Improving cultural safety and communication for Indigenous people in hospitals: a consumer-defined approach

In the hospitals of the Northern Territory state of Australia, Aboriginal and Torres Strait Islander people experience poorer outcomes and higher rates of self-discharge than non-Indigenous patients. These disparities reflect the ongoing effects of colonisation, structural racism and communication barriers within health systems.*  

The Communicate study was established as a multi-level partnership between Menzies School of Health Research, NT Health, the NT Aboriginal Interpreter Service, National Accreditation Authority for Translators and Interpreters, the Djalkiri Foundation, and First Nations leaders, working across Royal Darwin Hospital, Gove District Hospital, Katherine Hospital and Alice Springs Hospital.

It was developed to address the impacts of colonisation and systemic barriers in Northern Territory hospitals, where most patients are Aboriginal, but most staff are non-Aboriginal.

The team at NT Health work to achieve the best health and wellbeing for all Territorians through the development, management and performance of the public health system.

Co-designed with Aboriginal partners, Communicate makes hospital care more culturally safe and accessible through culturally and linguistically appropriate communication, as determined by Aboriginal patients and communities themselves.

It does this by focusing on practical changes in everyday care. Cultural safety training is delivered through Ask the Specialist: stories to inspire better care, using podcasts led by Aboriginal people from Larrakia, Tiwi and Yolŋu nations, reflecting the languages, cultures and lived experiences of communities served by Northern Territory Health hospitals.

A cross-site community of practice links clinicians across Royal Darwin Hospital, Katherine Hospital, Gove District Hospital and Alice Springs Hospital to support continuous quality improvement. Additionally, Aboriginal language interpreters are embedded into clinical teams to support shared understanding and informed decision making. 

 From international evidence to local system change in remote and Indigenous health services

Fiona Wake, executive director for clinical excellence and patient safety, commissioning and system improvement at Northern Territory Health, believes that the learnings gained from attending the International Forum on Quality and Safety in Healthcare were associated with refinement and scaling of the work. Exposure to international evidence and peer systems where consumers define quality and accountability was consistent with international evidence and comparable models, and supported its expansion across multiple sites. 

Sessions led by consumer advocates challenged traditional reporting frameworks that prioritise organisational metrics over patient experience, leading to greater emphasis on patient-defined indicators such as cultural safety, interpreter use and self-discharge. Comparable community governed models from Broome, Alaska and Canada demonstrated the applicability of these approaches for remote and Indigenous health services.

“The Forum helped us see that consumer-defined quality is not aspirational, but practical, measurable, and already happening in systems like ours.”

Fiona Wake, executive director for clinical excellence and patient safety
Commissioning and system improvement, Northern Territory Health, Australia

The early success of the Communicate study shows that effective change happens when Aboriginal patients and communities help shape how care is delivered, rather than commenting on it as an afterthought. It places Aboriginal voices at the centre of decisions about safe, effective care.

This view mirrors the discussions that took place at the International Forum on Quality and Safety in Healthcare in Canberra 2025, which emphasised the role of patient-defined measures in assessing and improving care quality.