Case Studies of 'Best Practice' in Recording Aboriginality
Archived August 2005
Introduction
Case Study 1 - Mornington Peninsula Hospital
Case Study 2 - West Gippsland Hospital
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Accurate data on the health status of the Koori community is essential for developing, monitoring and evaluating health programs which are aimed at addressing the low health status of Koori people in Victoria. Information on the causes of illness and premature death in the Koori community in Victoria is limited, as Aboriginality has not been accurately recorded on the official data collection systems which are used to measure health status in Victoria.
The Victorian Inpatient Minimum Database (VIMD) is currently the main source of information on illness patterns in the Koori community in Victoria.
The recording of Aboriginality of all patients admitted to public and private hospitals in Victoria has been a mandatory data item for the VIMD since 1 July 1993. The requirement that all patients admitted to public hospitals are asked at the time of admission to hospital whether they are of Aboriginal or Torres Strait Islander descent, has been included in the conditions of funding for public hospitals in Victoria since 1993-94.
The introduction of mandatory reporting of Aboriginality of persons admitted to hospital occurred at the same time that case mix funding was introduced to public hospitals. The changes involved for admissions staff and medical records staff with the introduction of case mix funding were extensive. Hospital staff had very little notice of the changes required in recording Aboriginality. There was little opportunity for staff to be given information on the importance of accurately recording this particular data item.
The Koori Health Unit of H&CS was keen to be able to monitor the implementation of recording Aboriginality of hospital patients and to document any initial difficulties which hospitals were experiencing.
In March 1994, staff of the Koori Health Unit surveyed forty-five public hospitals. The results of the survey were published in the report Are you of Aboriginal or Torres Strait Islander Descent? (Human Services June 1994).
The recommendations of the report which applied to hospitals covered changes to hospital forms, computer software, staff training and quality assurance checks on the Aboriginality data item.
Whether a person is of Aboriginal or Torres Strait Islander descent is an attribute of the person which obviously does not change. However, whether an Aboriginal or Torres Strait Islander patient chooses to be identified as an Aboriginal or Torres Strait Islander may change. Therefore, the recommendations included the need for all patients to be asked the Aboriginality question at every admission, and the requirement that Aboriginality should not be stored as a data item on the Patient Master Index database. These recommendations also reinforced the need to actually ask the Aboriginality question rather than relying on any other way of determining whether a person was of Aboriginal or Torres Strait Islander descent, and to ensure that there is an opportunity to correct inaccurate recording of Aboriginality at a previous admission.
A follow-up survey of all Victorian public and private hospitals was undertaken during October-November 1994 to determine the extent to which the recommendations of the initial survey report had been carried out.
The results of the follow-up survey were distributed to each Human Services Regional Office in May 1995, and a copy of the relevant regional report was also mailed directly to the Chief Medical Record Administrator of every public and private hospital in Victoria.
'Best Practice' Strategy Models
One of the recommendations of the follow-up survey was that 'best practice' strategy models for recording Aboriginality should be documented and shared amongst hospitals, to lessen negative comments and attitudes expressed by some hospitals as providing the barrier to achieving mandatory reporting of Aboriginality.In selecting hospitals for case studies of 'best practice' in regard to recording Aboriginality of patients admitted to hospital, it is acknowledged that the achievement of 'best-practice' is an ongoing process. The actual situation for each hospital across the State in regard to responding to the recommendations for recording Aboriginality will be unique. There is no one best way. Each hospital will require their own specific approach, based on the particular organisational structure, staffing, patient record system and the availability of funding for changes to computer systems.
The case studies demonstrate what has been able to be achieved in a relatively short space of time by two hospitals committed to accuracy in the reporting of Aboriginality of persons admitted to hospital. One of the hospitals, Mornington Peninsula Hospital, is a major metropolitan hospital. The other, West Gippsland Hospital, is a large country hospital. There has been a Koori Hospital Liaison Officer on the staff of West Gippsland Hospital for almost ten years, but there is not a position for a Koori Hospital Liaison Officer at Mornington Peninsula Hospital.
At both of these hospitals:
- Hospital forms used for pre-admission and patient registration include provision for recording whether patients are of Aboriginal or Torres Strait Islander descent.
- The computer screen recording whether a patient is of Aboriginal or Torres Strait Islander descent is labelled Aboriginality.
- Staff undertaking admissions have received one-to-one training in the requirement to ask all patients who were born in Australia at every admission whether they are of Aboriginal or Torres Strait Islander descent.
- The information and promotional material prepared by the Koori Health Unit has been utilised for patients and for staff training.
- Quality assurance checks on the Aboriginality data item are in place.
In regard to recording Aboriginality, key agencies include not only individual hospitals but also software suppliers and software user groups, and staff of Human Services. An ongoing commitment to the accurate recording of Aboriginality of patients admitted to hospitals is needed from each of these key areas. Achievement of best practice in recording Aboriginality is an on-going process.
The common threads which emerge in the case studies demonstrate:
- An acknowledgement of the need for education and training of all relevant staff in regard to recording Aboriginality to be undertaken with a direct and personal approach, using the information and resources provided by the Koori Health Unit.
- A commitment to quality assurance in reporting Aboriginality.
- The need for continued lobbying through software user groups.
- The need for additional funding to be provided to enable implementation of the changes recommended to hospital computer systems.
The Koori Health Unit would be particularly interested to learn how other hospitals are working towards implementation of the recommendations in regard to recording Aboriginality, so that this information can be shared between hospitals.
If you would like to share the experiences and ideas at your hospital,
please contact:
on telephone (03) 9616 7895 or fax (03) 9616 8383.