5. PROMOTE AN ORGANIZATIONAL CULTURE OF CULTURAL SAFETY BY EMPHASISING CULTURAL HUMILITY AND RELATIONS OF POWER

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"When I was filling out forms at the ER and they asked me … what religion I would like to put down, the only options given to me were various forms of Christianity. While I'm blond haired, green eyed and white I am culturally Jewish, but the assumption was made that I was Christian. This may seem minor but it was hurtful. There's no basis to assume that I am Christian and it put a bad taste in my mouth. I think having staff be aware of the importance of open ended questions, not just options, is important. First impressions when you're in pain are long lasting. I also think allowing people to put down whoever they want for pastoral care would make the process more inclusive." [Anonymous respondent to Refugee and Minority survey]

 

"I have observed EH staff make derogatory and negative, stereotypical comments about people from Indigenous cultures. I feel overall there is a lack of cultural sensitivity & awareness within the EH organization of different cultures and even of regional differences within the province." [Anonymous respondent to Staff survey]

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Training in cultural safety needs to be supported by an organizational culture that promotes cultural safety – for patients as well as providers. It was clear to us in our discussion with Eastern Health leaders and decision makers that this important aspect of creating a context of cultural safety is already well recognized. In response to the question, “What does diversity in Eastern Health look like to you?”, one decision maker summarized what a culturally safe health care system means:

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The hierarchy of power needs to be considered and also dismantled in several key ways that require advocacy in a sustained way for long-term change to the culture of the health care system itself. Self-reflection and evaluation needs to be done by Eastern Health leadership to fully explore this. Here, we present some observations on some of the ways this can be done, focusing on the most obvious “low hanging fruit”. We assume that a clear leadership structure that focuses on connecting the various parts of the system (as described in the first set of recommendations) will facilitate this advocacy process. These recommendations focus not on the cultures of patients, but on the culture of Eastern Health.

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➤ Reflect on Eastern Health’s place in the context of ongoing colonial oppression

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While establishing a culture that supports diversity in general is important, the immediate priority is to establish a sense of cultural safety for Indigenous patients.  It is a sad irony that newcomers to Canada report feeling welcomed and supported by staff who are going out of their way to try to accommodate the needs of newcomers, while Inuit, Innu and other Indigenous patients are consistently experiencing racism and marginalization in our health care system.  Several Calls to Action in the final report of the Truth and Reconciliation Commission pertain to health. Of these, two calls are directly related to creating a culture of safety:
 

• TRC Recommendation 18 – We call upon the federal, provincial, territorial and Aboriginal governments to acknowledge that the current state of Aboriginal health in Canada is a direct result of previous Canadian government policies, including residential schools, and to recognize and implement the health-care rights of Aboriginal people as identified in international law, constitutional law, and under the Treaties. 

• TRC Recommendation 23 – We call upon all levels of government to: Increase the number of Aboriginal professionals working in the health care field. Ensure the retention of Aboriginal health-care providers in Aboriginal communities. Provide cultural competency training for all health-care professionals.

 

Actions with respect to these recommendations include acknowledging the presence of underlying ideologies of racism and colonization. The literature on the health of Indigenous peoples in Canada shows that health gaps for Indigenous patients are the result of racialized policy choices, both past and present. The same policy choices that negatively impact health create unequal opportunity for Indigenous people to meet the eligibility criteria to apply to employment within the health professions.

 

While the focus of this research has been on patient needs (including the needs of providers with respect to addressing patient needs), this research of course also applies to health care providers who are themselves members of ethnically or racially ‘othered’ groups. When patients see diversity amongst health care professionals, this leads to a feeling of belonging and cultural safety. The community of health care providers and decision makers should closely resemble the patient population. In our province, this is particularly a problem with respect to the dearth of Indigenous physicians and health leaders.

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➤ Support education about and acceptance of traditional healing modalities

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One area of obvious priority in establishing a culture that promotes cultural safety for Indigenous patients as well as refugee patients is to set practice standards for understanding patients’ use of traditional healing modalities. It was clear for both Indigenous and refugee patients that there is a reluctance to divulge the use of traditional medicines to health care providers. It was also clear that physicians rarely ask. A structured program of education for staff and establishment of best practices is important here.

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