Island Health undertaking cultural safety assessment to better support Indigenous patients

Stakeholders discussed how to better support Indigenous patients receiving health care on Vancouver Island, where the health authority has become one of the province’s first to undertake a B.C. Cultural Safety and Humility Standard assessment. The topic was discussed during a panel on integrating Indigenous healing practices into health care at a summit hosted by the Nanaimo Regional Hospital District on Nov. 13 at the Vancouver Island Conference Centre. Brennan MacDonald, a vice-president of regional operations with the First Nations Health Authority, said she is proud of Island Health for stepping forward to be the first health authority in B.C. outside of the First Nations Health Authority to voluntarily undertake a B.C. Cultural Safety and Humility Standard [https://healthstandards.org/standard/cultural-safety-and-humility-standard/] assessment. She said it’s a great example of something a health authority can do to make improvements to the system to deliver culturally safe and appropriate care. “I think that all health authorities will go through the process, it is just a matter of timing and sequence,” she said. “Island Health being the first means we have a chance to model for the rest of the province, and the country, what it looks like to go through this. The standard itself is also being adopted nationally, so there will be opportunities for provinces across Canada to undertake similar work with the same goals.” The standard recognizes that First Nations, Métis, and Inuit individuals and communities experience racism and discrimination at many levels when seeking health-related care and services, creating barriers and harm including unacceptable rates of illness and distress, reduced access to care and services, and ignorance of cultural practices resulting in non-adherence to treatment plans. It can lead to avoidance of the health-care system due to fear and mistrust. The standard includes guidelines such as understanding Indigenous rights, protocols, and practices; incorporating those competency requirements into job descriptions, recruitment and hiring; and providing regular, mandatory anti-racism and cultural safety and humility education and training in the workplace. “It’s guidance around organizational structures and procedures – it will ensure we understand how to keep racism out of the health system and services that we’re designing,” MacDonald said. She added that the standard will provide a benchmark for health authorities to gauge where they are performing well and where they need to improve. Also speaking as part of the panel was Dr. Christine Hall, deputy registrar for the College of Physicians and Surgeons of British Columbia, who shared that the college has been collaborating with other B.C. health regulators and the Ministry of Health ahead of implementing the Health Professions and Occupations Act [https://www.bclaws.gov.bc.ca/civix/document/id/bills/billsprevious/3rd42nd:gov36-3#section467] in the spring. The act stipulates that superintendents must consult with Indigenous persons who provide similar types of health services in accordance with Indigenous practices; and administrators’ lists of support workers should include names put forward by Indigenous governing bodies. “Within the act are very specific legislative directives around management of our Indigenous patient needs…” Hall said. “Two steps around that are the creation of an Indigenous advisory circle, and that also includes support for Indigenous peoples who have been wronged in the health-care system. How do we now lead the system with actual Indigenous support – that’s formalized under the [act]. And of course we’re training all of our committees and our people around that.” In the long term, she said the college is working to embed Indigenous cultural safety and anti-racism principles into quality assurance and practice enhancement policies, as well as exploring partnerships regarding training for registrants. “While these are long-standing issues, the formalization of it is new for people who come to get a licence in B.C. So we’re walking with them as they understand what is expected of them.” Chief Michael Recalma of Qualicum First Nation shared a personal story during the event about receiving a kidney transplant and dialysis. One morning, when he was originally scheduled to go home but couldn’t, he said it was the practice of cedar brushing that turned that hospital room into a safe space. MacDonald noted that ceremonies and practices hold an integral part in healing. “The mind is very powerful, it can contribute to illness, or it can do the opposite,” she said. “That feels very empowering and I think that is a big foundation of what our wellness is about and how it shows up in our work.” MacDonald said part of supporting Indigenous patients is holding space for individuals to advocate and assert for their needs, but also to strive for a system that recognizes the diversity of approaches to well-being so that advocacy isn’t necessary. “While there are some who are able to do that, the history we know exists within our health-care system has caused harm.” In a statement, Island Health said there is ongoing work in bringing the B.C. Cultural Safety and Humility Standard to life as it moves towards accreditation, including the release of an organizational anti-racism and discrimination position statement and Indigenous-specific anti-racism and discrimination policy that “affirms everyone’s right to work and receive health care in a safe, anti-racist, and discrimination-free environment and aims create an environment that directly addresses Indigenous-specific racism and discrimination.”