What does this mean for health service organisations?
Improving identification rates of Aboriginal and Torres Strait Islander people in health service organisations has been prioritised as part of the Australian Government’s and all state and territory governments’ commitment to Closing the Gap though the Council of Australian Governments and the National Indigenous Reform Agreement.18
Incomplete and inaccurate identification of the Aboriginal and Torres Strait Islander population is commonplace in administrative and clinical information systems in health service organisations across Australia.52
Health service organisations are required to establish processes to accurately identify and record Aboriginal and Torres Strait Islander status. These processes should ensure that all people, regardless of appearance and across all service areas, are asked whether they identify as being of Aboriginal and/or Torres Strait Islander origin.
This information should be routinely recorded in information systems, and should be consistent across administrative and clinical information systems. Best-practice collection of Aboriginal and Torres Strait Islander status requires that:
All clients, whether Aboriginal, Torres Strait Islander or non-Indigenous, have the right to self-report their Indigenous status, rather than have their status assumed and recorded on their behalf.53
This right extends to non-Indigenous parents who wish to have the Aboriginal or Torres Strait Islander heritage of their child recognised.
An individual’s right not to identify as Aboriginal or Torres Strait Islander must be respected. Personal, historical, family or cultural reasons may influence an individual’s decision to identify, and these may vary over time.
Aboriginal and Torres Strait Islander people are more likely to identify as such if they are in a safe environment where they will not experience discrimination. Ensuring that health service organisations have a welcoming environment and a culturally competent workforce is critical.
Inaccurate recording of Aboriginal and Torres Strait Islander status can result in Aboriginal and Torres Strait Islander people being recorded as ‘non-Indigenous’ or ‘not stated’ within collection systems, which results in their exclusion from monitoring and analysis of service utilisation and health outcomes for Aboriginal and Torres Strait Islander patients. In turn, this may lead to under-reporting of the prevalence of disease and of service utilisation, and underplay inequalities in health. Importantly, this lack of detail can potentially lead to biased analysis and reporting of information that informs policy and practice.53
What are the benefits of taking action?
Benefits for the health service organisation include:
- Improved standards, more consistent practice, improved accuracy in recording status, and improvements in meeting the needs of Aboriginal and Torres Strait Islander people
- Accurate data on Aboriginal and Torres Strait Islander people to inform policy, and service planning and development54
- Accurate monitoring of disparities in health care and outcomes used to inform actions to reduce these disparities
- Accuracy of financial remuneration to organisations providing services to Aboriginal and Torres Strait Islander people through activity-based funding and service loadings.54
Benefits for the Aboriginal and Torres Strait Islander community include:
- Safe, high-quality and culturally appropriate clinical care
- Understanding that self-identification is important to enable access to services in response to community health needs
- Upholding of the rights of all Aboriginal and Torres Strait Islander people
- Improved quality of services available to individual patients and their families by informing care requirements, including population-specific improvements in clinical decision-making.55,56
- Develop and implement policy, procedures and protocols on Aboriginal and Torres Strait Islander identification
- Raise awareness with Aboriginal and Torres Strait Islander community members of the importance and benefits of recording Aboriginal and Torres Strait Islander status
- Promote self-identification by creating environments in health service organisations that are welcoming and friendly for Aboriginal and Torres Strait Islander people, including:
- displaying Aboriginal or Torres Strait Islander arts in the service facilities
- making promotional materials such as posters and pamphlets readily available
- Train and support the workforce to collect identification information in a culturally appropriate way
- Implement monitoring and evaluation systems to monitor and measure improvements in accuracy and consistency of identification rates, practices and data quality
- Develop or adapt user-friendly data collection systems that transmit data between administrative and clinical data systems.
Examples of supporting evidence
- Policies, procedures and protocols outlining processes for identification of Aboriginal and Torres Strait Islander patients, and recording of this information in administrative and clinical information systems
- Observation of the admission system to demonstrate that the identification question is mandatory
- Prompts in the admission and patient information systems to complete identification fields
- A continuous quality improvement protocol to monitor and review processes to improve the rate of Aboriginal and Torres Strait Islander identification and recording
- Results of audits of completed admission records
- Communication materials to inform Aboriginal and/or Torres Strait Islander people and encourage them to self-identify
- Orientation manuals and education resources on requesting Aboriginal and Torres Strait Islander status and records of attendance at training by the workforce
- Orientation manuals, memos, newsletters or other communication material provided to the workforce on the importance of identifying Aboriginal and Torres Strait Islander patients
- Evidence that information is shared between administrative and clinical information systems.
18. Council of Australian Governments. National Indigenous Reform Agreement (Closing the Gap). Canberra: Council of Australian Governments; 2012.
52. Steering Committee for the Review of Government Service Provision. Report on government services 2015: Indigenous compendium. Canberra: Productivity Commission; 2015.
53. Australian Institute of Health and Welfare. National best practice guidelines for collecting Indigenous status in health data sets. Canberra: AIHW; 2010.
54. Thompson SC, Woods JA, Katzenellenbogen JM. The quality of Indigenous identification in administrative health data in Australia: insights from studies using data linkage. BMC Med Inform Decis Mak 2012;12:133.
55. Australian Institute of Health and Welfare. Towards better Indigenous health data. Canberra: AIHW; 2013.
56. Kelaher M, Parry A, Day S, Paradies Y, Lawlor J, Solomon L. Improving the identification of Aboriginal and Torres Strait Islander people in mainstream general practice. Melbourne: Australian National University and The Lowitja Institute; 2010.