NDLI: Hospitals caring for rural Aboriginal patients: holding response and denial.

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Hospitals caring for rural Aboriginal patients: holding response and denial.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Dwyer, Judith Willis, Eileen Kelly, Janet
Spatial Coverage	South Australia
Description	Author Affiliation: Dwyer J ( Department of Health Care Management, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia. Email:); Willis E ( School of Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia. Email:); Kelly J ( Department of Health Care Management, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia. Email:)
Abstract	OBJECTIVE: To investigate how policy requiring cultural respect and attention to health equity is implemented in the care of rural and remote Aboriginal people in city hospitals. METHODS: Interviews with 26 staff in public hospitals in Adelaide, South Australia, were analysed (using a framework based on cultural competence) to identify their perceptions of the enabling strategies and systemic barriers against the implementation of official policy in the care of rural Aboriginal patients. RESULTS: The major underlying barriers were lack of knowledge and skills among staff generally, and the persistent use of 'business as usual' approaches in their hospitals, despite the clear need for proactive responses to the complex care journeys these patients undertake. Staff reported a sense that while they are required to provide responsive care, care systems often fail to authorise or guide necessary action to enable equitable care. CONCLUSIONS: Staff caring for rural Aboriginal patients are required to respond to complex particular needs in the absence of effective authorisation. We suggest that systemic misinterpretation of the principle of equal treatment is an important barrier against the development of culturally competent organisations. WHAT IS KNOWN ABOUT THIS TOPIC?: The care received by Aboriginal patients is less effective than it is for the population generally, and access to care is poorer. Those in rural and remote settings experience both severe access barriers and predictable complexity in their patient care journeys. This situation persists despite high-level policies that require tailored responses to the particular needs of Aboriginal people. WHAT DOES THIS PAPER ADD?: Staff who care for these patients develop skills and modify care delivery to respond to their particular needs, but they do so in the absence of systematic policies, procedures and programs that would 'build in' or authorise the required responsiveness. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS?: Systematic attention, at hospital and clinical unit level, to operationalising high policy goals is needed. The framework of cultural competence offers relevant guidance for efforts (at system, organisation and care delivery levels) to improve care, but requires organisations to address misinterpretation of the principle of equal treatment.
File Format	HTM / HTML
ISSN	01565788
e-ISSN	14498944
Journal	Australian Health Review
Issue Number	5
Volume Number	38
Language	English
Publisher	CSIRO
Publisher Date	2014-11-01
Publisher Place	Australia
Access Restriction	Open
Subject Keyword	Discipline Health Services Research Health Policy Hospitals, Rural Oceanic Ancestry Group Healthcare Disparities Interviews As Topic Qualitative Research South Australia Research Support, Non-u.s. Gov't
Content Type	Text
Resource Type	Article
Subject	Health Policy

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