Action 1.33: Welcoming environments

A welcoming environment in a health service organisation is about creating a place where Aboriginal and Torres Strait Islander people feel safe, comfortable, accepted, and confident that they will be respected, will be listened to and will receive high-quality care.

What does this mean for health service organisations?

In Australia, Country and language groups among Aboriginal and Torres Strait Islander people are diverse.Therefore, clinicians and health service organisations need to be aware of, and sensitive to, the complexity of Aboriginal and Torres Strait Islander cultural beliefs and practices. Australia’s first peoples live within a kinship network and have done so since before colonisation. The kinship network is an interconnected, structured social system in which each person’s role is determined and defined, and comes with clear obligations and responsibilities. If community protocols for kinship networks are not adhered to, cultural fragmentation can and does occur.

Many Aboriginal and Torres Strait Islander people find health service organisations – including primary healthcare centres, hospitals and day surgeries – unwelcoming.37,41Negative experiences can lead to reluctance to access services, disengagement with clinicians and care in these settings, and high rates of discharge against medical advice. These, in turn, affect health and wellbeing.48

A welcoming environment in a health service organisation is about creating a place where Aboriginal and Torres Strait Islander people feel safe, comfortable, accepted, and confident that they will be respected, will be listened to and will receive high-quality care. Welcoming spaces enable Aboriginal and Torres Strait Islander individuals, families and employees to uphold their cultural practices and beliefs.49

The physical, emotional and relational aspects of spaces are all critical components of creating welcoming environments49:

  • Physical – design, layout and appearance
  • Emotional – the feeling of being supported and cared for within the health service organisation
  • Relational – the quality of relationships developed with the workforce and other consumers.

Creating a welcoming environment requires a culturally competent workforce providing culturally safe care.

What are the benefits of taking action?

Benefits for the health service organisation include:

  • Redress of historical associations of institutions, including the impact of past policies, practices and treatments such as segregation and seclusion, and a perception that hospitals are a place where people go to die
  • Improved efficiency of services and use of resources
  • Improved performance of the system in meeting the healthcare needs of Aboriginal and Torres Strait Islander people
  • More productive and meaningful collaboration and partnerships with Aboriginal and Torres Strait Islander communities.

 

Benefits for the Aboriginal and Torres Strait Islander community include:

  • Improved access to healthcare services that meet the needs and circumstances of Aboriginal and Torres Strait Islander people
  • An increased feeling of safety and engagement with the health service organisation
  • Improved health outcomes and equality.

Key tasks

  • Work in partnership with local Aboriginal and Torres Strait Islander people to identify strategies to create and maintain a welcoming environment
  • Implement and monitor the effectiveness of the strategies
  • Involve local Aboriginal and Torres Strait Islander people in evaluation of the environment
  • Consider the impact on Aboriginal and Torres Strait Islander people as part of planning for capital works programs and prioritise projects that have significant benefits for Aboriginal and Torres Strait Islander people.

Suggested strategies

Examples of supporting evidence

  • Documentation of community consultation relating to creation of a welcoming environment
  • Policies, procedures or protocols on cultural diversity that cover the needs of Aboriginal and Torres Strait Islander patients and their families
  • Signs and plaques acknowledging traditional custodians
  • Statement of recognition, such as a plaque; printed words on glass doors and pavement; or artwork telling the story of place, traditional ownership, individuals or significant events
  • Flying of the Aboriginal and Torres Strait Islander flags, and a policy on half-mast days, including the death of a community member
  • Evidence of celebrating important events in the Aboriginal and Torres Strait Islander cultural calendar
  • Information brochures that outline what to expect when visiting the organisation, and the services available to support Aboriginal and Torres Strait Islander patients and families
  • Documentation of services that are tailored to meet the needs of Aboriginal and Torres Strait Islander people
  • Use of Aboriginal and Torres Strait Islander names (developed in partnership) for wards and meeting rooms
  • Survey results and reports on consumer satisfaction with the organisation’s actions to meet the needs of Aboriginal and Torres Strait Islander communities
  • Availability of Aboriginal and Torres Strait Islander liaison officer(s) or health worker(s), including in emergency departments
  • Evidence that Aboriginal and/or Torres Strait Islander people are involved in the development and implementation of the strategies, and that their views are sought routinely, particularly when the effectiveness of welcoming strategies are evaluated.

References

1. National Aboriginal and Torres Strait Islander Health Standing Committee of the Australian Health Ministers’ Advisory Council. Cultural respect framework 2016–2026 for Aboriginal and Torres Strait Islander health. Canberra: AHMAC; 2016.

37. Bainbridge R, McCalman J, Clifford A, Tsey K. Cultural competency in the delivery of health services for Indigenous people. Issues Paper No. 13 produced for the Closing the Gap Clearinghouse. Canberra: Australian Institute of Health and Welfare, and Melbourne: Australian Institute of Family Studies; 2015.

41. Dwyer J, Willis E, Kelly J. Hospitals caring for rural Aboriginal patients: holding response and denial. Aust Health Rev 2014;38:546–51.

48. Durey A, Wynaden D, Thompson SC, Davidson PM, Bessarab D, Katzenellenbogen JM. Owning solutions: a collaborative model to improve quality in hospital care for Aboriginal Australians. Nurs Inq 2012;19:144–52.

49. Davy C, Cass A, Brady J, DeVries J, Fewquandie B, Ingram S, et al. Facilitating engagement through strong relationships between primary healthcare and Aboriginal and Torres Strait Islander peoples. Aust N Z J Public Health 2016;40:535–41.