First Nations health
We work in partnership with government agencies, community-controlled health services, communities and the private sector to improve culturally safe care and health outcomes for First Nations peoples.
Aboriginal and Torres Strait Islander visitors are advised that this site and content may contain images and case studies relating to deceased persons.
Expressions of Interest now closed: standards for First Nations Cultural Safety Review
The standards for First Nations Cultural Safety Review is focused on strengthening cultural safety and addressing racism in hospital systems, including how health leaders are accountable for embedding and monitoring cultural safety across systems to improve First Nations health outcomes.
Expressions of interest are now closed. Thank you for your interest and participation. If you submitted an expression of interest, the First Nations Health Team will contact you with information on next steps.
For more information you can also email the First Nations Health Team.
Recent reports have demonstrated that systemic and institutional racism remains embedded across Australian healthcare structures, policies and practices, contributing directly to inequitable access and outcomes.
Embedding cultural safety into everyday systems and process within health services will re-orient healthcare delivery to focus on models, practices and approaches that respect and prioritise First Nations ways of knowing, being and doing. It will also help contribute to the elimination of racism and the delivery of better health outcomes for First Nations people.
Cultural safety
Cultural safety for First Nations people is determined by First Nations individuals, families and communities.
In health care, culturally safe practise is the ongoing critical reflection of knowledge, skills, attitudes, practising behaviours and power differentials in delivering safe, accessible and responsive healthcare free of racism.
Essential features of cultural safety are individuals and organisations:
- acknowledging colonisation and systemic racism, social, cultural, behavioural and economic factors which impact individual and community health
- acknowledging and addressing individual racism, their own biases, assumptions, stereotypes and prejudices and providing care that is holistic, free of bias and racism
- recognising the importance of self-determined decision-making, partnership and collaboration in healthcare which is driven by the individual, family and community
- fostering a safe working environment through leadership to support the rights and dignity of Aboriginal and Torres Strait Islander people and colleagues.
Under the Priority reforms for the National Agreement on Closing the Gap signed in July 2020, all government organisations have committed to ‘embedding and practicing meaningful cultural safety’ as well as ‘delivering services in partnership with Aboriginal and Torres Strait Islander organisations, communities and people’.
The standards for First Nations Cultural Safety Review
The Commission's First Nations Health Team is leading the standards for First Nations Cultural Safety review. Through a co-design process, this work will identify options for strengthening cultural safety in hospital care. The first stage of the review focuses on building the evidence base and engaging with key stakeholders and is currently underway.
First Nations Health Team
The First Nations Health Team leads the standards for First Nations Cultural Safety Review. For more information about this work, please email the team.
Aboriginal and Torres Strait Islander Health Advisory Group
The Aboriginal and Torres Strait Islander Health Advisory Group is a key governance body for the Review. The Advisory Group provides strategic advice, guidance and monitoring to help shape the Review and its co-design processes.
The Advisory Group includes representatives from a broad range of sectors, including Aboriginal and Torres Strait Islander clinicians, consumers, community-controlled organisations and peak bodies.
Other work on cultural safety
Independent Rapid Literature Review and Environmental Scan
About the report
The Australian Commission on Safety and Quality in Health Care (the Commission) commissioned an independent rapid literature review and environmental scan to inform options for strengthening cultural safety in Australian hospitals and support the Commission's broader standards for First Nations Cultural Safety Review. This work was undertaken by Jayde Fuller, Director of Indigenous Regulatory Practice.
This report is being shared as an independent resource to support consultation, engagement and co-design with Aboriginal and Torres Strait Islander peoples, organisations and other stakeholders. The findings provide an important evidence base to inform discussion and consideration of policy and reform options for strengthening First Nations cultural safety in hospitals and support ongoing discussions with First Nations peoples, communities, organisations, health services, professional bodies and governments. The report does not represent final Commission policy or decisions.
The review examined five key questions relating to:
- The meaning of culturally safe care from the perspective of First Nations patients and communities
- How cultural safety should be measured
- What governance and accountability mechanisms drive system-level change
- What conditions support structural transformation
- What would be required to shift standards from a competency-based to an accountability-based approach.
The review comprised:
- Part A: A rapid literature review of 145 peer-reviewed publications from Australia, Canada, Aotearoa New Zealand and the United States of America.
- Part B: An environmental scan of policy, standards, governance, accountability and measurement frameworks across the same jurisdictions.
Key themes identified in the review
The review identified a consistent gap between what the evidence suggests is required to achieve culturally safe care and what current regulatory and accountability frameworks require. Current approaches often focus on compliance and activity rather than outcomes experienced by First Nations patients, families and communities.
Key themes and potential approaches identified in the review include:
- Cultural safety: Align standards with a clear, patient-determined definition of cultural safety.
- Organisational accountability: Establish organisational requirements linked to measurable outcomes, rather than process completion.
- Measurement: Strengthen community-reported and patient-validated measures of cultural safety.
- Transparency: Increase transparency, public reporting and accountability for cultural safety outcomes.
- Governance: Embed First Nations leadership, oversight and governance within accountability arrangements.
National safety and quality standards
Our National Safety and Quality Health Service (NSQHS) Standards are developed in collaboration with states, territories, clinical experts, patients and carers. The primary aim of the NSQHS Standards are to improve the quality of health service provision by providing nationally consistent statements about the level of care consumers can expect from health services.
Actions to meet the needs of First Nations peoples
The current NSQHS Standards include six actions that focus specifically on supporting improvements to health care delivery for First Nations people.
| Clinical Governance Standard |
|
|---|---|
| Partnering with Consumers Standard |
|
| Comprehensive Care Standard |
|
Implementation resources
We have developed guidance for health services to help take action to meet these requirements including:
- NSQHS Standards User guide for Aboriginal and Torres Strait Islander health
- Understanding leave events for Aboriginal and Torres Strait Islander peoples and other Australians from health service organisations: A Systematic Literature Review
- NSQHS Standards Identifying Aboriginal and Torres Strait Islander people
Developing the Third Edition of the NSQHS Standards
We have started developing the third edition of the NSQHS Standards and are looking at how we can strengthen and improve a range of requirements including those to support cultural safety and improved outcomes for First Nations people. Visit the Third edition engagement hub to find out more.
Healthcare rights
The Australian Charter of Healthcare Rights describes what consumers, or someone they care for, can expect when receiving health care. These rights apply to all people in all places where health care is provided in Australia.
Your healthcare rights include the right to access, safety, respect, partnership, information, privacy and to give feedback without fear of it affecting care.
For First Nations people, delivering care aligned with the Charter means ensuring care is culturally safe and free from racism and discrimination.
My Healthcare Rights by Northern Sydney Local Health District
Northern Sydney Local Health District in New South Wales has developed a Charter Poster for First Nations people.
Story of the artwork
The Waraba (turtle) Artist: Peter Shine (Director NSLHD Aboriginal and Torres Strait Islander Health Service). The Waraba was chosen as the logo of the Aboriginal and Torres Strait Islander Health Service (ATSIHS), Northern Sydney Local Health District because the Waraba represents Resilience, Wisdom and Longevity of Aboriginal and Torres Strait Islander people across the nation. The Waraba sends a message to mob to continue to learn and share the knowledge and wisdom of the oldest surviving cultures in the world. The Waraba is the skin totem given to the artist and representative of the above story. This artwork has been used with Peter’s permission.
With permission other health services are welcome to use NSLHD’s version of the Charter to inspire your local adaptations. However, no part of the artwork in this document may be used, recreated or copied as it is specific to NSLHD Aboriginal and Torres Strait Islander Health Service
Other resources
We have a range of information and guidance to help improve the delivery of healthcare for First Nations people including.
Antimicrobial Stewardship
- Fact sheets for First Nations consumers and clinicians on medication shortages
- Guidance on Options for implementation of AMS primary care - Aboriginal Community Controlled Health Services
National Medicines Symposium
Presentations on:
- Diabetes in Aboriginal and Torres Strait Islander people – Dr Jason Agostino (NACCHO)
- Role of integrated pharmacists in medicines management for diabetes – Pippa Travers-Mason (Gurriny Yealamucka, Yarrabah)
- Digital tools for Case medicines management in Aboriginal Community Controlled Health Organisations – Alice Nugent (NACCHO)
Information on clinical topics
- Introductory information on cultural safety is included in the following clinical care standards: Sepsis, Hip Fracture, Stillbirth, Psychotropic Medicines in Cognitive Disability or Impairment, Heavy Menstrual Bleeding, Osteoarthritis of the Knee and Colonoscopy
- Delivering better sepsis care in regional and remote communities - Gove District Hospital, NT: Implementation case study
- Colonoscopy for Aboriginal and Torres Strait Islander peoples - Fact sheet
- Understanding leave events for Aboriginal and Torres Strait Islander people
- Australian Hospital Patient Experience Question Set - Aboriginal languages
- Experiences of Sepsis among First Nations Peoples in Australia
- Keeping Community Strong - Protecting Aboriginal and Torres Strait Islander communities from Sepsis