Understanding health and wellbeing key to improving outcomes for Māori trauma patients
The introduction of a health and wellbeing model based on Te Whare Tapa Whā is improving outcomes for Māori patients with traumatic brain injury (TBI) discharged from Puāwai rehabilitation unit in Ōtepoti Dunedin.
The Te Ara Mārama project aimed to improve communication with community services for Māori patients with a TBI when they leave hospital after experiencing major trauma. It was led by Māori, with Māori and for Māori, focusing specifically on Māori trauma patients because of their over-representation in TBI statistics.
The current system favoured a Western model of health which was continuing to deliver inequitable outcomes for Māori. While kaupapa Māori support services were available on discharge, staff at the unit did not always refer Māori patients to their service. Patients reported that they didn’t always know what support was available to them on discharge and needed support to access services. Re-admission rates were high as many patients did not feel safe navigating their own care in the community.
The Te Ara Mārama project team, part of Te Whatu Ora Southern, began engaging with kaupapa Māori service providers and held shared in-service education sessions between Puāwai rehabilitation unit staff and whānau ora navigators. They learnt about each other’s roles and how they could work together to support whānau using a te ao Māori approach. The importance of whakawhanaungatanga (building relationships) and respecting tikanga (Māori customs and protocols) is now emphasised during staff training.
All Māori patients began to be offered a referral to a kaupapa Māori community service provider and, if the referral was accepted, the provider assigned a whānau navigator who engaged with the whānau and clinical staff while the patient was in hospital, participated in joint goal setting and supported the transition back into the community. They also identified barriers to engaging in clinical services and advocated for whānau. Referral to kaupapa Māori services increased from 0 to 98 percent, with just over half of eligible patients accepting the referral.
Te Whare Tapa Whā was used as a way of understanding the health and wellbeing of their patients and the team used it to develop a assessment tool to set goals and identify what was important for patients to work on during their recovery and after discharge.
Consumer input was vital to the success of the project and staff held interviews with patients and whānau, which informed where improvements could be made.
Te Whatu Ora Southern has introduced equity workshops and weekly check-ins, enabling the organisation to embed equity principles into clinical care and strategy.
Read the full case study from Te Whatu Ora Southern below.
In 2021, the trauma rehabilitation national collaborative brought together 11 teams of rehabilitation clinicians from across Aotearoa New Zealand to complete quality improvement projects that would improve outcomes for patients’ rehabilitation after major trauma. The collaborative is part of a broader programme of work by the National Trauma Network, Accident Compensation Corporation and Te Tāhū Hauora Health Quality & Safety Commission to establish a contemporary system of trauma care in Aotearoa New Zealand. Find out more about the programme here.