Bukal Institutional Racism Matrix – McDermott Review

#CalloutIRAustralia points:


  • Professor Robyn McDermott reviewed the “A Matrix for identifying, measuring and monitoring institutional racism within public hospitals and health services
  • ‘This is a valuable and important development which can improve transparency, accountability and ultimately the performance of HHS [Hospital and Health Services] in service delivery to Aboriginal and Torres Strait Islanders.’
  • The Matrix should be tested in other settings in Australia, especially where there is a large proportion of Aboriginal and Torres Strait Islander clients, to validate the measures proposed.’
    Professor Robyn McDermott
  • The Bukal Institutional Racism Matrix (link) is an updated version of the first Matrix reviewed by McDermott.

The contents of this post are extracted from the review outcomes from Professor McDermott, which are provided as an Appendix to the report ‘Addressing Institutional Barriers to Health Equity for Aboriginal and Torres Strait Islander People in Queensland’s Hospital and Health Services


Overall summary

‘I believe this work is important and makes a significant contribution to a better, more robust, transparent and reproducible approach to monitoring the institutional response at the HHS level to persisting health outcome disparities between Aboriginal and Torres Strait Islanders and other Australians. 

The stated objective of the Matrix is to measure, score and monitor over time, progress made by Hospital and Health Services in Queensland in addressing perceived and actual institutional racism toward Aboriginal and Torres Strait Islander Australians seeking to access health care in the public sector. This is in response to what is perceived as ongoing failure of implementation of policy at the corporate and serviced delivery end, a failure which can be attributed to the persistence of subliminal institutional racism, at least in part. It contains a thoughtful preamble summarising some of the literature on the impact of institutional racism on health and access to health services, and some of the measures developed to date.

Importantly, it links the proposed measures to policy documents developed and endorsed by successive Commonwealth and State governments, and which have currency. It seeks to link actions by the HHS in the 5 domains of Governance, Policy Implementation, Service Delivery, Workforce recruitment and employment, and Financial Accountability.’

Strengths

‘The matrix addresses a really important area of policy and practice failure, one which continues to affect access to quality health care for Aboriginal and Torres Strait Islander Australians.

It links policy documents and measures to HHS level implementation, derived from annual reports and other information available in the public domain. The measures are clear, and the sourcing of these from publicly available documents e.g. annual reports is a robust and repeatable approach.

There is an ability to feed back to HHS and others, and to assess progress over time. The authors have populated the Matrix with measures from one HHS to develop a score.

The matrix has great potential to be used locally in Queensland, and also applied to other local HHS in other states, especially those with significant Aboriginal and Torres Strait Islander populations.’

Suggestions for improvement

‘Validation and the weightings attached to each domain: It is not clear how they were derived.

Perhaps the name should be changed from “Measuring Institutional Racism…”, to something like “Institutional progress in health service delivery to Aboriginal and Torres Strait Islander people: a proposed instrument”, as the scores do not really measure racism directly (that is a bit tricky) but rather identify important areas where the HHS has failed (or succeeded) in implementing the endorsed policy in these key domains.’

Recommendations

‘This is a valuable and important development which can improve transparency, accountability and ultimately the performance of HHS in service delivery to Aboriginal and Torres Strait Islanders.

The Matrix should be reviewed by an expert panel in population health and health services to identify areas for improvement in the measures, if any, and make comments on the utility or otherwise of the Matrix in this and other jurisdictions.

Following this, the Matrix should be tested in other settings in Australia, especially where there is a large proportion of Aboriginal and Torres Strait Islander clients, to validate the measures proposed.’


Institutional Racism Ratings for Queensland Health’s 16 Hospital and Health Services for 2014-2015

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