Improving Care for Aboriginal Patients in Victorian Health Services

Transcription

1 Improving Care for Aboriginal Patients in Victorian Health Services 22 March 2018 Chelsea Brand, Senior Project Officer Aboriginal Health and Wellbeing DHHS

2 Korin Korin Balit-Djak: Aboriginal Health, Wellbeing and Safety Strategic Plan

3 Delivering a policy Aboriginal communities have called for

4 Koolin Balit Evaluation Improving Cultural Responsiveness in Victorian Hospitals Case Study Findings

5 Indicators and Measures

6 Experiences of Aboriginal people: changes over time It was not possible to measure at the statewide or hospital level Aboriginal patient experience - and specifically changes over time. The VHES shows some promise but will need some refinement if it is to be the mechanism for measuring cultural safety for Aboriginal patients. VHES data is problematic it suggests Aboriginal patient experience (inpatients and presentations to ED) is not as positive as non- Aboriginal patients. The VHES data demonstrates higher levels of satisfaction of care for Aboriginal patients than the level expressed in qualitative interviews.

7 Improving Care for Aboriginal Patients (ICAP) Program The ICAP program was established in late 2004 as part of a reform that heralded a significant new approach to Aboriginal health funding and accreditation for Victorian public hospitals. Victorian public hospitals are funded through a model called the Weighted Inlier Equivalent Separations model (WIES). Until 2004 Victorian public hospitals received a 10 per cent WIES loading for treating Aboriginal and Torres Strait Islander patients in recognition of their higher costs of care. In 2004 when the ICAP program was established this loading increased to 30 per cent.

8 In Victoria WIES loading 30 per cent acute and sub-acute WIES loading is currently paid to health services for treating Aboriginal patients The loading is intended to cover the additional costs of providing culturally sensitive and appropriate services for Aboriginal people, and improve identification This loading is much higher than the national price adjustment for indigenous patients, which the Independent Hospital Pricing Authority (IHPA) has set at five per cent, based on the National Hospital Cost Data Collection Victoria has not aligned its loading with IHPA s because the size of the loading in the acute and sub-acute funding model is historical and was based on Victorian policy objectives

9 The ICAP program aims to; achieve accurate identification of all Aboriginal people presenting to Victorian hospitals and area mental health services improve access for Aboriginal people to Victorian hospitals and area mental health services support Victorian hospitals and area mental health services to provide high quality, holistic and culturally appropriate health care and referrals for Aboriginal people recognise that high quality, culturally appropriate health care for Aboriginal people is an organisation-wide responsibility, not just the responsibility of designated Aboriginal staff promote partnerships between Victorian hospitals, area mental health services and Aboriginal community controlled organisations in the planning and delivery of health care for Aboriginal people

10 CQI Tool As part of the ICAP guidelines the department requires health services who receive WIES funding to complete a report on their Aboriginal health initiatives through the Continuous Quality Improvement (CQI) tool. In 2011 an evaluation of the ICAP program revealed that the following key result areas best support improving cultural safety in our Victorian hospitals. 1. Engagement and Partnerships 2. Organisational development 3. Workforce development 4. Systems of care Unfortunately this requirement is not a mandatory requirement and up to 50% of health services receiving the loading do not report annually.

11 So far 1. Engagement and Partnerships 2. Organisational development 3. Workforce development 4. Systems of care ICAP Koolin Balit Evaluation findings 1. A commitment at the CEO and senior leadership level 2. Aboriginal Staff 3. Welcoming environment 4. Engagement and partnership with the local ACCO s 5. Accountability and reporting 6. Cultural safety training The only reporting mechanism for the WIES loading Not mandatory Approx 50% of Health services report Annually CQI reporting tool WIES Loading Korin Korin Balit-Djak Domain 3: System reform Strategic direction 3.1.1: Increase cultural capacity and cultural responsiveness health and human service sector. Increased from 10-30% in 2004 No mandatory reporting mechanism The Department is uncertain of how health services spent this WIES loading

12 Aboriginal WIES loading review In mid-2015, a review of the costs of providing care to Aboriginal people accessing public hospital services, concluded that Aboriginal patients cost 4 per cent more. In December 2016 the Victorian Health Pricing Framework Board agreed to retain the current the Aboriginal patient loading without change in both the acute and sub-acute funding models. The Board requested that the loading be explored in more detail over the next 12 months before further reviewing of the funding.

13 Aboriginal WIES loading reforms Key findings of the review include: poor cultural safety is a key driver of poor health outcomes for Aboriginal patients the loading has had no a significant impact on improving Aboriginal health outcomes in public hospitals investment in cultural safety among hospitals is extremely variable, and many are not making obvious, well-supported cultural safety investments, and hospitals reported that they need more support to improve cultural safety.

14 WIES loading review recommendations make changes to funding design, introduce new mandatory accountability mechanisms, and That other supporting reforms were needed, subject to further consultations.

15 What now? Despite significant investment in Victorian Hospitals to improve cultural safety and the heath outcomes of Aboriginal patients little improvement has been seen. In October 2017, the Australian Commission on Safety released Version 2 of the National Safety and Quality Health Service standards, requiring health services to meet six new standards specifically relating to Aboriginal health. Early consultations with Victorian health services indicated uncertainty regarding how the six new standards will be met.

16 Six New Standards 1. Setting safety and quality goals for Aboriginal and Torres Strait Islander people in health service organisations 2. Cultural competence in caring for Aboriginal and Torres Strait Islander consumers 3. Improving identification rates of Aboriginal and Torres Strait Islander consumers 4. Creating safe and welcoming environments for Aboriginal and Torres Strait Islander consumers 5. Effective and safe communication with Aboriginal and Torres Strait Islander consumers 6. Comprehensive care for Aboriginal and Torres Strait Islander consumers

17 ICAP and CQI tool review Review of ICAP Align with Version 2 of the National Standards Incorporate the findings of recent evaluations Align to its umbrella policy document the Cultural Safety Framework Provide strategic guidance for Victorian health services to provide culturally safe services to improve health outcomes for Aboriginal patients and their families, and create a culturally safe working environment for Aboriginal staff. Equip health services to continue to deliver sustainable culturally responsive services for Victorian Aboriginal patients and their families. Equip health services to continue to provide a culturally safe working environment for Aboriginal staff. All whilst working with the underlying principal of Korin Korin Balit-Djak Self-determination

18 Implementation of the Aboriginal WIES loading review recommendations: Development of the new funding model for Development of a reporting process for health services to acquit cultural safety expenditure. Designing guidance and other support materials Updating Policy and Funding Guidelines to clarify expectations of cultural safety funding. Investigating appropriate indicators of culturally safe

19 Where are we at? The first stage of these changes will be implemented in the 2018/19 financial year. With the remaining recommendations, including the supporting reforms to be developed in 2018/19 for implementation in 2019/20. These next stages will not only improve accountability of Victorian health services to the Aboriginal community and the department, but will also result in improved service delivery and health outcomes for Aboriginal and Torres Strait Islander people. These changes will also support health services to better promote their services to the broader Aboriginal community.

20 Thank you