St Vincent’s Hospital Melbourne has implemented a policy to enhance care for First Nations patients in its emergency department (ED). The policy, which took effect in April 2022, was developed in consultation with the Aboriginal community. It included working in partnership with the Victorian Aboriginal Community Controlled Health Organisation (VACCHO). This initiative comes as the hospital’s ED sees a notably higher percentage of First Nations patients compared to other emergency departments in the city.
Dr. Jonty Karro, the director of the emergency department, emphasized the urgency of addressing the healthcare needs of vulnerable populations. The overarching policy goal is to address these systemic biases that have historically and disproportionately harmed these patients. Despite the progress made, criticism has arisen regarding the policy, particularly from some medical professionals who have voiced their concerns.
Policy Background and Implementation
The emergency department at St Vincent’s Hospital Melbourne has long been aware of the disparities faced by First Nations patients. Before the policy was implemented, there was clear evidence that Indigenous patients received longer time to treatment. By comparison, their non-Indigenous peers were seen in a timelier manner. Dr. Karro noted that “Our First Nations patients were waiting two to three times as long for care in certain triage categories.”
The hospital recognized that elderly trauma patients, similar to First Nations individuals, frequently presented with conditions that were often “underappreciated” by triage nurses. In reply, the hospital redefined these patients as urgent patients, getting them higher priority to quickly available care.
“We’ve eliminated the gap between our First Nations and non-First Nations patients in terms of their waiting time to be seen by a clinician.” – Dr Jonty Karro
The ultimate goal of this policy is to improve the quality of care patients receive. It’s working to foster a sense of cultural safety inside the hospital. So St Vincent’s Hospital Melbourne is shifting the focus onto what these patients need. Through intentional focus and practices, they hope to address these underlying biases that have led to inequitable healthcare outcomes.
Achievements and Recognition
St Vincent’s Hospital Melbourne had recently received international acclaim for its exemplary efforts. The hospital’s policy was declared a finalist in the Victorian Public Healthcare Awards for Excellence in Aboriginal Health and Wellbeing. This public recognition highlights the healthcare facility’s dedication to inclusivity and their efforts to bridge the gap between First Nations people and accessible healthcare.
As a spokesperson for the Victorian state government told TCT, emergency departments are legally required to triage patients based on need and provide the highest priority care first. As EDs have had to adapt, “Emergency departments will always need to see the sickest patients first,” they said, reiterating the imperative of protecting equity in care.
Dr. Glenn Harrison underscored the ethical weight of these triage decisions that will be made under this new policy. He added that this strategy improves continuity of care for Indigenous patients. After launch, this hospital announced that Indigenous and non-Indigenous ED wait times are now equal—with both averaging 68 minutes.
Addressing Criticism and Ongoing Challenges
Even with all of this progress, plenty of criticism arose about the policy. Some health-care providers have protested this act of simple fairness, claiming it creates an unfair preference for First Nations patients. Civil society organizations, including AIDA, ACEM and RACP, were appalled by these perspectives, calling them “opportunistic” and “uninformed.”
“Recent divisive and racist comments opposing this policy, particularly from doctors in positions of authority, are opportunistic, uninformed and deeply concerning.” – AIDA, ACEM, and the RACP
The blowback against the policy and its rollout have led to serious doubts over whether it will accomplish what its backers hope. Some critics, including the Physicians of the 1st Nations, argue that this initiative will fail to resolve root systemic problems faced by First Nations patients. Dr. Karro supplemented these concerns with hope and resolve, encouraging the audience to push forward in improving the healthcare experience for Indigenous people.
“That doesn’t happen anymore … but there are still genuine reasons to be worried about the experience that you will have as an Aboriginal person when you’re going to a hospital.” – Abe Ropitini
Even Ricky ‘Dougie’ Hampson’s father expressed these sentiments, revealing a fear and lack of trust among Aboriginal communities to visit the hospital at all. “We are scared to go to hospitals. Our fear is real,” he said, emphasizing the need for ongoing improvement in cultural safety within healthcare settings.
Future Directions
Going forward, St Vincent’s Hospital Melbourne’s intention is to build on this work and keep developing how it delivers best care for First Nations’ patients. Dr. Karro noted that progress has been made, but more progress still needs to come. He stated, “They do disengage from that service from lack of care and equity within the system.”
Health issues
Like Danielle McMullen pointed out, barriers like language and stigma might make the access barriers that First Nations people face even worse. She emphasized that gaining trust and offering culturally safe environments is the key to reaching patients better.
“Access to healthcare is a 50-metre race and Aboriginal and Torres Strait Islander people are starting 100 metres behind the start line.” – No specific source mentioned
