#1829_WSLHD_Multicultural Health Plan_2B_WEB

Multicultural Health Western Sydney Local Health District

Multicultural Health Plan 2022-2025

Acknowledgement Western Sydney Local Health District acknowledges the first people of the land. The overarching Aboriginal nation in Western Sydney is the Darug nation. We pay our respect to Elders past, present and emerging. We acknowledge the importance of land, water, spirit, kinship and culture, and the importance that these elements have to the health, wellbeing and future of the Aboriginal and Torres Strait Islander community. We also acknowledge the diversity and richness of cultures within western Sydney and work to ensure that all communities have equitable access to health care.

Contents

Executive Summary

4 6 7 7 8 9 9

Why a District Multicultural Health Plan

Our Vision

Overarching Principles

Snapshot of Cultural and Linguistic Diversity in WSLHD

Priority Populations

Governance, Implementation and Monitoring

Development of the WSLHD Multicultural Health Plan Policy Context - Links to Key Plans and Policies

10 10 11 11 11 12 12 13 13 14 14 15

Strategic Priorities

NSW Government – Premier’s Priorities

NSW Plan for Healthy CALD Communities 2019-2023 Strategic Priorities

NSW Health COVID-19 Vaccinations Vulnerable Populations Strategy September 2021 Strategic Priority

NSW Refugee Health Plan 2020-2025 (draft) Goals and Strategic Priorities

WSLHD Implementation Plan 2022-2025

NSW Government Premier’s Priorities / Diversity Inclusion Belonging Guide – NSW Health

NSW Plan for Healthy CALD Communities 2019-2023

Strategic Priority 1 Strategic Priority 2 Strategic Priority 3 Strategic Priority 4 Strategic Priority 5 Strategic Priority 6 Strategic Priority 7 Strategic Priority 8 Strategic Priority 9 Strategic Priority 10 Strategic Priority 11 Strategic Priority 12

16 18 19 20 20 22 23 23 24 25 26 27 27 28 29 30

NSW Health COVID-19 Vaccinations Vulnerable Populations Strategy Priorities - September 2021

NSW Refugee Health Plan 2020-2025 (draft) Goals and Strategic Priorities

Goal 1 Goal 2 Goal 3

List of acronyms

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WSLHD Multicultural Health Plan 2022-2025

Executive Summary

The Western Sydney Local Health District (WSLHD) Multicultural Health Plan (the Plan) identifies systemic changes and actions required to improve District’s capacity to recognise and address the health needs, language and culture of culturally and linguistically diverse (CALD) consumers and communities. The Plan was developed to ensure WSLHD can provide exceptional care and services with no barriers, where CALD patients, carers, families and communities are well informed and supported to achieve best possible experiences pertaining to their healthcare. The Plan lists local-level strategies and actions to implement the NSW Health Plan for Healthy Culturally and Linguistically Diverse Communities 2019-2023 and NSW Refugee Health Plan 2020-25 (draft). Strategies, actions and improvements are the result of feedback and ideas shared by health professionals from different clinical and non-clinical networks. They were then developed into the Plan by members of the WSLHD Multicultural Health Committee.

The main recommendations required to ensure WSLHD is well placed to support and meet the needs of culturally and linguistically diverse patients and populations focus on: Improved safety and cultural responsiveness of care and services • Introducing mandatory cultural responsiveness and working with health care interpreter trainings for all WSLHD staff, so they can appropriately recognise and address needs of CALD patients, carers and consumers • Having mechanisms, skills and commitment to engage and support participation of all CALD patients and consumers in providing feedback on and evaluate services and care they need and receive • Having mechanisms imbedded within our system to measure provision of health care interpreter service at the key clinical points of interactions • Having capacity of the system to provide health care interpreters to all patients when and where required by staff and consumers to ensure equity and clinical safety standards.

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WSLHD Multicultural Health Plan 2022-2025

Improved communication and health literacy • Building our workforce capacity to effectively communicate with CALD patients and consumers through new and existing educational opportunities • Having strategies, tools and skills to develop decision- making capacity of CALD patients and their ability to actively engage in their care and management of their health. Improved engagement, participation and partnerships • Having strategies and commitment to engage and support participation of CALD patients, consumers and communities in strategic and service planning, developing care and service models, projects and quality improvement initiatives • Ensuring CALD patients, consumers and communities are included in projects and research by mechanisms to ensure their participation • Expanding partnerships with key multicultural, refugee health and community partners to guide, support and enhance the work of WSLHD services and programs.

Improved data collection on identities, needs and experiences

• Ensuring accuracy of data collected in eMR on country of birth, language spoken and need for interpreters • Understanding of priority health needs and issues impacting access to health services and health outcomes for CALD patients, consumers and communities including refugee and small and emerging communities. Identified initiatives align with the District and NSW Health plans and policies and comprise a mix of actions that are already underway and new initiatives for clinical and non-clinical services. They are based on the principles of quality and safety, access and equity, person centred care, engagement and empowerment, community development and collaboration, and evidence based practice. Governance, implementation and monitoring The WSLHD Multicultural Health Committee is responsible for overseeing the overall implementation of the Plan and monitoring progress achieved against the identified priorities and actions. The Plan also identifies specific internal clinical and non-clinical departments and services responsible for leading and supporting the implementation of identified improvements, and annual reporting on their progress to the WSLHD Multicultural Health Committee.

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WSLHD Multicultural Health Plan 2022-2025

Why a District Multicultural Health Plan

Western Sydney Local Health District is one of the most culturally diverse local health districts in NSW. A Multicultural Health Plan is needed to ensure that people living in western Sydney who are from culturally and linguistically diverse (CALD) backgrounds have equitable access to health care services that are culturally responsive, safe and high quality. This Plan enables Western Sydney Local Health District (WSLHD) to meet its obligations under the NSW Plan for Healthy Culturally and Linguistically Diverse Communities 2019–2023 and NSW Refugee Health Plan (draft).

It aims to ensure that there are strategies in place to understand the needs, experiences and identities of the CALD communities in western Sydney. Intended outcomes include: • improved access and quality of care for people from CALD communities, • improvements in health literacy enabling active engagement in decisions about their health and well-being, and • ensuring individual needs, language and culture are respected and responded to appropriately by our staff and organisation.

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WSLHD Multicultural Health Plan 2022-2025

Our Vision We endeavour to partner with members of culturally and linguistically diverse communities to plan, deliver and evaluate equitable, accessible, safe, culturally responsive and high quality services and care. Our vision is to provide exceptional care and services with no barriers, so culturally and linguistically patients, carers, families and communities are well informed and supported to achieve best possible experience and health.

Overarching Principles

Engagement and empowerment • Consumers and the community are included in decisions about their care and health services that affect them • Consumers and the community are engaged or invited into activities directed at improving services and care • Consumers and community are supported by effective communication in their preferred language and through a range of communication mediums (i.e. verbal, written and multimedia). Community development and collaboration • Feedback is sought from consumers and the broader community and they are engaged in developing solutions including co-design where appropriate and relevant • Working in partnership and collaboration with our communities. Evidence based practice • Programs and services are evidence based and/or supported by best practice in working with migrants and refugees • Understanding health and health literacy needs of CALD communities including emerging groups and challenges that impact on their physical, psychological and emotional health outcomes • A commitment to testing and implementing research/ quality improvement innovations and interventions to determine what works well with diverse populations and communities • A commitment to evaluating, publishing and translating our research and improvement work into practices.

Access and Equity • Access to quality health services that recognise and respect people’s linguistic and cultural background • Access to appropriate health information which is easy to understand • Timely access to public health services including mental health and oral health for vulnerable populations • Access to targeted health promotion and health education to support people to successfully navigate the Australian healthcare system and achieve optimal health • Equitable access to public healthcare and support for vulnerable groups • Equitable access and support to navigate the healthcare system and support system. Person centred care • Health policies, programs and services are respectful • Programs and clinical responses are responsive to individual health needs including: cultural, social, emotional and spiritual • Staff capacity is built and supported ensuring patients receive easy to understand information and effective communications about care and treatment options so they can participate in shared decision making about their treatment. and sensitive to socio-cultural contexts • Patient individual experience is valued

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WSLHD Multicultural Health Plan 2022-2025

Snapshot of Cultural and Linguistic Diversity in WSLHD

Refugee communities Between 2010 and 2020 11,864 refugee and

WSLHD is one of the most culturally and linguistically diverse regions in NSW. According to the Australian Bureau of Statistics 2021 Census:

humanitarian entrants settled in WSLHD. Most of refugees came from Afghanistan, Syria, Iraq, Iran and Sri Lanka and small numbers from the Democratic Republic of Congo and Myanmar. The ethnicity and language include Hazara (Afghan), Dari (Afghan), Syrian including Arabic speakers and Yazidis speaking Kurmanji, Iraqi including Chaldean (Arabic speaking), Iranian, Tamil, Kurdish, Armenian, Assyrian, Tajik and Pashtun (Afghan). The majority (approximately 85%) of refugees who settled in WSLHD in the last 10 years had poor or no English proficiency. 4 Refugees also came from other countries including Pakistan, China, Egypt, Bhutan, Sudan, Ethiopia, Somalia, Sierra Leone, Nepal and Tibet. Asylum seekers WSLHD has also a large population of asylum seekers which was estimated to be around 23,000. 5 Depending on their visa, asylum seekers may have limited access to Medicare, work permits and income support. Main asylum seeking groups are Arabic speakers from Syria, Iraq, Saudi Arabia, Darfur (Sudan), Lebanon; Dari, Hazaraghi, Pashtu, Persian speakers from Afghanistan, Pakistan and Iran; Tamil from Sri Lanka; and Mandarin speakers from China 6 , and since 2022 Ukrainian arrivals.

54.3% of residents spoke a language other than English at home

49.9% of residents were born in a non-English speaking country

Top twenty languages other than English spoken at home were: Mandarin, Arabic, Hindi, Cantonese, Punjabi, Tagalog/Filipino, Korean, Tamil, Urdu, Nepali, Gujarati, Telugu, Persian, Turkish, Bengali, Spanish, Vietnamese, Malayalam, Dari, Hazaraghi, and Sinhalese. 1 Top twenty non-English speaking countries of birth in WSLHD were: India, China, Philippines, Korea, Nepal, Lebanon, Sri Lanka, Pakistan, Fiji, Afghanistan, Iran, Hong Kong, Vietnam, Malaysia, Turkey, Bangladesh, Iraq, Indonesia, Egypt and Italy. 2 Other significant CALD populations in WSLHD are communities from Pacific Islands and Africa including Samoan, Tongan and Sudanese and South Sudanese communities. Proficiency in English varied among migrant and refugee populations. Communities with the largest number of people who identified as speaking English not well or not at all were Mandarin, Cantonese, Arabic, Korean, Turki sh, Punjabi, Persian, Tamil, Vietnamese, Hindi, Hazaraghi, Dari, Urdu and Gujarati speaking. 3

1 ABS TableBuilder, 2016 and 2021 Census, ABS data used with permission from the Australian Bureau of Statistics (https://www.abs.gov.au/), Epidemiology and Health Analytics, WSLHD. 2 ABS TableBuilder, 2016 and 2021 Census, ABS data used with permission from the Australian Bureau of Statistics (https://www.abs.gov.au/), Epidemiology and Health Analytics, WSLHD. 3 2021 Census, WSLHD speaks English not well or not at all by Language, Epidemiology and Health Analytics, WSLHDNovember 2022 4 Humanitarian Settlement ProgramDate of Arrival between 01/01/2010 and 31/12/2020, Settlement Database, Australian Government Department of Social Services 5 Refugee Council of Australia (estimates developed based on Bridging Visa and Permanent Protection Visa holders) 6 Draft NSWRefugee Health Plan 2020-25, MoH

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WSLHD Multicultural Health Plan 2022-2025

Priority populations Migrants, refugees and asylum seekers living in the community: with low English proficiency who are newly arrived from countries with different healthcare systems and cultural structures and who speak languages other than English

with low health literacy and/or low levels of literacy in their own language who may be socially isolated with comorbidities.

Governance, Implementation and Monitoring WSLHD Multicultural Health Committee oversees the implementation, monitoring and reporting on the WSLHD Multicultural Health Plan. The Committee facilitates the achievement of a whole-of-organisation multicultural health strategy and implementation plan and oversees the implementation of key health policies and plans that relate to CALD and refugee communities ensuring the District achieves its obligations under relevant state strategic priorities, policies, plans and legislation. The Plan will be monitored regularly to track progress achieved against the identified key priorities. Evidence on implemented changes will be reported annually to the Ministry of Health under the NSWMulticultural Policies and Services Program (MPSP) reporting program to demonstrate improvements achieved by the District towards outcomes of the NSWMulticultural Health and Refugee Health plans.

With the focus on: women and families children & young people men older people and people with disability LGBTQI (Lesbian, Gay, Bisexual, Transgender, Queer & Intersex).

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WSLHD Multicultural Health Plan 2022-2025

Development of the WSLHD Multicultural Health Plan

Policy Context - Links to Key Plans and Policies

In 2019, a District Multicultural Health Committee was established with the approval of the Chief Executive. Subsequently, the Committee undertook a self- assessment process to map existing activities and identify gaps against the then draft NSW Plan for Healthy Culturally and Linguistically Diverse Communities 2019 – 2023. The gaps section in the Plan refers to identified gaps from this self- assessment process which has been used to develop the priorities for Western Sydney Local Health District in this Plan. The Plan addresses strategic priorities from key NSW Health and NSW Government documents.

• PD2019_018 NSW Plan for Healthy CALD Communities 2019 -2023 NSW Plan for Healthy Culturally and Linguistically Diverse Communities 2019-2023 • NSW Refugee Health Plan 2020 – 2025 (draft) and NSW Refugee Health Plan 2022 - 2027 https://www.health.nsw.gov.au/multicultural/Pages/ refugee-health-policy.aspx • PD2020_039 Medicare Ineligible Asylum Seekers – Provision of Specified Public Health Services Medicare Ineligible Asylum Seekers - Provision of Specified Public Health Services • PD2017_044 Interpreters - Standard Procedures for Working with Health Care Interpreters • WSLHD Health Services Plan to 2026 • NSW Health Diversity Inclusion and Belonging Guide– NSW Health, https://www.health.nsw.gov.au/workforce/dib/pages/default.aspx • NSW Health Elevating the Human Experience – Our guide to action for patient, family, carer and caregiver experiences • NSW Health COVID-19 Vaccinations Vulnerable Populations Strategy September 2021

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WSLHD Multicultural Health Plan 2022-2025

Strategic Priorities NSW Government – Premier’s Priorities World-class public service – Drive public sector diversity by 2025 by having 50% of senior leadership roles held by women. 7 NSW Plan for Healthy CALD Communities 2019-2023 Strategic Priorities

OUTCOME 1: NSW Health has strategies in place to improve access and quality of care for all people from culturally and linguistically diverse backgrounds, particularly people with vulnerabilities Strategic Priority 1: WSLHD routinely considers the health needs of CALD consumers, their carers and families in the development and review of strategic plans, clinical and non-clinical service plans and relevant policies. Strategic Priority 2: WSLHD has systems and processes in place to support assessment, care planning, care delivery and transfer of care that meet the cultural and linguistic needs of consumers. Strategic Priority 3: WSLHD uses clinical record systems to track and monitor professional interpreter need and use. OUTCOME 2: NSW Health supports people from culturally and linguistically diverse backgrounds to build their health literacy so they can be actively involved in decisions about their health Strategic Priority 4: Our organisation routinely involves CALD consumers, their carers and families when developing, implementing and evaluating programs, projects and resources Strategic Priority 5: WSLHD communicates effectively with consumers of CALD backgrounds using a range of appropriate formats, media and communication channels Strategic Priority 6: Our organisation seeks to ensure that consumers, their carers and families can access professional healthcare interpreters when required and that infrastructure is in place to support the efficient provision of services.

OUTCOME 3: NSW Health is responsive to people’s individual needs, language and culture Strategic Priority 7: WSLHD leaders promote and improve cultural responsiveness. Strategic Priority 8: WSLHD assesses the cultural responsiveness of its staff and addresses gaps. We embed cultural responsiveness into our wider training activities and our approach to providing services. Strategic Priority 9: WSLHD provides services and has designated positions to work with and respond to the needs of priority CALD communities, including people from refugee backgrounds. OUTCOME 4: NSW Health understands the needs, experiences and identities of culturally and linguistically diverse communities in NSW Strategic Priority 10: WSLHD collects accurate language, country of birth and need for interpreter data in our clinical record systems Strategic Priority 11: WSLHD and its services can access clinical, population health, public health, and demographic data on CALD consumers to: • Develop understanding of consumer service access and use, and patient journeys • Identify priority health issues and groups of consumers who are at higher risk of poorer health outcomes • Respond to the needs of these consumers, including small and emerging groups Strategic Priority 12: WSLHD initiates or encourages research projects to understand evidence gaps for CALD consumers and communities.

7 In 2020, all LHDs were required to report in theMPSP on how the District supports women fromdiverse backgrounds in leadership roles

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WSLHD Multicultural Health Plan 2022-2025

NSW Health COVID-19 Vaccinations Vulnerable Populations Strategy September 2021 Strategic Priority: WSLHD implements and supports a range of initiatives to ensure the CALD communities are assisted and included in the response to the COIVD 19 pandemic. NSW Refugee Health Plan 2020-2025 (draft) Goals and Strategic Priorities Goal 1: People have timely access to culturally responsive and trauma – informed care Strategic Priority 1: NSW Health delivers culturally responsive and trauma-informed care that responds to the diversity that exists among refugee populations. Strategic Priority 2: NSW Health employs and trains a culturally responsive and resilient workforce. Strategic Priority 3: NSW Health supports people to understand and navigate the health system and be active participants in their own care. Strategic Priority 4: NSW Health provides timely and effective interpreting and language services. Strategic Priority 5: NSW Health involves people in planning, providing/developing and evaluating health services. Goal 3: NSW Health responds flexibly and collaboratively to meet new and emerging healthcare needs Strategic Priority 6: NSW Health provides equitable access to public healthcare for people from refugee backgrounds Strategic Priority 7: NSW Health maintains effective relationships with relevant agencies and partners. Goal 2: People are at the centre of their own care

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WSLHD Multicultural Health Plan 2022-2025

WSLHD Implementation Plan 2022-2025

NSW Government Premier’s Priorities / Diversity Inclusion Belonging Guide – NSW Health

Priority

Main gaps

What will we do

Major lead, stakeholder and partners People and Culture, Workforce Planning, Human Resources, Organisational Development and Learning (OD&L)

Analyse WSLHD workforce data to identify a number/proportion of CALD women in leadership roles and set an achievable target to reflect the diverse communities of the District

Multicultural Policy and Services Program (MPSP) reporting 2018/2020 WSLHD was unable to report on: • the number of women leaders from CALD backgrounds • the leadership training expenditure • planned pathways for CALD women Reason: Data not captured and reported

By 2025 50% of senior leadership roles is held by women Statement of commitment: NSW Health welcomes people from diverse backgrounds. We are committed to having a workforce that reflects the communities we serve

People and Culture, Workforce Planning, Human Resources, OD&L

Analyse WSLHD workforce data to identify a number/proportion of CALD women employed at all levels of the organisation including in clinical, non- clinical and supportive roles and main employment pathways for CALD women Implement actions identified through WSLHD Culture Strategy: Diversity & Inclusion including: “Provide opportunities for the career advancement of women and promotion of recruitment and selection training compliance by senior medical practitioners with the flow on to improved recruitment practices involving applicants from CALD / minority communities, and Develop a cultural competency framework.”

People and Culture, Diversity & Inclusion Sponsor/Director Allied Health

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WSLHD Multicultural Health Plan 2022-2025

NSW Plan for Healthy CALD Communities 2019-2023 Strategic Priorities

Strategic Priority 1:

WSLHD routinely considers the health needs of CALD consumers, their carers and families in the development and review of strategic plans, clinical and non-clinical service plans and relevant policies CALD.

Strategy

Main gaps

What will we do

Major lead, stakeholder and partners

Health Services Planning and Development (HSP&D), MCHS, Consumer Council

1.1.1 Ensure WSLHD Health Services Plan and any strategic or service plans are developed in consultation with CALD consumers, their carers and families and reflect their identified health needs and priorities. 1.1.2 Actively engage CALD communities early in the health service planning process to ensure that their health needs are addressed and to assist in developing appropriate actions

No evidence of routine engagement of CALD consumers/patients/carers in service/quality/ safety improvements, planning, and review/development of service/care models by most of the individual services

1.1 Include CALD consumers, their carers and families in policy development, strategic planning, clinical and non- clinical service planning processes 1.2 Collect evidence of improvements and change made based on consultations and feedback from CALD consumers, their carers and families

EDs / GMs, Quality & Accreditation Managers, HSP&D, MCHS, Consumer Council

EDs / GMs, Patient and Carer Experience, Standard 2 Committees

1.2.1 Implement a process to support the engagement of CALD consumers at a service level enabling them to provide feedback on their experience with and outcomes of care

Limited input received mostly from the most represented language groups. Input from more vulnerable or more specific ethnic groups is required No evidence of improvements based on feedback from CALD consumers Individual services identified the need to improve feedback from CALD but don’t have mechanisms to do it

1.2.2 Implement My Experience Matters surveys

EDs / GMs, Patient and Carer Experience, Standard 2 Committees

Patient and Carer Experience Translation Service (TS)

1.2.3 Ensure My Experience Matters surveys are available in relevant community languages to allow non-English speaking (NES) consumers to provide feedback

EDs / GMs, Patient and Carer Experience

1.2.4 Analyse the collected feedback data, report on identified issues, discuss and implement improvements as appropriate

EDs / GMs, Leading Better Value Care, ACI

1.2.5 Implement the PROM and PREM surveys in different languages to routinely collect, measure and assess feedback provided by CALD/NES consumers to inform and improve practices 1.2.6 Develop the capacity of staff to effectively engage and communicate with CALD patients and consumers in providing feedback associated with care, treatment and experience 1.2.7 Engage with Multicultural Health Services and external multicultural health providers to obtain feedback from the CALD community and consumers, especially on their access to and experience with health 1.2.8 Engage with CALD consumers, both internal and external to the organisation, to involve them in the consultation processes, research and improvement projects

Patient and Carer Experience, EDs / GMs, Health Literacy Hub (HLH)

EDs / GMs, MCHS, external multicultural health providers

EDs / GMs, MCHS, Consumer Council, HLH

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WSLHD Multicultural Health Plan 2022-2025

Strategic Priority 2:

WSLHD has systems and processes in place to support assessment, care planning, care delivery and transfer of care that meet the cultural and linguistic needs of consumers.

Strategy

Main gaps

What will we do

Major lead, stakeholder and partners

EDs / GMs, MCHS

2.1.1 Ensure CALD consumers/service users from a range of cultural groups, including vulnerable groups, are included in the development of new service models and models of care 2.1.2 Develop a culture of service delivery that is respectful of and tailored to the cultural and health needs of CALD consumers, including vulnerable groups 2.1.3 Collaborate with key stakeholders including primary health care providers, universities and multicultural health services, both statewide and local, to develop strategies to address the identified priority needs of CALD consumers, including vulnerable groups 2.1.4 Improve health literacy of CALD consumers, including vulnerable groups through the use of a range of initiatives which are evidence based and developed in collaboration with CALD consumers 2.1.5 Develop effective working relationships and partnerships with WSLHD Multicultural Health Services to support WSLHD services in the development of strategies that are responsive to the cultural and health needs of WSLHD CALD consumers and communities 2.1.6 Assess the need for establishing Westmead Dermatology Department Genital Dermatology Clinic and Pigmentation Disease Clinic 2.1.7 Partner with relevant stakeholders including CALD consumers to review Maternity Liaison Officer and Bilingual Health Worker service models and develop a new model to meet the current needs and demands 2.1.8 In consultation with relevant stakeholders, review NSW Education Program on (Female Genital Mutilation/Cutting) FGM/C community education and clinical response service models and develop new models to meet the current needs and demands 2.1.9 In consultation with relevant stakeholders review Transcultural Mental Health Centre (TMHC) referral pathways to improve Primary Care and community access to TMHC allowing them to refer identified at-risk CALD clients, including refugees 2.1.10 Develop specific Model of Care for clients who seek services from TMHC and are not attached to a NSW Health mental health services

Dermatology Department Westmead – need for establishing Genital Dermatology Clinic and Pigmentation Disease Clinic Maternity services access to antenatal classes and support of patients across acute services – Maternity Liaison Officers (MLOs) Referral to Transcultural Mental Health Centre (TMHC) –bilingual/bicultural clinicians/counsellors by non-MH services including GPs, community organisations

2.1 Develop models of care and other relevant strategies to meet the needs of CALD

EDs / GMs, MCHS, OD&L

WSLHDMCH Committee, MCHS, WSPHN, TAFEs, Universities, Statewide multicultural health services EDs / GMs, HLH/USYD Lab, MCHS, Population Health, Western Sydney Diabetes

EDs / GMs, MCHS, HLH/ USYD Lab

Westmead Dermatology Department

Multicultural Health Services, Women’s and Children’s Health Services BMDH & Westmead, Auburn Hospital

Multicultural Health Services, NSW Education

Program on FGM/C Strategic Response Committee, MoH

Transcultural Mental Health Centre (TMHC), WSPHN, WSLHD Mental Health Services

TMHC, WSPHN, WSLHD Mental Health Services

2.1.11 Identify funding source to support increase in referrals

TMHC, WSPHN, WSLHD Mental Health Services

TMHC, WSPHN, WSLHD Mental Health Services

2.1.12 Expand pool of TMHC sessional bilingual/ bicultural clinicians (and train and provide clinical supervision) to meet demand resulting from new referral pathways

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WSLHD Multicultural Health Plan 2022-2025

Strategic Priority 3:

WSLHD uses clinical record systems to track and monitor professional interpreter need and use.

Strategy

Main gaps

What will we do

Major lead, stakeholder and partners HCIS, WSLHD MCH Committee, OD&L

3.1.1 Develop a training module about HCIS by HCIS and recommend it as mandatory for frontline clinical and non-clinical staff 3.1.2 Support HCIS to advocate with the MoH to implement mandatory HETI module about Health Care Interpreter Services, including the awareness of Policy Directive, for all clinicians across NSW Health 3.1.3 Promote the PD2017_044 to clinicians, specifically their obligation to book a professional interpreter, document interpreter’s presence in eMR, or reasons for not engaging interpreters 3.1.4 Develop, implement and monitor a process to ensure HCI attendance if required. This will also include recording in eMR reasons for not providing a HCI as per Interpreter Policy 3.1.5 Develop and implement a 6 monthly audit to monitor and collect data on interpreter provision to patients identified as requiring interpreters 3.1.6 Report audit results to District Health Care Quality Committee and Standard 2 Committees and work on improving the use of interpreters based on identified issues and trends 3.1.7 Improve ims+ reporting on incidents related to engagement of and access to interpreters and communication issues related to CALD patients and work on improvements 3.2.1 Continue the ongoing implementation of video interpreting across WSLHD as the best alternative to face to face while enabling faster access to interpreters 3.2.2 Implement a more sophisticated booking system that will enable users to request interpreters online 3.2.3 In consultation with clinical services review and improve block booking and utilisation of interpreters’ time 3.2.4 Continue monitoring needs for interpreters in new emerging, rare and high demand languages and ensure access is improved 3.2.5 Improve access to face to face or video interpreting for clinical settings where telephone interpreting is not suitable

Interpreter attendance not routinely recorded in eMR Issues with interpreter access are not routinely reported as incidents through IMS+ Reasons for not providing interpreters are not recorded

3.1 Have strategies in place to ensure implementation of the NSW Health policy directives Standard Procedures for Working with Health Care Interpreters and monitor compliance that professional interpreters have been used as required by the policy

HCIS, EDs / GMs

HCIS, EDs / GMs

HCIS, EDs / GMs

HCIS, EDs / GMs

HCIS, EDs / GMs, Standard 2 Committees

EDs / GMs, HCIS, Clinical Governance

HCIS, EDs / GMs

Difficult access to face to face interpreters Difficulties in booking interpreters – waiting time on the phone to book Not enough time allocated for appointments Better access to face to face or video interpreters – telephone interpreters result in delays in procedures

3.2 Have strategies in place to address unmet demand for professional interpreter

HCIS, EDs / GMs

HCIS, EDs / GMs

HCIS

HCIS, EDs / GMs

Strategic Priority 3 continued over...

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WSLHD Multicultural Health Plan 2022-2025

...continued Strategic Priority 3

Strategy

Main gaps

What will we do

Major lead, stakeholder and partners

Clinical Governance, EDs / GMs, HCIS, Quality & Accreditation – Clinical Quality Systems Officer

No regular audits in place No system in place to run a report

3.3.1 Develop a process and implement a regular audit schedule to review consent for surgery/ procedures for clients/patients that are identified as needing language assistance to ensure they provided informed consent with the assistance of HCI 3.3.2 Analyse the audit data and develop strategies to improve the result to achieve 100% compliance by 2025 3.4.1 Develop and implement a method to systematically collect feedback from patients/ consumers and services on their experience with WSLHD HCIS to identify trends and needs and work on improvements 3.4.2 Report on collected feedback, planned improvements and explore opportunities for QIDS/QI projects

3.3 Conduct regular audits of consent for surgery/ procedures to ensure that professional interpreters are engaged in accordance with NSWHealth policy, aiming for 100% compliance 3.4 Collect and analyse HCIS data: occasions of service, unmet requests and cancellations to identify trends

EDs / GMs, HCIS, Risk Management, Clinical Governance

HCIS, Patient and Carer Experience

Need for patient and experience / satisfaction measure in relation to HCIS – identified as part of Standard 2

HCIS, WSLHD MCH Committee, District Health Care Quality Committee

and needs for improvements

HCIS, WSLHD MCH Committee

3.4.3 Review the outcomes and recommendations of the current MoH led review of HCIS and develop an implementation plan

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WSLHD Multicultural Health Plan 2022-2025

Strategic Priority 4:

Our organisation routinely involves CALD consumers, their carers and families when developing, implementing and evaluating programs, projects and resources.

Strategy

Main gaps

What will we do

Major lead, stakeholder and partners

Refer to 1.2.1, 1.2.2, 1.2.3, 1.2.4, 1.2.5, 1.2.6

No formal way for patients to feedback on their experience No routine involvement of CALD patients in My Experience Matter No KPIs for involving CALD, including NES patients in My Experience Matters or PRM surveys

4.1 Involve CALD consumers, their carers and families to improve safety, quality and service delivery

EDs / GMs, MCHS, OD&L

4.1.1 Identify a minimum benchmark for WSLHD and CALD patient/consumers involvement in MEM and aim to improve CALD participation each year 4.1.2 Implement processes to ensure routine engagement of CALD service users in consultations to improve CALD patients’ safety and experience

WSLHDMCH Committee, MCHS, WSPHN, TAFEs, Universities, Statewide multicultural health services EDs / GMs, HLH/USYD Lab, MCHS, Population Health, Western Sydney Diabetes

4.1.3 Regularly seek and respond to feedback from CALD consumers to improve their experience across the continuum of care

EDs / GMs, MCHS, HLH/ USYD Lab

4.1.4 Analyse My Experience Matters data to understand CALD experience across different facilities and services, and partner with CALD consumers to work on improvements 4.1.5 Partner with MCHS to support and enable consultations with CALD communities and consumers as appropriate in innovative approaches that are tailored to our culturally diverse communities 4.2.1 Support and encourage partnerships with statewide multicultural health services including NSW Refugee Health Service, NSW Education Program on FGM/C, Transcultural Mental Health Centre 4.2.2 Promote engagement of MCHS in a wide range of WSLHD consultations to provide advice and assistance 4.2.3 Routinely seek MCHS advice and expertise to ensure the District meets its obligations and commitments towards NSQHSS and relevant health and multicultural policies

Westmead Dermatology Department

WSLHDMCH Committee, MCHS, TMHC, Statewide multicultural health services

4.2 Maintain formal links with statewide and District multicultural health services to access advice and expertise

WSLHDMCH Committee, MCHS

District Executive, Standard 2 Committees, MCHS

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WSLHD Multicultural Health Plan 2022-2025

Strategic Priority 5:

WSLHD communicates effectively with consumers of CALD backgrounds using a range of appropriate formats, media and communication channels.

Strategy

Main gaps

What will we do

Major lead, stakeholder and partners

EDs / GMs, MCHS, Translation Service (TS), HLH

5.1.1 Ensure CALD patients, consumers and communities have access to easy to understand information to support their health needs and ability to be involved in decisions about their care 5.1.2 Explore the potential for the establishment of a seeding grants program to support WSLHD services in developing essential multilingual materials and develop appropriate processes to support the program (guidelines on the use of funding and application process) 5.1.3 Ensure guidelines, systems and processes are developed, implemented and evaluated to support staff in developing in language patient communication materials 5.1.4 Develop, implement and evaluate a process to ensure CALD consumers/service users’ feedback is sought on patient communication materials, including translated information prior to their implementation 5.1.5 Develop easy to access and understand patient/consumer rights and responsibilities information in English and in the top 15 WSLHD languages in written and video/audio formats

Dermatology Department Westmead – need for establishing Genital Dermatology Clinic and Pigmentation Disease Clinic Maternity services access to antenatal classes and support of patients across acute services – Maternity Liaison Officers (MLOs) Referral to Transcultural Mental Health Centre (TMHC) –bilingual/bicultural clinicians/counsellors by non-MH services including GPs, community organisations

5.1 Develop information resources in

formats that meet the needs of CALD consumers and are accessible

MCHS, TS, WSLHD MCH Committee

Translation Service, HLH

EDs / GMs, MCHS, TS

Patient and Carer Experience, Office of the Chief Executive, MCHS, TS, HLH EDs / GMs, WSLHD Multicultural Health Committee, HCIS Organisational Development &Learning, MCHS, Patient and Carer Experience, HLH Organisational Development &Learning, MCHS, Patient and Carer Experience, HLH

5.2.1 Increase Telehealth capabilities and escalate the need for acquisition of up-to-date equipment

Video interpreting not widely used and available There is no cultural sensitivity training routinely provided Knowledge of cultural sensitivity towards the end of life matters Lack of clear directions regarding the use of bilingual staff (clinical and non-clinical) in direct service delivery

5.2 Develop strategies to improve

communication between health staff and CALD consumers, their carers and families

5.2.2 Identify opportunities to incorporate intercultural communication and health literacy training into available training modules both face to face and online 5.2.3 Develop training modules for non-clinical and clinical staff to build their capacity to effectively communicate with CALD patients and consumers and implement through identified platforms and evaluate

Refer to 3.1.1

WSLHDMCH Committee, People & Culture, MCHS, HCIS

5.2.4 Develop a clear WSLHD position /policy on the use of bilingual staff (both clinical and non-clinical) in direct service delivery

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Strategic Priority 6: Our organisation seeks to ensure that consumers, their carers and families can access professional healthcare interpreters when required and that infrastructure is in place to support the efficient provision of services.

Strategy

Main gaps

What will we do

Major lead, stakeholder and partners

Refer to 3.2.1, 3.2.3, 3.2.4, 3.2.5

Interpreters leave after 30 min to another appointment / not enough time to discuss complex cases Difficulties in booking interpreters in some languages No evidence on Working with health care interpreters Policy (2017) implementation and limited awareness among staff Lack of training on working with HCIS

6.1 Improve access to and efficiency of interpreter service provision using appropriate infrastructure including video interpreting 6.2 Implement the NSWHealth policy: Interpreters- Standard Procedures for Working with

HCIS, WSLHD Policies and Procedures

6.2.1 Develop and implement plan and monitor the implementation of NSW Health Policy Directive PD2017_044: Interpreters-Standard Procedures for Working with Health Care Interpreters

Refer to 3.1.1, 5.2.5, 5.2.6

Health Care Interpreters

Strategic Priority 7:

WSLHD leaders promote and improve cultural responsiveness.

Strategy

Main gaps

What will we do

Major lead, stakeholder and partners

WSLHDMCH Committee, People and Culture, Diversity & Inclusion Sponsor, Organisational Development & Learning, EDs / GMs People and Culture, Diversity & Inclusion Sponsor Director Allied Health, WSLHD MCH Committee WSLHDMulticultural Health Committee, OD&L, MCHS

7.1.1 Improve the cultural responsiveness of departments, services and staff by identifying cultural responsiveness as a priority focus area and developing targets to measure and monitor improvements

WSLHD does not currently have strategic or operational plans to address cultural competence and responsiveness

7.1 Cultural responsiveness is championed by senior leaders

7.1.2 Develop a cultural competency framework as identified in WSLHD Cultural Framework / Diversity and Inclusion strategy

7.1.3 Recommend two HETI online training modules Working in Culturally Diverse Contexts or its equivalent (Course Code: 39962639) and Meeting the Health Needs of Refugees (CC: 116308950), as mandatory for WSLHD staff

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WSLHD Multicultural Health Plan 2022-2025

Strategic Priority 8:

WSLHD assesses the cultural responsiveness of its staff and addresses gaps. We embed cultural responsiveness into our wider training activities and our approach to providing services.

Strategy

Main gaps

What will we do

Major lead, stakeholder and partners

Refer to 3.1.1, 5.2.2, 5.2.3, 7.1.3, 7.1.4

Lack of training to improve skills in cultural competency / responsiveness – this training was identified by all participating EDs / GMs as a gap No systematic training on the use of HCIS and working with interpreters Cultural competency must be added as part of mandatory training (online/ face to face) for staff awareness Knowledge of cultural sensitivity towards the end of life matters Staff not aware of existing training modules on culturally responsive care

8.1 Develop and implement strategies to build the cultural responsiveness of staff

Organisational Development & Learning

8.1.2 Explore opportunities to establish a new training position within Organisational Development and Training team to support development and delivery of CALD competency training across the organisation 8.1.3 Partner with MCHS on projects and initiatives to improve mainstream services cultural responsiveness and knowledge about best practice with CALD consumers

EDs / GMs, Population Health, MCHS

Refer to 3.1.1, 7.1.3

8.2 Increase in the proportion of staff participating in My Health Learning modules relating to culturally responsive care and working with interpreters 8.3 Develop and implement local surveys to measure CALD consumers experience of care/ service 8.4 Aim to achieve a high proportion of Good/Very Good overall rating of care in the Bureau of Health Information, Admitted Adult Patient Survey (respondents who speak a language other than English at home)

Organisational Development & Learning Training, WSLHD MCH Committee

8.2.1 Monitor participation in culturally responsive care training modules and report annually to WSLHD MCH Committee to identify trends and needs for improvement

Refer to 1.2.2, 1.2.3, 1.2.4, 1.2.5, 4.1.8, 4.1.9

Surveys to measure CALD consumer experience have not been widely implemented

Clinical Governance, WSLHD MCH Committee, EDs / GMs EDs / GMs, WSLHD MCH Committee, Clinical Governance

8.4.1 Monitor outcomes and review results of Admitted Adult Patient Survey, Bureau of Health Information 8.4.2 Develop strategies to improve results related to effective communication and provision of interpreters when required

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Strategic Priority 9:

WSLHD provides services and has designated positions to work with and respond to the needs of priority CALD communities, including people from refugee backgrounds.

Strategy

Main gaps

What will we do

Major lead, stakeholder and partners

No designated workforce and training position in OD&L team to focus on and respond to training needs and build CALD cultural competency and responsiveness across the District Westmead Hospital Dermatology Dept – need for Genital Dermatology Clinic and Pigmentation Disease Clinic Use of bilingual staff in direct service delivery – lack of consistency and guidelines

9.1 Ensure WSLHD has designated positions and initiatives and services to work with and respond to the needs of priority CALD communities including people

WSLHDMulticultural Health Committee, EDs / GMs, MCH, HCIS, Epidemiology

9.1.1 Continue to support and maintain WSLHD Multicultural Health and HCIS with designated positions to work with and respond to the healthcare needs of people from migrant and refugee backgrounds 9.1.2 Monitor and assess CALD population growth and health needs and allocate resources adequately to identified demands and needs 9.1.3 Identify, review and update priority health needs and issues for CALD communities, including smaller and emerging communities and subgroups and develop programs and strategies to support identified priority health needs

WSLHDMulticultural Health Committee, EDs / GMs, MCHS, HCIS, Epidemiology WSLHDMCH Committee, EDs / GMs, MCHS, HCIS, Population Health, Epidemiology

from refugee backgrounds

Refer to 8.1.6, 2.1.6, 5.2.5

Strategic Priority 10:

Our organisation collects accurate language, country of birth and need for interpreter data in our clinical record systems.

Strategy

Main gaps

What will we do

Major lead, stakeholder and partners

Unable to assess the accuracy of data collected. No formal process in place to check or review. Booking interpreters for first appointments – no language identified when referral made by a GP or specialist

10.1 Improve accuracy of country of birth, preferred language and interpreter required data collection

Clinical Analytics and Performance Unit, Digital Health Solution, Epidemiology, EDs / GMs, MCHS, HCIS

10.1.1 Review existing data collection systems and identify ways they can be improved to support the accuracy of the data collection and data transition between systems to improve efficiency and accuracy 10.1.2 Include the need for accurate data on COB, preferred language and interpreter required in training modules for all staff involved in entering patient data into eMR and other relevant data systems

Digital Health Solution, EDs / GMs, HCIS, Corporate Services

10.1.3 Work with WS PHN to improve information on interpreter required in GP referral processes

Multicultural Health Services, WSPHN, HCIS, NSW RHS

10.1.4 Ensure the process is reflected in health pathways to prompt GPs

Health Pathways, MCHS. WSPHN Services

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