Within By understanding the impacts these events had, the

Within
the Physiotherapy setting, there is undeniably cultural bias and interpersonal discrimination
towards First People’s. Having said that, many physiotherapists are unaware
that their communication and/or mannerisms are offensive towards this
population. Another issue is not being aware of the cultural differences of First
Peoples, which leaves the practitioner at a disadvantage to provide healthcare
equality. A study by Gladman & Ryder (2015) found
that clinical academics and clinicians believe Australia’s healthcare model
does not meet the needs of First Peoples. Furthermore, at an institutional
level, most Physiotherapy Courses in Australian Universities lack a First
People’s subject or training. A great way to introduce this cultural safety
training is through Professional Development (PD) Workshops at the
institutional level, such as a hospital. 

 

This plan
involves the development and implementation of face-to-face cultural competency
workshops to be trialled at Toowoomba Base Hospital. This will be in the form
of five videos, after which there will be five 30-minute modules to be
completed weekly. After the five week period the participants will be asked to
write a short 300 word reflective journal using the principles of self-reflexivity
at the end of each fortnight for the next 16 weeks. The journals will discuss
interactions with First People’s as patients and what material from the PD
series they implemented and/or integrated into their practice to aid in the
service of their patients.

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These
videos were chosen as they explore the effects of western colonisation on the
health status of First Peoples and their relationships with health
professionals of the 21st century. By understanding the impacts
these events had, the Physiotherapist should be better equipped to treat with
patients who identify as First Peoples. The 5 videos are (Commonwealth
of Australia, 2014):

1.                 
The White Australia Policy

2.                 
Protection & Segregation

3.                 
Assimilation & Integration

4.                 
Self-determination & Self-management

5.                 
Indigenous Advancement Strategy

The
modules were specifically designed to provide Physiotherapists with ideas and
strategies of how to become more culturally capable when interacting with First
Peoples patients. The 5 modules are (Commonwealth of Australia, 2014):

1.                 
Respect

2.                 
Safety and Quality

3.                 
Reflection

4.                 
Communication

5.                 
Advocacy

During the 16 weeks, each patient that
identifies as a First People and has been treated by one of the participating
Physiotherapists at Toowoomba Base Hospital will be invited via phone call to
attend a group discussion at the end of the 20 weeks. Here patients can openly
discuss their experiences and if it differed from other physiotherapists or healthcare
professionals that did not participate. Furthermore, First People review patients
attendance rates will be compared with attendance records from 20 weeks prior
the PD workshop series.

Complications
between First Peoples and Physiotherapy practitioners have commonly occurred due
to the clinician failing to demonstrate or lack the skills of cultural safety. 
Being culturally
safe from a Physiotherapy perspective means allowing the patient’s
pre-existing cultural beliefs and desires to guide treatment options. This
requires the Physiotherapist to understand each patient’s cultural origins. In
addition, the practitioner themselves must know what cultural differences
they bring to the table and what potential subconscious power imbalances may evolve
from this (Taylor, Guerin 2010). First Peoples have faced racial discrimination
from healthcare professionals for decades which has resulted in First People’s
describing Western healthcare as alienating and foreign (Farrelly &
Lumpy, 2009). These negative psychosocial constructs have inherently lead to
ongoing poor relationships with healthcare professionals (Ziersch, Gallaher, Baum
& Bentley, 2011). It has been described that a ‘basic
trust’ is required to create positive and lasting relationships with
healthcare professionals and this can only begin with effective communication
(McMahon, 2007).
 
Ultimately,
to resolve the inequalities First Peoples face it has been widely contended
that healthcare professionals become more culturally sensitive and capable
(Zambas & Wright, 2016; Taylor
& Guerin, 2014). An example of this is in Fredricks
(2008) publication, which recalls a research project in Rockhampton that
interviewed First peoples women about cross-cultural training of health
professionals. One individual concluded that cultural capability training can
reduce the inequalities First peoples face, but requires a genuine individual
to make a change in their own practice (Fredricks, 2008). Fortunately, Physiotherapists
have daily opportunities to develop these skills compared with the general
public and it is in their best interest to reduce the anxiety they have
towards healthcare (Beach et al., 2005). This then
provides a safe clinical environment for First Peoples which should then
positively affect First People’s communities (Farrelly & Lumpy, 2009).
 
The
modules aim to improve the interactions between Physiotherapists and First
People’s patients through more diverse and safe communication styles and
patient centred outcomes. Ultimately, it will provide Physiotherapists with
the necessary knowledge and tools to become more culturally competent
practitioners and to create this ‘basic trust’. Applying these new techniques
should also help change current predispositions First Peoples have towards the
healthcare system, which in turn should assist in reducing the inequality and
inequity. Furthermore, the practitioner can use these principles within their
individual practice to provide a more multiculturally safe health service for
all.
 
As
previously mentioned, true cultural safety is being able to integrate the
patient’s experiences into the patient-clinician interaction (Taylor and Guerin, 2014). Ultimately, the onus is on the individual
physiotherapist to be proactive in their own practice to bring about change
to the inequality and inequity First People’s face in Australian healthcare.

The
two overarching objectives of this action plan are:

1. Improve the cultural competency of
Physiotherapists by increasing inter-cultural communication skills.

 2. Develop and nurture trustful and respectful
relationships with Australian Physiotherapists.

Specific
– Increase
physiotherapy cultural safety practice to improve First People’s relationships
and satisfaction with Toowoomba Hospital Physiotherapists.

Measurable
– Verbal
account of patient experiences at the group discussion level at the end of the 16-week
period. Aiming for positive experiences to compare with current literature of First
People’s experiences of Australian healthcare. Secondly, First Peoples review
patient attendance rates will be compared to 20 weeks prior the action plan
implementation and looking for a statistically significant difference (p<0.05). Achievable – Evidence within the literature describes First People's relationships and satisfaction with Australian healthcare is improved with cultural safety training (Kirmayer, 2013; Gerlach, 2012). Relevant – Literature suggests cultural safety training should be mandatory for all healthcare professionals as it is proven to have positive effects on health outcomes for First Peoples. Evidence of this is that First Peoples report feeling more comfortable in healthcare settings where cultural safety is practiced (Durey & Thompson, 2012). Timely – Allowing 12 months to achieve the culturally safe practice of Physiotherapists at Toowoomba Base Hospital Outpatients Department Improved First People's satisfaction with Physiotherapy sessions. The ability to develop stronger and lasting relationships between Physiotherapists and First Peoples.   It will also strive to promote a culturally inclusive healthcare environment for First People's communities. Lastly this action plan hopes to increase the awareness of the benefits of culturally safe practice and how it complements the evidence-based practice of Physiotherapists.  This action plan has two criteria to be considered successful. Firstly, patient accounts of satisfaction in their treatment by participating Physiotherapists. Secondly, a statistically significant increase in First People's review patient attendance rates when compared to 20 weeks prior action plan implementation. -                      Creation of the five videos about the impact of western colonisation on the health status of  First Peoples, in addition with the development of the five modules about becoming culturally competent practitioners, will be based upon the Aboriginal and Torres Strait Islander Health Curriculum Framework (Commonwealth of Australia 2014). These are to be created by course conveners of the First Peoples Health and Practice Course for Physiotherapy students at Griffith University. -                      As these course conveners are not staff of Toowoomba Base Hospital, it would be appropriate to pay these individuals for their services. Therefore, funding will be required to reach these needs. -                      Workshops and group discussion time after 20 weeks of practice will be held within the Physiotherapy outpatient's department, therefore no extra space is required. -                      Workshops will be run during normal Physiotherapy PD in-service times therefore no work time will be hindered. The Toowoomba Hospital IT department need to collate and analyse the First Peoples review patient attendance records during the 20 weeks of intervention and the 20 weeks prior the intervention. This action plan would likely improve patient adherence which would positively affect key performance indicators, although not specifically aimed at this.   This Physiotherapy PD series will not be made compulsory for the Outpatient Physiotherapists at Toowoomba Hospital. However, the benefit for participation is that this workshop series is accredited towards the Physiotherapists Professional Development hours which must be met yearly.   If the success criteria is met this action plan can be used as a foundation to build future cultural competency training programs directed at other health practices or facilities within Australia. This action plan would also compliment pre-existing Governmental cultural capability interventions such as the 'inclusion and diversity strategy 2015-2020'. This strategy strongly aligns with this action plan with the aim to create a workforce and workplace that accommodates for the diverse community we live in (Queensland Government, 2015). Consultation with key individuals, communities and organisations should be done prior to the commencement of this action plan: 1.                  The course convenors of First Peoples Health & Practice of Griffith University to make sure they are willing to create the video and module content for the PD workshops. These people are ideal as they are currently the leaders for providing cultural safety training for Physiotherapy Students at Griffith University. 2.                  Head of Physiotherapy and Allied health at Toowoomba Base Hospital. These individuals will be the clinical leaders for this action plan. This is also to confirm that the workshop series will be running as a substitute for the normal mandatory PD at the Outpatients department within the same time slot. 3.                  Esteemed Elders of Toowoomba's First People's community. This is to gain approval to undergo the action plan and to make clear its purpose. These Elders will also be the mediators between any First People's patient and clinician issues during the action plan, should they arise.   The literature asserts that introducing culturally respectful programs delivers promising results in reducing the disparities of First People's healthcare. The question left unanswered is one of long-term benefits to cultural safety training (Durey, 2010). Because of this, repeat measures should be taken again 6 months after the implementation of this action plan to see if First People's satisfaction with Physiotherapists is sustained.  Head of Physiotherapy and Allied Health at Toowoomba Base Hospital: These individuals are to oversee the entire action plan. It will be their responsibility to schedule the times for the workshop series to be held and to organise patient record access for the IT department. They will also be liaising between the team coordinator, team members and participants to keep within the timeframes as well as handling any business matters. Senior Physiotherapist at Toowoomba Base Hospital Outpatients Department: The main role as Team Coordinator is to keep the action plan as per schedule. This includes keeping participants accountable for attending the PD workshops and completing the fortnightly reflection journals. This individual is also responsible for assisting the Team members running the PD workshops and to answer specific Physiotherapy related questions. -               IT department: To collate and analyse the First Peoples patients review session attendance rates -               Griffith University First Peoples Health and Practice Course Convenors: To develop the videos and modules to be used in the PD workshops. It will also be their responsibility to run the PD workshops and discussing all relevant content and answering questions that the participating Physiotherapists may have -               Human resources department: -               Toowoomba First People's Elders: Their role is to make sure all the content to be put forth is appropriate and relevant to cultural safety training. An Elder will also be present at the group discussion to assist in clarification of misinformation. Elders are also to mediate between the clinician and First People's patients, should there be any complications arise during the action plan. The Clinical Leaders and Team Coordinator will review the action plan progress. Some important dates are as follows:   -               30/04/2018: Present the action plan to the physiotherapists at Toowoomba Base Hospital Outpatients Department to begin recruitment. This is to assess the amount of interest and if it is feasible to continue. -               02/05/2018: First day of the PD workshops. To discuss how the participants responded to the workshops and if any changes should be made. -               06/06/2018: Final day of the PD workshops. To conclude the sessions and answer any questions the participants have about the next 20 weeks. Here is also the time to reflect on any modifications for next time. -               30/03/2019: Final clinician reflection journal entry due. Identifying if there are any missing entries from the participants and if there were any patient-clinician complications over the last two and a half months. -               03/04/2019: Post group discussion to discuss patient responses and how the session could be modified or improved -               13/05/2019: Post action plan review of results with Clinical leaders, Team Coordinator and Team members. This is to assess if the action plan had a positive impact on First People's relationships with Physiotherapists and overall satisfaction. This is also the time to discuss any necessary changes for future endeavours.