Presentation by: Joe Gallagher, CEOFirst Nations Health Authority

March 2, 2017

2017 Quality Forum

Cultural Safety through Cultural Humility

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Makara’s Story

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Impact

“the legacy of Makara's story is that it makes me pause and think about the decisions we're making for all families regardless of their background or culture and asking myself, whose need is being met by doing something or ordering something. “

– Matt Brown, Regional Coroner, Vancouver Island

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Impact

54/58 infant autopsy completed with no retention

Two First Nation coroners

Regional relationships

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British Columbia First Nations

26 Cultural Groups

34 Languages

203 Bands (or First Nations)

3 Provincial First Nations Organizations

• BC Assembly of First Nations• First Nations Summit• Union of BC Indian Chiefs

For more information on efforts to revitalize BC First Nations languages,

visit: www.fpcc.ca

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What is Cultural Humility?

"I believe you understand what you think I said, but I'm not sure you realize that what you heard is not what I meant.” - Unknown, written on a blackboard in the band hall of the Weagamow Lake Reserve, 380 air miles north of Thunder Bay Ontario.

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Truth & Reconciliation

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First Nations Perspective of Health and Wellness

• The Lens the FNHA works through for everything it does

• Developed from the teachings and culture of BC First Nations

• FNHA - Health and Wellness Champion, Partner & Living it

• Commitment to supporting the health and wellness from the youngest to the oldest

• Commitment to the generations to come

• Our Health and Wellness Journey belongs to each of us and is as unique as we are

• Leading edge of systemic change to move from Health to Wellness

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Cultural Safety and Humility in Health Services for First Nations and Aboriginal People in British Columbia

Cultural Competency is something that we strive for.

Cultural Humility is the only way we get there.

With an open heart and open mind, we can increase the space for Cultural Safety.

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Statement on the importance of the Declaration on Cultural Safety and Humility

• “The Declaration is important because it gives us all permission to do what we need to do to achieve cultural safety with the services we provide through the incorporation of cultural humility.”

From an FNHA partner shared at a session to discuss the declaration and

subsequent framework (Victoria, Nov. 2015)

“It Starts With Me” we can each make a difference

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Introduction to Cultural Safety and Humility –Quality Forum 2016

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Graphic representation of Cultural Safety and Humility discussion – Quality Forum 2016

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Cultural Humility

A life-long process of self- reflection and self-critique to understand personal biases and to

develop and maintain mutually respectful partnerships based on mutual trust.

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Cultural Safety

Cultural safety goes beyond: Cultural awareness, which refers to awareness of differences

between cultures. Cultural sensitivity, which is about realizing the legitimacy of

difference and the power of one’s own life experience can have on others.

Cultural Safety: power imbalances inherent in the health care system. self-reflection on culture and power. Improve client experiences and lead to better care.

Indigenous Physicians Association of Canada and Association of Faculties of Medicine of Canada. 2009; National Aboriginal Health Organization, 2009

The aim of cultural safety is to create an environment free of racism and discrimination where people feel safe receiving care.

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Systemic barriers to achieve the vision

“I’m sorry, I’m embarrassed to say that when I faced someone who was being culturally unsafe to patients, instead of confronting the person, I left. I didn’t’ feel like I could do anything. There’s such a hierarchy.” - shared by a healthcare worker in BC.

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“Hardwire” cultural safety & cultural humility into health services in BC as part of the Provincial Quality & Safety Agenda

Hardwiring into the Health System

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5 Regional Health Authorities1 Provincial Health AuthorityMinistry of HealthFNHAHealth system partners and colleges

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Hardwiring Cultural Safety & Humility in Health System

Evaluation Rubrics

Self-Assessments

Guides & Frameworks

Education for Staff

Awareness Campaigns

Community Visits

Complaints Processes

Cultural Spaces in Facilities

Recruitment of Aboriginal staff

Policy Initiatives

Reciprocal Accountability

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PHSA: Left to Right: Arden Crystal, Executive VP, Patient & Employee Experience, Carl Roy, PHSA CEO, and Colleen Hart, VP, Provincial Population Health, Chronic Conditions & Specialized Populations

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HA CS&H Update: Interior Health

Created an evaluation rubric to conduct organizational self-assessment

Hired an Aboriginal cultural safety educator who is facilitating sessions with over 600 employees, including SET and Board

CEO and Board visits to each Nation Peacemaking circles for complaints resolution Guidelines for Advanced Spiritual Care in

developmentMany other local and Nation-level initiatives

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HA CS&H Update: Island Health

10 local cultural safety committees across region, which include physician participation

Culturally welcoming design, spaces, and signage in hospitals

Cultural safety training at priority sitesAdvancing availability of traditional foods in

hospitalPartnership between in-hospital and FNHA-

employed Nurse Navigators to support seamless transitions in care

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HA CS&H Update: Vancouver Coastal

Cultural protocol guide

Cultural safety framework

Employee surveys to assess self-reported ability to deliver culturally safe care: baseline to measure improvements

Significant number of local cultural sharing events

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HA CS&H Update: Northern Health

Joint First Nations-Northern Health Cultural Safety Working Group

Implemented complaints process and associated promotional and education materials

Educational fact sheet, video, poster targeted to Health Authority employees

Development of 32 local cultural safety resources by communities

Cultural safety webinar

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HA CS&H Update: Fraser Health

Joint FNHA-Fraser Health Cultural Safety Working Group

Communications campaign for Fraser Health staff (posters, videos, senior leadership blogs, open houses)

Board Chair & senior executive tour of communities

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HA CS&H Update: PHSA

PHSA Indigenous Cultural Safety (ICS) Framework and assessment

Development of intervention tools and an intervention strategy for responding to culturally unsafe policy and practice

Monthly National Indigenous Cultural Safety webinar learning series

Supporting a provincial system for pediatric autopsies that respects the ethical, cultural, and religious interests of families

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CS&H Update: BC Ministry of Health

5-year action plan: 2016-17 Establish Foundation; 2017-18 Enhance Capacities; 2018-19 Building Accountabilities; 2019-20 Reflections; 2020-21 Continuous Learning

Increasing recruitment & retention of Aboriginal staff

Staff building appropriate competencies into learning plans

Increasing awareness of partnership with First Nations across MOH work

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Cultural Safety and Humility Resource Booklet

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An individual approach to Cultural Safety & Humility

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1) Print the card 2) Make a commitment 3) Snap a pic 4) Hashtag

#itstartswithme

Take Action

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Health Regulators of BC sign Declaration of Cultural Safety and Humility – March 1, 2017

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Our Opportunity

All providers can improve the provision of safe services to First Nations clients by learning about the impact of colonization, residential schools, systemic racism, discrimination, stereotypes, health inequities and the social determinants of health on First Nations people.

San’yas Indigenous Cultural Safety (ICS) training is a great place to start. This eight hour online course is provided by the Provincial Health Services Authority (PHSA). Since April 2009, approximately 22,000 health professionals in BC took ICS training.

When healthcare professionals engage with First Nations peoples from a place of cultural humility, they are helping to create a health care environment where individuals feel safe and respected. First Nations peoples are therefore more likely to access care when they need it.

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Questions & Discussion

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Thank you

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Gayaxsixa (Hailhzaqvla)

Huy tseep q’u (Stz’uminus)

Dun’kwu (Haida)

Gila’kasla (Kwakwaka’wakw)

Kleco Kleco (Nuu-Chah-Nulth)

kʷukʷstéyp (Nlaka’pamux)

Snachailya (Carrier)

Mussi Cho (Kaska Dena)

Tooyksim niin (Nisga’a)

Kukwstsétsemc (Secwepemc)

c ̌ɛc ̌ɛhaθɛc ̌ (Ayajuthem)

Sechanalyagh (Tsilhqot’in)

kw'as ho:y (Halq̓eméylem)

T’oyaxsim nisim (Gitxsan)