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Table 7 Overview of CQI project objectives and examples of organisational changesa

From: Can a continuous quality improvement program create culturally safe emergency departments for Aboriginal people in Australia? A multiple baseline study

Project objectives EDs targeting objective Examples of observed organisational changes
Encourage Aboriginal patients to identify as Aboriginal in emergency departments (ED) 1, 2, 4, 5, 6, 7, 8 • Pamphlets and posters encouraging Aboriginal patients to identify as Aboriginal were established in EDs (n = 5) b.
• Training on how to ask patients about their Aboriginal status was delivered to ED staff and other hospital staff and embedded in staff orientation. Further, DVDs and other resources were developed to support this training (n = 6).
Maximise the quality of ED data and the use of these data to improve ED care for Aboriginal people 1, 4, 5, 7, 8 • Aboriginality was made a mandatory field in ED information systems and/or included in the patient registration screen (n = 3).
• Fields for Aboriginal identification and incomplete ED visits in Aboriginal patients were included in the data query applications of ED information systems to facilitate routine reporting (n = 2).
• A performance indicator dashboard on the ED care of Aboriginal patients was established to monitor and guide hospital practice (n = 1).
Increase the presence of Aboriginal Liaison Officers (ALO) in EDs 1, 2, 3, 4, 5, 6, 8 • Alert systems in ED information systems were established to link ALOs with Aboriginal patients (n = 1).
• A practice guideline was established for ALOs to follow-up Aboriginal patients who have an incomplete ED visit (n = 1).
• Messages about the availability of ALOs and how to use this service were streamed on televisions in the ED (n = 3).
Make ED and hospital wait areas welcoming for Aboriginal patients 1, 2, 4, 6, 7, 8 • Plaques acknowledging the traditional custodians of the land, maps describing the locations of Aboriginal clans and Aboriginal art were erected in ED wait areas (n = 5).
• The Aboriginal “dreaming garden” in the hospital was redeveloped in partnership with the local Aboriginal Land Council (n = 1).
• Survey of Aboriginal and other patients conducted and informed business case for redevelopment of ED wait area (n = 1).
Improve the Aboriginal cultural competence of ED staff and other hospital staff 1–8 • Aboriginal health workers (and sometimes non-Aboriginal staff) provided orientation to ED staff on Aboriginal cultural competence, local Aboriginal history and the roles of Aboriginal health workers and ALOs in the ED and hospital (n = 8).
• Aboriginal cultural competence training was mandated and embedded in hospital staff orientation and training calendars (n = 8).
• Hospital staff meetings implemented acknowledging events of significance to Aboriginal people (e.g. NAIDOC week) (n = 1)
Support the Aboriginal health workforce 1, 7 • A hospital Aboriginal employment strategy was established, which includes establishing an Aboriginal staff network, more Aboriginal-identified positions and mentoring programs for Aboriginal staff (n = 2).
Improve collaboration between the ED and Aboriginal community-controlled organisations 1–8 • A formal partnership agreement was established between the ED/hospital and the local Aboriginal community-controlled health service, which emphasised joint planning and service delivery and included provision for staff exchanges (n = 3).
• Existing referral mechanisms between the ED and local Aboriginal community-controlled health services were refined (n = 1).
Reduce incomplete ED visits among Aboriginal patients 1–8 • An ED critical incident response procedure was established for incomplete visits in Aboriginal patients, which sought to learn from the incident, prevent similar incidents in the future and ensure follow up and care of the affected patient (n = 1).
• Leaflets and electronic messaging were implemented in EDs explaining triage and administrative processes (n = 4).
• A process for informing patients of wait times was embedded into routine practice, such as the shift handover procedure (n = 4).
  1. aSimilar project objectives have been combined. Findings come from key informant interviews and review of program documentation.
  2. b n indicates the number of EDs achieving this outcome.