Transforming EDs towards Cultural Safety (TECS)

Overview

Initiative type

Redesign, Service Improvement

Status

Deliver

Published

23 March 2021

Summary

Through a grassroots approach, a multidisciplinary group of like-minded clinicians formed the Cairns ED Cultural Safety Working Group (CSWG), and have collaborated to achieve remarkable improvements in the cultural safety of Aboriginal and Torres Strait Islander people in the Cairns Hospital ED.

Key dates

Jul 2019 - Jun 2020

Partnerships

Queensland Emergency Department Strategic Advisory Panel (QEDSAP); Aboriginal and Torres Strait Islander Health Division; Cairns Hospital

Aim

The TECS initiative aims to capture the key messages of the Cairns ED Cultural Safety Working Group and create a starting place for other EDs to begin their journey of change towards cultural safety.

Outcomes

Creating culturally safe EDs that reduce the barriers to Aboriginal and Torres Strait Islander patients engaging with hospital-based emergency care by:

  • improving staff education
  • creating a more welcoming physical environment
  • effectively utilising existing resources
  • improving engagement with community organisations
  • improving identification of Aboriginal and Torres Strait Islander patients in order to provide culturally and clinically appropriate treatment in ED
  • ensuring Aboriginal and Torres Strait Islander staff members have a culturally safe place to work and taking steps to increase the Aboriginal and Torres Strait Islander ED workforce
  • reducing the number of Aboriginal and Torres Strait Islander patients who “did not wait” for treatment or left ED prior to completion of treatment.

Background

The gap in health outcomes between Aboriginal and Torres Strait Islander and non-Indigenous people is a well-documented priority area for both National and State Governments. Within Queensland Health there are many excellent cultural capability programs that provide a wide range of resources for each Hospital and Health Service (HHS) to improve services. As the front door to the hospital, Emergency Departments (EDs) are central to how a health service is perceived and can ‘set the scene’ for the entire health journey.

Methods

The primary objectives of the Cairns group were achieved by:

  • improved staff cultural capability through education
  • improving the physical environment in the ED, making it more welcoming (e.g. displaying artwork, positive images, flags and the Queensland Health “Statement of Commitment to Reconciliation”).
  • collaborating with other Queensland Health groups on issues specific to Aboriginal and Torres Strait Islander Health.
  • increasing the number of Aboriginal and Torres Strait Islander staff members across various streams, including Indigenous Liaison Officers and introducing Aboriginal Health Workers.
  • collaboration with community agencies such as homeless shelters. And hosting an open day for agencies in the ED to discuss better coordination of care.

The TECS initiative has attempted to capture the key messages of the Cairns CSWG in a resource pack, which creates a starting place for other EDs to begin their journey of change. Utilising these resources effectively requires the establishment of a core group of passionate clinicians The essence of what has been achieved in Cairns is strongly focused on being able to identify and respond to local issues that affect Aboriginal and Torres Strait Islander patients and staff as they occur.

The recommendations developed for TECS include examples of specific actions that a local ED team could choose to undertake, and align with the following three domains.

  • demonstrating Respect based on Increased Understanding
  • building Relationships
  • understanding Reciprocity and Creating Opportunities

The intention is to establish a network of ED specific cultural safety groups under the Queensland Emergency Department Strategic Advisory Panel (QEDSAP) to provide an ongoing avenue through which local members can share ideas and collaborate at a state-wide level.

Discussion

The TECS Initiative Lead is Stefan Kuiper, Staff Specialist Emergency Physician at Cairns Hospital, Cairns and Hinterland HHS.

Developed in Cairns Hospital following an external Cultural Capability Audit, the Cairns ED Cultural Safety Working Group was founded to improve the ED across the domains of Cultural Respect and Recognition, Relationship and Partnership, Communication, and Capacity Building. The core tenets of this working group are the focus of TECS.

A full data analysis is awaiting completion. Pre- and post-implementation data, such as the proportion of patients that discharged against medical advice, emergency length of stay and representation rates to the ED has been halved at Cairns ED since this initiative commenced.

Other evaluations are ongoing and include patient surveys and reviews at morbidity and mortality meetings, specifically evaluating how cultural safety was addressed.

Key contact

PROV-ED Project Team,  Healthcare Improvement Unit

Manager,  PROV-ED Project Team, CEQ

PROV-ED Project – Healthcare Improvement Unit (HIU) – Clinical Excellence Queensland (CEQ)

Email:  PROVED.Project@health.qld.gov.au

Last updated: April 2025

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