1. CREATE AN OBVIOUS GOVERNANCE AND LEADERSHIP STRUCTURE
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"If the cultural diversity isn’t owned by someone, nobody owns it, it dies. So who owns it? And if I own it, how do I keep my foot on my gas pedal that helps everyone else keep thinking about it? Because I got 180 gas pedals, I don’t need 181. So what is it that we can do to support people to not have to figure it out themselves? "[Nurse 2]
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Eastern Health must provide clear leadership, governance, and accountability with respect to diversity. Diversity programming within EH has been organized in a somewhat ad hoc manner, primarily based on which leaders have had a personal passion for the issue. There needs to be a clear structure and programming throughout EH. The current system is scattered with no clear ‘home’, vision, or leadership. How can this be achieved?
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➤ Have centralized leadership and oversight of the system-wide approach
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It needs to be somebody’s baby. It needs to be somebody saying, “Okay what can we do to support this? What can we do to promote this practice? What can we do to evaluate what’s happening? What can we do to empower the clinical people who are on the ground, in the field, to do more?” [Social worker 1]
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What is clear from our interviews with physicians, nurses, and other health care providers was that the organic and piece-meal programming, led by various staff primarily not in positions of power, was a source of frustration for health care providers. The feeling amongst health care providers is that it would be helpful to know who to go to for answers about the right thing to do.
A community-centred approach is key to success. Any visioning must involve formal and informal community stakeholders. A structure within EH must be completely inter-dependent with community organizations who assist with health care access for marginalized populations.
➤ Recognize and sanction diversity champions and initiatives
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"I think Eastern Health has no idea what kind of a gold mine they have in the sense of the kind of really fabulous work that’s done. They have no clue."[Physician 1]
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There are a number of “diversity champions” scattered throughout Eastern Health whose efforts are being done piece-meal, through self-motivation and self-education, and often above and beyond the duties that they would normally have to do. These individuals are often feeling unacknowledged, somewhat invisible, and unsupported in the work that they are doing to promote culturally safe care to newly arrived refugees. There is a need for leadership to recognize this work, to explicitly sanction it, and to commit to supporting it.
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➤ Evaluate programs and measure success
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Policies and programs need to meet national standards that have been well-established as best practice. Other provinces in Canada have a longer history of cross-cultural health care; some health authorities have long-standing programs and policies that have been examined and proven effective. Conducting research on what is being done well, and promoting EH’s successes through research and dissemination, is reportedly missing at this stage – largely because those who are doing innovative work are doing so in isolation from official programming. Excellence requires sanctioned programming, with goals that are measured and reported to those who are accountable.
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➤ Communicate and coordinate services
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An important gap raised by providers in terms of creating and sustaining culturally safe care is to ensure that policies and programs that do exist are made known to all providers. Approaches to care that solve some of the difficulties with access have been implemented in various places across Eastern Health – but as these are program- or site-specific with no links to an obvious leadership structure, the strategies are not known and shared and opportunities are being missed. The lack of oversight means that it is difficult for health care providers to know who is doing what; they are unable to access each other’s knowledge and tools.
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➤ Support capacity building
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We heard stories of diversity champions seeking out training outside of the province – self-motivated and self-funded – outside of their regular work schedule. This gap in accessible training and capacity building is an important one for EH to prioritize. This includes supporting peer training, by (1) having external experts come in to assist with developing supports; and (2) sending local health care providers elsewhere for training, in the spirit of a “train the trainer” model of peer education. One physician proposed a formal support group style peer learning process, with CME credit for physicians who participate. This model would require dedicated time and support for a physician leader to provide coordination and support to the training.
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