Evaluating cultural safety in outreach eye and ear surgical pathways

In Australia, Aboriginal and Torres Strait Islander people are disproportionately affected by sight and hearing-related health conditions, especially those living in rural and remote areas. To address this issue, the Eye and Ear Surgical Support (EESS) program, funded by the Australian Government Department of Health and Aged Care under the Indigenous Australians’ Health Program, aims to reduce instances of avoidable blindness and deafness through expediting access to eye and ear surgery, with services prioritised for people living in rural and remote areas.

CheckUP Australia coordinates the EESS program in Queensland as the jurisdictional fundholder of the Outreach Programs. CheckUP is a not-for-profit organisation committed to a vision of ‘better health for people and communities who need it most’. One crucial element that ensures the success of its EESS program is the provision of culturally safe pathways and practices. Despite the development and deployment of many patient-reported measures (PRM) in Australia’s healthcare systems, there is currently no patient-reported experience measure (PREM) validated for measuring cultural safety from the patient’s perspective in this outpatient surgical cohort.

To fill this gap and provide feedback to both service providers and potential patients, CheckUP has co-designed a PREM with Aboriginal and Torres Strait Islander patients, health workers and advisers, to understand the levels of cultural safety experienced under this model of care.

The PREM contains qualitative and quantitative items that measure three domains describing the key elements of cultural safety for EESS patients: practical and logistical support for the hospital visit; feeling welcome, safe and respected; and good communication and inclusiveness. It also measures satisfaction with the service and elicits patients’ expected outcomes.

The following domains and corresponding items are covered in the CheckUP PREM:

• Hospital visit support: transport; accommodation; physical comfort needs; access to an Indigenous Health Worker.
• Safety and respect: feeling welcome at the hospital; feeling safe; treated with respect; emotional needs met (like having family accompany them).
• Communication and inclusion: treatment explained so the patient understood what was happening; feeling included in decision-making about their health; feeling comfortable discussing their health information with medical staff.
• The future: expected difficulties following post-op care instructions; expected changes to life after surgery; would they recommend surgery to others; best parts of the surgery; what could be done better.

Since November 2021, feedback has been collected from over 120 patients who have undergone 14 eye and ear surgeries to date. Individual surgery visit reports have been compiled, together with localised recommendations for quality improvements. To achieve effective dissemination of this critical patient feedback and enable a collaborative quality improvement loop, continuous relationship building has been underway with key surgical pathway stakeholders, including staff from the Torres and Cape, Cairns and Hinterland, and Central Queensland Hospital and Health Services, as well as surgical and specialist clinical teams, primary health centres and community-controlled health services. Hospital and clinical staff reactions to receiving evaluation reports have so far indicated significant value is found in receiving patients’ cultural safety feedback, with staff indicating intentions to act on recommendations.

Feedback from each group surgery visit has also been compiled in a non-identifying, culturally appropriate infographic format and returned to patient community health clinics for display. These A4 poster-style documents provide affirmations of culturally safe and effective care to potential surgical patients, with the intention of reducing failure-to-attend rates due to anxiety or concern over inappropriate, ineffective or painful treatment.

CheckUP aims for culturally appropriate evaluation processes to be embedded in health service provision. To this end, CheckUP has started identifying and training interested local Aboriginal and Torres Strait Islander health workers and practitioners in the administration of the EESS PREM. In addition, PREMs containing the core domains of cultural safety pathways are in development for other First Nations outreach eye and ear treatment.