Aboriginal and Torres Strait Islander peoples: Heart Health Projects

Aboriginal and Torres Strait Islander patients face a range of barriers to accessing quality healthcare, including:    

• Communication breakdowns in the coordination of care between hospitals and the primary care sector   
• Less access to medical treatment. Members of the Aboriginal and Torres Strait Islander community may need to travel vast distances (even interstate), which can mean they are without their family, friends and support network   
• Members of the Aboriginal and Torres Strait Islander community may feel isolated and overwhelmed, especially if they are unfamiliar with the hospital environment, the local area, services or the local languages.   

The Lighthouse Hospital Project outlined actions to improve post discharge care. This can improve patient health and reduce a patient’s likelihood to re-present at emergency departments or be readmitted to hospital.   

Other actions to improve the patient journey include providing access to telehealth and enhancing relationships and coordination of care.   

• Racism and discrimination     
• A ‘one size fits all’ approach that doesn’t acknowledge and respect Aboriginal and Torres Strait Islander peoples’ cultures and differing views on health.   

The Lighthouse Hospital Project demonstrated that better health outcomes can be achieved for Aboriginal and Torres Strait Islander peoples through improved patient experiences and culturally responsive and flexible care.    

The phase three evaluation highlighted that more than three-quarters of Aboriginal and Torres Strait Islander peoples with ACS surveyed in Lighthouse Hospitals rated their hospital experience as ‘very good’ or ‘good’.    

Phase 3 hospitals developed a range of innovative solutions to support this such as:   

• The identification rates of Aboriginal and Torres Strait Islander patients are now more accurate at Lighthouse Hospitals, through implementation of a range of cultural development and training initiatives at each hospital.  
• A National online e-learning module suitable for frontline staff in the acute and primary health sector, is now available on the Heart Foundation website and available for national access.  
• Relationships have strengthened between hospital cardiac teams and Aboriginal Medical Services which has resulted in improved discharge processes, such as hospitals taking responsibility for patient follow-up appointments, providing access to medications, tracking of discharge paperwork and the provision of culturally sensitive follow-up patient care – for example, at the Princess Alexandra and Townsville hospitals.  
• Flexible models of cardiac rehabilitation services for Aboriginal and Torres Strait Islander patients are now available for example at Tamworth Rural and Referral Hospital. This has resulted in increasing attendance, adherence, and completion of programs.   
• The role, support and inclusion of Aboriginal Health Workers (AHW) in cardiac care teams and cardiac rehabilitation services has been expanded. For example, at The Flinders Medical Centre.  
• There was a significant improvement in the governance of cultural safety for staff and patients within all Lighthouse hospitals.  
• Patient access has improved for translation services. In addition, there has been an investment in cardiac talking boards in a range of local languages, for example at The Royal Darwin Hospital.   
• There are now hospital-led DAMA protocols for patients identified at risk of DAMA, such as at the Cairns Hinterland Hospital and Health Service and Royal Darwin Hospitals.  
• Changes to the physical environment of hospitals has provided culturally safe spaces for families and clinicians to meet. Some hospital non-Indigenous clinical staff have adopted clinical yarning techniques. This has been exemplified at Cairns Hinterland Hospital and Health Service.   

Project outcomes are the result of many key cultural and system improvements, including:  

• Stronger partnerships between hospitals, Aboriginal and Torres Strait Islander communities and organisations  
• Stronger hospital governance processes and increased executive leadership  
• Addressing cultural barriers and increased cultural awareness and culturally safe practice by hospital staff  
• Improved DAMA protocols and early identification and prevention of DAMA  
• Improved processes and education of staff on identification of Aboriginal and Torres Strait Islander peoples  
• Improved communication and care pathways between the acute sector and the primary healthcare sector.  

The Lighthouse Hospital Project aligned with the Better Cardiac Care for Aboriginal and Torres Strait Islander peoples program. The Australian Health Ministers’ Advisory Council identified the program as a national priority, with a focus on improving access to guideline-based therapy for ACS, within a culturally safe and appropriate environment.   

The project supported a range of Australian Government policies, programs and strategies which seek to reduce disadvantage among Aboriginal and Torres Strait Islander peoples, including inequalities in health outcomes and life expectancy.   

Phase 3, Lighthouse Hospital Project concluded on the 31st December 2019. The Heart Foundation is very proud of the achievements of all hospital cardiac departments who worked closely with their Aboriginal Health Units including many Aboriginal Health Workers and local Aboriginal Medical Services and Aboriginal Community Controlled Health Organisations across Australia.