​The Lighthouse hospital project

​The Lighthouse hospital project

Australia is a privileged nation by world standards. Despite this, not everyone is equal when it comes to heart health and Aboriginal and Torres Strait Islander people are the most disadvantaged. The reasons are complex and not only medical in nature. Aboriginal and Torres Strait Islander people have a troubled history with institutions of all kinds, including hospitals.

The Lighthouse Hospital project aims to change this experience by providing both a medically and culturally safe hospital environment. A culturally safe approach to healthcare respects, enhances and empowers the cultural identity and wellbeing of an individual.

This project matters because the facts are sobering. Cardiovascular disease occurs earlier, progresses faster and is associated with greater co-morbidities in Aboriginal and Torres Strait Islander peoples. They are admitted to hospital and suffer premature deaths more frequently compared with non-Indigenous Australians[1].

Major coronary events, such as heart attacks, occur at a rate three times that of the non- Indigenous population. Fatalities because of these events are 1.5 times more likely to occur, making it a leading contributor to the life expectancy gap [2].

Phase 3 (2017-2019)

The Australian Government Department of Health has provided $7.98m to support Phase 3 of the Lighthouse Project (1 January 2017- 30 June 2019). 

Phase 3 aims to reach just over one in every two Indigenous Australians admitted to hospital for a cardiac condition by recruiting 18 hospitals Nationally to implement the quality improvement toolkit.

The goal is to improve the integration of health services and care coordination by strengthening relationships between hospitals, local Aboriginal Community Controlled Organisations and Primary Health Networks.

We will monitor and evaluate the project phase over two and a half years to assess the impact on health outcomes for Aboriginal and Torres Strait Islander peoples. An economic analysis will also be completed to determine the benefits of implementing the toolkit on health outcomes.

Phase 3 will align with the Better Cardiac Care for Aboriginal and Torres Strait Islander peoples program. The Australian Health Ministers Advisory Council has identified this program as a national priority to improve access to guideline-based therapy for acute coronary syndromes within a culturally safe and appropriate environment.

Phase three was launched at Liverpool Hospital on Friday 10th of February with Hon Ken Wyatt AM, MP, in association with Liverpool Hospital; Regional Health Services, Community Leaders the Heart Foundation and AHHA Executives. 

Phase 2 (2013–2016)

Aim – To drive systemic change in acute care hospital settings to improve care for and the experience of Aboriginal and Torres Strait Islander peoples experiencing ACS.

In Phase two, the scope was to improve activities in eight public hospitals across Australia to improve clinical and cultural care for Aboriginal and Torres Strait Islander patients with ACS.

The toolkit

We developed a quality improvement toolkit, ‘Improving health outcomes for Aboriginal and Torres Strait Islander peoples with acute coronary syndrome’, to provide a framework to address health disparities.

The toolkit aimed to:

  • ensure care providers met minimum standards of care, cultural safety
  • identify practices and actions that can and/or should be improved
  • foster engagement
  • improve healthcare services for Aboriginal and Torres Strait Islander peoples with ACS.

The toolkit outlined four areas that were critical in providing holistic care for Aboriginal and Torres Strait Islander peoples and their families as they journeyed through the hospital system and return to their communities.

The four domains were:

  • governance
  • cultural competence
  • workforce
  • care pathways.

The pilot

Eight pilot hospitals participated in testing the toolkit:

  • Bairnsdale Regional Health Service, Victoria
  • Coffs Harbour Health Campus, New South Wales
  • Flinders Medical Centre, South Australia
  • Liverpool Hospital, New South Wales
  • Princess Alexandra Hospital, Queensland
  • Royal Perth Hospital, Western Australia
  • St Vincent’s Hospital, Victoria
  • Tamworth Rural Referral Hospital, New South Wales.

Each hospital developed an action plan that outlined the areas they would address and the quality improvement activities they would undertake during the pilot. The project outcomes were dependent on community engagement, capacity to embed change, project support and the governance structures at each site.

Key Phase 2 achievements

  • Improved relationships with Aboriginal and Torres Strait Islander patients
  • Strengthening relationships with the Aboriginal and Torres Strait Islander community and medical services
  • Creating culturally safe environments for Aboriginal and Torres Strait Islander patients
  • Increased self-identification among Aboriginal and Torres Strait Islander patients
  • Streamlining processes related to culturally appropriate clinical care of Aboriginal and Torres Strait Islander patients
  • Enhanced staff capacity to respond to the needs of Aboriginal and Torres Strait Islander patients

Phase 1 (2012–2013)

Aim – To improve the care of Aboriginal and Torres Strait Islander peoples experiencing acute coronary syndrome (ACS).

We developed this project was developed in response to a 2006 report from the Australian Institute of Health and Welfare (AIHW).

The project first focused on providing culturally safe and positive consumer experiences, which were reviewed by 10 organisations known for providing exemplary care in the treatment of Aboriginal and Torres Strait Islander patients with acute coronary syndromes (ACS).

The project identified key elements that make a difference to ACS care:

  • expanding roles for Aboriginal Liaison Officers, Health Workers, Patient Pathway Officers and equivalent roles
  • better identification of Aboriginal and Torres Strait Islander patients
  • building strong partnerships and communication channels with local Aboriginal and Torres Strait Islander communities and other relevant organisations
  • fostering and supporting clinical champions
  • building capacity for patient-focused care
  • use of technology
  • use of an industry-based quality matrix.

The Lighthouse hospital project is a joint initiative of the Heart Foundation and the Australian Healthcare and Hospitals Association and is funded by the Australian Government Department of Health.

Download the poster

References

  1. Australian Health Ministers Advisory Council (AHMAC). Aboriginal and Torres Strait Islander Health Performance Framework 2012 Report. Canberra: AHMAC, 2012.
  2.  Mathur S, Moon L, Leigh S. Aboriginal and Torres Strait Islander people with coronary heart disease: further perspectives on health status and treatment. Cardovascular disease series no. 25. Canberra: Australian Institute of Health and Welfare, 2006.

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