Blind Spots in the Hospital: An Absence of CALD Data.

Abstract

Accurate collection of culturally and linguistically diverse (CALD) data is essential for equitable healthcare delivery in multicultural settings, yet uptake of the Australian Bureau of Statistics (ABS) recommended core indicators across health services remains inconsistent. We conducted a mixed-methods study at a tertiary cancer centre to assess the completeness of CALD data collection and to explore perspectives from both staff and CALD community members. Quantitative analysis involved an audit of outpatient electronic medical records from January to December 2023, alongside a review of institutional policies, while qualitative data were obtained through surveys and interviews with administrative staff and focus groups with Mandarin, Arabic, and Greek-speaking community members. Among 7,243 outpatients, only three of four ABS minimum core indicators and one of eight standard CALD indicators were routinely collected. Incomplete data ("other" responses) were more frequent among patients born in non-English-speaking countries (26% vs. 13%, p < 0.0001) and those whose preferred language was not English (32% vs. 15%, p < 0.0001). Policy review identified limited guidance on CALD classification, and staff reported minimal CALD specific training, unclear responsibilities, and time pressures as key barriers to accurate data collection. Community participants identified language and interpreter need as the most meaningful indicators for clinical care. Overall, CALD data collection was found to be inconsistent and incomplete, limiting the capacity of health services to deliver equitable care and undertake informed service planning. Training, clearer protocols, and inclusion of broader indicators (e.g. ethnicity, year of arrival) could strengthen the responsiveness of health services to diverse populations.