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have developed accessibility checklists based on an American tool (Self Help for Hard of Hearing People, 1993) and adapted this to the local context. For example, an audit of our hospital auditorium found that the original audioloop met existing regulations but in practice very few seats received an acceptable signal. When the unit required replacement, technical expertise was sought and the loop selected provided wider coverage which was confirmed by improved consumer satisfaction. Engagement of consumers is also valuable in education. Feedback from staff in our organisation consistently indicates that consumers’ reporting on their experience of a service is a powerful tool in motivating change. 4. Seek out partnerships. For example, the Audiology Department and Princess Alexandra Support Services (including interpreter services, switchboard, enquiries and admissions) established a partnership in recognition that Deaf people face barriers in accessing health services similar to those from culturally and linguistically diverse backgrounds. Working together has resulted in the development of resources including desktop communication signs for outpatient clinics and communication alert stickers for the patient chart. An extensive training program for frontline staff has been conducted covering topics such as working with an interpreter and communication strategies. More recently in an alliance with Queensland Health Multicultural Services a ward communication tool was designed including words in common use in hospitals presented pictorially in Australian Sign Language (Auslan) and numbers and the alphabet in finger spelling. Future directions The hospital is currently trialling a communication kit for Deaf and hearing impaired patients that has been developed in consultation with consumers and staff. The aim in producing the kit was to address some of the communication issues commonly encountered during a hospital stay. Examples of items in the kit include Auslan ward words, a visual pain scale, a staff information brochure on managing hearing aids and cochlear implants, a communication alert sign, and a pad and pen. A feedback form in words and pictures has been developed to facilitate consumer evaluation of the kit. The vision for the future is to have the kit available in a web accessible format to facilitate statewide distribution. The commencement of the trial also highlighted an area for further investigation. As there is no comprehensive system in place to identify patients with special needs, it was difficult to issue kits efficiently to all patients who may benefit from its use. The elective admission process currently identifies patients who are Deaf and require sign language interpreters. There is no identification process for those patients with a hearing impairment who do not identify as Deaf. It is important for the future that systems are in place so that appropriate services or technology can be made available when required. The provision of real-time captioning for patient consultations remains a focus. Real-time captioning, the instant translation of the spoken word into text, is required when verbatim conversation is essential to effective communication. It is routinely available in our hospital for meetings involving consumers. It is rarely available for individual patient appointments apart from cases where the Audiology Department is involved in the long-term

management of a patient. Increasing access to portable e-health systems and the ability to deliver real-time captioning remotely holds promise for the future. There is also new work to be done in evaluating patient educational materials so that we are meeting the level of literacy of our consumers. Finally we need to investigate other ways that patients receive education to ensure that those with special needs have equitable access. In summary, over the last ten years it has been both challenging and rewarding to play a part in creating a hospital environment where people who are Deaf or have a hearing impairment have equitable access to the services and facilities they need. References Briffa, D. (1999). Deaf and mentally ill: Are their needs being met? Australasian Psychiatry , 7 (1), 7–10. Department of the Premier and Cabinet. (2004). Queensland government multicultural policy 2004 . Retrieved from http://www.multicultural.qld.gov.au/media/maq_ making_world_difference_policy.pdf Department of the Premier and Cabinet. (2009). Queensland government captioning policy 2009 . Retrieved from http://www.premiers.qld.gov.au/right-to-info/published- info/assets/captioning-policy.pdf Disability Discrimination Act. (1992). Retrieved from http:// www.comlaw.gov.au/ComLaw/Legislation/ActCompilation1. nsf/0/75A9AC46A3C6C8A1CA25768E00127EC3/$file/ DisabilityDiscrimination1992_WD02.pdf Disability Services Act. (2006). Retrieved from http:// www.legislation.qld.gov.au/LEGISLTN/CURRENT/D/ DisabServA06.pdf Princess Alexandra Hospital. (1999). Access for people who are Deaf or who have hearing impairments: Internal report : Brisbane: Author. Queensland Health. (2001). Deafness and mental health: A report on the mental health needs of Deaf and hearing impaired people in Queensland . Brisbane: AUthor. Queensland Health. (2007). Queensland Health Disability Service Plan 2007–2010 . Retrieved from http://www.health. qld.gov.au/publications/disability_plan/QH_DSP_web1.pdf Self Help for Hard of Hearing People. (1993). People with hearing loss and health care facilities: A guide for hospitals to comply with the Americans with Disability Act . Bethesda, MD: SHHH Publications. 1. Deaf with a capital D refers to culturally Deaf people who belong to the Deaf community through sharing values, beliefs and the use of sign language (Auslan). Evelyn Towers is director of the Audiology Department at Princess Alexandra Hospital in Brisbane specialising in adult diagnostics and rehabilitation. Evelyn has also worked extensively in improving health service accessibility for people who are Deaf or have a hearing impairment, for which she received a Queensland Health Leadership Award in 2007.

Correspondence to: Evelyn Towers Director of Audiology, Audiology Department Princess Alexandra Hospital Ipswich Road, Woolloongabba, Qld, 4102 phone: +617 3176 2327 email: evelyn_towers@health.qld.gov.au

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ACQ uiring knowledge in speech, language and hearing