This project explores intercultural communication between Aboriginal patients and non-Aboriginal staff at Alice Springs Hospital (ASH). Deficits in the quality of communication are well recognised in health care. These are magnified where language and or cultural differences are present. Poor intercultural communication in healthcare delivery in the Northern Territory, and adverse consequences of this has also been well documented. What is less well understood is whether efforts to improve cultural security within health systems have any impact upon intercultural communication.

A sequential, mixed methods study utilised a methodological bricolage of grounded theory and dramaturgical analysis techniques, hermeneutic phenomenological narratives and realist propositions based upon data focussed on intercultural communication experiences at ASH. Three participant groups were invited to participate: ASH staff members (Group A); Aboriginal staff members (Group B) and Aboriginal patients (Group C). In-depth interviews were conducted with Group A (n=12), semi-structured interviews and a focus group was conducted with Group B (n=7). A relaxed conversational style interview was conducted with Group C with an Aboriginal coresearcher (n=9). Participants were offered an interpreter so that the interview could be conducted in the preferred language. Only one interview was conducted using multiple languages with an unofficial interpreter and later translated with the help of the Aboriginal Interpreter Service (AIS).

Population and language data from the Australian Bureau of Statistics were collated to provide a picture of hospital service users. Data from the 2016 census showed that the hospital catchment area of 872,861 square kilometres contained six local government areas (LGAs) with a total population of 45,161. In the top responses of languages other than English, there were 13 Aboriginal languages and seven non-English languages in these LGA

Referral data were collected from the Aboriginal Support Services Unit (ASSU) at ASH and the AIS to describe types of requests and who utilised the services between July 2018 and June 2019. The top three reasons for referral data to the Aboriginal support services Unit (n=4,462) were interpreting (41.4%), transport (29.7%) and cultural brokerage (16.8%). The AIS (n=270) primarily managed mental health related referrals (27%), medical reviews (17%) and general discussions (16%).

Overarching themes emerged from the participant interviews. In general, three themes focus on procedural mechanisms and processes. Hard or challenging situations; education, knowledge, learning, and understanding; workflow, resources, protocols, and approaches. Themes about interpersonal aspects of communication include personalities, emotions, and expressed feelings; trust and relationships; cultural influences, differences, and explanations.

This PhD research project found that support service structures often do not align with staff expectations and needs. Aboriginal staff were seen as a vital link between non-Aboriginal staff and patients. However, several study participants mentioned an increase in the number Aboriginal employees and consideration of staffing requirements after hours was needed. Indigenous research methods of yarning and dadirri, employed by the co-researcher, are proposed as a method to enhance the therapeutic relationship between service user and healthcare staff.

These findings resulted in three propositions and four recommendations for local policy maker consideration.