Introduction: Aboriginal and Torres Strait Islander peoples should have access to healthcare journeys that are culturally safe, responsive to their needs and of high quality – yet for too many they are complex, challenging and often unsafe.
In response to those risks, the Health Journey Mapping (HJM) project, based at the University of Adelaide, has created a range of tools and resources to improve the quality and cultural safety of Aboriginal and Torres Strait Islander people’s healthcare journeys.
Emerging from the Managing Two Worlds Together project (2008-2015), led by Dr Janet Kelly and funded by the Lowitja Institute, the HJM project was conducted by members of the Adelaide-based Aboriginal Kidney Care Together – Improving Outcomes Now (AKction) project which aims to transform Aboriginal and Torres Strait Islander kidney health and healthcare.
Adelaide University project coordinator Amy Graham, a Kaurna/Narungga woman, and research assistant Alyssa Cormick, a Dutch/Irish/British woman, outline in the article below how HJM and its tools are based on underlying principles of equity, safety, and partnership.
Amy Graham and Alyssa Cormick write:
Imagine you are a healthcare worker in a busy clinic. An Aboriginal patient called Mrs Brown comes to see you, and you recognise that her healthcare needs are not being met. You want to sit down and talk with her to identify what is happening in her health and life, and how you can best support her.
But there are other patients to see, and you are in a rush. What can you do?
We are a part of a team of First Nations and non-Indigenous women from a range of research, education, and healthcare backgrounds who have collaboratively created a set of Health Journey Mapping (HJM) resources for use in healthcare settings.
These tools and resources can be used for all patients to better understand their journeys in the healthcare system, and particularly for patients with specific cultural, communication and healthcare needs. HJM resources allow healthcare workers to gather information about an individual’s health journey in the context of their life.
They justify taking time to have conversations, collect individuals’ truths, and can inform delivery of responsive and appropriate care. See the video below:
What are the current gaps in care?
Many people working within hospitals and health services strive to identify and respond to clinical and cultural safety needs to improve overall quality and coordination of care.
However, this is often difficult in current healthcare systems, which are underpinned by colonial and biomedical concepts and priorities. Current healthcare structures, policies and resources emphasise the needs of the dominant culture, failing to identify biased care, racist and stereotypical assumptions, and recognise and respond to the diverse needs of First Nations peoples.
A health practitioner told us: “We know many healthcare workers are striving to improve the care they deliver, but current systems are failing to meet patient’s complex needs.”
What is holistic health?
First Nations definitions of health are inclusive of social, historical, and political determinants which impact health. These holistic perceptions focus on all aspects of an individual’s life, identifying the interconnected relationships of all factors that affect health and wellbeing.
These full patient experiences are rarely captured in colonial and biomedical systems focusing on presence or absence of disease, disconnecting people from spirit, family, culture, community, and Country. We believe it is essential for healthcare to look at this broader picture of someone’s life, as it enables greater understanding of patients’ lived experiences.
Equitable healthcare
Due to significant inequities that still exist in healthcare, First Nations peoples experience disparities in health outcomes. It is important to move beyond providing the same care for all Australians, to ensuring equitable outcomes as not everyone enters health systems with the same resources, experiences, and health status.
There is subsequently a need to rehumanise the healthcare system, by focusing on individual patient’s needs. This can be achieved by taking time to listen to patients, understanding their stories, and building upon their existing strengths and resources, which we believe the HJM resource does.
What is health journey mapping?
Health journey mapping involves recording stages of a patient’s journey. Our HJM resource applies a culturally appropriate method for this, by mapping a patient’s holistic and biomedical health needs. This provides a structured way to listen to patients’ journeys, identify strengths and gaps in care, and develop the best strategies to improve patient/carer family responsibilities and situations.
Dr Janet Kelly, Project Lead, RN, says: “In health we record single episodes of care rather than a patient’s journey through the health system. It can be quite difficult to record or look for a written record of a patient’s life outside of healthcare. These mapping tools enable both a patient’s biomedical story, life story and priorities to be recorded and responded to.”
A simplified version of a journey map
Returning to the example of Mrs Brown, as you speak to her, you can use the HJM tools to identify that she is an Aboriginal Elder who has been diagnosed with kidney disease requiring her to move off Country to access dialysis and undergo hospital admissions in the city.
Using the tools, you can legitimise having this conversation, record what is happening in her life, identify strengths and gaps in her healthcare, and plan and take actions to support her situation. A simplified map of her journey could look like this.
The tools
During the project we developed three different tools. These can each map journeys like Mrs Brown’s in different ways and for different purposes.
You are not limited to mapping journeys with only one tool. The three tools have different uses, and can complement each other. By mapping an individual’s journey with one tool, you may identify different areas that require focus and the need to use another HJM tool.
HINT: If unsure, try starting with the clinical tool to get a quick snapshot of what is happening and to identify areas of focus or stages that may need to be mapped in greater detail with the other tools.
How to access
These HJM tools are currently available to the Lowitja Institute Members Community via their online Learning and Development Hub. It is free to join and gain access to the three mapping tools, educational resources and worked examples.
Access the tools here.
A truth telling tool
By recording health journeys from individual’s own perspective, their truths can be told. This enables patient’s lived experiences to be recorded and understood and can provide evidence of what is actually happening in their health journeys.
As Amy Graham says:
HJM has been designed with Aboriginal patients, families and their communities in mind, it centres us as the central stream of knowledge about who we are and what we need in our own healthcare, it gives us a voice and it provides health professionals with a tool to record our voices and incorporate what we say within their assessments and diagnosis.”
As part of a sponsored project, Croakey published a series of articles about AKction (see below), which readers can bookmark here.
