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Re: Shawny’s concerns about Victorian and Australian Governments

Reply #120 –
Let's hear from St Vincents:

"Hi everyone, Many of you will be aware of media coverage over the last few days related to our Emergency Department (ED) and our efforts to deliver fairer health outcomes for First Nations patients. I wanted to share a brief message with you to explain what we’re doing and why. Across almost every indicator, First Nations Australians experience worse health outcomes than non-Indigenous Australians. Research conducted in St Vincent’s Melbourne’s ED showed First Nations patients were three times more likely to leave without being seen than non-Indigenous patients. First Nations patients were also waiting, on average, three times longer compared to non-Indigenous patients. But our research also showed that First Nations patients were more likely to remain engaged with their care if seen within their first hour in the ED. We’ve been working to address this issue for many years, but in April 2024, we took a new approach and implemented what’s known as a Minimum Category Three Triage policy. The idea is straightforward: in an ED, patients assigned as being ‘Category Three’ receive medical assessment and start their treatment within 30 minutes of arrival. Under our policy, we now assign a minimum Category 3 to all First Nations patients so that they begin their treatment promptly and to minimise the risk of disengagement and poorer health outcomes.

The results have been outstanding. Since introduction, we have successfully closed the gap in ED wait times between First Nations and non-Indigenous patients. While there is still much work to do, that is something to celebrate. Let me be very clear about what this approach does not do… It has not affected overall wait times in the ED. Analysis of our approach – which concerns only a small number of First Nations patients in the ED each day – shows it has had no impact on overall ED flow. Patients presenting with a serious or life-threatening emergency – regardless of their background – will always be seen first. That's what ED triage is designed to do. We can do both. We’ve arranged our resources and processes so that the small number of First Nations patients in our ED don’t have their care delayed for longer than 30 minutes, while also making sure that the most urgent cases are still seen as a priority. We've closed the gap between two groups without negatively affecting either. This is what good healthcare looks like. The St Vincent’s mission has always been about helping people who face barriers to accessing quality healthcare. That’s who we are. It’s what defines us. And it’s core to this approach. I’m proud of what we’ve been able to achieve. I’m proud of our Aboriginal Health Liaison Team, our Emergency Department team, and all our staff who continue to show leadership through initiatives like this. While there has been much said over the past few days, please know that we will continue to advocate for what is right and for evidence-based healthcare. And if you’ve found the last few days upsetting, please approach your manager, colleagues, or our EAP service should you need assistance.

Kind regards, Nicole"

Evidence-based healthcare that has closed the gap between two groups without negatively affecting either?  That's got to be grounds for racist outrage!

"Negative waves are not helpful. Try saying something righteous and hopeful instead." Oddball

Re: Shawny’s concerns about Victorian and Australian Governments

Reply #121 –
Quote from: DJC – on
Let's hear from St Vincents:

"Hi everyone, Many of you will be aware of media coverage over the last few days related to our Emergency Department (ED) and our efforts to deliver fairer health outcomes for First Nations patients. I wanted to share a brief message with you to explain what we’re doing and why. Across almost every indicator, First Nations Australians experience worse health outcomes than non-Indigenous Australians. Research conducted in St Vincent’s Melbourne’s ED showed First Nations patients were three times more likely to leave without being seen than non-Indigenous patients. First Nations patients were also waiting, on average, three times longer compared to non-Indigenous patients. But our research also showed that First Nations patients were more likely to remain engaged with their care if seen within their first hour in the ED. We’ve been working to address this issue for many years, but in April 2024, we took a new approach and implemented what’s known as a Minimum Category Three Triage policy. The idea is straightforward: in an ED, patients assigned as being ‘Category Three’ receive medical assessment and start their treatment within 30 minutes of arrival. Under our policy, we now assign a minimum Category 3 to all First Nations patients so that they begin their treatment promptly and to minimise the risk of disengagement and poorer health outcomes.

The results have been outstanding. Since introduction, we have successfully closed the gap in ED wait times between First Nations and non-Indigenous patients. While there is still much work to do, that is something to celebrate. Let me be very clear about what this approach does not do… It has not affected overall wait times in the ED. Analysis of our approach – which concerns only a small number of First Nations patients in the ED each day – shows it has had no impact on overall ED flow. Patients presenting with a serious or life-threatening emergency – regardless of their background – will always be seen first. That's what ED triage is designed to do. We can do both. We’ve arranged our resources and processes so that the small number of First Nations patients in our ED don’t have their care delayed for longer than 30 minutes, while also making sure that the most urgent cases are still seen as a priority. We've closed the gap between two groups without negatively affecting either. This is what good healthcare looks like. The St Vincent’s mission has always been about helping people who face barriers to accessing quality healthcare. That’s who we are. It’s what defines us. And it’s core to this approach. I’m proud of what we’ve been able to achieve. I’m proud of our Aboriginal Health Liaison Team, our Emergency Department team, and all our staff who continue to show leadership through initiatives like this. While there has been much said over the past few days, please know that we will continue to advocate for what is right and for evidence-based healthcare. And if you’ve found the last few days upsetting, please approach your manager, colleagues, or our EAP service should you need assistance.

Kind regards, Nicole"

Evidence-based healthcare that has closed the gap between two groups without negatively affecting either?  That's got to be grounds for racist outrage!



I’m triggered… 🙄
Let’s go BIG !

Re: Shawny’s concerns about Victorian and Australian Governments

Reply #122 –
I should say that Nicole’s response is overdue.  The weasel word responses from the Victorian Government have fanned the flames and they should have been on the front foot as soon as the Murdoch media sought to foment outrage.
"Negative waves are not helpful. Try saying something righteous and hopeful instead." Oddball

Re: Shawny’s concerns about Victorian and Australian Governments

Reply #123 –
Quote from: northernblue – on
Quote from: Thryleon – on
this is not affirmative action.

If i walk in to this ED and an indigenous bloke walkS in, both with category 4 classification, EXACT SAME ISSUE, he goes first because he's indigenous even though I was triaged before him.  He gets upgraded to category 3.

Effectively they're fast tracked based on race.  Seems fair....

Mate, they die younger, they live sicker lives.
Come up and visit me and you’ll see that 40-70% of the NT mob are wrapped in filthy bandages despite the medical professions best efforts.
We are not discussing intelligent well educated and articulate people like say Ernie Dingo here, we are discussing the downtrodden.
If you and he presented simultaneously you would both recieve the same treatment as (relatively) young fit healthy men, of this I have no doubt.
Certainly so here in the Territory.

st Vincent's is not solely in the NT.

So are we saying they dont want to wait like the rest of us are forced to?

"everything you know is wrong"

Paul Hewson

Re: Shawny’s concerns about Victorian and Australian Governments

Reply #124 –
Quote from: Thryleon – on
Quote from: northernblue – on


Mate, they die younger, they live sicker lives.
Come up and visit me and you’ll see that 40-70% of the NT mob are wrapped in filthy bandages despite the medical professions best efforts.
We are not discussing intelligent well educated and articulate people like say Ernie Dingo here, we are discussing the downtrodden.
If you and he presented simultaneously you would both recieve the same treatment as (relatively) young fit healthy men, of this I have no doubt.
Certainly so here in the Territory.

st Vincent's is not solely in the NT.

So are we saying they dont want to wait like the rest of us are forced to?

Did you miss “First Nations patients were also waiting, on average, three times longer compared to non-Indigenous patients.”?
"Negative waves are not helpful. Try saying something righteous and hopeful instead." Oddball

Re: Shawny’s concerns about Victorian and Australian Governments

Reply #125 –
Quote from: DJC – on
Quote from: Thryleon – on
st Vincent's is not solely in the NT.

So are we saying they dont want to wait like the rest of us are forced to?

Did you miss “First Nations patients were also waiting, on average, three times longer compared to non-Indigenous patients.”?
I didnt miss this claim.  In fact there is no way to substantiate that and its precisely what someone defending this move would say irrespective of whether or not its fair.

Thing is, why is that the case?  Why are they waiting longer?  Is it because the data is skewed by hospitals in areas where there is more indigenous people being treated than not? 

More questions than answers out of the claim.  So by doing this in metro hospitals they treat the minority as priority to paper over not enough health care institutions in remote communities where the majority of indigenous patients presents skewing the data?

Is that the right outcome? Or more manipulation of the books to satisfy criteria?

Ultimately i dont know how anyone can defend a policy where an ethnic group is treated differently to others for right or wrong reasons. Sounds like they cant be bothered fixing the real reasons the issue exists and are papering over the cracks to me.
"everything you know is wrong"

Paul Hewson

Re: Shawny’s concerns about Victorian and Australian Governments

Reply #126 –
If St Vincent's were making indigenous wait 3 times longer because they're indigenous then they should be shut down.
2012 HAPPENED!!!!!!!

Re: Shawny’s concerns about Victorian and Australian Governments

Reply #127 –
Quote from: DJC – on
LP, you know that I worked in Indigenous affairs for over 30 years and that's not how the system works.  For a start, what "Federal benefits" would they be claiming?  With some exceptions, like Abstudy, Indigenous Australians access the same Centrelink payments as everyone else.  Skimming Centrelink payments wouldn't be a very lucrative form of blackmail.

In my experience, the mob is very quick to expose anyone who falsely claims to be Indigenous.  For example, see Michael Mansell's rejection of Bruce Pascoe's claim of Tasmanian Aboriginal ancestry: https://tasmaniantimes.com/2020/01/bruce-pascoe-is-not-aboriginal/
Yes, I understand all this, and I do not want to hijack this debate. My point is more about the elimination of subjectivity in the assessment, not whether or not it is actually needed.

Quote from: madbluboy – on
If St Vincent's were making indigenous wait 3 times longer because they're indigenous then they should be shut down.
On the specific issue, like the St Vincent's study, there are stats and then there are damn stats and lies, which feeds back into my doubts. You can take the numbers and make them say whatever you want through flexible categorisation or cherry-picking categories that paint a picture towards your desired conclusion.

For example, I was made aware was one of the key reasons for waiting for treatment in general is alcohol abuse preventing immediate treatment. So if you have a small subset that is categorised differently because of the choice of category they will show up strongly despite there being no embedded systematic discrimination. The root of the problem is then not really the system, but the social driver that causes alcoholism. So if the group you analyse has a higher percentage representation in terms of presenting under the influence of alcohol they will show up strongly.

Alcohol is a great example because some ethic groups present with a greater percentage allergic to alcohol, if you analyse treatments that delayed or denied due to alcohol allergy, without listing the alcohol allergy as a cause, the numbers will show up as Asians being discriminated against.

Like most stats, the problems are not the numbers, but how the numbers get interpreted, the conclusions drawn and the politics. The sad thing is that the politicians and media know this, they just choose not to communicate it because clear explanations do not rate.
"Extremists on either side will always meet in the Middle!"

Re: Shawny’s concerns about Victorian and Australian Governments

Reply #128 –
You have one disadvantaged group whose health outcomes are improved because of this policy, and other advantaged groups whose health outcomes are the same as a result of this policy.

Re: Shawny’s concerns about Victorian and Australian Governments

Reply #129 –
Quote from: PaulP – on
You have one disadvantaged group whose health outcomes are improved because of this policy, and other advantaged groups whose health outcomes are the same as a result of this policy.
I don't think anyone is genuinely disadvantaged, but I also fear the reason for the change is not really a reason at all!

If we first subset the health study by alcoholics, then subset the alcoholics by ethnicity, we will see biases appear but they aren't or may not be genuine biases as they are created by the selection of categories. If you remove the alcoholism from the figures and present the remaining data you have manufactured a bias that appears social or racist.

However, it could be argued if you swiftly promote someone to admission who you cannot yet begin treating, you will potentially be consuming a bed waiting for the opportunity to treat. In this case maybe someone is disadvantaged, but at the bare minimum you have created waste and inefficiency.

I would think in a resource stretched system the case for the "good of the many" suggests greater throughput.

I could be even more cynical, and suggest administrators see this as a way of getting increased funding, they need more resources to maintain or improvement treatment levels in the face of a "systematic bias"! ;) The Admins certainly know politicians won't make decisions that negatively impact their constituency.
"Extremists on either side will always meet in the Middle!"

Re: Shawny’s concerns about Victorian and Australian Governments

Reply #130 –
Quote from: Thryleon – on
Quote from: northernblue – on


Mate, they die younger, they live sicker lives.
Come up and visit me and you’ll see that 40-70% of the NT mob are wrapped in filthy bandages despite the medical professions best efforts.
We are not discussing intelligent well educated and articulate people like say Ernie Dingo here, we are discussing the downtrodden.
If you and he presented simultaneously you would both recieve the same treatment as (relatively) young fit healthy men, of this I have no doubt.
Certainly so here in the Territory.

st Vincent's is not solely in the NT.

So are we saying they dont want to wait like the rest of us are forced to?


st V isn’t in the nt.
What I’m saying is that if a white one and a black one present with the same problem the black one is more likely to die, statistically.
Let’s go BIG !

Re: Shawny’s concerns about Victorian and Australian Governments

Reply #131 –
Quote from: northernblue – on
Quote from: Thryleon – on
st Vincent's is not solely in the NT.

So are we saying they dont want to wait like the rest of us are forced to?


st V isn’t in the nt.
What I’m saying is that if a white one and a black one present with the same problem the black one is more likely to die, statistically.

That's a presumption based on General rule of thumb and I accept that and the statistics but there will be cases when the white fella might have a poor medical history himself which isn't going to be apparent to a time poor under pressure triage nurse asking the usual basic triage questions ie what's your problem today, pain level, medications, and check the vitals. Unless you have patient history from previous visits if any then you are guessing..

Re: Shawny’s concerns about Victorian and Australian Governments

Reply #132 –
Quote from: Thryleon – on
Quote from: DJC – on


Did you miss “First Nations patients were also waiting, on average, three times longer compared to non-Indigenous patients.”?
I didnt miss this claim.  In fact there is no way to substantiate that and its precisely what someone defending this move would say irrespective of whether or not its fair.

Thing is, why is that the case?  Why are they waiting longer?  Is it because the data is skewed by hospitals in areas where there is more indigenous people being treated than not? 

More questions than answers out of the claim.  So by doing this in metro hospitals they treat the minority as priority to paper over not enough health care institutions in remote communities where the majority of indigenous patients presents skewing the data?

Is that the right outcome? Or more manipulation of the books to satisfy criteria?

Ultimately i dont know how anyone can defend a policy where an ethnic group is treated differently to others for right or wrong reasons. Sounds like they cant be bothered fixing the real reasons the issue exists and are papering over the cracks to me.

No way to substantiate it?  Hospitals record whether patients are Indigenous and they record how long it takes for patients to be seen.  That's part of their reporting against performance indicators and closing the gap measures.  You can read all about the disparity in health care on the Australian Institute of Health and Welfare website.  For example:

"Between July 2019 and June 2021, the proportion of hospitalisations for Aboriginal and Torres Strait Islander (First Nations) people that had a procedure recorded was 12 percentage points lower than for non-Indigenous Australians, based on age-standardised percentages (66% compared with 78%)."

Then there's the Australian Commission on Safety and Quality in Health Care:

"The Board of St Vincent’s Hospital in inner Sydney monitors a number of indicators of quality of care for Aboriginal and Torres Strait Islander people, including rates of incomplete treatment in the Emergency Department (ED). Incomplete treatment includes patients who leave the ED before the medical team recommends discharge, those who are not present when called to be seen by a doctor and those who attended ED and did not wait to complete treatment - collectively known as leave events.

Incomplete treatment is associated with an increased risk of readmission and death.1 The NSW Ministry of Health has identified the high rate of incomplete treatment in EDs among Aboriginal and Torres Strait Islander patients compared to other patients (8.6% and 6.1%, respectively, nationally, 2019)2 as a priority issue.

The hospital Board requested that the ED department work to reduce the rate of incomplete treatment among Aboriginal and Torres Strait Islander patients."

Hospitals and agencies charged with monitoring health care outcomes don't make figures up.  They report actual data.

You're right to some extent about data skewing "with First Nations males and females living in Major cities expected to live around 5 years longer than those living in Remote and very remote areas".  However, St Vincents and other hospitals are working off their own patient data and remote hospitalisations and outcomes don't come into it . 

And your assumption that the majority of Indigenous patients present for treatment in remote communities is incorrect.  NSW has the highest Indigenous population with 339,500.  Victoria is just ahead of the NT with 78,600 people to 76,700 and no communities in Victoria are considered to be remote. 

Yes, it would be good to know why Indigenous patients at St Vincents and other hospitals have longer wait times and higher rates of incomplete treatment.  More importantly, it's good that these issues have been identified and are being addressed.
"Negative waves are not helpful. Try saying something righteous and hopeful instead." Oddball
 

Re: Shawny’s concerns about Victorian and Australian Governments

Reply #133 –
Quote from: DJC – on
Quote from: Thryleon – on
I didnt miss this claim.  In fact there is no way to substantiate that and its precisely what someone defending this move would say irrespective of whether or not its fair.

Thing is, why is that the case?  Why are they waiting longer?  Is it because the data is skewed by hospitals in areas where there is more indigenous people being treated than not? 

More questions than answers out of the claim.  So by doing this in metro hospitals they treat the minority as priority to paper over not enough health care institutions in remote communities where the majority of indigenous patients presents skewing the data?

Is that the right outcome? Or more manipulation of the books to satisfy criteria?

Ultimately i dont know how anyone can defend a policy where an ethnic group is treated differently to others for right or wrong reasons. Sounds like they cant be bothered fixing the real reasons the issue exists and are papering over the cracks to me.

No way to substantiate it?  Hospitals record whether patients are Indigenous and they record how long it takes for patients to be seen.  That's part of their reporting against performance indicators and closing the gap measures.  You can read all about the disparity in health care on the Australian Institute of Health and Welfare website.  For example:

"Between July 2019 and June 2021, the proportion of hospitalisations for Aboriginal and Torres Strait Islander (First Nations) people that had a procedure recorded was 12 percentage points lower than for non-Indigenous Australians, based on age-standardised percentages (66% compared with 78%)."

Then there's the Australian Commission on Safety and Quality in Health Care:

"The Board of St Vincent’s Hospital in inner Sydney monitors a number of indicators of quality of care for Aboriginal and Torres Strait Islander people, including rates of incomplete treatment in the Emergency Department (ED). Incomplete treatment includes patients who leave the ED before the medical team recommends discharge, those who are not present when called to be seen by a doctor and those who attended ED and did not wait to complete treatment - collectively known as leave events.

Incomplete treatment is associated with an increased risk of readmission and death.1 The NSW Ministry of Health has identified the high rate of incomplete treatment in EDs among Aboriginal and Torres Strait Islander patients compared to other patients (8.6% and 6.1%, respectively, nationally, 2019)2 as a priority issue.

The hospital Board requested that the ED department work to reduce the rate of incomplete treatment among Aboriginal and Torres Strait Islander patients."

Hospitals and agencies charged with monitoring health care outcomes don't make figures up.  They report actual data.

You're right to some extent about data skewing "with First Nations males and females living in Major cities expected to live around 5 years longer than those living in Remote and very remote areas".  However, St Vincents and other hospitals are working off their own patient data and remote hospitalisations and outcomes don't come into it . 

And your assumption that the majority of Indigenous patients present for treatment in remote communities is incorrect.  NSW has the highest Indigenous population with 339,500.  Victoria is just ahead of the NT with 78,600 people to 76,700 and no communities in Victoria are considered to be remote. 

Yes, it would be good to know why Indigenous patients at St Vincents and other hospitals have longer wait times and higher rates of incomplete treatment.  More importantly, it's good that these issues have been identified and are being addressed.


A couple of points:

1.  I've spent 14 years working in public health institutions.  Im no stranger to how data is collected.

2.  My wife is a member of HIMAA.  Im no stranger to health information management, how data is collected, coded and submitted about health and outcomes.  If st Vincent’s are using their own data here there's already a problem because they dont have access to other hospitals data.

To quote you "Incomplete treatment includes patients who leave the ED before the medical team recommends discharge, those who are not present when called to be seen by a doctor and those who attended ED and did not wait to complete treatment - collectively known as leave events."

So I was correct in one assumption earlier based on what you've quoted.  They dont want to wait and contribute to their own adverse outcomes so to fix this, we are now fast tracking them against the rest of the population.  

IMHO, anyone who contributes to their own mistreatment with the above behaviour gets what they deserve despite their backgrounds or indigenous status, and withdraws their right to complain. 


The figures are provided by the organisations implementing these policies, and are audited by bodies associated with them.  Forgive me for not trusting the accuracy of said numbers and figures as they are simply reported by the bodies that came up with this discriminatory decision and continue to find ways to see people who dont identify as indigenous as lesser.

Of course, lets just explain away the fact we are discriminating based on ethnic and cultural backgrounds.  Its clear that being non indigenous to Australia puts me on a less equal standing to the indigenous mob.

You know ive often wondered what it takes to identify as indigenous or Torres straight Islander.  I get that the indigenous people would need to accept this but on government forms you tick a box.  Is it audited and reviewed properly?  Does it ever get challenged? and now for the final point from me for this whole discussion, in the past all I have heard is about the reluctance for indigenous people to actually identify themselves as indigenous on these due to historic mistrust and mistreatment, so how do you come up with trustworthy figures when they would often abstain from doing so?

The figures arent trustworthy is my contention and it means a decision affecting many has been made based on the outcomes of the few standardised.  Thats possibly giving incorrect outcomes but as per usual our options are limited to whinging on a forum.

All people want, is equal treatment.  Special treatment serves only to further divide us.



"everything you know is wrong"

Paul Hewson

Re: Shawny’s concerns about Victorian and Australian Governments

Reply #134 –
I'll say this, I used to see a liver specialist at a public hospital here in Melbourne. Check is via swiping your Medicare card at a console where you get a ticket with a number. The wait at the specialist clinics there is normally horrendous. On one occasion, in my haste, I accidentally clicked yes to the Aboriginal and Torres Straight Islander question. I can tell you on that occasion my wait was minuscule, I virtually got called in straight away. Coincidence? Perhaps.
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