Queensland Health First Nations Design Framework

The built environment has historically been weaponised against First Nations communities. The Framework confronts the enduring legacy of colonisation, which has disproportionately impacted First Nations health outcomes primarily given First Nations peoples’ mistrust of the government and subsequent low presentation rates at healthcare facilities. Previous efforts to address disparities have often worsened situations, as evidenced by the Commonwealth Closing the Gap 2023 Annual Report recommendations to “fundamentally rethink” current systems. Despite good intentions, inadequate resources and a lack of cultural awareness compound these issues resulting in projects that overlook the potential of built infrastructure in improving First Nations health outcomes.

The Framework outlines a project approach that prioritises First Nations stakeholder engagement from beginning to end and beyond on health infrastructure projects. It outlines a new way of working for Queensland Health infrastructure delivery teams – a way that empowers First Nations communities to actively shape healthcare facilities and ensure Country-responsive and culturally safe spaces are delivered. In much the same way that culturally inappropriate health care can contribute to reduced health outcomes for Aboriginal and Torres Strait Islander peoples, by listening and implementing design changes that support culturally safe care, the Framework supports Queensland Health’s vision for health equity.

Through transforming space planning, functionality, and comfort within healthcare facilities, our healthcare systems have the potential to operate in more appropriate manners strengthened, rather than hindered, by design. By prioritising the insights of Traditional Custodians - who understand Country, its ecology and traditional practices- and broader First Nations community members – who understand the aspirations and needs of their communities - the Framework champions forward-thinking practices across commercial, environmental, and societal spheres. Socially, it affords agency to communities by meaningfully involving them in project processes. Economically, it fosters opportunities for First Nations individuals and businesses, promoting economic growth and independence.

The Framework is unique in that it is Queensland Health’s first design focussed First Nations initiative and the first to acknowledge the power of design as a step towards health equity. To ensure a holistic understanding and uptake of the Framework’s processes and principles, the document outlines a First Nations engagement approach in line with existing Queensland Government policies and aspirations and IAP2’s Public Participation Spectrum. While addressing a complex challenge that requires nuanced understanding, the Framework provides user-friendly guidance and outlines a step-by-step process for project teams, to ensure it is implementable at different stages of the health infrastructure design and delivery process. Emphases has been put on ensuring guidance is rigid enough to align with existing project methodologies, however adaptable enough to be delivered in a projects-specific manner. The Framework is also tailored to maximise community inputs and positive impact through defining two distinct First Nations engagement groups with unique focus areas. Engagement Group 1 comprises Traditional Custodians and focusses on Country-Centred Design, while Engagement Group 2 includes broader First Nations community members (ie. staff, users, visitors) with a focus on Community-Informed Design. This two-pronged approach ensures design outcomes are guided by diverse and representative perspectives.