Good Way Yarning for Better Health: Implementing Clinical Yarning in Western Australia's Midwest - Phase 1

The overall project is a mixed-method implementation study conducted over four phases. The ethics approval and this register is for phase one, a context analysis that includes understanding Aboriginal patients experience of communication (objective 1 – mixed method design using a patient survey and qualitative data collection); developing a system to collate existing health care information known to be associated with patient-practitioner communication (objective 2 – system development and retrospective audit of data from patient health care databases); and investigating barriers and enablers to implementing Clinical Yarning in Midwest (objective 3 – qualitative interviews with health care staff). The overall project has subsequent phases (develop implementation plan (Phase 2), roll out the implementation of Clinical Yarning (Phase 3) and Phase 4, measure change and understand implementation process which will be registered at a later date. Objectives: (Phase 1) 1. To understand Aboriginal patients experiences of communication in the Midwest. This will involve interviewing Aboriginal adult inpatients and outpatients from six Midwest health sites. The sampling frame for inpatients are all Aboriginal patients about to be discharged in a specified one-week period. The sampling frame for outpatients is a computer-generated random sample of all Aboriginal patients discharged within the previous 2 weeks. The overall sample size is 90 patients. The data collection will occur three times across the three-year project. Interviews can last up to 30 minutes. Interviews are to gather base line data of Aboriginal patient experiences prior to further project phases. Interviews will be repeated at 12 months (after Clinical Yarning training with Midwest staff) and at 24 months post initial data collection. 2. Develop a system to collate and analyse existing health care data that is associated with communication. This will involve collecting a range of data associated with patient communication experiences currently collected by local authorities over the past year and disaggregated into 6-month intervals, in order to provide a ‘snapshot’ of Aboriginal patients’ experiences. A search strategy and curated dataset will be developed to extract data from a range of data management systems to provide a baseline and enable ongoing monitoring and will include such things as take own leave (TOL), did not wait (DNW) in the emergency department, abscond or go missing, self-discharge, leave at their own risk (LOR), are away without leave (AWOL) or discharge against medical advice (DAMA). In addition, • Consumer feedback about the health service. • Patient re-admission and re-presentation rate within 30 days for the same health care problem. These data will be described in terms of overall incidence, number of re-admissions/re-presentations for Aboriginal/non-Aboriginal patients per 1000 health service separations, as a whole health region and disaggregated by site and clinical area within the Midwest. A curated dataset and search process will be developed in the initial phases of the project. These data are being collected from Midwest/state health databases, including consumer feedback. 3. To ascertain barriers and enablers to implementing Clinical Yarning training across the Midwest region at the individual, health service, and system-level. This will involve participants from five staff groups (Aboriginal staff, medical, nursing, allied health, managerial staff) working in, or visiting, each of the six sites in the Midwest. The sample size is approximately 20-30 or until thematic saturation has been reached. Purposive sampling using a maximum variation approach will be used to include the groups and sites. Focus groups of up to four participants and/or individual semi-structured interviews either face to face or via digital means. Research team members will conduct the interviews, which will be audio recorded and then transcribed.