Cultural Safety Foundation

General objective

Understand what cultural safety means in the context of healthcare and why it is essential to providing safe, high-quality and person-centred care for First Nations, Inuit and Métis.

Upon completion of this foundation, you will be able to:

• Recognize First Nations, Inuit and Métis-specific racism as a patient safety issue 
• Reflect on how racism and discrimination show up in healthcare, and how they affect First Nations, Inuit and Métis healthcare experiences and health outcomes
• Consider your own role in contributing to culturally safe care through humility, self-reflection and action 
• Identify opportunities to promote culturally safer care in your organization or improvement project

Before you begin 

Before diving in, take a moment to gather the materials you’ll need to complete this foundation: 

• The Cultural Safety Foundation worksheet (PDF)
• A quiet space to reflect and complete your section of the tool
• Time for a facilitated team discussion (approx. 20 minutes)
• A shared space (physical or digital) to record action ideas and next steps

Watch and reflect - Stories of care and harm

There is incredible diversity of cultures, languages, histories and experiences across First Nations, Inuit and Métis families, communities and Nations. A distinctions-based approach to cultural safety acknowledges and respects this diversity while recognizing that this diversity shapes the healthcare experiences of individuals, families and communities. Each person’s experience in seeking care and their perspective on what culturally safe care looks like is distinct. It is only the person receiving care who can determine whether their care was culturally safe.

The following video clips and articles share a range of care experiences and outcomes that highlight how racism in the healthcare system impacts the quality and safety of care accessed by First Nations, Inuit and Métis. These stories have been selected to reflect a range of care experiences and to prompt reflection on what cultural safety looks like in practice. These are shared not as isolated incidents, but as reflections of deeper, ongoing issues in healthcare systems. Listening is a first step toward recognition and responsibility.

Watch the following clips:

• Dean’s Story - Métis Nation–Saskatchewan (Watch from 3:45 to 8:40) 

• Keegan’s Story: Death of an Indigenous man left unattended in hospital - CBC News (Article + 1:14 video) 

• Inuit Cultural Safety in the Medical System - Tungasuvvingat Inuit  (Watch 0:00 to 2:00 or up to 3:05) 

• À la poursuite de la santé - Des communautés autochtones – Savoir Média (Watch from 18:39 to 24:00) 

Reflection questions: 

• What forms of harm are present in this story?
• How do power imbalances and systemic racism show up in the care described?
• What does this story teach us about cultural safety?
• How might this inform your own work?

Working towards addressing First Nations, Inuit and Métis-specific racism and improving cultural safety

Improving cultural safety requires each of us to reflect on how individual, structural and systemic biases contribute to racism and culturally unsafe care. Cultural safety must be defined by the recipient of care, and efforts to address racism and improve cultural safety must be co-created with First Nations, Inuit and Métis patients, families and communities. The journey towards culturally safer care should and will be different for every healthcare institution.

As a first step, build your understanding of the First Nations, Inuit and/or Métis patients, families and communities who you are serving. To begin:

1. Identify any existing reports or assessments related to the experiences of First Nations, Inuit and/or Métis in the health system in your region.
2. Identify whether your organization has/collects data about the experiences of First Nations, Inuit and Métis accessing care in your institution. If so, familiarize yourself with the stories within this data.
3. Familiarize yourself with any health-related content in relevant foundational documents including the Truth and Reconciliation Commission (TRC), the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP), Calls to Justice and Joyce’s Principle.
4. Identify whether your organization has existing engagement mechanisms with First Nations, Inuit and/or Métis patients, families and/or communities.

Once you have completed these four steps, identify an appropriate engagement mechanism. Seek to create meaningful, reciprocal relationships, and approach relationship building with humility. Many First Nations, Inuit and Métis have experienced significant harm through the healthcare system, so invest deeply in re-building trust.

You may seek guidance from First Nations, Inuit and/or Métis educators and leaders as you build relationships. Investing in internal capacity to engage trust building will support the cultural safety of those you seek to engage and create the foundation for meaningful reciprocal relationships. An engagement resource is coming soon to help guide and strengthen these efforts.

Once you have invested in building relationships, begin the process of identifying where to focus your efforts in addressing racism and improving cultural safety. This path will be specific to your context and community, and may include consideration of:

• Governance and leadership – e.g. inclusion of cultural safety and anti-racism in leadership competencies; a representational Board composition which includes First Nations, Inuit and/or Métis
• Equitable resourcing – e.g. adequate funding to support sustained improvements towards cultural safety; including of cultural safety and anti-racism across program budgets
• Workforce representation – e.g. co-creation of robust retention strategies for First Nations, Inuit and Métis staff; safe processes for staff to report incidents of racism
• Support of First Nations, Inuit and/or Métis healing and wellness practices – e.g. policies and protocols to support access to ceremonial spaces; inclusion and appropriate compensation for traditional practitioners and Elders
• Provide safe and equitable care – e.g. measure and report on inequities in access to care; co-create robust First Nations, Inuit and Métis incident reporting and management systems

Self-reflection worksheet

On your own, review the discussion questions in the worksheet (or see them below) and reflect on how these focus areas apply to your context.

• Who are the First Nations, Inuit and/or Métis governments, organizations, or communities being served within our program or initiative? What are their priorities and how do we know? What processes are in place within our organization to integrate their priorities into programs and services? 
• What policies or statements does our organization have related to reconciliation, cultural safety, anti-racism or health equity? How do they apply to our project? 
• What is our organization’s patient feedback process? What protocols are in place for tracking and responding to patient and staff reports of racism and discrimination?  

As part of your reflection, identify:

• One area where your organization is doing well
• One area where there is room for improvement
• One action your team could take to strengthen cultural safety in your workplace
  • Why is this action important and what issue does it address? 
  • What first step will we take? 

Group reflection and action planning

With your team, use the worksheet as a guide for discussion. Share your reflections and listen to others’ perspectives.

Together, identify:

• One area where your organization is doing well  
• One area that needs improvement
• One concrete action your team can take to better consider cultural safety in your implementation project   

You may wish to return to this conversation over time as your project evolves and your understanding deepens.

We call upon you to work toward meaningful engagement and relationships with the First Nations, Inuit and Métis individuals, families and communities who access care through your organization. This is an essential first step towards addressing racism and improving cultural safety.

Creating culturally safe care requires time, reflection and sustained action. We encourage you to stay connected with your team, your partners and the communities you serve as you continue this work.

• Read: Remembering Keegan - First Nations Health Authority (FNHA) 
• Watch: Rise Above Racism – a short video from the First Nations Health Managers Association (FNHMA) 
  (Duration: 3 minutes 30 seconds) 
• Watch: The Unforgotten – a film on Indigenous health, by the Canadian Medical Association (CMA)
• Watch: First Nations, Inuit and Métis experiences with racism in healthcare – Canadian Patient Safety Week 2024 webinar recording 
• Take the next step: Complete the Cultural Safety module in HEC’s free online course, Patient Safety Essentials. This optional module is strongly recommended for team members who have not yet participated in Indigenous cultural safety and humility training through their organization. 
  (Estimated time: 60 minutes)