraduate and postgraduate courses through readings, analysis of case studies, critical reflection and major assignments.
“A group of nursing schools across Australia are working with CATSINaM and the Leaders in Indigenous Nursing and Midwifery Education Network to explore how the tools can be used to help students better understand what patient centred care and cultural safety looks like in practice.”
Nationally and internationally the work is also being adapted and applied in research, clinical practice and policy and guidelines development across heart care, stroke care, prisoner health and renal care (with Dr Kelly part of the team working on the Lowitja Institute funded Catching Some AIR project).
Working with patients has been critical throughout the project, and Dr Kelly would like to see this expanded in the future. “We are continuing to work in partnership with patients, families and communities in the Improving Aboriginal Kidney Care Together project (MRFF funding). We are exploring ways that community members can use the tools themselves, in conjunction with health carers and health services, to better highlight gaps and implement improvements in health care journeys.”
Photo courtesy Danila Dilba Health Service. Doctor and patient not involved in this study.