The Aboriginal Cultural Engagement Self-Assessment Audit Tool is an annual continuous quality improvement mechanism that LHDs to quantify, monitor and improve the cultural and clinical safety of their facilities and services for Aboriginal patients. The tool aims to identify ways of strengthening cultural engagement between staff and their Aboriginal stakeholders by bringing a continuous quality improvement cycle to cultural engagement. The tool provides evidence during hospital accreditation, supports other local and organisational audits and activities developed to strengthen the cultural safety of NSW Health services. The tool embeds the six specific Aboriginal actions from the NSQHSS, the five strategic directions from the NSW Aboriginal Health Plan, the Priority Reform Areas from CTG and the principles of the framework.
Each Local Health District Board or Specialty Health Network Board is responsible for establishing and oversighting an effective governance and risk management framework for the network, setting its strategic directions, ensuring high standards of professional and ethical conduct are maintained, involving providers and the community in decisions that affect them, monitoring the service delivery and financial performance of the network against its targets and holding the network chief executive accountable for their performance.
In the context of NSW Health, clinical governance is the set of relationships and responsibilities established by a health service between Ministry of Health, Clinical Excellence Commission, Governing Board, executive, clinicians, health care workers, patients, health consumers, and other stakeholders to ensure good clinical outcomes. Implementation of a sound clinical governance system involves contributions by individuals and teams at all levels of the organisation.
Co-creation differs from co-design, as it allows people to collaboratively identify problems, which extends on co-design where issues are already pre-defined and on co-production where both problems and solutions are pre-defined14.
The commercial determinants of health are private sector activities affecting people’s health, directly or indirectly, positively or negatively. Commercial activities by private sector organisations shape the physical and social environments in which people live and work, and are a key determinant of Aboriginal peoples’ and communities’ health and wellbeing15.
The cultural determinants of health are anchored in Aboriginal ways of knowing, being and doing, centred upon the relationship of self to Country, kin, community, and spirituality. They are rights-based, as they hinge upon the inherent right to practice one’s Aboriginal culture, including through: connection to Country, family, kin and community; Aboriginal beliefs and knowledge; cultural expression and continuity; Aboriginal language; and self-determination and leadership.
Cultural load is a term to describe the (often invisible) load borne by Aboriginal people in the workplace, where they are either the only person or one of a small number of people from the Aboriginal community. This creates additional workload associated with things like being consistently expected to respond to all things relating to that community and speak on behalf of all its people. It can mean frequently having to provide information, knowledge, education and support on Aboriginal issues, topics and days of significance –often without any formally agreed reduction or alteration to, or acknowledgement of, a person’s current workload10.
Cultural safety is an Aboriginal and Torres Strait Islander specific concept in Australia. It is an experience that Aboriginal and Torres Strait Islander peoples have and its presence or absence can only be determined by them . A culturally safe environment for First Nations people is when their presence is welcomed and respected, experiences are believed and validated, cultures are centred and valued, knowledges and skills are recognised and supported, advice is listened to and acted upon and they do not experience racism in any form. Culturally safe care and services do not discriminate, are respectful, safe and enable meaningful communication and shared decision making. Cultural safety is defined by the individual interacting with the system and receiving care16.
Health equity is ‘the absence of unfair, avoidable or remediable differences among groups of people, whether those groups are defined socially, economically, demographically, geographically or by other dimensions of inequality (e.g., sex, gender, ethnicity, disability, or sexual orientation)’ and can be achieved when everyone can attain their full potential for health and wellbeing17.
A Local Health District or a statutory health corporation, NSW Ambulance and affiliated health organisations that provide clinical services. NSW Health support organisations that provide clinical services including Cancer Institute NSW.
The health system in NSW refers to all health organisations across the state combined. This includes the public health services of NSW Health, private Health Services (primary care, hospitals, medical specialists and allied health), Aboriginal Community Controlled health services and mainstream primary care services.
NSW Health organisations consist of:
Self-Determination is the human right of Indigenous people to control their own affairs and make meaningful decisions about their lives to fulfil their physical, emotional, cultural, spiritual, political, and economic needs .
Social determinants of health refer to the material conditions of people’s lives that are shaped by structures beyond their personal control19. They are non-medical factors that influence health outcomes. For Aboriginal peoples, racism is a social determinant of health in addition to those commonly acknowledged by the World Health Organization, such as income, education, employment, job security, housing, food security, early childhood development, transport and social support and exclusion18.
Decision-making is shared between government and Aboriginal and Torres Strait Islander people. Shared decision-making is: