Health care provider and consumer understandings of cultural safety and cultural competency in health care : an Australian study

There is increasing recognition in Australia that racial and ethnic minority groups experience significant disparities in health and health care compared with the average population and that the Australian health care system needs to be more responsive to the health and care needs of these groups. The paper presents the findings of a year long study that explored what providers and recipients of health care know and understand about the nature and implications of providing culturally safe and competent health care to minority racial and ethnic groups in Victoria, Australia. Analysis of the data obtained from interviewing 145 participants recruited from over 17 different organizational sites revealed a paucity of knowledge and understanding of this issue and the need for a new approach to redress the status quo.

Tissue donation and the attitudes of health care professionals

Since the first corneal transplant in 1905, improved surgical techniques and the development of immunosuppressive drugs have led to excellent success rates for organ and tissue transplantation procedures. This Chapter ,"'ill focus on the cadaveric donation of tissue and the attitudes towards it of health professionals, because they are key players in the donation- transplantation process.

The chapter begins with an overview of cadaveric tissue donation, including what can currently be transplanted. It will then present what is known about health professionals' attitudes to and knowledge of tissue donation and the impact that these have on donation rates. Attitudes, their components and their effect upon behaviour are explored using theories arising from social psychology to explain how these influence actual or intended behaviours associated with the discussion of donation wishes with relatives of the potential donor. Since some tissues, such as blood and bone marrow, can only normally be donated during life, these will be excluded since the behaviours associated with blood donation differ significantly from those associated with cadaveric tissue donation.

Using project evaluation to build capacity for integrated health care at local levels

Capacity-building evaluation featuring multidisciplinary cross-agency workshops fostered continuous quality improvement, while focusing on skills required and systemic barriers to health care integration between GPs and a regional hospital.

A cost-based equity weight for use in the economic evaluation of primary health care interventions: case study of the Australian Indigenous population

Background : Efficiency and equity are both important policy objectives in resource allocation. The discipline of health economics has traditionally focused on maximising efficiency, however addressing inequities in health also requires consideration. Methods to incorporate equity within economic evaluation techniques range from qualitative judgements to quantitative outcomes-based equity weights. Yet, due to definitional uncertainties and other inherent limitations, no method has been universally adopted to date. This paper proposes an alternative cost-based equity weight for use in the economic evaluation of interventions delivered from primary health care services.

Methods : Equity is defined in terms of 'access' to health services, with the vertical equity objective to achieve 'equitable access for unequal need'. Using the Australian Indigenous population as an illustrative case study, the magnitude of the equity weight is constructed using the ratio of the costs of providing specific interventions via Indigenous primary health care services compared with the costs of the same interventions delivered via mainstream services. Applying this weight to the costs of subsequent interventions deflates the costs of provision via Indigenous health services, and thus makes comparisons with mainstream more equitable when applied during economic evaluation.

Results : Based on achieving 'equitable access', existing measures of health inequity are suitable for establishing 'need', however the magnitude of health inequity is not necessarily proportional to the magnitude of resources required to redress it. Rather, equitable access may be better measured using appropriate methods of health service delivery for the target group. 'Equity of access' also suggests a focus on the processes of providing equitable health care rather than on outcomes, and therefore supports application of equity weights to the cost side rather than the outcomes side of the economic equation.

Conclusion : Cost-based weights have the potential to provide a pragmatic method of equity weight construction which is both understandable to policy makers and sensitive to the needs of target groups. It could improve the evidence base for resource allocation decisions, and be generalised to other disadvantaged groups who share similar concepts of equity. Development of this decision-making tool represents a potentially important avenue for further health economics research.

An exploration of the notion and nature of the construct of cultural safety and its applicability to the Australian health care context

Cultural safety has been promoted by its New Zealand proponents as an effective process for managing cultural risk in health care and improving the cultural responsiveness of mainstream health services when delivering care to culturally diverse populations. Its effectiveness in this regard has not, however, been comprehensively investigated. A key purpose of this study was to explore and describe what is known and understood about the notion of cultural safety and its possible application to and in Australian health care domains. Findings from the study indicate that the notion of cultural safety is conceptually problematic, poorly understood, and underresearched and, unless substantially revised, cannot be meaningfully applied to the cultural context of Australia.

Investigating people management issues in a third sector health care organisation - an inductive approach

Objective : To explain use of inductive convergent interviewing to generate the perceived critical people management issues, as perceived by staff, as a prelude to longitudinal surveys in a third sector health care organisation.

Design : Convergent interviewing is a qualitative technique that addresses research topics that lack theoretical underpinning and is an inductive, flexible, evolving research approach. The key issues converged after six rounds of interviews as well as a further round to ensure that all of the common people management issues had been generated.

Setting : Studies in employee behaviour in the health care industry exist, but there is little in the way of tested models of predictors of such behaviour in third sector organisations in the Australian health care industry. The context is what differentiates this study covering a range of facilities and positions in hospitals and aged care situations within one third sector health care organisation.

Subjects : The study proposed twenty seven extensive interviews over a range of facilities and positions. Twenty one interviewees participated in the final convergent process.

Conclusions : Critical issues included: workload across occupational groups, internal management support, adequate training, the appropriate skill mix in staff, physical risk in work, satisfaction, as well as other issues. These issues confirm the proposition of sector‑ness in health organisations that are multi‑dimensional rather than uni‑dimensional.

Lesbian parents negotiating the health care system in Australia

Twenty Australian lesbian-parented families were interviewed in multigenerational family groups about the interface between their public and private worlds. Experiences of the health care bureaucracy were difficult, whereas many participants found individual providers to be approachable and caring. Three strategies were used for disclosure of their sexual orientation to health care providers: private, proud, and passive. Influences on the strategy used included family formation, role of the non-birth parent, geographic location, and expected continuity of care. Parents displayed a high degree of thoughtful planning in utilizing their preferred disclosure strategy in order to optimize safety, particularly for their children.