Queensland Health First Nations Design Framework – 2024 Indigenous Design Award

Published on: 23 September 2024

PROUDLY PRESENTED BY RMIT UNIVERSITY, THE INDIGENOUS DESIGN AWARD RECOGNISES AND CELEBRATES THE IMPORTANT CONTRIBUTION THAT AUSTRALIA’S ABORIGINAL AND TORRES STRAIT ISLANDER DESIGNERS MAKE ACROSS THE SPECTRUM OF AUSTRALIAN DESIGN.

THE AWARD WELCOMES NOMINATIONS OF INDIGENOUS INDIVIDUALS AS WELL AS PROJECTS WHERE AT LEAST ONE MEMBER OF THE DESIGN TEAM IDENTIFIES AS ABORIGINAL OR TORRES STRAIT ISLANDER. RMIT AND INDIGENOUS COMMUNITY REPRESENTATIVES EVALUATE NOMINATED SUBMISSIONS AND SELECT THE OVERALL WINNER FOR THE AWARD BASED ON SPECIFIC EVALUATION CRITERIA.

Colonisation continues to cause disparities in Australia’s built environment and health systems. Aboriginal and Torres Strait Islander people suffer from disproportionately worse health outcomes and show poorer healthcare presentation rates. Additionally, previous efforts to create culturally safe healthcare have failed due to a lack of engagement with the First Nations community.

The 2024 Indigenous Design Award Winner is The Queensland Health First Nations Design Framework (the Framework). It acknowledges the power of design on the journey towards health equity. The document provides a roadmap to engaging Traditional Custodians and First Nations community members in the development and delivery stages of health infrastructure. It includes recommendations for shaping the commercial, environmental and societal impact of infrastructure projects through co-design practices.

Designed by Blaklash and commissioned by Health Infrastructure Queensland, the Framework was created in alignment with existing policies and frameworks by Queensland Health’s First Nations Health Office. It supports Queensland Health’s vision that built infrastructure has the potential to improve the healthcare experiences and outcomes of First Nations people.

We dove into the Framework’s co-design approach, inclusivity and use applications alongside Blaklash’s Principal, Tahlia Steadman and Managing Director, Troy Casey.

GDA: What elements of health equity does the Framework aim to address?

Troy Casey: It’s taking an approach that’s about holistic social change. For example, think about the Closing the Gap Report. The disparity between health outcomes is resulting in lower life expectancy rates for Aboriginal and Torres Strait Islander people. It also results in a higher likelihood that community will suffer from severe disease and preventable illness.

Historically, Aboriginal and Torres Strait Islander people also show poorer presentation rates in terms of accessing health care for a range of different reasons. The ability for the First Nations community to access health care becomes critical to lots of other measures and metrics as part of that conversation.

Tahlia Steadman: Historically the process of where facilities have been built has not been done in collaboration with Aboriginal and Torres Strait Islander communities. So there are times when sacred sites, scar trees, birthing trees have been removed to build a supposedly healing place there.

This process means people may already feel as though they are going against their own culture to go to a site for whatever reason, so how do we expect our communities to present to facilities and access healthcare? But our view is that if you involve people in the conversation, you can become aware of these types of things and be sure not to repeat it.

GDA: In the journey to improve the healthcare experience and outcomes for First Nations communities, why is it so important to consider the design of healthcare facilities?

Troy Casey: There’s a number of factors that, once you present to a facility, lead to better health outcomes. One of them is something that we don’t have control of, which is clinical services and the way patients are treated when they present. Not treated medically, but treated personally, but also how they feel in those places and spaces.

And so that’s the thing that we’re trying to tackle – how do we create culturally informed design responses that ensure Aboriginal and Torres Strait Islander people feel safe, welcome and invited into these spaces? Spaces that have often neglected them, or turned them away. Also, how do we ensure cultural practice is considered and supported through the design process?

We need to move towards design that not only creates safe spaces where you can see your culture represented, but also places that have been designed to facilitate your cultural practices.

GDA: Can you give us some examples of changes under the Framework that could create more culturally safe and inviting facilities?

Tahlia Steadman: One example is thinking about how a building is actually sited. Thinking about where buildings are located and orientated and deciding things like what the views are from inpatient rooms and waiting rooms. Thinking about if there is a way to champion views to a particular geographical landmark that makes local First Nations people feel more grounded and connected to where they are. To feel safe and looked after.

These design decisions are actually beneficial for everybody. It’s not just Aboriginal and Torres Strait Islander people that would benefit.

Troy Casey: Also, facilities could take family size into consideration. The family size of Aboriginal and Torres Strait Islander people is often bigger than average. And so, how do facilities start to think about particular spaces that can facilitate large group gatherings?

Tahlia Steadman: Even little things like thinking about if you’re in a community that has different clan groups and avoidance practices that need to be respected, thinking about how separate waiting spaces or other design outcomes can be considered … There’s lots of different opportunities to explore that are very different depending on where a project is located.

[The Blaklash team behind the Framework – Winner of the 2024 Indigenous Design Award Image: Blaklash]

Blaklash has delivered a portfolio of Country-led design projects over the years. How does your process change during a policy design project compared to an architecture or interior design project?

Troy Casey: What we’ve learnt from delivering projects without having a framework or a policy has been critical. We’ve seen firsthand, within projects, where we could have created really valuable outcomes if we had the right conversations earlier in the project timeline. That understanding enabled us to work closely with Health Infrastructure Queensland and say, ‘How might our tried and tested methodology align with your infrastructure delivery processes?’

The work that Haylene Grogan has done as Chief First Nations Health Officer at Queensland Health in creating these other frameworks is so critical. It’s about the way in which all of these frameworks and policies integrate to create a holistic approach to better health outcomes for our community.

The Framework prioritises the perspective of two First Nations engagement groups – Traditional Custodians and broader First Nations community members. What went into defining these groups and how did that contribute to the holistic nature of the Framework?

Tahlia Steadman: We say that it always starts with Country. So to respect and honour that, Traditional Custodians need to be acknowledged as those who can talk to Country and share that insight. So, in developing the Framework it felt like an obvious route to go down to identify Traditional Custodians as one of the key stakeholder groups to be engaged for these projects.

But then we also had to keep in mind that often people that use or work within these facilities, if you’re thinking of more urban and regional settings rather than remote, may not be Traditional Custodians of that area. Yet, there may be high populations of Aboriginal and Torres Strait Islander community members from all over that make up the local community, including Elders that could have lived there for 50 years.

For this reason, the second engagement group focuses on First Nations staff members, First Nations community members, consumers and people that are using these facilities for healthcare. They need to have their lived experience embedded into design outcomes as well so the Framework makes sure that their voices are heard as well.

GDA: How did you ensure the Framework was user friendly and able to be implemented at different stages of the health infrastructure design and delivery process and why was that important?

Tahlia Steadman: We’re very conscious of the fact that a lot of frameworks are developed and then sit on a shelf and are not be used, at least to their fullest. For this framework, we have tried to provide clarity and tangible actions for people to make implementation more approachable.

The Framework outlines how everyone has clear roles and responsibilities, so things don’t get blurry. The aim is that people know exactly where they stand in the process, which also makes self evaluating more effective too… The idea is also that the Framework can continue to evolve over time, it isn’t stagnant. In implementing it on projects, it can be tried and tested and continue to improve through learnings heard from community and project teams

GDA: The Framework achieves multiple aspects of inclusion, such as economic inclusion. How does the Framework benefit First Nations businesses?

Troy Casey: One of the major things that we always push for on projects that we deliver is the opportunity for economic impact. At the very minimum, that’s ensuring that community who contribute to the project are paid for their time… like any consultant would be if they provided their expertise on a project.

The second part of it is, how do we scaffold impact across the whole project from the outset? One way might be by engaging us as an Aboriginal business to guide the design. But further to that, we’re ensuring that other First Nations businesses, who can provide products or services to the construction or fit out phase, are engaged and involved in these projects from the beginning, throughout and beyond into operations and maintenance.

Everything we do is always trying to create more opportunities for other Aboriginal and Torres Strait Islander people.

As the 2024 Indigenous Design Award Winner, the Framework is an exemplar of how good co-design can drive Country-centred and community-led outcomes. By outlining how Aboriginal and Torres Strait Islander communities can be involved in projects from start to finish, it lays the foundation for the design and delivery of culturally safe healthcare facilities.

The Framework complements Queensland Health’s initiatives and deeply considers user needs to maximise the potential for positive impact. Congratulations to the team at Blaklash for using Country-led design to create opportunities for First Nations communities.