1. EDUCATE HEALTH CARE PROVIDERS
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"There is limited training available. There is one diversity course about Aboriginal patients; however, it is really limited in terms of addressing sources of racism with this population. We need to speak to other health authorities in other provinces that have been doing this type of staff education for decades." [Anonymous respondent to Staff survey]
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Diversity training is currently provided piece-meal. Health care providers were asked, in the survey, whether they believe they need more training on cultural/religious differences. The majority of respondents to that question (52/71 or 73%) believed or strongly believed that training on cultural/religious differences is needed. When asked about the need for training on racism, 52 of 70 respondents to that question (74%) agreed or strongly agreed in the need for training. Further, of 68 respondents to a question about the need for awareness training about non-dominant cultures or religions, 88% felt that they or their colleagues required education.
It is clear that training on diversity awareness, cultural competency, and cultural safety is needed for health care providers and decision makers. Five key recommendations for staff training emerged through our interviews with patients/supporters and providers:
(1) information about patient populations must be easy to access; (2) information must not inadvertently lead to a “recipe book”-style essentialist approach of how to provide care; (3) cultural competency training needs to emphasise cultural safety and humility; (4) methods must be designed to meet staff schedules and time constraints; (5) community-based experts should be partners in providing training; and (6) training must be linked to a wider organizational cultural that promotes cultural safety, for patients as well as providers.
➤ Make information about patient populations easily available
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Easy access to information about specific patient populations can be helpful to health care providers. In the absence of, or to accompany, cultural competency training, information sheets or websites that are quick and easy to access and readily available are a realistic and efficient way to convey straightforward information.
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➤ Ensure that information about patient populations is not essentialist in nature
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Cultural essentialism is the idea that people within a particular ethnic group have innate characteristics that are inherent to that group, including the belief that all individuals within a group will act similarly in a predictable and culturally defined way when it comes to health beliefs or decision making. This way of thinking is very restrictive and potentially harmful when applied by health care providers who think they are being culturally “sensitive” by believing that all individuals who are members of Group X will act or think in a certain way. Pamphlets or other training tools should be used as a means of providing some quick background context, not as a “how to” guide for health care decision making.
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➤ Schedule training to mesh with staff schedules and time constraints
"Don’t give me a resource to go to that I got to go read it online for 25 minutes to find the answer that was three minutes long for you to tell me – because I don’t have 25 minutes." [Nurse 2]
There was general consensus among health care providers and decision-makers that long, didactic training sessions are not practical and will not reach sufficient numbers of staff. Shorter mini-education sessions over coffee breaks, or lunch and learns, would be more effective.
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➤ Emphasize cultural safety and humility
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"I honestly think that some staff do not think that some comments are racist or culturally insensitive. There are sayings in Newfoundland that are very insensitive to minorities that are commonly said by people in the province, and I don't think that people stop to think ABOUT what they are saying and how it is being perceived." [Anonymous respondent to Staff survey]
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It is well established in the literature that training in cultural competency alone is insufficient, and that establishing a culture of safety should be the goal. Establishing a culture of safety requires training in cultural humility. Cultural humility requires turning the gaze inward (for individual health care providers and decision-makers, and for the institution as a whole), rather than focusing on the cultures of patients (with the dangers of essentialism that such an approach entails).
An approach that turns the gaze inward and focuses on cultural humility is more time consuming and more difficult to deliver than training that focuses on the cultures of patients. There is a tension in the two goals of training, on one hand having it be accessible and immediately applicable and focused on cultural beliefs and the lived experiences of particular patient populations; and on the other hand, having it be about cultural humility, institutionalized racism, the culture of the Canadian health care system, and colonialism. Currently across Canada, in the wake of social movements such as Idle No More and Black Lives Matter, all public institutions are being called on to turn the gaze inward, to learn, and to change. This is the priority.
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Finally, training must be done in partnership with community, in particular, the ANC and First Light; and community groups should not bear the burden of cost.