By Margo Greenwood, Hilary McGregor and Julia Petrasek MacDonald
In British Columbia, Northern Health is taking up the challenge of building cultural safety for Indigenous people both within the structures and systems of the organization and at the front lines of health care delivery. This is occurring within the context of a changing landscape of First Nations health governance in the province that is initiating New Relationships. This article discusses how Northern Health is taking steps towards cultural safety and provides concrete examples.
Health Service Delivery in Northern British Columbia
The landscape of northern British Columbia (BC) is vast and diverse with a relatively sparse population. It covers approximately two-thirds of the province and is home to about 300,000 people. Approximately 18% of the population is Indigenous.
Health services in BC are funded through the Ministry of Health and delivered through five regional health authorities. Unique in the province is the First Nations Health Authority (FNHA), the first Indigenous-led health authority in Canada. In 2013 FNHA assumed responsibility for the health programs and services previously administered by the First Nations and Inuit Health Branch. This historic transfer marked a New Relationship between First Nations, the province of British Columbia, and the Canadian government. Northern First Nations, the FNHA, and NH are working together to implement the Northern First Nations Health and Wellness Plan with goals and actions to support improved First Nations peoples’ health and wellness.
Repositioning Northern Health to Build a Culturally Safe Health System for Indigenous People
Cultural safety occurs when an individual feels affirmed and respected, is able to maintain dignity, and is safe from racism and discrimination. Health care service providers—and the organizations that support them—must reflect upon, understand, and if necessary, change any routine processes, habits, or behaviours that create unsafe healthcare experiences. Realizing concepts like cultural safety require different types of initiatives, activities, and processes. Following are examples of how Northern Health has made system changes to be more culturally safe.
In 2013, the CEO and Board of NH created a Vice President of Aboriginal Health position – the first executive-level position in Aboriginal Health in the country and a significant structural change that supports incorporation of Indigenous perspectives and priorities throughout organizational structures.
In July 2015, Northern Health, along with the BC Ministry of Health, FNHA and the remaining regional health authorities, signed a Declaration of Commitment to Cultural Safety and Humility, providing a mandate to advance cultural humility and safety in their practices with Indigenous people in BC. Furthermore, all new leadership job descriptions include a commitment and responsibility to the goals and intent of the Northern First Nations Health and Wellness Plan.
Building cultural safety at the front-lines of health service delivery
Northern Health (NH) is committed to advancing cultural humility and safety, especially at the front-lines of health service delivery. The Aboriginal Health (AH) team supports NH employees to learn about Indigenous peoples’ histories and current realities and provides a multitude of resources for employees. For example one fact sheet provides information on how to support continuous care as First Nations patients transition from acute care settings to their homes in First Nations communities.
In addition, NH funds seats for employees in a provincially-developed online Indigenous cultural safety training course. This course provides an important introduction to colonial histories in Canada along with opportunities to critically reflect on one’s own biases and assumptions about Indigenous people. The goal is for all employees to take the course.
Aboriginal Health Improvement Committees (AHICs) are an example of NH’s commitment to strengthen and enhance relationships with Indigenous people in northern BC. AHICs bring together local NH leaders, members of Indigenous organizations and communities, and representatives from the FNHA, to collaboratively address local health priorities. To date, the work of AHICs has included patient journey and process map activities to identify and address gaps and opportunities in health care service delivery. They have also developed over 30 local cultural resources to support increased cultural learning within the health system by informing health care providers about local Indigenous community protocols, histories, experiences and needs.
The examples described in this article represent only a small glimpse into the ongoing work by Northern Health and the Aboriginal Health team in collaboration with Indigenous communities, to build a culturally safe health system for Indigenous people in northern BC. These initiatives are helping one regional health authority take meaningful action on its commitment to improve the way health care services are delivered to Indigenous people. Northern Health recognizes that meaningful transformation in the face-to-face, on-the-ground interactions between Indigenous clients and health service providers requires an organizational commitment to cultural safety at all levels.