Discuss about te Improving the Cultural Responsiveness of Victorian Hospitals.
The evaluation plan deals with the ‘impact’ of the evaluation of the community program regarding ‘Improving the Cultural Responsiveness of Victorian Hospitals’. The evaluation plan involves the Aboriginal health evaluation through the program. Background information is provided regarding the program along with the goals and objectives that are being followed to make the program effective among the Aboriginals. In detail, analysis of the evaluation strategy has been drawn to discuss the purpose of the evaluation plan, along with the rationale of the evaluation, evaluation design, data collection and analysis method, the budget and the period of the program has been discussed.
‘Cultural responsiveness framework for Victorian health services/hospitals’ include several standards based on which cultural responsiveness are adhered to. The Health Service Cultural Diversity Plans (HSCDP) is responsible for framing the cultural responsiveness for Victorian health services (Brock, Charlton and Yeatman 2014). The main reason of formulating such plans was to introduce a range of strategies and policies, which would aid in removing the barrier that patient from culturally as well as linguistically diverse background faces. This led to the framing of the ‘Cultural Responsiveness Framework Implementation Plan’ to remove these barriers and make the patients more accessible towards the health care services (Mercer 2013). HSCDP intended to provide quality care to all by aiding in the promotion of the multicultural community of Victoria. It also intended to employ a workforce, which will be culturally proficient in treating the needs of such patients, adhering strictly to the school of beliefs they belong too. Several policies have been set up in context to the health related problems as faced by the Aboriginals (Pesco 2014), namely,
Koolin Balit: Victorian Government Strategic Directions for Aboriginal Health (2012-2022), Victorian Aboriginal Affairs Framework (2013-2018), Victorian Health Priorities Framework (2012-2022), Aboriginal Health Promotion and Chronic Care Partnership (AHPACC) (2011-2014), Victorian Aboriginal Healthplan (VACKH), National Aboriginal and Torres Strait Islander Workforce Strategic Framework (2011-2015).
Goals Specific To The Program
Objectives To Encompass In The Program
Strategies To Encourage Aboriginals To Join The Program
This program needs to be evaluated because the effectiveness of the program has to be assessed. The lack of education and the communication gap prevents the Aboriginals to be properly diagnosed by the doctors. Most of the times, the natives die due to lack of treatment and this also because of their reluctance in being treated with medicines (Mercer, Byrth and Jordan 2014). The life expectancy has gone down too for the Aboriginals as they develop several diseases, which prove to be life threatening for them for most of the times. The life expectancy of an average Aboriginal man is as low as 11.5 yrs and it is shockingly lower than that, 9.1 yrs for females (Kirmayer 2012). They also run a higher chance of being admitted in the hospital than a regular Australian. They are not very keen on using modern and advanced technology to be diagnosed or get the diseases treated. The neo-natal mortality rates are also very high among them due to the unhygienic delivery and handling of the new born (Komaric, Bedford and van Driel 2012). The program was developed in order to improve cultural responsiveness among the Victorian hospitals towards the Aboriginals so that they would approach the health personnel to receive help.
Cultural responsiveness relates to the idea where the health care services are respectful towards the cultural and language based requirements of the patients who belong to different communities (Nelson et al. 2014). It comprises of strategies that deals with providing care to patients irrespective of their cultural background, where the treatment is more culture oriented and involves lesser technical orientation. To be culturally responsive also requires one to be culturally competent (Durey et al. 2016). Hence, the the staff needs to be trained so that they are culturally competent to deal with patients. Several beliefs and practices are related to a patient’s community/ house of belief. The competence to take action regarding issues related to health care of different communities falls within the primary idea of cultural responsiveness (Walker , Schultz and Sonn 2014). There are six standards, which is a part of the cultural responsiveness’ framework. The first standard deals with the idea of practicing culturally responsive treatment on an entire organizational level. The second standard concerns with demonstration of leadership for cultural responsiveness (Clifford et al. 2015). The third standard states that interpreter is going to be provided to patients who need them. The fourth standard also demonstrates the inclusive pattern of practice in care planning. The fifth standard deals with the regular reviewing of programs as well as services are carried out by the CALD (Culturally and Linguistically Diverse, Australia) (Jongen et al. 2014). The sixth standard outlines the need of developing cultural responsiveness and the staffs are offered with opportunities to improve their professional attitude.
The Cultural responsiveness Framework is based on 4 typical domains, namely,
Domain 1 deals with the effectiveness of the organization. This domain speaks of the importance of considering the effectiveness of the cultural response framework on an all-whole organization movement (Maher, Turnour and Stewart 2012). This means that each branch of health science is initiated to participate in the effort of familiarizing with a culture based responsiveness treatment and care (Durey et al. 2016).
Domain 2 deals with the management of risk. Providing culturally safe treatment to patient forms the backbone of the second domain (Ware 2013). The Aboriginals feel threatened while accessing health care facilities recognized by the mainstream. Effective care and treatment can only be imparted to a patient when a fluency in communication between the caregivers and the patients exist (Browne, Hayes and Gleeson 2014). This aids in making better diagnosis of the ailment of the patient and prompt application of treatment. However, this proves to be problematic due to the communication gap. The appointment of efficient translators can solve this problem.
Domain 3 deals with the participation of the consumers in the plan. The culture responsiveness treatment program is a two way street. The patient requires to be taking an active participation in seeking help from the health care personnel (Chapman, Smith and Martin 2014).
Domain 4 deals with the effectiveness of workforce where, the health care personnel are trained to deal with patients from culturally diverse background (Durey et al. 2012). A trained approach will help the patients from giving away their apprehension from reneging in diagnosis and treatment which are modern and technologically advanced (Holland et al. 2014).
The Aboriginals are known to be affected by several diseases such as the diabetes, renal failure, respiratory diseases, circulatory system based diseases and several other contagious diseases (Kildea et al. 2012). Due to poverty, lack of education, lack of access to health services, and the conservative nature, they die premature death. This can be avoided if the Aboriginals can be persuaded in participating in the program. By hiring the natives and training them accordingly, can help in persuading the other natives to approach the doctors with lesser apprehension (Singer, Bennett-Levy and Rotumah 2015).
The strategies that were chalked as a part of the health program can only prove to be effective if they policies are essentially followed. A dearth of resources leads to the health plan facing a setback. Funds need to be oriented towards departments for allocation of translators to patients (Gwynn et al. 2015). Evaluation of the Aboriginal health program is important in order to assess whether the program is being effective or not in helping the Aboriginals. Based on the evaluation plan, decisions can be made whether or not the program needs to be scraped off or should be continued with (Truong, Paradies and Priest 2014).
The pattern of design that was chosen for the assessment of the evaluation plan was a quasi-experimental design. This experimental model helps in carrying out a study on an empirical basis (Parter and Browne 2012). The model concerns a target population on whom the impact of an intervention is tested. The quasi-experimental model helps in determining the variables in the experiment (Oliver 2013). In the current evaluation plan, quasi-experimental design will be applied to evaluate the program of improving the cultural responsiveness in Victorian hospitals as part of Aboriginal Health Plan. The evaluation plan study will involve nursing staff and doctors at the Victorian hospitals, which are in partnership with the Medical Unit of the Victorian Aboriginal Health Service. The contenders of the study belong to the age group of 20-40 years and they will be 2000 in number. From four pre-selected Victorian hospitals, 500 contenders will be chosen. The Royal Melbourne Hospital, St. Vincent’s Hospital was chosen as intervention group and Royal Jubilee Hospital, Victoria General Hospital was considered as the control or the comparison group. All the participants of the groups will have to undergo a pre- and post- interview sessions. The primary idea of the evaluation plan was to determine whether cultural responsiveness is being practiced effectively or not by the staff at the hospitals towards the Aboriginals.
The randomization of groups was not possible in the current evaluation plan, therefore quasi-experimental design was chosen. Quasi-experimental design was chosen because it is effective in analyzing pre- and post- experimental data (Durey 2013). This particular experimental is also being used as the intervention group is similar to the control group, that is, the participants are all nurses and doctors in both the cases. This uniformity in the groups aids in establishing quality match which is necessary for a good impact evaluation. This particular experimental design treats a program as an intervention in which the elements/strategies of the intervention are being achieved/ followed (Dwyer, Willis and Kelly 2014). Along with that, impact evaluation studies are best analyzed with the help of quasi-experimental design. Both the intervention as well as the control group is involved. In this particular evaluation plan, it is not possible to use individuals in a random fashion in the treatment or the control groups.
The quasi-experimental model as used to study the evaluation plan.
The intervention group consisted of nurses and doctors from the Royal Melbourne Hospital and St. Vincent’s hospital. The control group was represented by Royal Jubilee Hospital and Victoria General Hospital. They will be interviewed based on the questionnaire which will be prepared in simple English. They will be interviewed twice throughout the entire duration of the study, both the control and the intervention group. They will be interviewed prior to the implementation of the Aboriginal Health Plan program. The data collected that will be collected during this time will be kept in order to tally them with the data that will be collected post the implementation of the program. A longitudinal research based survey was carried out to collect the data.
The method that was used to analyze the data is known as the difference- in- differences design (DID). With the help of this particular design, it helps in comparing the changes in the result over a period of time in between the intervention as well as the comparison group in order to evaluate the impact. This method is useful evaluating quantitative impact, however it is usually used in relation with RDD (Regression Discontinuity Design) or PSM (Propensity Score Matching). DID is accompanied by either of the two designs in order to rule out any sort of bias subjects which might exist in the data (Browne et al. 2013). Removal of bias subject is necessary in order to maintain uniformity in the data to be evaluated. The only disadvantage of DID is the use of the assumption known as ‘parallel trend assumption’. This assumption allows the interest indicators present in the intervention as well as the control group to follow the same path.
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Strategies |
Person Concerned |
Dec |
Jan |
Duration Feb |
Mar |
Apr |
May |
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Formulation of the evaluation plan |
Surveyors |
ü |
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Selection of the hospital and the participants |
Surveyors |
ü |
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Conducting survey through questionnaire |
Surveyors |
ü |
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Performing telephonic interview |
Surveyors |
ü |
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Collection of data |
Surveyors |
ü |
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Analysis of data |
Data analysts/ Statistician |
ü |
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Arrange for community based program among the Aboriginals |
Surveyors |
ü |
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Arrange for orientation program for the healthcare staff |
Surveyors |
ü |
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Revision of the plan if necessary |
Surveyors |
ü |
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Items to be covered |
$ (in AUD) |
|
Workforce charges: |
|
|
Surveyors |
60,000 |
|
Data Analysts |
20,000 |
|
Travelling and Lodging |
10,000 |
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Subtotal |
90,000 |
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Miscellanées charges : |
|
|
Printing Questionnaires |
15,000 |
|
Advertisement printing |
35,000 |
|
Telephone call charges |
22,000 |
|
Subtotal |
72,000 |
|
Total |
162,000 |
Conclusion
There is one significant drawback of the evaluation plan, that is, the evaluation of the program was carried out only in a small area in Victoria. The perimeter of the study area has to be increased to determine the real effectiveness of the program. The Aboriginals who lack education and deny to be treated with medicines mete out the biggest setback for the program. If the Aboriginals cannot be persuaded in visiting the hospitals, the idea of providing culturally responsive treatment becomes pointless. The existing program should revise its aspects, where it should be included that creating awareness among the Aboriginals is the first measure that has to be addressed.
References:
Brock, E., Charlton, K.E. and Yeatman, H., 2014. Identification and evaluation of models of antenatal care in Australia–a review of the evidence.Australian and New Zealand Journal of Obstetrics and Gynaecology, 54(4), pp.300-311.
Browne, J., Hayes, R. and Gleeson, D., 2014. Aboriginal health policy: is nutrition the ‘gap’in ‘Closing the Gap’?. Australian and New Zealand journal of public health, 38(4), pp.362-369.
Browne, J., Thorpe, S., Tunny, N., Adams, K. and Palermo, C., 2013. A qualitative evaluation of a mentoring program for Aboriginal health workers and allied health professionals. Australian and New Zealand journal of public health, 37(5), pp.457-462.
Chapman, R., Smith, T. and Martin, C., 2014. Qualitative exploration of the perceived barriers and enablers to Aboriginal and Torres Strait Islander people accessing healthcare through one Victorian Emergency Department.Contemporary nurse, 48(1), pp.48-58.
Clifford, A., McCalman, J., Bainbridge, R. and Tsey, K., 2015. Interventions to improve cultural competency in health care for Indigenous peoples of Australia, New Zealand, Canada and the USA: a systematic review.International Journal for Quality in Health Care, 27(2), pp.89-98.
Durey, A., McEvoy, S., Swift-Otero, V., Taylor, K., Katzenellenbogen, J. and Bessarab, D., 2016. Improving healthcare for Aboriginal Australians through effective engagement between community and health services. BMC Health Services Research, 16(1), p.224.
Durey, A., Thompson, S.C., Wood, M. and Arabena, K., 2013. Future initiatives to improve the health and wellbeing of Aboriginal and Torres Strait Islander peoples. The Medical Journal of Australia, 199(1), pp.22-22.
Durey, A., Wynaden, D., Thompson, S.C., Davidson, P.M., Bessarab, D. and Katzenellenbogen, J.M., 2012. Owning solutions: a collaborative model to improve quality in hospital care for Aboriginal Australians. Nursing inquiry,19(2), pp.144-152.
Dwyer, J., Willis, E. and Kelly, J., 2014. Hospitals caring for rural Aboriginal patients: holding response and denial. Australian Health Review, 38(5), pp.546-551.
Gwynn, J., Lock, M., Turner, N., Dennison, R., Coleman, C., Kelly, B. and Wiggers, J., 2015. Aboriginal and Torres Strait Islander community governance of health research: Turning principles into practice. Australian Journal of Rural Health, 23(4), pp.235-242.
Holland, C., 2014. Close the Gap-progress and priorities report 2014.
Jongen, C., McCalman, J., Bainbridge, R. and Tsey, K., 2014. Aboriginal and Torres Strait Islander maternal and child health and wellbeing: a systematic search of programs and services in Australian primary health care settings.BMC pregnancy and childbirth, 14(1), p.1.
Kildea, S., Stapleton, H., Murphy, R., Low, N.B. and Gibbons, K., 2012. The Murri clinic: a comparative retrospective study of an antenatal clinic developed for Aboriginal and Torres Strait Islander women. BMC pregnancy and childbirth, 12(1), p.1.
Kirmayer, L., 2012. Rethinking cultural competence. Transcultural Psychiatry, 49(2), p.149.
Komaric, N., Bedford, S. and van Driel, M.L., 2012. Two sides of the coin: patient and provider perceptions of health care delivery to patients from culturally and linguistically diverse backgrounds. BMC health services research, 12(1), p.1.
Maher, L., Turnour, C. and Stewart, J., 2012. Reporting of Aboriginal people in health data collections in NSW. New South Wales public health bulletin,23(4), pp.61-62.
Mercer, C., 2013. The Experiences of Aboriginal Health Workers (AHWs) and Health Professionals Working Collaboratively in the Delivery of Health Care to Aboriginal Australians: A Systematic Review. HNE Handover: For Nurses and Midwives, 6(1).
Mercer, C., Byrth, J. and Jordan, Z., 2014. The experiences of Aboriginal health workers and nonâ€ÂAboriginal health professionals working collaboratively in the delivery of health care to Aboriginal Australians: a systematic review. JBI Database of Systematic Reviews and Implementation Reports, 12(3), pp.234-418.
Nelson, J., Ryan, K., Rotumah, D., Bennettâ€ÂLevy, J., Budden, W., Stirling, J., Wilson, S. and Beale, D., 2014. Aboriginal practitioners offer culturally safe and responsive CBT: Response to commentaries. Australian Psychologist, 49(1), pp.22-27.
Oliver, S.J., 2013. The role of traditional medicine practice in primary health care within Aboriginal Australia: a review of the literature. Journal of ethnobiology and ethnomedicine, 9(1), p.1.
Parter, C. and Browne, K., 2012. How can we do things differently in Aboriginal health? The same challenges seen through new eyes. New South Wales public health bulletin, 23(4), pp.45-47.
Pesco, D., 2014. Working With Aboriginal Children and Families: Cultural Responsiveness and Beyond. Canadian Journal of Speech-Language Pathology & Audiology, 38(2).
Singer, J., Bennett-Levy, J. and Rotumah, D., 2015. “You didn’t just consult community, you involved us”: transformation of a ‘top-down’Aboriginal mental health project into a ‘bottom-up’community-driven process. Australasian Psychiatry, 23(6), pp.614-619.
Truong, M., Paradies, Y. and Priest, N., 2014. Interventions to improve cultural competency in healthcare: a systematic review of reviews. BMC health services research, 14(1), p.1.
Walker, R. and Sonn, C., 2010. Working as a culturally competent mental health practitioner. Working together: Aboriginal and Torres Strait Islander health and wellbeing principles and practice, pp.157-180.
Walker, R., Schultz, C. and Sonn, C., 2014. Cultural competence–Transforming policy, services, programs and practice. Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice, pp.195-220.
Ware, V., 2013. Improving the accessibility of health services in urban and regional settings for Indigenous people (Vol. 27). Australian Institute of Health and Welfare.
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