Return to Country: A national platform study to return Aboriginal and Torres Strait Islander renal patients home

Study Part 2 (observation) Clinician leaders, patient-facing staff and patients from tertiary renal services/units participating in this study will participate in the following activities at baseline and after a minimum of two (and maximum of three) years: i) an organisational policies and procedures audit relevant to culturally safe practice for Aboriginal and/or Torres Strait Islander patients, adapted from National Safety and Quality of Health Care guidelines; ii) an on-line voluntary and anonymous staff survey designed to measure staff attitudes and beliefs toward Aboriginal and/or Torres Strait Islander patients, as well as self-reported communication styles and strategies staff use with patients. 20 minutes; iii) a report of relevant one year patient outcomes (death, treatment modality, return to postcode of original residence) for each centre using national renal (ANZDATA) registry data over the previous five years; iv) qualitative feedback from Aboriginal and/or Torres Strait Islander patient groups (ideally involving patients who are within one year of starting treatment) about their perceptions of treatment and care in five broad domains, as well as their responses to summaries of the information provided through activities (i), (ii) and (iii) above; and their willingness to be involved in a process of health service quality improvement - talking circles/focus group up to 10 renal patients in session, duration 2-3hr v) qualitative feedback from key staff informants at each centre about their responses to a report including data from activities (i), (ii), (iii) and (iv) above, including a qualitative assessment from them of the degree to which they feel their centre/service is providing adequate care, and their willingness to be involved in a process of health service quality improvement. Report presentation to renal executive, to renal staff through in-service and summary posters If the responses from patients (in activity (iv)) and key staff informants (in activity (v)) support engagement in health service quality improvement at the involved centre/service, a group (Study Part 3 - Change Phase: Community of Practice, CoP) including both will be convened and consent gained from the group for Return To Country researchers to observe the meetings and make suggestions for change when invited to do so. This will be the only "intervention" in the study (besides the provision of data from activities (i)-(v) above. Regardless of the involvement of the renal centre/service in the process of patient-staff health service quality improvement as part of the Return To Country Study, the initial activities (i)-(v) above will be repeated for each service after a minimum of two and maximum of three years since the initial activity. This will provide data about changes in processes, attitudes and outcomes of care.